ASSOCIATION OF ?-GLUTAMYLTRANSFERASES (GGT) WITH AND WITHOUT HYPERTENSIVE RETINOPATHY IN NORTH INDIAN POPULATION

?-Glutamyltransferase (GGT) has been extensively studied because it mediates the intracellular uptake of extracellular glutathione, a key component of the antioxidant mechanism. The most common modifiable risk factor for cardiovascular disease is hypertension, and has been found to be associated with serum GGT levels, especially in middle-aged and older adults. Serum GGT is involved in the pathogenesis of hypertension. A case-control study was conducted for 24 months with patients with pre-diagnosed hypertension in the ophthalmology department. Patients were classified into two groups, group 1 with 50 patients previously diagnosed hypertensive patients aged 40 years without hypertensive retinopathy and group 2 (100 patients) with had hypertensive retinopathy. Serum gamma-glutamyl- transferase was measured using the CORAL Colorimetric Assay Kit. Majority of patients were aged between 40 to 59 years and were females. SBP, DBP and MAP significantly increased in group 2 when compared with group 1. Majority of group 2 patients had GGT levels >40 U/l (89.0%), while the majority of group 1 had her GGT levels less than <40 U/L (62.0%). According to our study, GGT was significantly increased in patients with high blood pressure (SBP and DBP) and a family history of hypertension.

Association of serum uric acid with waist-hip ratio: A promising index for assessing cardiovascular disease risk profile

Background: Abdominal obesity is associated with insulin resistance, in turn, hyperinsulinemia and visceral adiposity lead to an increased uric acid (UA) absorption in renal tubules. Aim and Objectives: Accumulation of visceral fat is an underlying component of metabolic syndrome. Furthermore, the waist-hip ratio is an indirect tool for assessing visceral fat. The present study evaluates the association of UA levels with the waist-hip ratio. Materials and Methods: 160 subjects aged 18–60 years were enrolled in the study (those having any anatomical deformity, diabetes, and/or hypertension for more than 5 years were excluded from the study). Their anthropometric parameters, blood pressure, lipid profile, fasting plasma glucose, and serum UA levels were measured. Results: The study population was divided into three groups based on UA levels. The waist-hip ratio in a group of the hyperuricemic population was more as compared to groups of normal and below normal UA levels population and the association of UA level with waist-hip ratio was found to be significant (P = 0.045). Conclusion: The over-inflow of free fatty acid to the liver from accumulated visceral fat may be linked to the de novo purine synthesis through the pentose phosphate pathway, which may accelerate the production of UA.

Correlation of various histopathologic prognostic factors with Nottingham prognostic index and microvessel density in invasive breast carcinoma: A study of 100 cases.

BACKGROUND: Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. METHODS: This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. RESULTS: Of the 100 cases, 54% of the tumors were in T2 tumor size category (2‑5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41‑5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). CONCLUSION: NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.

Effect of Nigella sativa seeds extracts on iNOS through antioxidant potential only: Crude/total extract as molecular therapy drug.

There is general belief that only pure phytomolecules may be used as molecular therapeutic agent through one to one action. However, the traditional systems of medicine e.g. Ayurveda, uses the crude extracts, mostly water decoctions and oils, as drug. A comparative study of hexane, ethyl acetate and methanol fractions of N. Sativa seeds has been carried out on fresh rat-peritoneal-macrophage culture with reference to their role on various targets of lipopolysaccharide induced release of nitric oxide (NO) and inducible nitric oxide synthase (iNOS) expression. The results indicated significant antioxidant potential with methanolic extract as most effective. Its mechanism of action was proposed primarily through its antioxidant potential and not through direct inhibition of other kinases, involved in its signaling cascade.

Palliative weekly chemotherapy along with cetuximab in recurrent and metastatic head and neck cancers: A retrospective analysis.

Background: This study was undertaken to report the results of weekly combination chemotherapy with cetuximab in recurrent/metastatic head and neck squamous cell carcinoma (R/M SCCHN). Materials and Methods: Retrospective analysis of 35 R/M SCCHN patients who received cetuximab with weekly paclitaxel and platin (cisplatin/carboplatin) from SCCHN August 2006 to October 2008 at our Institute was performed. Results: Thirty-five patients (33 [94.3%] males and 2 [5.7%] females) received the planned weekly chemotherapy protocol. Median age of these patients was 52 years. Of the SCCHN 32 evaluable patients, 25 patients showed symptomatic improvement and 7 showed no improvement. Radiological responses using RECIST criteria reported CR in 1 patient (3.1%), PR in 17 patients (53.1%), and SD in 6 patients (18.8%). The remaining six patients demonstrated disease progression while two could not be assessed. Median overall survival (OS) was 8.016 months (95% CI; 6.572--9.461) and median PFS was 5.782 months (95% CI; 4.521--7.044). The major chemotherapy-related grades 2 and 3 toxicity recorded was cetuximab-induced rash reported in 24 patients. No treatment-related death within 30 days was observed. Conclusion: Cetuximab with weekly combination chemotherapy (Paclitaxel + Platinum compound) has shown promise, demonstrating comparable response and outcomes with acceptable toxicity in R/M SCCHN patients.

Screening for HIV infection by health professionals in India.

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.

Venous air embolism: does the site of embolism influence the hemodynamic changes?

Three hundred and ninety-seven patients undergoing posterior cranial fossa surgery in the sitting position were prospectively studied to evaluate the incidence of venous air embolism (VAE) and its effects on hemodynamics. End-tidal carbon dioxide (ETC02) tension was monitored to diagnose VAE. A sudden and sustained decrease in ETC02 of more than 5 mmHg, in the absence of sudden hypovolemia, was presumed to be the result of VAE. The site of probable air entrainment (whether muscle, bone or tumor) was noted. Hemodynamic consequences were managed symptomatically. ETC02 monitoring detected VAE in 22% of the patients. The highest incidence of embolism resulted from muscles and tumor (40% in each case). Forty-two per cent of patients developed hypotension during the embolic episode (systolic BP less than 100 mmHg). Ten per cent of patients developed ventricular arrhythmias during the embolic episode. Air aspiration was successful in 4.8%. There were no statistically significant differences in the frequency of VAE among the different groups (P>0.05). Also, the frequency of hypotension and ventricular arrhythmias were not significantly different, irrespective of the source of VAE (P>0.05). The general condition of the patients in the preoperative stage had no influence on the incidence of embolism, hypotension or ventricular arrhythmias.

Hemodynamic response to skull pins application in children: effect of lignocaine infiltration of scalp.

BACKGROUND: Skull pins application following local anesthetic infiltration of scalp obtunds hemodynamic changes in adults. No such study is available in children. METHODS: 30 children undergoing elective suboccipital craniectomy with skull pins fixation, were randomly allocated either to control group I, or lignocaine group II. Whereas in group I, pins were applied without any scalp infiltration. In group II, pins were applied 1 min. after scalp infiltration with 0.5% lignocaine (plain) at each pin site. RESULTS: Mean arterial pressure and heart rate were recorded during pinning (peak increase),1,4,7 and 10 min later, and were compared with the baseline (parameters recorded approximately 20 min. after intubation). Mean arterial pressure in group I peaked from 77.0 +/- 9.19 to 113.87 +/- 13.7mmHg (P<0.001) and remained significantly high throughout the study period. In Group II peak increase in mean arterial pressure was from 91.64 +/- 16.39 to 101.85 +/- 15.87 mmHg (P<0.01) and remained high till 1 min. only. Pins placement resulted in significant increase in heart rate only during pinning (peak increase) and up to 1 min. in both the groups (P<0.01). CONCLUSIONS: In children, skull pins placement 1 min. after scalp infiltration with 0.5% lignocaine plain fails to prevent the hemodynamic changes arising during pins placement (peak change) and up to 1 min. after pins placement. However, the technique successfully blocks these changes beyond 1 min. post skull pins fixation.

Sympathetic blockade for the relief of chronic pain.

The sympathetic blocks are useful in many ways for relief of chronic pain. The sympathetic block can be caused at pre- and paravertebral sympathetic ganglia eg, stellate ganglia, coeliac plexus and lumbar sympathetic ganglia. Indications for sympathetic blockade are: Complex regional pain syndrome, phantom limb pain, central pain, acute pancreatitis, pancreatic cancer and cancer pain from upper abdominal viscera. Stellate ganglion blockade is required for the diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions of head, neck and upper extremity. Coeliac plexus block is indicated in pain due to intra-abdominal cancer, stemming from organs innervated by coeliac plexus. Lumbar sympathetic block is indicated for diagnosis, prognosis and therapy for painful and other conditions associated with sympathetic dysfunctions like complex regional pain syndrome I and II, herpes zoster, amputation stump pain and inoperable peripheral vascular vasospastic diseases of the lower limb. Indications for superior hypogastric block are the prognostic and therapeutic purposes of cancer pelvic organs--uterus, cervix, bladder, prostate, urethra, testes and ovaries.

Aspiration vs nonaspiration technique of cytodiagnosis--a critical evaluation in 160 cases.

The two sampling techniques were studied in 160 randomly selected cases of superficial swellings in various sites of the body. They were sampled by fine needle aspiration (FNA) and by non-aspiration (NA) (a needle without application of aspiration pressure). Cell samples were cytologically assessed and critically evaluated using five objective parameters. Contamination with blood was more in lymphnode, thyroid and liver lesions in aspiration smears than NA smears and values were statistically significant. Similarly when compared for the degree of cellular trauma and cellular degeneration statistically significant better results were obtained by nonaspiration technique for lymphnode lesions. Regarding amount of cellular material obtained by FNA, statistical significant better results were found for breast lesions only. Statistically significant better maintenance of architecture was observed only for thyroid lesions by NA technique. Better average scores were observed by NA technique for lymphnode and thyroid only. Categorizing all the smears obtained by FNA & NA on the basis of their scores according to predetermined criteria, greater number of diagnostically adequate specimens were obtained by FNA than by NA but the number of diagnostically superior specimens obtained by NA technique was found to be more than that by FNA. The difference was found to be statistically significant. However the number of inadequate smears was also more by NA technique than by FNA technique.

Bone mineral content in normal and malnourished children.

Bone mineral content (BMC) was determined at the distal radius in 70 children aged 2-14 years; Group I comprising 34 normal healthy children and Group II 36 malnourished children by the method of single photon absorptiometry. The mean value of BMC in Group I was 0.3 +/- 0.04 g/cm in 2-5 year, 0.52 +/- 0.08 g/cm in 6-10 year and 0.77 +/- 0.88 g/cm in 11-14 year age groups. No significant difference in the BMC was seen between boys and girls. An increase of BMC corresponded to growth spurts in 2-5 year and 11-14 year age groups. There was a significant reduction of BMC in Group II and in grade III malnutrition in 2-5 year and 11-14 year age groups as compared to Group I children. The study provides normal BMC data for Indian children and suggests that this can help to detect undemineralization of bones in malnourished children during the growth periods.