Background:Early initiation of appropriate noninvasive respiratory support is utmost important intervention to avoid mechanical ventilation in severe bronchiolitis.Aim:This study aims to compare noninvasive continuous positive airway pressure (nCPAP) and hot humidified high-flow nasal cannulae (HHHFNC) as modes of respiratory support in infants with severe bronchiolitis.Methods:Prospective, randomized, open-label pilot study done in a tertiary-care hospital Pediatric Intensive Care Unit (PICU). Participants: 31 infants (excluding neonates) clinically diagnosed with acute bronchiolitis having peripheral capillary oxygen saturation (SpO2) <92% (with room air oxygen); Respiratory Distress Assessment Index (RDAI) ≥11. Intervention: nCPAP (n = 16) or HHHFNC (n = 15), initiated at enrollment. Primary outcome: Reduction of need of mechanical ventilation assessed by improvements in (i) SpO2% (ii) heart rate (HR); respiratory rate; (iii) partial pressure of carbon dioxide; (iv) partial pressure of oxygen; (v) COMFORT Score; (vi) RDAI from preintervention value. Secondary outcome: (i) total duration of noninvasive ventilation support; (ii) PICU length of stay; and (iii) incidence of nasal injury (NI).Results:Mean age was 3.41 ± 1.11 months (95% confidence interval 2.58–4.23). Compared to nCPAP, HHHFNC was better tolerated as indicated by better normalization of HR (P < 0.001); better COMFORT Score (P < 0.003) and lower incidence of NI (46.66% vs. 75%; P = 0.21). Improvements in other outcome measures were comparable for both groups. For both methods, no major patient complications occurred.Conclusion:HHHFNC is an emerging alternative to nCPAP in the management of infants with acute bronchiolitis.

Background: Little is known about the etiological risk factors of acute pancreatitis (AP) in Eastern India. Aims and Objective: The aim of this study is to assess current trends etiology of AP in Eastern India. Materials and Methods: A retrospective study with cross-sectional design was undertaken based on available medical records of patients admit between January 2014 and January 2017 with physician-assigned diagnoses of AP at KPC Medical College & Hospital, Kolkata (n = 234). Multivariate analyses were done to identify risk factors, and distribution was compared on the basis gender. Groups were selected on the basis of a working diagnosis. A stratified comparison was done in 3 commonest etiology groups identified: ‘alcohol’, ‘non-alcohol’ and ‘idiopathic’.Results: The commonest etiology was attributed to alcohol (29.4%), idiopathic cause (20.5%), and obstructive cause (14.5%). Prevalence of AP was higher with alcoholism in men (37% vs. 10.8%; p < 00.1), however, other causes like idiopathic cause (12.3% vs. 37.8%), duct obstruction (1.2% vs. 43.2%), obesity (6.1% vs. 24.3%), and hypertriglyceridemia (6.1% vs. 14.8%) were higher among females ( p < 0.001 for all comparisons). Compared to non-alcoholics, patients with idiopathic AP were more likely to be overweight ( p = 0.019) and have T2 DM ( p = 0.021). Moreover, impact assessment of T2 DM status further revealed that the risk of AP was even greater with obesity (Odds Ratio [OR] 1.37; 95% Confidence Interval [CI] 0.57 – 3.26; p = 0.047) and smoking (OR 1.72; 95% CI 1.0 – 2.97; p = 0.049). Eighteen cases (7.7%) of ‘severe’ AP were identified, mostly due to: trauma in 6 (2.5%), idiopathic in 6 (2.5%), gallstones in 4 (1.7%), and alcoholism in 2 (0.8%).Conclusion: Alcohol intake is the predominant etiological risk factor for acute pancreatitis in Eastern India. Gender and type 2 diabetes mellitus are important contributory determinants.Asian Journal of Medical Sciences Vol.8(6) 2017 24-29

ABSTRACT:AIM: To explore the stigmatizing pattern in people living with HIV/AIDS (PLWHA) and assess coping strategies adopted for quality of life (QOL) appraisal. METHoDS:In the background of a descriptive, cross-sectional research design, PLWHA attending HIV (human immunodeficiency virus) outpatient clinic at Medical College, Kolkata (n = 120) were enrolled through "snowball sampling." A brief semistructured interview schedule was used to elicit data on socio-demographics. Stigma was assessed using a 4-point scale (40-item). Quality of life was assessed using WHOQOL-BREF (World Health Organization Quality-of-Life) scale (26-item).RESuLTS: About 96.7% reported being stressed. Stigma was mostly confronted in socio-familial context. Fear of being stigmatized was much higher compared with those who actually faced stigma (69.2% vs 27.5%; P < .01). Quality of life negatively correlated with internalizing of stigma in the psychological domain (P < .01). Proportion experiencing actual stigma (women vs men: 79% vs 74%) experienced an above moderate QOL. Multiple defense mechanisms were identified. "Altruism," "Anticipation," and "Humor" were the most preferred defense strategies. However, such coping strategies appeared to be self-taught and only modestly helpful in managing perceived stigma. ConCLuSIonS:People living with HIV/AIDS should avoid internalizing stigmatized feeling and engage in social activities to work toward a better QOL.

India recently updated its guidelines on stem cell research (SCR), the National Guidelines for Stem Cell Research 2017. It was drafted under a collaborative effort from the Indian Council of Medical Research and Department of Biotechnology. The new guidelines are a part of a continuous endeavor to tackle scientific, technical, as well as perceived challenges in the field of SCR. It seeks to facilitate safe, ethical, and regulated translational and clinical SCR by engaging all stakeholders proactively.

Increasing incidence of artemisin resistance endangers very foundations of current guideline based antimalarial therapy. There is an unmet need to develop newer strategies, targeting novel pathophysiology to set high standards in antimalaria care. Of late, the antimalarial drug pipeline is becoming increasingly robust, and promises healthier outcomes. We discuss few drugs currently under pre-clinical development that have shown encouraging results.

Background:Suboptimal compliance to aerosol medication is common in pediatric asthma. Accordingly, the objective of this study is to assess noncompliance to aerosol therapy in childhood asthma and determine contributory factors.Materials and Methods:A prospective cohort study was conducted among pediatric patients attending asthma clinic. Patients (n = 215) having “mild” and “moderate” asthma severity rating were included. The total study duration was 12 months (June 2016–June 2017), with an active recruitment phase of 6 months. The minimum period for follow-up was 90 days. Caregivers were instructed to maintain an “asthma diary” for daily dosages of inhalers. At follow-up, the diary entries were corroborated with the amount of inhaler medication unused. Subsequently, medication compliance ratio (CR) was calculated according to the following formula: CR = number of medication doses taken/number of medication doses prescribed. CR% >80 was considered as “good compliance”.Results:A total of 169 patients (78.6%) returned for follow-up. The mean compliance to asthma medication was suboptimal (75.3%). The children were primarily prescribed inhaled corticosteroids and short-acting beta-agonist (SABA)-based regimens on index visit. Leukotriene receptor antagonist was added in select cases (67.9%). Nearly 45.6% of the patients had “good compliance.” CR correlated with the sociodemographic profile and disease severity. Higher socioeconomic status and proper inhaler technique reflected better symptom control. Fear of side effects, behavioral difficulties, and economic restrictions were the identified causes of medication default.Conclusion:In the Eastern part of India, compliance to aerosol therapy in pediatric asthma is suboptimal. Sociodemographics, disease severity, and inhaler technique are important determinants.

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OBjECTIvE: To analyze drug utilization (DU) pattern of antidiabetes drug (ADD) prescription in elderly type 2 diabetes mellitus (T2DM) in rural West Bengal based on 2016 World Health Organization (WHO) Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) Index. METHODS: This was a prospective observational study. Prescription data of 600 elderly patients (age > 60 years) attending outpatient clinic were screened over 12 months (January 2015 to January 2016) from 5 different rural hospitals in West Bengal. Pooled data were sorted and classified in accordance with 2016 ATC/DDD WHO Index. Direct cost associated and consumption of ADD were measured as DDD/1000 patients/day. The adverse drug reactions (ADRs) related to antidiabetic medicines were monitored. RESUlTS: During the study period, mean age of patients recorded was 66.4 ± 5.0 years, with 66.6% (n = 396) having history of T2DM > 5 years. Follow-up encounters (n = 2328) revealed metformin (94.67%), sulfonylureas (SUs) (50.54%), pioglitazone (24.22%), voglibose (22.50%), insulin (9.75%), and acarbose (6.82%) to be more prevalent, constituting DU 90% (92.01%). Combination of metformin plus SU was recorded in most of the patients (56%). Insulin, however, was found to be an underutilized class (P < .005). The DDD/1000 patients/day of metformin (2.918), glimepiride (1.577), and gliclazide (0.069) conformed to 2016 WHO ATC/DDD Index. The total ADD consumption during study period was 5.03 DDD/1000 patients/day. The average drug cost per encounter per day was Rs 11.24 ± 2.01. Nineteen ADRs were reported and their descriptions were found to be of hypoglycemia (n = 9), pedal edema (n = 2), and gastrointestinal upsets (n = 8). Target glycemic status was achieved in 40% monthly follow-up encounters. Low-store drug availability and poor compliance to treatment (>60%) were major determinants. Lack of regular aerobic exercises (>85%) and proper knowledge regarding medical nutrition therapy (MNT) (>80%) and low average consultation time (3.5 ± 0.6 minutes) were important contributing factors. COnClUSIOnS: The study exhibited increased utilization of 2 drug combinations of oral ADD and lower utilization of insulin during study period. Such inferences merit further exploration.