Vol 7, Issue 1, Jan-Mar, 2017

Objective: To investigate the socioeconomic patterning of cardiovascular disease (CVD), its mortality and associated risk factors in the Indian population. Methods: Studies conducted on Indian population between January 1992 and the second week of April 2015 satisfying predefined inclusion and exclusion criteria were selected. PubMed, Ebscohost, Google scholar and Google were searched for CVD prevalence, CVD mortality and its six risk factors (alcohol, tobacco, hypertension, diabetes, obesity and sedentary lifestyle w.r.t. socioeconomic status (SES)). Result: 3, 550, 404 participants and 1, 71, 657 households were studied though 72 selected studies. Of these 13, 31, 23, 20, 21 and 16 articles investigated alcohol, tobacco, hypertension, diabetes, obesity and sedentary lifestyle, respectively, and 11 studies investigated the trend of CVD and its mortality w.r.t. to SES. Higher SES is found to be positively associated with hypertension, diabetes, obesity and sedentary lifestyle, whereas lower SES is found to be positively associated with alcohol and tobacco consumption only. No consensus has been found among studies over socioeconomic patterning of CVD, but the burden of its mortality has been found to be positively associated with lower SES. Conclusion: Even after 25 years of liberalisation of the Indian economy, the association between the CVD and SES is still positive. Rich people are getting more affected by CVD risk factors, but the burden of CVD mortality lies with poor people who cannot afford expensive drugs and interventional treatment. Poor healthcare facilities, high out-of-pocket expenditure and not-so-favourable policies are adversely affecting the CVD health of the weaker sections of India. Key words: Cardiovascular (CVD) diseases, CVD risk factors, Socioeconomic disparity/inequality, India.

Background: EMS is in developing phase in India. There is a need to assess its outcomes based on signs and symptoms of patients at the time of EMS call. Aim: To assess the major outcomes of patients utilizing emergency medical services (EMS). Materials & Methods: Study was designed to assess major outcomes among patients brought to the hospital by EMS in Pune. It was hospital record based study. A person with medical background was trained to extract required data as per proforma enlisting all the required information. Glass gow coma scale (GCS) was used to assess severity of the patients. Patients with incomplete records were excluded. Data were entered in Microsoft excel and imported in SPSS 15.0 software for analysis. Frequencies and proportions were enlisted. Associations were tested by Chi squared test. Results: 849 patients were enrolled. 39.75% were females, 61.0% were males. Mean age 62.56 years (+20.76). Ambulance services reached at scene within 25 minutes in 75% cases. Highest number (38.4%) of patients had altered sensorium. 28% of the patients were in severe category and majority (62%) were in mild to moderate category of GCS scale. 9.7% patients with mild to moderate GCS died while 12.3% (27/212) patients with severe GCS died, difference in mortality was not significant (p=0.220, OR= 1.266, 95% CI= 0.814-1.969). Highest percentage of deaths among severe GCS category were recorded in patients with road traffic accidents (VIII) and seizures (XI). Conclusion: Study re-emphasizes importance of to reduce mortality among patient with severe GCS to the extent of mild to moderate GCS. Different measures need to be installed in present EMS systems for Patients with RTA and seizures. Key Words: EMS, GCS, Mortality.

Objective: To investigate the effect of parental age of onset of coronary heart disease (chd) or stroke on age of onset of chd or stroke in offspring. Design: inception cohort study. Method: the association between age of onset of chd or stroke in offspring and maternal age of onset of chd or stroke and the association between age of onset of chd or stroke in offspring and paternal age of onset of chd or stroke were assessed using the cox proportional hazard model after conditionally imputing the censored parents (i.E. Parents who did not experience chd or stroke during the study). Results: parental age of onset of chd was predictive of offspring age of onset of chd for both maternal age of onset of chd (p<0.0001 N=1378) and for paternal age of onset of chd (p=0.0005 N=1194). A negative estimate of the coefficient of interest signifies that late onset of coronary heart disease in parents is protective of onset of chd in offspring. Beer intake and hdl were important confounding variables associated with parental and offspring age of onset chd. Conclusions: using cox proportional hazard model, we found that late onset of chd or stroke in parents is cardioprotective for offspring. Parental age of onset of chd or stroke is associated with offspring age of onset of chd, and this relationship is described for each unit increase or decrease of age of onset using these statistical methods. This relationship suggests that data on parental history can be useful in the clinical setting in the determination of risk among those at intermediate levels of predicted risk using existing risk calculators. Key words: Cardiovascular Disease, Risk Factor, Coronary Heart Disease, Stroke, Cerebrovascular Accident, Onset of Cardiovascular Disease

Background: Haemoglobin E-β thalassemia is a common haemolytic anaemia in South-East Asia. The patients show remarkable clinical heterogeneity-ranging from asymptomatic anaemia to severe transfusion dependence. There is no specific marker to predict the frequency of blood transfusion (BT) required by these patients.This study aims to find suchfactors like age of first BT, spleen size, levels of haemoglobin E (HbE), haemoglobin F (HbF) and the ratio of HbE to HbF. Materials and Methods: Fifty-eight HbE-beta thalassemia patients visiting the Thalassemia OPD and day care centre of a tertiary care hospital were included in the study. They were grouped into 3 groups according to their age of first BT: group1 had patients with first BT below 2 years old, group2 had those with first BT at/ above 2 years old; those without any BT were in group3. Hb was estimated by automated cell counter. HbE & HbF levels were quantified by High Performance Liquid Chromatography (HPLC). Results: Out of 58 patients, seven patients belonged to group1, 46 to group2 and five to group3. Group1 patients had average spleen size>6 cm, lower levels of steady state Hb and low HbF% whereas group2 had spleen size ≤6 cm, higher steady state Hb levels and a higher HbF%. Significant statistical differences were observed in steady state Hb levels, HbF levels and spleen size. Conclusion: The study highlights that MCV, levels of HbE & HbF and the ratio of HbE to HbF can be used as predictors of severity and transfusion requirement in HbE-β thalassemia patients. Key words: E-β thalassemia, Severity, Transfusion requirement, HbE/HbF ratio, MCV.

Background: Animal bite is an emerging Public health problem causing injuries and even death. Increase incidences of dog bite have been reported from the Indian state of Kerala from last two years and there have been several instances of a single animal biting several victims at the same area. The preventive clinic of Calicut Medical College is a referral centre for the management of animal bite cases in North Kerala. Incidents of mass casualties are a source of panic and alarm among public. The present study analyses these incidents of mass casualties of animal bites studying the epidemiological profile of animals involved. Considering the paucity of studies in this area the information obtained from the present study may help in mapping risk areas and to take necessary control measures. Objectives: To find out the epidemiological and clinical profile of mass casualty due to animal bites reported to the institution. Methodology: Record based cross sectional study design. Review of the mass casualty register maintained at the Preventive Clinic. Details of animal bite cases treated in the clinic from 2014 April to 2015 March were collected. Sociodemographic characteristics, clinical profile and management details were analyzed. Results: A total of 7072 animal bite cases reported to the preventive clinic during the study period .Of this, there were 54 incidents of mass casualty involving 236 patients were registered to receive treatment in the clinic. Majority were males (53%). Adults (79.2%) were commonly effected than children (20.8%).Median age was found to be 36yrs . Exposure to dogs constituted 77.1% of cases, followed by fox (11.9%). All were category 3 wounds and were given anti rabies vaccine, anti rabies immunoglobulin and antibiotics. Conclusion: There were 54 incidents of animal bite mass causalities involving 236 people. Dogs were the commonest animal causing mass casualty. Control of stray dog population by animal birth control needed. Key words: Animal bite, Epidemiological, Clinical profile, Mass casualty, Mapping, Risk areas.

Introduction: Childhood asthma is the common chronic illness among school going children and is reportedly under diagnosed and undertreated. Rise in prevalence of childhood asthma is a matter of concern worldwide and in India also. Objectives: To estimate the prevalence of asthma among school children of 7th and 8th standard in semi-urban area of Bhopal and to find the association of various factors with asthma in the study population. Material and methods: This is a cross-sectional questionnaire based study, done among school going children of 7th and 8th standard, in the semiurban area of Bhopal. Questionnaire was based on that used by International Study of Asthma and Allergies in Childhood (ISSAC). Results: The prevalence of questionnaire diagnosed asthma among 331 school going children studied was found out to be 13.9%. Out of this majority i.e. around 87% were newly diagnosed asthmatics. Out of the various factors examined for association with asthma, family history of asthma, history of allergy and cough without cold were found to be significantly associated. Females were having more prevalence as that of males and the ratio being 1:1.5 (male: female). Other variables such as pets at home, environmental tobacco smoke, and absence of chimney for smoke did not show any statistically significant association with the study. Conclusions: The study confirms the higher trend of asthma prevalence as depicted by various studies. Key words: School, Child, Asthma, India, Prevalence, Risk factors.

Background: Nearly 50% of diabetics in India are undiagnosed and that the newly diagnosed diabetes patients are often found to have signs of complications. Objectives: To estimate the prevalence of diabetic complications, other than retinopathy and peripheral vascular disease, among known diabetic patients treated at healthcare centers in Kancheepuram district of Tamil Nadu; and to analyze the associations between chronic complications and patient’s demographics, T2DM characteristics. Methodology: A cross sectional study was carried out in sixteen out of fifty six health care centers in Kancheepuram district in Tamil Nadu by cluster sampling method using the semi-structured questionnaire, with medical record, physical examination and biochemical investigation to identify chronic kidney disease and co-morbid conditions of type 2 diabetes. A Disability Neuropathy Score (DNS) of more than zero and negative monofilament/vibration tests were used to classify patients as having signs of peripheral neuropathy. Results: Prevalence of Ischemic heart disease and stroke were 7.8% and 0.5% respectively. Prevalence of stage I kidney disease based on the KDOQI guidelines using the estimated GFR and urine PCR values was 30.7% , while chronic kidney disease (i.e., stage II or III or PCR>0.2) was seen in 10.4% patients. Based on the DNS scoring chart 59% of them had peripheral neuropathy while 19% of them had signs of peripheral neuropathy. Participants with at least one chronic complication of diabetes (excluding retinopathy) were 32.8 percent. Prevalence of hypertension was 61.4%. and Hyperlipidemia was 85.9% ,while high LDL, TGL was seen with 60.9% and 64.6% respectively, low HDL among 83.9 % of patient. Conclusion: The high prevalence of undiagnosed microvascular complications in known diabetics treated at primary care emphasis a strong need for routine screening for complications of diabetes and to create awareness on its early detection and prevention of progression. Key words: Prevalence, Type 2 diabetes complications, peripheral neuropathy, chronic kidney disease, primary health centre.

Context: Snake bite poisoning, is an important reason for hospitalization and death in rural India. Availability and timely administration of anti snake venom (ASV) at hospitals is an important factor in favourable prognosis for snake bite victims. Aims: To determine i. proportion of venomous bites to non venomous bites ii. proportion of snake bite cases administered Anti snake venom iii. supply and utilization of Anti snake venom in one year period for treating snake bite victims Settings and Design: A Cross sectional, study was conducted in a Government Medical college hospital in Mandya, Karnataka from November 2012 to October 2013 to ascertain ASV utilization. Methods and Material: Data was collected from hospitalized snake bite victims, from medico legal register (deaths) and in-patient records. Information on ASV stock and supplies, was obtained from the hospital main stores and ward indents. Statistical analysis used: Frequencies and Proportions. Results: 376 (n) snake bite cases were admitted to the hospital during the period, of which 77 victims (20.47%) had envenomation (including 4 deaths). Of 920 anti snake venom vials procured and supplied to the hospital, 915 vials were used, of which 531 vials (58.03%) were administered to those correctly diagnosed to have envenoming. 189 (50.13%) victims who were later diagnosed not to have envenoming, received 384 vials (41.97%). Conclusions: ASV utilization is complete and on a few occasions excessive. All cases of envenoming were not given 10 vials of ASV as suggested in the protocol. Some cases received 2 vials at admission and recovered. Key Messages: Administration of full dose of Anti snake venom to snake bite victims is constrained by stocks and availability of ASV. Though the Indian snake bite management protocol recommends an initial dose of 10 ASV vials, in the present state of mismatched case load and available base stock of anti snake venom in hospital stores, calls for prudence in ASV usage by the treating physicians. Key words: Anti-snake Venom, Envenoming, Mismatch, Stock, Supply, Utilization

Background: Smartphone usage has increased over the past few years in both students, professionals and the common man. Owing to this a model of excessive smartphone and smartphone addiction has been developed. The aim of the study was to assess the amount and types of smartphone usage amongst medical students. Methodology: The setting was a tertiary care medical college and a cross sectional design was employed. The subjects were 145 undergraduate (UG) and post graduate (PG) students studying in a tertiary care medical college. They were divided into two groups UG and PG. They were administered a semi-structured proforma and the App Usage Tracker (AUT) and Whatsapp usage statistics (WUS) app was installed to assess their smartphone usage pattern. The study compared two groups and chi square test, Mann Whitney U test, odds ratio and Pearson’s correlation was done using computerized statistical software. Results: There was no difference in data consumption and perceived time spent on smartphone between UG and PG groups. Undergraduates sent and received far greater messages than post graduates (p=0.0385 and p=0.0004). Participants who reported physical problems after smartphone use sent out significantly more number of messages on whatsapp over a period of 7 days (p = 0.046). Number of messages sent from whatsapp showed a significant positive correlation with number of messages received on whatsapp (r = 0.729, p < 0.001) and size of the media sent from whatsapp (r = 0.338, p < 0.001). Size of media sent from whatsapp correlated significantly with the number of messages received on whatsapp (r = 0.561, p < 0.001). Conclusion: Smartphone usage is an issue that needs to be looked at seriously amongst medical students and the emergence of problems related to smartphone usage in this population warrants further research. Key words: Facebook, Medical Student, Post Graduate, Smartphone, Smartphone Usage, Whatsapp, Youtube.

Surface level ozone is one of the important air pollutants. It is formed by the reaction of atmospheric pollutants in the presence of sunlight. The surface ozone shows temporal and spatial variations in the country. The levels are maximum during summer and minimum in monsoon seasons. The levels are maximum during daytime and minimum during night or early morning. In India, surface ozone levels are above the recommended threshold of 8 hour average of 100 μg/m3 for air quality monitoring at various stations. Exposure to high levels of surface ozone causes number of health problems. Short term exposure causes drop in lung function measures and it also affects the lung’s mucociliary function thereby increasing the susceptibility to bacterial infections. With increase in surface ozone levels, there is likelihood of an increase in risk of hospital admissions for Chronic Obstructive Pulmonary Diseases (COPD) and the number of cardiovascular and respiratory deaths. In children, increase in ozone concentration is associated with increase in hospital admissions and unscheduled asthma medications. The high levels of surface ozone are becoming a threat to people’s health and so surface ozone levels have to be monitored and steps taken to reduce their levels. Key words: Surface Ozone, Pollution, Respiratory, Cardiovascular Diseases, India Key Messages: Surface level ozone is an important air pollutant causing cardiovascular and respiratory diseases. The levels are above the recommended threshold at various stations in India. Surface ozone has to be monitored and steps taken to reduce their levels.

Introduction: Iron deficiency is a complication of regular blood donation. To recruit and retain regular voluntary blood donors, the iron status of the donors needs to be identified. Objective: The present study was done using a combination of hematological and iron status parameters to detect prevalence of iron deficiency anaemia in the voluntary blood donors. Method: Complete blood count was performed on three part hematology analyzer and serum ferritin was measured by standard enzyme immunoassay technique on 393 random voluntary blood donor samples. Ferritin values below 15 μg/L were considered iron deficient, 15- 20 borderline, and above 20 normal. Results: Out of 393 donors, 111 first time and 282 repeat donors. The repeat donors were subdivided into different subgroups like as per their last donation into group I to IV, and as per their frequency of donation into group A to D. First time donors had higher mean serum ferritin levels than that in repeat donors. 28.5 % of blood donors had depleted iron stores (serum ferritin <20 μg/L) and 19.6% of donors were anemic. Serum ferritin was markedly reduced in donors > 20 time donation frequency and last donation within 3-5 months. Conclusion: There was a significant correlation between the frequency of donations, last donation interval and the serum ferritin measurement so it should be included in the assessment of regular blood donors to secure adequate iron reserves in the donor population and there is a need to modify the donor acceptance criteria. Key words: Iron deficiency, Blood Donation, Hematological Parameters, Serum Ferritin.

Snake bite is a neglected tropical disease of global importance. India has the highest number of deaths (35,000-50,000 people dying per year) due to snakebites. 1 Common venomous snakes in India are common cobra (Najanaja), saw scaled viper (Echiscarinatus), Russell’s viper (Daboia russelii) and krait (Bungarus caeruleus). Daboia is one of the most common species responsible for causing the most snake bite incidents and deaths among all venomous snakes on account of many factors, such as their wide distribution, aggressive response to host, and frequent occurrence in dense populated areas. Development of parotid swelling after snake bite is a rare entity. The number of case reports from India documenting such as unusual complication were very few. The published data documenting parotid enlargement even in world literature are limited.2 So we are reporting a case with bilateral parotid gland enlargement following snake envenomation for its rarity.

Laurence Moon Bardet Beidl Syndrome is a rare Ciliopathic and Pleiotrophic human Autosomal recessive genetic disorder, which involves affects and effects on multiple organ system. Consanguineous marriage is usually the common cause. The characteristic feature of the disorder are progressive rod cone dystrophy, atypical retinitis Pigmentosa, myopia, central obesity, mental retardation, Anisometropia, Astigmatism, Postaxial Polydactyly, Hypogonadism in males, renal involvement. It affects males and females equally. The treatment of Laurence Moon Bardet Beidl Syndrome is usually directed towards the specific symptoms that are apparent in each individual. We here present a case report of 18 year old male patient presenting in medicine department with weakness of both lower limbs, inability to walk, progressive loss of vision and polydactyly. Key words: Obesity, Hypogonadism, Retinitis Pigmentosa, Para paresis, Mental retardation, rod cone dystrophy