L. Jeyaseelan

Segmental colonoscopic biopsies in the differentiation of ileocolic tuberculosis from Crohn's disease

Background and Aim:  The differentiation between Crohns disease (CD) and tuberculosis (TB) of the intestine can be difficult in areas where both diseases occur. The present study examined histological criteria that would enable the diagnosis in mucosal biopsies.

World studies of abuse in the family environment--risk factors for physical intimate partner violence.

Objectives: To identify risk factors for physical intimate partner violence against women in Chile, India, Egypt and the Philippines Design: Population-based household survey Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum and Vellore in India and Metro Manila, Philippines. Participants: Women aged 15–49 years of age who care for at least one child younger than 18 years of age. The number of participants was 442 in Chile, 631 in Egypt, 506 in Lucknow, 700 in Trivandrum, 716 in Vellore and 1000 in the Philippines. Main outcome measure: Risk of and protective factors against lifetime physical IPV. Results: Significant associations were found between several risk factors like regular alcohol consumption of the husband/partner, past witnessing of father beating mother, the womans poor mental health and poor family work status, with any lifetime physical IPV. Womans poor mental health and witnessing father beat mother were statistically significant only in a few sites. Poor family work status, differences in employment between husband and wife and experiencing harsh physical punishment during childhood, were not found to be statistically significant across all sites. Protective factors, like higher levels of husbands and wifes education, were only found to be significantly associated with any lifetime physical IPV in Trivandrum, India. Social support was not significantly associated with any lifetime physical IPV across all sites. Conclusions: These large population-based household surveys have provided empirical evidence of the widespread nature of domestic violence and the relative commonality of risk factors across sites.

Association between stigma, depression and quality of life of people living with HIV/AIDS (PLHA) in South India – a community based cross sectional study

BackgroundIndia has around 2.27 million adults living with HIV/AIDS who face several challenges in the medical management of their disease. Stigma, discrimination and psychosocial issues are prevalent. The objective of the study was to determine the prevalence of severe stigma and to study the association between this, depression and the quality of life (QOL) of people living with HIV/AIDS (PLHA) in Tamil Nadu.MethodsThis was a community based cross sectional study carried out in seven districts of Tamil Nadu, India, among 400 PLHA in the year 2009. The following scales were used for stigma, depression and quality of life, Berger scale, Major Depression Inventory (MDI) scale and the WHO BREF scale. Both Stigma and QOL were classified as none, moderate or severe/poor based on the tertile cut off values of the scale scores. Depression was classified as none, mild, moderate and severe. Logistic regression analyses were performed to study the risk factors.ResultsTwenty seven per cent of PLHA had experienced severe forms of stigma. These were severe forms of personalized stigma (28.8%), negative self-image (30.3%), perceived public attitude (18.2%) and disclosure concerns (26%). PLHA experiencing severe depression were 12% and those experiencing poor quality of life were 34%. Poor QOL reported in the physical, psychological, social and environmental domains was 42.5%, 40%, 51.2% and 34% respectively. PLHA who had severe personalized stigma and negative self-image had 3.4 (1.6-7.0) and 2.1 (1.0-4.1) times higher risk of severe depression respectively (p < .001). PLHA who had severe depression had experienced 2.7(1.1-7.7) times significantly poorer QOL.ConclusionsSevere forms of stigma were equivalently prevalent among all the categories of PLHA. However, PLHA who had experienced severe depression had only developed poor QOL. A high level of social support was associated with a high level of QOL.

Seizure outcome in patients with a solitary cerebral cysticercus granuloma

Objective: To study the long-term seizure outcome and determine factors that predict recurrence of seizures following early withdrawal of antiepileptic drugs (AEDs) in patients with a solitary cerebral cysticercus granuloma (SCCG). Methods: The authors prospectively studied 185 patients with SCCG and seizures in whom AEDs were withdrawn soon after (within 2 to 12 weeks) resolution of the SCCG was demonstrated on the CT scan. The follow-up of these patients ranged from 24 to 125 months (mean 65.8 months) or until seizure recurrence. Age, number of seizures, duration of AED therapy, occurrence of breakthrough seizures, administration of albendazole, and presence of a calcific residue of the SCCG on the CT scan were studied as prognostic factors to predict recurrence of seizures. Results: One hundred fifty-seven patients (84.9%) were seizure-free, whereas 28 patients (15.1%) had recurrence of seizures after withdrawal of AEDs. The recurrences occurred at a mean duration of 18.8 months (range 0.5 to 78 months) after withdrawal of AEDs. Multivariate analysis showed that presence of calcific residue on the CT scan, occurrence of breakthrough seizures, and occurrence of more than two seizures were associated with a higher risk of recurrence of seizures. The other factors including administration of albendazole therapy did not affect seizure recurrence. Conclusions: Nearly 85% of patients with a solitary cerebral cysticercus granuloma have a good seizure outcome following resolution of the lesion and early withdrawal of AEDs. However, recurrence of seizures can be expected in about 15% of patients. Patients with more than two seizures, those with breakthrough seizures, and those whose follow-up CT scan shows a calcific residue of the granuloma have a higher risk of recurrence and therefore need to be appropriately cautioned after withdrawal of AEDs. AED therapy might also have to be continued for longer periods in patients with these risk factors.

Adjunctive vitamin D for treatment of active tuberculosis in India: a randomised, double-blind, placebo-controlled trial

BACKGROUND Vitamin D has immunomodulatory effects that might aid clearance of mycobacterial infection. We aimed to assess whether vitamin D supplementation would reduce time to sputum culture conversion in patients with active tuberculosis. METHODS We did this randomised, double-blind, placebo-controlled, superiority trial at 13 sites in India. Treatment-naive patients who were sputum-smear positive, HIV negative, and had pulmonary tuberculosis were randomly assigned (1:1), with centrally labelled, serially numbered bottles, to receive standard active tuberculosis treatment with either supplemental high-dose oral vitamin D3 (four doses of 2·5 mg at weeks 0, 2, 4, and 6) or placebo. Neither the patients nor the clinical and laboratory investigators and personnel were aware of treatment assignment. The primary efficacy outcome was time to sputum culture conversion. Analysis was by modified intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00366470. FINDINGS Between Jan 20, 2010, and Aug 23, 2011, we randomly assigned 247 participants to the vitamin D group (n=121) or the placebo group (n=126), of whom 211 participants (n=101 and n=110, respectively) were included in the primary efficacy analysis. Median time to culture conversion in the vitamin D group was 43·0 days (95% CI 33·3-52·8) versus 42·0 days (33·9-50·1) in the placebo group (log-rank p=0·95). Three (2%) patients died in the vitamin D group and one (1%) patient died in the placebo group; no death was considered attributable to the study intervention. No patients had hypercalcaemia. INTERPRETATION Our findings show that vitamin D supplementation did not reduce time to sputum culture conversion. Further studies should investigate the role of vitamin D in prevention or reactivation of tuberculosis infection. FUNDING Dalhousie University and Infectious Diseases Training and Research Centre.

Survey of Physical Abuse during Pregnancy GMCH, Nagpur, India

Introduction: Domestic violence is a major health concern for women globally. Violence may commence or escalate during pregnancy and may be more frequent than obstetric complications e.g. preeclampsia or gestational diabetes for which they are routinely screened. No literature is available on abuse during pregnancy from India.

Antibiotic prescribing practices in primary and secondary health care facilities in Uttar Pradesh, India

Background:  Emerging antibiotic resistance in common pathogens is a worldwide problem known to be related to inappropriate overuse of antibiotics. Wide variability in antibiotic use throughout the world is because of various factors, including socio‐cultural differences.

Prediction of the femoral neck‐shaft angle from the length of the femoral neck

A total of 171 adult South Indian femora, devoid of gross pathology, are used to measure the neck‐shaft angle, length of the neck, intertrochanteric apical axis length, maximum vertical diameter of the head, kinematic radius, and maximum femoral length. The neck‐shaft angle ranges from 120° to 136° with a mean of 126.7° and no significant side difference. The angle significantly and positively correlates with neck length, intertrochanteric apical axis length, kinematic radius, and minimum femoral length (P < 0.001) but not with the vertical diameter of the head. Regression equations for the neck‐shaft angle against the correlated parameters are derived but only that against the length of the neck is strongly significant. From those correlations, 1) the neck‐shaft angle can be estimated from a proximal femoral fragment, and 2) the required size of the length of the neck can be determined to design prostheses for the restoration of normal neck‐shaft angle. Further, any estimated defective angle can be of help for forensic identification of an individual with pathological changes leading to an abnormal gait. Clin. Anat. 10:318–323, 1997.

RISK FACTORS FOR MALNUTRITION IN SOUTH INDIAN CHILDREN

Protein energy malnutrition is a major health problem in India and it affects the growth and development of young children. This study investigated the impact of hygiene, housing and sociodemographic variables on acute malnutrition in children aged 5-7, living in urban and rural areas. Ordinal logistic regression analysis showed that the overall prevalence of severe malnutrition was 8.2%. Older age, male sex, mothers poor education, lower family income, higher birth order of the child, use of dung or fire wood as fuel and defecation within the premises were significantly associated with malnutrition. Appropriate intervention programmes should be formulated to educate and support these families.

Nondiabetic renal disease in noninsulin-dependent diabetics in a South Indian hospital

Eighty patients with non-insulin-dependent diabetes mellitus being treated in a south Indian hospital were biopsied to confirm suspected nondiabetic renal disease (NDRD). The positive predictive value of the standard clinical indicators for NDRD in the presence or absence of diabetic retinopathy was 54 and 87%, respectively. These values are higher than those given by comparable studies in Western populations. This is probably due to a higher prevalence of NDRD in the population of south India, and especially of proliferative glomerulonephritis, which was found in 21.5% of the patients studied. Standard clinical predictors of NDRD in diabetics have a high predictive value in the tropics where there is a high prevalence of proliferative glomerulonephritis.