Comparison of diagnostic yield of GeneXpert MTB/RIF assay and ZN (Ziehl-Neelsen) staining in serosal fluids from HIV and non-HIV patients with extra-pulmonary tuberculosis

Background: India accounts for 23% of the global TB burden and of these 15-20% are extrapulmonary tuberculosis(EPTB). EPTB has diverse clinical presentation and often is over diagnosed because of lack of standardised diagnostic means. Yield of acid fast bacilli (AFB) from EPTB settings is very low and alternate facilities are nearly non-existent routinely. GeneXpert MTB/RIF has been recommended as a diagnostic tool for sputum samples. It has been also recommended for serosal fluids from HIV patients only. This study was done to compare the yield of GeneXpert MTB/RIF assay and ZN (Ziehl Neelsen) staining among HIV and non-HIV patients with suspected serosal TB.Methods: GeneXpert MTB/RIF assay and ZN staining was done in all serosal fluid samples in which a clinical diagnosis of serosal TB had been made by conventional methods.Results: A total of 81 extra pulmonary samples (21 from HIV and 60 from non-HIV patients) were processed in this study, which included 48 CSF, 19 pleural fluids and 14 ascitic fluid. Out of these, 34.5% (28/81) patients were both GeneXpert MTB/RIF as well as ZN stain positive whereas only 13.58%(11/81) patients were ZN stain positive. 4/21 (19.05%) samples from HIV patients were ZN stain positive and 9/21(42.85%) were GeneXpert positive. 7/60 (11.66%) samples from non-HIV patients were ZN stain positive and 19/60 (31.66%) were GeneXpert positive.Conclusions: GeneXpert MTB/RIF is more sensitive than ZN staining in EPTB. The yield in both HIV and non-HIV patients is the same

The study of prevalence of metabolic syndrome in the first degree relatives of type 2 diabetes mellitus patients

Background: Metabolic syndrome (MetS) is associated with higher incidence of new onset DM. First degree relatives (FDR) of T2DM patients also have an increased risk of new onset DM due to common genetic factors that can lead to obesity and dyslipidemia. Objectives of research work was to study the prevalence of MetS in FDR of T2DM patients.Methods: Cross-sectional study of FDR of T2DM patients. MetS defined by both IDF and NCEP-ATPIII criteria. All subjects underwent necessary biochemical tests, a detailed history in a pre defined proforma was taken and clinical examination was done as per protocol.Results: Mean age was 43.61±11.7 years. Prevalence of MetS was 35% by IDF and 25% by NCEP-ATPIII. According to IDF criteria, the most prevalent risk factors among FDR were central obesity and hypertension. Prevalence of MetS was higher in urban, sedentary and obese population.Conclusions: Prevalence of MetS is more in FDR of T2DM than that reported in the general population. Central obesity is the most prevalent risk factor. Targeted lifestyle intervention in this population may help prevent the development of MetS and T2DM

Maternal and fetal outcomes in HIV positive pregnant female

Background: Vertical Transmission is still not an uncommon mode of HIV transmission. HIV and its treatment can also affect maternal and fetal outcomes. We aimed to study incidence and factors of MTCT and maternal and fetal outcomes with the current standard of care.Methods: It was an observational study, at BRD medical college Gorakhpur. Pregnant, HIV positive females consenting for the study were enrolled. Follow up was up to 6 months post-delivery. Infant testing for transmission was done at 6 months.Results: A total 35 HIV positive pregnant female were studied. Follow up could be completed in only 29 patients. Four (13.79%) infants had HIV DNA detectable in whole blood at 6 months. Transmission was 16.6% in group taking ART for 3 months, 25% in mixed feeding group vs. 12% in exclusive breast feeding and 16.6% in NVD group vs. 9% in LSCS. Incidence of Preterm delivery was higher in group who took ART for longer duration. IUGR was present in 10/29 (27%) and growth failure in 12/29 (41%) infants.Conclusions: Longer ART duration and cesarean section delivery were more effective in preventing MTCT. Even exclusive breast feeding could result in MTCT. HIV exposure in utero may lead to IUGR. ART has no deleterious or positive effect on fetal growth but may be associated with preterm delivery. Better patient education will probably lead to earlier diagnosis and initiation of therapy to prevent transmission, and also to better fetal and infant outcomes

Study of prevalence of thyroid dysfunction in type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is associated with increased incidence of thyroid dysfunction (TD). The coexistence of thyroid dysfunction in T2DM patient is an important barrier in achieving treatment goal. The study regarding prevalence of TD in T2DM has not been done in patients of Eastern Uttar Pradesh. The present study was aimed to know the prevalence of thyroid dysfunction in T2DM in patients of Eastern Uttar Pradesh.Methods: This is an observational cross sectional prevalence study of thyroid dysfunction in 250 diagnosed T2DM patients deleat diagnosed based on ADA criteria attending the department of medicine Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, Study was India, done over a period of 1 year. Thyroid dysfunction was classified on the basis of ATA criteria. All subjects underwent a detailed history, clinical examination and relevant biochemical tests.Results: The prevalence of thyroid dysfunction in T2DM patients was found to be 20.4% in this study.Conclusions: The prevalence of thyroid dysfunction was found to be higher in type 2 diabetes mellitus patients in comparison to general population as mentioned in different literature

Safety and efficacy of dialyzer reuse by manual reprocessing: an observational study

Background: Haemodialysis is the main form of RRT in the patients of CKD. Haemodialysis is a costly procedure and is not afforded by many. Reuse of components of Haemodialysis circuit helps in reducing cost but may be associated with decreased efficacy and side effects.Methods: Prospective observational study. Manual reprocessing of dialyzer was done with either formaldehyde or peracetic acid. Single brand (Fresenius) dialyzer were used across all patients. Dialysis efficacy was calculated by URR and side effect and toxicity monitored in a predefined proforma.Results: A total 50 patients were studied (39 male and 11 female) with age ranging from 31-60 years. The mean urea reduction ratio after four dialysis session with the same dialyzer was 62.93% which is below KDOQI recommendation. The findings in our study suggest that URR was adequate upto three session of haemodialysis by reprocessed dialyzer but not beyond that. The choice of chemical for reprocessing did not affect the efficacy. As compared to F6 dialyze F8 dialyzer had better initial URR and this was maintained upto fourth reuse. Serum albumin levels correlated with the fall in efficacy of dialyzers. There were no significant complications of reuse of dialyzers across both methods of reprocessing and there was no dialyzer first use syndrome.Conclusions: ESRD affects a younger age group in our country. Use of large membrane area results in better efficacy. Dialyzer reuse with manual reprocessing is safe and also effective upto third and fourth use. Dialyzer reuse is associated with economic benefits

Is yoga an effective modality of stress reduction within medical population; a qualitative study within MBBS students of BRD medical college, Gorakhpur

Background: Stress is very common in medical professionals. Stress begins in the first year of medical school and increases with subsequent years of medical life. Stress decreases overall performance and had a multitude of health-related adverse effect. Yoga has been tried as a stress reduction technique in different populations. In present study yoga was performed in the 1st year MBBS students and impact on stress reduction was studied using PSS-10 stress scale.Methods: Study groups, yoga and control contained 26 and 27 subjects respectively. The yoga group practiced selected yogic asana, pranayama, and yoga nidra 1hour daily 6days a week for 3months. Control group kept in touch and allowed their usual activity as before. The PSS-10 scale used to measure the level of stress in both groups pre and post study.Results: There was a highly significant reduction in the PSS-10 Score (stress level) in the yoga group (P Value <0.0001) but there was no significant change in the PSS-10 Score of control group (P Value = 0.2930).Conclusions: Yoga is an effective modality of stress reduction technique in 1st year medical students. Therefore, yoga should be introduced as a part of the curricula in the first year of medical school. This may be taken as the 1st step in implantation of healthy lifestyle in future health care providers

Maternal and fetal outcomes in HIV positive pregnant female

Background: Vertical Transmission is still not an uncommon mode of HIV transmission. HIV and its treatment can also affect maternal and fetal outcomes. We aimed to study incidence and factors of MTCT and maternal and fetal outcomes with the current standard of care.Methods: It was an observational study, at BRD medical college Gorakhpur. Pregnant, HIV positive females consenting for the study were enrolled. Follow up was up to 6 months post-delivery. Infant testing for transmission was done at 6 months.Results: A total 35 HIV positive pregnant female were studied. Follow up could be completed in only 29 patients. Four (13.79%) infants had HIV DNA detectable in whole blood at 6 months. Transmission was 16.6% in group taking ART for &lt;3 month as compared to 11.7% in group taking ART for &gt;3 months, 25% in mixed feeding group vs. 12% in exclusive breast feeding and 16.6% in NVD group vs. 9% in LSCS. Incidence of Preterm delivery was higher in group who took ART for longer duration. IUGR was present in 10/29 (27%) and growth failure in 12/29 (41%) infants.Conclusions: Longer ART duration and cesarean section delivery were more effective in preventing MTCT. Even exclusive breast feeding could result in MTCT. HIV exposure in utero may lead to IUGR. ART has no deleterious or positive effect on fetal growth but may be associated with preterm delivery. Better patient education will probably lead to earlier diagnosis and initiation of therapy to prevent transmission, and also to better fetal and infant outcomes

Scrub Typhus as a Cause of Acute Encephalitis Syndrome, Gorakhpur, Uttar Pradesh, India

Outbreaks of acute encephalitis syndrome (AES) have been occurring in Gorakhpur Division, Uttar Pradesh, India, for several years. In 2016, we conducted a case–control study. Our findings revealed a high proportion of AES cases with Orientia tsutsugamushi IgM and IgG, indicating that scrub typhus is a cause of AES