Letter to Editor

International Journal of Health & Allied Sciences Vol. 2 Issue 3 Jul-Sep 2013 220
TCP. Direct binding assays for IgG or complement on the
platelet surface are very useful.
[7]
Most patients recover
within 7-10 days and do not require therapy, occasional
patients with platelet counts below 20,000/cu mm have
severe hemorrhage and may require temporary support
with glucocorticoids, plasmapheresis, platelet transfusions
or immunoglobulin. Reuse of the offending drug has to
be avoided in the future since only minute amounts of the
drug are needed to set up subsequent immune reactions.
In conclusion, this report describes a rare case of INH and
rifampicin induced TCP in a patient taking anti-tubercular
drugs observed on daily as well as intermittent regime.
However, are there any synergistic effect of both the drugs
in causing TCP, is a domain for further evaluation. Since
the patient had intolerance to two major anti-tubercular
drugs, he was counseled and started on second-line drugs
reflecting motivational and compliance challenge of
extended duration of treatment.
ACKNOWLEDGMENT
Department of TB and Respiratory Diseases, Pt. B.D. Sharma,
PGIMS, Rohtak - 124 001, India.
Ruchi Sachdeva, Sandeep Sachdeva
1
Departments of TB and Respiratory Diseases, and
1
Community Medicine, Pt. B.D. Sharma, Postgraduate Institute of
Medical Sciences, Rohtak, India
Address for correspondence:
Dr. Ruchi Sachdeva,
Department of TB and Respiratory Diseases, Pt. B.D. Sharma,
Postgraduate Institute of Medical Sciences, Rohtak - 124 001, India.
E-mail: drsachdeva@hotmail.com
REFERENCES
1. Wazny LD, Ariano RE. Evaluation and management of drug-induced
thrombocytopenia in the acutely ill patient. Pharmacotherapy
2000;20:292-307.
2. George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osborne
S, et al. Drug-induced thrombocytopenia: A systematic review of
published case reports. Ann Intern Med 1998;129:886-90.
3. Banu Rekha VV, Adhilakshmi AR, Jawahar MS. Rifampicin-induced
acute thrombocytopenia. Lung India 2005;22:122-4.
4. Lee EJ, Lee SH, Kim YE, Lee SJ, Cho YJ, Jeong YY, et al. A case of
isoniazid-induced thrombocytopenia: Recovery with immunoglobulin
therapy. Intern Med 2012;51:745-8.
5. Drews RE. Critical issues in hematology: Anemia, thrombocytopenia,
coagulopathy, and blood product transfusions in critically ill patients.
Clin Chest Med 2003;24:607-22.
6. Mi nt zer DM, Bi l l et SN, Chmi el ewski L. Dr ug- i nduced
hematol ogi c syndromes. Adv Hematol . 2009;2009:495863.
doi: 10.1155/2009/495863.
7. Di Berardino L, Perna G, Silvestri LG. Antibodies against rifampin in
patients with tuberculosis after discontinuation of daily treatment. Am
Rev Respir Dis 1976;114:1189-90.
8. Ferguson GC. Rifampicin and thrombocytopenia. Br Med J 1971;
3:638.
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DOI:
10.4103/2278-344X.120598
Ten year trend of sex
ratio at birth in a public
hospital of an indian
state with known
skewed sex ratio
Sir,
In all human populations, there is a fairly stable sex
ratio at birth (SRB), which is approximately 104 to 106
boys per hundred girls. Hypothetically, this is a natural
mechanism to circumvent increased male fetal loss than
female fetuses during gestation. Evidences suggest that
unless there is conscious intervention by humans, the
SRB will not change even over a century.
[1]
This is has
been found to be true in most of the developed countries.
In a study from USA (1975-2002), M/F sex ratio of live
birth was 1.05.
[2]
The disparity between male and female births was
observed for the first time in 1662 by John Graunt and
has been the object of scientific curiosity ever since.
[3]

SRB is an important demographic indicator that has
been distorted in some regions of the world, especially in
Asia due to strong son preferences and widely prevalent
sex selective practices. In context of India, A study from
large hospitals of Delhi (1993-2002) reported SRB as 1.15
and another from Jabalpur showed that M:F ratio was
1.12 with 888 females/1000 males.
[4,5]
In contrast, data
from a govt. medical college in Kerala revealed SRB as
958 girls/1000 males.
[6]
SRB for the state of Haryana
hovered between 837 to 848 (2004-10) according to
population estimates of sample registration system, far
below the national average of 905 girls/1000 boys.
[7]

According to Civil Registration System (CRS) with 96%
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Letter to Editor
International Journal of Health & Allied Sciences Vol. 2 Issue 3 Jul-Sep 2013 221
birth registration in the state of Haryana (total births:
5,63,556) during 2011, SRB stood at 833 girls/1000
boys. Similarly, child (0-6 years) sex ratio according to
Census-2011 has been low and alarming i.e. 914 for India,
830 (Haryana) and 807 for Rohtak, which is in contrast
to high favorable figure in the southern state of India i.e.
Kerala (959 girls/1000 boys).
[8]
Northern states of India particularly Punjab, Haryana,
Delhi, Jammu and Kashmir have a skewed sex ratio
unfavorable for females. With this background, present
study was undertaken to analyze time trend of sex ratio
at births (SRB) occurring in a government teaching
hospital of Haryana. This cross-sectional, retrospective,
record-based study was carried out in a government
medical college hospital of northern India that caters
to an average daily out-patient (OPD) attendance of
5000 patients of rural and urban background, mainly
from lower/middle socio-economic strata of the society
and supported by 1750 in-patient beds with more than
80,000 annual admissions. Till recently, this was the
only public-funded referral institute of the state. Due
to non-establishment of electronic health management
information system (HMIS) in the institution, monthly
abstracts of live births of 10 calendar years (2002-2011)
were extracted manually by investigators from log books
maintained in the labor room during Jan-Mar 2012, and
data management was done using MS excel sheet. Still
births were not included in this study.
Total live births during the reference period ranged from
5830 to 9165, suggesting increased institutional deliveries
over the years due enhanced promotion for the same in
the country. Sex ratio at birth is shown in Table 1. M:F
ratio ranged from 1.14 to 1.22. Pooled result of 76,179
births for the reference period suggested that there were
837 girls/1000 boys. The proportion of male births was
consistently found to be higher over a 10 year time-frame
[Figure 1].
To conclude, answer for a social problem lies in identifying
and effectively implementing biological, social, medical,
and legal solutions. The institutional study may not be
reflection of community, but it does mirror the situation
to an extent. We acknowledge few limitations as there was
no information on other co-variables, and also it has been
documented that sample size of birth observations should
be more than 100,000 to obtain robust SRB within narrow
95% confidence range.
[9]
ACKNOWLEDGMENT
Authors wish to thank staff from the department of Obstetrics and
Gynecology, and Pediatrics, PGIMS, Rohtak, India.
Sandeep Sachdeva, Smiti Nanda
1
, Ruchi Sachdeva
2
Departments of Community Medicine,
1
Obstetrics and
Gynecology, and
2
Respiratory Medicine,
Pt. B. D. Sharma, PGIMS, Rohtak, India
Address for correspondence:
Dr. Sandeep Sachdeva,
Department of Community Medicine,
Pt. B. D. Sharma, PGIMS, Rohtak, India.
E-mail: drsachdeva@hotmail.com
REFERENCES
1. Visaria L. Defcit of women in India: Magnitude, trends, regional
variations and determinants. Natl Med J India 2002;15(Suppl 1):19-25.
2. Egan JF, Campbell WA, Chapman A, Shamshirsaz AA, Gurram P,
Benn PA. Distortions of sex ratios at birth in the United States; evidence
for prenatal gender selection. Prenat Diagn 2011;31:560-5.
3. Graunt J. Natural and political observations made upon the bills of
mortality. London: Gregg International Publishers Limited; 1973.
4. Varghese J, Aruldas V, Jeemon P. Analysis of trends in sex ratio at
birth of hospitalized deliveries in the state of Delhi. New Delhi: Christian
Medical Association of India; 2005.
5. Gupta SK, Pal DK, Tiwari R, Gupta P, Agrawal L, Sarawagi R. A
descriptive study on the sex ratio at birth in institutional deliveries at
Jabalpur, Madhya Pradesh, India. J Clin Diag Res 2011;5:1219-23.
6. Child sex ratio in Kerala-a report. Available from: http://www.
socialsecuritymission.gov.in [Last accessed on 2012 Jul 30].
Table 1: Sex ratio at birth in a government teaching
hospital, Rohtak, 2002-11
Year Male birth Female birth M:F ratio F/1000 M
2002 3244 2586 1.25 797
2003 3453 3017 1.14 874
2004 3512 3075 1.14 876
2005 3822 3170 1.20 829
2006 4008 3502 1.14 874
2007 4314 3560 1.21 825
2008 4388 3777 1.16 861
2009 4541 3664 1.23 807
2010 5140 4241 1.21 825
2011 5046 4119 1.22 816
Total 41468 34711 1.19 837
0
1000
2000
3000
4000
5000
6000
1 2 3 4 5 6 7 8 9 10
B
i
r
t
h
s
Years
m
f
Figure 1: Births according to gender in a government
hospital, Rohtak (2002-2011)
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Letter to Editor
International Journal of Health & Allied Sciences Vol. 2 Issue 3 Jul-Sep 2013 222
7. Sample Registration System: 2010/12. Available from: http://www.
planningcommission.nic.in/data/datatable/0904/tab_125.pdf. [Last
accessed on 2012 Jul 30].
8. Census 2011. Provisional population totals. Offce of the Registrar
General and Census Commissioner, India. New Delhi: Ministry of
Home Affairs; 2011. Available from: http://www.censusindia.gov.in
[Last accessed on 2012 Jan 26].
9. Visaria PM. Sex ratio at birth in territories with a relatively complete
registration. Eugen Q 1967;14:132-42. A Chahnazarian. Historical trends
in the sex ratio at birth. Available from: https://www.jscholarship.library.jhu.
edu/./1774./WP90-01_Sex_Ratio.pdf [Last accessed on 2012 Feb 20].
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