Mastalgia and associated breast diseases in a tertiary care center, Tamil Nadu: A cross-sectional study

Background: Mastalgia is the common breast condition among women. Mastalgia has highly variable prevalence which ranges 41–79%. It is more common in age group between 30 and 50 years. Mastalgia is approached according to its classification into three major categories, that is, cyclical pain, non-cyclical pain, and extra mammary pain. Breast pain ranges from mild to severe influencing the lifestyle of women affecting sexual relations, sleep pattern, and decreasing their daily life activities. Aim and Objectives: The aim of the study was to determine the incidence of benign and malignant breast disease in mastalgia. Materials and Methods: This cross-sectional study was conducted in Government Medical College, Sivagangai. Patients complaining of breast pain were examined. The data were compiled in an Excel worksheet, Epiinfo version 7.0 was used to analyze the data. Results: In our study, 100 patients complaining of breast pain were examined ranging from age 18 to 68 years. The mean age of the study population was 37.54 years and standard deviation of 9.077. Among 100 patients with mastalgia only 1 (1.64%) had malignancy which is insignificant and among rest 99 patients with mastalgia, 60.61% had benign breast diseases and 39.39% had no any breast lesions. Benign breast diseases are more commonly found in patients with mastalgia. Conclusion: Women having mastalgia can be reassured and some lifestyle modifications may aid the women. Hence, early detection of any breast disease in women having mastalgia and treating accordingly has considerable importance. Lifestyle modifications are needed in patients with mastalgia and they should come to facility to check and identify the issues and solve soon.

Determination of individual type 2 diabetes risk profile in the North East Indian population & its association with anthropometric parameters

Background & objectives: Diabetes genomics research has illuminated single nucleotide polymorphism (SNP) in several genes including, fat mass and obesity associated (FTO) (rs9939609 and rs9926289), potassium voltage-gated channel subfamily J member 11 (rs5219), SLC30A 8 (rs13266634) and peroxisome proliferator-activated receptor gamma 2 (rs1805192). The present study was conducted to investigate the involvement of these polymorphisms in conferring susceptibility to type 2 diabetes (T2D) in the North East Indian population, and also to establish their association with anthropometric parameters. Methods: DNA was extracted from blood samples of 155 patients with T2D and 100 controls. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. To confirm the association between the inheritance of SNP and T2D development, logistic regression analysis was performed. Results: For the rs9939609 variant (FTO), the dominant model AA/(AT+TT) revealed significant association with T2D [odds ratio (OR)=2.03, P=0.021], but was non-significant post correction for multiple testing (P=0.002). For the rs13266634 variant (SLC30A 8), there was considerable but non-significant difference in the distribution pattern of genotypic polymorphisms between the patients and the controls (P=0.004). Significant association was observed in case of the recessive model (CC+CT)/TT (OR=4.56 P=0.001), after adjusting for age, gender and body mass index. In addition, a significant association (P=0.001) of low-density lipoprotein (mg/dl) could be established with the FTO (rs9926289) polymorphism assuming dominant model. Interpretation & conclusions: The current study demonstrated a modest but significant effect of SLC30A8 (rs13266634) polymorphisms on T2D predisposition. Considering the burgeoning prevalence of T2D in the Indian population, the contribution of these genetic variants studied, to the ever-increasing number of T2D cases, appears to be relatively low. This study may serve as a foundation for performing future genome-wide association studies (GWAS) involving larger populations.

Pleuropulmonary nocardiosis due to Nocardia otitidiscaviarum in a debilitated host.

Nocardia otitidiscaviarum is a rare cause of pulmonary nocardiosis. We present a case of pulmonary nocardiosis with pleural involvement in an adolescent with rheumatic heart disease and congestive cardiac failure presenting with right lower lobe consolidation and pleural effusion. Direct gram‑stain of pleural fluid showed pus cells with Gram‑positive filamentous branching bacilli. Empiric treatment with parenteral ceftriaxone and supportive therapy for cardiac failure was initiated. Pleural fluid culture yielded growth of N. otitidiscaviarum at 72 h. Antibiotic susceptibility testing showed resistance to cephalosporins. The patient expired due to congestive cardiac failure on the 5th day.

Myroides odoratus and Chryseobacterium indologenes: Two rare isolates in the immunocompromised.

Myroides spp and Chryseobacterium spp are uncommon clinical isolates, though more frequently reported to cause infections than other pigmented non‑fermentors. Two cases of Myroides odoratus and Chryseobacterium indologenes infection in a diabetic with pulmonary tuberculosis and a patient with de‑compensated alcoholic liver disease, respectively, are reported here. Anti‑microbial susceptibility testing of the isolates was performed by determining the minimum inhibitory concentration. The clinical picture, characteristic features of the isolates and the antibiotic susceptibility pattern are discussed briefly.

Vetiveria zizaniodes and terminalia chebula as alternative natural adsorbent for drinking water treatment.

Drinking water samples was collected from lake and silver cascade water falls in Kodaikanal were analyzed for physico- chemical characteristics. Vetiveria zizaniodes and Terminalia chebula plant extract were examined as natural alternative materials for drinking water treatment. The results was compared with the WHO standards of drinking water quality parameters namely pH, electrical conductivity, COD, magnesium, alkalinity, and sulfate, total dissolved solids and total hardness, dissolved oxygen, iron, fluoride. The result showed that, V. zizaniodes enhanced the water quality than T. chebula in terms of (denoted values). Therefore, the use of plant materials with low cost natural absorbents is recommended for eco-friendly, nontoxic, simplified water treatment.

Association of Postpartum Maternal Morbidities with Children’s Mental, Psychomotor and Language Development in Rural Bangladesh.

Little is known from developing countries about the effects of maternal morbidities diagnosed in the postpartum period on children’s development. The study aimed to document the relationships of such morbidities with care-giving practices by mothers, children’s developmental milestones and their language, mental and psychomotor development. Maternal morbidities were identified through physical examination at 6-9 weeks postpartum (n=488). Maternal care-giving practices and postnatal depression were assessed also at 6-9 weeks postpartum. Children’s milestones of development were measured at six months, and their mental (MDI) and psychomotor (PDI) development, language comprehension and expression, and quality of psychosocial stimulation at home were assessed at 12 months. Several approaches were used for identifying the relationships among different maternal morbidities, diagnosed by physicians, with children’s development. After controlling for the potential confounders, maternal anaemia diagnosed postpartum showed a small but significantly negative effect on children’s language expression while the effects on language comprehension did not reach the significance level (p=0.085). Children’s development at 12 months was related to psychosocial stimulation at home, nutritional status, education of parents, socioeconomic status, and care-giving practices of mothers at six weeks of age. Only a few mothers experienced each specific morbidity, and with the exception of anaemia, the sample-size was insufficient to make a conclusion regarding each specific morbidity. Further research with a sufficient sample-size of individual morbidities is required to determine the association of postpartum maternal morbidities with children’s development.

Subcutaneous phaeohyphomycosis due to Exophiala spinifera in an immunocompromised host.

A case of phaeohyphomycosis presenting as multiple subcutaneous abscesses in a young lady with deteriorating liver function was reported here. The lesion started as a solitary abscess in the neck, mimicking tuberculous cold abscess and rapidly involved the face, chest, arms, and legs within six months with ulceration and discharge of thick brownish foul smelling pus. Potassium hydroxide mount of pus from various sites revealed septate dematiaceous hyphae and pseudohyphae. Culture yielded pure growth of Exophiala spinifera. Tissue debridement was done along with initiation of antifungal therapy with ketoconazole. As liver function deteriorated, antifungal therapy was withdrawn after seven days. Patient expired three weeks after admission due to hepatic failure.

Serum homocysteine concentration in patients with acute MI and chronic IHD.

This was an observational study carried out in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka; with the active co-operation of Coronary Care Unit (CCU) of BSMMU & National Institute of Cardiovascular Disease (NICVD), Dhaka. This study was carried out from March 2002 to January 2003. Total seventy (70) subjects were studied. Out of them 20 were of Acute MI, 20 were Chronic ischemic heart disease (CHD) and 30 were age and sex matched healthy controls. Hospitalized diagnosed patients were selected by taking history, clinical examination and several investigations like ECG. Echocardiogram, Angiogram and several enzymes assay. Several studies in many countries showed that serum homocysteine (Hcy) was elevated in IHD Patient. Cardiovascular disease is alarmingly increasing in Bangladesh. So our aim and objective of the study was to find out the association of serum Hcy with Acute MI and chronic ischemic heart disease (CHD) patients in our population. Mean Hcy level of Acute MI were 21.16 +/- 4.56 (micromol/l), 27.55 +/- 10.40 (micromol/l) and that of control was 13.03 +/- 10.51(micromol/l). Serum Hcy was significantly higher in both cases than control. But insignificant difference was found between AMI vs CHD (P> 0.05). Quantitative measurement of serum Hcy was measured by fluorescence polarization Immunoassay (FPIA) in IMX analyzer (Abbott-USA).

Serum zinc and copper levels in the maternal blood and cord blood of neonates.

Estimation of serum zinc and copper in the maternal blood and cord blood of neonates was carried out to correlate the trace metals in the neonates and their mothers in relation to gestational age and birth weight. Sixty-five healthy neonates, both term and preterm and their mothers were selected. This cross sectional study was done at Azimpur Maternity Centre, Dhaka Medical College Hospital and Chemistry Division, Atomic Energy Centre, Dhaka, Bangladesh from July 1997 to June 1998. The estimation of trace metals was carried out by Atomic Absorption Spectrophotometry (AAS). The mean serum zinc levels in the maternal blood and cord blood were 0.47 +/- 0.24 microgram/ml and 0.85 +/- 0.33 microgram/ml respectively and the mean copper levels in the maternal blood and cord blood were 1.37 +/- 0.62 micrograms/ml and 0.31 +/- 0.32 microgram/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels. There was no significant correlation between gestational age and serum zinc levels in the cord or maternal blood. But significant inverse correlation was found between gestational age and serum levels of copper in the maternal and cord blood.

Self care in health.

The study "self care" was conducted in two Unions of one Upazila to assess prevalence, component and outcome of popular "self care" and their decision making process. Head of the family (500) and wives of the head of the family (500) were interviewed on alternate basis by trained interviewers on structured pretested questionnaire. Self care for remedial measure was universally practiced. Initial step related to treatment of diseases were "wait and see" (71.8%), "Self care" (18.4%), "Doctor/Homeopath" (9.8%). Self care was practiced by majority of the people in all other components. Those who reported "wait and see" as their first choice to deal with disease, about 79% waited for one day, 21% for two days. Education and income was found significant with practice of self care.

Health situation of slum dwellers of metropolitan area of Dhaka.

The study interviewed three hundred women, mostly the wives of the head of the household of urban slums. The study women were selected on random sampling basis. The knowledge of study women on preventive MCH care was good (39.7%) and about 21.7%, contacted some trained persons for advice on matters related to pregnancy and treatment of sickness. Almost all the deliveries were conducted at home by relations or neighbours (80.1%). Disease prevalence rate at the time of interview was 253/1000 population. Common diseases reported were fever 31.6%, intestinal problems 26.3%, measles 11.8%, skin diseases 7. 9%, chronic respiratory infection 9.2% and the rests were "others". About one third of the sick persons did not have any treatment. On the average 3.9 persons lived in one room of 2.4 x 4 metres. Source of water supply for drinking and other purposes was mostly municipal taps in a public place. Environmental sanitation for the area was poor.