Low incidence of metabolic syndrome in patients taking atypical antipsychotic in Eastern India

Background: Atypical antipsychotics, widely used in many psychiatric diseases, are known to cause metabolic syndrome (MetS). But, there is sparse of prospective study to see the effect of atypical antipsychotics causing MetS in drug na飗e or drug free patients among the Indian population. This study aimed to determine the incidence of MetS and change in individual risk factor for MetS in schizophrenia and mood disorder patients after three months of receiving atypical antipsychotics. Method: Sixty patients of schizophrenia (n=40) and mood disorders (n=20) were screened at the baseline and all of them were prospectively followed up for the occurrence of MetS after three months. Results: By applying the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP/ATP III) modified criteria for Asian, the incidence of MetS was found to be 11.66%. When analysing the individual risk factor for MetS, the mean value from baseline to follow-up was weight (in kg) 58.55�.03 to 59.80�.24 (p<0.001), waist circumference (cm) 80.52�33 to 81.43�42 (p<0.001), systolic blood pressure (mm/Hg) 113.93�28 to 117.53�.89 (p<0.001), diastolic blood pressure (mm/Hg) 74.80�31 to 78.32�79 (p<0.001), fasting blood glucose (mg/dl) 86.23�.02 to 91.35�.04 (p<0.001), triglyceride (mg/dl) 97.32�.41 to 101.25�.38 (p<0.001), high-density lipoproteins (HDL) (mg/dl) 48.07�98 to 48.05�57 (p=0.951). Conclusion: Our study suggests that incidence of MetS in Indian population was 11.66% after three months of using atypical antipsychotic drugs in patients with schizophrenia or mood disorder. The change in mean value in the individual risk factor for MetS was statistically significant. Long-term follow-up studies are required to identify the real burden of MetS after using atypical antipsychotic drugs.

Purification of heparin binding oviduct specific proteins and its effect on in vitro embryo development in cattle.

The objective of this study was to see the effect of purified heparin binding oviduct specific proteins (OSP) as media supplement on in vitro embryo developmental competence in cattle. The oviduct specific proteins were isolated from abattoir cattle oviducts and precipitated, dialyzed and at the end purified by high performance liquid chromatography system. The SDS-PAGE profile of eluted heparin binding protein (HBP) fraction showed bands between ~66 - ~97 kDa, while heparin unbinding protein (HUBP) fraction showed two bands at ~66 kDa and in total protein (TP) bands were ~60 - ~95 kDa. Collected all three OSP fractions were used as a media supplement in three different concentrations (0, 5 and 20 µg/mL) for in vitro maturation of immature oocytes, in vitro fertilization and culture of presumptive embryos at 38.5 ºC in 5% CO2 incubator with maximum humidity. The highest cleavage rate (73.40±2.36%) was observed at 5 µg/mL concentration level and lowest cleavage rate (27.63±1.89%) was obtained in 20 μg/mL total protein (TP) fraction. The highest blastocyst formation (26.47±1.47%) also occurred in 5 µg/mL concentration of total protein (TP) fraction and the lowest blastocyst rate (3.60±1.80%) was achieved at 20 µg/mL HBP fraction. The highest cleavage rate in the control group was 60.45±2.66% in TP fraction and blastocyst formation was 11.66±2.54% in HUBP fraction which was not significantly differ from HBP fraction. These results indicate that at 5 µg/mL of total OSP fraction (TP) and HBP used as media supplement increased the cleavage rate significantly as compared to HUBP fraction, and total OSP fraction (TP) increased blastocyst formation significantly (P<0.05) as compared to HBP & HUBP fraction.

Primary disseminated extrapulmonary multidrug resistant tuberculosis.

Disseminated tuberculosis is a common mode of presentation of tuberculosis in patients both with and without HIV/AIDS in India. However, primary multidrug resistance in disseminated tuberculosis involving only the extrapulmonary sites in an immunocompetent adult is rare. Here, we report a case of a 19-year-old man who had disseminated tuberculosis involving left pleura, pericardium, peritoneum and intraabdominal lymph nodes. He was initially taking WHO category I antituberculous drugs, but was not responding in spite of 5 months of chemotherapy. Culture of the pleural biopsy specimen grew Mycobacterium tuberculosis which was resistant to isoniazid and rifampicin. He was put on therapy for multidrug resistant tuberculosis,following 24 months of chemotherapyhe had an uneventful recovery.

Studies on the identification and control of pathogen Saprolegnia in selected Indian major carp fingerlings at mid hill altitude.

The Indian major carp cultured in ponds in the North Eastern hilly states of India frequently suffer from fungal disease during winter months resulting in mass mortality. This study examined the pathogenic fungi isolated from farmed raised Indian major carp fingerlings and identified as Saprolegnia. For treatment, the diseased fish were exposed to 4g salt per litre of water for 2 min followed by dip treatment with 5ppm KMnO4 for 10 min, thrice every week for a period of 6 weeks. The treatment resulted in recovery from the disease after 6 weeks from the beginning of treatment. Soon after recovery, the pond management practices such as removal of pond bottom soil, application of lime and replenishment with freshwater were followed in the infected ponds. Our study concluded that rapid decrease in pond water temperature from 22 to 8°C that remains low for months together coupled with increased water pH (9) and decreas dissolved oxygen (4ppm) causes saprolegniasis to the fingerlings of Indian major carps.

Dengue encephalitis.

Encephalitis is an uncommon manifestation of dengue fever. Here we present a 4-year-old female child from northeastern India with dengue encephalitis. To our knowledge, this is the first reported case of dengue encephalitis from this region.

Molecular appraisal of Indian animal isolates of Echinococcus granulosus.

BACKGROUND & OBJECTIVE: Cystic echinococcosis (CE) has a wide host range and distinct entities, not only reflected phenotypically but also by genotypic variation. Considering this fact, this study was undertaken to characterize the Indian isolates of Echinococcus granulosus to find out difference between Indian cattle, buffalo and sheep isolates on the basis of random amplification of polymorphic DNA (RAPD) PCR and PCR mediated restriction fragment length polymorphism (PCRRFLP) of internal transcribed spacer gene 1 (ITS1). METHODS: A total of 22 isolates of E. granulosus obtained from Indian cattle, buffalo and sheep (December 2004 - November 2005) were analysed by 26 random primers of 8-10 mers. After isolation of protoscoleces from fertile cyst, DNA was extracted, quantified and amplified by random primers. Internal transcribed spacer gene 1 (ITS1) was amplified using specific primer and digested by two restriction enzymes (Msp1 and Rsa1). RESULTS: Of the 26 primers, only two primers (5'ACC TGG ACA C3' and 5' TCA TCC GAG G3') could discriminate cattle, buffalo and sheep isolates collected from eastern part of India. Samples were further analysed by PCR mediated RFLP of internal transcribed spacer gene1 (ITS1) using two restriction enzymes (Msp1 and Rsa1). No ITS1 variants could be detected. INTERPRETATION & CONCLUSION: Our findings showed genotypic variation among Indian animal isolates of E. granulosus on the basis of RAPD fingerprinting.

Prevalence of major neurological disorders among geriatric population in the metropolitan city of Kolkata.

Well-conducted neuroepidemiological studies for the geriatric population are rare in India. In view of the growing aging population, we planned to determine the prevalence of common neurological disorders among the elderly population in the city of Kolkata. This was a cross-sectional study of a stratified random sample of the city population and carried in two stages through house to house survey. Initially, trained non-medical workers screened the cases with a validated family questionnaire and then a neurologist examined all the screened positive cases. A validated neuropsychological screening test was also applied among the elderly population with cognitive complaints. Results showed prevalence rates (per 1000 elderly population--> or = 60 years) of following disorders in decreasing order: stroke--33.93, essential tremor--13.76, dementia--7.89, Parkinsonism--3.30 and epilepsy--2.57. Sex-specific prevalence showed that stroke was commoner among men and that of other disorders among women. Age-specific prevalence recorded progressive increase in the rates of all disorders among both genders, though not uniformly among women. Overall the crude prevalence of neurological disorders was 60.9 per 1000. The present study shows higher rate of stroke as compared to other neurological disorders among elderly population in India, which needs urgent attention.

Limbic encephalitis--an uncommon presentation of systemic malignancy.

A 46 years, nondiabetic, nonhypertensive woman presented with headache, vomiting, low grade intermittent fever, behavioral abnormality and seizures for last three months. Clinically she had meningism with bilateral papilloedema. Based on CSF analysis, normal CT scan of brain and suspicious lesion in X-ray chest, she was put on anti-tuberculosis therapy. As the patient further deteriorated clinically, MRI of brain was carried out and revealed bilateral increased signal intensities in both medial temporal lobes in T2 and flair sequences. Inj. acyclovir was added considering the diagnosis of herpes simplex encephalitis. In spite of receiving treatment patient gradually became more drowsy and repeat X-ray chest with CT guided FNAC showed picture of adenocarcinoma of lung. So finally, we concluded it to be a case of limbic encephalitis.

A study of pulmonary tuberculosis in the elderly.

The incidence of tuberculosis (TB) is increasing globally. The diagnbsis of TB in elderly is often delayed due to the atypical presentation. There is also therapeutic problems because of presence of comorbidity, nutritional and socio-economic factors and increased incidence of adverse drug reactions and mortality. A prospective study was conducted among patients presenting with pulmonary tuberculosis at the department of TB and respiratory medicine in a tertiary care hospital between January, 2006 to July, 2006. Thirty patients aged more than 65 years were studied for their clinical characteristics, comorbid illnesses, sputum status, radiological features and adverse drug reactions. They were contrasted against the same parameters in 40 patients aged 65 years or less. The study showed that pulmonary TB in the elderly is characterised by (a) atypical symptoms, (b) more extensive radiological lesion with lower zone preponderance, (c) higher sputum positivity, (d) more frequent comorbidity, (e) more frequent side-effects and (f) higher mortality.

A random sample survey for prevalence of major neurological disorders in Kolkata.

BACKGROUND & OBJECTIVES: Large scale epidemiological studies on neurological disorders are very few in India. We therefore planned to conduct a cross-sectional population-based epidemiological study on a stratified randomly selected sample from the city of Kolkata to study the prevalence of major neurological disorders such as epilepsy, stroke, dementia and Parkinsonism. METHODS: The method of case ascertainment was two- stage house-to-house survey; the first stage was undertaken by a field team consisting of four field workers and a neuropsychologist. Screening questionnaire based on National Institute of Mental Health and Neuro Sciences (NIMHANS) protocol was used. In the second stage a neurologist examined all the screened positive cases. RESULTS: A total of 52,377 subjects participated in the study. The crude prevalence rates (per 100,000 population) of major neurological disorders with 95 per cent confidence intervals (95% CI) and age adjusted rates (AAR) based on US 2000 population were 557.5 (95% CI 496.17-624.40 and AAR - 516.77) in epilepsy, 486.85 (95% CI 377.0 to 551.11 and AAR-765.68) in stroke, 87.82 (95% CI 64.02-117.50 and AAR-168.4) in dementia and 45.82 (95% CI 29.64-67.63 and AAR-71.64) in Parkinsonism. The weighted prevalence rates (per 100,000) of the whole population based on re-screening of 10 per cent of negative samples were 763.89 (95% CI 690.55- 842.57) in epilepsy, 624.32 (95% CI 555.64-699.24) in stroke and 139.37 (95% CI 108.71-176.06) in dementia. INTERPRETATION & CONCLUSION: A high rate of stroke and overall lower prevalence of Parkinsonism and dementia was recorded as compared to western studies. High prevalence rate of stroke emphasizes the need to study incidence, morbidity and mortality profile of stroke including its socio-economic impact and also case-control analysis to determine the underlying risk factors.

Quality of life in Parkinson's disease--Indian scenario.

The subjective sense of well being is central to the concept of quality of life (QoL) and a good QoL should be the ultimate goal to any therapeutic measure. In Parkinson's disease (PD), several rating scale are in vogue to measure the QoL, namely PDQ-39, PDQ-8, SF-36, Likert scale etc. Parkinson's Impact Scale (PIMS) has been used in this study to assess the QoL which includes 10 items. METHODOLOGY: Thirty two patients of Parkinson's disease satisfying the UK Parkinson's disease brain bank diagnostic criteria, ranging from HY stage I to IV have been recruited. UPDRS was also administered to them. Statistical analysis was performed using Spearman rank correlation and multivariate stepwise regression analysis using SPSS for windows. RESULT: Seventy two percents were male, all getting levodopa, 72% got anticholinergics. Monthly income varied from Rs.800 (US dollars 17.10) to Rs.15,000 (US dollars 320) pm. Eighty eight percent belonged to HY II-III. UPDRS score ranged from 3-85 (40.4 +/- 18.6). PIMS total score ranged from 1-22 (10.4 +/- 6.1). DISCUSSION AND CONSLUSION: The QoL deteriorates with H-Y staging, the UPDRS score, not with advancing age as seen in other studies. It is also significantly influenced by duration of the disease and financial security. Surprisingly, the family and community relations were not significantly affected with advancing disease, perhaps due the close family and social tie up among Indians. So, measurement of QoL should be made an essential part to the routine assessment of PD patients to get a complete scenario of the problem. PIMS can serve as a comprehensive tool for the same suitable for use in the OPD.

Studies on diagnostic potential of secretory antigens of Mycobacterium bovis.

Culture filtrate proteins (CFPs) of M. bovis were produced by culturing the organism for a period of 3 weeks. These CFPs elicited a good delayed hypersensitivity (DTH) reaction in cattle and guinea pig. However, CFPs showed least cross-reactivity when tested in guinea pigs sensitized with M. bovis BCG and M. phlei. CFPs were found to be well recognized by T-cells of single intradermal test (SIDT) positive cattle and were also sero-reactive. Lymphocyte transformation assay revealed the culture filtrate antigens as major T-cell antigens. CFPs induced a good interferon gamma release as compared to conventional antigen, PPD, thereby highlighting their diagnostic capabilities.

A new method for isolation of leukocytes from the peripheral blood of amphibians [Bufo himalayanus, (Gunther)] and study of their surface morphology by scanning electron microscopy.

Using percoll as the density gradient, a new single step method to isolate leukocytes from the peripheral blood of amphibians (B. himalayanus) has been described. Isolated leukocytes were photographed under the scanning electron microscope and an attempt has been made to characterize the leukocyte population on the basis of surface morphology. Apart from regular blood cell types, B. himalayanus have slender, elongated and slightly curved leukocyte type cells in their peripheral blood. Such slender elongated cells were absent in the blood of a related species B. stomnaticus and hence could not be categorized under the known blood cell types.

Biochemical toxicity study on rat brain upon co-exposure to aluminium and ethanol.

Aluminium and alcohol are well known neuro toxins. Co-exposure of these neuro toxins has been studied in rats. Alcohol exposure significantly affected the aluminium content, protein content, acid phosphatase activity, alkaline phosphatase activity, alanine aminotransferase activity, glutathione-S-transferase activity, and glucose 6-phosphate dehy-drogenase activity of brain. Aluminium exposure, on the other hand, contributed significantly only in the alterations of aluminium content, acid phosphatase activity, and aspartate aminotransf erase activity of brain of rats in the present study. The interaction of both aluminium intoxication and alcohol exposure is significant only in the case of acid phosphatase and glutathione-S-transferase activities of brain. Therefore, from the observations of the present investigation, it can be suggested that the general neurotoxic-ity produced by aluminium is not modified by alcohol. However, the aluminium load and oxidative stress, caused by aluminium exposure, may be influenced by alcohol co-exposure.

Involuntary jerking of lower half of the body (spinal myoclonus).

A 55 years old, hypertensive, diabetic lady presented with sudden onset jerky movement of lower trunk and legs. It was present both in awake and sleep and got aggravated by mental stress as well as sensory stimulation. Examination revealed rhythmic jerks affecting muscles of lower abdomen and legs. The lower limbs had normal muscle bulk and power, increased tone, exaggerated deep tendon reflexes, bilateral flexor plantar response with normal sensory autonomic and cerebellar function. Investigations including CSF study, MRI of dorsal spine and NCV were normal. A combination therapy with tizanidine, baclofen and clonazepam induced gradual improvement within 6 weeks.

Bilateral intracerebral haemorrhages: an atypical presentation of Japanese encephalitis.

Japanese encephalitis is common human endemic encephalitis seen over various parts of the world. Usual presenting features include an encephalitic syndrome, symptoms of frontal lobe, basal ganglia and thalamic involvement. Characteristic radiological picture is bilateral thalamic and basal ganglia hypo density in the CT scan and hypo-intensity in T1 and hyperintensity in T2 weighted image in MRI. Very rarely occurrence of bilateral hemorrhage may be seen in these regions. This radiological change may be early indicator of the disease before serological confirmation by the available diagnostic modalities. In this communication, we have reported a case of Japanese encephalitis presented with bilateral basal ganglia hemorrhages.

Henoch-Schonlein purpura with intracerebral haemorrhage.

Henoch-Schonlein purpura is a leucocytoclastic vasculitis commonly seen among children and young adults. Neurological complications, though rare, include focal cerebral deficit, coma, convulsion, subarachnoid hemorrhage and chorea. We are reporting a 12 years boy with Henoch-Schonlein purpura who developed a large intracerebral hematoma in right occipital lobe. He made an uneventful recovery with conservative treatment and one year follow up revealed no major neurological sequelae.

Comparative evaluation of antiproliferative activity and induction of apoptosis by some fluoroquinolones with a human non-small cell lung cancer cell line in culture.

Lung cancer is the leading cause of cancer- related death in the world today. Since the effective management of drug resistant lung cancer, and particularly non-small cell lung carcinomas is a major problem, attempts need to be made to identify new potential anticancer drugs that can kill non-small cell lung cancer cells efficiently. In the present study, a human non-small cell lung carcinoma NCI-H460 cell line was used to evaluate the antiproliferative activity of Fluoroquinolones like Enoxacin, Norfloxacin, Ciprofloxacin and Levofloxacin. As determined by Sulphorodhamine B assay (SRB assay), all Fluoroquinolones caused cellular growth inhibition in a concentration and time-dependent manner. Enoxacin was found to be the most effective Fluoroquinolone followed by Norfloxacin, Ciprofloxacin and Levofloxacin. Growth inhibitory effects were also found to be independent of the concentrations of serum growth factors in culture medium or variation of initial cell seeding density and proved to be irreversible in nature. Appearance of rounded cells with altered morphology and cell surface blebbing indicated cell killing by apoptosis. Cell shrinkage, nuclear condensation & fragmentation, and cytoplasmic blebbing as indicated by MGG staining confirmed this to be the case. Thus, this investigation clearly demonstrated that the NCI-H460 human non-small cell lung carcinoma cell line is highly sensitive to Fluoroquinolone treatment. The Fluoroquinolones used in this study which are clinically used as antibacterial agents, can also inhibit tumor cell growth suggesting their potential use in a strategy for cancer treatment which might help in controlling cancer.

Arthropathic presentation of Wilson's disease.

A patient is described who presented with polyarthritis involving small and large joints of limbs with later onset of tremors affecting all four extremities. Investigations including genetic study confirmed the diagnosis of Wilson's disease (WD). The case highlights the importance of considering the possibility of WD in young patient presenting with repetitive unexplained joint symptoms with or without tremor.

Acute intracerebral haematoma--an unusual presentation of herpes simplex encephalitis.

A young man presented with acute headache, behavioral abnormality and CT scan evidence of intracerebral hematoma. Detailed investigation established its infective origin due to herpes simplex virus type-I. The patient made an excellent recovery following a course of acyclovir. Frank intracerebral haematoma in the form of well defined mass on CT scan in patient with herpes simplex encephalitis is extremely rare.