Correlation of platelet count/splenic diameter ratio for the diagnosis of esophageal varices in patients of cirrhosis of liver

Background: In patients with cirrhosis, endoscopic screening for esophageal varices is currently recommended as a gold standard tool at the time of diagnosis of cirrhosis and to institute prophylactic measures in patients with large esophageal varices. Newer methods have been proposed as alternatives to conventional endoscopy for the non-invasive or minimally invasive diagnosis of esophageal varices.Methods: This one year observational study was done in the Department of Medicine at Dr. Prabhakar Kore Hospital MRC Belagavi. A total of 70 patients with cirrhosis of liver were included in the study. Relevant clinical examination, laboratory workup like complete blood count, liver function test, ultrasound abdomen and all patients underwent screening upper gastrointestinal endoscopy. Platelet count to spleen diameter ratio was calculated for all patients.Results: 54 (77.14%) had varices. Males predominated with 64 (91%). Majority patients ranged in between 31-50 years. Evidence of esophageal varices was more common with cirrhosis secondary to alcoholism as compared to hepatitis B virus (HBV) and hepatitis C virus (HCV). The child Pugh score, platelet count, spleen size, platelet count/spleen diameter ratio in patients with varices was significantly different from patients without varices. Platelet count spleen diameter ratio cutoff value of 909 was obtained with sensitivity of 77% and specificity of 79%. The positive predictive value was 88% and negative predictive value was 62%.Conclusions: The platelet count to spleen diameter ratio may be useful inexpensive tool for diagnosing esophageal varices in liver cirrhosis noninvasively when endoscopy facilities are not available

Hypokalemia in hospitalized patients in tertiary care teaching hospital Belagavi, Karnataka, India: a retrospective study

Background: Hypokalemia is well known condition in which serum potassium levels falls less than the normal level (normal range 3.5 to 5.1mmol/L). It has adverse effect on cardiac rhythm, blood pressure.1 The objective of the study was to look for causes and associated factors of hypokalemia.Methods: Patients age, sex, potassium value and primary diagnosis of hypokalemia patients collected from tertiary care teaching hospital retrospectively. Hypokalemia patients are classified based on the severity of hypokalemia, age, sex and primary diagnosis. Results: Study reveals that both males and females are equally affected by hypokalemia, individuals with age between 40 to 60 are most affected and less than 20 are least affected by hypokalemia.Conclusions: Hypokalemia is significantly associated with gastrointestinal and genitourinary disorders when compared with other disorders

A simplified Indian diabetes risk score for screening for undiagnosed diabetic subjects

Aim: The aim of this study was to develop and validate a simplified Indian Diabetes Risk Score for detecting undiagnosed diabetes in India. Methods: The risk score was derived from the Chennai Urban Rural Epidemiology Study (CURES), an ongoing epidemiological study on a representative population of Chennai. Phase 1 of CURES recruited 26,001 individuals, of whom every tenth subject was requested to participate in Phase 3 for screening for diabetes using World Health Organization (WHO) 2hour venous plasma glucose criteria [i.e. ≥200 mg/dl]. The response rate was 90.4% (2350/2600). The Indian Diabetes Risk Score [IDRS] was developed based on results of multiple logistic regression analysis. Internal validation was performed on the same data. Results: IDRS used four risk factors: age, abdominal obesity, family history of diabetes and physical activity. Beta co-efficients were derived based on a multiple logistic regression analysis using undiagnosed diabetes as the dependent variable. The beta co-efficients were modified so as to obtain a maximum possible score of 100. Receiver Operating Characteristic [ROC] curves were constructed to identify the optimum value of IDRS for detecting diabetes by WHO consulting group criteria. Area under the curve for ROC was 0.698 (95% confidence interval (CI):0.663 .0.733). An IDRS value . 60 had the optimum sensitivity (72.5%) and specificity (60.1%) for determining undiagnosed diabetes with a positive predictive value of 17.0%, negative predictive value of 95.1%, and accuracy of 61.3%. Conclusion: This simplified Indian Diabetes Risk Score is useful for identifying undiagnosed diabetic subjects in India and could make screening programmes more cost effective

Random Capillary Blood Glucose Cut Points for Diabetes and Pre-Diabetes Derived From Community-Based Opportunistic Screening in India

OBJECTIVE: To determine random capillary blood glucose (RCBG) cut points that discriminate diabetic and pre-diabetic subjects from normal individuals. RESEARCH DESIGN AND METHODS: RCBG was performed in 1,333 individuals randomly chosen from 63,305 individuals who had participated in an opportunistic screening program. An oral glucose tolerance test was also performed by venous plasma glucose on an autoanalyzer. RCBG cut points that discriminate diabetes, impaired glucose tolerance (IGT), and impaired fasting glucose (IFG) were determined using receiver operating characteristic curves. RESULTS: Using 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) criterion, the RCBG cut point of 140 mg/dl (7.7 mmol/l) gave the highest sensitivity and specificity. For 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) and fasting plasma glucose (FPG) >or=126 mg/dl (7.0 mmol/l) criteria, either 2-h plasma glucose >or=200 mg/dl (11.1 mmol/l) or FPG >or=126 mg/dl (7.0 mmol/l) criterion, and the FPG >or=126 mg/dl (7.0 mmol/l) criterion, RCBG cut point was 143 mg/dl (7.9 mmol/l). RCBG cut points for IGT, IFG according to World Health Organization criterion, and IFG according to American Diabetes Association criterion were 119 mg/dl (6.6 mmol/l), 118 mg/dl (6.6 mmol/l), and 113 mg/dl (6.3 mmol/l), respectively. CONCLUSIONS: Asian Indians with RCBG >110 mg/dl at screening can be recommended to undergo definitive testing

Increased Awareness about Diabetes and Its Complications in a Whole City: Effectiveness of the “Prevention, Awareness, Counselling and Evaluation” [PACE] Diabetes Project [PACE-6]

Abstract Aims and Objectives : To determine the effectiveness of a large scale multipronged diabetes awareness program provided through community involvement in Chennai. Material and Methods: Mass awareness and free screening camps were conducted between 2004-2007 at various locations of Chennai as part of the Prevention, Awareness, Counselling and Evaluation [PACE] Diabetes Project. During a 3-year period, 774 diabetes awareness camps were conducted to reach the public directly. After the PACE project was completed, 3,000 individuals, representative of Chennai, were surveyed in 2007 using a systematic stratified random sampling technique. The results were compared to a similar survey carried out, as part of the Chennai Urban Rural Epidemiology Study [CURES] in 2001 - 2002, which served as a measure of baseline diabetes awareness. Results: Awareness of a condition called “diabetes” increased significantly from 75.5% in 2001-2002 (CURES) to 81% (p < 0.001) in 2007 (PACE). 74.1% of the citizens of Chennai are now aware that the prevalence of diabetes is increasing as compared to 60.2% earlier [p<0.001]. Significantly more people felt that diabetes could be prevented (p<0.001), and that a combination of diet and exercise were needed to do so (p<0.001). Respondents reporting obesity, family history of diabetes, hypertension and mental stress as risk factors increased significantly after PACE (p<0.001). More people were able to correctly identify the eyes (PACE 38.1% compared to CURES -16.1%, p < 0.001), kidney (PACE 42.3% compared to CURES 16.1%, p < 0.001), heart (PACE 4.6% compared to CURES 5.8%, p < 0.001) and feet (PACE 35.0% vs CURES 21.9%, p < 0.001) as the main organs affected by diabetes. Conclusion: Through direct public education and mass media campaigns, awareness about diabetes and its complications can be improved even in a whole city. If similar efforts are implemented state-wise and nationally, prevention and control of non-communicable diseases, specifically diabetes and cardiovascular disease, is an achievable goal in India.

Prevention Awareness Counselling and Evaluation (PACE) Diabetes Project: A Mega Multi-pronged Program for Diabetes Awareness and Prevention in South India (PACE - 5)

Objective: The Prevention Awareness Counselling Evaluation (PACE) Diabetes Project is a large scale community based project carried out to increase awareness of diabetes and its complications in Chennai city (population : 4.7 million) through 1) public education 2) media campaigns 3) general practitioner training 4) blood sugar screening and 5) community based “real life” prevention program Methods: Education took place in multiple forms and venues over the three-year period of the PACE project between 2004 - 2007. With the help of the community, awareness programs were conducted at residential sites, worksites, places of worship, public places and educational institutions through lectures, skits and street plays. Messages were also conveyed through popular local television and radio channels and print media. The General Practitioners (GPs) program included training in diabetes prevention, treatment and the advantages of early detection of complications. Free random capillary blood glucose testing was done for individuals who attended the awareness programs using glucose meter. Results: Over a three-year period, we conducted 774 education sessions, 675 of which were coupled with opportunistic blood glucose screening. A total of 76,645 individuals underwent blood glucose screening. We also set up 176 “PACE Diabetes Education Counters” across Chennai, which were regularly replenished with educational materials. In addition, we trained 232 general practitioners in diabetology prevention, treatment and screening for complications. Multiple television and radio shows were given and messages about diabetes sent as Short Message Service (SMS) through mobile phones. Overall, we estimate that we reached diabetes prevention messages to nearly two million people in Chennai through the PACE Diabetes Project, making it one of the largest diabetes awareness and prevention programs ever conducted in India. Conclusion: Mass awareness and screening programs are feasible and, through community empowerment, can help in prevention and control of non-commuincable diseases such as diabetes and its complications on a large scale

Evaluating the effect of care around labor and delivery practices on early neonatal mortality in the global network\u27s maternal and newborn health registry

Background: Neonatal deaths in first 28-days of life represent 47% of all deaths under the age of five years globally and are a focus of the United Nation\u27s (UN\u27s) Sustainable Development Goals. Pregnant women are delivering in facilities but that does not indicate quality of care during delivery and the postpartum period. The World Health Organization\u27s Essential Newborn Care (ENC) package reduces neonatal mortality, but lacks a simple and valid composite index that measures its effectiveness.Methods: Data on 5 intra-partum and 3 post-partum practices (indicators) recommended as part of ENC, routinely collected in NICHD\u27s Global Network\u27s (GN) Maternal Newborn Health Registry (MNHR) between 2010 and 2013, were included. We evaluated if all 8 practices (Care around Delivery - CAD), combined as an index was associated with reduced early neonatal mortality rates (days 0-6 of life).Results: A total of 150,848 live births were included in the analysis. The individual indicators varied across sites. All components were present in 19.9% births (range 0.4 to 31% across sites). Present indicators (8 components) were associated with reduced early neonatal mortality [adjusted RR (95% CI):0.81 (0.77, 0.85); p \u3c 0.0001]. Despite an overall association between CAD and early neonatal mortality (RR \u3c 1.0 for all early mortality): delivery by skilled birth attendant; presence of fetal heart and delayed bathing were associated with increased early neonatal mortality.Conclusions: Present indicators (8 practices) of CAD were associated with a 19% reduction in the risk of neonatal death in the diverse health facilities where delivery occurred within the GN MNHR. These indicators could be monitored to identify facilities that need to improve compliance with ENC practices to reduce preventable neonatal deaths. Three of the 8 indicators were associated with increased neonatal mortality, due to baby being sick at birth. Although promising, this composite index needs refinement before use to monitor facility-based quality of care in association with early neonatal mortality. Trial registration The identifier of the Maternal Newborn Health Registry at ClinicalTrials.gov is NCT01073475

Preconception nutrition intervention improved birth length and reduced stunting and wasting in newborns in south Asia: The women first randomized controlled trial

South Asia has \u3e50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), in the 1st trimester (Arm 2), or not at all (Arm 3). An additional protein-energy supplement was provided if BMI/m2 or gestational weight gain was less than guidelines. Gestational age was established in the 1st trimester and newborn anthropometry obtaine

Some new 3-substituted-4-amino-5-mercapto-4(H)-1,2,4-triazoles as nonsteroidal antiinflammatory agents

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Early pregnancy loss in Belagavi, Karnataka, India 2014–2017: a prospective population-based observational study in a low-resource setting

Background The prevalence of early pregnancy loss through miscarriage and medically terminated pregnancy (MTP) is largely unknown due to lack of early registration of pregnancies in most regions, and especially in low- and middle-income countries. Understanding the rates of early pregnancy loss as well as the characteristics of pregnant women who experience miscarriage or MTP can assist in better planning of reproductive health needs of women. Methods A prospective, population-based study was conducted in Belagavi District, south India. Using an active surveillance system of women of childbearing age, all women were enrolled as soon as possible during pregnancy. We evaluated rates and risk factors of miscarriage and MTP between 6 and 20 weeks gestation as well as rates of stillbirth and neonatal death. A hypothetical cohort of 1000 women pregnant at 6 weeks was created to demonstrate the impact of miscarriage and MTP on pregnancy outcome. Results A total of 30,166 women enrolled from 2014 to 2017 were included in this analysis. The rate of miscarriage per 1000 ongoing pregnancies between 6 and 8 weeks was 115.3, between 8 and 12 weeks the miscarriage rate was 101.9 per 1000 ongoing pregnancies and between 12 and 20 weeks the miscarriage rate was 60.3 per 1000 ongoing pregnancies. For those periods, the MTP rate was 40.2, 45.4, and 48.3 per 1000 ongoing pregnancies respectively. The stillbirth rate was 26/1000 and the neonatal mortality rate was 24/1000. The majority of miscarriages (96.6%) were unattended and occurred at home. The majority of MTPs occurred in a hospital and with a physician in attendance (69.6%), while 20.7% of MTPs occurred outside a health facility. Women who experienced a miscarriage were older and had a higher level of education but were less likely to be anemic than those with an ongoing pregnancy at 20 weeks. Women with MTP were older, had a higher level of education, higher parity, and higher BMI, compared to those with an ongoing pregnancy, but these results were not consistent across gestational age periods. Conclusions Of women with an ongoing pregnancy at 6 weeks, about 60% will have a living infant at 28 days of age. Two thirds of the losses will be spontaneous miscarriages and one third will be secondary to a MTP. High maternal age and education were the risk factors associated with miscarriage and MTP. Trial registration The trial is registered at clinicaltrials.gov. ClinicalTrial.gov Trial Registration: NCT01073475