Major Depression: A Short Term Naturalistic Study in Outpatients.

Background: Surprisingly data regarding naturalistic or observational studies carried out in India to study Major Depressive Disorder in patients seeking outpatient treatment is almost non-existing. So this study was conducted to study the presentation and baseline characteristics of Major Depressive Disorder in Indian outpatients and the subsequent treatment and outcome after a three month follow up. Methodology: Patients seeking outpatient treatment were recruited after diagnosing an episode of Major Depressive Disorder through a clinical interview for DSM IV TR. Sociodemographic and clinical characteristics were recorded at the time of recruitment and follow up evaluations done for 3 months. All the patients were given outpatient treatment best suited to the patient profile. Results :.More than 90% patients reported one or more somatic symptoms spontaneously on presentation . Barely half of the patients out of 119 recruited completed three month follow up. 50 (81%) patients out of 62 who received adequate treatment met recovery criteria at the end of three months. Initial depression severity and receiving regular adequate antidepressant therapy was found to be associated with recovery. While sociodemographic variables were not found to significantly affect treatment outcome or compliance. Conclusion : Somatic presentation of depression is quite common in Indian patients .The high noncompliance indicate the need for strategies to be made to improve compliance and the good response to treatment found in naturalistic conditions in this study calls for more such studies to be done for better understanding of predictors of outcome in naturalistic conditions in India.

Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution.

A 39 year old male, chronic alcoholic for 12 years, presented with recurrent abdominal pain for last 3 years. He was admitted in our hospital with history of breathlessness, chest pain and abdominal pain for last 20 days. On investigation he had raised total leukocyte count with elevated serum amylase and lipase. Chest radiograph showed mediastinal widening and ultrasound of abdomen revealed chronic pancreatitis with peripancreatic pseudocysts. CT scan revealed extensive phlegmonous collections with cyst formation in the mediastinum which extended from the level of thoracic inlet to below the level of the diaphragm. There were in addition multiple pancreatic and lesser sac pseudocysts. Patient was stable and was hence closely observed on conservative treatment with complete abstinence from alcohol. We performed no surgical, endoscopic or radiological interventions. A repeat CT performed after 14 weeks showed almost complete resolution of the mediastinal pseudocyst. Overall adequate conservative management and timely imaging follow-up before planning any intervention helped us to see that there can be spontaneous resolution of mediastinal pseudocysts.

Mekong malaria. II. Update of malaria, multi-drug resistance and economic development in the Mekong region of Southeast Asia.

In an expansion of the first Mekong Malaria monograph published in 1999, this second monograph updates the malaria database in the countries comprising the Mekong region of Southeast Asia. The update adds another 3 years' information to cover cumulative data from the 6 Mekong countries (Cambodia, China/Yunnan, Lao PDR, Myanmar, Thailand, Viet Nam) for the six-year period 1999-2001. The objective is to generate a more comprehensive regional perspective in what is a global epicenter of drug resistant falciparum malaria, in order to improve malaria control on a regional basis in the context of social and economic change. The further application of geographical information systems (GIS) to the analysis has underscored the overall asymmetry of disease patterns in the region, with increased emphasis on population mobility in disease spread. Of great importance is the continuing expansion of resistance of P. falciparum to antimalarial drugs in common use and the increasing employment of differing drug combinations as a result. The variation in drug policy among the 6 countries still represents a major obstacle to the institution of region-wide restrictions on drug misuse. An important step forward has been the establishment of 36 sentinel sites throughout the 6 countries, with the objective of standardizing the drug monitoring process; while not all sentinel sites are fully operational yet, the initial implementation has already given encouraging results in relation to disease monitoring. Some decreases in malaria mortality have been recorded. The disease patterns delineated by GIS are particularly instructive when focused on inter-country distribution, which is where more local collaborative effort can be made to rationalize resource utilization and policy development. Placing disease data in the context of socio-economic trends within and between countries serves to further identify the needs and the potential for placing emphasis on resource rationalization on a regional basis. Despite the difficulties, the 6-year time frame represented in this monograph gives confidence that the now well established collaboration is becoming a major factor in improving malaria control on a regional basis and hopefully redressing to a substantial degree the key problem of spread of drug resistance regionally and eventually globally.

Hepatoprotective activity of picroliv against carbon tetrachloride-induced liver damage in rats.

Administration of carbon tetrachloride to normal rats increased activities of hepatic 5(1)-nucleotidase, acid phosphatase, acid ribonuclease while the activities of succinate dehydrogenase, glucose 6-phosphatase, superoxide dismutase and cytochrome P450 were decreased. Levels of lipid peroxides, total lipids and cholesterol of liver were also increased. The activities of serum glutamate oxaloacetate transaminase, glutamate pyruvate transaminase and alkaline phosphatase were increased. Other serum parameters showing changes after carbon tetrachloride were: bilirubin, proteins, cholesterol, triglycerides and lipoprotein-X. Picroliv (from the plant Picrorhiza kurroa) in doses of 6 and 12 mg/kg provided a significant protection against most of the biochemical alterations produced by carbon tetrachloride. The degree of protection afforded by picroliv, when administered simultaneously or as a pretreatment was almost equal.

Evaluation of hepatoprotective activity of picroliv (from Picrorhiza kurroa) in Mastomys natalensis infected with Plasmodium berghei.

Administration of picroliv, a standardized fraction of alcoholic extent of Picrorhiza kurroa (3-12 mg/kg/day for two weeks) simultaneously with P. berghei infection showed significant protection against hepatic damage in Mastomys natalensis. The increased levels of serum glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT), alkaline phosphatase, lipoprotein-X (LP-X) and bilirubin in the infected animals were marked reduced by different doses of picroliv. In the liver, picroliv decreased the levels of lipid peroxides and hydroperoxides and facilitated the recovery of superoxide dismutase and glycogen. Picroliv had no effect on the degree of parasitaemia.

Platelet ionic calcium and serum total calcium in essential hypertension.

A total of 44 cases comprising hypertensive (31) and normotensive group (13) were studied. Serum total calcium concentrations remained unaltered in hypertensives. Platelet cytosolic calcium in hypertensive group was significantly higher as compared to the normotensive controls. Platelet cytosolic calcium correlated with systolic and diastolic blood pressure and mean arterial pressure significantly.

Lipid profile in smokers.

In this study we observed that all the lipids except HDL cholesterol were higher in heavy smokers and those making for longer duration. HDL cholesterol was lower in smokers than nonsmokers. The changes in lipid profile were similar in cigarette and bidi smokers.