Metabolic syndrome in patients with chronic plaque psoriatic disease: a case-control study from western Uttar Pradesh, India

Background: Various studies on psoriasis and metabolic syndrome have shown a large variation in their results. An increasing frequency is imposing a substantial burden on the overall health of psoriasis patients that needs to be appropriately foreseen and addressed. Aim of this study was to study various aspects of metabolic syndrome in patients with chronic plaque psoriatic disease in northern Indian region.Methods: A cohort of patients registering for treatment of chronic plaque psoriasis at Dermatology outpatients’ department formed the study population. Detailed history was captured. General physical examination was carried out. A thorough cutaneous examination was undertaken which captured details on type, distribution and arrangement of primary lesions and secondary changes in patients. After overnight fasting, venous blood samples were collected from the subjects and were analysed for serum glucose, triglyceride and HDL-cholesterol. Results: Metabolic syndrome in psoriasis was associated with higher age. Gender wise male preponderance was observed. Among the psoriasis cases, 64% had metabolic syndrome whereas among the control subjects 48% had the condition (p-value 0.158). The mean for serum triglyceride level for psoriasis patients (159.42 mg/dL) was higher than controls (144.25 mg/dL). Forty six percent of cases fulfilled elevated triglycerides ≥150 mg/dl as a criterion of metabolic syndrome, compared to 40% of controls. Conclusions: We observed a higher frequency of metabolic syndrome among psoriasis cases in a northern Indian population. An association of dyslipidemia with psoriasis was also noted. Routine screening of the condition to facilitate early diagnosis and treatment should be undertaken

Assessment of liver volume with spiral computerized tomography scanning: predicting liver volume by age and height

Background: Estimation of liver size has critical clinical implication. Precise knowledge of liver dimensions and volume is prerequisite for clinical assessment of liver disorders. Liver span as measured by palpation and USG is prone to inter-observer variability and poor repeatability. The aim was to assess the normal liver volume of healthy adults using spiral computed tomography scans and to observe its relationship with various body indices.Methods: In this prospective study, all the patients who underwent spiral computed tomography (CT) of the abdomen or thorax in department for conditions unrelated to the hepatobiliary system, during the study period were included. One hundred patients were selected using convenient sampling technique. Study subjects were evaluated clinically and also by laboratory tests. Volume was determined by multiplying the sum of all slices by the 3-D image reconstruction and volume-rendering tool.Results: Liver volume reciprocally correlated with age (correlation coefficient: r=0.11, p=0.04). Liver volume also correlated with other indices as body height (r=0.12, p=0.02), body weight (r=0.16, p=0.02), BMI (r=0.06, p=0.05) and BSA (r=0.04, p=0.01). Age and body height were found to be good predictors of liver volume (adjusted r2=0.011, F=3.169) and liver volume was best predicted by the following equation: liver volume=672.35+(-8.41x age)+(722.80 x body height).Conclusions: Liver volume is a reliable index of liver size and measurement of liver volume with spiral CT is useful method. Spiral CT can be utilized for measurement of liver volume for such purpose.

Prevalence and risk factors of varicose veins, skin trophic changes, and venous symptoms among northern Indian population

Background: Chronic venous disorders are an important cause of disease and disability worldwide. These disorders have substantial medical and economic consequences. The cost to society is also enormous. Despite the gravity of the problem, little effort has been made to meritoriously prevent such chronic disorders. Aim- This study was planned to analyze and ascertain prevalence and risk factors of varicose veins, skin trophic changes, and venous symptoms among northern Indian population.Methods: The present study was undertaken among the residents of adopted population by a tertiary care center of Uttar Pradesh. Sampling frame was selected from four villages falling within a radius of two kilometers from the tertiary care health center. Inclusion criteria were a person aged 18 years or older, falling in the sampling frame and willing to participate in the study. A total of 1012 eligible study subjects were contacted and interviewed. Detailed enquiry about venous symptoms, skin trophic changes, history of thromboembolic disease, family history of varicose veins, exercise activities, occupation etc was also made. Senior resident of Surgery department clinically evaluated the presence of varicose veins, edema and skin trophic changes in the legs.Results: 46.7% of females and 27.8% of males were found to be having varicose veins whereas 49.3% of females and 18.9% of males were having venous symptoms. Skin trophic changes were observed in 18.9% females and 5.2% of males respectively. History of varicose veins in first-degree relatives (OR 3.85, p=0.046) and age (OR 1.06, p=0.021) were significant important risk factors for varicose veins in both sexes. Age (OR 1.14, p=0.002), history of thromboembolic disease (OR 3.95, p=0.063) and pitting edema (OR 7.42, p=0.016) were three significant important risk factors for skin trophic changes among subjects with varicose veins.Conclusions: High prevalence of chronic venous disorders of the lower limbs was observed in residents of studied region. Results of this study calls for planning and initiation of serious efforts to prevent such chronic disorders.

Prevalence and risk factors of soil transmitted helminths from rural field practice area of a tertiary care center from northern India

Background: Soil-transmitted helminths (STH) are a major public health problem in our country, affecting the physical growth and cognitive development. STH infections are considered a leading cause of sickness, absenteeism and disability adjusted life years lost. Aim of the study was to assess the prevalence and risk factors of soil transmitted helminths (STH) in Farrukhabad district, India. Methods: A total of 1203 study subjects from 602 eligible households fulfilling the eligibilty criteria. Thus equal number of children and adults were recruited from rural and urban areas. In each household, one child participant of the age 1-15 years and one adult, older than 15 years, and willing to participate, were eligible to participate in this study. All enrolled subjects were provided with a screw- capped plastic container to collect their stool sample. The following day, a field worker visited the subject’s home to collect the container. Saline and iodine wet preparations were examined for the presence of nematode ova. All positive stool samples were re-examined by the McMaster egg counting technique to quantify the number of eggs per gram of stool.Results: Overall prevalence of STH was 14.3% (95% CI 4.4-19.2) among study subjects. Hookworm was the predominant STH identified with a prevalence of 11.3% (95% CI 1.1-17.4), followed by Ascaris lumbricoides with a prevalence of 4.5% (95% CI 0.5-7.6). Prevalence of STH was observed to be 13.2% (95% CI 8.7-17.2) and 7.6% (95% CI 4.4-10.7) in rural and urban areas respectively. Age category, residing in a field-hut, presence of cat at home, presence of untrimmed nails, open air defaecation, habitually eating food that has fallen on the ground, not washing hands with soap and water after defaecation, and consumption of deworming tablet turned out to be independent risk factors for acquiring STH infection in our study.Conclusions: Identification of at-risk groups along with Strategic planning and health education, awareness campaigns along with mass drug administration could reduce the burden of STH significantly.

Epidemiology and risk factors of healthcare associated infections from intensive care unit of a tertiary care hospital

Background: Nosocomial infections (NIs) result in increased morbidity, mortality and length of hospital stay. The Incidence of NIs, their risk factors and the antibiogram patterns vary across and within countries. We assessed the rates, infection sites, pathogens and risk factors of health-care-associated infections in ICU of a tertiary care hospital.Methods: In this retrospective study, all the patients admitted in Intensive Care Unit over a period of 6 months during August 2015 to January 2016 were included in the current study. Routine surveillance of various health-care-associated infections such as catheter-associated urinary tract infections (CAUTI), central-line-associated blood stream infections (CLABSI), and ventilator-associated pneumonias (VAP) was done by the Department of Microbiology through an Infection Surveillance Proforma. Patients’ records including Infection Surveillance Proforma served as study tools. Odd’s ratio was calculated to ascertain the strength of association of each risk factor.Results: Incidence rates of health-care-associated infections were 9.06/1000 urinary catheter days, 13.35/1000 central venous pressure line days and 5.42/1000 ventilator days. Most common organisms isolated from urine were Pseudomonas aeruginosa (34.48%), Enterococcus species (13.79%), Klebsiella pneumonia (13.79%) and Candida species (13.79%). Similarly three topmost organisms isolated from blood were Klebsiella pneumoniae (32.26%), Acinetobacter species (29.03%) and Pseudomonas aeruginosa (16.13%). Acinetobacter spp. (40.0%), Pseudomonas aeruginosa (33.33%) and Klebsiella pneumonia (13.33%) were most commonly responsible for tracheal infections. Presence of diabetes and COPD as well as length of ICU stay ≥8 days was significantly associated with health-care-associated infections.Conclusions: Diabetes, COPD and ICU stay for ≥8 days were found to be significantly associated with device-associated infections in our ICU. Data thus generated can be used to plan and modulate the potential intervention measures while managing device-associated infections

Knowledge towards post-mortem examination and reasons for not specialising in morbid anatomy: study among medical undergraduate students

Background: The use of autopsy in medical education has been declining just as autopsy rate has been falling worldwide. This is further worsened by the prevention of medical students from attending autopsy sections in some areas. Aim of the study was to ascertain the knowledge of medical students towards autopsy and post-mortem examination. An additional objective was to assess reasons for not specialising in morbid anatomy.  Methods: The present cross sectional study was carried out among students of a medical college in Uttar Pradesh in the month of February 2016 using pretested self-administered questionnaire. The study population consisted of undergraduate medical students who were currently studying the forensic medicine and toxicology. A detailed proforma containing 20 questions was framed for the purpose of capturing socio-demographic information of the study participants, questions concerning knowledge about the post-mortem and reasons for not specializing in morbid anatomy.Results: 82.2% were aware that post-mortems are conducted to know the cause and manner of death. Three students (3.3%) opined that the post-mortem is to harass the relatives of the deceased. Almost all the students were having a fair knowledge about the gross procedure involved in the post-mortem examination. Majority of male students would not wish to specialize in morbid anatomy because it deals with death, while most of female students said either they had made up their mind to specialize in some other fields or they do not want to touch and dissect dead bodies.Conclusions: Students possess a reasonable knowledge about post-mortem but knowledge alone may not be enough for increasing the post-mortem/autopsy rate, unless they acquire the skills required for the procedure as currently they are not provided with any training during their medical curriculum.

An evaluation of quality of life of skin cancer patients after surgery using dermatology life quality index tool

Background: Quality of life (QOL) has been identified as an important outcome in cancer researches yet the most common malignancy among humans, non-melanoma skin cancer (NMSC), but poorly studied. Aim of the study was to analyze the quality of life of non-melanoma skin cancer patients after surgery using dermatology life quality index inventory (DLQI).Methods: Retrospective cohort of patients operated for non-melanoma skin cancer in last 2 years and paid postoperative 4-month visit formed the study population. Inclusion criteria consisted of subjects operated for non-melanoma skin cancer and paid follow up visits having sufficient physical and mental capacity. Fifty-six subjects fulfilled the selection criteria laid down thus included in this study. Study tools were records of patients, which were obtained from medical records section. If any more information was required, study subjects were contacted.Results: Out of total 56 study subjects, Basal cell carcinomas were found in 91.1% (n=51); squamous cell carcinomas were detected in 7.2% (n=4). Single location wise more lesions were located on the nose 22.1% (n=15) and forehead 17.6% (12). For most patients (75%), the lesion had not been previously treated. 58.9% subjects did not have any other associated co-morbid condition. Lower mean values were observed post-operative i.e. lower DLQI scores were recorded 4 months after surgery in our study which indicates that adverse effects were not very prominent thus preserving quality of life post operatively. Paired sample t-tests revealed a significant effect on DLQI item 1 (p=0.008), item 2 (p=0.043), and item 4 (p=0.003), with scores decreasing (improving QOL) after treatment. The change in total DLQI score demonstrated a trend toward significance, with overall QOL improving after treatment (p=0.024).Conclusions: Previously commonly employed dermatological Quality of life tools demonstrated minimal handicap at initial diagnosis and little change after treatment of nonmelanoma skin cancer. Development of disease-specific instrument is warranted to explore the disease process.

Problem-based learning versus lecture-based learning in pharmacology in a junior doctor teaching program: a crossover study from northern India

Background: The undergraduate MBBS training in our country is still in the traditional mode. The main part of the curriculum consists of lecture, tutorial, practical and ward teaching classes with a limited number of problem based session. The objective of the study was undertaken to compare PBL with LBL in terms of students’ knowledge retention in the subject of Pharmacology in undergraduate medical training.Methods: The current survey was planned and executed by the Department of Pharmacology in collaboration with Medical Education Unit, MSDS Medical College, Fatehgarh in the batch currently posted in the Department of Pharmacology for practical classes. Fifty MBBS students posted were enrolled for the study and were divided in 2 groups. One of the topics was presented as LBL for the first group and as PBL for the second group. The other topic was presented as PBL for the first group and as LBL for the second group. Intervention and control groups were taken as those used PBL and LBL respectively. T test was used to compare mean scores obtained by students in the intervention and control groups.Results: Mean scores obtained by students in the intervention group (topics learnt with PBL) were higher (3.80 Vs 2.84) than mean scores obtained by students in the control group (topics learnt with LBL). Mean scores obtained by students in the intervention group were higher (3.72 Vs 2.96) than mean scores obtained by students in the control group.Conclusions: The current study indicates usefulness of Problem-based learning (PBL) over Lecture-based Learning (LBL) in terms of retention of knowledge. However further studies involving more number of students are warranted in order to generate stronger evidence on this tool for improving medical education in our setup.

An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

Background: The management of severe lower limb injury is one of the most controversial subjects in the field of Orthopedic surgery. While the advancement of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. The aim of study was to analyze and ascertain the clinical utility of mangled extremity severity score (MESS) in severely injured lower limbs.Methods: The current study was undertaken in the Department of Orthopedics among 50 patients who sustained high-energy injuries and approached a tertiary care center to seek care. The study design included both retrospective and prospective evaluation. Retrospectively 25 and prospectively 25 lower limbs in 54 patients with high-energy injuries were evaluated using mangled extremity severity score to assist in the decision-making process for the care of patients with such injuries. MESS served as study tool. Differences between the mean MESS scores for amputated and salvaged limbs were explored.Results: Crush injury of leg with fracture of tibia and fibula was observed in 78% of injured limbs. The most common mechanism of injury was high-energy trauma. Road traffic accidents accounted for 72% of patients. Mean hospitalization for primary amputation was 19.3 (8-26) days and for delayed amputation limbs was 36.6 (15-62) days and for salvaged limbs was 45.5 (14-128) days. In the prospective study, out of 7 injured limbs with a MESS score of equal or more than 7, 6 limbs were amputated and 1 limb was salvaged. Out of the remaining 18 injured limbs with a MESS score of less than 7, 17 limbs were successfully salvaged and one limb was amputated. In the retrospective study, 10 injured limbs with a MESS score of equal or more than 7 were amputated (mean score 8.4 with range of 10-8) and the remaining 15 injured limbs with a MESS score of less than 7 were salvaged (mean score 4.57 with range of (4-6)); suggesting a significant difference in the mean scores.Conclusions: MESS is a cost-effective, relatively simple and readily available scoring system, which assists the surgeon to identify variables that may ultimately influence the outcome of a severely traumatized extremity with arterial compromise due to high-energy injury.

Incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center of northern India

Background: The incidence of VAP varies among different studies, depending on the definition, the type of hospital or ICU, the population studied, and the level of antibiotic exposure. This study was planned to ascertain and analyse the incidence and risk factors associated with development of ventilator-associated pneumonia from a tertiary care center.Methods: In this retrospective study, all the adult patients on mechanical ventilation (MV) for more than 48 hours in the Medicine Intensive Care Unit (MICU) and the Critical Care Unit (CCU) during September 2015 to February 2016 were included in the current study. Patients diagnosed with pneumonia prior to MV or within 48 hours of MV were excluded from the study. Patients’ records served as study tools. Medical records department (MRD) was approached and data was collected on all patients who received mechanical ventilation during the study period. The relevant data were recorded from medical records, bedside flow sheets, radiographic reports, and reports of microbiological studies of the patients. The chi-square (χ²) test or Fisher’s exact test was used to compare different groups. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with development of ventilator-associated pneumonia.Results: Overall incidence of VAP was 23.54 per 1,000 ventilator days. The incidence of VAP in MICU and CCU were 31.77 and 16.47 per 1,000 ventilator days respectively. 60% of the cases were late-onset VAP, while 40% were early-onset VAP. The most common organism isolated was Pseudomonas aeruginosa followed by Methicillin-resistant Staphylococcus aureus (MRSA). Impaired consciousness, tracheostomy, re-intubation, emergency intubation, and nasogastric tube were significantly associated with VAP. On multivariate analysis, impaired consciousness, emergency intubation and tracheostomy were independent risk factor for VAP among study subjects.  Conclusions: Data thus generated can be used to plan and modulate the potential intervention measures while managing VAP. Knowledge of the important risk factors predisposing to VAP may prove to be useful in implementing effective preventive measures.