J. Mahanta

Urban rural differences in prevalence of self-reported diabetes in India—The WHO-ICMR Indian NCD risk factor surveillance

Recent reports show strikingly high prevalence of diabetes among urban Asian Indians; however, there are very few studies comparing urban, peri-urban and rural prevalence rates of diabetes and their risk factors at the national level. This study is a part of the national non-communicable diseases (NCD) risk factor surveillance conducted in different geographical locations (North, South, East, West/Central) in India between April 2003 and March 2005. A total of 44,523 individuals (age: 15-64 years) inclusive of 15,239 from urban, 15,760 from peri-urban/slum and 13,524 from rural areas were recruited. Major risk factors were studied using modified WHO STEPS approach. Diabetes was diagnosed based on self-reported diabetes diagnosed by a physician. The lowest prevalence of self-reported diabetes was recorded in rural (3.1%) followed by peri-urban/slum (3.2%) and the highest in urban areas (7.3%, odds ratio (OR) for urban areas: 2.48, 95% confidence interval (CI): 2.21-2.79, p<0.001). Urban residents with abdominal obesity and sedentary activity had the highest prevalence of self-reported diabetes (11.3%) while rural residents without abdominal obesity performing vigorous activity had the lowest prevalence (0.7%). In conclusion, this nation-wide NCD risk factor surveillance study shows that the prevalence of self-reported diabetes is higher in urban, intermediate in peri-urban and lowest in rural areas. Urban residence, abdominal obesity and physical inactivity are the risk factors associated with diabetes in this study.

Mycotic corneal ulcers in upper Assam

Purpose: To study the association of various risk factors and epidemiological variables of mycotic keratitis treated at a tertiary referral hospital of upper Assam. Materials and Methods: In this hospital-based prospective study a total of 310 consecutive corneal ulcer cases attending the ophthalmology outpatient department of Assam Medical College were enrolled between April 2007 and March 2009. After clinical and slit-lamp biomicroscopic examination in all suspected cases, smears and culture examination for fungus was done to establish the etiology. Demographic information and associated probable risk factors of individual cases were noted in a predesigned questionnaire. Results: In 188 (60.6%) cases fungal etiology could be established. Out of them 67.6% were males. The most commonly affected age group was 41-50 years (25.5%). The maximum (23.4%) cases were reported during the paddy harvesting season in Assam (January and February). Fungal element could be demonstrated in 65.2% cases in direct potassium hydroxide (KOH) mount. The commonest predisposing factor was corneal injury (74.5%). While diabetes was a significant systemic predisposing factor in mixed bacterial and fungal infections in 11.1% cases, blocked naso-lacrimal duct was the local predisposing factor in 11.1% of cases. Fusarium solani (25%) was the commonest isolate followed by Aspergillus species (19%), Curvularia species (18.5%) and Penicillium species (15.2%). Yeasts were isolated in 2.7% (n=5) cases. Conclusions: Ocular trauma was the commonest cause of fungal corneal ulcer in Assam and Fusarium solani was the commonest species responsible for it. Most of the mycotic ulcer cases come from rural areas including the tea gardens.

Atypical cutaneous lesions of Penicillium marneffei infection as a manifestation of the immune reconstitution inflammatory syndrome after highly active antiretroviral therapy

Penicillium marneffei infections normally manifest as molluscum contagiosum like skin lesion in HIV-infected persons. We report a case with verrucous lesions over nose and face due to Penicillium marneffei infection after HAART treatment. A 28-year-old man presented, after two weeks of HAART treatment, with multiple erythematous, scaly, papules and nodules with central necrosis predominantly in face and both extremities and scrotum. Microbiological investigations confirmed the diagnosis of Penicillium marneffei infection. This is perhaps the first case report with such manifestation due to Penicillium marneffei infection.

Measurement of cholesterol and triglycerides from a dried blood spot in an Indian Council of Medical Research–World Health Organization multicentric survey on risk factors for noncommunicable diseases in India

BACKGROUNDnDried blood may be a convenient method of sample collection in epidemiological studies; however, the method needs evaluation in a field settings. In the present study, feasibility of using dried blood for measurement of cholesterol and triglycerides was evaluated in multicenter surveillance study for noncommunicable disease (NCD).nnnMETHODSnSamples were collected in a cross-sectional study for NCD risk factor surveillance conducted in six centers in India. For every tenth subject recruited, a blood sample was also collected on filter paper. These 10% serum samples and dried blood spots were analyzed for cholesterol and triglycerides.nnnRESULTSnThe mean coefficient of variation (CV) for cholesterol was less than 10% between dried blood and serum in five of the six participating centers. Only one center showed a high CV of 14%. Similarly, the mean bias was less than 10% in five centers. The intraclass correlation between cholesterol values in dried blood and serum were greater than 0.638 in all centers, which suggests a good homogeneity of results. The mean CV for triglycerides ranged from 0.36% to 17.97%. The intraclass correlation between triglyceride values in dried blood and serum ranged from 0.756 to 0.880 in the sixxa0centers.nnnCONCLUSIONnIn conclusion, dried blood would be a good method for collection of blood for measurement of cholesterol and triglycerides for population health surveys. However, the benefits of bloodxa0spot analysis should be weighed against potential sources of errors attributable to sampling and other factors, such as temperature and humidity, in a country like India.

GSTM1 and GSTT1 polymorphism and susceptibility to esophageal cancer in high- and low-risk regions of India.

Glutathione transferases, a super family of dimeric phase II metabolic enzymes play a vital role in biotransformation of many substances. This study evaluates the influence of genetic polymorphism of GSTM1 and GSTT1 gene loci on esophageal cancer risk in Assam and Delhi from India. DNA from blood samples of esophageal cancer cases (203,112) and controls (286,150) from Assam and Delhi, respectively, were extracted. GSTM1 and GSTT1 polymorphisms were analyzed by multiplex PCR procedure. Differences in proportions were tested using Pearson’s chi-square test with odds ratio (OR) and 95xa0% confidence interval (CI). Risk of esophageal cancer was approximately twice in individuals having homozygous GSTM1 (OR-2.1, 95xa0% CI, 1.44–3.13) and GSTT1 null genotypes (OR-1.7,95xa0% CI, 0.99–2.77) in Assam, and around three times in GSTT1 null genotype (OR-2.9, 95xa0% CI, 1.56–5.27) in Delhi population. GSTM1 null genotype seems to play a protective role (OR-0.7, 95xa0% CI, 0.39–1.27) in Delhi. A significant association of GSTM1 null genotype with esophageal cancer was observed in a younger age group in Assam (OR-2.7, 95xa0% CI, 1.48–5.01), and in Delhi population association was observed in smokers with GSTT1 null genotype (OR-2.5, 95xa0% CI, 1.04–6.07), and alcoholics having GSTM1 null genotype (OR-2.6, 95xa0% CI, 0.99–6.77). Significant association of GSTM1 null genotype in Assam was observed between cancer cases and controls in fermented betel nut chewers only (OR-2.8, 95xa0% CI, 1.19–6.72), whereas, smoking and alcohol failed to show any correlation with GSTM1/GSTT1 genotypes. Cancer development is not only due to exogenous or endogenous carcinogens but depends on their interaction with genes that are involved in the detoxification of these carcinogens.

Sexually transmitted diseases in Assam: an experience in a tertiary care referral hospital.

BACKGROUNDnSexually transmitted diseases (STDs) including AIDS are becoming a major public health problem in developing countries worldwide.nnnAIMSnAll the adult patients attending VCTC and STD clinics of Assam Medical College between May 2002 and December 2005 were enrolled in the study.nnnMETHODSnRecords of patients with high-risk sexual behavior and presence of STD on clinical examination were recorded in a predesigned proforma.nnnRESULTSnOf 479 individuals, 186 (38.8%) had evidence of STD and 70 were positive for HIV. Most (64%) were in the age group of 15 to 30 years. Candidiasis (vulvovaginal candidiasis in women and candidal balanitis/balanoposthitis in men) was the most common finding on clinical examination (21.5%) followed by syphilis (17.2%), genital warts (15%), herpes genitalis (11.3%), non-gonococcal urethritis (10.8%), and gonococcal urethritis (7%).nnnCONCLUSIONnHigh percentage of unmarried people (>45%) reporting with STD, which points to potential danger of HIV transmission in the region.

Ocular thelaziasis in Assam: A report of two cases

Small, white, thread-like, motile worms were recovered from the conjunctival sac of a 13-year-old girl and a 50-year-old woman from Dibrugarh district, Assam, India. They were identified as thelazia species. These two cases have been reported due to their rarity in India and elsewhere.

Correlation of Molecular Markers, Pfmdr1-N86Y and Pfcrt-K76T, with In Vitro Chloroquine Resistant Plasmodium falciparum, Isolated in the Malaria Endemic States of Assam and Arunachal Pradesh, Northeast India

The mechanism of chloroquine (CQ) resistance in Plasmodium falciparum is not clearly understood. However, CQ resistance has been shown to be associated with point mutations in Pfcrt and Pfmdr1. These genes encode for digestive vacuole transmembrane proteins Pfcrt and Pgh1, respectively. The present study was carried out to analyze the association of Pfcrt-K76T and Pfmdr1-N86Y mutations with CQ resistance in Northeast Indian P. falciparum isolates. 115 P. falciparum isolates were subjected to in vitro CQ sensitivity testing and PCR-RFLP analysis for the Pfmdr1-N86Y and Pfcrt-K76T mutations. 100 isolates of P. falciparum were found to be resistant to CQ by the in vitro susceptibility test (geometric mean EC50 2.21 µM/L blood) while 15 were found to be CQ sensitive (geometric mean EC50 0.32 µM/L blood). All the CQ resistant isolates showed the presence of Pfmdr1 and Pfcrt mutations. CQ sensitive isolates were negative for these mutations. Strong linkage disequilibrium was observed between the alleles at these two loci (Pfmdr1-N86Y and Pfcrt-K76T). The results indicate that Pfmdr1-N86Y and Pfcrt-K76T mutations can be used as molecular markers to identify CQ resistance in P. falciparum. The result necessitates the evaluation of CQ in vivo therapeutic efficacy in endemic areas for more effective malaria control strategies.

Study on Nutritional Status of Tea Garden Workers of Assam with Special Emphasis to Body Mass Index (BMI) and Central Obesity

Abstract A cross sectional study was done on 1014 (Male 511 and female 503) tea garden workers of Assam to assess their nutritional status in terms of Body Mass Index (BMI) and central obesity. Normal BMI was observed only in 33.63 percent workers (In males 42.27 percent and in females 24.85 percent). It was observed that BMI decreased with the increase in age in both the sexes which was statistically significant (male F=3.33, P=0.019 and female F=7.82, P=0.000). As per WHO classification grade-I thinness was detected in 31.31% males and 33.2% of females. 16.05% males and 17.69% females had grade-II thinness. Severe degree of malnutrition was observed in 16.96% of the study subjects (In males 9.98% and in females 24.06%). Though waist to hip ratio (WHR) was below normal in both the sexes yet in males it showed an increasing trend with the increase in age and the difference was statistically significant (F=5.57, P=0.001).

Association of processed food, synergistic effect of alcohol and HBV with Hepatocellular Carcinoma in a high incidence region of India

BACKGROUNDnDietary factors, tobacco, and alcohol use have been identified as important factors of rising various cancer incidence in several northeastern states of India. However, little is known about the factors associated with hepatocellular carcinoma (HCC) in this region. The aim of the paper was to identify the factors associated with HCC in the northeast region.nnnMETHODSnA case-control study was conducted in Arunachal Pradesh and Sikkim, two northeastern states of India, including 104 histologically-confirmed cases of HCC and same number (104) of age and sex matched control enrolled. Logistic regression analysis was performed to identify the factors associated with HCC.nnnRESULTSnA statistically significant association was demonstrated between HCC and alcohol consumption, consumption of Sai-mod (OR 2.77, CI 1.57-4.87) a homemade alcohol beverage, and with HBV (OR 7.97, CI 3.36-18.94). Positive synergism index (Su202f=u202f3.04) was observed between HBV and alcohol consumption to risk of HCC. Higher intake of processed meat (OR 2.56, CI 1.09-6.03) and processed fish (OR 2.24, CI 1.02-4.95) were found associated with increased risk of HCC; and decreased risk of HCC with fresh fish, fruits, and milk.nnnCONCLUSIONSnStrong relationship between different dietary factors, alcohol beverage with HCC suggests that control on dietary and drinking habit will be an important strategy to combat HCC in this region. Risk factors identified in this study will help to plan more effectively targeted risk reduction strategies and programs in this region.