Association of subclinical hypothyroidism and HbA1c levels in non-diabetic subjects attending rural tertiary care centre in central India

Background: Subclinical hypothyroidism is defined as an elevated serum TSH level and normal concentrations of free T3 (FT3), free T4 (FT4), T3 and T4. A positive association between thyroid and diabetes mellitus is well recognized but to study the effect of thyroid disorders on glucose metabolism in non-diabetic patients is an area for extensive research. Present study was planned to assess correlation between subclinical hypothyroidism and glycosylated haemoglobin levels in non-diabetic patients.Methods: A case-control study was conducted on total 209 subjects. 109 patients were allotted in case group and 100 in control group. Controls were relatives and friends of patients who were matched for age and sex. Comparison between the case and the control groups were made using Student’s t-test (unpaired) and Box and Whisker Plot and regression graph were presented for correlation between serum TSH and HbA1c.Results: It was found that there was a positive correlation between the levels of serum TSH (µU/L) and HbA1c (%) in all the participants of the study by Pearson’s correlation coefficient (r=0.35, p < 0.0001).Conclusions: HbA1c levels are increased in subclinical hypothyroid patients. The effects of the elevated levels of Serum TSH on the HbA1c must be considered when interpreting the HbA1c for the diagnosis of diabetes or pre-diabetes in the subclinical hypothyroid patients

The prevalence of hypertension among young adults in a rural population of North India

Background: Most of the studies on hypertension provided the data on older age group. Most of the times, younger population remains unaddressed as they are assumed to be at a lower risk of developing the disease. So, the study on prevalence of hypertension among younger age group and their socio-demographic variables provides the guide for requirements of any intervention. Objective of present study is to estimate the prevalence of Hypertension among young adults in a rural population of central India.Methods: We collected data on socio-demographic characteristics and hypertension status from 1061 subjects aged 18–40 years. Relevant clinical parameters were collected (blood pressure recordings and anthropometric measurements).Results: Hypertension was detected in 188 of the 1061 subjects (17.7%). Prevalence among men was higher (18.8% compared to 15.2% among women). A total of 40.2% of the subjects was found to have pre-hypertension. Higher prevalence of hypertension was seen among those with a history of smoking.Conclusions: Most of the young adults with raised blood pressure were previously undiagnosed. A large number of subjects had prehypertension. Their early identification facilitates early, active management of blood pressure and formulation of preventive strategies thereby decreasing morbidity and mortality due to cardiovascular diseases and hypertension.

Effect of 1-methyl cyclopropene on the post harvest life and quality of kiwi fruit

115-122Studies were conducted to observe the effect of different concentrations of 1-methylcyclopropene (1-MCP) on the post-harvest life and quality of 'Allison' kiwifruit (Actinidia deliciosa). Fruit were treated with different concentrations of 1-MCP (0.5 μl l-1, 1.0 μl l-1, or 2.0 μl l-1) for 24 h at 20°C and untreated fruits served as control. After treatment, fruits were transferred to ambient temperature storage (22 ± 4°C, 65-70% relative humidity) for 18 days, during which observations on various physical, physiological and biochemical parameters were recorded at 3 days intervals. Our results revealed that 1-MCP @ 2.0 μl l-1 was the most effective treatment to delay softening and ripening in 'Allison' kiwifruit as such fruit showed the lowest weight loss (9.8 %), have highest fruit firmness (32.7 N), and began to ripen only after 12 days in storage, whereas untreated fruit started ripening on day-6 of storage. The activities of fruit softening enzymes such as polygalacturonase and lipoxygenase were lower, and total phenolics contents and antioxidant activity were higher in 1-MCP-treated fruits than in untreated fruits. 1-MCP-treated fruit exhibited lower rates of respiration and ethylene production than untreated fruits. Similarly, 1-MCP-treated fruit had high titratable acidity and ascorbic acid (AA) contents and lower soluble solids contents than untreated kiwifruits. Thus, 1-MCP @ 2.0 μl l-1 can be used for the post-harvest treatment of 'Allison' kiwifruit to enhance its shelf-life and marketability by approx, 6 days

Evaluation of Procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers in suspected cases of sepsis among patients attending Emergency Department and ICU of the tertiary care hospital in Western Uttar Pradesh

Background: Procalcitonin has characteristics of a biomarker, as there is a fast and specific increase in sepsis and it differentiates infections from non-infectious causes of sepsis. The present study was conducted to evaluate procalcitonin (PCT) and C-reactive protein (CRP) as biomarkers in suspected cases of sepsis. Materials &amp; Methods: The study was conducted on 80 cases in the department of medicine at Uttar Pradesh University of Medical Sciences (UPUMS), Saifai, Etawah. Cases clinically suspected of sepsis on admission to emergency department were included. 5ml of venous blood sample was withdrawn simultaneously for detection of PCT and CRP. Results: There were 45 (56.2%) male and 35 (43.7%) female. Blood culture was positive in 26 (32.5%) and negative in 54 (67.5%). Among 26 positive blood culture cases, 5 (19.23%) were caused by Gram-positive bacteria and 21 (80.76%) by Gram-negative bacteria. In Gram-positive cultures all 5 isolates identified were of Staphylococcus aureus. In Gram-negative cultures most common isolates were E. coli 9 (34.61%), followed by Klebsiella pneumoniae 6 isolates (23.07%) and 6 isolates of non-fermenting gram-negative bacilli (NFGNB) were isolated. Clinical conditions present in study subjects were chronic lung disease in 31cases (38.7%) followed by acute kidney failure in 27 cases and anaemia in 24 cases. Three cases also had gastrointestinal disease. Source of infection in culture positive patients were pneumonia 9 cases (34.6%), UTI 8 cases (30.7%), skin wounds/cellulitis 4 cases (15.3%), meningitis and biliary tract infection 3 cases each (11.5%). Source of infection in culture negative cases was pneumonia 19 cases (35.1%) followedbyUTI11cases (20.3%). Conclusion: PCT proved to be a reliable marker for sepsis diagnosis and is more relevant than CRP in patients with a positive blood culture

Comparison of dexmedetomidine and ketamine versus propofol and ketamine for procedural sedation in children undergoing minor cardiac procedures in cardiac catheterization laboratory

Background: The ideal anaesthetic technique for management of paediatric patients scheduled to undergo cardiac catheterisation is still not standardised. Aim: To compare the effects of ketamine-propofol and ketamine-dexmedetomidine combinations on hemodynamic parameters and recovery time in paediatric patients undergoing minor procedures and cardiac catheterisation under sedation for various congenital heart diseases. Material and Methods: 60 children of either sex undergoing cardiac catheterisation were randomly assigned into two groups Dexmedetomidine-ketamine group (DK) and Propofol-ketamine (PK) of 30 patients each. All patients were premedicated with glycopyrrolate and midazolam (0.05mg/kg) intravenously 5-10 min before anaesthetic induction. Group 'DK'received dexmedetomidineiv infusion 1 μg/kg over 10 min + ketamine1mg/kg bolus, followed by iv infusion of dexmedetomidine 0.5μg/kg/hr and of ketamine1 mg/kg/hr. Group 'PK' received propofol 1mg/kg and ketamine 1mg/kg/hr for induction followed by iv infusion of propofol 100 μg/kg/hr and ketamine 1 mg/kg/hr for maintenance. Haemodynamic parameters and recovery time was recorded postoperatively. Statistical Analysis: Independent sample t test was used to compare the statistical significance of continuous variables of both the groups.Chi square test was used for numerical data like gender.Fischer exact test was applied for non parametric data like ketamine consumption. Results: We observed that heart rate in dexmedetomidine (DK) group was significantly lower during the initial 25 mins after induction compared to the propofol (PK) group. Recovery was prolonged in the DK group compared to the PK group (40.88 vs. 22.28 min). Even ketamine boluses consumption was higher in DK group. Conclusion: Use of dexmedetomidine-ketamine combination is a safe alternative, without any hemodynamic orrespiratory effects during the cardiac catheterization procedure but with some delayed recovery

Predictors of nephrectomy in high grade blunt renal trauma patients treated primarily with conservative intent

Introduction: There is no consensus on the optimal management of high grade renal trauma. Delayed surgery increases the likelihood of secondary hemorrhage and persistent urinary extravasation, whereas immediate surgery results in high renal loss. Hence, the present study was undertaken to evaluate the predictors of nephrectomy and outcome of high Grade (III-V) renal injury, treated primarily with conservative intent. Materials and Methods: The records of 55 patients who were admitted to our institute with varying degrees of blunt renal trauma from January 2005 to December 2012 were retrospectively reviewed. Grade III-V renal injury was defined as high grade blunt renal trauma and was present in 44 patients. The factors analyzed to predict emergency intervention were demographic profile, grade of injury, degree of hemodynamic instability, requirement of blood transfusion, need for intervention, mode of intervention, and duration of intensive care unit stay. Results: Rest of the 40 patients with high grade injury (grade 3 and 4 )did not require emergency intervention and underwent a trail of conservative management. 7 of the 40 patients with high grade renal injury (grade 3 and 4), who were managed conservatively experienced complications requiring procedural intervention and three required a delayed nephrectomy. Presence of grade V injuries with hemodynamic instability and requirement of more than 10 packed cell units for resuscitation were predictors of nephrectomy. Predictors of complications were urinary extravasation and hemodynamic instability at presentation. Conclusion: Majority of the high grade renal injuries can be successfully managed conservatively. Grade V injuries and the need for more packed cell transfusions during resuscitation predict the need for emergency intervention

Herpes zoster as a presentation of diabetes mellitus

Background: Herpes zoster (HZ) occurs due to reactivation of latent Varicella zoster virus infection and affects in dermatomal pattern. HZ affects elderly and immunocompromised population. Some earlier studies shows that HZ is common in diabetes patients. Our aim was to find out incidence of diabetes mellitus in patients with HZ.Methods: Study was done on newly diagnosed HZ patients attending out door of UPUMS Saifai. Inclusion criteria include newly diagnosed case of HZ without previous history of diabetes. Patients with known immunocompromised state like HIV infection, corticosteroid therapy, chemotherapy, neoplastic disease etc were excluded. Fasting, post-prandial blood sugar and HbA1C of all patients done.Results: 22.54% patients with HZ had diabetes and 7.75% patients had impaired glucose tolerance at presentation. Undiagnosed diabetes is common in HZ patients.Conclusions: Our study indicates that incidence of undiagnosed diabetes is high among HZ patients and hence routine screening for diabetes should be done in all HZ patients

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BackgroundEstimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period.Methods22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution.FindingsGlobal all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations.InterpretationGlobal adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic