Adaptation and validation of the Bengali version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL)

Background: Chronic urticaria exerts a profound impact on quality of life. Recent guidelines recommend its evaluation in all chronic urticaria patients. Currently, the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL) is the only validated tool to assess chronic urticaria-specific quality of life. Objective: To validate and adapt the CU-Q2oL to the Bengali language for its widespread use. Methods: The CU-Q2oL questionnaire was translated into Bengali. Its internal consistency and reliability were tested by asking 42 chronic urticaria patients to complete this version. They completed the validated Bengali Dermatology Life Quality Index and Urticaria Control test questionnaires, and their scores were correlated with CU-Q2oL score to assess the validity of our Bengali version. Results: The mean CU-Q2oL score of our patients (mean age 38.41 ± 13.4 years, male: female 29:13) was 48.8 ± 16.5. Domain 4 (sleep problems) was worst affected, followed by domain 1 (pruritus), while domain 2 (swelling) was least affected. We detected an excellent overall internal consistency (Cronbach’s alpha = 0.93) of our version and nearly complete agreement (intra-class correlation coefficient = 0.91) between the test-retest scores. We found a significant positive correlation between the overall CU-Q2oL and Dermatology Life Quality Index scores (rs = 0.53, P = 0.0002), thus implying the validity of our version. Additionally, we noted a significant negative correlation between the overall CU-Q2oL and Urticaria Control test scores (rs = -0.48, P = 0.0007), suggestive of a more severe impairment of quality of life with poorer disease control. Limitations: Small sample size, observational design and bias in test-retest reliability analysis due to the use of rescue therapy in-between assessment sessions were important limitations of our study. Conclusion: The Bengali version of CU-Q2oL questio

A STUDY TO FIND OUT PSYCHIATRIC MORBIDITY IN COVID INTENSIVE CARE UNIT PATIENTS POST DISCHARGE

The COVID-19 was first observed in patients in Wuhan, China, in 2019 and it widely infected people across the world thereafter. In March 2020, World Health Organization declared it as a global pandemic. Patients admitted to intensive care units are prone to developing mental illnesses; in addition, patients in the COVID Intensive care unit were at a disadvantage as they had to be kept separated from family members due to the contagious nature of their illness. Moreover, communication with medical staff was difficult due to protective equipment worn by the health care workers as well as oxygen masks and tubes assisting the patients. In this study done in year 2020 to 2022, we tried to find out the impact that intensive care unit admission in the COVID intensive care unit had on the mental health of the patients. In our study, we found that a significant number of patients developed psychiatric morbidity after discharge from the COVID intensive care unit.

Antifungal stewardship: What we need to know

Antimicrobial stewardship refers to a well-coordinated program which promotes the scientific and rational use of antimicrobials, reduces the chances of drug resistance and improves patient outcomes. A comprehensive English language literature search was done across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) for the period 1990–2022, revealing a large volume of reports of growing resistance to established antifungal therapies, against a backdrop of irrational and unscientific prescriptions. As a result of this, antifungal stewardship, a new kid on the block, has recently garnered attention. This review article is an attempt to summarise the basic concept of stewardship programs, highlighting the dire need to implement the same in the present situation of antifungal resistance and treatment failure

Theory of mind deficit in women with breast cancer and depression: A comparative study

Background: Studies have established that Theory of Mind (ToM) is impaired in patients with depression, but few studies have investigated the status of ToM in breast cancer patients who often suffer from depression. Our objective was to compare the ToM deficits in women with breast cancer with and without depression with a control group. Methods: The study was conducted at the Oncology department of a multi-speciality hospital in Kolkata. It was a cross sectional matched control study. We compared the ToM performance of women with breast cancer and depression (N=39), breast cancer without depression (N=63) and a healthy control group (N=34) using the widely used ToM task, Reading the Mind in the Eyes test (Eyes Test). Depression was diagnosed using Mini - International Neuropsychiatric Interview following International Classification of Diseases - 10th edition guidelines. Chi-square and one-way analysis of variances was done. Results: Both groups of patients had greater impairment in ToM compared to healthy controls (p<0.05). Among breast cancer patients, presence of depression predicted even greater impairment of ToM (p<0.05). Lower income, less education and not being in any occupation other than homemaking were associated with greater ToM impairment across all groups (p<0.05). Conclusion: Breast cancer patients suffering from depression may have an additional burden of impaired social cognition, which may reduce their ability to shore up social support when it is most required. This needs to be addressed urgently to ensure better quality of life.

Prospective evaluation of early local complications of stoma and their risk factors

Background: Bowel stoma namely ileostomy and colostomy are frequently performed procedure and often associated with complications. Aim of this study was to assess early local complications and association with any risk factors.Methods: A total of 99 patients undergoing ileostomy or colostomy were analysed prospectively over a period 18 months. Comorbidity, preoperative clinical data, operative time, local complications within 12 weeks and hospital stay were documented. Univariate and multivariate analysis were used to find out any association.Results: Sixty-four ileostomies and 35 colostomies were analysed in our study. Median age was 55 years in both groups. Nontraumatic bowel perforation (42%) and colorectal malignancy (48.6%) were most common etiology for ileostomy and colostomy formation respectively.  64% of ileostomy and 68% of colostomy had one or more complications. Skin excoriation (31%) was most common complication in ileostomy group and it was stomal prolapse (17%) in colostomy group. Poor stoma care was prevalent in both groups. We found diabetes to have significant association with skin excoriation (p=0.002).Conclusions: Diabetes was identified as significant risk factor for skin excoriation in ileostomy group. Further long term data and larger population are needed for better evaluation of stomal complication and their risk factors.

A Study to Evaluate the Combined Use of Alvarado Score and Imaging for Diagnosis of Acute Appendicitis.

Acute appendicitis is one of the most common abdominal emergencies encountered in surgical practice. The diagnosis of acute appendicitis is an enigmatic challenge. Several studies have reported a variable diagnostic accuracy with a negative appendicectomy rate varying from 3% up to 20% using combined diagnostic modalities or using Alvarado score alone. The present study was carried out to evaluate the diagnostic efficacy of combined use of Alvarado score and imaging modalities (USG and / or CECT abdomen) for preoperative diagnosis of acute appendicitis.METHODSThe present study was a prospective observational study carried out in a tertiary hospital of a metropolitan city. The study period extended over two years, from January 2016 till December 2018. The study included 118 adults who presented with clinical features of acute appendicitis. Alvarado scoring system based mainly on clinical features was applied and graded. Compression USG was performed on all patients. CECT of abdomen was done in 30 patients having inconclusive results on USG. Appendicectomy was performed on all the patients after the Alvarado scoring and imaging. The histopathological findings of the surgical specimens were noted to confirm the pathological diagnosis. The sensitivity, specificity, PPV, NPV and accuracy of the diagnostic methods were calculated.RESULTSOut of 118 appendicectomies, 104 were found to be positive on histopathology, with an overall 11.86% negative appendicectomy rate. Combined use of imaging with a high Alvarado score (7-10) had a sensitivity of 95.74%, specificity of 100%, accuracy of 95.8%. Combined use of imaging with a low Alvarado score (3-6) had a sensitivity of 89.47%, specificity of 53.8%, accuracy of 82.85%. Alvarado score alone had a sensitivity of 45.19%, specificity of 92.85% and accuracy of 50.8%. USG alone showed a sensitivity of 71.15%, specificity of 71.42% and accuracy of 71.18%. CECT alone had a sensitivity of 88%, specificity of 60% and accuracy of 83.3%.CONCLUSIONSImaging modalities have a valuable role in terms of diagnostic accuracy particularly in cases having low Alvarado score. CECT though expensive is preferable to USG. However, the combined methodology of Alvarado scoring, and imaging is a rational approach for accurate diagnosis preventing surgical complications and minimizing negative appendicectomy rate.

Spectrum of endometrial lesions observed on histopathological examination of endometrial samples in women with abnormal uterine bleeding

Background: Abnormal uterine bleeding is one of the common gynecological complaints of women of all age groups. Histopathological study of endometrial biopsy and curettage samples is an effective diagnostic modality that can be used to identify cause of AUB at its earliest. This study was done to investigate the various endometrial causes of AUB that frequently come to our hospital and their incidence in various age groups i.e. reproductive, perimenopausal and postmenopausal.Methods: This study was conducted on 108 patients who clinically presented with AUB and had their endometrial biopsy and curettage specimens sent to the histopathology department of our tertiary care hospital and teaching centre, located in Uttar Pradesh from June 2018 to May 2019. The endometrial patterns were observed, and their frequencies and percentages were computed and classified age group wise.Results: These studies included patients with age range from 19 to 77 years. The predominant age group with AUB was reproductive age group (<40 years). The most common histopathological finding in this study was normal menstrual pattern (48.15 %). The endometrial pathologies observed were hormonal imbalance and pill effect (22.22%), atrophic endometrium (10.19%), chronic endometritis (5.56%), benign endometrial polyp (4.63%), gestation products (3.70%), endometrial hyperplasia (3.70%), and endometrial carcinoma (1.85%). Conclusion: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.Conclusions: The most commonly known cause of AUB in reproductive age group is due to hormonal imbalance. Endometrial hyperplasia and carcinoma are usually more common in the perimenopausal and postmenopausal age groups. Overall, in patients with no organic cause of AUB, normal cyclical endometrial pattern is the most prevalent endometrial pattern observed.

Tbx20 promotes H9c2 cell survival against oxidative stress and hypoxia in vitro

Sustained and cardiac injury specific overexpression of Tbx20 provide cardiac protection of adult heart by preserving cardiac function increasing its survival rate post myocardial infarction (MI). However, the molecular mechanism underlying this protective pathway is largely unknown. Thus, in the current study, we examined Tbx20 and associated protective signaling pathway against two specific injury inductions. Injury inductions were done by imparting the cultured cardiac H9c2 cells with oxidative stress and hypoxia. Both stresses resulted in increased Tbx20 expression which activated the level of Nmyc1 and Bmp2 showing increased cellular proliferative rate. However, it was not sufficient to overcome the stress responses owing to increased apoptosis. The sustained overexpression of Tbx20, prior to injury induction, showed further enhancement in the expression patterns of Nmyc1 and Bmp2 that accelerated the proliferation rate, thus promoting the formation of increased number of viable cells, reducing the cellular apoptosis post injury. Moreover, overexpressed Tbx20 inhibits cellular hypertrophy post injury by increasing the activation level of Yap1 and together may follow a feedback loop mechanism downregulating the p-Akt activity. Therefore, Tbx20 overexpression has been found to be sufficient to impart cardiac protection post injury by triggering its associated signaling molecules.

A Clinical Comparative Study between Fentanyl and Dexmeditomidine as an Adjuvant with 0.75% Ropivacaine in Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

Introduction: Epidural anasthesia is a common method for anaesthetic management after lower limb orthopaedic surgery. The aim is to study the anesthetic effects along with hemodynamics and adverse effects, if any when fentanyl and dexmeditomidine are used as an adjuvant to 0.75% Ropivacaine in epidural anesthesia for major lower limb orthopaedic surgery. Material and methods: The study included 100 cases classified randomly into two groups (each=50): Group RF: Patient receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/kg Fentanyl. Group RD: Patients receiving epidural anesthesia with 15 ml of 0.75% Ropivacaine and 1microgram/Kg of Dexmeditomidine. Results: The quality of analgesia was better with dexmedetomidine than fentanyl group (p<0.05), andthe requirement for first rescue top up was significantly latter with dexmedetomidine than fentanyl group (p<0.05).In our study while comparing the adverse effects between the two groups we did not found any significant difference between the two groups statistically. The incidence of nausea and vomiting was higher in fentanyl group while incidences of urinary retention, shivering and dry mouth was higher in dexmedetomidine group. Conclusion: Dexmedetomidine is a better adjuvant to epidural ropivacaine compared to fentanyl for epidural anaesthesia in patients undergoing lower limb orthopaedic procedures.

A Case Study On Mutrashmari (renal Calculi) With Brukkasulantaka Vati

Aim: To evaluate the clinical effect of Brukkasulanta vati in the management of Renal calculi (Mutrashmari). Background: Renal calculi (Mutrashmari) is a most common disease of urinary system, affecting 10-12% of the population in industrialized countries which is caused by a complex process of several physicochemical events including super saturation, nucleation, growth, aggregation and retention with the kidney. A renal calculi cause symptoms severe pain in the renal angle, pain that radiates to the lower abdomen, pain on urination, cloudy or foul smelling urine, urinating more often than usual etc. which resembles with similar symptoms like Vastivedana, Mutrakrichhrata, Sarudhiramutrata, Atiavilamutrata. Results and Discussion: Brukkasulanta Vati was selected from Rasatantrasara & Siddhaprayoga Samgraha. The drug has the property of Dipana, Pachanaanulomana, Sulahara, Mutrajanana, Bhedana, Lekhana and Sothahara. The disease possess Tridosaja mainly Kaphavatajasamprapti, andthe drug has the property of Vatakaphahara, which breaks down the Samprapti of Mutrashmari. Conclusion: Brukkasulantaka vati markedly reducing pain, dysuria, increased frequency of micturation reduction of size and expulsion of calculus.

Altmetrics: A new paradigm for scholarly communication

Counting citations have been the usual norm to determine the impact of any research and/or scholar. However, with majority of the scholarly activities happening on the World Wide Web, traditional counting of citations is now being termed “slower.” The recent explosion of online data storage for many articles may serve as a pool which uses social media sites to navigate. Altmetrics has been proposed as the new entity which aims to change the focus of the scholarly reward system to value and encourage web-native scholarship. This paper makes an attempt to understand altmetrics.

A Comparative Study of Autonomic Cardiovascular Parameters in Obese and Non-Obese Adults

Globally, the epidemic of obesity in children and young adults is on a constant rise over the past decade. Obesity makes individual highly susceptible to a variety of chronic diseases and their complications. An altered autonomic response in the form of enhanced baseline sympathetic activity, feeble response to sympathetic stimuli and compromised parasympathetic activity is observed in obesity. We have assessed potentially perturbed autonomic responses in young overweight/obese first year medical students. Methods: This cross sectional analytical study was undertaken in the research lab of the Department of Physiology, M.K.C.G. Medical College over a period of 12 months on 300 students (both males and females) to determine sympathetic and parasympathetic responses to stress using hand-grip dynamometer and sinus arrhythmia test respectively. Independent ‘t’ test, Pearson’s correlation coefficient and multiple linear regression analysis in SPSS 20.0 was used to statistically ascertain the differences for the aforementioned parameters between obese and non-obese adults. Results: Weight, Body mass index (BMI), waist hip ratio (WHR), Pulse rate (PR), baseline systolic blood pressure (BSBP) & baseline diastolic blood pressure (BDBP) is significantly greater in obese than in non-obese. BMI shows positive correlation with BSBP & BDBP (r=0.660**; p<0.001 & 640**; p<0.001) and negative correlation with ΔDBP, and E/I Ratio. A negative correlation is appreciated amongst ΔDBP and BMI (R2 = 39.6). A similar negative correlation is again seen between E/I ratio and BMI (R2 = 37.2). Conclusion: Obesity potentially alters autonomic balance with increased sympathetic and reduced parasympathetic tone posing elevated risk of cardiovascular and cerebrovascular accidents.

Dental pain and its impact on quality of life among indigenous adolescents of Himalayas (Ladakh), India.

Background: Ladakh has less than optimal oral health care services and a poor transport and connectivity with other areas of the country during most part of the year. Therefore, immediate address to any dental pain is not possible. This study aims to determine the prevalence of dental pain among 12–15-year-old schoolchildren of Leh, Ladakh after the commutation impairing time of the year. Materials and Methods: A cross-sectional study was conducted in May 2014 to determine the prevalence and impact of dental pain among adolescents residing in Leh, Ladakh. A total of 264 students in the age group of 12–15 years participated in the study. The data were obtained using a pretested questionnaire that elicited information on past experience (6 months) of dental pain and the resultant impact on their daily lives. Statistical Analysis Used: Descriptive statistics was used for distribution of frequencies. Results: The response rate was 75.7%. Seventy-seven percent of the students reported dental pain in the past 6 months. About 89% of the students reported, at least, one impact due to dental pain. Females reported more than their male counterpart. Difficulty in eating was found to be commonly reported impact followed by difficulty in sleeping. Conclusions: The prevalence of dental pain and its impact was found to be high. There is a need for a paradigm shift in focus of oral health services from urban areas to remote and rural areas. Knowledge about the magnitude of dental pain can be used to evaluate and plan preventive and curative services in remote and rural areas.

Depression And Anxiety In Mothers Of Children With Cancer And How They Cope With It: A Cross-Sectional Hospital Based Study In Eastern India

Objective: Cancer is a chronic, long-term illness that affects not only the child but also the family as a whole. The family faces objective as well as subjective difficulties, e.g. stress, anxiety and depression. The burden is often experienced by mothers, since they take on the major responsibility of care giving. We conducted a study in mothers of children with acute lymphoblastic leukemia (ALL) and determined whether their coping mechanisms were acceptable and if these mechanisms were helpful to reduce depression. Methods: Mothers of 58 children with Pre (precursor) B cell leukemia were evaluated using Beck's depressive inventory (BDI), Coping Health Inventory for Parents (CHIP), and State-Trait Anxiety Inventory (STAI). Results: Coping with behaviors used by mothers of children with ALL was ineffective. The mothers mostly used coping behavior, which involved family life and relationships, and the parents' outlook on life of the affected child. The use of CHIP sub scale-type I, ie.“talking with other individuals/parents in my same situation” was significantly related to more use of sub scale-type II, ie. “doing things together as a family, involving all members of the family” are both were significantly related to STAI (p < 0.001). However total BDI score was not significantly related with any of the coping scores (BDI scores more than 9). Patients with higher BDI scores had lower scores in all sub scales of CHIP. Conclusions: Our subjects did not use social support and did not understand the medical situation through communication with other parents, or medical professionals. Fewer depressed patients used more coping skills. Educating the parents about healthy coping mechanism can be a good way to reduce stress. Encouraging social support networking and providing information about the disease may help to increase the acceptance among the mothers with ALL. A

Spatial distribution & physicochemical characterization of the breeding habitats of Aedes aegypti in & around Kolkata, West Bengal, India.

Background & objectives: Dengue infection is endemic in several areas and the dengue virus is transmitted by Aedes mosquitoes. Thus, it becomes important to understand the breeding ecology of dengue vector and characterize the physicochemical parameters of its breeding habitat. The objective of this study was to analyze the physicochemical parameters of the breeding habitat of the dengue vector and to find out the nutrient composition of the habitat in and around Kolkata, West Bengal. In addition, a geographic information system (GIS) was used to map the disease prone areas for its effective management and prevention. Methods: Water samples were collected from various breeding habitats of Aedes mosquitoes of Kolkata and adjoining areas and were analysed for various physicochemical properties like acidity, alkalinity, hardness, electrical conductivity, total dissolved solids, concentration of chloride (Cl-), sodium (Na+), potassium (K+), fluoride (F-) in relation to larval prevalence. Results: Parameters like water pH, total dissolved solids, total hardness, electrical conductivity, concentration of chloride, sodium and potassium were seen to vary throughout the year. Certain parameters were found to be dependent on container type, like concentration of fluoride. Significant positive correlations were seen between per dip larval density and total dissolved solids (TDS) and electrical conductivity. Interpretation & conclusions: Water pH, electrical conductivity, total dissolved solids were seen to play a major role in the ovipositional preferences. Container type did not seem to affect TDS. Tyres had the highest TDS in most of the cases. Nutrient composition like sodium concentration was mostly found in the coconut shells, potassium concentration also showed the same. Thus, container type and various parameters and nutrients play a major role in determining where a gravid female mosquito will lay its eggs. It was observed that by altering various chemical and physical properties of breeding habitats it was possible to control the larvae survivability.

Knowledge, Problems and Practices of Adolescent Girls During Menstruation.

Background: Menstruation is a normal phenomenon and is almost universal in all females of reproductive age. Adolescence has been recognized as a special period which signifies the transition from girlhood to womanhood with the start of menstruation but there are substantial lacunae in knowledge about menstruation, problems they face and practices they adopt in this period. Objectives: 1.To know the knowledge about menstruation in adolescents, 2.To assess problems of menstruation, 3.To address the special needs regarding maintenance of hygiene during menstruation, 4.To notice impact of socioeconomic status upon them. Material and Method: A descriptive observational (cross sectional) study was carried to assess the knowledge, problems and practices by adolescent girls attending schools in a rural area of Kishanganj district (Bihar). A proforma consisted of predesigned , pretested, structured questionnaire to be filled up by the students and a check-list of height, wt, BP, HC, WC, to be filled up by the researchers , were used. Results: Among 200 adolescents, 70% knew that menstruation is a normal phenomenon; 79% were suffering from menstrual problems and regarding type of absorbats; 70% were using only sanitary napkins, while 30% were using both sanitary napkins and cloth as absorbants. Conclusion: This study shows a lack of understandings of the importance of maintenance of hygiene during menstruation and a lot of gap is present between problems during menstruation in adolescents due to lack of knowledge and proper guidance.

Androgen - secreting steroid cell tumor of the ovary.

Steroid cell tumors (SCTs), not otherwise specifi ed of the ovary are rare subgroup of sex cord tumors, which account for less than 0.1% of all ovarian tumors and also that will present at any age. The majority of these tumors produce steroids with testosterone being the most common. A case of a 28-year-old woman who presented with symptoms of virilization is reported. Although SCTs are generally benign, there is a risk for malignant transformation. Surgery is the most important and hallmark treatment.

Comparative analysis of the genomes of Shigella dysenteriae type 2 & type 7 isolates.

Background & objectives: The four species of the genus Shigella, namely, S. dysenteriae, S. flexneri, S. boydii and S. sonnei cause a wide spectrum of illness from watery diarrhoea to severe dysentery. Genomes of these four species show great diversity. In this study, NotI, XbaI or I-CeuI restriction enzyme digested genomes of two Shigella dysenteriae isolates belonging to the serotypes 2 and 7 were extensively analyzed to find their relatedness, if any, with the whole genome sequenced strains of S. dysenteriae type 1 and S. flexneri type 2a. Methods: Pulsed-field gel electrophoresis (PFGE) technique was used to determine the diversity of Shigella genomes by rapid construction of physical maps. DNA end labelling, Southern hybridization and PCR techniques were also applied for mapping purposes. Results: The intron-coded enzyme I-CeuI cuts the bacterial genome specifically at its rrn operon. PFGE of I-CeuI digested S. dysenteriae genomes were found to carry seven rrn operons. However, I-CeuI profiles showed distinct restriction fragment polymorphism (RFLP) between the isolates as well as with the whole genome sequenced isolates. Further studies revealed that the genome sizes and I-CeuI linkage maps of the S. dysenteriae type 7 and type 2 isolates were similar to that of S. dysenteriae type 1 and S. flexneri type 2a genomes, respectively. Interpretation & conclusions: Our findings indicate that the type 7 and type 1 isolates of S. dysenteriae were probably evolved from a same precursor, while the type 2 and S. flexneri type 2a were probably evolved and diversified from a common progenitor.

Virgin coconut oil improves hepatic lipid metabolism in rats–compared with copra oil, olive oil and sunflower oil.

Effect of virgin coconut oil (VCO) on lipid levels and regulation of lipid metabolism compared with copra oil (CO), olive oil (OO), and sunflower oil (SFO) has been reported. Male Sprague-Dawley rats were fed different oils at 8% level for 45 days along with synthetic diet. Results showed that VCO feeding significantly lowered (P<0.05) levels of total cholesterol, LDL+ VLDL cholesterol, Apo B and triglycerides in serum and tissues compared to rats fed CO, OO and SFO, while HDL-cholesterol and Apo A1 were significantly (P<0.05) higher in serum of rats fed VCO than other groups. Hepatic lipogenesis was also down regulated in VCO fed rats, which was evident from the decreased activities of enzymes viz., HMG CoA reductase, glucose-6-phosphate dehydrogenase, isocitrate dehydrogenase and malic enzyme. In addition, VCO significantly (P<0.05) increased the activities of lipoprotein lipase, lecithin cholesterol acyl transferase and enhanced formation of bile acids. Results demonstrated hypolipidemic effect of VCO by regulating the synthesis and degradation of lipids.