Haemophagocytic lymphohistiocytosis in patients with human immunodeficiency virus infection: to treat or not to treat

Haemophagocytic lymphohistiocytosis (HLH) in Human Immunodeficiency Virus (HIV) infected individuals can either be due to the disease itself or due to associated infections/malignancies. The treatment for HLH requires immunosuppressive therapy but administering immunosuppressive therapy to an already immunosuppressed patient (HIV infection) is complex. We present two such cases of HLH in patients infected with HIV. In the first case, no alternate cause for HLH was found even after extensive investigations and it was attributed to the uncontrolled HIV replication. Patient was started on dexamethasone for the same but succumbed to hospital acquired pneumonia. The second patient was diagnosed with Hodgkin's lymphoma but he succumbed to his illness before initiating immunosuppressive therapy for HLH. We report these cases to highlight the dilemma and a need for further research in this direction

ANEMIA AND VITAMIN B12 DEFICIENCY IN ELDERLY.

 Objective: The present study was carried out to assess the prevalence of anemia, vitamin B12 deficiency and hyperhomocysteinemia among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 234 elderly aged 60 and above in slums of West Delhi. 5 ml blood was collected from 116 elderly and was analyzed for hemoglobin, Vitamin B12 and homocysteine. Anemia was defined as hemoglobin <130 g/L and <120 g/l for male and female, respectively, Vitamin B12 deficiency as serum Vitamin B12 <203 pg/ml and hyperhomocysteinemia as serum homocysteine >15 μmol/l.Results: The overall prevalence of anemia, Vitamin B12 deficiency, and hyperhomocysteinemia among elderly was 57.76%, 36.36%, and 57.57%, respectively. Among anemic elderly, 33.33% and 64.15% had Vitamin B12 deficiency and hyperhomocysteinemia, respectively.Conclusion: More than half of the elderly population was anemic, while one-third was having Vitamin B12 deficiency

PREVALENCE OF HYPERTENSION AMONG ADULT POPULATION IN SLUMS OF WEST DELHI

Objective: The present study was conducted to assess the prevalence of hypertension in adult population residing in slums of West Delhi.Methods: A cross-sectional study was conducted among adult population of 18-59 years residing in urban slums of West Delhi. Blood pressure was measured using digital machine (OMRON). The data obtained were analyzed for percent prevalence, mean, standard deviation, and median. Joint National Committee (JNC)on prevention, detection, evaluation, and treatment of high blood pressure (JNC)VI and JNC VII criteria were used to classify hypertension.Results: The overall prevalence of hypertension was 25.3%. The prevalence was higher (27.9%)in males than females (22.8%)and also in the age group 46-59 years (43.0%)as compared to 18-45 years (19.8%). The overall prevalence of prehypertension, Stage I and Stage II hypertension, respectively, was 35.2%, 16.1% and 9.2%.Conclusion: A one-fourth of the adult population is hypertensive. Early diagnosis and treatment are advisable, besides awareness about dietary and lifestyle modification

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

PREVALENCE OF HYPERTENSION AMONG ELDERLY RESIDING IN SLUMS OF WEST

 Objective: The present study was carried out to assess the prevalence of hypertension among elderly in slums of West Delhi.Methods: A cross-sectional study was carried out among 202 elderly residing in urban slums of West Delhi. Hypertension was classified as per JNC VII criteria. Blood pressure was measured twice using digital machine (OMRON) after an interval of 5 min. The data obtained were analyzed for percent prevalence, mean, standard deviation, and median.Results: The overall prevalence of hypertension was 49.1%; higher among male (56.0%) than female (41.9%). The prevalence of Stage I, Stage II, and isolated systolic hypertension was 30.7%, 18.8%, and 47%, respectively.Conclusion: Almost half of the elderly population in slums was hypertensive. Periodical health checkup and management through treatment and dietary and lifestyle modification is needed.Â

Acute hemorrhagic encephalitis: An unusual presentation of dengue viral infection

Dengue is a common viral infection worldwide with presentation varying from clinically silent infection to dengue fever, dengue hemorrhagic fever, and severe fulminant dengue shock syndrome. Neurological manifestation usually results from multisystem dysfunction secondary to vascular leak. Presentation as hemorrhagic encephalitis is very rare. Here we present the case of a 13-year-old female admitted with generalized tonic clonic seizures. Plain computed tomography (CT) scan of head revealed hypodensities in bilateral deep gray matter nuclei and right posterior parietal lobe without any hemorrhage. Cerebrospinal fluid (CSF) and serology were positive for IgM and IgG antibodies to dengue viral antigen. Contrast-enhanced magnetic resonance imaging (MRI) revealed multifocal T2 and fluid attenuated inversion recovery (FLAIR) hyperintensities in bilateral cerebral parenchyma including basal ganglia. No hemorrhage was seen. She was managed with steroids. As her clinical condition deteriorated, after being stable for 2 days, repeat MRI was done which revealed development of hemorrhage within the lesions, and diagnosis of acute hemorrhagic encephalitis of dengue viral etiology was made

HOMOCYSTEINE STATUS OF ELDERLY SLUM WOMEN IN DELHI

Objective: The study was undertaken to assess homocysteine levels among economically deprived elderly women in Delhi.Methods: The study was carried out among elderly women aged 60–70 years residing in Kirti Nagar slums of West Delhi. Blood samples were collected, and serum homocysteine was analyzed using chemiluminescent immunometric assay. Hyperhomocysteinemia was defined as serum homocysteine >15 μmol/l. Dietary information was also collected using 24 h dietary recall method and food frequency questionnaire.Results: The prevalence of hyperhomocysteinemia was 16.9%. The mean serum homocysteine was 12.35±6.43 μmol/l. Serum homocysteine levels ranged from 3.84 to 35.20 μmol/l. It was observed that hyperhomocysteinemia was higher in vegetarians (31.2%) compared to non-vegetarians (6.7%).Conclusion: The prevalence of hyperhomocysteinemia is higher among vegetarians than non-vegetarians. Further, research is necessary to see the effect of elevated homocysteine in multiple age-related diseases

Soluble Inter-Cellular Adhesion Molecule-1 in Urban Asian North Indians: Relationships with Anthropometric and Metabolic Covariates

Background: High prevalence of diabetes, obesity, and dyslipidemias in people belonging to poor socio-economic strata in urban slums of northern India has been recorded recently. To assess whether this population has high levels of soluble intercellular adhesion molecule-1 (sICAM-1), a cytokine involved in the pathogenesis of atherosclerosis, we investigated subjects belonging to poor socio-economic strata in urban slums and compared them to healthy control subjects from non-slum urban areas of New Delhi

Awareness, Perception, and Practice of Obese Patients toward COVID-19: A Study from Tertiary Care Center, India

Introduction: COVID-19 has emerged as a global health crisis. It has been established that people with obesity are prone to develop severe manifestations of COVID-19. Since there is no established treatment of the disease, yet, it is essential to increase public awareness toward prevention of infection. This study was aimed to assess the awareness, perception, and practices of obese subjects toward COVID-19 infection. Methods: This cross-sectional study was conducted among 260 obese patients between August 2020 and November 2020 who were enrolled in obesity and metabolic disorders clinic at our institute. A structured questionnaire consisting of 23 questions (15 of knowledge, four of perception, and four of practices) was administered by telephonic interview with the patients. Multiple regression analyses were conducted to identify factors associated with poor knowledge and practice toward COVID-19. Results: The mean age of the participants was 41.7 ± 10.2 years, with 166 (64%) females. Mean awareness score obtained by subjects was 9.1 ± 2.2 out of 15. The scores were categorized into good, moderate, and poor. Subjects with poor awareness constituted 36% of study population. Mean perception score of participants was 14.0 ± 2 out of 20. Majority of patients (69.2%) had moderate perception score. Mean score obtained in practices was 18.5 ± 2.1 out of 20 and 92% of subjects reported good practices. Age was negatively associated with awareness score. Gender and educational qualification had a significant impact on awareness score with males having better awareness then females. Graduates and above had higher awareness score. Increase in awareness score was found to be associated with improved practices but not with perception. Conclusion: The prevalence of good practices toward COVID-19 among obese patients was high (92%) although poor awareness was also highly prevalent (36%). Increasing the awareness through various means should be considered