Poor Functional Outcome in Patients with Voluntary Knee Instability after Anterior Cruciate Ligament Reconstruction

Background@#Anterior cruciate ligament reconstruction (ACLR) remains the gold standard treatment for anterior cruciate ligament (ACL) injury. However, a good functional outcome even after a successful surgery depends on multiple factors. It has been observed that certain patients with a chronic ACL injury demonstrate knee instability voluntarily. The authors observed that these patients might not perform well even after a successful surgery. This study aims to assess the outcome after ACL and other ligament reconstruction in patients with voluntary knee instability. @*Methods@#From a total of 824 patients who underwent ACLR, 13 patients with a history of voluntary knee instability were selected, and data of these patients (demographic and clinical profile) were obtained. Outcomes of surgery in this group of patients were evaluated by using Lysholm score and Tegner activity level. @*Results@#All patients were young men with a chronic ACL injury and manifested instability. Associated injuries were lateral meniscus tear in 3 patients, medial meniscus tear in 2, and posterolateral corner (PLC) injury in 3. ACLR was done using the semitendinosus-gracilis graft in all patients. Further, anterolateral ligament reconstruction was done in 2 patients and PLC reconstruction, in 3 patients. The mean Lysholm score was 54.76 (range, 48–62) preoperatively and 60.92 (range, 54–78) at a mean follow-up of 14.3 months (range, 11–26 months). The median Tegner activity level was 6 (range, 5–7) before injury and 4 (range, 3–5) at the final follow-up. Twelve of the 13 patients were able to demonstrate instability voluntarily at the time of the final follow-up. @*Conclusions@#In patients with ACL and other ligament injuries who demonstrated voluntary knee instability, the functional outcome even after successful ligament reconstruction was poor.

Incidence of HIV infection in eastern Uttar Pradesh: HIV counseling and testing services record based retrospective study

Background: India has approximately 2.4 million of people living with HIV and out of these two thirds live in rural areas. This study may yield significant data to understand epidemiology of HIV/AIDS in this region that would help in designing techniques for effective implementation to prevent this infection.Methods: The present study was a comprehensive retrospective hospital-based investigation of the HIV infection in eastern Uttar Pradesh, India based on a large number of clinical samples at HCTS centre, representing different geographic regions and has been functional since 2002, conducting HIV tests, counselling of patients as well as maintains proper records.Results: A total of 444 HIV positive clients were registered in this retrospective study. The male and female ratio among all positive clients was 1.67:1 and the most common age group for both the genders was 35-49 years. Among 444 HIV positive clients, HIV-TB co-infection found in 72 (16.21%) cases. Out of 444 clients, 177 (40%) and 167 (38%) found extremely immunocompromised with low CD4 cells count in range between of 0-100 cells/mm3 and >100-350 cells/mm3 respectively. Mortality was seen in 72 (16%) out of 444 HIV positive clients.Conclusions: There is an urgent need of information, education about this disease and by providing suitable occupation or to make them aware, which will markedly help in preventing the spread of HIV pandemic in this geographical region.

Pulmonary function test in patients of type 2 diabetes mellitus

Background: We are today witnessing a pandemic of diabetes mellitus (DM), globally and nationally. DM and its complications have become the most important contemporary and challenging health problems. Diabetes is not associated with any specific pulmonary symptom and hence periodic screening for lung disease is not done in diabetic patients. However, an extensive microvascular circulation and an abundant connective tissue in the lung raise the possibility that the lung may also be a target organ in diabetic patients. The aim and objectives were to study the pulmonary function of individual with type 2 diabetes mellitus patients by performing spirometry.Methods: Study included non-smoker diabetic patients, who had no history of respiratory disease, were selected for this study and undergone pulmonary function test by spirometry. The study was conducted at department of General Medicine Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India.Results: Present study, author found that there was significant derangement in the spirometric readings in the diabetic patients. The FEV1/FVC values further declines as the duration of diabetes increased.Conclusions: Spirometric values (FVC, FEV1, FEV1/FVC) were consistently lower in subjects with type 2 diabetes mellitus. The effect on FVC predicted % was found to be more pronounced in subjects whose duration of DM was more than 5 years.

Study Of Suicidality And Suicide Behavior Among Individuals With Long-Standing Duration Of Schizophrenia In India: An Explorative Study

Suicide is a common occurrence in schizophrenia and is seen in all phases of the illness. Early identification of patients who are more likely to attempt suicide may help in suicide prevention among patients with schizophrenia. The present study was aimed at determining the clinical differences and differences in demographic and risk factors in patients with schizophrenia that attempt suicide and those that do not. Methods: A total of 200 consecutive follow-up patients having schizophrenia were assessed clinically for variables related to suicide and suicidal behaviour in the outpatient department of a tertiary psychiatry centre. All patients were administered the Positive and Negative Symptom Scale (PANSS) for schizophrenia to assess clinical symptoms and severity while the Clinical Global Impression – Severity (CGI-S) scale was also used. Results: Out of the 200 patients studied, 38% (n = 76) patients had made one severe suicide attempt by excluding parasuicide or deliberate self-harm at least once, and 9.5% (n = 19) had attempted suicide more than three times. More patients with a suicide attempt showed good clinical outcome (CGI ≥ 3) (42.1% versus 33.0%, χ 2 = 1.040, p = 0.301). The patients who attempted suicide were predominantly male, with a mean age of 34.2 years. Lesser number of them was single (32.89% vs. 43.5%, χ 2 = 1.814, p = 0.178). Their duration of illness was shorter (9.6 years versus 11.4 years, t = 2.8841, p = 0.0043) and more patients with attempted suicide had higher scores on negative symptoms scales of PANSS (t=2.1122, p = 0.035) at the time of assessment. Conclusions: The findings in our research warrant the need studying suicide in schizophrenia in larger samples and to replicate our findings and also determine methods to reduce the incidence of suicide in schizophrenia via interventional programmes. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Electroencephalographic Abnormality And Clinical Response In Patients With First - Episode Schizophrenia Treated With Clozapine

Objective: Clozapine is seen as a gold standard for treatment refractory schizophrenia; however, it is not recommended for the treatment of first-episode psychosis mainly due to concerns of severe side effects. An indicator for response holds tremendous clinical value to select patients who can benefit from clozapine, safely. EEG abnormality has been reported to be one such parameter, yet the definite conclusion of the nature of EEG changes and its predictive value remains undetermined. The present study was undertaken to examine electroencephalographic (EEG) abnormalities and clinical response subsequent to clozapine therapy in schizophrenia. Methods: A total of 80 first-episode patients were recruited for a 12 week study, from a tertiary care centre in Mumbai, India. First episode was defined as an illness of less than 2 years duration and first hospitalization since illness. EEG abnormalities, psychopathology, and positive and negative symptoms were examined at baseline and again after 12 weeks of clozapine treatment. Results: There were some types of EEG abnormalities found in pretreatment state in at least two-thirds of patients. The number of patients showing EEG abnormality at the end of the 12 weeks of treatment increased significantly, which included theta (θ) frequency, slow waves, and sharp waves. Symptomatically, significant improvement was seen in both positive as well as negative symptoms scores. However, there was no significant correlation between EEG changes and clinical outcome. Conclusion: There was significant abnormality in the number of patients exhibiting EEG abnormalities. Baseline pretreatment EEG abnormalities were present in a considerable number of patients, and these EEG abnormalities did not significantly correlate with clinical improvement, except suggesting a trend towards such correlation.

Wound healing potential of flowers extracts of Woodfordia fruticosa Kurz.

Wound healing or repair is the body’s natural process of regenerating dermal and epidermal tissue. Woodfordia fruticosa Kurz (Family: Lythraceae) is used traditionally in wound healing by the tribals of Chhattisgarh district. However, there is a paucity of scientific data in support. In this study, we evaluated antimicrobial activity of petroleum ether, chloroform, ethanolic and aqueous extracts against a diverse range of gram +ve and gram -ve bacteria along with pathogenic fungi. The wound healing activity of ethanolic extract was also evaluated at dose levels of 250 and 500 mg/kg body wt in rats by excision, incision and dead space wound healing models along with histopathology of wound area of skin. The ethanolic extract showed potent wound healing activity, as evident from the increase in the wound contraction and breaking strength in dose-dependent manner. Treatment with ethanolic extract (250 and 500 mg/kg body wt) showed significant dose-dependently decrease in epithelization period and scar area. Hydroxyproline, hexuronic acid and hexosamine contents, the important constituents of extracellular matrix of healing were also correlated with the observed healing pattern. During early wound healing phase, pro-inflammatory cytokines TNF-α, IL-6 and anti-inflammatory cytokine IL-10 levels were found to be upregulated by the ethanolic extract treatment. The ethanolic extract exhibited a strong and broad spectrum antimicrobial activity, as compared to other extracts. It showed very low Minimum inhibitory concentration (MIC) values and inhibited the growth of E. coli, Staphylococcus aureus and Candida albicans in concentration of 2.5 µg/disc. Thus, the results of the present study demonstrated the strong wound healing potential and antimicrobial activities of W. fruticosa, flowers, supporting the folklore use of the plant by the tribal people of Chhattisgarh district.

Evaluation of GenoType® MTBDRplus assay for rapid detection of drug susceptibility testing of multi-drug resistance tuberculosis in Northern India.

Background: The problem of multi-drug resistance tuberculosis (MDR-TB) is growing in several hotspots throughout the world. Rapid and accurate diagnosis of MDR-TB is crucial to facilitate early treatment and to reduce its spread in the community. The aim of the present study was to evaluate the new, novel GenoType® MTBDRplus assay for rapid detection of drug susceptibility testing (DST) of MDR-TB cases in Northern India. Materials and Methods: A total of 550 specimens were collected from highly suspected drug resistant from pulmonary and extra-pulmonary TB cases. All the specimens were processed by Ziehl- Neelsen staining, culture, differentiation by the GenoType® CM assay, fi rst line DST using BacT/ALERT 3D system and GenoType® MTBDRplus assay. The concordance of the GenoType® MTBDRplus assay was calculated in comparison with conventional DST results. Results: Overall the sensitivity for detection of rifampicin, isoniazid and MDR-TB resistance by GenoType® MTBDRplus assay was 98.0%, 98.4% and 98.2% respectively. Out of 55 MDR-TB strains, 45 (81.8%), 52 (94.5%) and 17 (30.9%) strains showed mutation in rpoB, katG and inhA genes respectively (P < 0.05). The most prominent mutations in rpoB, katG and inhA genes were; 37 (67.3%) in S531L, 52 (94.5%) in S315T1 and 11 (20%) in C15T regions respectively (P < 0.05). Conclusions: Our study demonstrated a high concordance between the GenoType® MTBDRplus assay resistance patterns and those were observed by conventional DST with good sensitivity, specifi city with short turnaround times and to control new cases of MDR-TB in countries with a high prevalence of MDR-TB.

Pharmacological evaluation of hyperin for antihyperglycemic activity and effect on lipid profile in diabetic rats.

Antihyperglycemic potential of hyperin at 25 and 50 mg/kg doses for 30 days to streptozotocin induced diabetic rats has been reported. In oral glucose tolerance test, hyperin treated rats showed a significant reduction in blood glucose level after 120 min. It was found that hyperin exhibited dose dependent and significant antihyperglycemic activity in streptozotocin induced diabetic rats which were nearly similar with standard drug glybenclamide. Activities of glucose-6-phosphatase, fructose-1,6-bisphosphatase, glycogen phosphorylase, glycosylated haemoglobin and level of serum urea and creatinine were significantly decreased in hyperin supplemented diabetic rats, dose dependently. Activities of hexokinase and glycogen synthase were increased with augmentation in liver glycogen, insulin and haemoglobin content in hyperin treated diabetic rats. General hematological parameters did not show any significant change in hyperin treated diabetic rats hence it is safe at these doses. Histopathological studies showed significant morphological changes in pancreatic β-cells of streptozotocin induced diabetic rats. A decreased number of secretory granules of β- cells were observed in diabetic rats and these pathological abnormalities were normalized after treatment with hyperin and standard drug glybenclamide. Further, hyperin decreases significant in serum total cholesterol, triglyceride, low density lipoprotein, very low density lipoprotein levels coupled with elevation of high density lipoprotein in diabetic rats. These results suggest that hyperin has a pivotal role in blood glucose level in streptozotocin induced hyperglycemia by improving the function of pancreatic islets and increasing glycolysis and decreasing gluconeogenesis.

Antihyperglycemic activity of Woodfordia fruticosa (Kurz) flowers extracts in glucose metabolism and lipid peroxidation in streptozotocin-induced diabetic rats.

The ethanolic extract of W. fruticosa flowers (250 and 500 mg/kg) significantly reduced fasting blood glucose level and increased insulin level after 21 days treatment in streptozotocin diabetic rats. The extract also increased catalase, superoxide dismutase, glutathione reductase, glutathione peroxidase activities significantly and reduced lipid peroxidation. Glycolytic enzymes showed a significant increase in their levels while a significant decrease was observed in the levels of the gluconeogenic enzymes in ethanolic extract treated diabetic rats. The extract has a favourable effect on the histopathological changes of the pancreatic β- cells in streptozotocin induced diabetic rats. The results suggest that W. fruticosa possess potential antihyperglycemic effect by regulating glucose homeostasis and antioxidant efficacy in streptozotocin-induced diabetic rats.

Antihyperglycemic activity, antihyperlipedemic activity, haematological effects and histopathological analysis of Sapindus mukorossi Gaerten fruits in streptozotocin induced diabetic rats

OBJECTIVE@#To investigate the antihyperglycemic and antihyperlipidemic properties of hydroalcoholic extract of fruits of Sapindus mukorossi Gaerten and its beneficial effect on haematological parameters with histopathological analysis in streptozotocin induced diabetic rats.@*METHODS@#Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and standard drug glybenclamide (0.5 mg/kg body weight) were administered to diabetic rats. Effect of extract on hyperglycemia, hyperlipidemia and hematological parameters was studied in diabetic rats. Histopathological changes in diabetic rat pancreas were also observed after extract and glybenclamide treatment.@*RESULTS@#Daily oral administration of Sapindus mukorossi fruits extract (250 and 500 mg/kg body weight) and glybenclamide for 20 days showed beneficial effects on blood glucose level (P<0.01) and lipid level. The extract has a favorable effect on the histopathological changes of the pancreas in streptozotocin induced diabetes.@*CONCLUSION@#These findings reveal that the hydroalcoholic extract of Sapindus mukorossi fruits extract possesses antihyperglycemic and antihyperlipidemic properties. In addition, the extract can prevent various complications of diabetes and improve some haematological parameters.

Antihyperglycemic and antihyperlipidemic activity of ethyl acetate fraction of Rhododendron arboreum Smith flowers in streptozotocin induced diabetic rats and its role in regulating carbohydrate metabolism

<p><b>OBJECTIVE</b>To explore and identify the most potent antihyperglycemic fraction from the ethanol extract of Rhododendron arboreum (R. arboreum) flowers.</p><p><b>METHODS</b>Normal and streptozotocin induced diabetic rats were treated with all four fractions of R. arboreum flowers for short term and with fraction 3 for long term study. On completion of the treatment, a range of indicators were tested including fasting blood glucose, plasma protein, haemoglobin A1C, insulin secretion, body weight, blood lipid profile and carbohydrate metabolism regulating enzymes of liver.</p><p><b>RESULTS</b>In short term study, the fraction 3 (Active fraction) produced a significant (P<0.000 1) reduction (73.6%) in blood glucose level at a dose of 200 mg/kg after the treatment in the diabetic rats. Administration of active fraction (200 and 400 mg/kg) once daily for 30 d in streptozotocin diabetic rats resulted in a significant (P<0.001 to P<0.000 1) fall in blood glucose level, hemoglobin A1C, serum urea and creatinine with significant but a increase in insulin level similar to standard drug glybenclamide. Further, the active fraction showed antihyperlipidemic activity as evidenced by significant (P<0.001 to P<0.000 1) decreases in serum serum total cholesterol, triglycerides, low density lipoprotein cholesterol and very low density cholesterol levels coupled together with elevation of high density lipoprotein cholesterol in the diabetic rats.</p><p><b>CONCLUSIONS</b>The active fraction of R. arboreum flowers decreases streptozotocin induced hyperglycemia by promoting insulin secretion and glycolysis and by decreasing gluconeogenesis.</p>

A study of ventricular asynchrony in patients with varying QRS duration and its correlation with left ventricular function.

BACKGROUND: Biventricular pacing (cardiac resynchronization therapy) has been shown to improve patients of dilated cardiomyopathy (DCMP), which include largely those with broad QRS complex (LBBB) and a few with normal QRS duration having associated interventricular and/or intraventricular delay. The true prevalence of ventricular asynchrony in a broad subset of patients of DCMP however has not been studied at large and it is unclear if there is association of asynchrony with the LV function. The present study was therefore conducted to assess the prevalence of ventricular asynchrony in a broad set of patients of dilated cardiomyopathy with varying QRS duration and also trying to correlate the same with the LV function. METHOD AND RESULTS: Ninety three consecutive patients of DCMP (EF < 40%) with varying QRS duration and twenty patients with broad QRS complexes (LBBB morphology) with normal LV function (LVEF > 40%) were studied. The patients were then grouped as Group-I, including patients of DCMP with broad QRS (>120 msec, LBBB morphology) (n = 40), Group-II, including patients of DCMP with narrow QRS, (QRS width < or = 120 msec) (n = 53) and Group-III, including patients of LBBB with normal LV function (n = 20). Ventricular asynchrony was diagnosed using standard echocardiography criteria on 2-D, M-mode and pulse wave Doppler including, 1) Interventricular delay:- diagnosed when the difference between aortic (Q-AV) and pulmonary ejection delays (Q-PV) was 340 msec and 2) Intraventricular delay:- diagnosed when posterior left ventricular activation occurred later than onset of diastolic mitral inflow or septal to post wall motion delay of > or = 130 msec. Ventricular asynchrony was present in 97.5% (39/40) in Group-I, 50.9% (27/53) in Group-II and 90% (18/20) in Group-III. Amongst this however interventricular conduction delay was present in 97.5% (39/40) of group-I, 20.7% (11/53) of group-II and 90% )18/20) of group-III, while intraventricular delay was present in 62.5% (25/40) of Group-I, 43.3% (23/53) of Group-II and none of Group-III. Analyzing the contribution of LV dysfunction independent of QRS duration to the occurrence of LV dyssynchrony, patients were further divided in three groups, viz. DCM with LVEF < 20% (group A) (mean LVEF = 16.53 +/- 2.28%), DCM with LVEF > or = 20% (group-B) (mean LVEF = 27.15 +/- 4.29%) and LBBB with normal LV function (group C) (mean LVEF = 53.45 +/- 4.83%). The mean QRS durations were not different between groups A and B (114.3 +/- 32.2 msec vs. 109.1 +/- 13.9 msec, respectively, p = 0.16). However group A had a significantly higher number of patients with ventricular asynchrony compared to group B [37/45 (82.2%) vs. 29/48 (60.4%), p = 0.001)]. CONCLUSION: We conclude that there is a wide prevalence of, but heterogeneity in occurrence of ventricular asynchrony among patients of dilated cardiomyopathy. The asynchrony possibly relates more to left ventricular function in addition rather than to the QRS duration alone. Criteria for biventricular pacing probably need to relate to ventricular asynchrony than to the QRS duration alone.

Anti-inflammatory and antinociceptive activity of stem juice powder of Tinospora cordifolia Miers in experimental animals

The stem juice powder of Tinospora cordifolia Miers. [Menispermaceae, TIP] was studied for the possible activity of anti-inflammatory and antinociceptive to rationalize the folkloric use of the plant juice as rasayana. TIP at the dose of 50-200 mg/kg caused a significant and dose dependent inhibition of swelling caused by the X carrageenin [1%] and histamine [10-3 g/ ml, 0.1 ml] induced paw edema in rats. The effect was comparable to the standard cycloxygenase inhibitor Ibuprofen 100 mg/kg and percent protection was 18.43% and 18.12% respectively. Administration of TJP [50-200 mg/kg] on analgesy-meter induced mechanical pain exhibited a moderate and dose dependent increase in the pain threshold. However TJP significantly prevented the pain reaction in acetic acid [0.6%] induced writhing in mice and the degree of percent inhibition was 16.98%-35.47%, which is equivalent to 36.67% produced by ibuprofen. These data indicate that the stem juice powder of Tinospora cordifolia rationalizes the traditional system of medicine