Derangement of liver function tests in dengue patients

Background: Changes in the liver function test may serve as an early marker for timely diagnosis and identification of patients who may develop severe dengue. The purpose of this study was to examine the link between dengue fever severity and liver function test. Methods: This prospective observational study was conducted in the Department of General Medicine, Madhesh Institute of health sciences, provincial hospital, Janakpurdham in which we included dengue positive patients (aged 18 years or more) based on NS1 antigen or high titer on IgM/IgG testing from July 2023 till August 2023. We excluded patients with diseases like malaria, cirrhosis of liver, enteric fever, viral hepatitis or any other disease or taking any medication which can derange LFT. Results: We included 96 patients fulfilling the study criteria. Of these, 71% had DF, 22% had DHF and 7% had DSS. Among liver enzymes, mean AST of the patients was significantly higher in DSS group of patients (775.19�.65 U/l), as compared to those in the DF and DHF group of patients, p value <0.01. Similarly, mean ALT of the patients was significantly higher in DSS group of patients (387.8�.6 U/l), as compared to those in the DF and DHF group of patients, p value<0.01. On the contrary, mean alkaline phosphatase levels were similar between the three patient groups. Conclusions: Based on the results our study, we conclude that raised AST and ALT levels were significantly associated with severity of DSS and DHF. Patients with dengue infection should have a baseline liver function test and subsequent LFT monitoring to detect early hepatic impairment.

EXPLORING THE SOLASTALGIA: PREDICTING THE COGNITIVE FAILURES AMONG DROUGHT PRONE FARMERS

The climatic changes mainly effect the farming profession as, India is regarded as an agricultural portion of the globe because many of its regions are perfect for agrarian production; Due to this shift in climate various types of natural disasters are taking place. One such calamity among several disasters is drought. The present paper focuses on the cognitive failures experienced by the farmers suffering with drought. This paper attempts to study the psychological turmoil experienced by the famers which is termed as, Solastalgia. It is a novel concept that has evolved to make environmental distress more meaningful and clearer. Unlike nostalgia — the morose or anxiousness encountered by individuals who get separated from their home — Solastalgia is the havoc caused by changes in the environment, as it affects people while they are attached to their home settings. The results manifested that the grief observed among the farmers due to the change in their environment hits the mental health and psycho- social status of the agriculturalists. The most important indicator for intellectual failures in the pandemic circumstances is constant substance abuse done by the farmers due to the crop failures they have experienced

Energy and Protein Intake During Pregnancy in Relation to Preterm Birth: A Case Control Study.

Objective: To find the association of maternal energy and protein intake with preterm birth. Design: Case-control study. Setting: Two hospitals at Lucknow in Northern India. Participants: Cases (n=350) were defined as mothers (age 18-40 y) of singleton live preterm (<37 wks) neonates. Controls (n=350) were mothers who delivered a singleton neonate, consecutive to enrolled case, after completing 37 weeks of gestation. Results: There was a statistically significant lower mean (SD) energy intake [cases 1624 (249) Kcal vs. controls 1911 (341) Kcal; P<0.001] and protein intake [cases 32.1 (6.1) vs. controls 37.2 (7.0); P<0.001] among women who delivered preterm neonates. Maternal energy and protein intake had significant positive correlation with neonatal weight, length, foot length, head circumference and chest circumference. Conclusion: Lower energy and protein intake during pregnancy is possibly associated with preterm birth.

Facial lupus vulgaris of bilateral periorbital skin and conjunctiva: A case report and brief review.

A 22-year-old male presented to the Dermatology Department with bilateral plaque lesions distributed symmetrically over malar area, bridge of nose and upper eyelids progressing over 1 year 3 months. Lesion remained unhealed after antibiotic treatment. Microscopy and culture for fungal and mycobacterial infections were negative. The Mantoux test showed an exaggerated response and PCR was positive for Mycobacterium tuberculosis complex. Patient was treated successfully with anti-tubercular therapy.

Biological behavior and disease pattern of carcinoma gallbladder shown on 64-slice CT scanner: A hospital-based retrospective observational study and our experience.

Purpose: The aim of this diagnostic observational study was to assess the spread and biological behavior of gallbladder cancer using 64-slice computerized tomography (CT) scanner in this particular geographic belt (eastern Uttar Pradesh, western Bihar, and northern Madhya Pradesh provinces of North India). Indians are ethnically and culturally different from their Western counterparts among whom the incidence of this disease is comparatively low. Subjects and Methods: After systemic examination, all patients (87) were subjected to ultrasonographic examination. All cases were histopathologically proven. Confirmed cases were subjected to volumetric CT examination of abdomen and pelvis, plain, post contrast and delayed phase. Results: Majority of the cases were adenocarcinoma. There was female preponderance with majority belonging to fifth and sixth decades. Commonest presentation was diffuse, irregular, enhancing wall thickening in 49.4%. Majority had invasion of liver parenchyma (74.7%). Cholelithiasis was seen in 48.3% cases. Invasion of biliary radicals was high (13.8-18.4%). Eleven cases had invasion of portal vein and tumor thrombus, with hepatic artery invasion in one case. In two cases, both hepatic artery and portal vein invasion was seen. Portal and peripancreatic nodal metastasis was seen in 58.5%. Distant metastasis was reported. Conclusion: Few studies involving the Indian population have attempted to use multi-row detector CT to define the biological behavior of carcinoma gallbladder. The opinion whether the pathology is operable or non-operable can reasonably be given. This large-scale, single-center study gives insight about the epidemiology and biological behavior of carcinoma gallbladder.

A case of human thelaziasis from Himachal Pradesh.

Small, chalky-white, threadlike, motile worms were isolated from the conjunctival sac of a 32 year-old woman residing in the Himalaya mountains. They were identified as both male and female worms of Thelazia callipaeda. To the best of our knowledge, this is the second case report of human thelaziasis from India.

Malignant tumours of the minor salivary glands: a survival analysis of 17 years from a tertiary referral cancer centre.

BACKGROUND: Malignant tumours of the minor salivary glands are rare and constitute less than 0.5% of all malignant neoplasms. AIM: This study was carried out to evaluate the clinical presentation, site distribution, treatment, survival and predictors of survival in malignant minor salivary gland tumours. SETTING: A tertiary care, superspeciality referral hospital. DESIGN: Retrospective analysis. PATIENTS AND METHOD: Forty-two cases of minor salivary gland tumours treated over a period of 17 years were reviewed for clinical presentation, histopathology, stage distribution, treatment and treatment outcome. STATISTICAL ANALYSIS: Survival by Kaplan Meier Method and the outcomes were compared using log-rank test. RESULTS: The mean age of the patients was 46.9 years with a male to female ratio of 1.4:1. Majority of the patients presented with a painless progressive swelling, with 13 (31%) of them in T2 stage. About one-third of the patients had palpable lymph nodes at presentation, while none had distant metastasis. Palate was the commonest site and mucoepidermoid carcinoma was the commonest hispathological type. About 1/3 of the patients were treated with primary surgery and were followed up by adjuvant radiotherapy. Seven patients underwent palliative treatment alone. Over a mean follow-up of 30 months, 5 patients failed. The disease free survival was 72% at 5-year, none of the factors studied were found to significantly influence survival. CONCLUSIONS: Results of the present study suggest that minor salivary gland tumours should be treated with primary surgery irrespective of site and histological type to achieve best loco-regional control and survival.

Attributing death to cancer: cause-specific survival estimation.

Cancer survival estimation is an important part of assessing the overall strength of cancer care in a region. Generally, the death of a patient is taken as the end point in estimation of overall survival. When calculating the overall survival, the cause of death is not taken into account. With increasing demand for better survival of cancer patients it is important for clinicians and researchers to know about survival statistics due to disease of interest, i.e. net survival. It is also important to choose the best method for estimating net survival. Increase in the use of computer programmes has made it possible to carry out statistical analysis without guidance from a bio-statistician. This is of prime importance in third- world countries as there are a few trained bio-statisticians to guide clinicians and researchers. The present communication describes current methods used to estimate net survival such as cause-specific survival and relative survival. The limitation of estimation of cause-specific survival particularly in India and the usefulness of relative survival are discussed. The various sources for estimating cancer survival are also discussed. As survival-estimates are to be projected on to the population at large, it becomes important to measure the variation of the estimates, and thus confidence intervals are used. Rothman's confidence interval gives the most satisfactory result for survival estimate.

Management of attention deficit/hyperactivity disorder--use of an effective paradigm.

The management of ADHD poses a great problem before the psychologists, psychiatrists and different behavioural scientists. The multi-model approach, combining pharmacologic with different non-pharmacologic interventions, is more effective than any form of therapy. In the present study the theta feedback, a non-pharmacologic technique, has shown beneficial role among the low medicated ADHD cases. The present study also signifies the role of multi-model intervention in the management of ADHD.

Fermentation of starch to ethanol by an amylolytic yeast Saccharomyces diastaticus SM-10.

A total of fifteen yeast strains were isolated from natural sources including fruits, soil, molasses, honey and a variety of indigeneous fermented foods. Screening of these strains for growth, ethanol production and glucoamylase activity led to selection of a yeast strain SM-10 identified as S. diastaticus having maximum glucoamylase activity (80 units ml(-1)) and ethanol production from starch (3.5%). Ethanol production from wheat flour was found to be 1.75% which could be increased to 5.2% after treatment of wheat flour with pepsin, diastase and glucoamylase.

Development of a distress inventory for cancer: preliminary results.

CONTEXT: Advances in cancer treatment have led to cure and prolongation of patients' lives; however associated psychosocial problems, including distress, can detrimentally affect patients' compliance with treatment and ultimately, their outcome. Symptom distress has been well addressed in many studies; however, psychological distress has only been quantified by using depression or anxiety scales/checklists or quality of life scales containing a distress sub scale/component or by the use of scales that are not psychological distress-specific. AIMS: The present study is an attempt to construct a psychological distress inventory for specific use with cancer patients. SETTINGS AND DESIGN: The standardisation sample consisted of 63 randomly selected patients with head and neck cancer who had undergone/ were undergoing curative treatment at the Regional Cancer Centre, Trivandrum. PATIENTS AND METHODS: The Distress Inventory for Cancer contained 57 positively and negatively toned items. An item analysis was conducted, followed by a factor analysis, thereby identifying the domains influencing distress. RESULTS: The final questionnaire contained 26 items subdivided into four domains viz. the personal, spiritual, physical, and the family domains, with each domain providing a sub score. The reliability coefficient (Cronbach's alpha) of the scale was found to be 0.85. CONCLUSIONS: These are the preliminary results of an ongoing study on global distress and tool development process. Reported here is the first step towards development of such tool.

Primary malignant chest wall tumours.

Neoplasms of the chest wall are not uncommon. Majority of the tumours occurring in the chest wall are benign. The tumours may arise from the soft tissues,connective tissues or bone. Metastatic tumours can arise as a result of direct infiltration or haematogenous spread. The management of these tumours is challenging. Resection of the chest wall with or without the excision of ribs, require reconstruction not only for aesthetic reasons but also for providing the stability to the chest wall which is of prime importance in maintaining the respiratory functions. In this article, 46 cases of the primary malignant chest wall tumours seen over a period of 5 years are reviewed.

Oral cancer among patients under the age of 35 years.

BACKGROUND: Cancer of the oral cavity is one of the commonest cancers among males. AIMS: To assess the aetiological factors, patient characteristics, treatment and the outcome in young patients with oral cancer. SETTINGS AND DESIGN: A retrospective descriptive study of patients under the age of 35 years with cancer of the oral cavity treated between 1982-1996, with the last follow-up till 2001, using the tumour registry data of Regional Cancer Centre (RCC), Trivandrum, Kerala, India. SUBJECT AND METHOD: The detailed clinical, treatment and follow-up data were obtained from the computerised records of RCC and recorded on a preset proforma. This was analysed with emphasis on age, sex, risk factors, site, histology, clinical extent and treatment methods and survival in the study group. STATISTICAL ANALYSIS: The survival analysis was carried by Kaplan-Meier method and the difference in survival was analysed using log-rank test. RESULTS: Out of 264 patients analysed, tongue was the commonest site identified in 136 (52%) patients followed by buccal mucosa in 69 (26%) patients. A male female ratio of 2.3:1 was observed with a significantly higher male preponderance in buccal mucosa (4.3:1). Prior exposure to tobacco or alcohol was noted in 59.4% patients, with more habitués in buccal mucosa cancer. Histological confirmation was present only in 83.7% patients and among them most were squamous cell carcinoma (85.9%). Radiotherapy, surgery or combined modalities of treatment were employed for majority of patients. The 5-year survival was 57.3%. T stage of the tumour was found to be significant in predicting disease free survival (P=0.03). CONCLUSIONS: The importance of early detection for clinical down staging is stressed. There is a need to investigate the aetiology of intra oral cancers in younger patients since a significant proportion (almost 40%) of these patients do not have associated risk factors for cancer.

Acute abdomen in patients receiving chemotherapy.

OBJECTIVE: To assess the incidence of acute abdomen in patients receiving chemotherapy and to evaluate the factors affecting the clinical decision-making. MATERIAL AND METHODS: Retrospective analysis of surgical oncology references for the patients developing acute abdomen while receiving chemotherapy was carried out. A surgical oncologist reviewed each referral and a full work-up was carried out. Surgical interventions were carried out as and when deemed necessary. Response to treatment, whether surgical or conservative, was used as main outcome variable. RESULTS: Mean age of the patients was 37 years (7-58 years). Half of the patients were receiving chemotherapy for lymphoproliferative disorders, 13 for haematological malignancies and 3 for ovarian cancer. Clinical diagnosis was of acute appendicitis in 13, paralytic ileus in 9, typhilitis in 3 and intestinal perforation in 2, acute intestinal obstruction in 3, and obstructed hernia and intussception in one each. Six patients underwent surgery. Two patients expired postoperatively of progressive septicaemia and multi-system organ failure. CONCLUSION: Evaluation of cancer patients on chemotherapy is difficult. Tenderness, presence of peritoneal signs and absence of exaggerated bowel sounds are most important clinical signs, however they may be blunted by progressive neutropenia or corticosteroid administration. Decision to operate, should be made with extreme caution as mortality and morbidity after surgery is high.

Rehabilitation of cancer patients.

With the developments in cancer treatment, more and more patients are surviving their disease. However, very little emphasis is being placed to rehabilitate these cancer survivors. Ignorance, social structure, stigma attached in seeking psychological help, and poor communication skills of oncology staff all contribute to poor rehabilitative efforts. The priority of governmental agencies and health efforts to fight rampant communicable diseases, malnutrition, maternal health, and the frequent natural calamities, puts rehabilitation movements in the back seat. Treatment and prevention of disability and its rehabilitation requires comprehensive and multidisciplinary approach. There is an urgent need to promote physical and psychological rehabilitation.

Tobacco smoking and hypertension.

Coronary artery diseases is rapidly increasing in our part of the world. The South Asian ethnic groups are especially vulnerable to coronary artery disease. The two most striking features of coronary artery disease in the South Asian population are extreme prematurity and severity of the disease, both resulting from the malignant atherosclerosis that begins at an earlier age than in other population. Triple vessel disease and complicated lesions are not common even in young people and follow a malignant course. The most important aspect of prevention is to identify individuals with high risk of coronary artery disease at an early age and aggressive modification of risk factors. Tobacco smoking and hypertension are the two most important risk factors for coronary heart disease and stroke. Both of these risk factors have very high prevalence in India, Nepal and other countries of this region. There is a synergistic interaction of tobacco smoking with hypertension and high blood cholesterol which greatly increase coronary heart disease risk as well as sudden death and stroke.