Internet Addiction and Sleep Quality Among Medical Students of Delhi: A New Age Epidemic

Background: Recently there is an explosive growth of internet usage among youth worldwide. Internet addiction is defined as psychological dependence on the Internet leading to inability to control one’s use of the Internet. Objective: To study the prevalence of internet addiction and quality of sleep among medical students of Delhi and to find out the factors associated with internet addiction. Methods: A cross-sectional study, using stratified random sampling method was conducted among un-dergraduate students of VMMC & Safdarjung hospital Delhi. Young’s internet addiction test and Pitts-burgh sleep quality index was administered. Results: Mean age of study participant was 20.3 ± 2.3 SD years. Internet addiction was found in more than half of the study participant. Poor sleep quality was also found in more than half (57.2%) of them. On analysing internet addiction with associated factors, it was observed that gender, monthly data usage, source of internet use, phone use while eating, ever notice by teacher in class while using phone, month-ly expenditure and quality of sleep were statistically significantly (p < .001) associated. Conclusion: This study implies that internet addiction was high among medical student. More than half of the study participants was suffering from poor sleep quality.

A giant retroperitoneal liposarcoma with hemoperitoneum: A rare tumor with unusual presentation

Retroperitoneal liposarcoma (RPLS) is a rare mesenchymal tumor which accounts for 0.02–0.7% of all malignancy. The presentations of these tumors are non-specific and early diagnosis is often missed. We are reporting a rare case of 17-year-old girl who came to us with complaints of abdominal distension and other non-specific symptoms but after few hours of admission, she had acute abdomen with hemodynamic instability. She underwent emergency laparotomy and found to have a giant 25 × 20 × 10 cm ruptured retroperitoneum tumor causing hemoperitoneum. The tumor involved left ovary and fallopian tube as well. Complete resection of tumor with left salpingooophorectomy was done. The patient was kept in intensive care unit and discharged in good health after 15 days. This presentation of RPLS has not been reported yet and may demand early diagnosis and management of these tumors. The histopathology revealed dedifferentiated liposarcoma with rhabdomyosarcomatous differentiation. The patient is completely fine at 16 months of follow-up while writing this report. Again, heterologous dedifferentiation of liposarcoma with spindle cell component is a rare morphologic spectrum. Liposarcomas can have various histologic types. In dedifferentiated types, the line of differentiation needs to be identified to decide further line of treatment. Therefore, thorough histopathological analysis and immunostaining is needed. Treatment includes complete surgical resection. Role of radiotherapy and chemotherapy is debatable and is still under trial. Dedifferentiated RPLS with rhabdomyosarcomatous differentiation is a rare tumor and its presentation as acute abdomen and hemoperitoneum has never been reported previously

MRI is the modality of choice for evaluation of spinal lesions

Introduction: Spine is a longitudinal structure, and precise location of the level of a lesion from clinical examination can be difficult. MRI of spine shows the anatomy of the vertebrae that makes up the spine, as well as the discs, spinal cord and the intervertebral foramina through which the nerves pass. It also allows us to differentiate between healthy tissue and diseased tissue. Materials and methods: This study aimed at diagnosing and following up cases of spinal lesions in the department of Radio diagnosis of SBKS Medical Institute and Research Centre and Dhiraj General Hospital. The study is performed using conventional X-rays and MRI. Results: Maximum numbers of patients were between 41–50 years age group followed by 21-30 and 31-40 years of age group, whereas patients of paediatric (00-10 years) and geriatric (>70 years) age group constituted only 8% patients. Average age of patients was 42.5 years. Lumbar spine was the most commonly affected spine region. Maximum numbers of patients were of degenerative and disc lesions (49%). Conclusion: MRI by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes is investigation of choice for spine and spinal cord pathologies. The ability to image the cord directly rather than indirectly as in myelography, the absence of bone artifact as in computed tomography, and the multiplanar capabilities indicate that MRI is the procedure of choice in the examination of the spinal cord.

Gallbladder cancer incidence in Gwalior district of India: Five-year trend based on the registry of a regional cancer center.

BACKGROUND: We have reported here the 5-year incidence (2004–2008) of gallbladder cancer (GBC) in North Central India along with its descriptive epidemiology. This provides potential clues for better prevention. The present study has also evaluated the association of ABO blood groups with GBC. PATIENTS AND METHODS: The study comprised 742 GBC cases referred to the regional cancer hospital, Gwalior, during 2004–2008. The demographic statistics of Gwalior district was considered to calculate the relative risk and incidence rates. ABO blood group distribution amongst 90,000 healthy subjects registered in the local blood bank during 2002–2007 was taken as controls to study the association of blood groups with GBC. RESULTS: The age-standardized total incidence rate of GBC was calculated to be 7.16/1,00,000. The relative risk of females getting GBC was 2.693 at 95% confidence interval of 2.304–3.151 (P < 0.0001). The females formed 69.5% of total cancer cases, with age-standardized incidence rate of 10/1,00,000. The mean age of male and female GBC cases was found to be 55.4 years (SD = 13, SE = 0.77) and 51.5 years (SD = 12.3, SE = 0.50), respectively. The blood groups A (P = 0.0022) and AB (P < 0.0001) had a positive association with GBC with significant level of differences in comparison to controls. CONCLUSION: Our study provided an estimate of a 5-year incidence of GBC in North Central India for the first time. With regard to the association of risk factors like obesity, age, and urban living with GBC, the findings of the present study are contradictory to the general opinion. Blood groups A and AB were found to be associated with GBC, which would be provisional for further investigations.

The liver function test enzymes and glucose level are positively correlated in gallbladder cancer: A cancer registry data analysis from north central India.

Aim of Study: To investigate the trend of expression of liver function test enzymes and other biochemical changes during gallbladder carcinogenesis. Materials and Methods: Eight hundred and seventy-eight gallbladder disease patients were selected to study the liver function test enzymes and routine blood biochemical changes in the last five years (2004-08). Statistical analysis was performed using Graph Pad prism® 5.02 software. Results: The liver function test enzymes showed significant correlations among themselves, and with glucose in gallbladder cancer and gallstone disease patients (N = 878). Out of 878 gallbladder cases, 46 (5.24%) showed significantly higher glucose level of 216.66 mg/dL (P < 0.0001). All the three pathological conditions of gallbladder, gallbladder cancer with stones (GBCS), gallbladder cancer without stones (GBC) and calculus cholecystitis (CC), showed highly significant positive correlation (Pearson) between Serum Glutamic Oxaloactetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT) [P < 0.0001, (GBCS); P < 0.0001, (GBC), and P < 0.0001, (CC)]. SGOT and SGPT also showed positive correlation with higher glucose level independently, in both GBCS and CC (P < 0.0001 and P < 0.0001), respectively. Conclusion: Simultaneous elevation of glucose and liver function test enzymes in GBC makes the diagnosis complex. Any patient of gallbladder diseases with higher level of glucose may have the possibility of developing gallbladder cancer.

DAZL 260A>G and MTHFR 677C>T variants in sperm DNA of infertile Indian men.

DAZL (deleted in azoospermia-like) 260A>G and MTHFR (methylene tetrahydrofolate reductase) 677C>T are two important autosomal variants associated with impaired spermatogenesis. In this study, we investigated DAZL 260A>G and MTHFR 677C>T variants in sperm DNA and their frequency in oligozoospermic infertile men of Indian origin. The study on sperm DNA was performed, since it is more prone to oxidative stress-induced damage and mutation. One hundred oligozoopsermic infertile men having normal chromosomal complement with intact Y chromosome and 100 age- and ethnically-matched fertile controls were investigated for these variants in their sperm genome. Spermatozoa were separated by gradient centrifugation and DNA was isolated and analyzed for the single nucleotide polymorphisms (SNPs) by polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP). The results showed no significant differences in the frequency of DAZL AG (P = 0.58) and MTHFR CT (P = 0.44) between oligozoospermic infertile men and controls. However, 8% (8/100) oligozoospermic infertile men harbored both the variants and showed significantly (P<0.0001) lower sperm count (3.28 ± 1.1 vs 12.50 ± 4.09) compared to infertile men with either of the single variant. None of the fertile controls showed the presence of the both variants. In conclusion, the combined effect of both DAZL 260A>G and MTHFR 677C>T variants may have role in compromised sperm count. However, further studies are required to find the pathological role of these combined variants in male infertility.

Studies on Cyanobacterial Biodiversity in Paper Mill and Pharmaceutical Industrial Effluents.

A thorough knowledge of the physical, chemical and biological characteristics of an industrial waste is a crucial requirement for any attempt at chemical and/or biological treatment of the waste. Hence the present study was aimed to assess the physicochemical characteristics and cyanobacterial study on different industrial effluents. In the present study, effluents from two different places, paper mill and pharmaceutical industries, were selected to determine the cyanobacterial biodiversity. It was revealed that the physicochemical characteristics of both effluents studied were more or less similar. Total 25 species of cyanobacteria were found to be distributed in two different effluents in which twenty two were found in paper mill and fourteen were in pharmaceutical industries. Some of the species of cyanobacteria like Microcystis aeruginosa, Oscillatoria curviceps, O. princeps, Phormidium ambiguum, P. corium and few more were recorded in both the effluent analyzed. The dominant genus was recorded to be Oscillatoria and among themselves its six species were recorded. The abundance of cyanobacteria in these effluents was due to favorable contents of organic matter, rich calcium and nutrients such as nitrates and phosphates with less dissolved oxygen. Therefore, it can clearly stated that physicochemical characters together with biological monitoring of industrial effluents provided converging lines of evidences for evaluation of polluted habitats in this case as in some other studies reported by many researcher. This type of study would be valuable for future pollution abatement programmes.

Morquio Syndrome in Two Siblings: A Case Report.

Morquio syndrome is a rare inherited autosomal recessive disorder characterized by the accumulation of mucopolysaccharides (glycosaminoglycans) in various body tissues. It is rare cause of dwarfism. Many pediatricians therefore are unlikely to see this case hence may miss the diagnosis due to lack of experience. With this view we report two siblings with this dwarfism highlighting the classical clinical and radiological presentation.

Inverted papilloma of the urinary bladder: Rigorous surveillance needed: An Indian experience.

Aims: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. Materials and Methods :0 We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. Results: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. Conclusions: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.

Assessment of air pollution tolerance index of some trees in Moradabad city, India.

To see the relative tolerance of the plant species, ten different plant species i.e. Ficus rumphii, Pongamia pinnata, Alstonia scholaris, Holoptelea integrifolia, Saraca indica, Pithecolobium dulcis, Cassia simea, Bauhinia variegata, Azadirachta indica and Grewelia robusta was taken from residential (SI), industrial (SII) and commercial (SIII) area of the city as this flora is very much common to the Brass city and is planted on the roadside. The quality of air with respect to SPM,SO2 and NO2 has been also assessed on respective sites to see its effect on biochemical parameters of the leaves i.e. pH, total water content, chlorophyll and ascorbic acid and evaluate the (air pollution tolerance index(APTI) of various plants. It was concluded that Pongamia pinnata 15.8, Pithecolobium dulcis 34.8, Holoptelea integrifolia 55.8 and Saraca indica 52.0 have very high APTI value over control so these are considered as high tolerant tree species, Ficus rumphii 35.7, Azadirachta indica 30.5 and Grewelia robusta 34.3 have slightly more APTI value over control so these are considered as moderately tolerant tree species and Alstonia scholaris 21.5,Cassia simea 6.09 and Bauhinia variegata 18.22 have less APTI value than control, so these are sensitive species respectively. One way ANOVA finds the obtained values to be highly significant (p <0.001) at the industrial site. Thus present findings show that Brass and allied industries are the prominent sources responsible for the elevated level of air pollutants at the industrial site.

Drug use pattern in children at a teaching hospital.

This study aimed to evaluate drug utilization in pediatric out-patient department of a tertiary care teaching hospital. The patient and drug information of 254 patients was analyzed for WHO recommended prescribing indicators. The average number of drugs per prescription was 2.31 and 45% of medicines were prescribed from National List of Essential Medicines. The use of injectibles was low (1.18%) while an antibiotic was prescribed in 29.1%. Only 5.8% medicines were prescribed by generic name. Interventions are required to improve prescribing by generic name so as to further rationalize drug use in pediatric population.

Pulmonary function profile in patients with benign goiters without symptoms of respiratory compromise and the early effect of thyroidectomy.

BACKGROUND: A large number of patients in our country develop goiters which seem to be apparently asymptomatic. Conventional radiography does not address the abnormal air flow dynamics. Flow volume loop studies have shown characteristic dampening of both inspiratory and expiratory curves. Pulmonary function tests (PFT) can provide a simple noninvasive method of assessing airway compromise. AIM: To address the effect of longstanding asymptomatic, benign goiter by performing PFT on the preoperative airway dynamics and the early postoperative changes at six weeks. SETTING AND DESIGN: Tertiary care center, Prospective study. MATERIALS AND METHODS: Sixty-four patients with benign goiters were included after they satisfied the necessary exclusion and inclusion criteria. Pulmonary function tests were performed in the pre and postoperative period. STATISTICAL ANALYSIS USED: SPSS ver. 10 software, Pearson's Bivariate correlation and students T test. Results: The preoperative PFT showed significant reduction in the Vital capacity (VC), Forced Vital Capacity (FVC), Forced expiratory volume in one second (FEV1), mid expiratory flow (MEF 25) and MEF 50 in the females and VC, FVC and FEV1 in males. Postoperatively significant improvement was observed in the tidal volume (VT) and FEV1 in the females and airway resistance in males. CONCLUSIONS: Pulmonary function tests can demonstrate the unmanifested abnormal airflow dynamics in benign asymptomatic goiters, which would have otherwise taken years to manifest. This abnormality improved after thyroidectomy, especially the forced expiratory maneuvers. The duration and weight of the goiter correlated well with reduction in FEV1 and its subsequent improvement after surgery in females.

Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder

OBJECTIVE: We report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. MATERIALS AND METHODS: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (GTSC) with neobladder between 1997 and 2002 were retrospectively reviewed. Our surgical technique is also described. Radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. An orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. RESULTS: Operating time ranged from 4.5 to six hours with a mean of 5.3 hours. Ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. Seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. One patient died of metastases and another of pelvic recurrence. There were no urethral recurrences. Patient satisfaction with the procedure was high. CONCLUSIONS: Gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. Our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.

Clinico-Radiological Spectrum of Neuronal Migrational Disorders: A Study of Paediatric Patients in the Western Region of Nepal.

Objective: This study was conducted in a tertiary care paediatric hospital to ascertain the spectrum of clinical and radiological features of Neuronal Migrational Disorders in children. The role of inheritance in Neuronal Migrational Disorders is under intense investigation. Studies on Neuronal Migrational Disorders (NMDs) in children from developing countries are lacking. Method: Retrospective analysis of records of diagnosed cases by neuroimaging as Neuronal Migrational Disorders in the Department of Paediatrics. Results: Eighteen Children (2days to 8years age) with different types of neuronal migrational disorder based on neuro-imaging were included. Observed anomalies included Lissencephaly (33.3%), Pachygyria (16.6%), Polymicrogyria (5.5%), Heterotopia (11.1%), Schizencephaly (22.2%) and Hemimegalencephaly (5.5%). Focal Seizure in 5 (27.7%) cases, Generalised Tonic Clonic Seizures in 3 (16.6%) and Myoclonic Seizure in 2 (11.1%) cases were the types of seizure present in 10 (55.5%) patients. Five patients presented with Quadriparesis, two with Hemiplegia and one with Congenital Talipes Equinovarus. All the eighteen patients had some degree of Cognitive Developmental Delay. Conclusion: Lissencephaly is the most common type of Neuronal Migrational Disorder followed by Schizencepahly. Focal Seizure and Quadriparesis were the common manifestations. Family history of similar cases with parental consanguinity in Schizencephaly cases gives a clue to the autosomal recessive mode of inheritance. Family history of similar cases of Schizencephaly without any history of consanguinity indicates an autosomal pattern of inheritance.

Synergistic antimicrobial activity of tea & antibiotics.

Tea leaves are known for its antibacterial activity against many microorganisms. In this study we attempted to describe the synergistic antimicrobial activity of tea and antibiotics against enteropathogens. Antimicrobial activity of boiled water tea extract and organic solvent extract were studied against Salmonella typhimurium 1402/84, S. typhi, S. typhi Ty2a, Shigella dysenteriae, Yersinia enterocolitica C770, and Escherichia coli (EPEC P2 1265) determining minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC) and death rate kinetics at MBC of tea extract in presence of subinhibitory concentration of antibiotic. Both green tea or black tea extracts effectively inhibited the growth of S. typhimurium 1402/84, S. typhi, S. typhi Ty2a, S. dysenteriae, Y. enterocolitica C770, and E.coli (EPEC P2 1265). However, the growth inhibitory concentration of tea extract was lower for green tea as compared to black tea extract. Antimicrobial activity of green tea tea methanol: water extract tea was better as compared to boiled water tea extract of green tea. Based on death rate kinetics results, S.typhi Ty2a appeared to be highly sensitive and Y. enterocolitica C770 the most resistant. Chloramphenicol and tea extract in combination inhibited the growth of S.dysenteriae at 2.5 microg/ml chloramphenicol (MIC 5 microg/ml) and 5.094 mg/ml black tea extract (MIC 9.089 mg/ml). Tea extract showed synergistic activity with chloramphenicol and other antibiotics like gentamycin, methicillin and nalidixic acid against test strains.

Developmental study of thermotolerance and the heat shock response in Lucilia cuprina (Weidemann).

The ability to withstand thermal stress in a laboratory population of the blowfly Lucilia cuprina (measured as per cent adult survival following varying periods of exposure to elevated temperature up to a maximum of 48°C) was in the order pupa > larva > adult. Pre-exposure to a mild heat shock (37°C) induced tolerance to temperatures which were otherwise lethal. An analysis of heat shock-induced protein synthesis during development at similar elevated temperatures presented patterns corresponding to the above observations on thermotolerance. The induced level of synthesis of major heat shock proteins (viz., 79, 69, 28, 20 and 19 kDa) were greater in larval tissues than in most of the adult tissues except gonads. The response varied between young (2 days) and old (30 days) adults in a tissue-specific manner. In general, heat shock protein 69 kDa was most abundant in all the tissues studied. Control as well as heat shocked Malpighian tubules of adults uniquely showed two major [35S]methionine labelled bands corresponding to approximately 62 and 64 kDa. Immunoblots showed the 62 kDa protein to cross react with an antibody against Helioihis HSP60. Although the synthesis of the 62 kDa polypeptide was prominent only in Malpighian tubules of adult blowflies, nearly equal levels of this HSP60 family polypeptide were present in all tissues (control as well heat shocked) except the larval salivary glands.

Hydatid cyst of ovary--a case report.

A rare case of ovarian hydatid cyst has been reported here in a 30 years old lady. This lady had a pet dog for last 6 years.

Multiple traumatic bone cysts of jaws. Report of a case.

An unusual case of bilateral traumatic bone cyst occurring simultaneously in both jaws is being reported. The clinical features and treatment plan for these cysts have been discussed. It has been seen that exploration of such cystic cavity results in a rapid healing of the defect in a short span of time.

Restriction enzyme digestion of heterochromatin in Drosophila nasuta.

In situ digestion of metaphase and polytene chromosomes and of interphase nuclei in different cell types of Drosophila nasuta with restriction enzymes revealed that enzymes like AluI, EcoRI, HaeIII, Sau3a and SinI did not affect Giemsa-stainability of heterochromatin while that of euchromatin was significantly reduced; TaqI and SalI digested both heterochromatin and euchromatin in mitotic chromosomes. Digestion of genomic DNA with AluI, EcoRI, HaeIII, Sau3a and KpnI left a 23 kb DNA band undigested in agarose gels while with TaqI, no such undigested band was seen. The AluI resistant 23 kb DNA hybridized in situ specifically with the heterochromatic chromocentre. It appears that the digestibility of heterochromatin region in genome of Drosophila nasuta with the tested restriction enzymes is dependent on the availability of their recognition sites.