Microbial Composition of Smokeless Tobacco Products from Karnataka

Background: Though there is a lot of literature available about presence of carcinogenic chemicals in these products, there is lack of information regarding the microbial composition of these products. Aim & Objective: The study was conducted with the objective of assessing microbial composition of smokeless tobacco products and factors associated with higher colony count. Methodology: This cross sectional study included a total of 43 samples obtained from four districts of Karnataka namely Udupi, Bengaluru, Bidar and Belagavi. Microbial populations were assessed using quantitative aerobic culture and colony forming units per gram was reported for each sample. The data was entered into excel and analysed using Statistical Package for Social Sciences version 16.0. Results have been expressed as frequencies and percentages. Univarate analysis was done to study association between background characteristics and higher colony counts. Results: All except three samples showed bacterial contamination. Two samples showed pathogenic bacterial growth, while the other 38 samples had non-pathogenic bacteria. There was no association between background characteristics and colony counts. Conclusions: Microbial contamination of smokeless tobacco products is common. There is a need to further investigate various factors associated with microbial contamination so that necessary interventions can be implemented.

Effect of socio-cultural factors in therapeutic intervention

Comorbidity and presence of family dysfunction in personality disorders, namely borderline personality disorder have been found commonly with bipolar affective disorder clients. Dialectic behaviour therapy (DBT) though has shown efficacy in treatment of such conditions, at times due to the socio-cultural differences of the models adopted from the western concept, there is a felt difficulty in the formulation of the therapeutic model making it necessary to collaborate with other models for smoother formulation and improvement in the overall functioning in the clients. A 21-year-old female of bipolar affective disorder with emotionally unstable personality disorder traits was referred to a psychiatric social worker for assessment and plan of intervention inclusive of DBT and family-focused therapy (FFT). Twenty sessions, each lasting for one hour were conducted with the client and family, each on an inpatient basis to (1) Assess and grade the problems in hierarchy, (2) Understand the socio-cultural constructs in sessions, (3) Teach DBT concepts and relaxation techniques to ameliorate stress and help her to improve the relationship and dynamics with her family through FFT. At the time of discharge, the client had improved nearly 30%, and the client and family were more confident in facing social situations, emotional dysregulation, interpersonal issues, distress tolerance goals which has been explained in the context of the socio-cultural factors focusing on alliance, institutions, expectations, and cultural adaptation involved in therapy and the involvement it had in the therapeutic process.

High-altitude pulmonary oedema: Newer treatment modalities for an age-old problem

Background & objectives: High-altitude pulmonary oedema (HAPE) continues to challenge the healthcare providers at remote, resource-constrained settings. High-altitude terrain itself precludes convenience of resources. This study was conducted to evaluate the rise in peripheral capillary saturation of oxygen (SpO2) by the use of a partial rebreathing mask (PRM) in comparison to Hudson's mask among patients with HAPE. Methods: This was a single-centre, randomized crossover study to determine the efficiency of PRM in comparison to Hudson's mask. A total of 88 patients with HAPE referred to a secondary healthcare facility at an altitude of 11,500 feet from January to October 2013 were studied. A crossover after adequate wash-out on both modalities was conducted for first two days of hospital admission. All patients with HAPE were managed with bed rest and stand-alone oxygen supplementation with no adjuvant pharmacotherapy. Results: The mean SpO2on ambient air on arrival was 66.92�.8 per cent for all patients with HAPE. Higher SpO2values were achieved with PRM in comparison to Hudson's mask on day one (86.08�15 vs. 77.23�09%) and day two (89.94�96 vs. 83.39�93%). The difference was more pronounced on day one as compared to day two. Interpretation & conclusions: Mean SpO2values were found to be significantly higher among HAPE patients using PRM compared to those on Hudson's mask. Further studies to understand the translation of this incremental response in SpO2to clinical benefits (recovery times, mortality rates and hospital stay) need to be undertaken.

Allogeneic haematopoietic stem cell transplantation: The Army hospital experience.

Background. We analysed the results of allogeneic haematopoietic stem cell transplantation (HSCT) in various genetic disorders, bone marrow failures and haematological malignancies done from 2002 to 2010 at the Army Hospital, Research and Referral, Delhi. Methods. A total of 119 matched-related allogeneic- HSCTs (allo-HSCTs) were done in 114 patients (men 76, women 38) aged between 2 and 60 years. Peripheral blood stem cells (n=75) and bone marrow (n=43) were used as the source of stem cells. Results. The overall survival was 62.3% (71/114) at a median follow-up of 34 months. Graft versus host disease (GVHD) was seen in 42 (36.8%) patients; grade III/IV acute GVHD in 17 (15%) and chronic GVHD in 24 (21%) patients. There were 4 (3.5%) graft rejections and one nonengraftment. The overall mortality was 37.7% (n=43) and the main causes of death were GVHD (32%), infections (26%), relapse (23%) and regimen-related toxicity (11%). Conclusion. Our results are comparable to published data in most disease conditions. With improvements in GVHD prophylaxis and better supportive care, we need to further reduce our mortality and morbidity.

Glycaemic status and prevalence of comorbid conditions among people with diabetes in Kerala.

BACKGROUND: We aimed to assess the glycaemic status and prevalence of comorbid conditions such as obesity, hypertension and dyslipidaemia in people with diabetes in a southern Indian community. METHODS: A cross-sectional community survey of adults > 18 years of age was done in central Kerala. Among the 3069 subjects surveyed, 276 were known to have diabetes. Of these, 169 who had type 2 diabetes underwent a detailed physical examination and anthropometric measurements, and determination of levels of fasting blood glucose, glycosylated haemoglobin, fasting lipid, serum creatinine and urine protein. Data of 164 subjects who had glycosylated haemoglobin levels were included for final analysis. RESULTS: The mean (SD) duration of diabetes was 5.5 (5.04) years and the mean age was 56.9 (11.4) years. Among the patients, 28 (17.2%) were receiving no treatment for diabetes, 24 (14.7%) were on diet control and 111 (68%) on pharmacotherapy. Only 6 patients were on insulin. The mean fasting blood glucose was 153 (63) mg/dl and the mean glycosylated haemoglobin level was 8.1 (2.34)%. In 60% of patients, the glycosylated haemoglobin level was above the recommended target of 7%. Obesity (31%), hypertension (51%), low-density lipoprotein cholesterol > 100 mg/dl (90%) and serum triglyceride levels > 150 mg/ dl (38%) were present in the study population. Only 29% of patients were on antihypertensive treatment and 5% on lipid-lowering agents. CONCLUSION: In this population, only 40% of people with diabetes had adequate glycaemic control. The use of insulin was infrequent. Comorbid conditions were common and inadequately treated. This indicates a lack of proper diabetic care in this community, which could lead to an increase in the burden of cardiovascular disease in the future.

Protein-c deficiency presenting with subacute intestinal obstruction due to mesenteric vein thrombosis.

We describe a patient with protein C deficiency who presented with subacute intestinal obstruction due to ischaemic small bowel stricture. The patient also had left sided ileofemoral thrombosis. Venous thrombosis at unusual sites especially if associated with deep vein thrombosis of lower limb warrants a thorough screen for underlying thrombophilia. This, however, is a rare cause for ischaemic small bowel stricture.

Audit of care of patients with congenital adrenal hyperplasia due to 21-Hydroxylase deficiency in a referral hospital in South India.

We carried out an audit of management of patients with 21-Hydroxylase deficiency CAH who presented to the Department of Endocrinology OPD from 1999 till 2004 and had a minimum follow up of 6 months. Of the 30 patients analysed 24 were girls and 6 were boys. The majority belonged to the Christian community. One third had a history of consanguinity or family history of similar illness. Sex assignment was appropriate in most. Karyotyping was done in half. Half the patients had adequate follow up and 17 OHP measurements. Only 7 out of 30 children had normal height for age. Bone age was done in 16 patients only. Most were on hydrocortisone. The average age of genital surgery was 31 months.

Extensive chronic graft-versus-host disease of skin successfully treated with thalidomide.

Thirty years female underwent allogenic peripheral blood stem cell transplantation for chronic myeloid leukaemia--chronic phase. She developed grade II acute skin graft-versus-host disease (GVHD) which was treated with cyclosporine and a short course of steroids. She developed extensive chronic GVHD of the skin and liver three hundred days post-transplant. She was managed with the standard immunosuppressants with partial response of liver dysfunction but no response of skin lesions. She showed a good response to therapy with resolution of skin lesions after treatment with thalidomide.

Influence of juvenile hormone analogue on food consumption and digestive enzyme activities in Spodoptera mauritia Boisd.

Final instar larvae of S. mauritia treated topically on day 0, 1, 2 and day 3 with a daily dose of 20 microg juvenile hormone analogue (JHA) showed an increase in most of the nutritional parameters such as approximate digestibility, efficiency of conversion of ingested food, consumption index and growth rate. Also, the activities of digestive enzymes amylase, invertase, trehalase and protease increased significantly in JHA treated larvae. The supernumerary larvae formed after JHA treatments showed an increase in the activities of digestive enzymes. Neck-ligated larvae treated with 10 microg JHA exhibited a significant increase in the activities of trehalase and protease. The results demonstrate that treatments of JHA increase the activities of digestive enzymes in the last instar larvae of S. mauritia.

Community utilisation of subcentres in primary health care--an analysis of determinants in Kerala.

The determinants of utilisation of subcentre services in a random sample of 247 subcentres from three out of 14 districts of Kerala were investigated. Physical verification of the facilities was done in a subset of 90 subcentres and household surveys of 750 households were performed in the service areas of those subcentres. About 30 per cent of the beneficiaries utilised services of the subcentres during the reference period. The relationship of selected predictor variables on utilisation of the services was found out. The district in which a subcentre was physically present was found to be the most important correlate of its utilisation.

Gangliogliomas: A report of five cases.

Gangliogliomas are rare tumors of the Central Nervous System. Five gangliogliomas were diagnosed out of 1560 brain tumours surgically resected out in a period of 5 years accounting for 0. 32%. We have tried to discuss in detail the pathological features of these tumours and have mentioned the clinical and radiological features associated with them. All the slides, tissue blocks and pathology reports of the surgical specimens of gangliglioma were reviewed and the clinical and radiological data reviewed. The ages of the patients ranged from 7-65 years with 4 males and 1 female. The tumors were located in the lateral ventricle (a rare site), temporal, parietal and the frontal lobes with duration of seizures varying from 1-9 years. The tumors were diagnosed by the presence of a dual population of neoplastic ganglionic and glial components. The glial components consisted of pilocytic astrocytes (l case), fibrillary astrocytes (2 cases), oligodendrocytes (1 case) and anaplastic astrocytes and oligodendrocytes (1 case). There was one-grade I GG, three-Grade II GGs and one-grade III GG. Astrocytes were the commonest glial component of GGs, either pilocytic or fibrillary. Oligodendrocytes as the glial component of GGs was seen in 2 cases one of which was anaplastic and this is a rare finding.

Cord blood stem cell banking and transplantation.

Stem cells have the ability to divide for indefinite periods in culture and to give rise to specialized cells. Cord blood as a source of hematopoietic stem cells (HSC) has several advantages as it is easily available, involves non-invasive collection procedure and is better tolerated across the HLA barrier. Since the first cord blood transplant in 1988, over 2500 cord blood HSC transplants have been done world wide. Since then, the advantages of cord blood as a source of hematopietic stem cells for transplantation have become clear. Firstly, the proliferative capacity of HSC in cord blood is superior to that of cells in bone marrow or blood from adults. A 100 ml unit of cord blood contains 1/10th the number of nucleated cells and progenitor cells (CD34+ cells) present in 1000 ml of bone marrow, but because they proliferate rapidly, the stem cell in a single unit of cord blood can reconstitute the entire haematopoietic system. Secondly, the use of cord blood reduces the risk of graft vs host disease. Cord Blood Stem Cell banks have been established in Europe and United States to supply HSC for related and unrelated donors. Currently, more than 65,000 units are available and more than 2500 patients have received transplants of cord blood. Results in children have clearly shown that the number of nucleated cells in the infused cord blood influences the speed of recovery of neutrophils and platelets after myeloablative chemotherapy. The optimal dose is about 2 x 10(7) nucleated cells/kg of body weight. The present study was carried out for collection, separation, enumeration and cryopreservation of cord blood HSC and establishing a Cord Blood HSC Bank. 172 samples of cord blood HSC were collected after delivery of infant prior to expulsion of placenta. The average cord blood volume collected was 101.20 ml. Mononuclear cell count ranged from 7.36 to 25.6 x 10(7)/ml. Viability count of mononuclear cells was 98.1%. After 1 year of cryopreservation, the viability count on revival was over 82.1%. Related cord blood stem cell transplantation was carried out in three cases at Army Hospital (R&R), Delhi Cantt.

Macromolecular synthesis in wing discs of Spodoptera mauritia Boisd: effects of a juvenile hormone analogue.

Last instar larvae of S. mauritia treated topically on day 0, day 1, day 2 and day 3 with a daily (dose of 25 microg juvenile hormone analogue (JHA) moulted into supernumerary larvae. The imaginal discs of the supernumerary larvae especially those of mouthparts and thoracic appendages showed pupal characteristics. However the wing discs, which showed only partial differentiation, were uneverted and highly tanned. In an effort to provide an explanation to this anomaly the RNA, DNA and protein profile in the wing discs of supernumerary larvae were studied. Quantitative analysis of DNA, RNA and protein showed a considerable increase in the amount of DNA and protein and a decline in RNA level. SDS-PAGE analysis of wing disc proteins of JHA treated larvae showed a reduction in the expression of many major proteins that were predominant in the wing discs of control larvae. The results suggest that JHA induced inactivation of genes involved in the synthesis of proteins needed for evagination process may be responsible for the formation of uneverted, partially differentiated pupal wing discs in supernumerary larvae.

Coronary heart disease and its risk factors in first-generation immigrant Asian Indians to the United States of America.

The prevalence of coronary heart disease (CHD) and its risk factors in first-generation Asian Indian immigrants to the United States of America (US) were compared with those of the native Caucasian population. A total of 1688 Asian Indian physicians and their family members (1131 men and 557 women, age > or = 20 years) completed a questionnaire and in 580 subjects serum lipoproteins were determined. The age-adjusted prevalence of myocardial infarction and/or angina was approximately three times more in Asian Indian men compared to the Framingham Offspring Study (7.2% versus 2.5%; P < 0.0001) but was similar in women (0.3% versus 1%; p = 0.64). Asian Indians had higher prevalence of noninsulin-dependent diabetes mellitus (NIDDM; 7.6% versus 1%; p < 0.0001) but markedly lower prevalence of cigarette smoking (1.3% versus 27%; p < 0.0001) and obesity (4.2% versus 22%; p < 0.0001). Hypertension was less prevalent in Asian Indian men 14.2% versus 19.1%, p < 0.008) but similar in women (11.3% versus 11.4%). The prevalence of elevated total a low-density lipoprotein (LDL) cholesterol levels was similar in men [17% versus 23.4% (p = 0.24) and 13.7% versus 22.3% (p = 0.22), respectively] but lower in women [15% versus 26.1% (p = 0.018) and 14.3% versus 19.6% (p = 0.047) respectively]. The mean levels of high-density lipoprotein (HDL) cholesterol were less in younger (30-39 years) Asian Indian men (mean: 0.98 versus 1.18 mmol/l; p < 0.001) and middle-aged (30-59 years) women (mean: 1.24 versus 1.45 mmol/l; p < 0.001). The prevalence of hypertriglyceridaemia was similar in men (18.5% versus 11.3%), but higher in Asian Indian women (8.3% versus 4.1%, p = 0.02). To conclude, immigrant Asian Indian men to the US have high prevalence of CHD, NIDDM, low HDL cholesterol levels and hypertriglyceridaemia. All these have "insulin resistance" as a common pathogenetic mechanism and seem to be the most important risk factors.

Yellow nail syndrome: a rarity in Indians?

Reports of yellow nail syndrome have been few and far between. The classical triad of the syndrome has not been reported in Indian literature. We report a case of yellow nail syndrome in a forty-year-old male, who had yellowish-brown nails from birth. He developed lymphoedema of the legs at the age of twenty years and presented with pleural effusion at the age of forty years. Although a case of yellow nail syndrome has been reported from India, the classical triad of the syndrome is yet to be documented from our country. The condition may be missed because of the long time difference in presentation of different components of the syndrome and also because of the dark skin colour of Indians.

Changes in level of certain serum constituents following sciatectomy in the common frog, Rana tigrina (Daud).

Effect of unilateral (one leg) and bilateral (two legs) sciatectomy was studied on certain serum constituents in the male frog over a period of 3 weeks. The level of creatine kinase, acid and alkaline phosphatases, urea, glucose and proteins increased initially following sciatectomy and decreased subsequently from day 14 onwards, the per cent change being more pronounced in case of bilaterally sciatectomized frogs. The present results indicate an increase in the rate of deamination of proteins in the liver, an impairment in the transportation processes across the cell membrane and an increase in cellular lysosomal activity on sciatectomy suggesting a change either in the amount or in the rate of various enzyme reactions. It is concluded that sciatectomy induces alterations in general metabolic activities and the functional state of the animal. Altered values of various serum constituents thus permit to speculate analysis of the factor that may be contributing to the atrophic processes and the wasting of the muscle fibres known to set in the denervated muscle.

Reduction of UV-induced mitotic delay by caffeine in BUdR-substituted plasmodia of Physarum polycephalum.

Chromosomal DNA of the synchronously mitotic plasmodia of P. polycephalum was substituted with 5-bromo-2'-deoxyuridine, by growing the plasmodia during S phase, on a medium containing this nucleoside analog. A strong synergism was observed between bromodeoxyuridine and UV-irradiation, in late G2-irradiated plasmodia in that, the mitotic delay obtained in them was much more than a simple sum of the delays induced by these two agents individually. It was also observed that the mitotic delay in this system is reduced significantly by different concentrations of caffeine applied immediately after irradiation and there was a stage specificity in this effect. The reduction in mitotic delay was maximum (80%) in those plasmodia irradiated 20-30 min before control metaphase, when mitogenic factors also reach their maximum activity in this system. It is proposed that the mitotic delay reducing effect of caffeine is due to its ability to promote the activity of the mitogenic factors, largely independent of the system which is responsible for monitoring the state of the chromosomal DNA.

Differential effect of cordycepin on S and G2 phases of cell cycle in plasmodia of Physarum polycephalum Schw.

Effect of pulse treatments of cordycepin, an analog of adenosine, on S and G2 phases of the cell cycle of the mitotically synchronous plasmodia of Physarum polycephalum has been studied. Various concentrations of the drug (50-200 micrograms ml-1) were found to be effective in delaying mitosis by several hours in both the phases. However, there was a significant increase in mitotic delay in those treated during G2. It is suggested that this extra delay during G2 could be due to the transcriptive level inhibition of specific RNA types, such as that of tubulins, whose gene activity is cell cycle regulated and turned on during G2 in Physarum, or alternatively because of a deficiency for ATP and the consequent inhibition of events such as mitotic spindle assembly and phosphorylation of histones.