A study of scrub meningoencephalitis and keeping it as a common differential diagnosis

Background: Scrub typhus is caused by the organism Orientia tsutsugamushi, transmitted by trombiculid mites. Meningoencephalitis as a cause of mortality in cases of scrub typhus is becoming a common entity now. Aims and objectives were to study the incidence of meningoencephalitis in scrub typhus cases admitted to our hospital and stress the importance of keeping it as a common differential diagnosis.Methods: A descriptive observational study of 39 diagnosed cases of scrub typhus admitted to our hospital for 6 months duration (May 2018 to October 2018) was conducted. Data concerning the cases were recorded and analyzed using appropriate statistics.Results: Out of 39 cases admitted, 8 patients were diagnosed as having meningoencephalitis. Patients with meningoencephalitis had severe thrombocytopenia when compared to those without any central nervous system (CNS) symptoms. All patients responded well to doxycycline therapy with no mortality amongst cases under study.Conclusions: There have been numerous outbreaks of scrub typhus in our state of Rajasthan, especially in the Hadoti region. And in recent years, scrub typhus has been an important contributor to the newer class of emerging infections causing mortality in India. Meningoencephalitis although rare forms a major part of the complications of scrub typhus

Correlation between thyroxin hormone level, bilirubin and uric acid in diabetic subjects

Background: Levels of thyroxin hormone along with T3, TSH and other markers such as uric acid, bilirubin and glucose are important in diagnosis and medical management of diabetes mellitus and thyroid disorder. Relationship between these parameters are important in both diabetes mellitus and Thyroid gland disease, as both disorders are increasing very fast in Indian population. Present study aimed to analyzed T3, T4, TSH, uric acid and bilirubin in Haroti Region of Jhalawar, Rajasthan in diabetic and non diabetic subjects.Methods: One hundred diabetes mellitus subjects and 100 healthy control subjects were analyzed for determination of thyroxin, T3, TSH, uric acid and bilirubin by commercial kit method.Results: One hundred subjects of diabetes mellitus between age 30-60 years male and female were analyzed. It was observed significantly T3 <0.001 T4 <0.001 TSH <0.001 bilirubin <0.01 in diabetic subjects and found to be significant when compared in both groups. However, uric acid level insignificant in both patients and control groups.Conclusions:This study demonstrated that thyroxin hormone with T3, TSH and bilirubin and uric acid, are important parameters and their values are significant when compared with healthy subjects in diabetes mellitus and thyroid disorder. 

Role of cartridge-based nucleic acid amplification test to diagnose tuberculosis at tertiary care teaching hospital in Rajasthan, India

Background: Tuberculosis is one of the top 10 causes of death worldwide as per the Global TB report 2017, the estimated incidence of TB in India was approximately 28,00,000 cases accounting for about a quarter of the world’s TB cases (10 million). It is of utmost important to diagnose early and treat it to reduce disease transmission. GeneXpert MTB/RIF, an automated cartridge-based molecular technique detects Mycobacterium Tuberculosis and rifampicin resistance within two hours, has been recommended by WHO for rapid diagnosis of TB.Methods: Author conducted a retrospective study in the Department of TB and Chest, of tertiary care center at Jhalawar Medical College (JMC), Jhalawar to evaluate and analyze the role of CBNAAT to diagnose tuberculosis from 1st January 2018 to 31st December 2018. Author included all patients who came to department of TB and Chest of JMC, Jhalawar either new/ relapsed/ defaulters/ referred cases from ART/ ICTC center, Pediatric Department; Gynaecology and Obstetrics Department, peripheral Government Health Care Facilities and Private Hospitals of Jhalawar District catering about 15.5 lac population were subjected to both ZN staining/ Fluorescent microscopy and CBNAAT in the study period.Results: A total of 3078 samples (pulmonary 2739+EP 339) were tested for ZN staining / Fluorescent microscopy and CBNAAT during the study period. Mean age of the study population was 36.5±10.3 years. 1873 tested were negative and 1205 samples were positive for CBNAAT. Of these 1205 positive samples, 1174 were sputum/ BAL samples and 31 were extra pulmonary samples. Authors found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases, 3 rifampicin resistance cases were detected in extra pulmonary samples. CBNAAT could identify 255 cases (14.01%) that were smear negative. Author found TB-HIV coinfection rate of 18.75%.Conclusions: Author found CBNAAT to be an important diagnostic modality especially in smear negative patients for early diagnosis and treatment. Author could detect Mycobacterium Tuberculosis in 14.01% of patients with negative smear microscopy for AFB. In PLHIV, CBNAAT detected Mycobacterium Tuberculosis in 18.75% (12/64) of patients. Author found rifampicin resistance rate of 6.98% (82/1174) in pulmonary tuberculosis cases

Lattice Boltzmann Simulation of Incompressible Fluid Flow in Two-sided Converging and Diverging Lid-driven Square Cavity

The present study focuses on the predictions of flow behavior, streamlines and some other factors of a two adjacent-sided converging and diverging lid-driven square cavity filled with fluid. In the diverging case, the top wall of the cavity is considered to be in motion from left to right, and the left wall is considered to be in motion from top to bottom simultaneously with identical speeds. It is found that for a low Reynolds number, the flow behavior seems to be symmetric with respect to one of the diagonals of the cavity, and at a critical Reynolds number 1121, the symmetry of the flow behavior blows up, and an asymmetric form is obtained due to the increased inertia and turbulence effects. Any increment in the Reynolds number above the critical Reynolds number develops this asymmetry gradually more and more. In the second phenomenon, the converging phenomenon, the top wall of the cavity is assumed to be in motion from left to right, and the right wall is assumed to be in motion from bottom to top simultaneously with identical speeds so that they converge at the corner of the cavity. This case gives rise to two critical Reynolds numbers Re = 969 and Re = 2053 and the flow behavior for both asymmetric states was found to be opposite. Furthermore, the rate of convergence of the present methodology, lattice Boltzmann methodology, for various Reynolds numbers is found to be very high except for the critical and their nearby Reynolds numbers

Emergency Pneumonectomy: A Life-Saving Measure for Severe Recurrent Hemoptysis in Tuberculosis Cavitary Lesion

Hemoptysis constitutes a common and urgent medical problem. Swift and effective management is of crucial importance, especially in severe, life-threatening cases. Because of bronchial artery or a branch of pulmonary artery erosion due to cavitary infiltration, bronchiectasis, fungus ball, broncholithiasis, or destroyed lung, the bleeding can lead to highly compromised gas exchange or sometimes can be a life-threatening situation. Chest computerized tomography and bronchoscopy remain the methods of choice for lateralization of the disease. Some patients can be treated successfully with endobronchial interventions. Bronchial artery embolization can be rewarding in some patients but the recurrence rate is higher in tuberculosis than other etiologies of hemoptysis. Surgical resection of the lung, mainly lobectomy, remains a life-saving procedure but it should be performed very selectively to avoid higher postoperative morbidity and mortality

Plasma lipoprotein subfraction concentrations are associated with lipid metabolism and age-related macular degeneration

10.1194/jlr.M073684Journal of Lipid Research5891785-179

Association of Dietary and Physical Activity Patterns and Hypertension in Western Rajasthan, 2022

Introduction: Hypertension (HTN) is a modifiable risk factor for coronary artery disease, heart failure, cerebrovascular disease and chronic renal failure. HTN affects about 1 billion people globally; by 2025, up to 1.58 billion adults worldwide are likely to suffer from complications of HTN. This study was done to know the diet and physical activity patterns and HTN among the population of three districts of Western Rajasthan. Objectives: To study the dietary and physical activity patterns among the population of Western Rajasthan. and to compare key findings among three districts Pali, Jodhpur and Barmer so that lifestyle changes can be recommended. Methods: A case-control study was done among attendees of NCD clinics of tertiary-level centers in Pali, Barmer and Jodhpur. Hospital Controls were matched to age (± 5 years) and gender Considering the prevalence of HTN to be 20%*, the proportion of exposure in the general population as 0.2, odds ratio to be 2.2, power =80%, alpha=5% sample size is estimated to be 102 cases &amp; 102 controls (from each district). Results: Overall being married (OR= 3.3), having diabetes Cardiac disease (OR= 2.6), excessive salt consumption (OR= 2.7), moderate physical exercise less than 30 minutes (OR=1.9), using oil other than vegetable oil(OR=1.8) , Age &gt;?60 years (OR =1.4) were the key risk factors. It was found that high BMI (BMI&gt;27), consumption of non-vegetable oils (12.7%) was highest in Jodhpur, lack of moderate exercise for at least 30 minutes (81%), lack of sports activity (92%) was highest in Pali, least number of days/week of fruits and vegetables consumption (~1.64 days) was seen in Barmer. Conclusions: Change in quantity of salt consumption and incorporation of moderate physical exercise for &gt;30 minutes was most followed in control of HTN among the attendees of NCD Clinics from the multiple advise given

Efficacy of maternal B-12 supplementation in vegetarian women for improving infant neurodevelopment: protocol for the MATCOBIND multicentre, double-blind, randomised controlled trial

INTRODUCTION: Vitamin B12 deficiency is widely prevalent across many low- and middle-income countries, especially where the diet is low in animal sources. While many observational studies show associations between B12 deficiency in pregnancy and infant cognitive function (including memory, language and motor skills), evidence from clinical trials is sparse and inconclusive. METHODS AND ANALYSIS: This double-blind, multicentre, randomised controlled trial will enrol 720 vegetarian pregnant women in their first trimester from antenatal clinics at two hospitals (one in India and one in Nepal). Eligible mothers who give written consent will be randomised to receive either 250 mcg methylcobalamin or 50 mcg (quasi control), from enrolment to 6 months post-partum, given as an oral daily capsule. All mothers and their infants will continue to receive standard clinical care. The primary trial outcome is the offspring's neurodevelopment status at 9 months of age, assessed using the Development Assessment Scale of Indian Infants. Secondary outcomes include the infant's biochemical B12 status at age 9 months and maternal biochemical B12 status in the first and third trimesters. Maternal biochemical B12 status will also be assessed in the first trimester. Modification of association by a priori identified factors will also be explored. ETHICAL CONSIDERATIONS AND DISSEMINATION: The study protocol has been approved by ethical committees at each study site (India and Nepal) and at University College London, UK. The study results will be disseminated to healthcare professionals and academics globally via conferences, presentations and publications. Researchers at each study site will share results with participants during their follow-up visits.Trial registration numberCTRI/2018/07/015048 (Clinical Trial Registry of India); NCT04083560 (ClinicalTrials.gov)

Effect of aliskiren on post-discharge outcomes among diabetic and non-diabetic patients hospitalized for heart failure: insights from the ASTRONAUT trial

Aims The objective of the Aliskiren Trial on Acute Heart Failure Outcomes (ASTRONAUT) was to determine whether aliskiren, a direct renin inhibitor, would improve post-discharge outcomes in patients with hospitalization for heart failure (HHF) with reduced ejection fraction. Pre-specified subgroup analyses suggested potential heterogeneity in post-discharge outcomes with aliskiren in patients with and without baseline diabetes mellitus (DM). Methods and results ASTRONAUT included 953 patients without DM (aliskiren 489; placebo 464) and 662 patients with DM (aliskiren 319; placebo 343) (as reported by study investigators). Study endpoints included the first occurrence of cardiovascular death or HHF within 6 and 12 months, all-cause death within 6 and 12 months, and change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) at 1, 6, and 12 months. Data regarding risk of hyperkalaemia, renal impairment, and hypotension, and changes in additional serum biomarkers were collected. The effect of aliskiren on cardiovascular death or HHF within 6 months (primary endpoint) did not significantly differ by baseline DM status (P = 0.08 for interaction), but reached statistical significance at 12 months (non-DM: HR: 0.80, 95% CI: 0.64-0.99; DM: HR: 1.16, 95% CI: 0.91-1.47; P = 0.03 for interaction). Risk of 12-month all-cause death with aliskiren significantly differed by the presence of baseline DM (non-DM: HR: 0.69, 95% CI: 0.50-0.94; DM: HR: 1.64, 95% CI: 1.15-2.33; P < 0.01 for interaction). Among non-diabetics, aliskiren significantly reduced NT-proBNP through 6 months and plasma troponin I and aldosterone through 12 months, as compared to placebo. Among diabetic patients, aliskiren reduced plasma troponin I and aldosterone relative to placebo through 1 month only. There was a trend towards differing risk of post-baseline potassium ≥6 mmol/L with aliskiren by underlying DM status (non-DM: HR: 1.17, 95% CI: 0.71-1.93; DM: HR: 2.39, 95% CI: 1.30-4.42; P = 0.07 for interaction). Conclusion This pre-specified subgroup analysis from the ASTRONAUT trial generates the hypothesis that the addition of aliskiren to standard HHF therapy in non-diabetic patients is generally well-tolerated and improves post-discharge outcomes and biomarker profiles. In contrast, diabetic patients receiving aliskiren appear to have worse post-discharge outcomes. Future prospective investigations are needed to confirm potential benefits of renin inhibition in a large cohort of HHF patients without D