Identifying high risk patients post myocardial infarction with reduced left ventricular function using loop recorders INSPIRE-ELR clinical study

Aims: Sudden cardiac death (SCD) continues to be a devastating complication amongst survivors of myocardial infarction (MI). Mortality is high in the initial months after MI. The aims of the INSPIRE-ELR study were to assess the proportion of patients with significant arrhythmias early after MI and the association with mortality during 12 months of follow-up. Methods: The study included 249 patients within 14 days after MI with left ventricular ejection fraction (LVEF) _x0001_35% at discharge in 11 hospitals in India. Patients received a wearable external loop recorder (ELR) 5 ± 3 days after MI to monitor arrhythmias for 7 days. Results: Patients were predominantly male (86%) with a mean age of 56 ± 12 years. In 82%, reperfusion had been done and all received standard of care cardiovascular medications at discharge. LVEF was 32.2 ± 3.9%, measured 5.1 ± 3.0 days after MI. Of the 233 patients who completed monitoring (7.1 ± 1.5 days), 81 (35%) experienced significant arrhythmias, including Ventricular Tachycardia/Fibrillation (VT/ VF): 10 (4.3%); frequent Premature Ventricular Contractions (PVCs): 65 (28%); Atrial Fibrillation (AF): 8 (3.4%); chronic atrial flutter: 4 (1.7%); 2nd or 3rd degree Atrioventricular (AV) block: 4 (1.7%); and symptomatic bradycardia: 8 (3.4%). In total, 26 patients died. Mortality was higher in patients with clinically significant arrhythmia (at 12 months: 23.6% vs 4.8% with 19 vs 7 deaths, hazard ratio (HR) ¼ 5.5, 95% confidence interval (CI) 2.3 to 13.0, p < 0.0001). Excluding 7 deaths during ELR monitoring, HR ¼ 4.5, p < 0.001. Conclusion: ELR applied in patients with acute MI and LV dysfunction at the time of discharge identifies patients with high mortality risk.

Development and validation of a Hindi language health-related quality of life questionnaire for melasma in Indian patients.

Background: Melasma, which is fairly common in Indians, causes signifi cant emotional and psychological impact. A Hindi instrument would be useful to assess the impact of melasma on the quality of life in Indian patients. Objective: To create a semantic equivalent of the original MELASQOL questionnaire in Hindi and validate it. Methods: A Hindi adaptation of the original MELASQOL (Hi-MELASQOL) was prepared using previously established guidelines. After pre-testing, the Hi-MELASQOL questionnaire was administered to 100 women with melasma visiting the out-patient registration counter of Safdarjung Hospital, Delhi. These women were also administered a Hindi equivalent of the Health Related Quality of Life (HRQOL) questionnaire. Melasma area severity index (MASI) of all the participants was calculated. Results: The mean MASI score was 20.0 ± 7.5 and Hi-MELASQOL score was 37.19 ± 18.15; both were highly, positively and signifi cantly correlated. Reliability analysis showed satisfactory results. Physical health, emotional well-being and social life were the most adversely affected life domains. Limitations: It was a single-center study and the number of patients studied could have been larger. Conclusion: Hi-MELASQOL is a reliable and validated tool to measure the quality of life in Indians with melasma.

Needle stick injuries among health care workers in a tertiary care hospital of India.

Background & objectives: Percutaneous injuries caused by needlesticks, pose a significant risk of occupational transmission of bloodborne pathogens. Their incidence is considerably higher than current estimates, and hence a low injury rate should not be interpreted as a non existent problem. The present study was carried out to determine the occurrence of NSI among various categories of health care workers (HCWs), and the causal factors, the circumstances under which these occur and to, explore the possibilities of measures to prevent these through improvements in knowledge, attitude and practice. Methods: The study group consisted of 428 HCWs of various categories of a tertiary care hospital in New Delhi, and was carried out with the help of an anonymous, self-reporting questionnaire structured specifically to identify predictive factors associated with NSIs. Results: The commonest clinical activity to cause the NSI was blood withdrawal (55%), followed by suturing (20.3%) and vaccination (11.7%). The practice of recapping needles after use was still prevalent among HCWs (66.3%). Some HCWs also revealed that they bent the needles before discarding (11.4%). It was alarming to note that only 40 per cent of the HCWs knew about the availability of PEP services in the hospital and 75 per cent of exposed nursing students did not seek PEP. Interpretation & conclusions: The present study showed a high occurrence of NSI in HCWs with a high rate of ignorance and apathy. These issues need to be addressed, through appropriate education and other interventional strategies by the hospital infection control committee.

Periodontal Disease and Coronary Heart Disease.

The epidemiological cohort randomized studies have demonstrated an association between periodontal disease and coronary heart disease. The study was conducted on 241 subjects with verified CHD from a Department of Cardiology and 50 subject without CHD from Govt. Dental College PGIMS, Rohtak. Information on diabetic states, smoking habits, alcohol consumption and lipid profile was obtained. Full month probing depth, clinical loss of attachment and bleeding on probing was performed.The CHD group had a significantly higher probing depth, clinical loss of attachment and bleeding on probing while lipid profile become opposite as compared to non-CHD group. Clinical loss of attachment increase with risk factors such as smoking, alcoholism, male,increasing age, triglycerides and HDL-C levels. The present study showed a positive association between periodontal disease&CHD in agreement with previous studies.

Epidemiology and genetics of dilated cardiomyopathy in the Indian context.

Background: Dilated cardiomyopathy (DCM) still remains to be a poorly understood and less analyzed group of cardiac-muscle disorders when compared to hypertrophic cardiomyopathy (HCM). Also, the vast clinical heterogeneity among the patients has rendered the small and isolated kindred studies less informative on the genetics and epidemiology of DCM. Aim of the study: The study aimed at understanding the epidemiology and genetics of DCMs in the Indian context. Materials and methods/ Statistical analysis: One hundred seven DCM patients and 105 healthy individuals were included in the study for epidemiological and genetic risk factor identification and to fit the possible mode of inheritance. Single's ascertainment methodology for segregation analysis and Penrose frequency estimates were followed to evaluate for the role of specific epidemiological factors in the disease etiology. Chi-square analysis was carried out to interpret the results statistically. Results and Conclusion: Our study suggests that epidemiological factors like gender, age at onset and vegetarian diet in conjunction with sarcomere gene mutations may play a role in the disease expression. Similarly, segregation analysis for the possible mode of inheritance showed a deviation from the autosomal dominant mode of inheritance, strengthening the underlying genetic heterogeneity of DCM.

A comparative study of low dose weekly paclitaxel versus cisplatin with concurrent radiation in the treatment of locally advanced head and neck cancers.

PURPOSE: The purpose of this study was to compare low dose weekly paclitaxel versus cisplatin with concurrent radiation in locally advanced head and neck cancers. MATERIALS AND METHODS: From August 2005 to July 2006, a total of 100 biopsy proven, locally advanced head and neck cancers were enrolled for the study. All the patients were stratified in two groups, study group A and control group B. Study group patients received injection Paclitaxel 20 mg/m 2 , I/V 1 hr infusion weekly for 6 weeks and control group patients received injection Cisplatin 30 mg/m 2 , I/V 2 hrs infusion weekly for 6 weeks. All patients received 66-70 Gy concurrent radiation at the rate of 2 Gy/day, 5 #/week, in 6-7 weeks by cobalt theratron phoenix - 80 teletherapy units. RESULT: Complete response achieved in 73% of patients in study group and 64% of patients in control group. There was no statistically significant difference observed between the study group and the control group (chi2 = 1.167, df = 1, level of significance 0.05). On 3-10 months of follow-up 59% of patients in the study group and 42% of patients in the control group are alive and disease free. Local toxicities including mucositis, dysphasia and skin reactions were more in the study group but tolerable. CONCLUSION: Efficacy of paclitaxel in low dose weekly schedule is comparable to cisplatin in locally advanced head and neck squamous cell carcinoma. Further analysis and follow-up are needed to evaluate if this benefit will translate into prolonged survival.

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.

Great auricular nerve involvement in leprosy: scope for misdiagnosis.

Three patients with neuritis of the great auricular nerve (GAN) have been reported. Two patients seen by physicians and an otolaryngologist had prominent and tender cord along the neck with facial edema and history of fainting attack in one, and erythema and hyperaesthesia of the ear in the other simulating vascular occlusion, which were confirmed to be leprosy in Type 1 reaction by the dermatologist. In the third, cold abscess in the nerve that had persisted after anti-leprosy treatment was mistaken as tuberculous cervical lymphadenitis by a surgeon since aspiration had revealed acid-fast bacilli. The probable reasons for misdiagnosis include rarity of involvement of the GAN and its proximity to main blood vessels, and the need for careful interpretation of laboratory results.

Depression in geriatric population in urban slums of Mumbai.

A community based study was conducted in an urban slum of Mumbai to assess the epidemiological factors associated with geriatric population and depression. A sample size of 196 was taken according to Lots quality technique, including all elderly above 60 years of age in the study area. Depressed elderly (using Geriatric Depression Scale) constituted 45.9% of the study population and was more in females (57.8%, p < 0.05). The significant variables associated with depression were poor socio-economic status, marital status, non-working or dependency and illiteracy (p < 0.05). Depressed elderly were more inclined towards substance abuse (58.13%), had disturbed sleep patterns (61.6%) and mostly suffered from acute/chronic illness (p < 0.05).

Oral ulcer as an unusual feature of visceral leishmaniasis in an AIDS patient.

Leishmaniasis, a globally prevalent parasitic disease, occurs in three forms, viz, visceral, cutaneous and mucocutaneous. It is transmitted by female Phlebotomus sandflies. Human immunodeficiency virus (HIV) infection is increasing worldwide and several reports indicate a rising trend of VL / HIV co-infection, modifying the traditional anthroponotic pattern of VL transmission. India is one of the countries having the largest burden of leishmaniasis; nevertheless, there are very few HIV / leishmania co-infection cases reported so far. We report a 35-year-old homemaker infected with the human immunodeficiency virus; she presented with an oral ulcer. The investigations carried out on her revealed that she was afflicted by visceral leishmaniasis and the oral ulceration was a part of the same. This is only the second such case from the Indian subcontinent and more significantly from a non-endemic area.

Detection of paracetamol in skin tissue by GC-MS: A case study.

A 13 year-old child suffered an anaphylactic reaction to a drug combination and died in the clinic. The Investigating Officer collected an assortment of drugs and injection vials from the clinic and forwarded them along with the injection site of the victim's skin and some viscera to the laboratory for examination. At the laboratory, the samples were subjected to chemical and chromatographic analysis. After extracting the drug from the biological samples, TLC was done using a new solvent system, which improved the separation of drug from the matrix. A gas chromatographic-mass spectrometric (GC-MS) method devised for the determination of paracetamol residue in skin tissues was done. This method allows for detection of residual drug in biological tissues by using single-ion monitoring, and confirmation by a full scan electron impact (El) mass spectrum. Paracetamol was extracted with ether/chloroform from the samples after acidic and basic extraction procedures, cleaned up and washed, followed by partition between chloroform. The cleaned up extract was injected into the GC-MS, and detection was done using single ion monitoring at m/z 109.

Multiple eccrine hidrocystomas: report of two cases treated unsuccessfully with atropine ointment.

Eccrine hidrocystomas are rare, benign, cystic lesions with a lining that resembles that of the eccrine sweat gland and may be solitary or multiple. Multiple eccrine hidrocystomas occur predominantly on the face as asymptomatic, skin-colored to bluish lesions associated with a chronic course and seasonal variability. Treatment of multiple lesions on the face is challenging. Efficacy with atropine ointment is variable. Botulinum toxin and pulsed dye laser are reported to be beneficial. Two cases of multiple eccrine hidrocystomas are reported who showed no response to 1% atropine ointment.

Hypoacusis in vitiligo.

BACKGROUND: Vitiligo affects melanocytes in the skin. Since melanocytes are present in other organs as well, it is plausible that they may be similarly affected. METHODS: A comparative study of audiological functions was carried out in 180 patients of vitiligo and 60 non-vitiligo controls in the age group of 5-40 years. RESULTS: In vitiligo patients sensorineural hypoacusis of mild degree was found in 18, moderate in 13 and mild conductive hypoacusis in 3. In controls sensorineural hypoacusis of mild degree was found in only 2 cases. CONCLUSION: The difference between the two groups was statistically significant. Vitiligo patients have a higher prevalence of sensorineural hypoacusis.

Histoid leprosy with ENL reaction.

A 23-year old man presented with firm cutaneous and subcutaneous nodules of histoid leprosy. Some of the nodules suppurated after multidrug therapy (MDT) and these nodules showed features of erythema nodosum leprosum (ENL) on histopathological examination. ENL is a rare phenomenon observed in histoid leprosy.

Interspecific hybridization in Brassica juncea and Brassica tournefortii through embryo rescue and their evaluation for biotic and abiotic stress tolerance.

Interspecific hybrids were obtained in an otherwise incompatible cross Brassica juncea x Brassica tournefortii through in vitro culture of hybrid embryos. The best response was observed from culture of embryos excised 20 days after pollination on MS medium supplemented with kinetin, alpha-naphthylacetic acid, gibberellic acid, glutamine and casein hydrolysate. One hybrid plant had many distinct or intermediate characters. It was tolerant to aphid attack, exhibited irregularities in meiotic events and was partially fertile. The F2 open pollinated and BC1 progenies showed a large diversity in their morphological traits and some promising plants with less aphid infection, drought tolerance and high yield were selected.

Epidemic dropsy: a study of cutaneous manifestations with histopathological correlation.

Clinical and histopathological features of epidemic dropsy were studied in 19 patients. Bilateral pitting pedal oedema, erythrocyanosis and tachycardia without fever were the predominant clinical features. Histology revealed deposition of hyaline material on the walls of dermal blood vessels.

Abdominal hernia following abdominal herpes zoster.

We report a case of abdominal hernia in TIO and 11 segments following herpes zoster at T11 segment.

Transgenic strategies for genetic improvement of Basmati rice.

Transgenic approach offers an attractive alternative to conventional techniques for the genetic improvement of Basmati rice because they enable the introduction of one or more genes into a leading cultivar without affecting its genetic background. During the last ten years, a rapid progress has been made towards the development of transformation methods in rice. Several transformation methods including Agrobacterium, biolistic, and DNA uptake by protoplasts, have been employed to produce transgenic rice. An array of useful genes is now available and many of these have already been transferred in rice to improve the resistance against biotic and abiotic stresses. In Basmati rice, a beginning has already been made regarding the development of tissue culture protocols, transformation methods and production of useful transgenic plants. The application and future prospects of transformation technology to engineer the resistance against insect pests (stem borer, leaf folder, brown plant hopper, gall midge), fungal diseases (blast, bakanae/foot, rot), bacterial diseases (bacterial leaf blight, sheath blight), abiotic stresses (salinity and drought) and improved nutritional quality (accumulation of provitamin A and essential amino acids in endosperm) in Basmati rice, have been addressed.