Anaemia and Iron studies among women of reproductive age group: A Cross-sectional survey of a Large Cantonment in Western Maharashtra

Background: Anaemia remains a major cause of concern among the women of reproductive age in our country. However, there is a wide variation amongst different socio-economic strata. Aim & Objectives: This study was conducted among women of reproductive age for prevalence of anaemia and its association with certain socio-clinical variables in cantonment. Methods: It was a cross-sectional study. The information regarding socio-demographic variables, anthropometric measurements and clinical parameters were taken. Hemogram and iron profile was done by collecting venous blood from the participants. Results: Data was analyzed for 722 participants. There were 140 (20.2% (95% CI: 17.2 – 23.3)) non-pregnant women of reproductive age-group having anemia. Out of these 140, mild, moderate and severe anaemia was seen in 57(40.7%), 77(55%), 06(4.3) respectively. The major factors associated with anaemia were heavy menstruation and higher parity. Amongst these 140, iron deficiency anaemia was diagnosed in 135 (96.7%). Among the 28 pregnant women, eight were anaemic (28.6: 95% CI 19.1-63.9). Conclusion: The results of our study showed lower prevalence of anaemia than national level and majority of these were iron deficiency anaemia, which is amenable to prevention and treatment

MR imaging in spinal cord/ canal tumors

Introduction: A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and spinal column, can cause significant morbidity and can be associated with mortality as well accounts for approximately 15% of cranio-spinal tumors. Aim: The present study was designed to determine the predictive value of Magnetic Resonance Imaging in diagnosing intra spinal tumors and to correlate findings on Magnetic Resonance Imaging with Pathological diagnosis. Materials and methods: This prospective study was conducted in Osmania General Hospital from 2009 to 2012 over a period of 3 years. The study group included 40 patients. In all patients, data on history, clinical examination and clinical diagnosis was obtained. MRI was performed on a 1.5 Tesla electromagnet (GE Company). The primary pulse sequences included T1 and T2W1 using spin echo and gradient echo techniques. The MR morphology was correlated with surgical and histopathological features. Results: The patients had age groups ranging from 2 years – 60 years with a mean age of 33 years. Twenty eight were males and twelve were females. The most commonly encountered symptoms were neurological deficit in 33, sensory loss in 25, bowel and bladder dysfunction in 20 and pain in 13 patients. Of the forty intra dural tumors, 28 were extra medullary and 12 were intra medullary present. Most of the tumors were located in the cervical and the dorsolumbar spine accounting for more than 50%. The most common tumor encountered in our study was schwannoma (22/40), followed by ependymoma (7/40), meningioma (4/40), astrocytoma (4/40), one each of Dermoid, arachnoid cyst and round cell tumor. The most commonly located in cervical, Cervicodorsal position (20), followed by lumbar (8), dorsolumbar (5), dorsal (5) and cervicolumbar (1), lumbosacral (1). MRI features of forty patients with intra dural tumors were studied and their signal intensities were correlated with the pathological findings. MRI diagnosis of intra dural tumors was correct in 34 of the 40 tumors. Contrast was useful for better delineation of the tumor and its characterization. However the different types of tumors could not be differentiated by their degree of contrast enhancement. Aithagani Rama Chandraiah, D Ravi Chander, Sunita Bajaj. MR imaging in spinal cord/ canal tumors. IAIM, 2016; 3(11): 18-26. Page 19 Conclusion: Magnetic Resonance Imaging was found to be a highly sensitive imaging procedure and the method of choice for intra spinal tumors. Contrast was useful for better delineation of the tumor and its characterization.

Computerized tomography guided percutaneous transthoracic fine needle aspiration of lung lesions

Introduction: Computed tomogram guided fine needle aspiration cytology (FNAC) is an important and useful investigation to differentiate between benign and malignant lesions of lungs. With computed tomography (CT) it is possible to perform a biopsy on almost any portion of lung with high degree of safety and minimal morbidity avoiding more invasive techniques. Aim: The present study was designed to assess the efficacy of CT guided fine needle aspiration of lung lesions and to assess the incidence of complications. Materials and methods: 65 cases of both sex and varying age groups referred to radiology department for CT guided lung FNAC from October 2012 to January 2013 were included in this study. Relevant clinical history and investigations were obtained from the patient. Informed and written consent was taken from the patient. The lesions were localized by CT scan and after the needle tip was confirmed to be in the desired location, aspirations were performed. Results: A total 65 cases, 53 cases were male and 12 cases were female with mean age 49.23 years. The most common diagnosis observed following biopsy was malignancy (non small cell carcinoma) in 41 cases (63%), benign lesion in 6 cases (9%) and 3% showed mixed lesions. Among 65 cases, 49 cases (75%) showed adequate material in the aspirate specimen, where as 12 cases (18.4%) showed inadequate tissue for diagnosis. However 4 cases were lost on follow up. Complications observed during procedure include pneumothorax in 11 cases (16.9%) and hemoptysis/pulmonary hemorrhage in 2 cases (3%). Conclusion: CT guided FNAC is well recognized procedure with good efficacy for evaluation of pulmonary lesions with minimal complications, most common being pneumothorax followed by hemoptysis.

Study of the association of metabolic syndrome with schizophrenia in north eastern part of India.

Background: During last several years there has been growing interest in metabolic abnormalities in Schizophrenia. Studies in this context are lacking in this part of India. Aims & Objective: To study the association of metabolic syndrome with schizophrenia in North eastern part of India. Material and Methods: 50 Adult schizophrenic patients diagnosed as per DSM-IV TR Criteria and age and sex matched 50 subjects of control group were included in for prevalence of MetS as per the criteria of the International Diabetes Federation (IDF). Informed consent was obtained. The study was approved by local ethical committee. Results: Maximum numbers of subjects were in the age group 21-30 years and males were more than female in schizophrenia group. 14 (28%) patients in schizophrenia group and 6 (12%) subjects in control group had MetS. The mean Serum triglyceride of schizophrenia (153.41 ± 57.26) was significantly higher (p<0.05). Mean BMI of schizophrenia (22.55 ± 4.19) was higher as compared to control group (22.30 ± 3.35). 38 patients (76%) were taking antipsychotics for more than 6 months of duration, in which 14 patients (28%) were found to be having MetS while 24 patients (48%) had no MetS. 2nd generation antipsychotics were taken by 35 patients (70%) in which 14 patients (28%) were found to have MetS while 21 patient (42%) had no MetS. Conclusion: This study showed that prevalence of MetS, risk factors, was more in schizophrenia than control group and it was present more commonly in patients taking second generation antipsychotics.

A case-control study on insulin resistance, metabolic co-variates & prediction score in non-alcoholic fatty liver disease.

Background & objectives: Asian Indians have a high prevalence of insulin resistance and the metabolic syndrome. Currently, non-alcoholic fatty liver disease (NAFLD) is considered to be an integral part of the metabolic syndrome with insulin resistance as a central pathogenic factor. We studied anthropometric parameters, insulin resistance and metabolic co-variates in subjects with NAFLD as compared to those without NAFLD, and also developed a prediction score for NAFLD. Methods: Thirty nine subjects with NAFLD and 82 controls were selected for the study after ultrasonography of 121 consecutive apparently healthy subjects. Anthropometric profile [body mass index (BMI), waist circumference (WC) etc,], lipid profile, hepatic aminotransferases, fasting blood glucose (FBG), insulin were recorded and value of homeostasis model assessment of insulin resistance (HOMA-IR) was analysed. Step-wise logistic regression analysis and area under the receiver operator curve (aROC) were analysed to arrive at a prediction score. Results: Overall, prevalence of NAFLD was 32.2 per cent and prevalence of metabolic syndrome was seen in 41 per cent among cases and 19.5 per cent in controls (P<0.01). Subjects with NAFLD had significantly higher values of BMI, WC, hip circumference, FBG, fasting insulin, total cholesterol and serum triglycerides. Step-wise logistic regression analysis showed odds ratio (OR) and 95 per cent confidence interval (CI) for BMI [ 4.3 (1.6, 11.3)], FBG [5.5 (1.5, 19.8)] and fasting insulin [ 2.4 (1.0, 5.8)] as independent predictors of NAFLD. The prediction score for NAFLD was; 1 (fasting insulin) +1.6 (BMI) + 1.9 (FBG) (sensitivity of 84.6%, specificity of 51.2% and aROC 76%). Interpretation & conclusion: In this study, presence of NAFLD indicated close relationship with multiple features of metabolic syndrome. The prediction score developed could be used as a screening tool to predict NAFLD among Asian Indians in north India.

Bilateral retinoblastoma in early infancy: a case report.

Retinoblastoma is the most common primary intraocular tumour of childhood. Though congenital, it is not diagnosed at birth, and is usually seen between 1-2 years of age. We here report a case of bilateral retinoblastoma with early presentation at the age of one month.

Augmentation of non-specific immunity in mice by gold preparations used in traditional systems of medicine.

BACKGROUND & OBJECTIVES: Gold preparations are highly valued in Indian systems of medicine and extensively used for tonic and rejuvenating properties. This study was aimed to evaluate the effects of Ayurvedic gold preparation Swarna Bhasma (SB) and Unani preparation Kushta Tila Kalan (KTK) on non-specific immunity in mice. A gold-containing drug auranofin (AN) used in modern medicine was studied for comparison. METHODS: Male mice were administered with the incremental doses of these drugs orally for 10 days. Parameters of study included body weight, organ weight, peritoneal exudate cell (PEC) counts and phagocytic activity of PEC. RESULTS: Both test drugs (KTK and SB) significantly (P < 0.001) increased counts of peritoneal macrophages and stimulated phagocytic index of macrophages. AN elicited a suppressive action on these parameters. INTERPRETATION & CONCLUSION: Traditional preparations of gold exhibited immunostimulant activity on macrophage functions in contrast to immunosuppressive effects of AN. This is an interesting observation and gives a rational basis to the claims of efficacy and safety of gold when used in calcined forms.

Influence of education and occupation on knowledge about diabetes control.

BACKGROUND: A global epidemic of diabetes has been predicted during the first quarter of the twenty-first century, with a substantial increase in its prevalence in India. Good management of diabetes is a necessary step towards its control and blood glucose testing forms an integral part of this. This study was undertaken to assess the importance of education and occupation in relation to knowledge about good control of diabetes. METHODS: Perception patterns regarding methods for testing blood glucose and metabolic control were assessed by the direct interview method in 793 patients with type 2 diabetes. Patients' knowledge levels were compared for different educational and occupational categories using the Normal test (z-test) and the Student's t-test. RESULTS: The difference between the mean ages of men and women diabetics was not significant (p > 0.1). It was found that 46.7% of the subjects were aware of the importance of blood glucose testing. Awareness regarding the importance of microalbuminuria, lipid profile and glycosylated haemoglobin was observed in 24.1%, 15.5% and 7.6% of patients, respectively. A positive impact of education on overall knowledge levels was observed. However, no definite relationship was found between knowledge and occupation. CONCLUSION: There was a total lack of knowledge regarding self-care of diabetes in all educational and occupational categories (including patients who were qualified doctors). This calls for an urgent need to create greater public awareness. This study may serve as a guideline for developing an educational package for different subsections of the community.

Disseminated tuberculosis causing bilateral adrenal enlargement and Addison's disease.

The clinical features and computed tomography imaging of a patient with acute adrenal failure following disseminated tuberculosis is described.

Adrenocortical reserve and morphology in tuberculosis.

Ninety seven patients (63 males, mean age 31.8 years, SD 2.3) with various forms of tuberculosis were studied. All of them were HIV negative. Thirty normal control subjects (16 males, mean age 36.4 years, SD 1.8) were also studied. Fifty-eight of the 97 patients (59.8%) were malnourished (BMI < 18 kg/m2). The mean basal serum cortisol was lower in the TB group (n = 91) (351 nmol/1; SD 150) as compared to the normal control group (n = 8) (402 nmol/1; SD 93) but this difference did not attain statistical significance. Following administration of synthetic ACTH (cosyntropin), the 30 and 60 minutes mean serum cortisol values in the TB group were significantly lower as compared to the normal control group (p < 0.05). Forty five of the 91 patients (49.5%) who underwent the ACTH stimulation test had compromised adrenal reserve. Fourteen of the 86 patients (16.3%) in whom adrenal morphology was studied revealed adrenal gland enlargement on abdominal CT scan. ACTH stimulation was done in 12 of these 14 patients and eight of them had compromised adrenal reserve. Repeat ACTH stimulation done six months to one year after treatment in 13 patients revealed significantly increased 30 minutes (p < 0.05) and 60 minutes (p < 0.05) serum cortisol values. While nine of these 13 patients were negative responders before treatment, only three of them had evidence of compromised adrenal reserve after one year of antituberculosis treatment, (p < 0.05). Serum cortisol values in patients with drug-sensitive and drug-resistant tuberculosis did not differ significantly. Patients with drug-resistant tuberculosis had a higher prevalence of adrenal gland enlargement (7 of the 30) as compared to those with drug-sensitive tuberculosis (7 of the 56) (p = NS). Subclinical adrenal insufficiency is prevalent in a significant number of patients with both drug-sensitive and drug-resistant tuberculosis, and in some of these it is associated with adrenal gland enlargement. The compromised adrenal reserve and enlargement seem to reverse with therapy.

Analgesic activity of gold preparations used in Ayurveda & Unani-Tibb.

Calcined gold preparations, Ayurvedic Swarna Bhasma (SB) and Unani Kushta Tila Kalan (KTK) were investigated for analgesic effects in rats and mice using four types of noxious stimuli. Auranofin (AN) used in modern medicine was also studied for comparisons. The test drugs SB and KTK (25-50 mg/kg, p.o.) and AN (2.5-5.0 mg/kg, p.o.) exhibited analgesic activity against chemical (acetic acid induced writhing), electrical (pododolorimeter), thermal (Eddy's hot plate and analgesiometer) and mechanical (tail clip) test. While the analgesic effects of SB and KTK could be partly blocked by pretreatment with naloxone (1-5 mg/kg, i.p.,--15 min), such antagonism was not discernible with AN at the doses used. Involvement of opioidergic mechanism is suggested for the observed analgesic activity.