Sickle Cell Anemia is a common hematological disorder affecting children, mostly from indigenous tribal populations in Africa and India. There is no synthesized evidence to inform policy on its prevalence and distribution across India. Therefore, this systematic review and meta-analysis aims to estimate and summarize the prevalence of Sickle Cell Disease (SCD) and Sickle Cell Trait (SCT) among children aged < 18 years in India. Following standardized methods of systematic reviews, a comprehensive search of all major medical databases was performed. Through independent stepwise screening, ten eligible studies were included in the study. Original peer-reviewed studies reporting the prevalence of either SCD or SCT among Indian children below 18 years of age were included for subsequent methodological quality assessment and data extraction using predefined standardized tools. Random and fixed effects models for meta-analysis were used to arrive at summary estimates for prevalence with 95% confidence intervals. Subgroup analysis was performed among tribal and non-tribal children. The included studies used data from around 2 million participants in total. The pooled prevalence of SCD among children in India is 0.8% (95% CI: 0.6-1.0%) and that of SCT was 9.2% (95% CI: 8.5-10.0%).

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Introduction: SGLT2 inhibitors are a new class of drugs approved for type 2 diabetes (T2DM) and have been placed high in treatment algorithm following the robust data supporting their use. Aim: We studied the long term efficacy and safety of Canagliglozin (CANA) versus placebo in Indian adults with type 2 diabetes who were inadequately controlled with metformin (MET) monotherapy. Methods: The study was undertaken at Sevayan Diabetes Centre, India with due consent from participants. Patients (HbA1c 8-12%) on MET were invited to participate. Those on other antidiabetic drugs or insulin were excluded. The CANA arm was administered CANA 100mg OD in addition to MET. The other group received placebo (PBO) and MET. Doses of MET were kept unchanged throughout the study. Antihypertensive, statin and antiplatelets were continued unchanged. Participants were compared after 52 weeks of enrollment. Result: Data of 96 (M/F 62/34) subjects were available for analysis (n=46 on CANA, n=50 on PBO). Groups were similar at baseline. Pre-enrollment HbA1c (%), FPG (mg%) and PPG (mg%) in CANA and PBO arm were 9.94±1.04 and 9.89±1.1, 193.2±26.1 and 193.6±33.0 and 261.3±28.1 and 260.5±30.3 in order (p=NS for all). After 52 weeks of treatment, CANA arm showed clinically meaningful 1.61±1.05% reduction in HbA1c from baseline (p= 0.0048), whereas the PBO arm witnessed a non-significant elevation in HbA1c. Use of CANA significantly decreased FPG by 60.05±17.75mg% and PPG by 62.35±21.92 mg%, whereas the PBO group noticed no appreciable changes in those glycemic parameters. Mycotic infections were common in CANA users (n=6 vs. n=3 in PBO), but improved with personal hygiene. Incidences of documented hypoglycemia were similar in both groups (12 in each). Conclusion: In Indian diabetics uncontrolled with metformin monotherapy, addition of canagliflozin resulted in statistically significant and durable reductions in HbA1c, FPG and PPG over 52 weeks period. Participants tolerated CANA well without any additional risk of hypoglycemia. Disclosure H. Mahapatra: None. M. Khuntia: None. L. Mahapatra: None. S. Das: None. B. Jena: None. S. Mishra: None. R.K. Padhi: None. A.R. Jena: None. R.K. Khatua: None. A. Patwari: None. S.K. Pradhan: None. S. Biswal: None. S. Nayak: None. U.S. Mishra: None. A.K. Sahoo: None. Funding Jyoti Foundation

Background and aims: Achieving glycemic goals is crucial in the overall management of diabetes. Selecting the right medication for the individual patient is of paramount importance in the present day’s patient centric glucose control. Metformin is the first line and gold standard antihyperglycemic agent that can be offered to type 2 diabetics. Addition of a second or third agent or insulin should be considered in those whose HbA1c remains high despite the up-regulated metformin dose or those who do not tolerate metformin. We aimed to find the pattern of metformin use in type 2 diabetic subjects in a diabetes specialty centre in coastal Odisha. Materials and methods: This observational study was conducted in a diabetes setup in coastal Odisha in June 2018. After obtaining consent from patients, authors looked into the prescriptions of all type 2 diabetic adults. Subjects who were prescribed metformin (in any dose) were enrolled in the study. Those with established nephropathy, coronary artery disease, stroke or cancers were excluded. Results:There were 802 footfalls noted during the study period, of which 723 metformin taking participants (298 females, 41.2%) were considered for analysis (79 persons were excluded: not meeting inclusion criteria/ not willing to participate/ history of nephropathy/ CAD/ stroke). Mean age, diabetes duration, FPG, HbA1c, serum creatinine, eGFR of the study population were 51.6±10.6 years, 11.9±11.2 years, 138.7±51.7 mg/dl, 7.8±2.1%, 0.93±0.29 mg/dl and 96.5±11.1ml/min respectively. Patients were prescribed metformin in various doses, i.e., 500mg (42 patients, 5.8%), 850mg (47 patients, 6.5%), 1000mg (396 patients, 54.8%), 1500mg (13 patients, 1.8%), 1700mg (86 patients, 11.9%) and 2000mg (130 patients, 18.0%), and 2500mg (9 patients, 1.2%). Metformin was prescribed as monotherapy (n=34, 4.7%) or along with other OADs (n=589, 81.5%) or in combination with insulin (n=178, 24.6%). Retrospective analysis of the medical records and further questioning revealed that gastric intolerance was the commonest reason for withdrawal of metformin in otherwise eligible subjects. Conclusion: Metformin was the most commonly prescribed antidiabetic drug and the daily dose of more than 85% of the metformin administered individuals was 1000mg or above.

Introduction- Perinatal hypoxia leading to hypoxic-ischemic encephalopathy (HIE) is a leading cause of neonatal and under 5 mortality across the world and in India. There are wide regional and social variations in the risk factors associated with HIE and this study was conducted to assess the maternal & fetal risk factors in newborns with moderate to severe HIE. Methodology- This was a case-control study at the SNCU of MKCG Medical College and Hospital in southern Odisha where 100 cases of HIE and 100 matched controls were recruited over a period of 2 years. Data on maternal, antenatal, intrapartum, and post-delivery risk factors were collected from medical records and history taking using a pre-defined proforma. Comparative bivariate analysis was done to assess the strength of association of these risk factors between the two groups.  Results- The incidence of HIE is more in 20-30 years age group, however, risk of HIE is significant in <20 years age group. Maternal anemia is a significant risk factor but Bad Obstetric History (BOH) has only clinical correlation. There is no statistical significance for antepartum hemorrhage (APH), pregnancy-induced hypertension (PIH) or gestational diabetes mellitus (GDM) in cases of HIE.