A study on the circulating genotypes of hepatitis C virus in a tertiary care hospital in Central Kerala

Background: Hepatitis C is an emerging infection in India, which is known to progresses to liver cirrhosis and hepatocellular carcinoma. The persistence of chronic HCV infection is due to the existence of various genotypes and its various subtypes. There are seven different genotypes of HCV. These genotypes vary in their severity to cause infections as well as their response to treatment. Aim: This study aims at identifying the predominant genotypes of HCV in a population of patients presenting in a tertiary care center in Central Kerala. Settings and Design: This study was conducted at a tertiary care hospital and medical college, located in Central Kerala in the Department of Microbiology from January 2014 to June 2015.The sample size was 600 and a high risk group of patients attending the gastroenterology department, deaddiction centre and health care workers were screened. Materials and Methods: Serum samples were subjected to EIA, either rapid card or ELISA. Serum samples that were positive for HCV antibodies were confirmed by PCR. Twenty seven samples were positive for HCV antibodies by ELISA/rapid card, out of which 16 were confirmed by PCR. These 16 samples were subjected to gene sequencing to identify the genotype. Results: The prevalent genotypes isolated in this study was genotype 1, 3 and 4. Genotype 1 and 3 was predominantly seen transmitted by blood transfusions and multiple hemodialysis. The variability in laboratory parameters like SGOT and SGPT and its ratio with each genotype was also evaluated. Conclusion: To conclude, the occurrence of genotype 4 at a similar level to genotype 1 shows diffusion of new genotype in Kerala.

Histology and ultrastructure of male reproductive system of the Indian Spiny lobster Panulirus homarus (Decapoda: Palinuridae) / Histología y ultraestructura del sistema reproductor masculino de la langosta espinosa de la India Panulirus homarus (Decapoda: Palinuridae)

The spiny lobster Panulirus homarus, distributed along the Southeast and Southwest coasts of India, is an important commercial species having mariculture potential. Despite its importance, the structural and ultrastructure features of male gonads from this species have received scarce attention. Hence this study was aimed to describe the male reproductive tract of the species, using standard histological and electron microscopy techniques. Gonads from 94 specimens of P. homarus ranging in carapace length 37mm-92mm from vizhinjam (Southwest coast of India.) were obtained and processed for the study (Histology-70 numbers & ultrastructure-24 numbers). The male reproductive system consists of paired testis and vas deferens located in the cephalothoracic region. Macroscopically, the reproductive tract was observed in lobsters >35mm carapace length. In immature testis, spermatogonia were seen which measured 6.9-13.8µm in diameter and in the mature testis primary (5.4-5.9µm) and secondary spermatocytes (2.8-3µm) and spermatids (2.2-2.4µm) were present. Each vas deferens consists of proximal and distal portions. The spermatophoric mass begins formation in the proximal vas deferens. In the distal vas deferens the spermatophoric mass containing the spermatozoa are arranged in packets towards the periphery by the gelatinous matrix produced by the typhlosole. Ultrastructurally, the spermatogonia have lamina, nucleus and mitochondria like bodies, the primary spermatocytes have nucleus, dense chromatin and vacuolated cytoplasm and the spermatids have mitochondria, endoplasmic reticulum and centrioles. The endoplasmic reticulum and the nuclear envelope in the spermatids form the acrosome. The radial arms with microtubules are formed in association with the dense endoplasmic reticulum, near the nucleus. The sperm has a spherical structure with the nucleus, lamellar region, spikes and acrosome. This is the first comprehensive report of the structure of the male gametes and spermatogenesis in P. homarus from Indian waters.Rev. Biol. Trop. 62 (2): 533-541. Epub 2014 June 01.

La langosta espinosa Panulirus homarus, distribuida a lo largo de las costas sudeste y sudoeste de la India, es una especie de importancia comercial con gran potencial para la mari-cultura. A pesar de su importancia, las características estructurales y ultraestructurales de las gónadas masculinas de esta especie han sido poco estudiadas. Debido a esto, el objetivo de este estudio fue describir el aparato reproductor masculino de dicha especie, utilizando técnicas convencionales de microscopía histológica y electrónica. Se procesaron 94 ejemplares de P. homarus de vizhinjam (costa suroeste de la India) (70 individuos para histología y 24 para ultraestructura), cuyos caparazones variaron de 37 mm a 92 mm de longitud. El sistema reproductor masculino de esta especie consistió en un par de testículos y un conducto deferente situados en la región céfalo-torácica. Macroscópicamente, el aparato reproductor se observó en langostas con una longitud de caparazón >35mm. En testículos inmaduros, la espermatogonia midió 6.9-13.8μm de diámetro y se encontró presente en los testículos maduros primarios (5.4-5.9μm), espermatocitos secundarios (2.8 a 3 μm) y espermátidas (2.2-2.4μm). Cada conducto deferente consistió de porciones proximales y distales. La formación de la masa espermatofórica comienza en los conductos deferentes proximales. En el conducto deferente distal espermatofórico, la masa que contiene los espermatozoides está dispuesta en paquetes hacia la periferia, en una matriz gelatinosa producida por el tiflosol. Ultraestructuralmente, las espermatogonias presentan una lámina, núcleo y mitocondrias, los espermatocitos primarios tienen núcleo, cromatina densa y citoplasma vacuolado, mientras que las espermátidas tienen mitocondrias, retículo endoplasmático y centríolos. En las espermátidas, el retículo endoplásmico y la envoltura nuclear forman el acrosoma. Los brazos radiales con microtúbulos se forman en asociación con el retículo endoplásmico denso, cerca del núcleo. El esperma presenta una estructura esférica con el núcleo, la región laminar, las espinas y el acrosoma. Este documento constituye el primer informe exhaustivo de la estructura de los gametos masculinos y espermatogénesis en P. homarus de la India.

Religious beliefs, coping skills and responsibility to family as factors protecting against deliberate self-harm

Background. Deliberate self-harm (DSH) ranges from behaviours aiming to communicate distress or relieve tension; but where suicide is not intended, to suicide. Not all individuals are prone to DSH, which suggests that there are factors that protect against it. Identifying these could play an important role in the management and prevention of DSH. Objectives. This study examined whether religious beliefs, coping skills and responsibility to family serve as factors protecting against DSH in Kota Kinabalu, Sabah, Malaysia. Method. A cross-sectional comparative study assessed DSH patients consecutively admitted or directly referred to Queen Elizabeth General Hospital and Hospital Mesra Bukit Padang during the period December 2006 - April 2007. DSH patients (N=42) were matched with controls (N=42) for gender, age, religion, race, occupation and marital status. The DSH and control groups were compared using psychosocial tests that assess coping skills, religious beliefs and responsibility to family. Results. There were significant differences in religious beliefs (p=0.01) and responsibility to family (p=0.03) between the DSH patients and the control group. There were also significant differences in coping skills, DSH patients tending to use emotion-orientated coping (p=0.01) as opposed to taskand avoidance-orientated coping. caution is required in generalising the results owing to limitations of the study. Further extensive research on religious and psychotherapeutic interventions and prospective studies on protective factors will be helpful

Hepatoprotective effects of taurine against mercury induced toxicity in rats.

An attempt has been made to study the influence of taurine on mercury intoxicated rats. The animals were treated with sublethal dose of mercuric chloride (2 mg/kg body wt.) for 30 days. During the mercury treatment, the level ofAspartate transaminase(AST), Alanine transaminase (ALT) and Alkaline phosphatase(ALP) in serum and lipid peroxidation (LPO) in liver tissue significantly increased whereas Glutathione (GSH), Glutathione peroxidase(GPx), Catalase (CAT) and Superoxide dismutase (SOD) were simultaneously decreased in the liver tissue. Present results indicate that the liver tissue was completely damaged, after mercury treatment. In another group of animals, taurine (5 mg/kg body wt.) was administrated for another 15 days. Taurine administration was observed to improve the liver function in mercury intoxicated animal as indicated by the decline in increased levels of AST, ALT and ALP in serum and LPO content in liver tissue. The decreased level of antioxidant system (GSH, GPx, CATand SOD) has been promoted Results suggested that taurine played a vital role in reducing the mercury toxicity in intoxicated animals.

Thrombolysis with percutaneous transluminal balloon angioplasty of a blocked modified Blalock-Taussig shunt.

Transcatheter balloon recanalization of occluded Blalock-Taussig shunts in the early post-operative period has been reported in the past but there are issues regarding the role of thrombolysis in this situation. We present our experience with such a procedure in an infant with blocked modified Blalock-Taussig shunt.

Cerebral perfusion pressure management of severe diffuse head injury: effect on brain compliance and intracranial pressure.

BACKGROUND: Cerebral perfusion pressure management (CPPM) is an accepted modality of treatment of severe diffuse head injury (SDHI). However, CPPM has the potential to cause transcapillary exudation in the presence of a disrupted blood brain barrier and can lead to further increase of intracranial pressure (ICP) and worsening of compliance. AIMS: This study attempts to evaluate the effect of both transient and prolonged changes in cerebral perfusion pressure (CPP) on ICP and cerebral compliance as measured by the Pressure Volume Index (PVI), and to correlate changes in PVI with outcome at 12 months using the Glasgow Outcome Score. SETTINGS AND DESIGN: Prospective study in a neurosurgical ICU. MATERIAL AND METHODS: Twenty-seven SDHI patients managed using standard protocol to maintain CPP above 70 mmHg. Mean arterial pressure (MAP), ICP and CPP were monitored every half-hour. Daily monitoring of the PVI and ICP was done before, and after the induced elevation of MAP using IV Dopamine infusion. The relationship between CPP, MAP, ICP, PVI and outcome was evaluated. STATISTICAL ANALYSIS USED: The paired and independent samples T-test, and the Pearson correlation coefficient. RESULTS: CPPM rarely leads to progressive rise in ICP. Maintaining CPP above 70mmHg does not influence ICP or PVI. Transient elevations in CPP above 70mmHg may produce a small rise in ICP. Trend of change in PVI influenced outcome despite similar ICP and CPP. CONCLUSION: Elevating the CPP above 70mmHg does not either reduce the ICP or worsen the compliance. Monitoring changes in compliance should form an integral part of CPPM.

Cerebral blood flow velocity changes under nitrous oxide halothane anesthesia in patients with frontotemporal gliomas: a comparison of the normal and abnormal cerebral hemispheres.

BACKGROUND: Regional differences in vascular response to anesthetic agents in brain areas with and without tumors have not been investigated till now. The existence of such differences may influence the regional distribution of cerebral blood flow under anesthesia. MATERIAL AND METHODS: In 8 patients with frontotemporal gliomas, middle cerebral artery blood flow velocity (VMCA), pulsatality index (PI) and resistance index (RI) were determined in the normal and pathological cerebral hemispheres before and after stable nitrous oxide-halothane anesthesia. RESULTS: During halothane anesthesia, there was an increase in VMCA both in the normal cerebral hemisphere (69 +/- 11 to 100 +/- 38 cm/s; P = 0.05) and the hemisphere with tumor (65 +/- 17 to 83 +/- 28 cm/s; P = 0.04). A significant decrease in the pulsatality index and the resistance index was also observed in both the hemispheres (P < 0.05). The percentage changes of VMCA, PI and RI in both the hemispheres after anesthesia were not significantly different. CONCLUSIONS: In patients with cerebral tumors, nitrous oxide-halothane anesthesia causes comparable changes of cerebral blood flow velocities in the hemisphere with tumor and the normal hemisphere.

Evaluation of nimodipine in the treatment of severe diffuse head injury: a double-blind placebo-controlled trial.

AIMS: The aim of this study was to establish whether nimodipine given orally soon after severe diffuse head injury for a period of three weeks improved outcome. MATERIAL AND METHODS: The present report analyzes the results of a prospective randomized double-blind placebo-controlled trial of nimodipine in 97 severe head injury patients (GCS Score < or =8) treated at the Department of Neurosurgery, NIMHANS, between January 1995 and June 1996. The patients were randomly assigned to two groups which were matched for age, sex, mode of injury, time interval from injury to admission, neurological status and CT scan findings. One group was given nimodipine 30 mg Q6H and the other group was given a placebo. The outcome of these patients at 6 months was evaluated using the Glasgow Outcome Score by and a psychologist. RESULTS: Results showed no significant difference in the functional and psychological outcome between the two groups, even in patients with subarachnoid hemorrhage. No adverse drug events were recorded. CONCLUSION: Oral nimodipine given for three weeks does not improve outcome in patients with severe diffuse head injury.

Outcome prediction model for severe diffuse brain injuries: development and evaluation.

BACKGROUND: Intensive care resources for the management of severe diffuse brain injury patients (SDBI) are limited. Their optimal use is possible only if we can predict at admission which patients are unlikely to improve. AIMS: To develop a simple and effective model to predict poor outcome in patients with SDBI in order to help guide initial therapy. MATERIAL AND METHODS: The prognostic factors and outcomes of 289 patients with severe diffuse brain injury (GCS 3-8) were analyzed retrospectively. The prognostic factors analyzed were age, mode of injury, GCS at admission, pupillary reaction, horizontal oculocephalic reflex, and CT scan findings. Outcome at 1 month was classified as unfavorable--death or persistent vegetative state, or favorable--improvement with or without some disability. A stepwise linear logistic regression analysis was used to identify the most important predictors of poor outcome. A prediction model (NIMHANS model-NM) was developed using these factors. NM and several currently available outcome prediction models were prospectively applied in a separate group of 26 patients with severe diffuse brain injury managed with a different protocol. RESULTS: The most important predictors of poor outcome were found to be the horizontal oculocephalic reflex, motor score of GCS, and midline shift on CT scan. NM was found to be more sensitive (75%) and specific (67%) than most other models in predicting unfavorable outcome. NM had high false pessimistic results (33%). CONCLUSION: Prediction models cannot be used to guide initial therapy.

Bacterial profile of sepsis in a neonatal unit in south India.

OBJECTIVE: To study the pattern of sepsis in a neonatal unit in south India and assess the influence of maternal factors on early onset sepsis (EOS). DESIGN: Prospective survey from 1995-1996. SETTING: Medical College Hospital. SUBJECTS: All inborn babies who had clinical signs of sepsis or were born to mothers with potential risk factors for infection were screened for sepsis. Neonatal septicemia was defined as a disease of infants who were younger than 1 month of age, were clinically ill, and had positive blood cultures. RESULTS: Among 13,367 live births in the study period, there were 131 episodes of neonatal septicemia among 125 newborn infants, 18 (14.4%) of whom died. Thirty (24%) had EOS (< or = 48 hours) and 95 (76%) had late onset sepsis (LOS) (> or = 48 hours). Sepsis occurred in 9.8 per 1000 livebirths and 4.4% of all nursery admissions. E. coli and E. fecalis were the predominant organisms causing EOS, while Klebsiella and E. fecalis were the predominant organisms in LOS. The mean gestational age (GA) and birth weight (BW) of babies with EOS was significantly higher than those with LOS. Maternal factors significantly associated with EOS were meconium staining of liquor and multiple vaginal examinations. CONCLUSIONS: The incidence of neonatal bacterial sepsis is 9.8 per 1000 livebirths. E. coli and Klebsiella were the most common organisms causing EOS and LOS, respectively. E. fecalis was also a major pathogen, both in EOS and LOS.

The prediction of serum IgG levels by scanning densitometry.

A novel approach has been described. In this method the serum IgG level can be predicted with a fair degree of accuracy by scanning densitometry and total serum protein values. This approach might be useful as a screening procedure for hypogammaglobulinemia.

Observations on the intra familial clustering of leprosy cases in Trivandrum City.

A survey in the Southern wards of Trivandrum City showed that 552 houses are harbouring 699 leprosy patients. 84.2% of the houses are having single cases and 15.8% with two or more cases. As the size of the household increases the average number of cases per house increases (r = 0.273 P less than .01) In some houses there are more leprosy patients than healthy persons showing significant clustering. Out of the total cases 9.87% are lepromatous 5.58% borderline and 84.55% neural type. The prevalence rate was lowest in less than 10 year age group and highest in 21-40 age group. The overall prevalence rate is almost equal in males and females.