A CROSS SECTIONAL STUDY OF NICOTINE DEPENDENCE AND ITS DETERMINANTS IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AT INSTITUTE OF RESPIRATORY DISEASES, SAWAI MAN SINGH MEDICAL COLLEGE, JAIPUR, RAJASTHAN.

Background: Smoking cessation is the most powerful intervention to modify progression of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. Thus, nicotine dependence status and factors associated with moderate to high nicotine Dependence in patients with COPD needs to be evaluated. Method: A hospital based cross-sectional observational study performed on 50 patients with COPD attending the outpatient department at smoking cessation clinic, Institute of Respiratory Diseases, SMS Medical College, Jaipur, Rajasthan during 2019-2020. Result: Multiple logistic regression analysis revealed that low education status, age 60 yrs., and mild to moderate airflow obstruction were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

In vitro Efficacy of Emblica officinalis Against MRSA Isolated from Buffaloes Suffering from Subclinical Mastitis

The present study describes in- vitro efficacy of Emblica officinalis against Methicillin Resistant S. aureus mastitis. Diffusion technique was used to assess in-vitro efficacy of Emblica officinalis. Zone of inhibition was measured and used to compare the in-vitro efficacy. The zone ranged between 10-13 mm with maximum zone of 13 mm observed in 200 and 225 mg/ml DMSO disc, followed by 12 mm in 175 and 150 mg/ml DMSO disc, 11 mm in 125 mg/ml DMSO disc and 10 mm in 100 mg/ml DMSO disc. The results indicate that the sensitivity pattern for Emblica officinalis at 200 & 175 mg/ml DMSO concentration and was comparable with the standard antibiotics in Methicillin sensitive S. aureus. In Methicillin resistant S. aureus isolates, the zone of inhibition was in the order Oxytetracycline (15mm) followed by Emblica officinalis -200 (13 mm) and Methicillin, ampicillin, gentamicin, ofloxacin were resistance

The various metabolic factors involved in stone recurrence: a prospective study

Background: Nephrolithiasis is the most common chronic kidney condition, is globally increasing in both sexes. Five main types of renal stones viz., calcium oxalate stones, calcium phosphate stones, uric acid stones, struvite stones and cystine stones. Purpose of the study is to evaluate various metabolic factors contributing to recurrent renal stone and determining appropriate medical treatment and diet modification to prevent recurrent renal stone disease.Methods: This study was carried out in P.G. Department of Surgery, S.R.N. Hospital associated with M.L.N. Medical College, Allahabad. A total of 120 cases of recurrent renal calculi in and outpatient between August 2017 and July 2019 were included in the study. All patients were stone free at the time of metabolic urine evaluation.Results: Most of the patients in the study were in the age 21 to 50 years. 80% were males and 20% were females. In 24-hour urine analysis most common metabolic abnormality seems to be hyperoxaluria (92.5%) followed by hypercalciuria (82.5%), high pH (67.5%), and least common seems to be hypocitraturia (15%), followed by hyperphosphaturia (20%), hypernatreturia (25%), and low level of potassium (25%).Conclusions: All patient of recurrent stone formation are advised increase fluid intake. In patient with hypercalciuria and hypocitraturia, dietary restriction of protein, oxalate and sodium, treatment includes thiazides supplemented with potassium citrate. In patient with hyperoxaluria dietary restriction of oxalate rich food and in hyperuricosuria dietary restriction of animal protein is advised.

Awareness regarding self care among diabetics in urban slum of Kolkata: a community-based, cross-sectional study

Background: Diabetes mellitus is a disease associated with significant morbidity and mortality. Patients with diabetes have higher rates of coronary artery disease, peripheral vascular disease, retinopathy, neuropathy and nephropathy. Many of these complications can be prevented with appropriate medical care that often requires significant alterations in lifestyle and strict adherence to self-care tasks to obtain good control of disease. Awareness regarding the complications of this disease will play a vital role in its prevention and control. While lack of adherence to the treatment and self-care leads to poor glycemic control, thereby, increasing hazardous complications. Objective of the study was the present study was conducted to assess the knowledge of diabetic patients regarding the disease and its complications, and to estimate the knowledge and adherence to self-care practices concerned with Type 2 diabetes mellitus.Methods: The study was conducted in Tangra an urban slum of Kolkata from July 2018 to December 2018. A house to house survey was conducted to identify the known diabetics in the community and data of 362 patients were collected.Results: A total of 362 diabetic patients consented and participated in the study of whom 191(52.76%) were male and 171(42.74%) female. Majority of the respondents (26.52%) between the age of 50-59 years, 140(38.67%) belonged to upper middle class. Though 332(91.71%) respondents were aware regarding diet control but only 170(46.96%) were actually practicing the recommended diet schedules. Knowledge of the respondents regarding eye, foot, skin and dental care was very low, only 67(18.51%), 102(28.28%), 62(17.13%) and 46(12.71%) respondents were aware respectively and practices were still lower.Conclusions: Overall the level of self-care activities among diabetic patients in our study was quite low. Government policies should help in creating guidelines on comprehensive diabetes management within the primary health care setting including availability of medicines and diagnostic services and creating public awareness.

A study on evaluation of ASHAs for their knowledge, attitude and practice towards newborn care in Howrah district of West Bengal

Background: : Accredited Social Health Activist (ASHA) is a trained female community health activist. ASHAs are local women trained to act as facilitator and promoters of health care in their communities. ASHA is trained to work as an interface between the community and the public health system. ASHA play an important role in newborn care to reduce their morbidity and mortality.Methods: Data were collected from ASHAs working in Shibbur area of Howrah District, west Bengal. The study sample consisted of 70 ASHAs working in the Shibpur area that fulfilled the inclusion criteria. A predesigned pretested questionnaire of ASHA was used to collect data in the study.Results: The mean age of ASHAs was 35.74 years. Only 32 (45.71%) had received middle level (class VIII) education. Only 45.71 % of ASHAs had good knowledge and practice regarding hypothermia and its complication and the procedure of providing warmth the baby after delivery. Only 57.1% of ASHA had good knowledge regarding counseling and problem solving on breast feeding. Only 38.57% had good knowledge and practices on identification and basic skill on management of Low Birth Weight (LBW) having birth weight of <2.5kg and pre-term baby (<37 weeks of gestation).Conclusions: In the present study, we found that Knowledge, Attitude and Practice of ASHAs were inadequate in some aspects of newborn care. This gap of knowledge should be taken seriously during training procedures so that effective knowledge and essential skill for newborn care can be imparted. During recruitment of ASHAs higher literally status should be given preferences.

Estimation of prevalence of risk factors for coronary artery disease in a rural population in Howrah, West Bengal

Background: Coronary artery disease (CAD) is a major cause of death globally in both developed and developing countries. Coronary artery disease which was once thought to be a disease of the urban population is now involving the rural community in an increased number. So a study of major coronary risk factors in rural communities will help to adopt various strategies particularly behavior change and communication relevant for these communities to prevent these risk factors and lower CAD related mortality and morbidity. Objective was to estimate rates of the various risk factors for CAD and identify the high-risk groups in the rural community.Methods: A community based cross sectional study was carried out in a rural area in the Howrah district of West Bengal. Four hundred and eighteen (418) persons (212 males and 206 females) were subjected to study using structured, pretested and predesigned schedule. Coronary artery disease risk factors were assessed. Statistical analysis was done with the help of statistical software, the SPSS 20.0 for windows.Results: The study observed that prevalence of tobacco use among the study population was the most significant risk factor (42.3%). The prevalence of other coronary risk factors ranged from 10-20%. Tobacco use, alcohol consumption and sedentary life style were significantly more amongst males. Whereas truncal obesity and systolic hypertension more among females.Conclusions: Various comprehensive strategies particularly behavior change and communication targeting these high risk population need to be emphasized to lower CAD related morbidity burden in the community.

Importance of Conventional Radiography in Diagnosis and Management of Giant Cell Tumour at an unusual location.

Giant cell tumour (GCT) or osteoclastoma of the bone is mostly benign but locally aggressive primary tumour of unknown origin occurring at epiphysis. It is a tumour of long bones and rarely seen in bones of hand and foot. The cases are reported in tarsal and carpal bone but involvement of metatarsal bone is very rare. We present a case of twenty years old female patient with GCT of second metatarsal of left foot. The patient underwent aggressive curettage and filling with bone chips and is on regular follow up.

A new futuristic glaucoma therapeutic management paradigm.

Glaucoma is a group of diseases, characterized by a progressive form of optic nerve damage. Current studies indicate more selective pathophysiological involvement, thereby targeted therapies are warranted. Although both the prostaglandin analogs and beta blockers are still, most commonly used drugs for glaucoma, due to their effi cacy, lack of adverse effects. In addition, a stepped care approach is the corner stone for its management. In addition, attempts have been made to enhance patient compliance and ocular delivery of already available anti-glaucoma drugs such as pilocarpine and timolol maleate. Notable among futuristic treatment options are; novel delivery systems, benzalkonium chloride-free drugs, various glaucoma drainage devices, new targeted therapies and prompt diagnosis plus aggressive treatment, in patients with primary angle closure glaucoma. Promising new focus on vision sparing, greater patient safety and tolerability will provide improved treatment options and long-term preservation of vision and quality of life.

To study the effect of glycemic control and duration of disease on pulmonary function tests and diffusion capacity in type 2 diabetes mellitus.

Background: Type 2 diabetes mellitus is known to cause serious progressive macro and micro vascular complications leading to end organ damage like retinopathy, nephropathy and neuropathy. Pulmonary complications due to collagen and elastin changes as well as microangiopathy has also been demonstrated in type 2 diabetes mellitus but prevalence in most of population is unknown and its possible correlation with duration of disease and degree of glycemic control is not studied more in our population. Aims and objectives: To compare Pulmonary Function Tests (PFT) in type 2 diabetes mellitus with control group and to evaluate possible correlation of PFT with status of sugar control and duration of disease. Methods: Consecutively consenting 120 subjects who satisfied the inclusion criteria were recruited over one year duration. These 120 subjects are categorised into two i.e. healthy volunteers recruited as controls (n=60) and type 2 diabetic patients (n=60). Results: Both group compared and studied with each other. Diabetic patients showed a significant reduction in Forced Expiratory Volume in one second (FEV1), Forced Vital Capacity (FVC) and pulmonary diffusion capacity for carbon monoxide (DLCO) relative to their matched controls and these values were further reduced in diabetic patients with uncontrolled glycemic status. Conclusion: Our study concluded that lung functions in type2 diabetes mellitus are impaired with restrictive pattern of respiratory abnormality. Duration of diabetes did not influence on pulmonary function and diffusion capacity.

A rare presentation of dengue fever: acute motor quadriparesis due to hypokalemia.

Hypokalemia can lead to acute onset pure motor flaccid quadriparesis. Although there are many causes of hypokalemia but dengue is a one rare cause of them which can cause hypokalemia. Simply correction of potassium improve the weakness dramatically. We reported a case who presented to us with acute motor quadriparesis, finally diagnosed hypokalemia due to dengue

Genito-urinary tuberculosis revisited - 13 years' experience of a single centre.

Background: Tuberculosis had been declared by the World Health Organization (WHO) as ‘public health emergency’ in 1993. Extra pulmonary tuberculosis (E.P.T.B.) comprises 20-25% total burden of the disease in which genitourinary tuberculosis (G.U.T.B.) is 4%. Timely diagnosis and treatment will prevent the sequelae of this disease. Aims: To know the varied clinical presentations, diagnostic modalities and management of G.U.T.B. Methods: During a 13-year-period, 117 retrospective cases of GUTB were admitted in the tertiary care centre. They were analyzed for clinical presentation, diagnostic modalities and management. Results: Young patients mainly in third decade of life were commonly affected with higher incidence in females. In our study, the most common presentation was irritative voiding symptoms (66.47%) followed by haematuria (47.60%). Although it can affect the entire organ in genito-urinary system but, in the present study, kidney was the most affected organ (64.9%) following ureter (27.35%), urinary bladder (17.09%), prostate (3.4%) and epididymis (5.19%). In this study, we had not encountered any case of testicular and penile tuberculosis. Among the different diagnostic modalities in this study, the diagnostic positivity rate was 41.6% for the urine AFB test, 55.4% for the urine M. tuberculosis culture test and 67.7% for PCR. Chest x-ray was positive in 25.6% (30). ESR was raised in 62.5% and Mantoux test was positive in 61.2% patients. Conclusion: A high index of suspicion and a wide range of investigations may be required to achieve a complete diagnosis of genitourinary tuberculosis. Though short course chemotherapy with four-drug-regimen for sixmonth- duration is the mainstay of treatment, surgical interventions were required in 60% of cases of this study.

Homology modeling and active site analysis of leptin receptor of homo sapiens involved in obesity.

The discovery of leptin has initiated a flurry of research into the molecular basis of weight control. In obese people levels of leptin found in the blood are normally very high and more than sufficient to suppress the appetite and increase the metabolism. This however does not happen and it is believed that obesity may be the result of a resistance to leptin. This suggests that the problem in these individuals may be related to a lack of binding of the leptin protein to its receptor. No known structure of leptin receptor is known. Therefore in present the present study we model the 3D structure of leptin receptor using MODELLER. This was done using the template GP130 of H. sapiens (PDB code: 1BQU). On the basic of results MODEL 6 was selected as the best model. The observed G-factors for the present model were -0.22 for dihedrals, -0.32 for covalent and overall -0.25. The MODEL 6 contains 88.7% of the residues in the most favored region, 11.3 % in the additional allowed and no single residue in generously allowed regions and disallowed region. The predicted model was further analyzed to locate the residues in the active sites those provide interactions with the ligand.

Multicystic dysplastic kidney - A need for conservative and long term approach.

Objective. We retrospectively studied our cases of Multicystic Dysplastic Kidney (MCDK). The review was aimed at identifying the pattern of the disease in Indian Scenario and the required management thereof. Methods. We studied the clinical, radiological and nuclear scan findings of 22 patients with unilateral MCDK. They were diagnosed and/or treated in our unit from 1999 to 2007. The diagnosis was achieved by Ultrasound and further confirmed by DMSA scans. Other ancillary investigations like Micturating cystourethrogram were done if indicated. These patients were followed and followup investigations consisted of renal ultrasound, blood pressure measurement, and urinalysis and blood biochemistry. Results. A total of 22 patients (18 boys and 4 girls) with unilateral MCDK were investigated and followed for a mean period of 41 months. MCDK was detected on antenatal ultrasound only in 12(55%) and postnatally in 10(45%) babies. Mean age for postnatal diagnosis was 20 months. Follow up ultrasound revealed complete involution of MCDK in 3 patients and partial regression in 11 patients. The size of dysplastic kidney was unchanged in 4 patients and a further 4 patients underwent nephrectomy. Indications of nephrectomy were parental anxiety in 2, hypertension in 1 and palpable mass in 1. Conclusion. Large proportion (45%) of patients in presented series are diagnosed post natally contrary to western world where more than 80% are diagnosed antenatally. Uncomplicated isolated MCDK carry good prognosis with nephrectomy required in only a few patients. Association with other urological anomalies in ipsilateral/contralateral genitourinary tract is important to identify as they have worse outcome in terms of ultimate renal function. All patients with simple/complex unilateral MCDK should be advised long term follow up for the possible development of hypertension and/or hyper infiltration injury.

Inhibition of sodium current by carbamazepine in dorsal root ganglion neurons in vitro.

Carbamazepine (CBZ), one of the most commonly prescribed antiepileptic drug, is proposed to inhibit Na+ channel. In this study, we have investigated the effects of CBZ on Na+ current, evoked in cultured dorsal root ganglion (DRG) neurons from neonatal rats using whole cell patch clamp technique. In small DRG neurons (20–25 μm), Na+ current was obtained by blocking K+ and Ca2+ currents with appropriate ion replacement and channel blockers. Separation of the Na+ current components was achieved on the basis of response to the conditioning voltage. The CBZ depressed Na+ current in a dose-dependent manner. The maximal Na+ current was depressed at 300 μM of CBZ, where 94±5.1% of depression was observed. The depression of normalized current amplitude was found to be 72±13.2%, 84±10%, 85±7.1% and 95±5.2% at 10, 30, 100 and 300 μM of CBZ concentrations, respectively, at –20 mV test pulse, when compared with control. The depression of current amplitude was observed as 48±12.3%, 42±15.2%, 71±17.7% and 90±5.8% at 10, 30, 100 and 300 μM of CBZ concentration, respectively, at 0 mV voltage pulse. The depression of Na+ currents was found to be dose-dependant at –20 and –10 mV but not at 0 mV. It is concluded that the depression of Na+ currents by CBZ may be responsible for inhibiting the neurotransmitter release.

Ptychodiscus brevis toxin decreases the spontaneous activity of rat right atria involving muscarinic receptors and potassium channels.

Marine dinoflagellate Ptychodiscus brevis toxin (PbTx), is known to produce toxic effects on cardiovascular system. The present experiments were conducted to evaluate the effect of synthetic phosphorus containing Ptychodiscus brevis toxin on spontaneously beating right atrium in vitro. The PbTx (0.84-84 microM) decreased the rate and force of right atrial contractions in a concentration-dependent manner. Ethanol, a vehicle present in highest concentration of PbTx, had no effect on atrial rate or force of contraction. Pretreatment with atropine blocked the PbTx-induced decrease in atrial rate and force of contraction. The tetraethylammonium, a potassium channel blocker, blocked the PbTx-induced decrease in atrial rate and force, where as, L-type of calcium channel blocker, nifedipine blocked the PbTx-induced force of contraction but not the rate changes. The results indicate that the PbTx decreased the atrial rate and force of contraction via cholinergic receptors involving K+ channel.

Special considerations for effective blood pressure control in diabetes.

On the one hand, there is a steep rise in the incidence of both diabetes mellitus as well as hypertension. On the other hand, this phenomenon has led to significantly increased morbidity and mortality. The focus in the coming years, therefore, would be obviously on special considerations and special strategies required for effective control of blood pressure in people suffering from diabetes. In a patient with diabetes mellitus and hypertension, achieving normotension is as important as achieving euglycaemia. Consensus is in favour of aggressive lifestyle modifications. Polypharmacy is emphasised for optimal control. The pharmacological treatment differs due to effects of certain drugs on lipid profile, insulin sensitivity and glucose metabolism.

In defence of animal insulins.

The term 'human insulin' is a misnomer, as its source is not human pancreas but the pork pancreas from where insulin is humanised by modern techniques of genetic engineering. With the use of purified animal insulin, untoward effects occur infrequently. Porcine insulin is different from human insulin in only one amino acid. They have also been found to be equal in terms of effect on plasma glucose, glycated haemoglobin and insulin dose requirements. A lesser written fact is that while human insulin can produce all the problems encountered with animal insulin, there are certain more serious additional problems experienced with use of human insulin.