Imaging & neuropsychological changes in brain with spiritual practice: A pilot study

Background & objectives: Some studies have systematically assessed the effects of spiritual practice (SP) on the brain using combined neuropsychological testing and functional imaging. The objective of the present study was to compare imaging and neuropsychological changes in healthy individuals after SP and those with only physical exercise. Methods: Healthy adult male volunteers, aged 25-45 yr were randomized into two groups. Group 1 (SP group) underwent the SP and group 2 (controls) did brisk walk for 30 min daily. Detailed neuropsychological evaluation, resting-state functional magnetic resonance imaging (fMRI) and brain 99mTc ethyl cysteinate dimer single-photon emission computed tomography (SPECT) were carried out for both groups before and three months after intervention. Results: Post-intervention, resting state fMRI showed increased connections of left precuneus (in the posterior cingulate cortex area of default mode network) in group 1 and increased left frontal connections in group 2. The neuropsychological tests showed significant improvement in 'Speed of Processing' (Digit Symbol Test) in group 1 and in Focused Attention (Trail Making A) in group 2. The SPECT data in group 1 showed significant improvement in perfusion of the frontal areas, with relatively lesser improvement in parietal areas. Group 2 showed significant improvement in perfusion predominantly in parietal areas, as compared to frontal areas. In addition, significantly improved mood was reported by group 1 and not by group 2. Interpretation & conclusions: This pilot study shows important functional imaging and neuropsychological changes in the brain with SP.

Comparative study in newer techniques for management of diabetic foot

Background: Diabetic foot is the commonest complication of Diabetes Mellitus. It is not totally curable or preventable but with positive approach mortality and morbidity due to diabetic foot can be reduced. Aim and objectives: To find out which type of treatment modality is better in terms of costeffectiveness and number of dressings in patients of diabetic foot, to salvage the limb in diabetic patient with help of various modalities of treatment available to our hospitals, to prevent the recurrence of such lesion by careful follow up, by educating the patient about foot care and prescribing pressure distributing footwear, and rehabilitation of patient once the ulcer has healed. Materials and methods: A total of 60 patients having diabetic foot were included. Clinical assessment was done of all patients after admitting them. History and clinical findings were written as per preformed proforma. All patients were sent to foot wear specialist. All this patients initially underwent debridement or removal of necrotic patch, according to the presenting feature. Depending on the condition of the ulcer (size or slough) they were dressed with newer techniques. Newer techniques used were Vac (Vacuum assisted closure) and Non-Vac (Hydrocolloid, Hydrogel, collagen, Platelet derived growth factor). Results: Majority of diabetic patients were having neuropathic and traumatic type of lesions. 30 patients were dressed with V ac (Vacuum assisted closure) and remaining 30 patients were dressed with Non-V ac. In which 5 patients were dressed with Hydrocolloid, 3 patients were dressed with Hydrogel, 12 patients were dressed with collagen and 10 patients were dressed with platelet derived growth factor. Comparison between V ac and Non-V ac types of dressing in terms of number of dressings, duration of stay, cost effectiveness is done by applying Z-Test. It was significant. Desai A, Panchal A, Parmar H. Comparative study in newer techniques for management of diabetic foot. IAIM, 2016; 3(8): 79-82. Page 80 Conclusion: Newer techniques for dressing- VAC or NON-VAC decreases the morbidity of the patient and also better in terms of cost-effectiveness and duration of stay as compared to conventional dressings.

Acute pancreatitis: Causes, pathophysiology, different modalities of management.

Background: This study was intended to throw light upon the topic of acute pancreatitis, its incidence, etiology, pathogenesis as well as its management. Aim and objectives: To review and study the patients who presented with acute pancreatitis, to find out the incidence of acute pancreatitis and study the various etiological factors, to study the various modalities of treatment of acute pancreatitis, both conservative as well as operative, to study the incidence and management of complications of acute pancreatitis, factors influencing incidence as well as its outcome. Materials and methods: This was a prospective study of management of 50 cases of acute pancreatitis, admitted in surgical department. All admitted patients underwent work up for the diagnosis and cause of Acute Pancreatitis. The severity grading was done according to the Ranson’s criteria. All patients were monitored with serial examinations and investigations. Patients with mild pancreatitis were treated conservatively at first and surgical intervention was done only in cases of gallstone pancreatitis with diagnosed GB or CBD calculi. Surgical intervention was in form of cholecystectomy or ERCP. Patients with severe pancreatitis were treated conservatively at first. Outcome was monitored in terms of discharge from hospital or mortality. Each patient was evaluated as per the predesigned proforma of the study, a copy of which is attached. Follow up of a minimum of six months was kept and patients with recurrent attacks were monitored and treated either conservatively or surgically as indicated. Results: The highest incidence of acute pancreatitis was found in the age group of 41 to 60 years followed by the age group of 21 to 40 years. Acute pancreatitis was found more commonly in males. Desai A, Panchal H, Parmar H. Acute pancreatitis: Causes, pathophysiology, different modalities of management. IAIM, 2016; 3(4): 66-71. Page 67 (41 out of 50 that is 82%) compared to females (9 out of 50 that is 18%). Alcohol was found to be the most common cause of acute pancreatitis (44%) , followed closely by Gallstones (36%), While in 10% of patients no cause could be found (idiopathic group). Overall conservative management is favorable over surgical management in terms of mortality in about 70% of cases. Mortality was not found in the mild pancreatitis group and all 34 patients were discharged. However, 6 out of 16 patients with severe pancreatitis expired (37.5%). Conclusion: Conservative management is more favourable in both mild and severe type of acute pancreatitis.

Significance of Epstein-Barr virus (HHV-4) and CMV (HHV-5) infection among subtype-C human immunodeficiency virus-infected individuals.

Purpose: Opportunistic viral infections are one of the major causes of morbidity and mortality in HIV infection and their molecular detection in the whole blood could be a useful diagnostic tool. Objective: The frequency of opportunistic DNA virus infections among HIV-1-infected individuals using multiplex real-time PCR assays was studied. Materials and Methods: The subjects were in two groups; group 1: Having CD4 counts <100 cells/μl (n = 118) and the group 2: counts >350 cells/μl (n = 173). Individuals were classified by WHO clinical staging system. Samples from 70 healthy individuals were tested as controls. In-house qualitative multiplex real-time PCR was standardised and whole blood samples from 291 were tested, followed by quantitative real-time PCR for positives. In a proportion of samples genotypes of Epstein-Barr virus (EBV) and CMV were determined. Results: The two major viral infections observed were EBV and CMV. The univariate analysis of CMV load showed significant association with cryptococcal meningitis, oral hairy leukoplakia (OHL), CMV retinitis, CD4 counts and WHO staging (P < 0.05) while the multivariate analysis showed an association with OHL (P = 0.02) and WHO staging (P = 0.05). Univariate analysis showed an association of EBV load with CD4 counts and WHO staging (P < 0.05) and multivariate analysis had association only with CD4 counts. The CMV load was significantly associated with elevated SGPT and SGOT level (P < 0.05) while the EBV had only with SGOT. Conclusion: This study showed an association of EBV and CMV load with CD4+ T cell counts, WHO staging and elevated liver enzymes. These viral infections can accelerate HIV disease and multiplex real-time PCR can be used for the early detection. Genotype 1 and 2 of EBV and genotype gB1 and gB2 of CMV were the prevalent in the HIV-1 subtype C-infected south Indians.

Iodine Nutrition in Upper Socioeconomic School Children of Delhi.

We assessed the iodine nutrition of upper socioeconomic strata school children from Delhi to identify its association with goiter, thyroid autoimmunity or thyroid function. After informed consent of parents, all assenting students (n=997) from one randomly selected section of each class from five private schools representing all the zones of Delhi) were evaluated for goiter, urinary iodine excretion, thyroid function and antibody status. Median urinary iodine was 35.28μg/dL. Goiter was present in 123 (12.3%) and positive anti-TPO antibodies in 17 (2.6%). Increased urinary iodine was associated with thyroid dysfunction, though not with goiter.

Role of parecoxib in pre-emptive analgesia: comparison of the efficacy and safety of pre- and postoperative parecoxib in patients undergoing general surgery.

Management of acute postoperative pain remains sub-optimal despite the availability of multiple analgesics and improved pain management strategies (with nearly 80 % of patients reporting moderate to extreme pain following surgery). To evaluate the role of parecoxib as a pre-emptive analgesic in patients undergoing general surgery, the present study was undertaken. Eighty patients of either sex, aged 18 to 70 years, requiring elective ambulatory general surgery like hernioplasty, appendicectomy, cholecystectomy, etc, were enrolled in this prospective, randomised, assessor-blind, parallel-group, comparative trial. Eligible patients were randomised to receive a single dose of 40 mg of parecoxib IM/IV either 30-45 minutes prior to induction of anesthesia (pre-emptive analgesia) or in the postoperative period when one reported pain or when the effects of anesthesia were worn off (whichever was earlier). The primary measures of efficacy were pain intensity scores measured on a visual analog scale (VAS) and pain relief before and after therapy. Adverse event monitoring, physical examination and changes in laboratory tests, chest x-ray and ECG were used to evaluate safety. A comparison of the pain intensity scores between the two groups revealed that patients treated with parecoxib preoperatively did not complain of pain in the entire postoperative period up to 12 hours. Mild pain (1.05+/-1.36) was reported by patients in this group only at the 24 hours assessment. On the other hand, patients treated with parecoxib in the postoperative period, experienced severe pain at baseline, which declined gradually up to 12 hours. The difference in the pain intensity scores between the two groups was statistically significant at all the time intervals from 0 hour to 24 hours. All the 40 patients (100%) in the pre-operatively treated group reported total pain relief at 12 hours compared to only 22 patients (55%) in the postoperative period. At 24 hours total pain relief was reported by 70% of the patients in the pre-operatively treated group, compared to only 20% (8) patients in the postoperatively treated group. The difference between the two groups was statistically significant in favour of the pre-operatively treated group (p<0.05). Present results suggested that pre-operative administration of parecoxib was more effective than a postoperative use in providing pain relief in postoperative period in patients undergoing elective general surgical procedures. Both the regimens were well tolerated. Based on the above data, it appears that pre-operative dose of parecoxib 40 mg IV/IM is a useful optionfor pre-emptive analgesia in general surgical practice.

An open study to evaluate the efficacy and safety of tazarotene gel (0.1%) in acne vulgaris.

BACKGROUND: Tazarotene is a new third generation topical acetylenic retinoid. The present study was conducted to evaluate the efficacy and safety of tazarotene gel (0.1%) in Indian patients of acne vulgaris. METHODS: The present study was a prospective, open, multicentric, phase III trial. The duration of study was 14 weeks, including a 12-week active treatment period, preceded by a 2-week washout phase. Patients applied 0.1% tazarotene gel as a thin film over the affected area once daily in the evening. The efficacy was evaluated by analyzing changes in the number of facial acne lesions and patient's and physicians' global assessment. The efficacy parameters were assessed at baseline, visits 2, 4, 8, and 12 weeks. Tolerability and safety was assessed by physical examination, laboratory parameters and evaluation of adverse events. RESULTS: A total of 126 patients in 6 centers completed the study. At the end of the 8th and 12th weeks, the mean number of inflammatory lesions reduced by 70.6% and 86.1%, non-inflammatory lesions by 81.5% and 92%, and total lesion count 75.6% and 88.8% respectively from baseline. Also, 90.7% and 93.6% of total study cases showed complete to moderate clearance of acne lesions according to physicians at the end of the 8th and 12th weeks. CONCLUSIONS: This study confirms the efficacy and safety of tazarotene gel (0.1%) in Indian patients of acne vulgaris.

Evaluation of the efficacy, safety and tolerability of Tacrolimus ointment in Indian patients of moderate to severe atopic dermatitis: a multicentric, open label, phase III study.

AIM OF STUDY: Tacrolimus, a topical immunomodulator, has been introduced as a new treatment for moderate to severe atopic dermatitis. The present study was conducted to evaluate the efficacy, safety and tolerability of Tacrolimus ointment in patients of atopic dermatitis in an Indian setting. METHODS: The present study was a prospective, open, multicentric, Phase III trial.The duration of study was 5 weeks, including a 3-week active treatment period, preceded by a 1-week washout phase and followed by a 1-week follow-up phase. Patients diagnosed to be suffering from moderate to severe atopic dermatitis as per the Rajka and Langeland criteria were treated with Tacrolimus ointment 0.03% twice daily. Efficacy was assessed by modified Eczema Area Sensitivity Index (mEASI) score, patient's and physician's global assessment. Tolerability and safety was assessed by physical examination, laboratory parameters and evaluation of adverse events. RESULTS: There was a statistically significant decrease in the modified Eczema Area Sensitivity Index (mEASI) score (P< 0.05). Patient's and Physician's global evaluation of treatment was complete resolution to very good improvement in most of the patients. The laboratory values were within normal limits. The drug was well tolerated. CONCLUSIONS: This study confirms the efficacy and safety of Tacrolimus ointment 0.03% in Indian patients of moderate to severe atopic dermatitis.

Efficacy and safety of butenafine in superficial dermatophytoses (tinea pedis, tinea cruris, tinea corporis).

Superficial dermatophytoses of skin are very common infections seen in clinical practice. Besides topical imidazoles, triazoles and allylamines, topical butenafine (a benzylamine derivative) is a novel agent with broad antifungal activity. One hundred and eleven patients with tinea infections were enrolled in this multicentric, randomised, single-blind non-comparative study, which involved application of butenafine (1%) cream in tinea pedis (4 weeks) and tinea cruris and tinea corporis (2 weeks) cases. The results showed that butenafine causes rapid resolution of signs and symptoms (erythema itching, burning, crusting, scaling, etc), with good patient and physician acceptability of treatment. The broader spectrum fungicidal activity and better drug retention in superficial skin layers may be responsible for this beneficial effect.

Evaluation of efficacy and safety of iron polymaltose complex and folic acid (Mumfer) vs iron formulation (ferrous fumarate) in female patients with anaemia.

Treatment of iron deficiency anaemia with conventional oral preparations is handicapped by unpredictable haematological response in addition to potential for irritating gastrointestinal adverse events. Iron polymaltose complex (IPC), a novel oral iron formulation with better absorbability, predictable haematinic response and less side effects was compared with oral ferrous fumarate in 100 female patients with documented iron deficiency anaemia. Clinical parameters (pallor, weakness) as well as biochemical parameters (Hb, serum iron, total iron binding capacity) show favourable changes with IPC; the physician and patient assessment also favour IPC over ferrous fumarate.

Efficacy and safety of Ascoril in the management of cough--National Study Group report.

A total of 768 patients were recruited by 81 physicians and paediatricians all over the country in this National Study Group of 'Ascoril + Expectorant'. The results of this first large scale study of a cough formula indicates that 'Ascoril + Expectorant' is effective in controlling cough, breathlessness and decreasing the volume of sputum. No serious adverse events were noted. Ascoril was well accepted by the patients and its efficacy was rated very high by the physician. The National Study Group concludes that 'Ascoril + Expectorant' is highly effective in the management of cough associated with lower respiratory tract infection and COPDs.

Endometrial stromal sarcoma with sex-cord like features.

Endometrial stromal sarcomas are rare, low grade, malignant uterine tumours. Sometimes, they manifest an epithelial like or sex-cord like differentiation. This is a report of one such case in a 35 year old female.

Evaluation of safety and efficacy of ketoconazole 2% and zinc pyrithione 1% shampoo in patients with moderate to severe dandruff--a postmarketing study.

A postmarketing study was conducted on 236 patients from 23 centres suffering from moderate to severe dandruff with a combination of ketoconazole and zinc pyrithione (1%) for a duration of 4 weeks with 2 weeks further follow-up. Scoring of dandruff was done on a 0-10 scale for each of the 6 regions of scalp at each week up to 6 weeks. The results indicate that there was a consistent improvement in dandruff scores over the treatment period and a reduction of > 90% was seen for all areas of scalp individually as well as collectively as compared to baseline. The treatment also showed significant improvement in other signs and symptoms such as erythema and itching, with a highly favourable adverse event profile. The overall assessment for global improvement by investigators showed good-excellent results with high acceptability amongst the patient population for the treatment. A combination shampoo of ketoconazole (2%) and zinc pyrithione (1%) offers a safe and effective option in the treatment of dandruff.

Cryptococcosis in the immunocompromised host with special reference to AIDS.

Cryptococcosis is increasing because of an ever rising population of immunocompromised individuals especially those with acquired immune deficiency syndrome (AIDS). Cryptococcal infection of the central nervous system (CNS) were diagnosed in 149 cases over a period of 19.5 years (January 1978-June 1998). Culture was positive in all cases except three who were already on antifungal therapy. India ink mounts of cerebrospinal fluid (CSF) revealed encapsulated cryptococci in 134, and cryptococcal antigen was detected in 111 of 114 patients tested. A comparison of laboratory and certain clinical parameters in patients with and without associated HIV infection showed that a poor CSF cell response and culture of cryptococci from extra-neural sites was more often associated with HIV infection and was statistically significant. Further, presence of concomitant infection especially tuberculosis, and mortality were higher in the HIV positive group.

Candid-B cream in the treatment of candidiasis with inflammatory dermatoses--National Study Group.

Physicians (n = 84) across the country prescribed candid-B cream (clotrimazole 1% + beclomethasone dipropionate 0.025%) on 822 patients suffering from candidiasis with inflammatory diseases to evaluate the efficacy and safety of the combination. The results showed reduction in severity was more than 80% for all symptoms/signs except scaling and lichenification where the reduction was 76.05% and 66.03% respectively. Only one patient complained of adverse reaction. So in the treatment of coexisting candidiasis and inflammatory dermatoses the combination of clotrimazole 1% + beclomethasone 0.025% (candid-B cream) was found to be highly effective.

Evaluation of safety and efficacy of supirocin-B (mupirocin 2% + betamethasone dipropionate 0.05%) in infected dermatoses--a post marketing study.

The aim of the present post marketing study was to study the safety and efficacy of supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) in the treatment of infected dermatoses. For this purpose physicians from different parts of India were requested to keep the clinical records prospectively as per a specially designed proforma over a follow-up period of 7 days, whenever they prescribed supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) for local application, three times a day, to their patients having either primary infection complicated by dermatoses or dermatoses infected secondarily. From the analysis of 251 clinical records contributed by 27 physicians, it was evident that in clinical practice, supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) was found to be safe and very effective by physicians in the treatment of infected dermatoses in 94.8% of the patients. Similarly 92.4% of the patients reported more than 70% improvement in their symptoms after 7 days of treatment. No adverse effects were reported during the treatment period by any of the patients except worsening of skin lesions by one patient. Thus from this study, supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) seems to be safe and effective in the treatment of infected dermatoses.

Efficacy and safety of Ascoril expectorant and other cough formula in the treatment of cough management in paediatric and adult patients--a randomised double-blind comparative trial.

The present study was undertaken to study the comparative safety and efficacy of two cough formulas viz, Ascoril expectorant and other cough formula in the management of cough associated with respiratory disorders. Fifty patients having cough associated with various respiratory disorders like bronchitis and upper or lower respiratory tract infections were randomly divided into 2 equal groups and were treated with one of the two cough formulas viz, Ascoril cough formula and other cough formula in double-blind manner over a period of 15 days. The evaluation of improvement was carried out by a rating scale using three clinical parameters--cough, sputum and breathlessness. The physicians were asked to rate the effectiveness of the therapy and patients were asked to rate the acceptability of therapy using pre-defined operational criteria. It was observed that the improvement and symptom relief was almost immediate, quicker and better in the group receiving Ascoril as compared to other group. On effectiveness parameter, 96% of the physicians rated Ascoril as having either 'very high effectiveness or high effectiveness' as opposed to only 34% of the physicians who rated other cough formula as having 'high' or 'very high effectiveness'. While on parameter of acceptability, 96% of the patients rated acceptability of Ascoril as 'high' or 'good' as opposed to only 24% of the patients who rated other cough formula 'high' or 'good'. The findings of this study suggests that Ascoril cough formula has better efficacy as well as better patient acceptability. Thus, Ascoril cough formula is superior to other cough formula in management of cough associated with respiratory disorders.