Anand Srivastava

Isolated systolic hypertension and its determinants - A cross-sectional study in the adult population of Lucknow district in North India

Objectives: 1) To determine the prevalence of isolated systolic hypertension (ISH) in the adult population of Lucknow district. 2) To study the determinants of ISH especially the relationship with age. Materials and Methods: A community-based cross-sectional study was conducted in four randomly selected areas of Lucknow district. A total of 800 subjects, aged 20 years and above, 400 from urban and 400 from rural area of Lucknow district were included in the study. The statistical tools used for analysis were Pearsons Chi-square test and multiple logistic regression. Results: The prevalence of ISH according to JNC-7 criteria was 4.3%, which was 5.1% in men and 3.6% in women. A significant increase in the prevalence of ISH was seen with an increase in age. Multivariate logistic regression analysis of the determinants showed that age, BMI and smoking were significant independent risk factors of ISH. Conclusions: Given the risk of cardiovascular disease associated with ISH, the findings of this study emphasize the need for further research to document the impact of modifiable risk factors of ISH and the effect of hypertension screening and specific health promotion in bringing down the burden of ISH and related cardiovascular morbidity.

Determinants of utilization of antenatal care services in rural Lucknow, India

Background: Antenatal care services are the first steps towards ensuring the health of mothers and the newborn. This is the key component for achieving Millennium Development Goals by 2015. But Indias performance continues to be poor in providing antenatal care services to its huge population, particularly in the rural areas. Objective: To assess the determinants of utilization of antenatal services by rural beneficiaries in Lucknow, a district of north India. Materials and Methods: The study, cross-sectional in design, was conducted from August 2009 to July 2010. Multistage random sampling was used for selecting villages. A total of 352 recently delivered women were selected following systematic random sampling. Logistic regression was used to find out the determinants of three antenatal care services. Results: Overall, 85.5% of the beneficiaries surveyed were found to receive at least three antenatal care services from any health facility. Community health centre was the most common source for such care. Significant difference was found between beneficiaries who took three antenatal care visits and who did not in terms of age, socio economic status, and timing of registration. On multiple regression, only age (OR = 2.107, 95% CI = 1.132 – 3.923) and timing of registration (OR = 2.817, 95% CI = 1.487 – 5.338) were found to be the predictors for three antenatal care visits. Conclusion: Intervention should be focused on young and late registered women for ensuring sufficient care during pregnancy.

Factors associated with the preference for delivery at the government hospitals in rural areas of Lucknow district in Uttar Pradesh

For assuring safe maternal and newborn health, institutional delivery was given paramount importance. In India, in spite of several efforts, lesser than 40% deliveries are conducted at health facilities, mostly at private sector. The present cross-sectional study aimed to find out the determinants of preference for delivery at government hospitals in rural areas of Lucknow, a district in Uttar Pradesh. Multistage random sampling was used for selecting villages. From them, 352 recently delivered women were selected, following systematic random sampling. Overall, 84.9% of deliveries were conducted at health institutions. Out of them, 79.3% were at government hospitals. Applying multivariate logistic regression, Hindu women (odds ratio [OR] = 3.205), women belonging to lower socio-economic class (OR = 4.630) and late registered women (OR = 2.320) were found to be more likely to deliver at government hospitals. Attention should be given to religion, social status and timing of registration for ensuring higher fraction of deliveries at government set-up.

High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in district of Northern India

Context: Prevention with a positive approach has been advocated as one of the main strategies to diminish the new instances of HIV and the target are those who are engaged in high-risk sexual behavior. Therefore, understanding the risky behaviors of the HIV-infected individual is important. Aims: This study aimed to assess the prevalence and the predictors of high-risk sexual behavior among people living with HIV/AIDS (PLHA). Settings and Design: A hospital-based cross-sectional study was conducted at antiretroviral therapy centers of two tertiary care hospitals in Lucknow. Materials and Methods: A total of 322 HIV-positive patients were interviewed about their sexual behaviors during last 3 months using a pretested questionnaire. Statistical Analysis Used: Probability (p) was calculated to test for statistical significance at 5% level of significance. Association between risk factors and high-risk sexual behavior was determined using bivariate analysis followed by multivariate logistic regression. Results: Prevalence of high-risk sexual behavior was 24.5%. Of these patients, multiple sexual partners were reported by 67.3% whereas about 46.9% were engaged in unprotected sex. Multivariate logistic regression analysis revealed that high-risk sexual behavior was significantly associated with nonsupporting attitude of spouse (odds ratio [OR]: 18; 95% confidence interval [CI]: 1.4–225.5; P = 0.02) and alcohol consumption (OR: 9.3; 95% CI: 2.4–35.4; P = 0.001). Conclusions: Specific intervention addressing alcohol consumption and encouragement of spouse and family support should be integrated in the routine HIV/AIDS care and treatment apart from HIV transmission and prevention knowledge.

Comparison of Visual Inspection with Acetic Acid and the Pap Smear for Cervical Cancer Screening

Objective: To evaluate the efficacy of visual inspection with acetic acid (VIA) in the early detection of cervical cancer and compare it with the Pap smear. Study Design: This was a cross-sectional study conducted over a period of 3 months. A total of 316 patients who attended the Gynecology Outpatient Department of Eras Lucknow Medical College and Hospital, fulfilled the inclusion criteria, and gave their informed consent were included. Results: VIA was found positive in 38 patients (12.6%). Pap smear was positive in 31 patients (10.3%). Twenty-eight patients had a positive VIA and a positive Pap smear, 3 had a negative VIA and a positive Pap smear, 10 had a positive VIA and a negative Pap smear, and 34 had a negative VIA and a negative Pap smear. Conclusion: The sensitivity of VIA and the Pap smear was found to be nearly equal, 93.3 and 93.8%, respectively. The Pap smear was found to be more specific than VIA, i.e., 72.9 versus 60%. In terms of test accuracy, the Pap smear was found to have greater test accuracy, i.e., 77.3 versus 66.7% for VIA.

Linezolid-induced optic neuropathy in XDR pulmonary TB: A case series

Optic neuropathy has been reported as a side effect of long-term use of linezolid. This is particularly seen in cases of extensively drug resistant tuberculosis (XDR-TB) where treatment with linezolid may continue for about 24-30 months. We, hereby, report two cases of XDR-TB treated patients with a regimen containing linezolid who developed progressive painless loss of vision during the course of treatment. In both the cases, the visual symptoms resolved completely on withdrawing linezolid. Early recognition of this rare side effect and timely withdrawal may salvage the eyesight of such patients.

Elevated blood pressure and its associated risk factors among adolescents of a North Indian City - A cross-sectional study

Context: Amidst the uncertainty in childhood blood pressure (BP) thresholds, besides the ambiguity in levels and duration of BP elevation causing organ damage, hypertension is present in substantial number of asymptomatic children and adolescents with only a few studies disclosing the setup. With projection of deaths due to noncommunicable diseases in 2030 rising to 52 million, it is necessary to know about the knowledge of present adolescents about BP and its modifiable risk factors. Aims: (1) To assess the prevalence of elevated BP among adolescents and to ascertain the associated risk factors. (2) To assess adolescents knowledge about BP and its modifiable factors. Settings and Design: A community-based cross-sectional study was conducted on school going adolescents of Lucknow, from September 2014 to August 2015. Subjects and Methods: BP, height, and weight were measured following standard protocols, Centers for Disease Control and Prevention charts for finding respective cut-off values and oral questionnaire for assessing lifestyle risk factors were used. Statistical Analysis: Chi-square, unpaired t-test, and logistic regression were used. Results: Of the 1041 participants, elevated BP (BP percentile ≥90) was prevalent in 24.2%. On regression, factors such as obesity (adjusted odds ratio [aOR] = 5.8, 95% confidence interval [CI] = 3.6–9.4), low fruit diet (aOR = 3.3, 95% CI = 2.1–5.4), and frequent junk food consumption (aOR = 1.9, 95% CI = 1.3–2.8) raised the odds of elevated BP while it was lowered by being physically active (aOR = 0.67, 95% CI = 0.46–0.97). Of 86.3% of children (n = 898) who were fathomed of BP, only less than third (33% and 21.9%) acquainted of BP raising and lowering practices, respectively. Conclusions: Prevalence of high BP is colossal with only a few children knowing its amendable nature. Strenuous efforts targeting detrimental behaviors and imparting the sense of healthy lifestyle enhancing practices are vital to control this epidemic.

Detection of anaplastic lymphoma kinase gene re-arrangement in non-small cell lung carcinoma in the indian population: comparison of techniques and immunohistochemistry clones

OBJECTIVE Predictive and prognostic markers have revolutionized personalized therapy in non-small cell lung carcinoma (NSCLC). Crizotinib is now approved for locally advanced or metastatic NSCLC that is anaplastic lymphoma kinase (ALK) positive by either Fluorescence in situ hybridization (FISH) or immunohistochemistry (IHC). The current study aimed to detect the incidence of ALK gene re-arrangement in the Indian population, to compare the various IHC antibodies with FISH as a gold standard, and to analyze the morphology of cases with ALK phenotype. MATERIAL AND METHOD A case series of 614 cases of NSCLC were included. IHC for detection of ALK phenotype was compared with FISH using 5A4 clone (Labvision, USA), ALK-1(Dako, Denmark) and D5F3 clone (Ventana, USA). RESULTS ALK gene rearrangement was evident in 4.07% of the cases. Cases with ALK phenotype had unique histomorphology with presence of mucin or signet ring cells in association with necrosis, high tumour grade and poor differentiation. Comparison of various antibody clones used in IHC revealed that the sensitivity and specificity using the D5F3 clone (100%, 100%) and 5A4 clone (87.5%, 100%) were similar while the ALK-1 clone had the lowest sensitivity and specificity (50%, 95.5%). CONCLUSION The incidence of ALK gene rearrangement in NSCLC in the current Indian study is within the worldwide reported range of 3-5%. This is the first study from the Indian subcontinent to compare various IHC antibodies used for detection of ALK phenotype. IHC using D5F3 clone and 5A4 clone may be considered as a rapid reliable and inexpensive method for detection of ALK gene rearrangement.

Multiple abdominal abscesses – A not so common presentation of NTM

Non-tuberculous Mycobacteria/Mycobacterium other than tuberculosis (MOTT) are ubiquitous organisms. They are acid fast bacilli often giving trouble to the physician to distinguish it from Mycobacterium tuberculosis. These organisms are a menace for the treating physician as when to treat and when not to treat. They are often difficult to diagnose and may present in a variety of forms with propensity to cause number of infections of different body parts and organs. They are more common in immunocompromised individuals e.g. HIV infection. Here we are reporting a not so common manifestation of NTM which presented as multiple abdominal abscesses in a middle aged female probably secondary to surgical site infection, however she responded dramatically to the designed treatment.

Two cases of eyelid tuberculosis – An uncommon presentation of ocular tuberculosis

Mycobacterium tuberculosis apart from being the causative agent of pulmonary tuberculosis is also notorious to cause tuberculosis at various sites in the human body and ocular tuberculosis is one of the extra pulmonary manifestations of this organism. The most common presentation of ocular tuberculosis is anterior uveitis or choroiditis caused by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by tuberculosis is most of the times secondary to orbital involvement and often seen in the form of drainage sinus. Isolated eyelid tuberculosis is however uncommon. Here we report two such cases of eyelid tuberculosis in different age groups; first case in a young female and second case of an old aged female with different presentation. Fortunately both of them responded well to the antitubercular treatment.