Volume12,Issue4

1. Study of Chronic Kidney Disease-Mineral Bone Disorders in Advanced Renal Failure Patients: A Hospital-Based Cross-Sectional Study
Shubham Agrawal, Anchin Kalia, Prakharanshu Singh Dhakar, Megha Agarwal, Dhananjai Agrawal
Abstract
Background: Chronic kidney disease (CKD) is associated with significant disconcertion in bone and mineral metabolism, which leads to alteration in serum concentrations of calcium(Ca), phosphorus(P), parathyroid hormone (PTH), and Vitamin D and it also leads to abnormalities in bone remodeling, renal osteodystrophy (ROD) and extraskeletal calcification. So we aim to assess the alteration in mineral metabolism, abnormal changes in bone mineral density (BMD) and extra skeletal calcification in newly detected, untreated predialysis stage 4 and 5 chronic kidney disease (CKD) patients at a tertiary care hospital in North India. Methods:  Hospital based cross sectional study was conducted in patients of CKD detected in Mahatma Gandhi Hospital Jaipur. Total 120 subjects of CKD measured for serum calcium (Ca), phosphorous (P), creatinine, 25-hydroxy Vitamin D [25(OH)D] and intact PTH (iPTH). Lateral lumbar X-ray performed in a standing position for abdominal aortic calcification (AAC) assessment using 24-point scale by Kauppila et al. Results: Kauppila scale(K scale) significantly (p <0.001) increases with severity of CKD. K scale in stage 3 was 15.78+3.27, in stage 4 it was 17.19+3.20 and in stage 5 it was 19.62+1.58. ‘z’ score for DEXA scan increases significantly (p<0.0001) with severity of disease calcification. Conclusion: In our study we found newly detected Indian patients of CKD with high prevalence of disturbances in mineral metabolism which is shown by hyperparathyroidism, Vitamin D deficiency, BMD abnormality and valvular, vascular calcification.

2. Cord Serum Albumin (CSA) Measurement and Prediction of Newborn Hyperbilirubinemia Based on CSA Values: Prospective Observational Study
Rizwan Ahmar, Sadia Parween, Amit Kumar, Anand Kumar Gupta
Abstract
Aim: Aim of this study was measuring the Cord Serum Albumin level (CSA) and predicting neonatal hyperbilirubinemia based on cord serum albumin levels. Methods: This prospective observational study was carried out in the Department of Pediatrics, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India from August 2019 to July 2020. Total 110 born  term healthy neonates were included in this study. 3 ml of cord blood was collected at birth in a Serum-separating tube and was sent for estimation of cord blood albumin and TSH. On detecting the presence of icterus, Blood was sent for estimation of Total Bilirubin (TB). Results: In the study a total of 110 babies were registered. Out of this 58(52.73) % were female and 52(47.27%) were male. Depending on the cord albumin levels the babies were grouped into two: >2.8 gm/dl (Group 1) and <2.8 gm/dl (Group 2). Lower normal limit for cord serum albumin in term babies is 2.6g m/dl. There was a total of 88 babies in Group 1 and 22 babies in Group 2. The mean gestational age was among Group 1 was 38.95±2.31 weeks and Group 2 was 37.98±2.33. It was noted that babies born at a lower gestational age had a higher chance of having a low albumin value and subsequent hyperbilirubinemia (p=0.001). The anthropometric profile of both the groups were compared and it was noted that only the birth weight had a significant correlation with cord albumin (p<0.001). A significant correlation was noted between the Cord TSH and cord Albumin levels in this study. Out of 110 babies, 53 babies developed icterus. Under group 1, 36 babies developed icterus and under group 2, 17 babies developed icterus. The total bilirubin levels were significant in Group 2 (p<0.001). 22 babies of the 53 with icterus required phototherapy and it was noted that majority of these babies were from group 2 (p<0.05). Only 1 baby required exchange transfusion and it belonged to group 2. In our study, the sensitivity of cord albumin to detect hyperbilirubinemia in newborn was determined and found to be 74.55%, while specificity was 63.64%. The positive predictive value was found to be 42.73% and the negative predictive value was found to be 91.82%. The accuracy rate was 68.18%. Conclusion: Cord albumin levels help to determine and predict the possibility of hyperbilirubinemia among neonates. Hence this can help to identify the at-risk neonates. So, routine determination of cord albumin can be advocated to keep a track on at risk neonates.

3. An Observational Study of the Prevalence and Risk Factors for Primary Open Angle Glaucoma in Diabetic Patients in a Tertiary Care Facility
Mobashir Sarfraz Ali, Nazia Imam
Abstract
Aim: Prevalence and risk factors associated with primary open angle glaucoma in diabetic patients. Methods: This Cross-sectional study was done at Regional Institute of Ophthalmology (RIO), Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India for 1 year. All documented diabetic cases attending Department of Regional Institute of Ophthalmology giving consent for work up for the study, IOP > 21 mmHg (by Applanation tonometry) with visual field defects, IOP > 21 mmHg (by Applanation tonometry) with optic nerve head changes, Optic nerve head changes with visual field defects and Normal IOP with no visual field defects or optic nerve head changes, with asymmetry of IOP in both eyes of > 5 mmHg were included in this study. Results: The results of the study show clear cut evidence of increased incidence of POAG in diabetic patients, which was 7%. The distribution of age in the study population ranges from 37 to 68 years. The mean age of study participants was 49.58 years and a SD of 8.16 years. There is a significant association between age and POAG. No significant association was found between gender and POAG. No significant association was found between duration of DM and prevalence of POAG. POAG was found to be more in patients with a family history of glaucoma. Conclusion: Patients with diabetes are at increased risk of open-angle glaucoma, Glaucoma family history and retinopathy are the main risk factors for open-angle glaucoma in the early years of diabetes.

4. Evaluation of Sonographic Prostate Volume in Relation with International Prostate Symptom Score.
Bijendar Kumar Meena, Sweta Meena
Abstract
Background: The severity of lower urinary track symptoms can be estimated by the International Prostate Symptoms Score (IPSS). IPSS has seven-point questionnaire with maximum total attainable score of 35 to evaluate baseline patient discomfort. IPSS is also a used for follow up of patient’s symptoms improvement. Material & Methods: The present prospective study was conducted at department of radiodiagnosis of our tertiary care hospital. The study duration was of six months from January 2019 to June 2019. A sample size of 100 was calculated at 95% confidence interval at 5% acceptable margin of error. Patients with lower urinary tract symptoms were enrolled in the study. All the patients underwent Transabdominal ultrasonography for the measurement of prostate size/volume. Results: In the present study, the Grading the severity of symptoms based on IPSS score classify study participants in three groups. Out of the 22% patients had mild symptoms, 40% patients had moderate symptoms and 28% patients had severe symptoms. The prostate volume was calculated by calculating Prolate ellipsoid formula Antero-posterior x Transverse x Cranio-caudal x 0.52. 12% patients had prostatic volume of ≤ 20 cc, 26% patients had prostatic volume of 21 -30 (Grade I), 34% patients had prostatic volume of 31-50 cc (Grade II), 21% patients had prostatic volume of 51-80 cc (Grade III), 7% patients had prostatic volume of ≥80 cc (Grade IV) Conclusion:  We concluded from the present study that we did not found any correlation between the age and international prostate symptom score and also we did not found any correlation between prostate volume or prostate enlargement grading and IPSS score.

5.Pattern of Mental Health Profile among Adolescent at Tertiary Care Hospital.
Ashok Goyal, Ashok Kumar Agarwal, Abdul Sajid Mansoori
Abstract
Background: Mental health disorders are the leading cause of morbidity among young people all around the world, which accounts for 12% of the global psychiatric morbidity and 40% of DALY due to mental health disorders. Adolescence stage is considered to be the most productive duration of life, hence psychiatric morbidity at this age group affect the quality of life of not only the individual itself but also the family and community. Material & Methods: A total of 100 study participants aged between 10 to 19 years were included in study by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Proper written informed consent from participants, parents or guardians was taken before start of study. Results: mental retardation was present among 22% of the study participants and attention‑deficit hyperactivity disorder present among 14% of the study participants. 10% of the adolescents had pervasive developmental disorder and 8% of the adolescents had borderline intellectual functioning. Major depressive disorder was found in 7% adolescents, anxiety disorders were found in 6% adolescents and disruptive behavior disorders were found in 4% adolescents. Bipolar affective disorder was found in 2% adolescents and schizophrenia was found in 1% adolescents. Comorbid mental health disorders were found in 20% of the study participants. Conclusion: The mental health disorders were found higher 10-14 years of age group among adolescents with male preponderance. Majority of the adolescents were from a rural area and living in nuclear families. Mental retardation and attention‑deficit hyperactivity disorder were the most common psychiatric disorders reported.

6. Evaluation of Invasive Prenatal Test Indications and Outcomes at a Tertiary Care Center: Experience from Western India.
Rekha Gupta, Charul Mittal, Jai Chowdhary, Vijay Singh Nahata
Abstract
Background: Prevention of genetic disorders by prenatal detection is now standard antenatal care. We present retrospective analysis of indications and results of invasive prenatal procedures amniocentesis and chorionic villous sampling (CVS) in 284 patients at tertiary care teaching university hospital. Methods: Maternal age and indication were obtained. Gestation age for amniocentesis was 16 weeks onward and for CVS was 11-14 weeks. Results were analyzed with respect to indications. Result: Out of total 284 invasive procedures, 60.91% were amniocentesis and 39.08% were CVS. Total 50.70% of fetuses were tested for chromosomal anomaly. Most frequent indication was abnormal serum screen test (54.86% of cases). Among remaining 48.94% of cases, procedures were done with indication of family history of single gene disorder. Sample which was tested for chromosomal anomaly 4.35% of fetuses found affected. Most frequent chromosomal anomaly was Down syndrome (33% of cases). On the contrary, samples which were tested for single gene disorder 19.42% fetuses found affected. Most frequent indication was previous child with thalassemia major. Conclusion: For detection of Down syndrome, most predictable indication from present study is abnormal serum screen test combined with soft marker in USG. USG detectable major malformation has highest yield in detection of affected fetuses but it needs a syndromic approach like testing for single gene disorder if standard microarray test comes normal.