Assessment of quality-of-life in cancer patients at tertiary care hospital in North India

Introduction: Cancer is a disease that emerges as a result of abnormal cell proliferation and their propensity to spread from one bodily region to another. There are over a hundred different types of cancer that impact individuals all over the world. It is difficult to identify in the early stages, but there are certain warning signals that the cells will turn malignant. Quality of life (QOL) is described by the World Health Organisation as "individuals' perception of life, values, objectives, standards, and interests within the cultural framework of the social environment in which they live and in relation to their goals, expectations, standards, and concerns." QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual. Aim and Objective: To assess socio-demographic factors and quality of life among cancer patients in tertiary care hospital. Materials and Methods: A hospital-based prospective observational study was conducted at Guru Gobind Singh Medical College and Hospital Faridkot district, Punjab (India). The study was conducted for a period of six months after getting approval from Institutional Ethical Committee (IEC). Generic instrument, SF-36 was used to assess the QOL. The study was analyzed on SPSS version 26.0 software. Descriptive and analytical analysis was used to describe the results. Results: Linear regression was conducted to see the relationship of physical functioning score with age and weight of the patients. The descriptive statistics shows the mean and standard deviation of the variable. The mean of physical functioning score was found to be (M = 27.82, SD = 15.635). The physical functioning score and age, weight of the patients in linear regression shows that the age and weight explain 17.5% Conclusion: Treatment revealed that severe and moderate activities restricted nearly half of the assessed patients, with body pain interfering with employment and routine activities. According to the findings of the current study, QOL deteriorates as the disease progresses. Cancer unquestionably has a detrimental influence on patients' quality of life, which is connected to the illness process itself, the therapy administered, and the length of the disease. (AU)

Inadequate vitamin D level: association with low energy fractures of distal radius in young patients and its predictors in Karachi, Pakistan

Background:The objective of the study was to determine association of inadequacy of vitamin D level with low energy fractures of distal radius and its predictors in young patients in Karachi Pakistan. Methods:Cross-sectional study was conducted on 220 young patients, visited hospital with low energy fracture of distal radius.A questionnaire was designed and filled after taking consent includes details regarding age, gender, occupation, area of skin and sun exposure duration, dietary habits, type of clothing and residence used. Serum Vitamin D3 levels were determined and compared with serum calcium levels, serum phosphorus and alkaline phosphatase levels.Results:Among 220 patients ranging from 12-45 years, mean 28±23.33SD. Female were 172(78.18%). Mostly have history of fall 127(57.72%)and RTA 63(28.63). Sun exposure duration in majority of participant was 1-2 hour/day 132(60%). Variable coloured clothes used by majority participant 135(61.36%) and variable fabric 102(46.36%). 202(91.8%) patients had deficiency of vitamin D and correlated with duration of sunlight exposure significantly, also with exposure of large skin area, dietary consumption of vitamin D rich food and worn variable clothing colours. Serum phosphorus level and serum alkaline phosphatase level were negatively correlated with vitamin D significantly whereas positively correlated with serum calcium.Conclusions:Prevalence of vitamin D deficiency is very high in low energy fracture of distal radius in young populationand sun exposure duration found to be most common predictor of inadequate D levels. A national food fortification program and campaign of public awareness to increase sunlight exposure and increase intake of vitamin D rich food are urgently needed.

A pharmacological study on the effect of calendula officinalis extract on wound healing in animals

Background: Calendula officinalis is one of those plants which have medicinal importance due to its flowers (HECO) has pharmacological activity the important pharmacological parameters have been less investigated properly and can be scientifically proved by reverse pharmacology. It was found of interest to evaluate these properties of extract of flowers of Calendula officinalis.Methods: Study was conducted in Albino Wistar rats. For evaluating wound healing activity Excision wound model and Incision wound mode were used containing 4 groups each. The wound contraction was studied by tracing the raw wound area on graph paper. Scar area and time for complete epithelisation were measured. The percentage of wound contraction was recorded. The differences between experimental groups were compared by ANOVA followed by Students “t” unpaired test.Results: In the excision wound healing model, 5% and 10% flowers showed a highly significant reduction in wound area as compared with control. In incision wound model, rats treated with 5% and 10% ointment of Calendula officinalis flowers extract showed highly significant increase in tensile strength as compared to control.Conclusions: It was found that the Calendula extract enhanced the wound healing in both the models as seen by increased synthesis of connective tissue especially collagen. There was a significant increase in the granuloma tissue. In both the models wound contraction and increased tensile strength was found to be statistically significant.

Re-Modelling of North Indian Talus: A Pressure Effect of Squatting Position

Background: Anatomical variations of the skeleton provide information on daily activities, living conditions, cultural behaviour and health problems of any society. Squatting is a good example of such behaviour/function producing skeletal markers due to remodelling, on the bones of lower limb by putting strong pressure and traction forces on the knee and ankle joints. It is associated with modifications of the neck of the talus (squatting facets) and its trochlear- malleolar surfaces (trochlear extensions). Methods: An observational analytical study was designed to observe anatomical variations in 616 dry, macerated human tali of both sides in north Indian population where squatting is a part of regular behaviour. Differences in the form and extent of this facet, trochlear extensions or articular (malleolar) extensions may be noted. Results: The frequency of occurrence of these facets and extensions has been found to vary considerably in different races. A much more pronounced forward prolongation has been found to be present in the north Indian talus in this series. A high frequency of forward prolongation of medial articular surface in Indian population suggests that, not only the squatting posture and habitual sartorial posture (palthi position/ tailor position) but the prevalence of walking for long distances may be responsible for this. Conclusion: The results provide an opportunity to study the relationship between past and modern population, and also describe the daily activity of life and cultural structure. Anatomical variations of the neck of the talus (squatting facets) and its trochlear- malleolar surfaces (trochlear extensions) can be of help in pathologies of foot for reconstruction and rehabilitation procedures. It will also provide ethnic data for anthropologists and forensic experts about talar variations and would be of direct relevance in anatomy teaching

Exogenous application of putrescine at pre-anthesis enhances the thermotolerance of wheat (Triticum aestivum L.).

Antioxidant enzymes, besides being involved in various developmental processes, are known to be important for environmental stress tolerance in plants. In this study, the effect of treatment of 2.5 mM putrescine (Put), heat stress (HS -42°C for 2 h) and their combination on the expression and activity of antioxidant enzymes was studied at pre-anthesis in the leaves of two wheat (Triticum aestivum L.) cultivars — HDR77 (thermotolerant) and HD2329 (thermosusceptible). We observed that 2.5 mM Put before HS significantly enhanced the transcript levels of superoxide dismutase (SOD), catalase (CAT), cytoplasmic and peroxisomal ascorbate peroxidase (cAPX, pAPX) in both the cultivars. However, the activities of antioxidant enzymes (SOD, CAT, APX and GR), as well as accumulation of antioxidants (ascorbic acid and total thiol content) were higher in HDR77 than in HD2329 in response to the treatment 2.5 mM Put + HS. No significant change was observed in the proline accumulation in response to HS and combined treatment of 2.5 mM Put + HS. A decrease in the H2O2 accumulation, lipid peroxidation and increase in cell membrane stability (CMS) were observed in response to 2.5 mM Put + HS treatment, as compared to HS treatment alone in both the cultivars; HDR77 was, however, more responsive to 2.5 mM Put + HS treatment. Put (2.5 mM) treatment at pre-anthesis thus modulated the defense mechanism responsible for the thermotolerance capacity of wheat under the heat stress. Elicitors like Put, therefore, need to be further studied for temporarily manipulating the thermotolerance capacity of wheat grown under the field conditions in view of the impending global climate change.

Characterization of differentially expressed stress-associated proteins in starch granule development under heat stress in wheat (Triticum aestivum L.).

Abiotic stress causes abrupt increase in the expression of stress-associated proteins, which provide tolerance by modulating the defense mechanism of plants. Small heat shock proteins (sHSPs) and anti-oxidant enzymes are important for environmental stress tolerance of the plants. In this study, two full-length cDNAs encoding small heat shock protein (sHSP) and superoxide dismutase (SOD), designated as TasHSP and SODI were identified and characterized from C-306 (thermotolerant) and PBW343 (thermosusceptible) cultivars of wheat (Triticum aestivum L.). An alpha crystalline domain was observed in TasHSP and manganese/iron binding domain in case of SODI. Quantitative real-time PCR showed very high transcript level of TasHSP and SOD in C-306 compared to PBW343 at different stages of growth and against differential heat stress (HS). Under differential HS at milky-dough stage, the fold change in transcript of both TasHSP and SOD was observed maximum in C-306, compared to PBW343. Protein profiling and isoenzymes analysis showed the expression of several heat-stable proteins and prominent isoenzymes of SOD in C-306, compared to PBW343. Scanning electron microscopy (SEM) of starch granules showed globular, well-shaped and more numbers of endospermic cells in C-306, compared to defragmented, irregular shaped and shrunken granules in case of PBW343 under HS treatment (42°C for 2 h). Diurnal change in soluble starch synthase (SSS) activity showed an increase in the activity during afternoon (35°C), compared to morning (29°C) and evening (32°C) in both the cultivars. Under heat stress (42°C for 2 h), a drastic decrease in the SSS activity was observed, due to the thermal denaturation of the enzyme. Thermotolerance capacity analyzed using cell membrane stability (CMS) showed significantly higher CMS in case of C-306, compared to PBW343 at different stages of growth. Findings suggest that abundance of TasHSP and SODI during milky-dough stage plays a very important role in starch granule biosynthesis. The mechanism may be further exploited to develop tolerant wheat cultivar with high quality seeds.

Personality Profile and Coping Skills among Coronary Heart Disease Patients and Non-Patient Groups.

Background: Coronary heart disease is a leading cause of death and a major cause of disability worldwide. Aims: This study was conducted to see whether there are certain specific personality pattern of coronary heart disease patients and the coping strategies they use to deal with these stressful situations. Methodology: A sample of 30 male patients diagnosed as having coronary heart disease were selected from the outdoor and indoor patient cardiology departments of Ramkrishna Care Hospital and Modern Medical Hospital, Raipur, Chhattisgarh. Results and Conclusions: It was found that CHD patients have certain specific personality traits which reflect that these persons have low frustration tolerance for unsatisfactory conditions, are neurotically fatigued, easily annoyed and emotional (Factor C). They are suspicious and are often involved in their own ego and are self-opinionated and interested in internal mental life.

Genome Wide Identification of Target Heat Shock Protein90 Genes and Their Differential Expression against Heat Stress in Wheat.

Aims: To study the genetic and transcript profiling of the genes specifying cytosolic HSP90s in Triticum aestivum. Study Design: Random sampling. Place and Duration of Study: Indian Agricultural Research Institute, New Delhi, India, between August to December, 2011. Methodology: We include C-306 (thermotolerant) and PBW343 (thermosusceptible) cultivars of wheat for the study. Total RNA was isolated using Trizol method and gene was identified and isolated using RT-PCR. In silico characterization was done using different bioinformatic tools. Quantitative real time PCR was carried out using BioRad CFX96 platform and Pfaffl’s method was used for the comparative change in fold expression of the gene. Results: Here, we report cloning of an HSP90 gene from C-306 wheat cultivar having an ORF of 700 amino acids. Genome Blast identified 3 different clusters of reference sequence on chromosome no 4, 8 and 9 having LOC 100125696 and showing maximum homology with HSP90 reported from Triticum aestivum. Pure amino acid composition revealed highest composition of glutamic acid followed by lysine and leucine whereas, cysteine composition was lowest. Protein characterization showed the existence of 10 networks of coevolved amino acids. Quantitative real time PCR showed 1.5, 4.5, 5 & 7.4 fold increase in expression of HSP90 in case of C-306 compared to 2.5, 6.4, 6.9 & 5.6 fold increase in case of PBW343 at vegetative (root & shoot), pollination and milky dough stage. Multiple co-chaperones of HSP90 were observed by immunoblot assay in response to differential heat shock. Conclusion: This investigation proves that HSP90 is one of the key components of defense mechanism in wheat against heat stress which requires the formation of cochaperone complexes with HSP70 for its functional activity. There is a need to exploit the transcription factors associated with HSP90 and its regulation and differential expression in order to use it for developing thermotolerant wheat cultivars.

Miltefosine in children with visceral leishmaniasis.

Sixty four children (38 boys and 26 girls), aged 1 yr to 14 yr, presenting with fever, splenomegaly and positive LD body in splenic smear examination, admitted to pediatric ward of Nalanda Medical college and Child care center between 1st July 03 to 30th June 04 were taken for study. Patients were categorized into two groups: 44 were in Group I (Patients who had not received prior antileishmanial drug) and 20 in Group II (Patients who had received 30 days course of SAG; 20 mg per kg per day). All patients were given Miltefosine in dose of 2.5 per kg per day od or bid per orally to a maximum of 100 mg and were followed at completion of therapy, 1 month and 6 months for clinical response, splenic size and parasite density. 63 patients had parasitological cure with relapse in one patient of Group I during follow up. One patient in Group II had no response with first course but became parasitologically negative with 2nd course of Miltefosine. In Group I, one patient had persistent splenomegaly and found to have associated portal hypertension. GI side effects i.e. diarrhea and vomiting were observed in 26 and 23 patients respectively. Majority of patients had pancytopenia. Elevated ALT (> 3 times of normal) were seen in 28 and 11 patients of Group I and Group II respectively which returned to normal in subsequent follow up. The final cure rates were 93.2 percent and 95 percent in Groups I and II respectively.

Oral atropine sulfate for infantile hypertrophic pyloric stenosis.

This study aimed to evaluate the effectiveness of oral atropine in the management of IHPS. Cases were diagnosed clinically and confirmed sonographically. Atropine was given orally from the outset at a dose of 0.18 mg/kg/day in eight divided doses, increased daily by 1/4th of the commencing dose till vomiting ceased. Ultrasonographic evaluation of pyloric muscle thickness and length was done at the commencement of treatment, after completion of treatment and at 3, 6, 9, 12 and 15 months follow up. Oral atropine was effective in 11/12 (91.06%) cases. Vomiting ceased in 14 to 21 days in all cases. One case required initial 7 days of i.v. treatment followed by 18 days oral treatment to stop vomiting. USG evidence of normalization of pylorus was observed in all these cases, 3-15 months after completion of treatment. We conclude that oral atropine proved to be a simple, effective, safe, very cheap and acceptable treatment option for IHPS.

Department of Paediatrics, Nalanda Medical College, Patna.

Cysticercosis is the most common parasitic disease of the central nervous system. The disease has worlwide distribution. The cysticerci might lodge in the brain parenchyma, spinal cord, eyes, ventricular system, subarachnoid space and muscle. These are most often seen in basal meninges. The presence of human lymphocyte antigen-related antigens on the surface of cysticerci has a direct relationship with microscopic signs of damage to cysticerci. The clinical manifestations depend upon number and topography of lesions, the individual immune response to the parasite and the sequelae of previous infestations. The diagnostic criteria of neurocysticercosis can be based on absolute criteria, major criteria, minor criteria and epidemiological criteria. Computerised tomography (CT) head is still most useful diagnostic tool for the diagnosis of neurocysticercosis but magnetic resonance imaging has some advantages over computerised tomography. The mainstay of therapy lies on medical and surgical intervention. Medical therapy consists of cysticidal drugs. Surgical therapy is indicated in intraventricular and subarachnoid neurocysticercosis. Steriods are used for anti-oedema measures. Anti-epileptics can also be tried. The measures for prevention of cysticercosis are proper disposal of human waste, treatment of water contaminated with human faeces before its use in irrigation of vegetable cultivation, proper cooking of pork and repeated treatment in taenia carriers.

Miltefosine: an oral drug for visceral leishmaniasis.

Miltefosine, a phosphocholine analogue originally developed as antimalignant drug, has been found to be highly active against leishmania in vitro and animal model. Based on these experiences this drug was tried against human visceral leishmaniasis and found to be highly effective and achieved 97% and 94% cure in phase 2 and phase 3 trial in children.

Management of diarrhoea in practice.

Diarrhoea, a major cause of morbidity and mortality can be produced by a variety of etiological factors. Management protocol includes assessment of the child, physical examination, lab-evaluation, assessment of severity of dehydration and rehydration therapy using either of the following - WHO - ORS, Home available fluids (HAF), sugar salt solution (SSS), improve WHO-ORS, Amino acid fortified ORS, rice based ORS, low osmolarity ORS. Intravenous fluids are required if patients can't accept orally. Commonly observed electrolyte disturbances are hypernatremia, hyponatremia and hypokalemia. Concussion is a common problem and can result due to electrolyte imbalance, cavernous sinus thrombosis, associated meningitis, shigella encephalopathy and hypoglycemia in undernourished children. Treatment includes i.v. diazepam and i.v. glucose and correction of electrolyte imbalance. Additional treatment interventions include antimicrobial drugs including antibiotics, antimotility drugs, absorbents, nutritional and micro and macro nutrient supplementation.

Congenital hypertrophic pyloric stenosis.

Congenital hypertrophic pyloric stenosis, an important cause of intractable vomiting in infants is diagnosed clinically and confirmed ultrasonographically. Other useful interventions are plain radiography and barium study. Differential diagnosis includes pylorospasm and gastroesophageal reflux. Management protocol includes correction of dehydration and electrolyte imbalance and either Fredet Ramstedt pyloromyotomy or medical treatment with atropine sulphate. Atropine is initially given intravenously till vomiting is controlled and then orally at double the effective i.v. done for another 3 weeks. Atropine sulphate is generally well tolerated and side effects are few like tachycardia, raised SGPT and hyperthermia. Atropine sulphate is very effective, cheap, safe and perhaps more acceptable treatment option for CHPS.