Awareness about harmful effects of cigarette smoking among adolescents in Shamirpet mandal, Hyderabad

Background: Tobacco smoking is habit which usually begins in the adolescent age. It is a risk factor for many non-communicable diseases and mortality can be prevented if smoking is quit.Methods: It is a cross sectional study.2 schools were randomly selected from urban and rural areas in field practice area of Mediciti Institute of Medical Sciences. A GYTS questionnaire is modified to local setting and administered to the students.Results: A total of 367 students were enrolled. The level of awareness regarding harmful effects of tobacco consumption was good. It was 98.85% in urban areas and 94.84% in rural areas.Conclusions: As adolescent is the age of habit forming identification of the problem and correcting it at early stage itself will be beneficial for individuals, family and society.

Management of patients with breast cancer: are we ready in India for sentinel lymph node biopsy?

Breast cancer is the commonest cancer among women worldwide. Surgery plays an important role in its management. Axillary lymph node dissection has been the standard of care for staging, prognostication and control of axillary disease for almost a century. However, this time-tested paradigm is shifting gradually in the western world, because of the increasing use of screening mammography resulting in the detection of a large proportion of node-negative early breast cancers and a significant incidence of axillary lymph node dissection-related arm morbidity. Minimally invasive and less morbid procedures such as sentinel lymph node biopsy are being used more commonly in the West. However, the western experience cannot be directly extrapolated to the Indian scenario because of the differences in patient profile, treatment standards and expertise available. There is a need to critically analyse these issues before the Indian medical community advocates sentinel lymph node biopsy as a routine procedure for managing patients with breast cancer.

Routine chest radiography after permanent pacemaker implantation: is it necessary?

BACKGROUND AND AIMS: Chest radiographs (CXRs) are performed routinely after permanent pacemaker implantation to identify pacemaker lead position and exclude pneumothorax. We assessed the clinical value and need for this procedure. DESIGN: Retrospective analysis of pacemaker data and CXRs following permanent pacemaker insertion between December 2002 and February 2004. MATERIALS AND METHODS: Post-procedural CXRs were available in 125/126 consecutive patients after either first endocardial pacemaker implantation or insertion of at least one new lead. Subclavian vein puncture was used for venous access in all cases. CXRs were examined to establish the incidence of pneumothorax and assess pacing lead positions. The clinical records were examined in all patients who had subsequent CXRs or a further pacemaker procedure to identify the indication for these and to establish whether CXR had influenced patient management. RESULTS: In total, 192 post-procedural CXRs were performed, either postero-anterior (PA) and/or lateral views. Ventricular and/or atrial pacing lead contour and electrode position was considered radiographically appropriate in 86% CXRs. Fourteen per cent of post-procedural radiographs were considered to have radiologically sub-optimal pacemaker lead positioning. None of the patients with these "abnormal" radiographs experienced subsequent pacemaker complications or had further radiographs recorded at a later date. Later repeat CXRs were performed in 16 patients (13%) but only 3 patients (2%) had pacing abnormalities as the primary indication. All three had satisfactory pacing lead position on initial post-implantation and later radiographs, but required further procedures for lead re-positioning. Iatrogenic pneumothorax occurred in one patient (incidence 0.8%) in our series. CXR confirmed the clinical diagnosis and allowed an assessment of size to guide treatment. CONCLUSION: Routine CXR after permanent pacemaker insertion is not necessary in uncomplicated cases with adequate pacing characteristics.

The first successful simultaneous pancreas-kidney transplant in India.

Insulin-dependent diabetes mellitus is associated with renal failure, diabetic retinopathy, neuropathy and vasculopathy. We report the first successful simultaneous pancreas-kidney transplant in India in a young diabetic with renal failure. The dual transplant has cured his diabetes and renal failure and has had a beneficial effect on his neuropathy, retinopathy and quality of life. Obstacles to dual transplant in India include a lack of suitable recipients and a cadaver donor programme that is still in its infancy.

Incidence of enteroadherence in diarrhoegenic Escherichia coli in infants in Delhi.

Fifty-six isolates of Escherichia coli including 40 isolates from diarrhoeic infants and 16 from non-diarrhoeic infants were investigated. Twenty-two of the diarrhoeic isolates were typable, the most common serogroup being 086 (33%). None of the non-diarrheic isolates are typable with EPEC antisera with enteropathogenes. Adherence tests with HEp-2 cell line revealed localized adherence in 23%, diffuse adherence in 14% and aggregative adherence in 5.7% of the 35 isolates tested. Aggregative adherence was not observed in any of the EPEC isolates. None of the isolates in the control group exhibited localized or aggregative adherence. However, 25% of these isolates showed diffuse adherence (DA) which was not significantly different from the incidence of DA (34%) in the test group (p > 0.05). The importance of serogrouping and studying adherence pattern of E. coli isolates in establishing their pathogenic potential is thus emphasized.

Needle stick injuries among medical students.

Questionnaires were distributed among 200 medical students regarding safety precautions observed while perfonning various invasive procedures during their clinical posting. Only 106 students responded with the completed questionnaire. The most common procedure performed by the students was drawing of blood, with an average frequency of 60.8 per month. Sixty-one per cent of the students reported being injured during the various procedures and only 3 5.5% of them used gloves. Resheathing the needle was responsible for causing injury to 69% of the students, which was significantly higher than injuries occurring while entry into the vein or withdrawing the needle (p<0.05).

Incidence of HTLV-I in high-risk population in Delhi.

Human infection due to HTLV-I occurs by transmission of infected T-cells via sexual intercourse, blood transfusion or breastfeeding. The present investigation was carried out to find the incidence of HTLV-I in high risk population and its relationship with syphilis and HIV infection. The study group comprised 124 antenatal cases, 9 patients attending Sexually Transmitted Disease (STD) clinics and 144 blood donors. Passive particle agglutination test was performed on all the test sera for anti HTLV-I antibodies. VDRL and Treponema pallidum haemagglutination tests were carried out on sera from antenatal and STD cases. Sera from blood donors were tested for HIV antibodies by ELISA and confirmed by Western Blot. Anti HTLV-I antibodies were found in 10.6% of the cases studied. There was no association between the presence of anti HTLV-I antibodies and syphilis in expectant mothers and STD cases. However, significant association was found between the former and HIV infection in blood donors.

A randomized double-blind controlled study of nimodipine in acute cerebral ischemic stroke.

A randomized placebo controlled double-blind clinical trial of nimodipine was conducted in 31 patients of acute cerebral infarction. Nimodipine was administered in dosage of 120 mg/day for 28 days. Treatment was begun within 48 hours of ischemic stroke. Diagnosis was confirmed by computed tomographic (CT) scan. Similar number of patients (control) received placebo. Neurological assessment was done at the time of entry into the trial, and after 4 weeks, by using Mathew's scale. After four weeks of treatment with nimodipine or placebo, Mathew's scale score improved significantly (< 0.001) in both groups, but difference in mean score between two groups was insignificant (> 0.05). However, significant difference (< 0.05) was noted in relative change in neurological deficit (mean X-value) of two groups. The nimodipine group had higher value in scores on Mathew's scale. No adverse reaction, was observed in either group. The study suggests a beneficial a effect of nimodipine in acute cerebral ischaemia.

Perioperative myocardial infarction in coronary artery disease patients and 'at-risk' for coronary artery disease patients undergoing non-cardiac surgery.

BACKGROUND: Perioperative myocardial infarction (POMI) carries a high mortality and occurs more commonly in patients with a history of coronary artery disease (CAD). However, there are also other patients undergoing surgery who are 'at risk' for CAD but who do not have a history of infarction or angina. We compared the incidence of POMI in these two groups. METHODS: In a prospective study of 69 men and 39 women over 30 years of age undergoing non-cardiac surgery under general or regional anaesthesia, 56 had definite CAD and 52 were 'at-risk' for CAD. All these patients were followed up with serial postoperative electrocardiography and CK-MB isoenzyme analysis for the diagnosis of POMI. RESULTS: The POMI rate was 32% in definite CAD patients and 15% in patients 'at-risk' for CAD. Mortality in patients with POMI was 17% in those with CAD and 13% in those 'at-risk' for CAD. Perioperative myocardial infarction was maximal in the first 24 hours following surgery (77%). All the POMIs were painless. Anaesthesia techniques--whether regional or general--did not influence the incidence of POMI (Chi-square, p > 0.05). The type of drugs used in the treatment of CAD such as beta-blockers, calcium channel blockers and antiplatelet agents did not cause any difference in the incidence of POMI (Chi-square, p > 0.05). Patients who had either an intraoperative hypertensive episode, tachycardia, arrhythmias or ST-segment changes had a higher incidence of POMI (Chi-square, p > 0.05). The incidence of POMI was not lower in patients undergoing transurethral resection of the prostate compared to patients undergoing other types of non-cardiac surgery (Chi-square, p > 0.05). CONCLUSION: POMI occurs in one-third of patients with a history of CAD and one-sixth of those 'at-risk'. It carries a mortality of 17% and 13% respectively. Decisions to operate on such patients should be taken with caution.

Platelet serotonin kinetics in acute myocardial infarction before and after thrombolysis.

Platelet count, platelet serotonin uptake and platelet serotonin content were analysed in 21 subjects consisting of 11 patients of evolving acute myocardial infarction (AMI) and 10 matched healthy controls before and after administration of streptokinase. Platelet counts were significantly reduced in AMI with a subsequent rise following thrombolysis. Platelet 5-HT uptake was also significantly increased in AMI and following thrombolysis, it showed a trend towards normalization. Platelet 5-HT content was significantly increased in AMI with no further significant change following thrombolysis. The results suggest that platelet activation as revealed by reduced platelet count and altered platelet serotonin kinetics, occurs in AMI and this activation is inhibited following thrombolysis. Further, it is also apparent that it is not the reperfusion but the thrombolytic agent that is responsible for inhibition of platelet activation.

Eales' disease with progressive spastic paraparesis.

Eales disease is a disease of unknown aetiology characterised by ophthalmic changes and often neurological involvement as in multiple sclerosis. We are reporting a case of Eales' disease in a 27 yr old male with chronic progressive non compressive motor myelopathy.

Platelet aggregation in migraine.

This study was conducted on forty male patients aged 17-35 years, suffering from migraine. Platelet aggregation was evaluated in them twice, once in the aura and headache phase of migraine and the other during the period in which patient was asymptomatic. We observed significant increase in platelet aggregation during the aura and headache phase of the migrainous attack in comparison to the headache-free interval. Platelet hyperaggregability may be an important factor in the pathogenesis of migraine.

Platelet norepinephrine efflux in thrombotic stroke.

Twenty CT proven patients of thrombotic stroke who were non-diabetic, non-hypertensive and non-hyperlipidemic were evaluated in acute phase (within 7 days of onset of neurological deficit) for platelet count and spontaneous platelet norepinephrine (NE) efflux, measured as the fraction (of initial total content) of 3H-NE released from platelets in 30 and 60 min. NE efflux was significantly greater (P less than 0.001) in stroke patients (34.09 +/- 4.92% at 30 min and 50.45 +/- 7.1% at 60 min) as compared to controls (23.27 +/- 4.16% at 30 min and 39.49 +/- 3.27% at 60 min). This excessive efflux may result in increased concentrations of NE in local plasma, which by causing enhanced platelet aggregation and damage to vascular endothelium and vasospasm, may contribute towards the development and progression of cerebral thrombosis.

Age related toxic effects of endosulfan on certain enzymes of rat erythrocytes.

The effect of oral administration of endosulfan (12.5 mg/kg body weight), daily for 4 days was investigated on erythrocytes of female rats of 4 different age groups i.e. 15, 30, 70 and 365 days old. Erythrocyte membrane Na+, K(+)-ATPase and Mg2(+)-ATPase activities were significantly inhibited in all the age groups of rats. However, percent inhibition was maximum in the youngest animals. A significant decrease in the activity of erythrocyte glutathione reductase was observed in 30 and 70 days old rats whereas a significant increase in the activity of glucose-6-phosphate dehydrogenase (G-6-PD) was observed in these groups. The increase in G-6-PD activity may be a physiological response to compensate for decrease in the reduced glutathione level which results from decrease in the activity of glutathione reductase.