A comparative study to assess drinking expectancy and functioning in alcohol dependent patients with and without co-morbid depression

Background: Alcohol dependence syndrome (ADS) and major depressive disorder are highly prevalent. Much less is known about the expectancy of alcohol use in depressed patients with ADS. Few studies had compared the expectancy of alcohol use in ADS patients with and without co-morbid depression. Assessing the above factors may help to formulate effective prevention strategies. This study was designed to assess the difference in expectancy of alcohol use and functioning in patients with ADS with and without co-morbid depression.Methods: The difference in expectancy of alcohol use in 96 alcohol dependent patients, of which 24 had co-morbid depression and 72 without co-morbid depression was studied using drinking expectancy questionnaire. In addition, we compared the difference in functioning between the two groups using GAF.Results: Prevalence of depression in alcohol dependent patients was 25%. ADS patients with co-morbid depression had less expectancy about alcohol use for sexual enhancement and had lower level of functioning compared to ADS patients without depression.Conclusions: Less expectancy on sexual enhancement in patients with ADS and co-morbid depression could be possibly due to reduced libido in depressed patients. The observed lower functioning in ADS patients with co-morbid depression despite no difference in severity of alcohol use may be possibly explained by the added burden of both the diseases.

Pattern of alcohol use and drinking antecedents in alcohol dependent patients with and without co-morbid depression: a comparative study

Background: Few studies have compared the pattern of alcohol use in Alcohol dependence syndrome (ADS) patients with and without co-morbid depression. Assessing the pattern may throw light into prevention of relapses more effectively in alcohol dependent patients with co-morbid depression. This study was undertaken to assess the difference in pattern of drinking of alcohol in patients with alcohol dependence with and without co-morbid depression.Methods: A descriptive comparative study was designed to compare the difference in pattern of alcohol use in alcohol dependent patients with co-morbid depression and without co-morbid depression. Severity of dependence on alcohol was assessed using Alcohol Use Disorders Identification Test (AUDIT). Drinking pattern was assessed using Timeline Follow back Calender and Drinking Pattern Questionnaire. The data were statistically analysed.Results: Total 96 alcohol dependent patients (24 had co-morbid depression and 72 without co-morbid depression) were included in the study. There were no significant differences in alcohol use in both the groups in terms of AUDIT scores, amount of drinking, abstinence days or binge drinking. More frequent drinking was observed in circumstances related to emotional, physiological, financial and children related situations in patients with co-morbid depression (p<0.05).Conclusions: Drinking circumstances like emotional, physiological, financial and children related situations require more attention while assessing, treating and aiming at relapse of prevention in ADS patients with co-morbid depression.

A Cross Sectional, Analytical Study of the Morbidity Pattern among Boys Residing in Social Welfare Hostels in Tirupati Town, A. P..

The role of hostels in the educational advancement of backward classes is long recognized. In closed homes like hostels, the morbid conditions especially infectious diseases like skin diseases and respiratory diseases tend to rapidly spread among others and become difficult to control. There is increased nutritional demand in this age group because of pubertal changes. It has been found that several school children especially from socially backward sections of the community suffer from nutritional health problems as well as other physical health problems. We wanted to evaluate the morbidity pattern among boys residing in social welfare hostels.METHODSThis is a cross sectional, analytical study to determine the morbidity pattern among boys residing in social welfare hostels. This present study was conducted from August 2013 to July 2014 among boys residing in three welfare hostels, one each for scheduled castes, scheduled tribes and backward classes in Tirupati town.RESULTSThe common prevalent morbid conditions found were skin disorders (46.4%), nutritional disorders (43.1%), eye diseases (29.0%), respiratory diseases (15.3%) gastrointestinal diseases (13.6%), ENT diseases (9.5%,), musculoskeletal conditions (1.0%), and other diseases (5.7%).CONCLUSIONSHealth education and increasing the nutritional supplements improve the health of children with regard to personal hygiene and common diseases. Provision of necessary materials like soaps, oils etc., under supervision of hostel staff will go a long way in controlling these infections.

Diabetes mellitus in the Tamil Nadu State—Noncommunicable diseases nurse model in diabetic retinopathy screening

Tamil Nadu is one of the states in India, where the diabetic retinopathy (DR) project was implemented in the Tirunelveli District. Aravind Eye Hospital, Tirunelveli was the mentoring institution and ophthalmology department of Tirunelveli Medical College and Hospital (TVMCH) was the implementing partner. The objective of the project was to develop a district level model for building capacity at the government health system for effective screening, diagnosis and management (primary to tertiary) of diabetic retinopathy. The DR screening, counseling, referral and follow-up tasks were included in the scope of Non- Communicable Disease (NCD) nurses at the respective Community Health Centres and Primary Health Centres using the tele-medicine platform. During the project period (December 2016 to June 2019), 8,574 people with diabetes were registered at the 18 CHCs/PHCs. 6,462 (75.4% of those registered) were screened by NCD staff. The government has agreed to scale up services in 3 more districts.

Downregulation of apolipoprotein A-IV in plasma & impaired reverse cholesterol transport in individuals with recent acts of deliberate self-harm

Background & objectives: The major limiting factor in the prevention of suicide is the limited knowledge on molecular insights in individuals at risk. Identification of peripheral protein markers which can classify individuals at high-risk of suicide might aid in early diagnosis and effective medical intervention. The aim of the present study was, therefore, to analyze the differential regulation of plasma proteins in individuals with deliberate self-harm compared to controls. Methods: Using two-dimensional gel electrophoresis coupled with matrix-assisted laser desorption-ionization mass spectrometry, differentially expressed plasma proteins were identified in study participants with deliberate self-harm compared to age- and gender-matched controls. The finding was validated using mass spectrometry-based isotope-labelled relative quantification and Western blot analysis in a new set of individuals with deliberate self-harm and controls. Results: The plasma proteomic analysis showed that apolipoprotein A-IV (Apo A-IV ) was downregulated by 2.63-fold (confidence interval: 1.52-4.54) in individuals with deliberate self-harm (n=10) compared to matched controls, which was consistent in mass spectrometry-based relative quantification and Western blot analysis performed in an independent set of individuals with deliberate self-harm (n=18). In addition, plasma levels of total cholesterol, esterified cholesterol and high-density lipoprotein (HDL) were observed to be significantly lower individuals with deliberate self-harm compared to controls. Interpretation & conclusions: Apo A-IV, which plays a crucial role in the esterification of free cholesterol, was found to be downregulated with concomitantly decreased levels of HDL, esterified cholesterol and total cholesterol in individuals with deliberate self-harm compared to matched controls. The present findings might provide a link between the differential regulation of plasma proteins and the previously reported results on altered cholesterol levels in individuals with deliberate self-harm.

Elevated levels of glutathionyl haemoglobin as an oxidative stress marker in patients with major depressive disorder

Background & objectives: Oxidative stress has been implicated in the pathophysiology of major depressive disorder (MDD), but biomarkers to assess oxidative stress in patients with MDD have yielded ambiguous results. Glutathionyl haemoglobin (GS-Hb) has been reported as a stable and potential biomarker for oxidative stress in various clinical conditions. The objective of the study was to evaluate GS-Hb as a potential biomarker of oxidative stress in patients with MDD through its quantification and to compare the levels of GS-Hb in age- and gender-matched healthy controls. Methods: The levels of GS-Hb were estimated using liquid chromatography coupled to electrospray ionization mass spectrometry in patients diagnosed with MDD and in a subset of patients after six weeks of treatment with selective serotonin reuptake inhibitors (SSRIs). Results: GS-Hb levels in drug-naïve patients with MDD (n=26) were significantly elevated compared to matched healthy controls (n=17). GS-Hb levels were not significantly different between MDD patients with and without co-morbid anxiety disorders. There were no significant differences in GS-Hb levels following six weeks of treatment with SSRIs compared to baseline. Interpretation & conclusions: Compared to controls, GS-Hb level in patients with MDD was significantly elevated, suggestive of increased oxidative stress associated with MDD. However, six weeks of antidepressant treatment was not sufficient to modify the alterations in antioxidant/oxidant system. Further studies need to be done with a large sample of MDD patients with a longer duration of antidepressant treatment.

Analytical Method Development For Simultaneous Determination Of Ubidecarenone And Vitamin E Acetate In Capsule Dosage Form By Hplc

Objective: To develop and validate a new simple, accurate, precise and sensitive high performance liquid chromatographic method (HPLC) method for simultaneous estimation of ubidecarenone and vitamin E acetate in capsule dosage form as per international conference on harmonization (ICH) guidelines. Methods: The chromatographic separation of drugs were achieved using hypersil C8 column (250 mm x 4.6 mm, 5µ) in isocratic elution mode with a mobile phase of methanol: ethanol: n-hexane (80:10:10 v/v/v) at a flow rate of 1 ml/min with ultra-violet (UV) detection at 210 nm. Results: The optimized method produced sharp peaks with good resolution, minimum tailing factor and satisfactory retention time were found to be 5.745 min and 12.565 min for vitamin E acetate and ubidecarenone respectively. The method was linear in the range of 60-180 µg/ml for ubidecarenone and 20-60 µg/ml for vitamin E acetate with a correlation coefficient of 0.999 and 0.9993 respectively. Mean recoveries observed for ubidecarenone and vitamin E acetate were 99.85% and 99.73% respectively. The percentage relative standard deviation (% RSD) of peak area for system precision, method precision, and intermediate precision were found to be less than 0.37%. The lower degree of % RSD obtained has proved that the method was precise and robust. Conclusion: A new simple HPLC method was developed and validated as per ICH guidelines for the simultaneous estimation of ubidecarenone and vitamin E acetate and the method can be effectively applied for the routine analysis of active pharmaceutical ingredient (API) and formulations.

Reliability and validity of a Kannada rate of reading test

Purpose: Kannada, one of the Dravidian languages, is the official language of Karnataka state of India. There is a need for a test using Kannada words that can assess visual aspects of reading independently of syntactic and semantic knowledge. Methods: A test of reading rate in Kannada was developed following the design principles of the Wilkins Rate of Reading Test (RRT). Fifteen high-frequency bisyllabic Kannada words were selected. Children were recruited from state and private schools that used Kannada or English as the medium of instruction. A total of 799 children from Grade 2 to 9 participated in the study. Reading rate was measured using the English RRT and the Kannada version twice in immediate succession during the first session. In 85 children, measurements using the Kannada RRT were repeated after an interval of 15 days. Results: Pearson product moment correlation between the two immediately successive tests was 0.95 for the Kannada RRT and 0.91 for the English RRT. The correlation for the tests separated by an interval of 15 days was 0.83. When Kannada was the medium of instruction, there was little difference between test scores for Kannada and English. When English was the medium of instruction, test scores were greater in English. Scores increased as expected with age (P < 0.0001), similarly for Kannada and English tests. Conclusion: The newly developed Kannada RRT is both reliable and valid and can be used as a tool for measuring the visual aspects of reading.

Scalenus Anterior Muscle With Two Heads Associated With Variation In The Branches Of Subclavian Artery: A Rare Presentation

Arterial variations are quite common. Many studies had elaborated variations in branching pattern of subclavianartery. Present study illustrates a unique feature of scalenus anterior muscle having two heads of origin and acommon trunk for internal thoracic artery (ITA) and thyrocervical trunk (TCT). This rare common trunk passesbetween two heads of right scalenus anterior. Such rare variation was not reported so far. The rarity of suchvariation signifies the necessity of the present study. On the left side all branches arose normally from subclavianartery except dorsal scapular artery which originates from second part itself instead of third part which is aquite common variation. The Internal thoracic artery is widely utilized as a great conduit for MyocardialRevascularization. This common truncal origin is of great surgical importance to Cardiothoracic Surgeons,Cardiovascular Surgeons and Interventional Therapy Radiologists.

Neonatal outcomes in early term neonates versus term neonates in a tertiary care hospital – A cross sectional comparative study.

Background: Preterm birth is one of the chief causes of neonatal mortality and morbidity. The larger studies presented higher rate of adverse outcomes in association to term infants in contrast of neonatal mortality and morbidity. The majority of studies confirmed significantly higher rate of adverse outcomes in preterm in the contrast of neonatal mortality and morbidity. In this contest, we studied Ramprakash MA, Charanraj H, Manikumar S, Srinivasan K, Umadevi L, Giridhar S, Rathinasamy. Neonatal outcomes in early term neonates versus term neonates in a tertiary care hospital - A cross sectional comparative study. IAIM, 2016; 3(4): 21-26. Page 22 the association between different antenatal parameters between early term neonates and full term neonates and to compare neonatal complications. Materials and methods: A total 180 neonates born in the study setting, for a period of 6 months were included and study was conducted in Department of Neonatology and Obstetrics and Gynecology in a tertiary care teaching hospital in south India. A structured and validated case report form was designed for the purpose of data collection. The tool was validated by including the inputs from five experts in the subject area. Descriptive analysis of demographic parameters, antenatal and intra natal parameters were done. Chi square test was used to assess the statistical significance of the association. P value < 0.05 was considered as statistically significant. IBM SPSS version 21 was used for statistical analysis. Results: A total of 180 infants were included in the study, out of which 92 infants (51.1%) were early term and the remaining 88 (48.9%) were full term infants. The odds of early term pregnancy were 2.44 (95 % CI 1.04 to 5.7, p value 0.028) times higher in diabetic mothers, compared to mothers without diabetes. The odds of early term pregnancy was 4.08(95% CI 1.66 to 10.06, p value 0.001) for maternal hypertension and 11.81(95% CI 1.50 to 93.77, p value 0.004) for maternal anemia. The proportion of LSCS was quite high in early term pregnancy, compared to term pregnancy (52.2% Vs 18.2%, p value <0.001). The proportion of small for gestational age (SGA) babies was 29.7% in early term pregnancies (P value 0.011). The odds of hypoglycemia were 3.42 times more in ET pregnancies, compared to full term pregnancies (OR 3.423, 95 % CI 1.37 to 8.52, p value 0.006). Conclusion: The early-term delivery is associated with greater morbidity. There was reasonable relationship was evident involving maternal diabetes mellitus, hypertension, anemia, IUGR and early term pregnancy. The proportion of LSCS was reasonably high in early term pregnancy with slightly higher proportion small for gestational age babies. Neonatal intensive care admissions were found higher in early term than full term pregnancies. Further, there is continual relationship between gestational age and neonatal morbidity from early pregnancy

Listening to the voices of the general public in India on biomedical research – an exploratory study.

Medical research, from clinical trials to novel research on stored samples, is growing rapidly in India. Ethical regulations largely reflect standard international guidelines and the norms of “good clinical practice”. Through in-depth interviews, this study aimed to explore the perceptions, motivations and concerns of the public with respect to participation in clinical trials and biobanking-related research. It was found that the expectation of therapeutic benefit reflects “therapeutic misconception” and this, along with a poor understanding of research, leads to favourable participation in clinical trials. A relatively low level of awareness and knowledge of health matters and research (health literacy), along with the differences in the power of the doctor and the participant, lead to an unquestioning trust in the physician or the institution conducting the research. “Informed consent” is thought to protect the interests of the researcher and the institution rather than the participants’ rights. Biobanking research was very new to the participants and relatively unknown. Thus, it has not yet filtered into the public consciousness. As a result, the perceptions of the general public do not appear to be sufficiently evolved.

Trier Social Stress Test in Indian Adolescents.

Objective: To test the Trier Social Stress Test for children (TSSTC) in a cohort of Indian adolescents. Design: Cohort study Setting: Holdsworth Memorial Hospital, Mysore, India. Participants: Adolescent children (N=273, 134 males; mean age 13.6 yrs) selected from an ongoing birth cohort; 269 completed the test. Intervention: Performance of 5-minutes each of public- speaking and mental arithmetic tasks in front of two unfamiliar ‘evaluators’. Outcome measures: Salivary cortisol concentrations were measured at baseline and at regular intervals after the TSST-C. Continuous measurements of heart rate, finger blood pressure, stroke volume, cardiac output and systemic vascular resistance were carried out before, during and for 10 minutes after the TSSTC using a finger cuff. Results: Cortisol concentrations [mean increment (SD): 6.1 (6.9) ng/mL], heart rate [4.6 (10.1) bpm], systolic [24.2 (11.6) mmHg] and diastolic blood pressure [16.5 (7.3) mmHg], cardiac output [0.6 (0.7) L/min], stroke volume [4.0 (5.6) mL] and systemic vascular resistance [225 (282) dyn.s/cm5] increased significantly (P<0.001) from baseline after inducing stress. Conclusions: The TSST-C produces stress-responses in Indian adolescents of a sufficient magnitude to be a useful tool for examining stress physiology and its relationships to disease outcomes in this population.

Tobacco cessation outcomes in a cohort of patients attending a chest medicine outpatient clinic in Bangalore city, southern India.

Background & objectives: Nicotine dependence is a widely prevalent and harmful chronic addictive disorder. Quitting tobacco use is however, uncommon in India. We present long-term treatment outcomes of out-patient, tobacco cessation treatments from a specialty clinic setting in southern India. Methods: Patients seen in a tobacco cessation clinic were characterized for tobacco use, nicotine dependence and motivation for quitting and offered pharmacologic/non-pharmacologic treatment. They were subsequently contacted telephonically at a mean (±standard deviation) of 24 (±9.1) months to assess tobacco cessation outcome defined as ‘point prevalence of 1-month abstinence’ by self-reporting. Results: The mean age of participants was 48.0 ±14.0 yr. Tobacco use distribution was: beedis only (22%), cigarettes only (49%), beedis and cigarettes (18%), chewing only (2%), and smoking and chewing (9%). Two-thirds had high level of nicotine dependence. Of the 189 patients enrolled, only 15 per cent attended follow up clinics. Only 106 (56%) patients were successfully contacted telephonically and 83 (44%) were lost to follow up. Self-reported point prevalence abstinence was 5 per cent by ‘intent-to-treat’ analysis and 10 per cent by ‘responder’ analysis. Two clinical parameters – high level of nicotine dependence [estimated by the heaviness of smoking index (HSI)] and the absence of vascular or other chronic disease were found to be associated with successful quitting; these were however, not significant on multivariate analysis. Interpretation & conclusions: Our study has identified low quit-rates in a cohort of patients attending a hospital-based tobacco cessation clinic. In the absence of clear-cut predictors of cessation with low quit-rates, there should be continued efforts to improve cessation outcomes and identify predictors for action.

Ethical challenges in biobanking: moving the agenda forward in India.

There is no agreement on the typology and definition of biobanks. The present regulations across countries, including India, focus on genomic and genetic databases and DNA and cell line biobanking. It is unclear how the range of the holdings of biological samples in diagnostic and research laboratories fall under these regulatory frameworks. Biobank-related research has become very attractive because of advances in sample storage and data processing, a better understanding of the human genome, and high throughput laboratory assays.

P-glycoprotein expression as a predictor of response to neoadjuvant chemotherapy in breast cancer.

BACKGROUND: Chemoresistance is an important factor determining the response of tumor to neoadjuvant chemotherapy (NACT). P-glycoprotein (P-gp) expression-mediated drug efflux is one of the mechanisms responsible for multi-drug resistance. Our study was aimed to determine the role of P-gp expression as a predictor of response to NACT in locally advanced breast cancer (LABC) patients. MATERIALS AND METHODS: P-gp expression was performed by real-time quantitative polymerase chain reaction [qRT-PCR] in 76 patients with LABC. Response to adriamycin-based regimen was assessed both clinically and with contrast enhanced computed tomography (CECT) scan before and after NACT. The significance of correlation between tumor and P-gp levels was determined with Chi-square test. RESULTS: Twenty-one had high and 55 had low P-gp expression. On analyzing P-gp expression with response by World Health Organization (WHO) criteria, statistical significance was obtained (P = 0.038). Similarly, assessment of P-gp expression with response by Response Evaluation in Solid Tumors (RECIST) criteria in 48 patients showed statistical significance (P = 0.0005). CONCLUSION: This study proves that P-gp expression is a determinant factor in predicting response to NACT. Finally, detection of P-gp expression status before initiation of chemotherapy can be used as a predictive marker for NACT response and will also aid in avoiding the toxic side effects of NACT in non-responders.

Antidiabetic activity of Pseudarthria viscida aqueous root extract in neonatal streptozotocin-induced NIDDM rats

The antidiabetic activity of the aqueous root extract of Pseudarthria viscida (L.) Wight & Arn., Fabaceae, was investigated in normal and neonatal streptozotocin (n2-STZ)-induced non insulin-dependent diabetes mellitus (NIDDM) rats and compared with glibenclamide as a reference standard. Two different doses (250 and 500 mg/kg) of the extract were administered to normal and experimental diabetic rats for 21 days. Fasting blood glucose levels, serum lipid profiles and changes in body weight were evaluated in normal and diabetic rats while serum insulin, glycated hemoglobin, urea, creatinine, magnesium, protein, albumin and glycogen, glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), lactate dehydrogenase (LDH) levels in kidney and liver were evaluated additionally in diabetic rats. Treatment with extract at both dose levels was found to exhibit antidiabetic activity, with the higher dose showing more significant activity.

Antihypercholesterolaemic influence of dietary tender cluster beans (Cyamopsis tetragonoloba) in cholesterol fed rats.

Background & objectives: Cluster beans (Cyamopsis tetragonoloba) are rich source of soluble fibre content and are known for their cholesterol lowering effect. The beneficial anti-hypercholesterolaemic effect of whole dietary cluster beans as a source of dietary fibre was evaluated in high cholesterol diet induced hypercholesterolaemia in experimental rats. Methods: Male Wistar rats (90-95 g) divided in six groups of 10 rats each were used. Freeze dried tender cluster beans were included at 12.5 and 25 per cent levels in the diet of animals maintained for 8 wk either on high (0.5%) cholesterol diet or basal control diet. Results: Significant anti-hypercholesterolaemic effect was seen in cluster bean fed animals, the decrease in serum cholesterol being particularly in the LDL associated fraction. There was also a beneficial increase in HDL associated cholesterol fraction. Hepatic lipid profile showed a significant decrease in both cholesterol and triglycerides as a result of feeding tender cluster beans along with high cholesterol diet. Interpretation & Conclusions: The present experimental results showed the beneficial hypocholesterolaemic and hypolipidimic influences dietary tender cluster beans in atherogenic situation. Studies in human need to be done to confirm the results.

Prevalence of & knowledge, attitude & practices towards HIV & sexually transmitted infections (STIs) among female sex workers (FSWs) in Andhra Pradesh.

Background & objectives: As part of the baseline survey carried out during 2005-06, biological and behavioural data were generated on about 3200 female sex workers (FSWs), from eight districts of Andhra Pradesh (AP), India. This study describes the relationship between socio-demographic and behavioural factors with consistent condom use (CCU) and HIV among FSWs in AP. Methods: A cross-sectional community-based study was conducted among female sex workers (FSW) in eight districts of Andhra Pradesh, India, using conventional cluster sampling and time-location cluster sampling. Key risk behaviours and STIs related to the spread of HIV were assessed. Blood samples were collected to detect syphilis, Herpes simplex virus type 2 (HSV-2) Chlamydia trachomatis (CT), Neiserria gonorrhoeae (NG) and HIV serology. Results: About 70 per cent of the FSWs were illiterates, nearly 50 per cent were currently married and 41 per cent of the FSWs had sex work as the sole source of income. More than 95 per cent of the FSWs heard of HIV, but about 99 per cent believed that HIV/AIDS cannot be prevented. Logistic regression analysis showed significantly lesser CCU with high client volume, not carrying condom and could not use condom in past 1 month due to various reasons such as non co-operation by the clients. Similarly, CCU was significantly (P<0.001) lesser (only 8.9%) with regular non-commercial partners. Overall there was 16.3 per cent prevalence of HIV amongst FSWs. C. trachomatis and N. gonorrheae were prevalent in 3.4 and 2 per cent of the FSWs, respectively and about 70 per cent of the FSWs were positive for HSV2 serology. HIV was significantly associated with STIs. Interpretation & conclusions: Misconception that HIV/AIDS cannot be prevented is very high. Most of the subjects in the present study had first sexual debut at a very young age. HIV was associated with STIs, emphasizing aggressive STI diagnosis and treatment. CCU must be emphasized right from first sexual debut with all clients and non-commercial partners as well.