COVID-19 Lockdown and Improvement in Air Quality Index: A Learning Lesson

Introduction: The basic requirements for human survival include air, food, and water; a decrease in quality of which has a deep impact on health. An increase in population with increasing globalization, industrialization, and increased energy demand has led to increased air pollution in cities world over. Multiple national programs to improve air quality have been unsuccessful. Coronavirus disease 2019 (COVID-19) pandemic-led lockdown is a large-scale experiment that is unprecedented and could not have been done at regular times. Indirect effects include cutting down emissions from industries, vehicles, and diesel generators. Materials and methods: In this ambispective observational study, we compared the air quality index (AQI) and levels of other pollutants in the two cities of Delhi and Kanpur during the period of the lockdown, the same period during the preceding year, and during the rainy season. Results: It was observed that the cities of India with notoriously polluted air, i.e., Delhi and Kanpur, had unprecedented improvement in air quality during lockdown (Delhi, AQI: 86.91 � 32.38 vs 249.36 � 60.25 and Kanpur, AQI: 81.60 � 38.54 vs 137.06 � 46.74). The improvement was even better than the preceding year's monsoon for Delhi. The AQI was comparable in both cities during the lockdown. Conclusion: The AQI was falling in the 搒atisfactory� range in both Delhi and Kanpur during the lockdown. This may, in turn, favorably unfold a reduction in the incidence, progression, and exacerbation of respiratory illnesses. This is an eye-opening change and calls for urgent action to maintain the same. Timely and well-framed steps should be sought; a revolutionary carbon-free and green energy economic model is much needed. Most air pollution is preventable and can be managed by humans if a stringent action plan is rolled out and implemented sternly by government agencies.

Is there any correlation between tumor infiltrating lymphocytes and expression of EGFR in squamous cell carcinoma of head and neck? A retrospective observational study

Background: The dismal survival of one of the commonest malignancies of the world, head neck squamous cell carcinomas (HNSCC), has prompted researchers to probe into its various characteristics, especially those which reflect the outcome. Over the years, even though epidermal growth factor receptor (EGFR) and tumor-infiltrating lymphocytes (TIL) have emerged as useful biomarkers of the disease, the two parameters have rarely been considered in conjunction. Aims and Objectives: The study aimed to assess if there is any correlation between TIL levels (both stromal and intratumoral) and site, grade, stage, and EGFR score of HNSCC. Materials and Methods: A retrospective observational study was conducted in which histopathologically confirmed cases of HNSCC were included. The site of tumor, grade, stage, stromal and intratumoral TIL levels, and EGFR score were noted for each case. The data were analyzed using standard statistical tests. Results: The study population consisted of 122 patients with a mean age of 53.8 ± 9.2 years. The oral cavity was the commonest site of tumor (109 cases, 89.3%). Most cases were moderately differentiated (75, 61.5%). Pathological staging showed 66 cases (54%) to be in pT1, and 92 cases (75.4%) to be in pN0. In 68 cases (55.7%), stromal TIL level was high, and intratumoral TIL was low in 102 cases (83.6%). A statistically significant correlation was found between TIL levels and site, grade, pathological stage, and EGFR score of HNSCC. Conclusion: This pioneering study is unique in its exploration of the correlation between two significant biomarkers of HNSCC – TIL and EGFR score.

Self-reported reproductive tract infection/ sexually transmitted infection and health care seeking behavior among the women living in a slum of Kolkata

Background: Sexually Transmitted Infection (STI) is a public health problem of significance in most parts of the world. It adversely affects reproductive health in both sexes but its impact on women‟s reproductive health is far devastating. Objectives: The study was conducted to know the prevalence of self-reported STI among the currently married women living in the slum area of Kolkata, the factors related with it and also to study their care seeking behavior following the infection. Materials and methods: This community based descriptive study was conducted by interviewing currently married women residing in a slum of Kolkata. Symptoms of STI and healthcare seeking behavior following the infection were enquired. Symptoms were grouped into complexes and presumptive diagnosis was made. Results: The prevalence of symptoms suggestive of STIs in the study population was found to be 47.8%.The most common symptoms reported by the sufferers were low backache (29.6%), burning micturition (25.2 %), and genital itching (23.5%). All symptoms were more common in the women living in the joint family, having one or more history of abortion. Symptoms of urinary tract infection was more in the age group of >30 years and those with >10 years of marriage. Whereas, vaginitis was more common in <30 years (p= 0.01). Only 49.0% of the sufferers consulted a health facility for Chakrabarti S, Chakrabarti A. Self-reported reproductive tract infection/ sexually transmitted infection and health care seeking behavior among the women living in a slum of Kolkata. IAIM, 2017; 4(4): 46-52. Page 47 treatment and most of them (62.9%) availed health service from the urban health training centre of the area. Conclusion: The present study found high prevalence of self-perceived reproductive morbidity among women in the slum setting. In the study there was no scope of laboratory investigation and was based on recall of the event in preceding three months

Consequence of neo-adjuvant chemotherapy on morphology of breast carcinoma: A systematic evaluation.

BACKGROUND: Neo‑adjuvant chemotherapy (NAC) in locally advanced breast cancer is the present trend. Following NAC, a considerable alteration of morphology occurs in the tumor. AIMS: To study effects of NAC on morphology of breast carcinoma and to evaluate the pathologic response (PR). MATERIALS AND METHODS: A total of 39 surgically resected mastectomy specimens of patients of invasive locally advanced breast carcinoma who received NAC were evaluated for macroscopic and microscopic (by routine stains and immunohistochemistry) alteration of morphology. RESULTS: Macroscopically well‑defined tumor noted in 25 cases (64.1%) and in the rest (14 cases, 35.9%), only fibrotic areas identified. Microscopic examination identified malignant cells in 29 (74.4%), significant chronic inflammation in 24 (61.5%), hyalinized fibrosed stroma in 25 (64.1%) and necrosis in 11 (28.2%) cases. Immunohistochemistry assisted in differentiating malignant cells from histiocytes. In 15 cases (38.5%), axillary lymph nodes isolated where fibrosis seen in 12 (30.8%) and malignant cell in 8 (20.5%) cases. In 34 cases where the pre‑treatment biopsy were available, complete pathologic response (pCR) and partial pathologic response (pPR) were achieved in 7 (20.6%) and 23 (67.4%) cases respectively. DISCUSSION: Protocol of systematic evaluation of morphological changes is different in cases of a patient treated by NAC. Nature of malignancy was difficult to categorize as morphology of typical breast carcinomas were altered. Sometimes, immunohistochemistry is advantageous as routine H and E stains are not sufficient to isolate malignant cells in fibrotic and necrotic areas. Appropriate morphological evaluation of the mastectomy specimen is absolutely crucial for assessment of PR and subsequent management.

Collision tumor of ovary: a rare combination of dysgerminoma and serous cystadenocarcinoma.

Collision tumors of ovary are rare neoplasms and most commonly consist of a teratoma with mucinous tumor. Combination of papillary serous cystsdenocarcinoma and dysgerminoma was yet to be reported. A twenty years female patient presented with a large tumor of right ovary. Microscopically it was diagnosed as a collision tumor of ovary composed of dysgerminoma and serous cystadenocarcinoma. Mixed tumour can arise from divergent differentiation of a single type of stem cell. But components of collision tumor must arise from separate clones. Possibility of collision tumour should always kept in mind during assessment of difficult ovarian tumors to avoid diagnostic error. Key words: Collision tumor, dysgerminoma and serous cystadenocarcinoma.

Knowledge, experience & attitudes concerning electroconvulsive therapy among patients & their relatives.

Background & objectives: Electroconvulsive therapy (ECT) is used frequently in developing countries, but investigations of patients’ awareness and perception of ECT are rare. The present study thus attempted a comprehensive examination of knowledge, experience and attitudes concerning ECT among patients treated with brief-pulse, bilateral, modified ECT, and their relatives. Methods: Of the 153 recipients of ECT, 77 patients and relatives were eventually assessed using questionnaires designed to evaluate their awareness and views about ECT. Results: Patients were middle-aged, poorly-educated, often unemployed, with chronic, severe, and predominantly psychotic illnesses. Relatives were mainly parents, older, better-educated and usually employed. Apart from the very rudimentary aspects, patients were largely unaware of the procedure. Though most did not find the experience of ECT upsetting, sizeable proportions expressed dissatisfaction with aspects such as informed consent, fear of treatment and memory impairment. Although patients were mostly positive about ECT, ambivalent attitudes were also common, but clearly negative views were rare. Relatives were significantly likely to be more aware, more satisfied with the experience and have more favourable attitudes towards ECT, than patients. Interpretation & conclusions: The results endorse the notion that recipients of ECT are generally well-disposed towards the treatment, but also indicate areas where practice of ECT needs to be improved to enhance satisfaction among patients and relatives.

Detection of prodromal symptoms of relapse in mania & unipolar depression by relatives & patients.

Background & objectives: Detection of prodromal symptoms among patients with mania by their immediate relatives has been seldom examined. We carried out this study to examine the ability to detect and report prodromol symptoms of manic relapses by patients themselves and their relatives. Methods: The ability of patients and their relatives to detect prodromal symptoms was examined among 60 remitted patients, 30 each with DSM-IV diagnoses of bipolar disorder and recurrent depressive disorder, with recent manic/depressive relapses, and their 60 immediate relatives, using an instrument composed of items from common symptom-scales, as well as by unstructured interview. Results: Seventy per cent of patients with mania reported prodromes prior to relapse. This was significantly (P<0.01) less than the proportion of their relatives (97%), as well as the proportion of patients with unipolar depression (93%), reporting prodromal symptoms (P<0.05) among patients. Mean duration of the prodromal period reported by patients with mania was about 20 days (median-10 days); relatives reported durations which were longer by about 5 days. Prodromes of unipolar depression (mean 42.7 days; median- 21 days), were significantly longer than of mania, when reported by patients, but not by their relatives. Differences in reporting of prodromes, between relatives and patients seen in mania, were not observed in unipolar depression. The number and type of prodromal symptoms of mania reported was similar among patients and relatives. Interpretation & conclusions: Our findings showed that relatives of patients with mania were better at detecting prodromes of relapse; thus, input from relatives can improve the early detection of prodromal symptoms to prevent relapses of bipolar disorder.

Influence of drying of biosludge on organochlorine compounds from pulp and paper industry.

Pulp and paper industry is one of the major sources of man-made generation of organochlorine compounds. During biological treatment of wastewater, part of organochlorine compounds is discharged with treated effluent and part is retained on biomass and disposed of as waste activated sludge. Due to presence of these compounds, the disposal of biosludge from pulp and paper industry has become an issue. The estimation of adsorbable organic halogen (AOX) compounds after drying and grinding resulted in 49% lower concentration of AOX due to stripping of purgeable compounds. These purgeable compounds are not released at 60oC in aqueous medium during estimation of purgeable organic halogen (POX) compounds. Dispersion of sludge by sonication overcomes the loss of POX compounds and results in higher concentration of AOX compounds. The drying of biosludge samples at 45, 100 oC and in presence of sun light resulted in 20.1, 49.0 and 29.6% removal of purgeable AOX compounds, respectively. The lab scale sorption study using dichloromethane (as volatile organochlorine compound) reveal that biosludge from pulp and paper industry is a good adsorbent of volatile organochlorine compounds and results in poor release of these compounds during estimation of POX compounds.

Psychosocial factors associated with relapse in men with alcohol or opioid dependence.

Background & objectives: Relapse is a common and distressing aspect of substance dependence mediated by several biological and psychosocial factors. This study examined the association between demographic variables, clinical parameters and certain psychosocial factors and relapse among patients with either alcohol or opioid dependence. Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, coping strategies, self-efficacy, stressful life events and perceived social support were carried out among patients with alcohol/opoid dependence (n=30) who had relapsed and compared with those (n=30) who had managed to remain abstinent. Similar comparisons were also carried out between relapsed and abstinent patients in the individual subgroups of alcohol and opioid dependence. Results: Patients who had relapsed were significantly more likely (i) to have a positive family history of substance use and higher number of previous relapses; (ii) to be using maladaptive coping strategies; (iii) to have been exposed to a higher total number of ‘high risk’ situations; and (iv) have experienced a higher number of undesirable life events. Those who had remained abstinent tended to use significantly more number of coping strategies, principally adaptive ones and scored significantly higher on all measures of self-efficacy. Factors influencing relapse appeared to be largely similar among patients with alcohol and opioid dependence. Interpretation & conclusions: This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It extended these results to substances other than alcohol and provides the basis for investigating correlates of relapse in a wide range of behavioural and substance use problems.

Observations of hepatic encephalopathy profile in a tertiary care centre.

A study was conducted among 67 patients presenting with hepatic encephalopathy to establish the aetiological diagnosis and record the incidence of acute and chronic liver diseases. They all had undergone thorough clinical and laboratory evaluation. The factor precipitating encephalopathy was also identified. Among 67 patients 19 (28.4%) had acute liver disease and 48 (71.6%) had chronic liver disease. Majority of patients had grade 2 encephalopathy at presentation. Among the acute cases most common aetiology was acute viral hepatitis due to hepatitis B and E viruses whereas alcoholic liver disease was the most frequent cause of chronic liver disease. The most common precipitating factor was gastro-intestinal haemorrhage.

Frequency of major affective disorders in first-degree relatives of patients with type 2 diabetes mellitus.

BACKGROUND & OBJECTIVES: A genetic link between diabetes and depression has been proposed, but hardly explored. Data on family studies exploring relation between depression and diabetes are scanty. This study attempted to assess the prevalence of major affective disorders in first-degree relatives of patients with type 2 diabetes mellitus (T 2 DM). METHODS: Fifty probands with T 2 DM, in whom other psychiatric disorders had been excluded, were chosen. Morbid risks and prevalence figures for depression and mania were estimated in 481 first-degree relatives of these 50 probands using the family interview for genetic studies. RESULTS: Of the 481 first-degree relatives of probands, only six had affective disorders. The morbid risk for depression in first-degree relatives was 2.99 and 3.87 per cent, assuming age of risk at 15-60 and 15-50 yr respectively, while the morbid risk for mania was 0.59 and 0.77 per cent in these age groups. INTERPRETATION & CONCLUSION: The morbid risks/prevalence rates among first-degree relatives of probands with T2 DM were not higher than those of the general population rates derived from earlier Indian and western studies. This study did not demonstrate a family aggregation of affective disorders in patients with T 2 DM. Increased prevalence of affective disorders in diabetes could be due to non-genetic factors.

Prevalence of anti HCV, HBsAg and HIV antibodies in high risk recipients of blood and blood products.

Along with hepatitis B virus (HBV) and human immunodeficiency virus (HIV), Hepatitis C virus (HCV) is emerging as a major transfusion hazard. 22 cases of haemophilia (A 19, B 3) and 20 cases of thalassaemia (2 16, E(2) 4) constituted the study group. Patients tested for anti HCV (using third generation ELISA), HBsAg and antibodies to HIV I and II. Prevalence of anti HCV was 54.5% in haemophilics and 5% in thalassaemics. HBsAg was detected in 9.09% haemophilics and 5% thalassaemics. No anti HIV was detected in this cohort. Anti HCV seropositivity in haemophilics has increased compare to previous studies.

Sarcoma-like mural nodules in ovarian mucinous cystadenomas--a report of two cases.

Sarcoma-like mural nodule is a very rare occurrence in a mucinous tumour of the ovary. Two such nodules having morphologically benign features with osteoclastic giant cells, in the wall of mucinous cystadenoma are described. In addition, these nodules exhibited reactive vascular proliferations. The sarcoma-like nodules are associated with a favourable outcome and must be distinguished from other malignant nodules composed of sarcoma or anaplastic carcinoma that may also occur in the wall of mucinous ovarian tumours.

Genetic diversity and differentiation of Indian isolates of Phytophthora infestans as revealed by RAPD analysis.

Sixty-seven isolates of Phytophthora infestans collected from Himalayan hill regions and subtropical planes of India were characterized by RAPD markers to assess diversity and differentiation based on location of origin. Ten random decamer primers generated 161 polymorphic fragments. Association of P. infestans isolates on the dendrogram and PCO plot revealed two clear grouping based on geographical location of origin-hill isolates and plane isolates. Quantification of diversity by Shannon index of diversity analysis demonstrated that most of the diversity was present with a particular population (hill or plane) of P. infestans isolates, with 85% variation being within and 15% being between hill and plane isolates. Subtropical plane isolates of P. infestans exhibited higher variability compared to hill isolates and they were more dispersed on the PCO plot. No clear differentiation of isolates based on mating type was reflected on the dendrogram and PCO plot.

Lithium - induced tardive dystonia.

Tardive dystonia is an uncommon form of chronic dystonia, which usually develops on exposure to neuroleptics. Tardive dystonia (Tdt) following lithium therapy has not been previously reported. The case of 38 year old man with bipolar affective disorder who developed tardive dystonia while on maintenance lithium treatment is described. Presentation of Tdt in this patient was fairly characteristic although there was no suggestion of recent neuroleptic exposure. Tdt known to have poor treatment response, responded very well to clozapine, a novel anti-psychotic, in this case. To conclude, Tdt may develop on exposure to drugs other than neuroleptics. An adequate trial to clozapine can prove to be a useful treatment option.

The neurology of eclampsia : some observations.

Nineteen patients admitted with diagnosis of eclampsia in a large general hospital between 1996 - 1999, were analyzed. Eight patients were referred to neurologists for assessment and management. All these patients had recurrent generalized seizures. Five patients developed visual disturbance. Neuroimaging (CT and/or MRI) revealed symmetrical occipital lesions in all. One patient had a large pontine lesion. Seizure control was achieved in all with intravenous phenytoin. All patients recovered fully without any residual neurological deficit and their radiological brain lesions resolved completely, in all except one case. The neurological manifestations and neuroimaging features in cases of eclampsia have been reviewed. A brief note on the pathogenesis of the cerebral lesions is included and the controversial aspect of seizure control in eclampsia highlighted.

Squatting, blood pressure and stroke.

Most Indians still adopt squatting posture in toilets. In a group of 67 healthy volunteers, squatting produced a small (8.09 +/- 7.04 mm Hg) but significant rise in systolic blood pressure (SBP) but not in diastolic (DBP). However, in a group of randomly selected treated hypertensives (N=104) squatting produced a much greater and significant rise in both SBP (14.46 +/- 11.63 mm Hg) and DBP (9.10 +/- 9.19 mm Hg). The possible clinical significance of this rise of BP in squatting has been evaluated in 100 consecutive CT proved patients with stroke by analysing their stroke onset data in relation to time, place, posture and activity. Most strokes (52%) occurred in the morning hours (5 am-9 am) and at home (86%) and over a third (36%) while in toilets. Thirty six percent of strokes occurred when the subjects squatted, mostly during defecation. More than half of hemorrhagic strokes occurred in the squatting position. The relationship of these clinical observations with the BP changes noted above on squatting appears to be more than fortuitous. We would suggest that hypertensive subjects and those at risk of stroke should avoid squatting and urge physicians to check squatting BP while monitoring anti-hypertensive therapy.

Vocal cord dysfunction presenting as refractory asthma.

Vocal cord dysfunction is a rare variety of upper airway obstruction characterized by typical laryngoscopic features and may mimic an acute asthma attack. The case presented in this report pertains to a 15-year-old girl who had repeated acute episodes of dyspnoea and wheezing and remained non-responsive to corticosteroids and inhaled bronchodilators requiring endotracheal intubations for adequate control. Laryngoscopic findings were consistent with vocal cord dysfunction. She was treated with a tracheostomy and psychological support.

The usefulness of prostate specific antigen density as a screening method for prostatic carcinoma.

Prostate specific antigen (PSA) has been used extensively for monitoring the progression of prostatic cancer since its discovery in 1979. Unfortunately the measurement of PSA in serum is not sufficiently specific for early detection of prostatic carcinoma (CaP) as it is secreted by normal as well as hyperplastic or cancerous prostatic tissue. As serum PSA is the reflection of the number of prostatic epithelial cells, a small cancerous prostate gland having increased number of cells per unit volume leaks more PSA in serum than a benign, large gland. Thus the concept of PSA density (PSAD) has been proposed (the quotient of serum PSA divided by the volume of prostate in cubic centimeter) as an indicator for prostatic malignancy. In the present study pre-operative PSAD values of 65 cases of prostatic diseases were calculated [54 cases of benign prostatic hyperplasia (BPH) and 11 cases of C3P]. Serum PSA was measured by enzyme linked immunosorbent assay (ELISA) method and the prostatic volume was measured by transrectal ultrasonography (TRUS). Although 8 cases of BPH (14.8%) had raised PSA level, abnormal PSAD (0.1 or above) was noted in only 3 cases. All cases having PSAD value above 0.2 had carcinoma. The PSAD value above 0.1 in cases of CaP was found to be significant (p<0.001). By using PSAD as screening test the sensitivity increased from 85.1% to 94.4% and positive predictive value increased from 55.5% to 75%, compared to the detection of carcinoma by measuring PSA alone. The present study concludes that PSAD is more useful for prediction of CaP and the need of prostatic biopsy for early detection.