The Journal of the Association of Physicians of India
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J Assoc Physicians India · Feb 2009
The malaria severity score: a method for severity assessment and risk prediction of hospital mortality for falciparum malaria in adults.
There is paucity of research to quantify the severity and to predict the mortality risk of severe falciparum malaria even if it affects multiple organ systems during the course of the disease. Therefore, the aim of the present study is to develop a severity score for assessment of disease severity and risk prediction in adult patients of severe falciparum malaria on the first day of hospitalisation. ⋯ This prospective study provides an objective tool for assessing severity levels for organ dysfunction and prediction of risk of mortality in severe falciparum malaria which can be used for treatment and research. It has been observed that no two patients of falciparum malaria are same in severity. The severity varies over time and malaria can affect single or multiple organs with different levels of severity which can be quantified as level I, II, and III. Neurologic and renal dysfunction were the most severe with level III severity, followed by haematologic, cardiovascular, and respiratory dysfunction with level-II severity, as well as hepatic and metabolic dysfunction the least severe with level-I severity. Patient of malaria can be stratified as low, intermediate, and high risk depending on the MSS. With the help of MSS daily risk estimates and recovery time of OD can be determined.
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J Assoc Physicians India · Feb 2009
ReviewConsensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management.
Asian Indians exhibit unique features of obesity; excess body fat, abdominal adiposity, increased subcutaneous and intra-abdominal fat, and deposition of fat in ectopic sites (liver, muscle, etc.). Obesity is a major driver for the widely prevalent metabolic syndrome and type 2 diabetes mellitus (T2DM) in Asian Indians in India and those residing in other countries. Based on percentage body fat and morbidity data, limits of normal BMI are narrower and lower in Asian Indians than in white Caucasians. ⋯ Application of these guidelines on countrywide basis is also likely to have a deceleration effect on the escalating problem of T2DM and cardiovascular disease. These guidelines could be revised in future as appropriate, after another large and countrywide consensus process. Till that time, these should be used by clinicians, researchers and policymakers dealing with obesity and related diseases.
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J Assoc Physicians India · Jan 2009
ReviewAlbumin and lipid enriched albumin for the critically ill.
Albumin, the principal transporter of plasma fatty acids, binds to majority of the drugs ingested, traps oxygen radicals and has potent anti-oxidant actions. Albumin binds to its specific binding sites on vascular endothelial cells and thus, prevents endothelial apoptosis. Albumin regulates the enzyme pyruvate dehydrogenase, the flux of glucose and lactate in astrocytes, and enhances the formation of anti-inflammatory lipoxins, resolvins and protectins from docosahexaenoic acid (DHA) and other polyunsaturated fatty acids that, in turn, could limit ischemia-induced neuronal damage. This may explain the beneficial action of DHA-enriched albumin in stroke and other critical diseases.
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J Assoc Physicians India · Jan 2009
ReviewVitamin D status in India--its implications and remedial measures.
Vitamin D deficiency is epidemic in India despite of plenty of sunshine. The interpretation of vitamin D levels should be done with the solar zenith angle, minimal erythemal dose, skintype, UV Index and geographical location. All Indian studies uniformly point to low 25(OH)D levels in the populations studies despite abundant sunshine. ⋯ The effect of short course of loading doses of vitamin D doesn't have a lasting effect and a maintenance dose is needed. Low 25(OH)D levels has its implications of lower peak bone mass and lower BMD compared to west. There may be a public health need to fortify Indian foods with vitamin D.