Role of visual evoked potential as a window to detect functional changes that occur without signs of diabetic retinopathy in fundoscopy: Case series involving symptomatic overt diabetic pregnant women

Diabetic retinopathy (DR) is a microvascular complication associated with diabetes mellitus. Pregnancy is a major risk factor for DR in diabetic women. Recent evidenced suggests that in course of DR functional changes including damage of pre-ganglionic and ganglionic cells in retina precede structural microvascular changes. A number of studies in the past have highlighted the role of pattern visual evoked potential (VEP) in detecting such functional changes. However, the study of VEP changes in diabetic pregnancies remains unexplored. This case series has the objective of exploring VEP changes in symptomatic OVD cases, who had no signs of DR on fundoscopy. We present two cases of overt diabetic women who complaint of straining of eyes, headache, and difficulty in reading during pregnancy. Complete ophthalmic examination was done in both the cases followed by a VEP test. VEP test was done as a part of a research project. The ethical clearance for the project was obtained from the Institute’s Ethics Committee before the commencement of the study. Fundoscopic examination in both cases revealed that the retina was within normal limits with no signs of retinopathy. In Case 1, P100 latency was increased for the left eye and was normal for the right eye during the first visit. While P100 latency was increased for both left and right eye during the second visit. There was a substantial increase in P100 latency for both eyes in second visit as compared to first visit. In Case 2, P100 latency was increased for both left and right eye and amplitude decreased for the left eye. This is a case series consisting of symptomatic overt diabetic pregnant women who had increased P100 latency despite no signs of retinopathy in fundoscopy. The previous studies have reported that multiple follow-ups with ophthalmoscopy may not be cost-effective in diabetic pregnant women. VEP provides a window for detection of early functional changes that may help identify at risk patients for follow-up and early intervention.

Behavioural and histopathological effects of azodye on kidney and gills of Labeo rohita fingerlings.

The present paper emphasizes on the histopathological effects of an azo dye, Direct Green 6 on the kidney and gills of Labeo rohita by light microscopy. Fingerlings were exposed to sublethal concentrations (2.5, 5.0 and 10.0 ppm) of dye for 5, 10 and 15 days to study histopathological changes. No histopathological changes were seen in the kidney and gills of control fingerlings. Unlike control fingerlings, both the target organs showed some histopathological changes. Fingerlings exposed to 2.5 ppm concentration of the dye showed shrinkage of glomerulus, increased peritubular space, decreased lumen while 5.0 ppm produced haemorrhage in the interstitial tissue and mild degeneration in the kidney. Necrosis in the tubular epithelium, distruction of cell membrane and loss of cellular cytoplasm were observed in kidney of fingerlings exposed to 10 ppm dye concentration. Gills of fingerlings exposed to 2.5 ppm of dye showed aneurism and mild degenerated central axis. 5 ppm of dye concentration produced remarkable changes like epithelial lifting, hyperplasia, enlarged and vacuolated cartilage cells. Haemorrhagic tip, fusion and curling of secondary gill lamellae and at some places complete removal of them were also observed in gills of fingerlings exposed to 10 ppm.

A review of the HIV-infected homeless sub-population at the Centre for HIV/AIDS Research, Education and Services, Department of Medicine, University Hospital of the West Indies / Una revisión de la subpoblación sin hogar de infectados por el VIH en el Centro para la Investigación, Educación y Servicios del VIH/SIDA, del Departamento de Medicina del Hospital Universitario de West Indies

OBJECTIVE: The twin epidemics of HIV and homelessness present several challenging aspects to the development of programmes for the provision of treatment and care. This paper describes the characteristics of this population being managed by a collaborative effort between the Centre for HIV/AIDS Research, Education and Services, Department of Medicine, University Hospital of the West Indies and the National Council on Drug Abuse. SUBJECTS AND METHODS: A retrospective descriptive study was conducted via review of patients'medical files. Demographic and clinical data of the HIV-infected homeless population were summarized, highlighting issues related to the provision of care, rates of antiretroviral therapy (ART) uptake and subsequent adherence to treatment and known factors associated with HIV transmission. RESULTS: A total of 12 cases were included in the analysis. There was an average age of 38.0 years (IQR 32.5-49.25) with the majority being female, nine (75.0%). Late stage diagnosis was a common feature. The majority of cases were eligible for ART on first contact, with CD4 counts on average being 284.4 (95% CI 10.9.0, 459.8). Significant risk factors for HIV transmission were also identified as all cases reported being sexual active with limited condom use reported and high reported numbers of lifetime partners, 30 (IQR 25.0-100.0). Other factors identified include eight (66.6%) cases reporting sexually transmitted infection (STI) symptoms, 10 (83.3%) reporting substance abuse and nine (75.0%) reporting sex work. CONCLUSION: The implementation of combination interventions providing a comprehensive package of services that address the multitude of issues facing the HIV-infected homeless population is required in order to appropriately manage this population.

OBJETIVO: Las epidemias gemelas del VIH y las personas sin hogar, presentan varios aspectos desafiantes para el desarrollo de programas que ofrecen atención y tratamiento. Este trabajo describe las características de esta población, y su manejo como parte de un esfuerzo de colaboración entre el Centro para la investigación, educación y servicios del VIH/SIDA, del Departamento de Medicina del Hospital Universitario de West Indies, y el Consejo Nacional para el Abuso de Drogas. SUJETOS Y MÉTODOS: Se realizó un estudio descriptivo retrospectivo mediante revisión de expedientes médicos de los pacientes. Se resumieron los datos clínicos y demográficos de la población sin hogar infectada por el VIH, destacando las cuestiones relacionadas con la prestación de asistencia, las tasas de adopción de terapia antirretroviral (TAR), y la posterior adherencia al tratamiento, además de factores conocidos, asociados con la transmisión del VIH. RESULTADOS: Un total de 12 casos se incluyeron en el análisis. La edad promedio fue de 38.0 años (IQR 32.5-49.25), siendo mujeres la mayoría, 9 (75.0%). El diagnóstico en etapa tardía fue una característica común. La mayoría de los casos fueron elegibles para TAR desde el primer contacto, con conteos CD4 de 284.4 (95% CI 10.9.0, 459.8) como promedio. También se identificaron factores de riesgo significativos para la transmisión del VIH, ya que todos los casos reportaron actividad sexual con un uso limitado de condón, y un gran número de parejas sexuales durante toda la vida, 30 (IQR 25.0-100.0). Otros factores identificados incluyen 8 (66,6%) casos que reportaron síntomas de infección de transmisión sexual (ITS), 10 (83,3%) que reportaron abuso de sustancias, y 9 (75.0%) que reportaron trabajo sexual. CONCLUSIÓN: Se requiere la implementación de intervenciones de combinación que ofrezcan un paquete integral de servicios que respondan a los numerosos problemas que enfrenta la población sin hogar infectada por VIH, a fin de tratar adecuadamente a esta población.

A study on presentation and behavior of colo-rectal carcinoma in young Indian patients.

Background: Colorectal cancer is rare in younger age group. Most cases occur in the second decade of life and are clinically aggressive. The prognosis of these patients is generally poor. This is a retrospective study in which data of Indian patients was compared to standard literature. Methods: Data on 32 young patients with colorectal cancer between ages of 10-25 years treated between January 2000 and December 2006 was reviewed. Clinical presentation, natural history and response to therapy were evaluated. Results: Studied cases comprised 9.9% of the total number of colorectal cancer patients. The median age of presentation was 21.5 years. Four-fifths of the cases presented in late stage. Nodal involvement was seen in 38% cases and metastatic disease in 12% cases. The rectum was the most commonly involved site. A majority of the patients presented with pain (81%), altered bowel habits (72%) and bleeding per rectum (78%). Surgery was done in 16 cases; radiotherapy in 16 patients; while chemotherapy was used in 19 cases. Responses at completion of treatment were seen in 28% cases; while 1 year post treatment only 12% cases were alive and only 6% at 2 years. Conclusions: Colorectal cancer in younger age is rare and a high level of suspicion is necessary to diagnose it at an early and curable stage. Rectal bleeding therefore should not be ignored but evaluated further with at least a digital rectal examination and a sigmoidoscopy. Failure to do so results in late presentation with consequent dismal survival rates.

Use of antimicrobial agents and granulocyte colony stimulating factors for febrile neutropenia in cancer patients in a tertiary care hospital in India.

Background: Use of antimicrobials (AM) and granulocyte colony stimulating factors (G-CSF) affect the outcome and cost of treatment of febrile neutropenia (FN). There are no studies describing the AM utilization pattern or the use of G-CSF and cost incurred on them in cancer patients with FN from India. Materials and Methods: A study was conducted in a tertiary care, teaching hospital in New Delhi, India, with the objectives of describing the utilization pattern of AM and G-CSF in cancer patients with FN. The efficacy and costs of AM and G-CSF prescribed were also assessed. Results: A total of 211 patients with FN were enrolled in the study. A majority of 207 (98.1%) were in the low-risk category. The average number of AM used per patient was 2.45 ± 0.02 and the AM exposure density was 1.19. All patients were administered five different combinations of AM regimens and G-CSF, irrespective of the risk category. No difference in the time to defervesence or in the recovery of ANC counts were observed with the different AM regimens. The average drug cost per febrile neutropenia episode (FNE) was Rs 4694.45 ± 296.35 (113.95 ± 7.19$). G-CSF accounted for 76.14 - 97.58% of the total costs. Conclusion: Large variations in the pattern of AM prescribed with routine use of G-CSF, irrespective of the risk status, was observed. Guidelines for the rational and cost-effective use of AM and G-CSF in patients with FN needed to be prepared. This was especially important as treatment was given free of cost to all patients admitted in the government health facility.

A retrospective study of 18 cases of adenoid cystic cancer at a tertiary care centre in Delhi.

Context: Adenoid cystic carcinoma (ACC) is a rare neoplasm that usually arises from the salivary, lacrimal, or other exocrine glands. It is characteristically locally infiltrative in nature and has a tendency toward local recurrence, high propensity for perineural invasion, and prolonged clinical course. Aim: To analyze the presentation and natural history of cases of adenoid cystic tumors of salivary glands in our institution; and to compare with the existing literature. Design and Setting: Retrospective study at the Department of Radiotherapy. Materials and Methods: Data on 18 patients of ACC of the salivary glands treated between 2004 and 2008 were reviewed with respect to clinical presentation, stage, and histology. Results: There were 8 cases of major salivary gland tumors (47%), of which 2 were in the submandibular and 6 were involving the parotid. Ten patients (53%) had minor salivary gland involvement. Two patients had metastasis at the time of presentation. All patients underwent surgery. Radiotherapy was delivered to 16 patients and chemotherapy to 6 patients (concurrent, n = 3 and adjuvant, n = 3) and no adjuvant therapy was given to 2 patients. All patients were alive at a median follow-up of 3 years. No patient developed local or distant failure during the study duration. Conclusion: ACC has locally aggressive behavior. Radiotherapy adjuvant to surgery improves local control in locally advanced disease. Longer follow-up is mandatory in view of incidence of late metastasis.

Psychosocial disorders in women undergoing postoperative radiation and chemotherapy for breast cancer in India.

Background: Breast cancer is the most common cancer in urban India, but no study has been carried out on psychosocial disorders in breast cancer patients. Aims: The present study has been undertaken to evaluate behavioural and psychosocial impacts before and after treatment of women with breast cancer. Settings and Design: The study was carried out in a reputed hospital in Delhi. Patients and Methods: A total of 97 breast cancer patients matched for age and economic status were divided into group A (66) and group B (31) on the basis of treatment modalities offered to the patient. These women were interviewed, before and after the treatment, and the observations were recorded in a pre-tested structured questionnaire. Statistical Analysis: Chi-square test and Fisher's exact test were used to calculate statistical significance. Results: Although the extent of sociobehavioral disorders were higher in patients on postoperative adjuvant chemotherapy and radiotherapy when compared with those on postoperative adjuvant chemotherapy alone, the difference was, however, not statistically significant. Psychological reactions were observed in 31% of patients but after intervention, 65% showed adjustment within 4 to 12 weeks, whereas the rest showed late adjustments. Conclusions: Breast disfigurement and sexuality were found to be least important, but psychological and social support appears to significantly influence the treatment outcome and rehabilitation of breast cancer patients in India.

Effect of surfactants on phosphatase level of fresh water fish Labeo rohita.

Alterations in the activity of enzymes Acid phosphatase (E.C.3.1.3.2) and Alkaline phosphatase (EC 3.1.3.1) in organs such as liver, gills and muscle of rohu following its exposure to surfactants viz. CTAB, SDS and Triton X- 100 were analyzed. Different levels of exposure were given depending on the LC50 value of the surfactant used. Also, the influence of age and weight of the organisms was tested simultaneously. The activity of ACP in the tissues of fish exposed to all the three surfactants showed marked enhancement after exposure; the effect being highest in the liver followed by gill and muscle. Activity levels of ALP in different tissues of the fish exposed to the surfactants also showed an increase. Maximum increase was found in the liver followed by muscle, and gill. The increase in the levels of these enzymes indicates a stressful condition of the fish.

Risk factors with breast cancer among women in Delhi.

BACKGROUND: The incidence of breast cancer is on the rise in India, breast cancer is the second most common malignancy in Indian women. AIM: The aim of this study was to find out the association of various risk factors with breast cancer among women in Delhi. SETTINGS AND DESIGN: This was a case-control study in Lok Nayak Hospital, Delhi. METHODS AND MATERIAL: 332 women were studied. Subjects were women with breast cancer (N = 115) and age matched Control subjects (N-217) without breast cancer, attending Lok Nayak Hospital during 2006. Subjects were interviewed using a pretested questionnaire. The risk factors studied were: age, parity, socioeconomic status, marital status, breast feeding, menarche, menopause, family history. STATISTICAL ANALYSIS: Data was expressed in proportion. RESULTS AND CONCLUSIONS: Age of the patient ranged from 25 to 80 years. In this study, 69 (60%) cases and 127 (58.5%) controls were illiterate, the mean duration sum of total breast feeding for all children was 6.58 years in cases and 7.4 years in controls (OR = 1.91; 95% CI, 1.17 - 3.13) (P P P< 0.05). There was a significant difference between breast cancer cases and controls in relation to place of residence, occupation, marital status, body mass index and breast feeding.

Primitive neuroectodermal tumor of prostate.

Primitive neuroectodermal tumors (PNETs) are malignant proliferations of small, undifferentiated neuroectodermal cells occurring mainly in children and share the same reciprocal translocation between chromosomes 11 and 22 and the same patterns of biochemical and oncogene expression as osseus and extraosseus Ewing's sarcoma. Some PNETs occur in the brain, while others (the peripheral PNETs) occur in sites outside the brain, such as in the extremities, pelvis and the chest wall. They mostly originate in the chest, pelvis and retroperitoneum; in rare cases, occurrence in the head and neck area has also been seen. We present a rare case of primitive neuroectodermal tumor arising in the prostate gland in a 25-year-old male. To the best of our knowledge, this is the first documentation of a primary peripheral primitive neuroectodermal tumor in the prostate gland of any patient from India and rarely reported in English literature.

Metastatic ovarian tumour in patient of carcinoma stomach.

Krukenberg tumour (KT) is a metastatic ovarian tumour with primary usually seen in the gastrointestinal tract. Here we report the case of a 50-year old menopausal patient with gastric tumour presenting with solitary metastasis to the ovary within 5 months of primary gastric surgery, for which total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. This case stresses the urgent need for early detection and surveillance of treatable tumours metastasising to the ovary.

Percutaneous transluminal angioplasty in an embolic middle cerebral artery occlusion.

A young lady developed left middle cerebral artery embolism after percutaneous transseptal mitral commissurotomy. She was successfully treated with immediate percutaneous transluminal angioplasty. There was complete recovery of neurological deficit.

Effect of cancer treatment modalities on serum lipids and lipoproteins among women with carcinoma of the breast.

Serum lipids and lipoproteins were studied in 61 breast cancer patients before initiation of therapy and subsequently during and after completion of cancer therapy. Different serum lipid fractions were estimated by enzymatic method. It was observed that mean levels of serum triglycerides, total cholesterol and low density lipoprotein (LDL)-cholesterol among untreated breast cancer patients decreased significantly after treatment. On the contrary, an increasing trend in the levels of high density lipoprotein (HDL)-cholesterol was noticed in patients during the course of treatment. This study reflects the effects of cancer therapy in the alteration of levels of different serum lipid fractions in the patients with breast cancer.

Glutathione level and its relation to radiation therapy in patients with cancer of uterine cervix.

Glutathione functions as an important antioxidant in the destruction of hydrogen peroxide and lipid peroxides by providing substrate for the glutathione peroxidase and also promotes the ascorbic acid. Glutathione plays a vital role in detoxification of xenobiotics, carcinogens, free radicals and maintenance of immune functions. The study was aimed to determine plasma glutathione as well as erythrocyte glutathione and glutathione peroxidase in patients with invasive cervical carcinoma (n = 30) before initiation and after completion of radiotherapy and subsequently, at the time of first three monthly follow-up visit. The levels of plasma glutathione, erythrocyte glutathione and glutathione peroxidase activity were found to be lower in all cervical cancer patients as compared to age matched normal control women. The study indicates a change in antioxidant status in relation with the glutathione system among patients with invasive carcinoma of the uterine cervix. This study also demonstrates the effect of radiation therapy on this antioxidant system.

Swallowing performance after radiotherapy for squamous cell carcinoma oesophagus.

OBJECTIVE: To consider assessment of swallowing performance status as an alternative to survival in reporting results of treatment in patients with carcinoma oesophagus. METHODS: Twenty five patients of squamous cell carcinoma of oesophagus treated with radiotherapy were evaluated clinically, radiologically and endoscopically, to assess their response to treatment. RESULTS: Two months after radiotherapy, 10 of 25 patients had swallowing score-1. During radiotherapy, oesophagitis involving normal oesophagus and diseased segment was seen in 64% of cases. Fifty six percent of patients developed stricture (24% malignant, 32% benign). At the end of two years, only five patients were alive, two with swallowing score of 2, two with swallowing score of 3 and one with swallowing score of 4. CONCLUSION: As the overall survival in carcinoma oesophagus is poor, the short term criteria for assessing the response of treatment should be swallowing performance status. Radiotherapy treatment can provide substantial palliation for patients debilitated by dysphagia.

Role of radiation therapy in carcinoma of the gall bladder--a preliminary indian experience.

Carcinoma of the gall bladder has a poor prognosis despite surgical resection of the tumour. We prospectively enrolled 21 patients with histologically proven adenocarcinoma of the gall bladder, who were stage III or beyond for post operative radiotherapy. Six month survival was 67% (14 of 21 patients) while one year survival was 33% (7 out of 21 patients) and five year survival was 23% (5 of 21 patients). Those patients who had residual disease or were considered inoperable at surgery had no improvement in survival. The 1 year and 5 year survival in these patients was encouraging with radiotherapy in the present open labelled study of radiotherapy in patients with carcinoma of the gall bladder.

Stability and kinetic behaviour of some enzymes in surfactant environment.

The interaction of alpha-chymotrypsin, invertase, alcohol dehydrogenase and alkaline phosphatase with some ionic and non-ionic surfactants, viz. sodium dodecyl sulphate, dioctyl sodium sulphosuccinate, hexadecyltrimethylammonium bromide, tetradecyltrimethylammonium bromide and Triton X-100, has been examined by studying the effect of varying surfactant concentrations on enzyme activities as well as by determining the time-dependent inactivation and the time-independent inhibition. The kinetic parameters, Km and Vmax, for alpha-chymotrypsin-catalysed reaction in presence of sodium dodecyl sulphate were evaluated. Anionic surfactants markedly decreased enzyme activity, whereas cationic surfactants were less effective. Nonionics showed no effect. This change in enzyme activity was also dependent on the nature of enzyme.