Correlation of Gastric Scintigraphy and Clinical Symptoms in the Diagnosis of Gastroparesis and its Impact on Quality of Life: A Pan India Real World Study

Background: Gastroparesis with its varied etiology is one of the major health issues in India. Poor correlation between delayed gastric emptying and its symptoms is well-known. This study was planned to evaluate the proportion of confirmed gastroparesis by scintigraphy among patients with suggestive clinical features, their underlying aetiologies and clinical profiling in a real-world setting in India. Settings and Design: Patients clinically diagnosed with gastroparesis, presenting varyingdegreesofsymptoms for at least 12-weeks, were enrolled in this multic-entric,cross-sectional, clinico-epidemiological study. Results: Overall, 196/201 enrolled patients underwent gastric scintigraphy; 88 (45%) were found to be scintigraphically positive and 108 (55%) patients were only clinically positive. Underlying etiologies of gastroparesis were idiopathic (51.2%), type-2 diabetes (44.8%), type-1 diabetes (2.5%) and psychological conditions (1.5%). Most patients presented symptoms like postprandial fullness (75.6%), bloating (50.7%), abdominal pain (45.3%), nausea (41.3%), abdominal discomfort (40.3%), early satiety (37.8%) and vomiting (17.9%) of moderate severity. Common dietary risk factors were fatty diet (66.7%), fiber-rich food (57.7%) and carbonated drinks (18.9%). Weight loss (6.5%), esophagitis (5.5%) and electrolyte disturbances (0.5%) were the associated complications. About 89.8% were on proton-pump inhibitors, followed by prokinetics (51.8%) and antiemetics (8.4%). The mean PAGI-QoL score was 3.6 ± 0.94, suggesting a moderate effect of gastroparesis on QoL. Conclusion: Poor correlation exists between gastric scintigraphy and gastrointestinal symptoms, thus reiterating the significance of the clinical diagnosis of gastroparesis, especially in diabetes. Only about half of the patients were prescribed prokinetics, emphasizing the need for appropriate pharmacotherapy using prokinetics for holistic management of gastroparesis.

Polyvaccine: joining the links in the cascade of type 1 diabetes

The incidence of type 1 diabetes mellitus (T1DM), an autoimmune disorder, has ascended considerably with around 98,200 and 15,900 incidents in children below 15 years of age, globally and in India, respectively. This is typically due to environmental changes leading to genetic modifications. Also, T1DM encompasses the presence of autoantigens and many other etiologies which can be targeted by proper immunization. In this paper, we consciously discuss and collate various candidate triggers of islet autoimmunity and other factors expected to promote progression of T1DM. This paper bridges all the mechanisms caused by these factors and linking them with each other. We have also highlighted on the novel corona virus as a trigger for T1DM. Finally, we suggest that an amalgamated model of polyvaccine can batter the condition by inducing protection against various triggers of T1DM.

Anterior Wall Myocardial Infarction With Conduction Defect And It's Outcome During Hospital Stay

Background: Qrbb myocardial infarction has high mortality and morbidity. So we want to study in hospital outcome of qrbbb myocardial infarction Methods: It is a prospective study. We studied qrbbb mi patients admitted in our hospital from December 2016 to June 2017 Results: About 90% of patients had heart failure. And 80% of patients required ventilatory support in the form of non–invasive positive pressure ventilation (NIPPV) or invasive ventilation. About 37% of patients had ventricular arrhythmias. Thrombolysis with streptokinase was done in 64% of patients and with tenecteplase for 20% of the patients. Percutaneous transluminal coronary angioplasty (PTCA) was done in 47% patients. Two patients had pharmacoinvasive PTCA. 16% of patients were conservatively treated due to late presentation. 24% patients died during hospital stay while 76% got discharged. 14% of patients had reversal of rbbb wave. 14% had stent thrombosis. 100% of patients had left anterior descending artery (LAD) disease. While 10% had left main coronary artery disease and 14% had triple vessel disease (TVD), 10% were sent for coronary artery bypass grafting (CABG). Conclusions: qRBBB AWMI carries high mortality of 24% with 90% of patients going in to heart failure. Ejection fraction is a good predictor of death and diabetes is a covariate of predictor of death.

Developmental Dysplasia of Spastic Hip in Children with Cerebral Palsy in Southern India.

We studied the proportion of developmental dysplasia of spastic hip in children with cerebral palsy. Children with cerebral palsy aged 2-12 years were enrolled. Migration percentage was measured on pelvic radiographs. Hip dysplasia was seen in 15 (12.7%) children.

Case report of a chest wall cystic hygroma in a teenager

Cystic hygroma or cystic lymphangioma is a congenital malformation of lymphatic origin. Their occurrence on the chest wall is very rare, and they progressively grow with age infiltrating into the local tissues, around muscle fibers and nerves, making them difficult and hazardous to remove. There are various treatment modalities of such lesion. Based on the literature surgical excision is the preferred treatment of choice in cystic hygroma because it gives a better cure rate compared to other modalities. We report a case successful excision of anterolateral chest wall cystic hygroma in a teenager in Hospital Serdang. KEY WORDS:

Genetic diversity of 15 autosomal short tandem repeats loci using the AmpFLSTR ® Identifiler™ kit in a Bhil Tribe Population from Gujarat state, India.

MATERIALS AND METHODS: The genetic diversity and forensic parameters based on 15 autosomal short tandem repeats (STR) loci; D8S1179,D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317,D16S539, D2S1338, D19S433, vWA, TPOX, D18S51,D5S818, and FGA in AmpFLSTR® Identifiler™ kit from Applied Biosystems, Foster City, CA, USA were evaluated in saliva samples of 297 unrelated individuals from the Bhil Tribe population of Gujarat state, India to study genetic diversities and relatedness of this population with other national and international populations. RESUITS: Statistical analysis of the data revealed all loci were within Hardy-Weinberg Equilibrium expectations with the exception of the locus vWA (0.019) and locus D18S51 (0.016). The neighbour joining phylogeny tree and Principal Co-ordinate Analysis plot constructed based on Fst distances from autosomal STRs allele frequencies of the present study and other national as well as international populations show clustering of all the South Asian populations in one branch of the tree, while Middle Eastern and African populations cluster in a separate branch. CONCLUSION: Our findings reveal strong genetic affinities seen between the Indo-European (IE) speaking Bhil Tribe of Gujarat and Dravidian groups of South India.

Descriptive Epidemiology of Novel Influenza A (H1N1), Andhra Pradesh 2009-2010.

Background: The fi rst case of pandemic Infl uenza A (H1N1) in India was reported from Hyderabad, Andhra Pradesh on 16th May 2009. Subsequently, all suspected cases seeking treatment from A (H1N1) treatment centers and their contacts were tested. Laboratory confi rmed cases were hospitalized and treated with antivirals according to national guidelines. We reviewed the surveillance data to assess the morbidity and mortality due to A (H1N1) in the state of Andhra Pradesh (population-76,210,007) during the period from May 2009 to December 2010. Materials and Methods: We obtained the line-list of suspected (infl uenza like illness as per World Health Organization case defi nition) and laboratory confi rmed cases of A (H1N1) from the state unit of integrated disease surveillance project. We analyzed the data to describe the distribution of case-patients by time, place and person. Results: During May 2009 to December 2010, a total of 6527 suspected (attack rate: 8.6/100,000) and 1480 (attack rate: 1.9/100,000) laboratory confi rmed cases were reported from the State. Nearly 90% of the suspected and 93% of the confi rmed cases was from nine districts of Telangana region, which includes Hyderabad. Nearly 65% of total confi rmed cases were reported from Hyderabad. The attack rate was maximum (2.6/100,000) in the age group of 25-49 years. The cases peaked during August-October. 109 case-patients died (Case fatality ratio: 7%) and most (80%) of these patients had comorbid conditions such as diabetes (24%), chronic obstructive pulmonary disease (20%), hypertension (11%) and pregnancy (11%). Case fatality was higher (16%) among patients who were older than 60 years of age compared with other age groups. Conclusions: In Andhra Pradesh, H1N1 transmission peaked during August-October months and predominately affected adults. Case fatality was higher in patients older than 60 years with comorbid conditions.

Quality of life among people with epilepsy: A cross-sectional study from rural southern India.

Background. Epilepsy can be associated with profound physical, social and psychological consequences and it has an impact on a person’s quality of life. We assessed the quality of life and factors associated with a poor quality of life, among adults with epilepsy in a rural block of Tamil Nadu. Methods. We interviewed 91 epilepsy patients from 20 randomly selected villages using a structured questionnaire including World Health Organization Quality of Life BREF (WHOQOL-BREF), Patient Health Questionnaire 2 (PHQ-2) and Generalized Anxiety Disorder 7 (GAD-7) questionnaires. Results. The mean (SD) total score of the quality of life scale was 61.49 (12.56). Those who were single, separated or widowed (t statistic= –2.71, p<0.01), had not completed primary education (t statistic=–2.308, p<0.05), not currently going for work (t statistic=–2.748, p<0.01), had seizure in the past one year (t statistic=–4.068, p<0.01), had depressive symptoms (t statistic=–3.207, p<0.01), had higher anxiety scores (t statistic=–2.727, p<0.01), had low scores in the quality of life questionnaire. Multivariate analysis showed increasing age, education less than grade V, being unmarried, widowed or separated, lower per capita income, a high anxiety score and experiencing a seizure episode in the past one year to be significantly associated with a low score in the WHOQOL-BREF questionnaire (adjusted R2=0.378, SE 9.90). Conclusion. The presence of anxiety, lack of primary education, being single, separated or widowed, increasing age, low per capita income and having a seizure episode in the past year are associated with lower quality of life among people with epilepsy.

Behavioural and neurochemical evaluation of Perment® an herbal formulation in chronic unpredictable mild stress induced depressive model.

Perment®, a polyherbal Ayurvedic formulation that contains equal parts of Clitoria ternatea Linn., Withania somnifera Dun., Asparagus racemosus Linn., Bacopa monniera Linn., is used clinically as mood elevators. The aim of the present study was to explore the behavioural effects and to understand possible mode of action of Perment® in stress induced depressive model. Chronic unpredictable mild stress (CUMS) was used to induce depression in rats. Open field exploratory behaviour, elevated plus maze, social interaction and behavioural despair tests were used to assess behaviour. Using standard protocols plasma noradrenaline, serotonin, corticosterone and brain/adrenal corticosterone levels were measured to support the behavioural effects of Perment®. Exposure to CUMS for 21 days caused anxiety and depression in rats, as indicated by significant decrease in locomotor activity in the open field exploratory behaviour test and increased immobility period in the behavioural despair test. Perment® predominantly exhibited antidepressant action than anxiolytic activity. Further Perment® increased the plasma noradrenaline and serotonin levels in stressed rats. No significant alteration in the brain corticosterone level in stressed rats was observed with Perment® treatment. However the adrenal corticosterone level is decreased with Perment®. It can be concluded that the Perment® formulation exhibited synergistic activity, has a significant antidepressant and anxiolytic activity, which may be mediated through adrenergic and serotonergic system activation. Currently the formulation is clinically used as anxiolytic but the present results suggest that the formulation can also be indicated in patients affected with depression.

In vitro effects of garlic (allium sativum l.) And african basil (ocimum gratissimum l.) On pathogens isolated from rotted cassava roots / Efectos in vitro del ajo (Allium Sativum L.) Y Albahaca africana (Ocimum Gratissimum L.) Sobre patógenos aislados de raíces de yuca podrida / Efeitos in vitro do alho (Allium Sativum l.) E Alfavaca-Cravo (Ocimum Gratissimum L.) Sobre patógenos isolados de raízes de mandioca podre

Six fungal pathogens causing rot in post-harvest cassava tuberous roots were investigated in vitro for the study of the fungi toxic effects of Allium sativum (L) and Ocimum gratissimum (L.) using aqueous extraction methods. Fungi were isolated by cutting rotted tissue at the interface between healthy and infected portions of the root. Pathogenicity tests revealed that Fusarium oxysporum, F. solani, Botryodiplodia theobromae, Macrophomina phaseolina, Penicillium oxalicum and Aspergillus niger induced rot in healthy cassava tubers after 8 days of re-inoculation, with P. oxalicum as the most virulent. Four different extract concentrations were obtained from each plant part by blending 25, 50, 75 and 100g in 100ml of sterile distilled water (SDW).The fungi toxic effect of the extracts showed that A. sativum had effective inhibition (25.2-86.9%) on mycelial growth of all tested fungi, while extracts of O. gratissimum showed slight to moderately effective inhibition (0.9 to 64.5%) on mycelial growth of all fungi, with the exception of B. theobromae and M. phaseolina, which showed the lowest percentage of inhibition with both plant extracts. The most toxic effect of the extracts was observed with A. sativum at 10%, with significant (P<0.01) inhibition on all fungi tested. The study showed the potential of crude extracts of A. sativum and O. gratissimum on fungal pathogens affecting cassava. This potential of the crude extract of these plants provides an alternative to farmers to reduce and control cassava rot, since they are inexpensive, non-phytotoxic and easy to prepare.

Seis hongos patógenos causantes de pudrición post-cosecha en raíces de yuca fueron investigados in vitro para estudiar los efectos funguitóxicos de Allium sativum (L) y Ocimum gratissimum (L) utilizando métodos de extracción acuosa. Los hongos fueron aislados cortando tejido enfermo en la interfase entre las partes sana e infectada de la raíz. Pruebas de patogenicidad mostraron que Fusarium oxysporum, F. solani, Botryodiplodia theobromae, Macrophomina phaseolina, Penicillium oxalicum y Aspergillus niger inducen pudrición en tubérculos sanos de yuca tras 8 días de reinoculación, siendo P. oxalicum el más virulento. Cuatro concentraciones de extracto fueron obtenidas de cada planta mezclando 25, 50, 75 o 100g con 100ml de agua destilada estéril. El efecto funguitóxico de los extractos mostró que A. sativum produjo una inhibición efectiva (25,2-56,9%) del crecimiento micelial de todos los hongos ensayados, mientras que los extractos de O. gratissimum mostraron débil a moderadamente efectiva inhibición (0,9 a 64,5%) del crecimiento micelial de todos los hongos con excepción de B. theobromae y M. phaseolina, que mostraron el menor porcentaje de inhibición con ambos extractos. El efecto más tóxico de los extractos fue observado con 10% A. sativum, con inhibición significativa (P<0,01) sobre todos los hongos estudiados. El ensayo mostró el potencial de extractos crudos de A. sativum y O. gratissimum sobre hongos patógenos que afectan la yuca. Este potencial del extracto crudo de estas plantas provee una alternativa a los campesinos para el control y reducción de la pudrición de la yuca, por ser económicos, no fitotóxicos y fácil de preparar.

Seis fungos patógenos causantes de apodrecimento pos-colheita em raízes de mandioca foram investigados in vitro para estudar os efeitos fungitóxicos de Allium sativum (L) e Ocimum gratissimum (L) utilizando métodos de extração aquosa. Os fungos foram isolados cortando tecido doente na interfase entre as partes sadias e infetadas da raíz. Provas de patogenicidade mostraram que Fusarium oxysporum, F. solani, Botryodiplodia theobromae, Macrophomina phaseolina, Penicillium oxalicum e Aspergillus niger induzem apodrecimento em tubérculos sadios de mandioca depois de 8 dias de reinoculação, sendo P. oxalicum o mais virulento. Quatro concentrações de extrato foram obtidas de cada planta misturando 25, 50, 75 ou 100g con 100ml de água destilada estéril. O efeito fungitóxico dos extratos mostrou que A. sativum produziu uma inibição efetiva (25,2-56,9%) do crescimento micelial de todos os fungos ensaiados, enquanto que os extratos de O. gratissimum mostraram fraca a moderadamente efetiva inibição (0,9 a 64,5%) do crescimento micelial de todos os fungos com exceção de B. theobromae e M. phaseolina, que mostraram a menor porcentagem de inibição com ambos extratos. O efeito mais tóxico dos extratos foi observado com 10% A. sativum, com inibição significativa (P<0,01) sobre todos os fungos estudados. O ensaio mostrou o potencial de extratos crus de A. sativum e O. gratissimum sobre fungos patógenos que afetam a mandioca. Este potencial do extrato cru destas plantas provê uma alternativa aos camponeses para o controle e redução do apodrecimento da mandioca, por ser econômicos, não fitotóxicos e fácil de preparar.

Clinico-laboratory profile of pediatric HIV in Karnataka.

OBJECTIVE: To study the clinical manifestations and incidence of opportunistic infections in HIV/AIDS seropositive proven hospitalized children. METHODS: Proven HIV seropositive children aged between 18 months to 12 years, admitted between April 2004 to June 2005 (15 months) to pediatric medical ward, KIMS, Hubli, were enrolled. Socio-demographic characteristics and clinical manifestations were recorded in the predesigned proforma. A complete physical examination and laboratory investigations were performed at the time of admission. Children were categorized as per 1994 revised CDC classification of pediatric HIV infection. RESULTS: Number of HIV seropositive children admitted during study period was 71. Vertical transmission was noted in 94.37%, which is the major route of transmission. The common symptoms noted were persistent fever (70.42%), persistent cough (59.15%), loss of appetite (59.15%), loss of weight (56.33%) and recurrent diarrhea (30.99%). The common signs present were, hepatomegaly (69.04%), skin lesions (59.15%), lymphadenopathy (57.75%) and severe malnutrition (54.93%). The common opportunistic infections observed were tuberculosis (38.03%), recurrent diarrhea (30.99%), oral candidiasis (21.13%) and recurrent bacterial pneumonia (12.68%). Six (8.45%) children died during the study period, which included 4 (5.63%) cases of HIV-encephalopathy. CONCLUSION: Vertical transmission was the major route of HIV infection. Persistent fever, cough, loss of appetite and loss of weight were common presenting clinical features. Tuberculosis was the commonest opportunistic infection.

Organochlorine residuals in groundwater of Pondicherry region.

Nineteen representative water samples were collected from surface and ground water sources, covering urban, rural area, shallow and deep aquifers in Pondicherry region. The samples were analysed for various pesticide residues such as HCH, Aldrin and DDT. Both surface and ground water sources found to exhibit the residuals of various pesticides. The residual levels oforganochlorine pesticides were found to be three to four times more in ground water sources of agricultural areas than in urban areas, indicating the impact of usage of pesticides for agriculture. It is evident that total residuals of organochlorine pesticides are more in tanks followed by shallow wells and deep wells. However, the residual levels of pesticides were found well below the maximum acceptable level of 100 ng/L for individual pesticides for drinking purpose in the study area. Though the residual levels of pesticides in the study area were well below the acute toxicological problems, the major concern is for long term, chronic exposure from compounds that may be carcinogenic.

PCR detection and typing of human papilloma virus DNA in squamous carcinoma of the cervix in a cohort of Sri Lankan women.

OBJECTIVE: To determine the prevalence of human papilloma virus (HPV) types 16 and 18 in squamous carcinomas of the cervix in Sri Lanka. DESIGN: Case control study. SETTING: One gynaecological unit at the Cancer Institute, Maharagama, Sri Lanka. PATIENTS: 15 patients with squamous carcinoma of the cervix, and 15 age matched controls with histologically normal cervices. MEASUREMENTS: DNA was extracted from paraffin embedded cervical biopsies. Polymerase chain reaction was performed on extracted DNA employing primers specific for HPV types 16 and 18. RESULTS: HPV 16 DNA was detected in 11 out of 15 cervical cancer biopsies (73.3%), in comparison with 3 out of 15 normal controls (20%). HPV 18 was detected in 3 out of 15 cervical cancer biopsies, but not in a single control biopsy. CONCLUSION: Despite the limited number of cases in this cohort, this study supports the strong association between HPV 16 and squamous cancer of the cervix.

Study on ground water characteristics and the effects of discharged effluents from textile units at Karur District.

A study was made on the physico-chemical characteristics of water samples mixed with effluent discharged from textile industries at Chellandipalayam (Site--I), Senaparatti (Site--II) and Pasupathipalayam (Sites--III and IV) revealed the elevated levels of Ca, Mg, Na, Cr, K, Ni, Cu, Zn, CO3, SO4, NO3 and Cl- . The concentrations of these ions exceeded the limit prescribed by ISI. The increase in the concentrations of ions was revealed by higher values of electrical conductivity (EC). Water at these sites was found to be hard, brackish and unsuitable for drinking purpose. In all these sites, the seed germination of rice alone was significantly affected among the other crops tested. Irrigation of crops with ground water notably lowered the quantity of reserve food in rice, wheat (starch), and sugarcane (sugar), indicating the interference of their metabolic pathway by polluted ground water.

Nutrient concentration in groundwater of Pondicherry region.

The surface and groundwater samples were collected from urban, rural areas, shallow and deep aquifers in Pondicherry region. The samples were analysed for various nutrients such as Nitrate Nitrogen, Nitrite Nitrogen, Ammonia Nitrogen, Phosphate and Dissolved silica.The elevated concentrations often fold increase against a background concentration of less than 2 mg/L of nitrates was observed in the study area. The maximum nitrate concentration (22 mg/L) in water is well within the limits of 45 mg/L prescribed by World Health Organization. The nutrients were observed about 2 to 3 times higher in groundwater of urban areas than in rural areas, indicating abundant leaching of nutrients from municipal waste and sewage effluent. The nutrients displayed a trend of higher concentration in shallow groundwater and lower in the water in deep aquifer and tank water. The higher concentrations of dissolved silica (13 mg/L to 100 mg/L) against an average concentration of 5 mg/L in the ground water of unreactive aquifers shows the presence of amorphous silica in the subsurface formations, slightly acidic to neutral nature of water in aquifers and also interaction between formation material and water.

Chronic hepatitis in a large Indian hospital.

BACKGROUND. In developed countries as well as in Southeast Asia, the hepatitis B and C viruses are the main causes of chronic hepatitis. In India, however, there have been no major investigations on the aetiology of chronic hepatitis. (The hepatitis E virus which is responsible for half the sporadic and most of the epidemic cases of acute viral hepatitis in India does not cause chronic disease.) We, therefore, studied the profile of chronic hepatitis in India. METHODS. The clinical presentation, aetiology, serology and histological changes were studied prospectively in 48 patients with chronic hepatitis admitted to the All India Institute of Medical Sciences, New Delhi. Of these, 44 (92%) had chronic active hepatitis, 3 (6.3%) had chronic persistent hepatitis and 1 (2%) had chronic lobular hepatitis. RESULTS. The hepatitis B virus was the aetiological agent in 24 (50%) of these patients, the hepatitis D virus in association with hepatitis B virus in 10 (21%), the hepatitis C virus in 7 (15%) and the non-A, non-B viruses other than the hepatitis C virus in 6 (13%). One patient (2.0%) had autoimmune chronic active hepatitis. Jaundice at presentation was seen in 33 (69%) patients and more than half had hypoalbuminaemia (< 3 g/dl) with a prolonged prothrombin time. Alanine aminotransferase levels were less than 5 times above normal in over two-thirds of the patients. The highest alanine aminotransferase values were observed in patients with hepatitis D virus infection whereas the lowest were seen in patients with non-A, non-B related chronic active hepatitis. Histological examination revealed bridging necrosis in 40 (91%) patients with chronic active hepatitis indicating a severe form of disease. Replication of the hepatitis B virus was seen in 13 patients with chronic hepatitis, 5 of whom had hepatitis D virus-induced chronic hepatitis. Patients with hepatitis B virus replication had higher alanine aminotransferase values and more severe bridging necrosis than patients who did not have replicating viruses. Higher alanine aminotransferase values, ascites and oesophageal varices were encountered more frequently in patients with hepatitis B and D virus than in those with non-A, non-B related chronic hepatitis. CONCLUSION. Chronic hepatitis is not uncommon in India. It presents with evidence of severe disease and, as elsewhere, is most frequently caused by the hepatitis B virus.