Efficacy of topical tulsi (Ocimum sanctum) paste for the management of oral submucous fibrosis – A clinical study

Context: Oral submucous fibrosis (OSMF) is a chronic insidious oral potentially malignant disorder characterized by increased collagen deposition and reduced collagen degradation causing burning sensation and difficulty in mouth opening. Aim: To assess the efficacy of topical Tulsi (Ocimum sanctum) paste for the management of OSMF. Settings and Design: Institution?based clinical trial. Materials and Methods: The study included a total of 60 OSMF patients categorized into three Groups A, B and C (20 in each) depending on the severity according to Lai DR et al. classification. The patients were advised for topical Tulsi paste application and were evaluated for the reduction in the burning sensation and improvement in mouth opening every month for 3 subsequent months using the numeric pain rating scale (NRS) and a Vernier calliper, respectively. Statistical Analysis: The baseline and 3?month recordings were subjected to inter? and intra?group statistical analysis using Kruskal–Wallis analysis of variance (ANOVA), Mann–Whitney U, one?way ANOVA, Tukey’s multiple post?hoc and Wilcoxon matched?pairs tests. Results: There was a reduction in the burning sensation and improvement in the mouth opening in all three groups. The reduction in the burning sensation was statistically significant among all the groups (P < 0.05) and the NRS scores after 3 months among the three groups were not statistically significant (P > 0.05). There was a statistically significant difference (P < 0.05) in the improvement of mouth opening between Group A and B; A and C; but not between B and C. Conclusion: Tulsi paste showed a significant reduction in the burning sensation and improvement of the mouth opening thereby proving to be a safe and promising medicament for OSMF

A clinical and microbiological profile of urinary tract infection in patients with chronic kidney diseases

Background: Urinary tract infections (UTIs) are a major public health problem in terms of morbidity and financial cost in CKD patients in India. The resistance pattern of community acquired uropathogens in CKD patients has not been extensively studied. Thus, knowledge of local antimicrobial susceptibility patterns of common uropathogens is essential for prudent empiric therapy of community acquired UTIs.Methods: It is a cross sectional study conducted in a tertiary care hospital involving 65 chronic kidney disease patients with UTI who attended general medicine OPD and those admitted in wards after fulfilling the inclusion and exclusion criteria, after obtaining written informed consent. Blood sample and urine samples were collected from these patients and sent for blood analysis, urine analysis and urine culture and sensitivity.Results: Among 65 CKD participants with UTI who were studied, E. coli (47.7%) and K. pneumoniae (15.4%) were the most common isolates which were sensitive in order of colistin, polymyxin B, meropenem (carbapenem) and less sensitive to other commonly used antibiotics.Conclusions: The main purpose of this study was to find the various common local uropathogens in CKD patients and their antibiotic profile which will help in formulating antibiotic therapies. As previously stated, there are very few studies regarding profile and management of UTI in CKD patients. Hence this study can throw some light into this area.

Evaluation of hepatocellular dysfunction and its association with severity in dengue patients

Background: Dengue is a mosquito-borne infection that in recent years has become an important disease of international public health concern. Dengue virus infections and illness when symptomatic, that patients tend to present with a significantly wide variety manifestations. The aim of the study was to evaluate liver dysfunction in patients with dengue infections.Methods: The present study was undertaken as an observational cross-sectional study the period June 2017 to December 2018. The details of all patients with serologically proved dengue fever admitted in the hospital were reviewed. Data including routine blood count, liver function test (LFT), prothrombin time (PT), activated partial prothrombin time (APTT), abdominal ultrasonography was studied. Statistical analysis: Data was analyzed using SPSS version 21.0. Difference between proportions was tested by using chi square test. Pearson correlation coefficient was used to measure linear correlation between two continuous variables. A p value <0.05 was consideredstatistically significant.Results: Majority of the study participants were in the age group of 16-30 years (57.5%) and were males (64.5%). Fever, Headache and joint pain were the most common symptoms noted among the study participants. Majority of the study participants were found to have elevated levels of SGOT (75.3%), SGPT (64.2%) levels and lower levels ofserum albumin (68.6%) on evaluation. Statistically significant association was observed between elevated liver enzymes and presence of features of dengue haemorrhagic fever.Conclusions: Considerably high proportion of patients with dengue infection were found to have hepatic dysfunction in the form of deranged liver enzymes.

Prevalence and implications of depression in type-2 diabetes mellitus: a follow up study

Background: There are not many longitudinal or prospective studies to determine the association between Diabetes Mellitus (DM) and depression in Indian scenario. Present study was mainly intended to find out the prevalence of depression in diabetic individuals and its impact on diabetes. The aim of the present endeavour was to study the prevalence of depression in diabetic patients, its impact on the clinical course of diabetes and to study the association between clinical courses of depression and diabetes.Methods: It is a prospective analytical study done in MGMCRI. All diabetic patients, aged 30years and above were taken up. Those who screened positive for depression were further assessed using PHQ9 questionnaire and were subjected to antidepression management. From the total number of diabetic patients screened, the prevalence of depression was calculated. Equal number of T2DM patients who screened negative for psychiatric disorders were taken as control. PHQ-9, FBS, PPBS, HbA1c were measured at baseline and repeated at 3rd month of follow-up.Results: In our study the prevalence of depression among diabetic individuals was found to be 15%. The difference in improvement of HbA1c from baseline to follow up was statistically significant when compared between groups having mild, moderate and severe depression, with maximum fall of HbA1c in the group with severe depression. This implies the positive effect of treating depression on glycemic control.Conclusions: This study shows that when diabetes and depression were addressed together it has a positive effect on the glycemic control and the depressive symptoms emphasizing the need for a collaborative management and need for screening diabetes patients for depression for a better care.

A comparative study of serum adiponectin levels in patients of acute coronary syndrome with and without central obesity

Background: Coronary artery disease burden has been on a rise globally with it emerging as the principle cause of death even in the Indian subcontinent. Serum adiponectin has recently gained interest due to its close relation with atherosclerotic CAD and Metabolic syndrome. The levels of serum adiponectin are reduced in ACS. There is a paucity of studies in South Indian population comparing the effect of central obesity in patient with ACS. The aim of the present endeavour was to study the association of serum adiponectin in risk evaluation of patient with acute coronary syndrome with and without central obesityMethods: The study was conducted in a tertiary center in patient who presented with first time ACS they were grouped into two groups based on the presence and absence of central obesity. Central obesity was defined on the basis of waist to hip ratio. Serum adiponectin levels were estimated in both the groups using ELISA method. The results were statistically analyzed using t- test.Results: Authors concluded that the mean age of patients presenting first time with ACS was 55±12years in both the group. There was a significantly raised LDL and Total Cholesterol (TC) level in patient with central obesity. The estimated serum adiponectin level was reduced in both the group with more significant reduction in group with central obesity. The mean adiponectin level in CAD patients with central obesity was 2.326±1.437µg/ml as compared to 3.486±1.6999μg/ml in patients without central obesity, which was statistically significant (p value <0.0049).Conclusions: Authors concluded that serum adiponectin levels were reduced in both the group with ACS with a further reduction in patient with central obesity. It was also observed that there was a significant relation between adiponectin level and visceral fat as compared to superficial fat, as adiponectin was significantly reduced in patient higher waist-hip ratio.

Study of HbA1C levels in patients with type 2 diabetes mellitus in relation to diabetic retinopathy in Indian population

Background: In the recent years diabetes mellitus (DM) has emerged as a major public health problem worldwide with potential to develop vascular and neuropathic complications. HbA1c has got an important role in monitoring the treatment and risk of developing micro and macrovascular complications. Present study is done to determine the prevalence of diabetic retinopathy (DR) in association with raise in HbA1c and also to correlate the severity of Diabetic retinopathy with the levels of HbA1c.Methods: In this descriptive observational study 50 diabetes mellitus patients with visual disturbances who attended the Department of General medicine and Department of Ophthalmology between January 2012 to December 2012 at Vydehi institute of medical sciences and research centre are selected. All the patients were subjected to the relevant investigations along with dilated retinal examination and slit lamp examination. The results were tabulated according to the severity of retinopathy and other clinical variables.Results: In this study majority of the patient were in the age group of 61-70 years and 68% were male patients. Mean duration of diabetes mellitus was 9.8±5.34 years. Also 54% of them had coexisting hypertension. Present study showed the presence of diabetic retinopathy in 64% of patients, out of which 24% of them had mild DR and 14% had moderate DR.Conclusions: Present study showed as the HbA1c level increases severity of the diabetic retinopathy also increases. And also, patients who had microalbuminuria and longer the duration of diabetes higher the chances of microvascular complications. Hence HbA1c can be used as a useful tool to assess the long-term control of diabetes mellitus and hence the development of diabetic retinopathy.

A prospective study of electrocardiographic and echocardiographic changes in patients with cerebrovascular accidents

Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.

Correlation of portal vein diameter with the presence of oesophageal varices in chronic liver disease: a prospective study

Background: Guidelines recommends upper gastrointestinal endoscopy for all the patients with cirrhosis of liver to rule out portal hypertension. Many patients may not be willing to undergo this unpleasant procedure or resources may not be available. In this study, authors aim to identify the effectiveness of portal vein size as a non-invasive predictor of esophageal varices.Methods: In this prospective observational study of 30 patients, patients with liver cirrhosis without a previous history of upper GI bleeding were included between November 2012 and October 2014. Relevant clinical parameters were assessed which included physical examination, complete hemogram, biochemical workup, upper GI endoscopy and ultrasonographic measurement of portal vein diameter.Results: Out of the study population 70% of the patients had Oesophageal varices. Ultrasonography abdomen showed portal vein dilatation(>13mm) in 66.6% cases. The mean portal vein diameter in our study group was 13.1mm and majority of patients had portal vein between 13-13.9 mm (43.3%). A cut-off point of more than 13 mm had strong significant relationship (p<0.01) with presence of esophageal varices (sensitivity of 100%, specificity of 90% and positive predictive value of 95.24%). Higher grades of esophageal varices exists with larger portal vein size.Conclusions: From present study, authors conclude that portal vein size and its dilatation detected ultrasonographically can determine the presence of esophageal varices and can hence identify the subset of patients who require endoscopy for the prophylactic management of variceal bleeding. Therefore, reduce the burden on the endoscopy units, avoiding unnecessary screening endoscopies. Apart from being non-invasive, portal vein diameter is a relatively inexpensive and easily reproducible parameter.

Epidermal growth factor receptor protein expression in lung cancer and survival analysis

Background: Epidermal Growth Factor Receptor (EGFR) is one of the important molecules involved in lung cancer initiation and progression. Studies on over expression of EGFR and its survival in relation with Non-small cell lung cancer (NSCLC) patients have yielded controversial results. Prevalence of EGFR expression in NSCLC patients and 6-month survival in south Indian population is unknown.Methods: We carried out a prospective study in tertiary hospital. Diagnosed patients with NSCLC were included in the study and were interviewed with questionnaire containing demography and investigations like Chest X-ray, CT thorax, Bronchoscopy were recorded. EGFR expression analysis was done for all patients and were followed up monthly for 6 months and details of survival and treatment were collected. Cox regression analysis was used to assess their survival.Results: 50 patients with NSCLC were included. Forty-four (88%) were men, median age of study group was 65 years. Twenty-seven patients (54%) had Adenocarcinoma, 14 patients (28%) had Squamous cell carcinoma, 7 patients (14%) had poorly differentiated carcinoma and 2 patients (4%) had large cell carcinoma. Thirty-four (68%) samples were positive for EGFR expression. On multivariate analysis we found patients who took chemotherapy and with good performance status (Karnofsky score >65 and Eastern Cooperative Oncology Group >2.5) had better survival at 6 months.Conclusions: Patients with EGFR positivity had better survival with chemotherapy but worse with radiotherapy. Patients who took chemotherapy and had good performance status had better survival on multivariate analysis. We didn’t find any correlation between EGFR positivity and poor survival.

An expression of p53 marker in colorectal cancer with histopathological correlation

Introduction: Colorectal cancer is the major cause of mortality and morbidity worldwide. Colorectal cancer is the malignant epithelial tumor of the colon and rectum. Incidence in India are quite low about 2 to 8 per 1,00,000. Colorectal cancer develop through a multistep process as characterized by histopathological precursors lesion and molecular genetic alterations including adenomatous polyposis coli 9APC), K-RAS, and p53. The p53 mutations seem to be associated with poor prognosis in colorectal cancer, p53 protein overexpression has been shown to correlate with patient survival. Aim and objectives: To diagnose colorectal carcinomas on H&E sections, to perform and interpret p53 immunostaining on all diagnosed colorectal carcinomas, to infer the rate of positivity and negativity of the P53 mutations in the colorectal lesions, to correlate the p53 mutations with the grade and stage of the colorectal carcinomas, to indicate the prognostic value of p53 mutations in colorectal carcinomas Materials and methods: A prospective study was done for duration of 3 years i.e., 2014- 2016 on in MGM Hospital Warangal. All the colorectal biopsies and resection specimens in all age groups, received in the pathology department during this period were considered after a histopathological diagnosis of the lesion was made, the paraffin blocks of the samples which had met the criteria of inclusion are collected and proceed for immunohistochemical marker. Results: In our study the commonest age group were from 60-69 years with majority of the lesions diagnosed as adenocarcinomas. Males contributed to large number of cases (36) and rectum is the most common site in the present study. Most of cases in this study are of stage IV (AJCC) (30%) and are well differentiated carcinomas (43.3%). p53 overexpression was seen in 40/60 cases. In present study there is statistically significant correlation between p53 overexpression and stage of tumor p value 0.04. In rectal cancers p53 overexpression was more common that colon cancers. Rectum showed 47.5% positivity and left colon 35%. Thus in present study rectal cancers showed high p53 G. Vandana, S. Lokesh Rao Magar, D. Swetha, S. Sandhya. An expression of p53 marker in colorectal cancer with histopathological correlation. IAIM, 2017; 4(12): 168-184. Page 169 expression. There was no significant correlation of p53 over expression and grade of colorectal Adenocarcinoma but statistically significant correlation was observed with advance stage and p53 overexpression in conventional adenocarcinomas, thus p53 overexpression serves as poor prognostic marker in colorectal adenocarcinomas and it may help to assess the responsiveness of patients to standard chemotherapy. Conclusion: In our study, we noted p53 overexpression in 66.6 % of colorectal cancer. There is an increase in p53 expression with increasing stage of tumor. There is statistically significant correlation between stage and p53 expressions. In conclusion p53 seem to have an important role in the carcinogenesis of colorectal cancers. The evaluation of p53 over expression using a standardized IHC procedure could be clinically useful marker for identification of colorectal cancer patients likely to benefit from Standard chemotherapy regime currently used for this disease.

A Study on Expression of P53 in Surface Epithelial Ovarian Tumours

Aims and Objectives (1) To perform and interpret p53 immunostaining on the diagnosed malignant surface epithelial ovarian tumours. (2) To correlate expression of p53 with histological type of malignancy. Materials and Methods A 2-year prospective study was done i.e., from October 2011 to September 2013 on ‘A study on expression of p53 in surface epithelial ovarian tumours’ in MGM Hospital, Warangal. All the ovarian surface epithelial tumour specimens, received in the pathology department during this period were considered. Results A total of 121 cases were studied, out of which benign tumours were the most common (64.4%), followed by malignancy (25.6%) and 12 cases(10%) of borderline malignancy. Most of the benign tumours were unilateral; the cases that showed bilateral involvement were mostly malignant. The maximum number of cases in the present study was seen in the age group of 31–60 year. The youngest patient was 16 year old and the oldest was 68 year old. Serous cyst adenoma was the most common neoplasm found and accounted for 53 cases (43.8%), followed by mucinous cystadenoma, which accounted for 21 cases (17.3%). Nine cases of serous cystadenofibroma (7.43%), 3 borderline serous tumours (2.47%) and 11 serous cystadenocarcinoma (9%) were found in the present study. Out of the 44 mucinous tumours, 21 were benign (17.3%), 3 were of borderline malignancy (2.47%) and 20 were malignant (16.5%). One case of mucinous cystadenocarcinoma was found to be associated with adenocarcinoma of ascending colon. One case of benign Brenner tumour was also found in the present study. The rate of p53 abnormalities varies with histological type, grade and stage of the tumour. P53 expression was more in malignant serous tumours as compared to the malignant mucinous tumours.