St. Stephen’s Hospital

BACKGROUND: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a program to implement a 19-item surgical safety checklist designed to improve team communication and consistency of care would reduce complications and deaths associated with surgery. METHODS: Between October 2007 and September 2008, eight hospitals in eight cities (Toronto, Canada; New Delhi, India; Amman, Jordan; Auckland, New Zealand; Manila, Philippines; Ifakara, Tanzania; London, England; and Seattle, WA) representing a variety of economic circumstances and diverse populations of patients participated in the World Health Organization's Safe Surgery Saves Lives program. We prospectively collected data on clinical processes and outcomes from 3733 consecutively enrolled patients 16 years of age or older who were undergoing noncardiac surgery. We subsequently collected data on 3955 consecutively enrolled patients after the introduction of the Surgical Safety Checklist. The primary end point was the rate of complications, including death, during hospitalization within the first 30 days after the operation. RESULTS: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P=0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). CONCLUSIONS: Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

BACKGROUND: Surgical disease is inadequately addressed globally, and emergency conditions requiring surgery contribute substantially to the global disease burden. METHODS: This was a review of studies that contributed to define the population-based health burden of emergency surgical conditions (excluding trauma and obstetrics) and the status of available capacity to address this burden. Further data were retrieved from the Global Burden of Disease Study 2010 and the University of Washington's Institute for Health Metrics and Evaluation online data. RESULTS: In the index year of 2010, there were 896,000 deaths, 20 million years of life lost and 25 million disability-adjusted life-years from 11 emergency general surgical conditions reported individually in the Global Burden of Disease Study. The most common cause of death was complicated peptic ulcer disease, followed by aortic aneurysm, bowel obstruction, biliary disease, mesenteric ischaemia, peripheral vascular disease, abscess and soft tissue infections, and appendicitis. The mortality rate was higher in high-income countries (HICs) than in low- and middle-income countries (LMICs) (24.3 versus 10.6 deaths per 100,000 inhabitants respectively), primarily owing to a higher rate of vascular disease in HICs. However, because of the much larger population, 70 per cent of deaths occurred in LMICs. Deaths from vascular disease rose from 15 to 25 per cent of surgical emergency-related deaths in LMICs (from 1990 to 2010). Surgical capacity to address this burden is suboptimal in LMICs, with fewer than one operating theatre per 100,000 inhabitants in many LMICs, whereas some HICs have more than 14 per 100,000 inhabitants. CONCLUSION: The global burden of surgical emergencies is described insufficiently. The bare estimates indicate a tremendous health burden. LMICs carry the majority of emergency conditions; in these countries the pattern of surgical disease is changing and capacity to deal with the problem is inadequate. The data presented in this study will be useful for both the surgical and public health communities to plan a more adequate response.

AIMS: To compare the vitamin D status of 34 children, 9-24 months old, living in an area of Delhi renowned for high levels of atmospheric pollution (Mori Gate), with a comparable age matched group of children from a less polluted (Gurgaon) area of the city. METHODS: Serum concentrations of calcium, alkaline phosphatase (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25(OH)D), and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured. Haze scores, regarded as a surrogate marker of solar UVB radiation reaching ground level, were measured in both areas. RESULTS: Mean 25(OH)D of children in the Mori Gate area was 12.4 (7) ng/ml, compared with 27.1 (7) ng/ml in children living in the Gurgaon area (p < 0.001). The median ALP (p < 0.05) and mean PTH (p < 0.001) concentrations were higher in children living in the Mori Gate area than in the Gurgaon area. The mean haze score in the Mori Gate area (2.1 (0.5)) was significantly lower (p < 0.05) than in the Gurgaon area (2.7 (0.4)), indicating less solar UVB reaching the ground in Mori Gate. CONCLUSION: We suggest that children living in areas of high atmospheric pollution are at risk of developing vitamin D deficiency rickets and should be offered vitamin D supplements.

OBJECTIVES: To prevent death from atrial fibrillation, a cardiac disease which kills by producing emboli. Atrial fibrillation causes about 25% of strokes and increases stroke rate by five times. Over 90% of these embolic strokes are from clots originating in the left atrial appendage. This study addresses the surgical feasibility of removing the appendage to prevent future deaths in two subcategories of patients. (1) Prophylactic removal during open-heart surgery to study its safety. Theoretically, as these patients age and some develop atrial fibrillation, protection from embolic strokes would already be present. (2) Therapeutic removal in chronic atrial fibrillation patients by means of a thorascopic approach. Its technical feasibility is demonstrated. Its actual stroke prevention potential awaits large studies. METHODS: Appendectomy has been evaluated three ways. (1) Experimentally, thorascopic appendage removal was performed on 20 goats with endoscopic approach. Late studies showed a cleanly healed atrial closure after stapling, and no puckering of tissue as seen with the purse-string approach. (2) Safety of human appendectomy was demonstrated in 437 patients (1995-1997). Routine appendectomy was performed during open-heart surgery. Forty-three appendages were stapled, 391 sutured off. (3) Thorascopic appendectomy in seven patients with chronic atrial fibrillation has been successfully accomplished as an isolated surgical procedure. Stapling or suture closure provides a much cleaner, non-puckered suture line than a purse string. RESULTS: In prophylactic removal, no acute bleeding occurred. No late problems have been identified. Endoscopic removal of the appendage has been successful in seven atrial fibrillation patients. CONCLUSIONS: The left atrial appendage is a lethal source of emboli in atrial fibrillation patients. As patients age and often develop atrial fibrillation, prophylactic appendage removal whenever the chest is open is suggested as a method to prevent future strokes. In chronic atrial fibrillation patients, appendectomy can be done with a mini-thorascopic approach. Further studies are planned to demonstrate the effectiveness of appendectomy in preventing strokes in the chronic fibrillating patients.

Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy or chemoradiation for young women with stage IA2 to IB cervical cancers. Thirty-three patients were offered this procedure. The mean age was 30.5 years (range 23-37). Three procedures were abandoned because of positive pelvic nodes (two patients) and involvement of the margin between the amputated cervix and uterine fundus (one patient). Of the remaining 30 patients, 10 had stage IA2 tumours, 15 had stage IB1 and 5 had stage IB2. During follow up of a median of 47 months (mean 32 months, range 14-75 months), no recurrences have been detected. A normal menstrual pattern resumed within eight weeks of surgery in all but two patients. Five patients attempted to conceive. Three women have fallen pregnant, resulting in one first trimester miscarriage and two caesarean section deliveries at term. Our experience suggests that abdominal radical trachelectomy provides a method of treating women with stage IA2 to IB cervical cancers with conservation of fertility without apparently compromising recurrence or survival rates. It appears to provide equivalent oncological safety to a standard Wertheim hysterectomy using a technique familiar to all practising gynaecologic oncologists.

In a prospective study of 154 AIDS patients, 48 (31%) complained of pain on swallowing both liquids and solids and 32 (21%) of these also had dysphagia. While candidiasis was the most common cause of symptoms (26 patients), discrete ulceration of the oesophagus occurred in 12 instances in 10 patients (four cytomegalovirus, four herpes simplex virus, three aphthous ulcer, one peptic ulcer). One patient had a diffuse oesophagitis caused by Mycobacterium avium intracellulare. No cause was found for the oesophageal symptoms in four patients. Kaposi's sarcoma (KS) was found in seven patients associated with other pathology in four. All 26 patients with oesophageal candidiasis only, also had oral involvement. All the patients with herpes simplex virus (four) and aphthous ulcers (three) had obvious perioral involvement. Three of the four patients with cytomegalovirus ulceration had evidence of disease elsewhere (colon or retina). All patients with Kaposi's sarcoma lesions had skin and buccal cavity involvement. The cause of oesophageal disease was usually obvious at endoscopy. The appearance of candidiasis was typical and the various ulcerating lesions also had different macroscopic configurations. Cytomegalovirus infection produced deep linear ulcers in the distal oesophagus, herpes simplex oesophagitis is similar in appearance to the typical perioral lesions of fluid filled vesicles. Diagnostic radiology was not helpful in most patients. In nine of 17 patients with candidiasis, the barium swallow examination performed within 24 hours of presentation was normal. In only three of seven patients with oesophageal ulceration (three cytomegalovirus, two herpes simplex virus, one aphthous, one peptic) was there evidence of an abnormality. Treatment produces symptomatic relief. All patients with candidiasis responded to ketoconazole, the four with herpes simplex virus to acyclovir and one of three with aphthous ulceration had a dramatic response to thalidomide. The three patients with cytomegalovirus infection who were treated with foscarnet had a prolonged remission of symptoms. The overall prognosis of patients with oesophageal symptoms is poor, with an average survival time from a definitive diagnosis of five months (range one to 13).

<h3>Background</h3> Rheumatologists are often confronted with systematic and rare diseases. Even among the rare diseases, clinical features may overlap, but treatment options for different diseases may differ. <h3>Objectives</h3> To illustrate the diagnostic challenges the clinician is confronted with when facing rare and systemic diseases in clinical practice with a case report where clinical features were overlapping. <h3>Methods</h3> A 64-year-old woman was presented to our institution after suffering from two ischemic strokes. Cerebral imaging was suggestive of large-vessel vasculitis. Additionally, imaging also revealed a left-sided retro-orbital mass. Her past medical history was notable for retroperitoneal fibrosis with ureteral obstruction requiring percutaneous drainage six months before presentation and placement of a cardiac pacemaker several years ago. Treatment with high-dose prednisone had been initiated but showed no clinical or laboratory improvement. <h3>Results</h3> Clinical examination revealed mild persistent facial hemiparesis and difficulty with ambulation. Mild exophthalmos was present on her left side. On palpation, there were palpable axillary masses bilaterally. Otherwise, her physical examination was normal. Laboratory analysis revealed elevated soluble interleukin-2 receptor levels at 2800 IU/mL (N: 230–770 IU/mL) and mildly increased C-reactive protein at 10 mg/L (N: &lt;5 mg/L). Autoantibodies, including rheumatoid factor, IgG4, ANCA, ANA, and ENA were all within normal range. Plasma cells were normal on flow cytometric analysis. A PET-CT was performed which revealed signs of alveolitis, retroperitoneal fibrosis, axillary masses with strong tracer uptake (figure 1) as well as tracer uptake of the left femur and periaortic sheathing. We performed a biopsy of the left-sided axillary mass. Histopathologic analysis showed Touton giant cells and septal fibrosis. Staining was negative for CD1a and S100 but positive for CD68. Molecular pathologic analysis revealed the presence of the BRAFV600E mutation, findings that are consistent with the diagnosis of Erdheim-Chester disease. We initiated treatment with the BRAF-inhibitor vemurafenib and will follow the patient closely. Staining for IgG4 was negative. <h3>Conclusions</h3> Erdheim-Chester disease (ECD) and IgG4-related disease are very rare disorders and can present with similar clinical findings, such as retroperitoneal fibrosis, alveolitis or lymph node enlargement. About 500 cases of ECD worldwide have been reported. ECD is a non-Langerhans cell histiocytosis with a reported five-year survival rate of about 68%. Roughly 50% of patients show a BRAF mutation. Various treatment options have been reported and are recommended by the recently published consensus guidelines (1). These include interferon-alpha, vemurafenib and also TNF-alpha inhibitors, such as infliximab, but also interleukin-antagonists, such as anakinra (IL-1) or tocilizumab (IL-6). Rheumatologists have to consider non-Langerhans cell histiocytoses in the differential of systemic diseases because the distinction can be difficult and imaging, as well as meticulous histopathologic analyses, are necessary to correctly diagnose these patients because treatment differs. <h3>References</h3> Diamond EL et al. Consensus guidelines for the diagnosis and clinical management of Erdheim-Chester disease. Blood 2014 Jul 24;124(4):483–92. <h3>Disclosure of Interest</h3> None declared

Of 234 patients with AIDS diagnosed at St. Stephen's Hospital between January 1981 and June 1987, 26 (11%) were found to have cryptosporidiosis. Stool examination was positive in all patients, but an average of three specimens (range 1-6) were required before a positive diagnosis was made. Other methods of diagnosis included jejunal and rectal biopsy and aspiration of the duodenal contents. Twenty three (89%) lived for six months from the time of diagnosis and 16 (60%) were alive at one year. Only five patients died as a direct result of cryptosporidial infection, while 10 other patients died from another complication of AIDS. Fifteen patients were enrolled in a prospective controlled study of erythromycin or spiramycin in the treatment of cryptosporidial diarrhoea. Most patients showed a significant response to antibiotic therapy but treatment was limited because of side effects. All patients responded to antidiarrhoeal agents, particularly long acting morphine sulphate. Three of our patients recently given zidovudine (AZT) have responded with a cessation of diarrhoea and cryptosporidia are no longer isolated from the stools.

Between February 1983 and April 1986 we studied peripheral blood and bone marrow samples from 20 patients with human immunodeficiency virus (HIV) related disease. 14 patients had AIDS, three had ARC, two had PGL and one had ITP as a sole manifestation of HIV related disease. Peripheral blood abnormalities included marked anisocytosis and poikilocytosis, rouleaux formation, neutropenia, lymphopenia, monocytopenia, a left shift in the granulocyte series and, in the patients with AIDS, vacuolated monocytes. The most frequent bone marrow abnormalities were reticuloendothelial iron block, dyserythropoiesis, megaloblastic change and erythroid hypoplasia. Excess histiocytes were noted in four marrows, one exhibiting haemophagocytosis. None of the bone marrows showed lymphopenia. Eight of the 20 marrows were difficult or impossible to aspirate. None of the trephine biopsies showed increased reticulin. The causes of these abnormalities are probably multiple and include opportunistic infections, drug therapy, immune mechanisms and possibly direct insult by the HIV virus.

OBJECTIVE: To evaluate the point prevalence of Hepatitis B in India. DESIGN: Meta-analysis of data on point prevalence from different parts of the country. DATA SOURCES: Searches were made in Medline, Cochrane Library and Best bets and previous reviews. A limited hand search of cross references was also done. Finally a consultation with experts was held to enlarge the references base. REVIEW METHODS: Studies reporting prevalence of HBsAg were selected. Data from high risk groups were excluded. MAIN RESULTS: 54 papers reporting data on 61 populations were identified. The true prevalence for each study was calculated from the reported prevalence using the specificity and sensitivity of the test employed. The true prevalence in non-tribal populations is 2.4% (95% CI: 2.2%-2.7%). True prevalence among tribal populations is 15.9% (CI: 11.4%-20.4%). CONCLUSION: These figures may be useful in estimation of the burden of the disease in the country and for projecting the cost-benefits of immunization.

BACKGROUND: For 10,000-40,000 women each year, cervical cancer complicates pregnancy. Current therapy usually terminates the pregnancy and results in the loss of future fertility. Abdominal radical trachelectomy is a fertility-preserving alternative to radical hysterectomy for young women with cervical cancer. CASES: We report five pregnancies complicated by cervical cancer treated by abdominal radical trachelectomy with preservation of the concurrent pregnancy and the birth of two healthy term infants. CONCLUSION: Pregnancy complicated by concurrent cervical cancer can be managed with abdominal radical trachelectomy during pregnancy while preserving future fertility.

To assess the effect of intravenous cidofovir on delaying progression of previously treated, relapsing cytomegalovirus (CMV) retinitis, we conducted a randomized, controlled comparison of two maintenance dose levels of cidofovir. One hundred and fifty patients with AIDS and CMV retinitis that had progressed or was persistently active despite treatment with ganciclovir, foscarnet, or both were randomized to receive induction cidofovir, 5 mg/kg once weekly for 2 weeks, then maintenance therapy with either 5 mg/kg or 3 mg/kg once every other week. Concomitant probenecid and intravenous hydration were administered with each cidofovir dose. Retinitis progression was assessed in the first 100 patients by bilateral, full-field retinal photographs read at a central reading center by an ophthalmologist masked to treatment assignment. Incidence of side effects, changes in visual acuity, and mortality were also assessed. Median time to retinitis progression as assessed by retinal photography was not reached (95% confidence interval [CI], 115 days-upper limit not reached) in the 5-mg/kg group, and was 49 days (95% CI, 35-52 days) in the 3-mg/kg group (p = .0006). Dose-dependent asymptomatic proteinuria (39%) and serum creatinine elevation (24%) were the most common adverse events thought to be related to cidofovir. Reversible probenecid reactions including constitutional symptoms and nausea occurred in 65 of 150 (43%) patients. Cidofovir therapy is effective in delaying progression of CMV retinitis that had previously progressed using other anti-CMV therapies.

The dermatological findings on examination of 13 patients with Aquired Immune Deficiency Syndrome (AIDS) and a further 40 who arc anti-HTLV III positive without AIDS, are presented. Six of the AIDS patients had Kaposi's sarcoma. Five AIDS patients and eight non-AIDS patients had seborrhoeic dermatitis. Two AIDS and eight non-AIDS patients have extensive folliculitis. Biopsy proven immune complex vasculitis developed in two AIDS patients shortly before death. One AIDS patient had acquired ichthyosis and another two developed asteatotic eczema and the fourth‘dry skin’. Fungal infection of the skin, angular cheilitis and a recent history of herpes zoster has also been commonly found. The authors believe that these various manifestations can be explained by low T cell immunity and the effects of severe chronic illness.

OBJECTIVE: To determine if a uterus can be retrieved for reproductive organ transplantation and to describe the surgical technique. METHODS: We participated in a local organ donor network retrieval team for over 6 months. Heart-beating, brain-dead multi-organ donors were identified through an existing donor network following routine protocols. RESULTS: After institutional review board and organ donor network approval of the uterus transplantation project, approximately 1,800 eligible organ donors were identified as required by legislation. Multi-organ procurement surgery took place in approximate 150 of these, with nine specifically consented for the uterus retrieval. Regularly performed multi-organ transplantation retrievals included the uterus without complications in eight donors. Pedicles used included the ovarian, uterine, or internal iliac vessels. After retrieval, serial histology sections throughout the period of cold ischemia, taken every 15-30 minutes, showed no signs of change over 12 hours of cold ischemia. CONCLUSION: The human uterus can be obtained from local organ donor networks using existing protocols. LEVEL OF EVIDENCE: III.

The electronic Hamiltonian for a general atom is obtained as far as terms in 1/c2 and m/MA by reducing a relativistic wave equation with four components for each electron and nucleon to an approximately relativistic form with two components per particle. The presence of non-Hermitian terms in the reduced Hamiltonian is explained. Relativistic corrections to the Coulomb and nuclear interactions and the effect of the intrinsic magnetic moments are treated by first-order perturbation theory. The electronic Hamiltonian is obtained in the centre-of-mass system of the atom. The hyperfine structure interaction is obtained by expressing all electron-nucleon terms as multipole expansions, giving the previously known hyperfine structure expansion with recoil corrections. The exact operator for the nuclear field effect in isotope shift is obtained from the Coulomb interaction. The presence of other corrections depending on nuclear structure is indicated. Terms referring only to s electrons are not considered as the reduction procedure used does not cover the contact approach of particles (cf. Ma 1956). The usual calculation of the normal mass effect in isotope shift is investigated for non-s-electron configurations and is shown to be justified if 0.1% of the spin-orbit interaction and the whole of the other relativistic perturbations are negligible in comparison with the term value.

Purpose Artificial Intelligence (AI) is an emerging technology and turned into a field of knowledge that has been consistently displacing technologies for a change in human life. It is applied in all spheres of life as reflected in the review of the literature section here. As applicable in the field of libraries too, this study scientifically mapped the papers on AAIL and analyze its growth, collaboration network, trending topics, or research hot spots to highlight the challenges and opportunities in adopting AI-based advancements in library systems and processes. Design/methodology/approach The study was developed with a bibliometric approach, considering a decade, 2012 to 2021 for data extraction from a premier database, Scopus . The steps followed are (1) identification, selection of keywords, and forming the search strategy with the approval of a panel of computer scientists and librarians and (2) design and development of a perfect algorithm to verify these selected keywords in title-abstract-keywords of Scopus (3) Performing data processing in some state-of-the-art bibliometric visualization tools, Biblioshiny R and VOSviewer (4) discussing the findings for practical implications of the study and limitations. Findings As evident from several papers, not much research has been conducted on AI applications in libraries in comparison to topics like AI applications in cancer, health, medicine, education, and agriculture. As per the Price law, the growth pattern is exponential. The total number of papers relevant to the subject is 1462 (single and multi-authored) contributed by 5400 authors with 0.271 documents per author and around 4 authors per document. Papers occurred mostly in open-access journals. The productive journal is the Journal of Chemical Information and Modelling (NP = 63) while the highly consistent and impactful is the Journal of Machine Learning Research (z-index=63.58 and CPP = 56.17). In the case of authors, J Chen (z-index=28.86 and CPP = 43.75) is the most consistent and impactful author. At the country level, the USA has recorded the highest number of papers positioned at the center of the co-authorship network but at the institutional level, China takes the 1st position. The trending topics of research are machine learning, large dataset, deep learning, high-level languages, etc. The present information system has a high potential to improve if integrated with AI technologies. Practical implications The number of scientific papers has increased over time. The evolution of themes like machine learning implicates AI as a broad field of knowledge that converges with other disciplines. The themes like large datasets imply that AI may be applied to analyze and interpret these data and support decision-making in public sector enterprises. Theme named high-level language emerged as a research hotspot which indicated that extensive research has been going on in this area to improve computer systems for facilitating the processing of data with high momentum. These implications are of high strategic worth for policymakers, library stakeholders, researchers and the government as a whole for decision-making. Originality/value The analysis of collaboration, prolific authors/journals using consistency factor and CPP, testing the relationship between consistency (z-index) and impact (h-index), using state-of-the-art network visualization and cluster analysis techniques make this study novel and differentiates it from the traditional bibliometric analysis. To the best of the author's knowledge, this work is the first attempt to comprehend the research streams and provide a holistic view of research on the application of AI in libraries. The insights obtained from this analysis are instrumental for both academics and practitioners.

Cryptosporidium spp., a common cause of diarrhea in children, were investigated in the first multisite study in India. Diarrheal stools from hospitalized children aged <5 years from Delhi, Trichy, and Vellore were analyzed by microscopy, PCR-restriction fragment length polymorphism (RFLP), and/or sequencing at the small-subunit (SSU) rRNA and Cpgp40/15 loci for species determination and subgenotyping, respectively. Seventy of 2,579 (2.7%) children, 75% of whom were <2 years old, had cryptosporidial diarrhea as determined by microscopy. Genotyping and subgenotyping showed that Cryptosporidium hominis was the most commonly identified species (59/67 children), and subgenotypes Ie, Ia, Ib, and Id were common in all centers. A novel C. parvum subgenotype, IIn, was identified in Vellore. Meteorological analysis revealed a higher rate of cryptosporidial positivity during hotter and drier weather in Delhi.

We report our experience of peripheral blood and bone marrow changes in patients with HIV disease. Abnormalities were most commonly seen in patients with advanced disease. In AIDS group IV patients (CDC classification) anaemia (92%) neutropenia (85%) monocytopenia (75%) and thrombocytopenia (61%) have their highest incidence, the reason being a combination of factors such as infection, myelosuppressive drugs and HIV infection itself. Bone marrow examinations were performed most commonly for microbiological culture (25%) and the investigation of anaemia (16%). Morphological changes in the bone marrow were non-specific and not pathognomic; however erythroid hypoplasia was found to be a distinctive feature associated with MAI infection. The procedure provided a high yield for microbiological culture, particularly in MAI infection.

OBJECTIVE: This retrospective study was conducted to determine the incidence of various complications of Plasmodium vivax malaria based on review of case records. METHODS: The case records of all confirmed cases of malaria over the period of one year (September 2005-August 2006) were studied. Complete blood count, peripheral blood findings, liver and kidney functions were reviewed. The results of rapid diagnostic test for malaria (OptiMAL test, Diamed AG, Switzerland) were correlated with the peripheral blood smear findings in the patients in whom it was requested. All abnormal results like a positive direct Coomb's test were noted. Findings were clinically correlated. RESULTS: There were 265 confirmed cases by peripheral blood examination. Of these 221 were due to Plasmodium vivax and 41 due to P. falciparum. Two cases had mixed infection and in one case the species could not be identified as it showed only malarial pigment. The peak incidence of malaria was seen in September 2005 and August 2006. The complications in P. vivax were thrombocytopenia, biochemical evidence of hepatic dysfunction, renal damage, positive DCT and death due to ARDS. Thrombocytopenia was seen in 213 patients with counts < 20 x 103/microl in 13 patients. Nine (4%) patients had serum bilirubin >3 mg/dl with normal liver enzymes. Liver enzymes were elevated in 60 patients with seven patients showing liver enzymes level, three times the normal. Renal dysfunction was seen in 17 patients with serum creatinine ranging from 1.3-10.65 mg/dl. One patient went into acute renal failure following quinine therapy and showed red cell fragments in the peripheral blood. In two children DCT was positive with the peripheral smear showing RBC agglutinates around the parasitised RBC. There were three maternal deaths at about 32 weeks gestation due to ARDS. The peripheral blood smear in these patients showed WBC agglutinates. CONCLUSION: This paper is presented to highlight that P. vivax malaria though considered to be a benign entity can also have a severe and complicated course which is usually associated with P. falciparum malaria.

BACKGROUND: Old age is often associated with functional decline and physical dependence, thus compromising the ability to carry out basic tasks required for daily living. There are very few community-based studies on functional disability among elderly, especially in India. This study was done to find out the prevalence of functional disability and associated risk factors among the elderly in urbanized villages of Delhi. METHODS: A cross-sectional study was conducted in two urbanized villages of East Delhi. A semi-structured interview schedule was used to record the socio-demographic and relevant personal details of the elderly (>60 years). Functional disability was defined as a disability in activities of daily living (ADL) or blindness or bilateral hearing impairment or a combination of these. Statistical analysis included simple descriptive analysis and tests of significance like Chi-square test. The multiple logistic regression was used to identify predictors of functional disability. RESULTS: Data were collected from 360 study participants. Around one-fourth (25.6%) of the study participants were having a functional disability. Older age, presence of chronic disease, and having possible malnutrition were found to be significant predictors of functional disability among the elderly by applying the multiple logistic regression. CONCLUSIONS: Functional disability needs to be identified at an early stage using appropriate tools so that proper interventions can be directed to those who need it to ensure healthy aging.