Sero-epidemiology of toxoplasmosis and associated risk factors among antenatal women in Ranchi, Jharkhand, India

Background: Toxoplasmosis seroprevalence in antenatal women has remained a contentious issue in Indian subcontinent. Bad obstetric history (BOH) is specific to women of childbearing age and can be caused by infection with Toxoplama gondii. In Jharkhand, scarce data exist for the roles of toxoplasmosis in the aetiology of adverse pregnancy outcome. Aim: To study the sero-epidemiology of Toxoplasmosis and associated risk factors among antenatal women attending antenatal clinic of a tertiary care hospital in Ranchi, Jharkhand, India.Methods: A case-control study was conducted on antenatal women attending antenatal clinic from the June 2010 to May 2011. The study group comprised 102 antenatal women of with BOH while the control group comprised 102 multiparous, age-matched antenatal women without BOH. Latex Slide agglutination test for antibodies to T.gondii was utilized. The research was approved by institutional ethical committee. Descriptive and inferential statistics was applied.Results: The overall seroprevalence of T.gondii among antenatal women was 15.19%, with significantly more in women with BOH (24.50%) as compared to women without BOH (5.88%). The seroprevalence in women with BOH gradually increased with advancing age: 8.33% in age less than 20 years to 50% in women older than 30 years. The seroprevalence increased steadily with number of BOH: 9.67% in women with one BOH to 37.50% in women with three or more BOH. Risk factors like Illiteracy, rural residence, owning a cat and non-veg dietary habit showed significant association.Conclusions: The seroprevalence of toxoplasmosis is high among antenatal women with BOH. Routine serological test is recommended for all pregnant women with BOH

Base Deficit as a Predictor of Mortality in Sepsis and Septic Shock.

Introduction: Sepsis is a common problem encountered in the emergency room which needs to be intervened early. It is always difficult to have the quick prognostic marker of sepsis in busy emergency. So this study was conducted to determine whether base deficit can be used as an indicator of mortality among septic patients in emergency room set up like ours. Methods: It was a hospital-based descriptive cross-sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from March 2018 to December 2018.  Acute physiology and chronic health evaluation II score(APACHE II), Base deficit, Sequential Organ Failure Assessment(SOFA)score on first day of arrival in the emergency room were calculated. The association of 28-day outcome with Acute physiology and chronic Health Evaluation II score, Base deficit value and SOFA score were derived. Results: Out of 229 patients with septic shock 62 died (27%) and among 71 patients without septic shock,12 died(16.9%) .Overall mortality was 24.66 %(n= 74).The area under the ROC curve for Base deficit(0.864;95% C.I.=0.822-0.906), APACHE II( 0.782;95%C.I=0.718-0.848;,SOFA(0.689;95% C.I=0.620-0.757) were greater than 0.7 except for SOFA which signifies these test to  have fair efficacy to predict mortality. Conclusions: High base deficit value predicts mortality in patients with sepsis and septic shock. Keywords: Base Deficit; Sepsis; Septic Shock, Predictor, Mortality DOI: http://doi.org/10.3126/jkahs.v2i2.2516

Clinical Presentation in Chronic Kidney Disease Patients on Regular Haemodialysis Attending in Tribhuvan University Teaching Hospital Emergency Services

Background: Chronic kidney disease is increasing day by day and so is condition of renal replacement therapy; mainly hemodialysis. Emergency visit of the patients under maintenance hemodialysis is frequent. The objective of the study is to study clinical parameters of these patients so that in future these deranged parameters can be focused during patient management and decrease their emergency visit. Methods: A prospective cross sectional study was conducted in emergency services of Tribhuvan University Teaching Hospital from 1st May 2018 to 31st October 2018 among the adult chronic kidney disease patients under maintenance hemodialysis. Ethical approval was taken from Institutional review board, Institute of medicine, TribhuvanUniversity.Nonprobability sampling method was used. Total of 300 patients were enrolled in the study. Patients’ age, sex, causes, laboratory parameter during emergency visit, need of emergency hemodialysis, and need of blood transfusion were studied. Results: Out of total 300 patients, mean age was 45.64 years (S.D =17.15). 190 (63.3 %) were male and 110(36.70%) were female. 152(50.70%) of patients had hypertension. Diabetes and Glomerulonephritis both had equal prevalence of 63(21%). Mean hemoglobin was 6.52gm% (S.D = 1.93). Mean pH was 7.17 (S.D =0.154). Mean serum potassium and creatinine level were 5.77 mEq/L (S.D =0.76) and 1076.03 mmol/l (S.D =367.25) respectively. Area under the Receiver Operating Curve was 0.660 for potassium and 0.598 for serum creatinine. Conclusions: Causes of chronic kidney disease, decreased hemoglobin level, increased serum creatinine and potassium level and metabolic acidosis are causes of frequent emergency room visit among CKD patients.  So these conditions need to be addressed to decrease emergency visit of these patients. Keywords: chronic kidney disease; emergency presentation; mortality. DOI: http://doi.org/10.3126/jkahs.v2i2.2516

Gross corelation between waist hip ration and random blood sugar level in Thami tribe of Dolakha district in Nepal

Introduction:  Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal. Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer. Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in  random blood sugar level both in males(p=0.008) and females(p=0.007). Conclusions:  Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run. Keywords: blood sugar level; diabetes; Thami community; waist hip ratio  

Gross corelation between waist hip ration and random blood sugar level in Thami tribe of Dolakha district in Nepal

Introduction: Diabetes is one of the major public health problems in Nepal. Very few studies on correlation between waist hip ratio and random blood sugar have been done in remote areas of Nepal particularly in minor ethnic groups like Thami. This study attempted to compare waist hip ratio and blood sugar level in Thami community of Nepal. Methods: This cross sectional study was conducted in sub-health post of Lapilang village of Dolakha district of Nepal. A total of 243 local inhabitants from Thami Tribe participated in the study. Waist hip ratio was calculated after taking measurements of waist and hip using flexible measuring tape; and, blood glucose level was measured by glucometer. Results: The mean age of the participants was 46.02 years; among participants 126(51.9%) were males and 117(48.1%) were females. Mean waist hip ratio was 0.87, mean blood sugar level was 124.5mg%.Increase in Waist hip ratio correlated significantly with increase in random blood sugar level both in males(p=0.008) and females(p=0.007). Conclusions: Increase in waist hip ratio is associated with increase in random blood sugar level. Therefore, there is a need of public awareness program to reduce waist circumference thus reducing weight of people to prevent development of diabetes mellitus in long run. Keywords: blood sugar level; diabetes; Thami community; waist hip rati

A Comparative Study of Lipid Profile among Smokers and Non Smokers

Introduction: Smoking is a risk factor for the development of cardiovascular diseases and many other diseases. Smoking is found to alter the lipid profile and poses a risk for atherosclerosis. This study aims to compare the lipid profile between smokers and non-smokers. Methods: Hospital-based observational study was carried out in Tribhuwan University, Teaching hospital, Kathmandu, Nepal on 90 smokers and 90 non-smokers who were apparently healthy. Data on socio-demographic variables were collected using a questionnaire and lipid profile was estimated on fasting venous blood in an auto-analyzer. The lipid levels of smokers and non-smokers were compared using t-test . Results: Most of the smokers were daily wagers and they consumed alcohol and high fat food compared to non smokers. The serum levels of HDL were significantly lower in smokers compared to nonsmokers.LDL level was positively correlated with numbers of cigarettes/ beedi smoked. The LDL level was significantly high in those who smoked more than 10 cigarettes or beedis. The duration of smoking had no significant effect on lipid profile. LDL and VLDL were significantly high among those with pack years more than 3. LDL levels positively correlated with pack year. Conclusion: Tobacco smoking is associated with dyslipidemia (increased LDL-c and decrease HDL-c level. Keywords: Dyslipidemia; HDL; LDL; Lipid profile; Smoking. DOI: http://dx.doi.org/10.3126/jkahs.v2i1.2438

Pleural fluid serum bilirubin ratio for differentiating exudative and transudative effusions

Background:  In pleural effusion, differentiating exudative and transudative fluid is an important clinical evaluation. The objective of the study was to determine the efficacy of pleural fluid serum bilirubin ratio in differentiating exudative and transudative effusions. In resource-limited settings with no facilities to measure lactate dehydrogenase (LDH) levels, using pleural fluid bilirubin ratio may help in better clinical decision. Methods:  It was a prospective observational study, conducted in the emergency department of Tribhuvan University Teaching Hospital. All the patients attending for emergency care with pleural effusion from 6th Jan 2015 to 5th Jan 2016 were included. The cases were divided as exudates and transudates on basis of final diagnosis. Serum and pleural fluid specimen were collected and sent for investigations. The data for various laboratory parameters especially those of lights criteria and bilirubin ratio were then analyzed and fluid nature was compared with results from parameters and final diagnoses. Results:  Among 103 cases, 71.84% had exudate and 28.16% had transudate. The commonest cause of effusion was pneumonia 35.92%, second being tubercular 23.30% followed by malignant effusion 12.60%, congestive heart failure 11.65%, chronic kidney disease 10.67% and liver cirrhosis 5.82%. The mean bilirubin ratio for exudates exceeded that for transudates. Considering the cutoff point of 0.6, the sensitivity, specificity, positive predictive value and negative predictive value were respectively 88.00%, 93.00%, 97.00% & 75.00%. Conclusions:   Pleural fluid serum bilirubin ratio can be utilized as a diagnostic tool for differentiating exudative and transudative effusions. Keywords:   bilirubin ratio; exudates; light’s criteria; pleural effusion; transudates.        

Prediction of Varietal Replacement in Wheat (Triticum aestivum L.)

Nine wheat genotypes, viz., K-508, K-17, K-818, RAJ4037, RAJ3404, K-8903, DBW-14, K-9357 and HD-2967 were evaluated in a randomized block design on nine parameters, viz., tillering ability, plant height, grain yield per plant, peduncle length, spikelets per spike, flag leaf area, thousand grain weight, days to maturity and grains per spike at experimental farm of BRD PG College, Deoria, Uttar Pradesh, India with objective of recommending suitable plant types to farmers of this region. Normalized cumulative ranks (NCR) were used as criteria for selecting suitable plant types. Small flag leaf and early maturity were the criteria of selection (left directional selection) and remaining seven characters were selected for higher values (right directional selection). The suitability order of varieties/genotypes, as per NCR values was DBW-14, HD-2967, K-508, RAJ-4037, K-818, RAJ-3404, K-17, K-9357 and K-8903. The top four varieties, namely DBW-14, HD-2967, K-508 and RAJ-4037 could be recommended for cultivation in this region. When all nine characters were selected for higher values, the suitability order came as HD2967, RAJ4037, DBW-14 and K-9357. High positive correlations were observed between peduncle length and test weight (0.831) and plant height and days to maturity (0.652). When peduncle length, test weight, plant height and days to maturity were made criteria of selection, the suitability order was DBW-14, K-818, HD-2967 and RAJ-3404. HD-2967 is the standard check variety and popular in this region. Therefore, a few of these selected/recommended varieties would give close fight to HD-2967 and might replace it eventually

Joint Indian Chest Society-National College of Chest Physicians (India) guidelines for spirometry

Although a simple and useful pulmonary function test, spirometry remains underutilized in India. The Indian Chest Society and National College of Chest Physicians (India) jointly supported an expert group to provide recommendations for spirometry in India. Based on a scientific grading of available published evidence, as well as other international recommendations, we propose a consensus statement for planning, performing and interpreting spirometry in a systematic manner across all levels of healthcare in India. We stress the use of standard equipment, and the need for quality control, to optimize testing. Important technical requirements for patient selection, and proper conduct of the vital capacity maneuver, are outlined. A brief algorithm to interpret and report spirometric data using minimal and most important variables is presented. The use of statistically valid lower limits of normality during interpretation is emphasized, and a listing of Indian reference equations is provided for this purpose. Other important issues such as peak expiratory flow, bronchodilator reversibility testing, and technician training are also discussed. We hope that this document will improve use of spirometry in a standardized fashion across diverse settings in India