Study of liver enzyme variation in children with dengue fever

Background: Dengue fever continues to be one of the major public health problems in large parts of the world, with an estimated 50 million dengue infections occurring annually. Liver enzyme variation is commonly seen in patients with dengue fever. This study was undertaken to assess the pattern of liver enzyme variation in children with dengue fever and to correlate it with the severity of this disease.Methods: Observational, descriptive hospital-based study involving 100 children who were serologically positive for dengue fever. The cases were classified as Mild, Moderate and Severe Dengue based on National Guidelines of clinical management of Dengue fever, 2015 and severity was assessed in each category. The study assessed the variability of liver enzymes in these children.Results: Aspartate Aminotransferase (AST) was elevated in 56 cases whereas Alanine Aminotransferase (ALT) was elevated in 44 cases. The elevation in liver enzymes in mild cases was 52%, moderate cases was 75% and severe cases was 100%. In cases presenting on day 1 of fever, enzymes were elevated in 0%, on day 2 in 20%, on day 3 in 38%, on day 4 in 51%, on day 5 in 90% and on day 6 in 88%.Conclusions: Liver Enzyme (AST and ALT) elevation in Dengue is a common feature. AST elevation was more common than ALT. Highest elevation in liver enzymes were observed on 5th and 6th day of fever. Liver enzyme elevation was more commonly seen in moderate and severe cases.

A study on sleep patterns and sleep problems in children aged 6 to 15 years as perceived by their parents

Background: The objective is to study the sleep pattern and occurrence of sleep problems in children aged 6 to 15 years, visiting the Outpatient clinic at a tertiary care hospital, as perceived by the parents and to establish the common causal association as perceived by the parents for developing sleep problems. 'Methods: The study design was based on the descriptive study. The duration of the study was from 1st June to 31st July. Data was collected from all the children visiting the Pediatric OPD and those who are admitted, Department of Pediatrics, Father Muller Medical College. Sample size: convenient sampling. Considering the prevalence of sleep disturbance in children as 10%, estimated error of 5% and confidence interval of 5%, sample size was 139. Children who followed the inclusion and exclusion criteria were considered for the study. Informed consent was taken from the parent. Relevant details were asked to the parents of the child and a pre-designed proforma was filled by the investigator accordingly. SDSC questionnaire was used and a cut off score of 39 was considered.Results: Out of the 140 children who completed the survey, 48% of the children had sleep disturbances.' The most common was disorder of initiating and maintaining sleep. The most common association was with need for accompaniment, followed by use of gadgets. The prevalence of sleep disorders is underestimated, and it is important to recognize them early.Conclusions: The increasing use of electronic gadgets could be a possible cause of sleep disturbances, which suggests that the exposure of children to these gadgets maybe reduced.

Reactive Nodular Fibrous Pseudotumor: A Rare Mesenchymal Tumor

Reactive nodular fibrous pseudotumor (RNFP) is a recently described non-neoplastic mesenchymal lesion arising from the gastrointestinal tract, mesentery, or retroperitoneum. It is a rare entity with only a few cases reported in literature so far and is less aggressive when compared to other mesenchymal lesions such as gastrointestinal stromal tumor (GIST) or fibromatosis. Here, we present the case of a 20-year-old female who presented with a huge abdominal mass. Contrast-enhanced computed tomography was suggestive of pseudopapillary tumor of the pancreas. The patient underwent exploratory laparotomy and excision of the mass in toto along with sleeve gastrectomy and splenectomy. Post-operative histopathology confirmed the entity to be RNFP. This case illustrates the need for keeping RNFP in mind as a differential diagnosis in a case of large abdominal mass as it has a fairly good prognosis with no reported recurrence after surgical excision.

A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India.

Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.

A Simple Method to Check the Border Extensions of Custom Tray.

Proper extensions of custom trays are of supreme importance during border molding and final impression making. This article describes a novel method to evaluate the peripheral extensions of custom trays prior to border molding.

Customized Alar Stent Fabrication for Atrophic Rhinitis Patient: A Non-invasive Technique.

Atrophic Rhinitis is a form of chronic rhinitis in which the nasal mucosa atrophies and hardens; eventually causing the nasal passages to dilate and dry out. Other prominent findings include foul smelling crusts and bleeding. Despite various local, medical and surgical methods suggested for the treatment of this slowly progressing disease, the problem with respect to the proper maintenance of the nasal valve area remains unsolved. The alar stent prevents the narrowing of the nostrils and helps in maintaining the airway patency. This article describes a simplified, non-invasive technique for the fabrication of a heat polymerized clear acrylic resin alar stent for treating the atrophic rhinitis patient.

Phenotypic identification & molecular detection of blandm-1 gene in multidrug resistant Gram-negative bacilli in a tertiary care centre.

Background & objectives: Carbapenemase-producing Enterobacteriaceae isolates have been increasingly identified worldwide. Though molecular data regarding New Delhi metallo-beta-lactamase-1 (NDM-1) producers are available, data regarding their rate of infection in a hospital setting and percentage among different clinical isolates are scarce. Hence, this study was undertaken to determine the occurrence of blaNDM-1 gene among clinical isolates of multidrug resistant Gram-negative bacilli (MDRGNB) in a tertiary care centre in Bangalore, Karnataka, India. Methods: A total of 74 MDRGNB isolates were studied. These were screened for MBL production by phenotypic assays such as double disk synergy test (DDST) and Modified Hodge’s test (MHT). PCR was performed for the molecular detection of the gene and antibiograms were confirmed by automated bacteriology system. Results: Of the 74 MDRGNB isolates, 34 were positive for blaNDM-1 gene. All isolates were resistant to aztreonam and two isolates were resistant to tigecycline. Complete resistance to the tested carbapenems was seen in 28 (82.35%) of the positive isolates whereas variable carbapenem resistance was seen in six (17.64%) of the positive clinical isolates. Of the total 34 PCR positive isolates, 33 (97.05%) NDM-1 producers were identified by DDST and 26 (76.47%) by MHT as producers of MBL. Interpretation & conclusions: A high percentage of plasmid encoded NDM was noted in MDRGNB. Phenotypic and molecular screening should be employed along with routine antimicrobial susceptibility testing to reflect the true number of metallo-beta-lactamase producers.

Willingness to participate in a clinical trial and understanding of informed consent information among medical students.

Studies have shown that the decision to participate or not participate in a clinical trial does not necessarily imply that the volunteers have completely understood the clinical trial process. A study carried out among medical and non-medical student volunteers revealed that even though the former group had a better recollection of the key facts, their understanding was still below expectation. In our study, medical students were invited to voluntarily take part in a hypothetical exercise in which they were presented with an informed consent form to indicate their willingness to participate in an anti-malarial drug trial. They were encouraged to clarify their doubts and asked to answer a questionnaire to determine their willingness/unwillingness. They were asked to state their reasons and recall key information given in the informed consent form. Responses were submitted by 155 students and 51% of the respondents consented to participate in the trial. As many as 13.5% did not know the name of the drug under study, 14.8% could not recall the main adverse effects to be expected, and 12.3% did not know that they could opt out of the study, this being significantly more in those who had consented to participate (p0.0. As is evident from our study, even presenting a detailed consent form containing an explanation might leave a considerably large number of potential volunteers with an incomplete understanding of the study. Therefore, it is necessary to make an active effort to ensure that the counselling of the volunteers is based on their ability to comprehend the information provided.

Epidemiology and symptom profile of gastroesophageal reflux in the Indian population: Report of the Indian Society of Gastroenterology Task Force.

Background Gastroesophageal reflux disease (GERD) and its complications are thought to be infrequent in India; there are no data from India on the prevalence of and risk factors for GERD. The Indian Society of Gastroenterology formed a task force aiming to study: (a) the frequency and profile of GERD in India, (b) factors including diet associated with GERD. Methods In this prospective, multi-center (12 centers) study, data were obtained using a questionnaire from 3224 subjects regarding the frequency, severity and duration of heartburn, regurgitation and other symptoms of GERD. Data were also obtained regarding their dietary habits, addictions, and lifestyle, and whether any of these were related or had been altered because of symptoms. Data were analyzed using univariate and multivariate methods. Results Two hundred and forty-five (7.6%) of 3224 subjects had heartburn and/or regurgitation at least once a week. On univariate analysis, older age (OR 1.012; 95% CI 1.003–1.021), consumption of non-vegetarian and fried foods, aerated drinks, tea/coffee were associated with GERD. Frequency of smoking was similar among subjects with or without GERD. Body mass index (BMI) was similar in subjects with and without GERD. On multivariate analysis, consumption of non-vegetarian food was independently associated with GERD symptoms. Overlap with symptoms of irritable bowel syndrome was not uncommon; 21% reported difficulty in passage of stool and 9% had mucus in stools. About 25% of patients had consulted a doctor previously for their gastrointestinal symptoms. Conclusion 7.6% of Indian subjects have significant GERD symptoms. Consumption of non-vegetarian foods was an independent predictor of GERD. BMI was comparable among subjects with or without GERD.

Effect of selenium on the physiochemical status of rat testes.

Selenium (Se) is required for normal testicular development and spermatogenesis in rats. However, there are indications that excess of selenium affects the testicular morphology, resulting in the interruption of spermatogenesis. The biochemical mechanisms underlying these morphological alterations have not so far been investigated. Therefore, in order to have a better understanding of the action of selenium in disturbing the fertility, this study was undertaken, taking into account certain testicular bio-chemical parameters related to reproduction in selenium-intoxicated rats. Effects of sub-lethal doses (100, 250, and 500 micrograms of Se/100g body weight, once in five days, for a month) of selenium on testicular biochemical parameters were studied. Significant dose-dependent alterations in testicular levels of cholesterol, ascorbic acid, glycogen, protein, sialic acid, phosphatases and transaminases were observed in selenium-treated rats, as compared to controls. These findings indicate that sub-lethal doses of selenium may adversely affect gonadal biochemical homeostasis.

Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force.

AIMS: To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. METHODS: In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. RESULTS: Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 <or= stools/week), 50 (4%) had diarrhea-predominant IBS (>3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. CONCLUSIONS: Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.

Management of oral health in patients irradiated for head and neck cancer: a review.

Management of oral health plays an integral role in the treatment of Head & Neck Cancers. Radiation therapy is a significant treatment modality in the management of Head and Neck Cancers. However, high dose of radiation is also associated with side effects. Oral health management plays an important role in preventing these complications. Therefore it is mandatory to initiate prompt oral health care that can prevent the associated orodental complications. This article is a review on oral complications associated with radiation therapy, their prevention and management.

Safety and radiosensitizing efficacy of sanazole (AK 2123) in oropharyngeal cancers: randomized controlled double blind clinical trial.

Oropharynx is an important site of cancer in India. Global comparison indicates higher incidences in India. Radiotherapy remains an important treatment modality. Efforts to improve loco-regional treatment and prolong survival are areas of focus. Radiosensitizers in hypoxic tumors have shown promise. AIM: To study the safety and radiosensitizing efficacy of sanazole in oropharyngeal squamous cell carcinoma (stage T2-4, N0-3, M0) as phase-II double blind controlled trial in patients treated with conventional radiotherapy. SETTINGS AND DESIGN: Single institutional, randomized, double-blind, placebo-controlled trial. MATERIALS AND METHODS: Group 1 (control; n = 23) received normal saline infusion, group 2 (test; n = 23) received sanazole biweekly 1.25 g intravenous infusion 15 minutes before radiotherapy. Surrogate end points of efficacy were tumor and nodal size; safety parameters were mucositis, salivary and skin reactions, dysphagia, vomiting, dysgeusia and neurological deficit. Investigators blinded to the trial evaluated patients, weekly during treatment for six weeks and thereafter monthly for three months. STATISTICAL METHODS: Non-parametric, Friedman's, Chi square, Mann-Whitney U tests. RESULTS: In the test, 15 (65%) patients had complete response, five (22%) partial/no response, two (9%) died, one (4%) lost to follow up. In the control, five (22%) patients had complete response, 16 (70%) partial/no response, one (4%) died, one (4%) lost to follow up. Short-term loco-regional response was better in the test (DF = 3, 95% Confidence Interval 0.418, 0.452, P = 0.0048). In the test group significant vomiting and one case of grade 3 neurological deficit was observed. CONCLUSION: The study validates the usefulness of sanazole for initial loco-regional control in oropharyngeal cancers.

Molecular characterization of hepatitis A virus from a large outbreak from Kerala, India.

BACKGROUND & OBJECTIVES: Hepatitis A is highly prevalent in India and mainly presents as a sporadic disease. This study investigated an outbreak of viral hepatitis at Medical College Hospital area, Kottayam, Kerala state, India during January 2005. METHODS: Blood (133), faecal (1), sewage (4), and water samples (13) were collected. Sera were tested for IgG- and IgM-anti-HAV and IgM antibodies against hepatitis E (IgM-anti-HEV). Sewage, faeces and water samples were tested for HAV RNA in nested RT-PCR and HAV RNA positive samples were further processed for RNA quantitation using Real Time PCR. RESULTS: Of the 1180 total cases, 540 were reported from Medical college area. Two deaths were reported among doctors. Patients from the community gave a previous history of visit to medical college hospital area. The sewage treatment plant at the campus was non-functional since 1990 and the untreated sewage was constantly overflowing and getting mixed with a canal. At the time of the study, all the water sources were superchlorinated. HAV RNA was present in the faeces of hepatitis A patient (1.36 x 10(7) copies/ml), sewage tank (2.57 x 10(3) copies/ml and the canal (<100 copies/ml). None of the 13 water samples concentrated 10,000-fold and the soil sample showed presence of HAV RNA. Phylogenetic analysis based on 5'-non-coding and P2 regions showed HAV-genotype IIIA in all samples. INTERPRETATION & CONCLUSION: The aetiological agent of the present outbreak was found to be HAV. Epidemic hepatitis A (genotype-IIIA) is emerging in Indian adults, emphasizing the need for definite policy for control.

Enteral feeding by fistuloclysis in a midjejunal fistula.

Enterocutaneous fistulas are potentially life-threatening complications of gastrointestinal surgery. Nutritional support is the mainstay of management. We report a 32-year-old man who developed an enterocutaneous fistula following surgery for ulcerative colitis. Enteral feeding was attempted by introducing a Foley's catheter through the midjejunal fistula.

Efficacy and tolerability of itopride hydrochloride in patients with non-ulcer dyspepsia.

To document the clinical efficacy and tolerability of itopride hydrochloride in patients with non-ulcer dyspepsia an open-label, non-comparative study, was undertaken at the Medical College, Thiruvananthapuram, among patients with endoscopically confirmed diagnosis of non-ulcer dyspepsia or chronic gastritis. Itopride hydrochloride 50 mg (1 tablet) thrice a day for 2 weeks was administered among them. Relief of symptoms at the end of two weeks treatment, assessed as marked/complete, moderate, slight, none or worse; QT interval on ECG; adverse events; haemogram; serum chemistry for hepatic and renal functions. None had QT prolongation on ECG. At the end of 2 weeks' treatment, moderate to complete relief of symptoms was reported by 22 patients (73%), whereas 5 (17%) reproted slight improvement, and 3 (10%) reported no improvement. Clinical tolerability was excellent in 28 patients (93%) and good in 2 (7%). None of the patients had any prolongation of QT on ECG, nor did any patient show any abnormality in haemogram or serum chemistry during the treatment.

Evaluation of hepatoprotective activity of Ginkgo biloba in rats.

The mechanism of hepatoprotective effects of Ginkgo biloba (GB), an herbal preparation with wide variety of therapeutic application, on paracetamol (Pcml) induced hepatic damage in rats has been investigated. GB treatment restored the marker enzyme levels indicating the in vivo protective effects against Pcml induced liver damage both in preventive and curative aspects. GB also reversed the increased TBARS levels, and elevated the GSH content of the liver. The results obtained from the study indicate hepatoprotective nature of GB, which might be due to its ability to prevent lipid peroxidation and replenishing the gllutathione level. The effects of GB were comparable to that of silymarin.