Socio-economic & household risk factors of malaria in tribal areas of Madhya Pradesh, central India.

Background & objectives: Malaria is a major public health problem in many states of the country, particularly, in Madhya Pradesh where both Plasmodium vivax and P. falciparum are endemic. Although many studies have been conducted to investigate risk factors for malaria, but only a few have examined household and socio-economic risk factors. The present study was, therefore, undertaken to explore the relationship of different socio-demographic, socio-economic and behavioural risk factors with malaria prevalence in tribal areas of Madhya Pradesh, India. Methods: This study was undertaken in all 62 villages of Bargi Primary Health Centre from May 2005 to June 2008. These villages comprised 7117 households with an average family size of five members. fortnightly fever surveys were conducted in all villages to assess prevalence of malaria infection in the community. The distinct univariate and multivariate logistic regression models were fitted on the data set. Results: The important socio-demographic risk factors like age of household head, social group, occupation and family size; socio-economic factors like type of walls of house, place of drinking water source, irrigated land, cash crop; and behavioural variables like place of sleeping, use of bed nets, etc. were found significantly associated with malaria in univariate analyses. in multivariate analyses only social groups, family size, type of walls of house, and place of sleeping had strong significant association with prevalence of malaria. Interpretation & conclusions: The study shows that in tribal areas where people are living in poor quality of houses with no proper use of preventive measures, malaria is firmly established. We conclude that community based interventions which bring improvement in standard of living, access to healthcare facilities and health awareness, will have a significant impact on malaria prevention in these areas.

Low free to total PSA ratio is not a good discriminator of chronic prostatitis and prostate cancer: An Indian experience.

Aims: To find out the utility of free to total PSA ratio in discriminating chronic prostatitis and prostate cancer. Setting and design: The patients visited urology clinics at Batra Hospital and Medical Research Center, New Delhi. Background: The use of serum free to total PSA as a diagnostic tool for prostate cancer has led to early detection of prostate cancer; however, the effect of inflammation on f/t PSA ratio restricts its use in early detection of cancer. Materials and Methods: The study was conducted in age related 101 patients which include 27 carcinoma patients (group I), 34 BPH patients (group II) and 40 chronic prostatitis patients (group III). Serum total PSA (tPSA) and free PSA (fPSA) were analyzed on Elecsys 2010. These were compared with histological reports of biopsy specimen. Other biochemistry tests were done on Randox Imola. P Value was calculated using one way ANOVA with posthoc Bonferroni analysis. Results: Serum total PSA levels were comparable in group I and III and were higher than group II (P < 0.049). Serum fPSA in group I was not significantly different from group II and III, However, group II has higher levels than group III (P < 0.035). Difference was significant for f/t PSA ratio in group I and II (P < 0.00) and group II and III (P < 0.000).Group I and III were with comparable levels (P < 0.807). Conclusions: f/t PSA ratio is not a good discriminator for malignancy and chronic prostatitis. This limitation of f/t PSA ratio must be taken into consideration while interpreting the results clinically.

Evaluation of oxidative stress and antioxidant activity in pre and post hemodialysis in chronic renal failure patients from Western region of Nepal.

Objective: To evaluate the oxidative stress and antioxidant activity in pre and post hemodialy- sis in chronic renal failure patients using a diacetate cellulose membrane. Background: Chronic Renal Failure is a gradual, progressive and irreversible loss of normal functioning of kidneys. This is associated with increased formation of reactive oxygen species and increased oxidative stress. No studies have been undertaken in this area in Nepal. Method: The study groups were devided into chronic renal failure patients undergoing hemodialysis (n=52) and healthy controls (n=52). Diacetate cellulose was used as dialyzer membrane for chronic renal failure patients. Blood samples were collected in EDTAbottles and plasma was used for the estimation of oxidative stress marker, total antioxidant activity, vita- min C, α-tocopherol, urea and creatinine. Results: There was significant reduction in the levels of vitamin C,α -tocopherol and total antiox- idant activity in post dialysis patients compared to predialysis and control groups (p<0.001). Plasma urea and creatinine levels were high in predialysis patients compared to controls and was significantly reduced after dialysis. Significantly elevated malondialdehyde levelswere found in chronic renal failure patients before and after dialysis when compared with controls. Conclusion: The results of our study indicate that there are reduced levels antioxidants in chronic renal patients in pre and post dialysis condition and also more loss of antioxidants after dialysis. All these condition leads to increased oxidative stress in these patients.

Impact of Tonsillectomy on Quality-of-life in Children: Our Experience.

An important requirement of contemporary medicine is the assessment of patient benefit or change in health status resulting from medical or surgical intervention. Tonsillectomy is a commonly performed surgery in children. Its indications and benefits have been documented in the literature but to the best of our knowledge, there have been no Indian studies to measure the quality-of-life (QOL), post-tonsillectomy, in children. Objective: To assess QOL of children after tonsillectomy, with or without adenoidectomy. Study design and setting: Retrospective study in a tertiary referral center. Methodology: The sample consisted of 136 children who had undergone tonsillectomy with or without adenoidectomy over a period of two years. The parents of these children were sent a questionnaire to assess their QOL six months after the surgery. The questionnaire used was a modified version of Glasgow Children’s Benefit Inventory (GCBI), a post-intervention, health-related benefit measure. Results: Forty-four questionnaires were returned (32.2% response rate). Four questionnaires were declared invalid. Two parents reported worsening of a few symptoms, resulting in a negative score. In the remainder, the total score ranged from 2.08 to 91.6. Conclusions: Sixty-eight percent of the parents were extremely satisfied after the surgery. Overall, the parents reported change for the better in various observed aspects of the life of their children as reflected in the positive scores after intervention. Most of them reported decreased number of visits to the doctor and decreased need for antibiotic prescription, that is, there was an improvement in the ‘physical health’ aspect of the life of children. But there was no change observed in the ‘emotional and psychosocial’ aspect of behavior in children.

Apolipoprotein E polymorphism and its relation to plasma lipids in coronary heart disease.

Background : The present investigation is aimed at examining the Apolipoprotein E (APOE) genotypic influence on coronary heart disease (CHD) risk in northwest India (Punjab), where this disease is emerging as a major threat to public-health care system. Materials and Methods: The present study comprised of angiographically diagnosed coronary heart disease patients (n = 193) and controls (n = 150) of Punjab. Genetic polymorphism of APOE gene was investigated by polymerase chain reaction (PCR), and its association with lipid levels was evaluated. Results : The allele frequencies of epsilon2, epsilon3, and epsilon4 were 0.054, 0.795, 0.151; and 0.077, 0.856, 0.067 in patients and controls respectively. The bearers of E3/E4 genotype had threefold higher propensity of developing CHD in this population (OR, 3.04; CI, 1.55-6.25; P P P Conclusions : A significant association (P = 0.016) of epsilon4 allele, especially E3/E4 genotype, with CHD was observed, along with HDL-C and LDL-C concentrations, in the population of northwest India.

Oxidative stress, antioxidant status and lipid profile in ischemic heart disease patients from western region of Nepal.

Disturbed lipid profile is one of the most important and potent risk factors in ischemic heart disease (IHD). In recent years, it has been demonstrated that raised oxidative stress promotes several undesirable pathways including the formation of oxidised LDL (O-LDL) and oxidized cholesterol which encourages cholesterol accumulation in arterial tissues. We, therefore, aimed to ascertain the redox balance by measuring oxidative stress (OS) and total antioxidant activity (TAA) along with lipid profile to determine their possible association with IHD. Our study group comprised of 28 confirmed cases of IHD. The inclusion criterion was history of chest pain, ischemic changes in the ECG and good left ventricular (LV) function. Patients with diabetes mellitus, poor LV function, previous infarct and valvular heart disease were excluded. Lipid profile, plasma thiobarbituric acid reactive substances (TBARS), plasma total antioxidant activity (TAA) and urinary TBARS were estimated in these patients by standard procedures and the values were compared with 30 age, sex and socioeconomically matched normal healthy control subjects. Body mass index (BMI) and waist/hip ratio (W/H ratio) was also noted in both the groups. Lipid profile and OS (TBARS levels) were significantly raised in IHD patients. Though statistically not significant but TAA tended to be lower and urinary TBARS levels tended to be higher in patients. BMI, W/H ratio, smoking and alcohol did not show discernible association with lipid profile, OS or TAA. OS is significantly raised in majority of IHD patients. The non association of BMI, W/H ratio, smoking and alcohol with lipid profile, OS and TAA suggest that there are other risk factors which primarily contribute to the initiation and progression of IHD.

A study of oxidative stress, antioxidant status and lipid profile in diabetic patient in the western region of Nepal.

AIMS AND OBJECTIVES: Diabetes mellitus (DM) is often termed as a disease of premature aging. Several studies have indicated lopsided redox balance due to pro oxidant environment as one of the important etiological factors. Some recent researches also indicate a causal relationship with oxidative stress (OS). So far, no study has been undertaken on this aspect in Nepali populations. We, therefore, aimed this maiden study in Nepali population to examine redox balance by measuring OS and antioxidant status along with lipid profile in 37 patients of DM type- 2 and 30 matched normal subjects. METHODOLOGY: Thirty seven patients of DM type-2 without any complications (mean age= 57.6+/- 10.6 years) and 30 normal subjects (mean age= 55.8 +/- 14.8 years) were included in this study. Body Mass Index (BMI) and Waist/Hip (W/H) ratio were measured. Fasting blood sample was collected for the analysis of total antioxidant activity (TAA), plasma and urinary thiobarbituric acid reactive substances (TBARS) and lipid profile by standard procedures in both the groups. The statistical analysis was done with SPSS 10 version. RESULTS: Total cholesterol, triglyceride, VLDL-cholesterol, LDL-cholesterol, plasma and urinary TBARS were significantly raised whereas, plasma TAA was significantly reduced in DM type-2 patients as compared to controls. The comparison of old and fresh cases revealed that though TAA was lower and PTBARS and UTBARS were higher in patients but did not attain the level of significance. W/H ratio is significantly higher in patients compared to normal subjects. But, no significant correlation of BMI and W/H with lipid profile is observed in both control and patients. CONCLUSION: Oxidative stress is raised in type 2 DM patients. This along with deranged lipid profile and decreased antioxidant status could be the risk factors in the development of complications associated with DM.

Cigarette smoke induced oxidative insult in local population of Pokhara.

OBJECTIVES: To assess the effect of cigarette smoking on lipid peroxidation induced oxidative stress, antioxidants, uric acid and blood sugar in normal subjects. METHODS: The study included 61 normal subjects with regular smoking habit and 57 never-smokers normal subjects matched in respect to socio-economic status, age and BMI. Information regarding smoking habit and other personal details were collected by oral questionnaire. Total antioxidant activity (TAA), reduced glutathione (GSH), alpha-tocopherol (alpha-T), ascorbic acid (AA), uric acid (UA), plasma and urinary thiobarbituric acid reactive substances (TBARS), fasting blood sugar (FBS) and urinary creatinine (Cr) were estimated by standard procedures in both the groups. Ferric Reducing Antioxidant Power (FRAP) procedure is used to estimate TAA which measures total dietary antioxidants. Statistical analysis was done with SPSS version 10. RESULTS: The mean pack years smoked by smokers was 14.4 +/- 15.8. The plasma TBARS level in smokers and never-smokers was 2.6 +/- 0.8 and 2.5 +/- 0.6 micromol/L respectively. The respective figure for urinary TBARS level was 4.6 +/- 2.7 and 3.7 +/- 1.4 micromol/gmCr. Smokers did not show any significant difference from never-smokers with respect to GSH, alpha-T, AA, plasma TBARS and FBS. However, the smokers had significantly lower levels of TAA (p<0.05) and raised level of urinary TBARS (p<0.05) and uric acid (p<0.01) as compared to never-smokers. CONCLUSION: Our study suggests that smoking induces mild lipid peroxidation but the body is able to compensate for it by removing its adducts. Importantly it also indicates enhanced oxidation of purines which are essential components of both DNA and RNA. Dietary antioxidants are consumed to scavenge free radicals (FR) and other reactive species (RS) in smoke. Female smokers are more prone to oxidative insult than male smokers. In summary RS present in smoke induce mild lipid peroxidation but are not the major contributors of redox imbalance in smoke induced toxicity in the selected subjects.

Vitamin C status in cancer patients and healthy subjects from the local population of Pokhara.

OBJECTIVES: To assess vitamin C status by determining plasma ascorbic acid level in 55 cancer patients and 55 matched normal subjects serving as control. METHODS: The proven cancer patients were selected from those attending Manipal Teaching Hospital, Pokhara. Matched controls were from the staff of Manipal Teaching Hospital or attendants of the patients. Plasma ascorbic acid was determined by the method of Natelson. Unpaired student 't' test was used for the statistical evaluation. Statistical analysis was done by SPSS version 9 software. RESULTS: The mean level of vitamin C in normal subjects and patients was 1.03+/-0.26 mg/dl and 0.90+/-0.30 mg/dl respectively. None of the subjects in either group had deficient status (<0.2 mg/dl). Although its status was normal in both the groups but patients had lower level than normal subjects. Smokers and alcohol consumers had significantly lower level than non-smoker and non-alcoholics. CONCLUSION: In the local population, vitamin C deficiency is not an etiologic factor in malignancy. Smoking and alcohol adversely affects the status of this vitamin.

Oxidative stress and antioxidant status in cardiovascular diseases in population of western Nepal.

OBJECTIVES: To observe if there is any connectivity between oxidative stress and cardiovascular diseases (CVDs). MATERIALS AND METHODS: Patients suffering from different cardiovascular diseases (hypertension, ischemic heart disease, rheumatic heart disease) attending Manipal Teaching Hospital, Pokhara and strictly matched controls were selected for this study. Oxidative stress (OS) was measured by plasma thiobarbituric acid reacting substances (TBARS) where as antioxidant status was measured by estimating vitamin E, vitamin C and total antioxidant activity (TAA) in plasma. RESULTS: The mean level of TBARS, TAA, vitamin C and E were 2.20+0.43 nmol/ml, 547+98 mol/l, 0.88+0.15 mg/dl and 0.75+0.20 mg/dl respectively in patients. The respective values in controls were 1.86+0.43 nmol/ml, 859+139 mol/l, 0.94+0.15 mg/dl and 1.10+0.30 mg/dl. Although the OS seems to be raised in patients, is practically insufficient to oxidize biomolecules and induce CVDs. Despite vitamin C and E levels being well within normal limits, the TAA was significantly and considerably lower in patients. This is a highly interesting observation suggesting that dietary antioxidants other than these vitamins were preferentially consumed to control OS because procedure for TAA used in this study practically measures only total dietary antioxidants. CONCLUSION: OS does not appear to be an etiological factor for the cardiovascular diseases; rather slightly raised OS in patients seems to be a consequence. Further the raised OS was not due to lower nutrient antioxidant (vit. C and vit. E) in the local population studied herein.

Delivery systems for pediatric parenteral nutrition.

Delivery systems for parenteral nutrition have to be based on fundamental principles regarding venous access, choice of intravenous line, need for inline filters, infusion rate control and mode of packaging into "all in one" bags/two line/or the older three line system and, above all, the aseptic maintenance of this delivery system. Delivery systems need to be modified as per the available resources and hospital where they are to be used. Central venous access and handling of lines demand a high level of dedication and discipline, ideally left to a dedicated team of nurses and doctors. Staff training is the key factor in developing an efficient delivery system.

Zinc and copper in preterm neonates: relationship with breast milk.

The study was conducted to assess copper and zinc levels in neonate's serum, mother's serum, neonate's hair and urine and to ascertain association between them. It is of concern whether zinc and copper deficiency is present at birth and maternal blood and breast milk zinc and copper levels have any effect on this. The study sample included 155 neonates with gestational age 26-41 wks and birth weight 0.550-3.800 kg. Mother's serum, breast milk, neonate's serum, hair, urine samples were analysed for zinc and copper by atomic absorption spectrophotometry. Gestational age was estimated either singly or by combination of date of last normal menses, fetal ultrasonography, and postnatal measures of physical and neurological development by clinical examination and weight by Secca electronic balance. The neonates were classified into term and preterm, small (SGA) and appropriate for gestational age (AGA). Neonates over 37 wks and 2.5 kg served as controls. To assess the dependency, relationship and effectiveness of quantitative predictive variables on the predictions of values, multiple regression analysis was used. Neonates between 26-30 wks gestational age and < 2.5 kg birth weight had significantly low serum zinc and copper. Breast milk zinc was low in mothers delivering preterm and < 2.5 kg neonates. Urinary copper and zinc levels were high in preterm appropriate for gestational age (Pre AGA) than term neonates. Multiple regression analysis revealed that neonate's serum Cu, serum Zn, hair Cu, hair Zn, urine Cu and urine Zn had contribution variability of 49.8%, 51.8%, 49.2%, 16.6%, 52.2% and 68.9%, respectively. The effect of mother's serum, breast milk, and neonate's serum copper and zinc collectively was significant for serum copper (F = 29.59) and hair zinc (F = 32.03). Preterm and low birth weight infants during subsequent growth and development should be supplemented with zinc and copper when on breast feeding.

IDPH-8261--a new nonsteroidal antiinflammatory agent.

IDPH-8261, methyl alpha-methyl-4-(3-thienyl)benzeneacetate, exhibited marked anti-inflammatory activity in acute, subacute and chronic models of inflammation. In rats, IDPH-8261 exhibited a dose related inhibition of carrageenin-induced rat paw edema and the inhibition was greater than ibuprofen, phenylbutazone, but was three times less than indomethacin. It exhibited anti-inflammatory activity in normal and adrenalectomized rats. It also exhibited the activity against various phlogistic agents. IDPH-8261 exhibited AI activity in subacute granuloma tests. In adjuvant-induced established polyarthritis. IDPH-8261 exhibited anti-arthritic effect at a very low dose (ED50 = 4 mg/kg, p.o.). Ulcerogenic liability was the lowest (UD50 = 180 mg/kg, p.o.), when compared to reference standard drugs. Low toxicity and high efficacy may make this compound a potentially useful therapeutic agent.

Involvement of receptors in IDPH-791 induced prolongation of pentobarbitone hypnosis.

IDPH-791, when injected (ip) to mice potentiated the pentobarbitone sleeping time in a dose dependent manner. Involvement of neurotransmitters and receptors in this effect was studied using various receptor blockers, enzyme inhibitors, agonist and an amine depletor. Pretreatment with high dose of yohimbine (0.5 mg/kg), haloperidol, cyproheptadine, atropine and a combination of atropine and yohimbine significantly reversed the activity. Physostigmine, diethyldithiocarbamate and high dose of apomorphine (2.5 mg/kg) potentiated the subminimal effect of IDPH-791, whereas low dose of apomorphine (0.1 mg/kg) failed to potentiate. However, reserpine significantly reversed this response. Prazosin, phenoxybenzamine, low dose of yohimbine (0.25 mg/kg), propranolol, methysergide, mepyramine and cimetidine did not produce any change, thus ruling out the involvement of adrenergic, serotonergic and histaminergic systems. There seems to be simultaneous involvement of muscarinic receptors and postsynaptic dopamine (D2) receptors in IDPH-791 induced potentiation of pentobarbitone hypnosis.

Effectiveness of a unani therapy (sangesarmahi) in management of urinary stone disease.

A Unani medicine called fish stones, an isolate from the skull of Channa sp. when given to stone bearing patient daily in 3 equally divided doses (25 mg/capsule) for 5 days, spontaneously voided the stone in 36% of the stone patients during 5 days of therapy. The therapy did not influence the urinary chemistry and was not a powerful expulsion agent of stone but did effect on ureteric muscles to facilitate the movement of stone down the urinary tract. In guinea pigs, the therapy could not reduce the intensity of experimentally induced hyperoxaluria but showed several other beneficial effects. It decreased urinary uric acid and mucoprotein levels, serum LDH and ALT level; prevented rise in liver LDH and GAO activities and kidney-LDH activity. Histological examination revealed decreased intensity of calcification in liver, kidney and bladder tissues.

Effect of dietary methionine and inorganic sulfate with and without calcium supplementation, on urinary calcium excretion of guinea pigs (Cavia porcellus).

Supplementation of sodium sulfate and DL-methionine along with the standard diet to guinea pigs nearly doubled the urinary calcium in 6 weeks. This was probably due to decreased tubular reabsorption of calcium which was complexed with sulfate in the tubular lumen. A mild calcium load didn't further enhance calcium excretion in sodium sulfate supplemented group, but did so in methionine supplemented group. It may be due to methionine which might have increased the intestinal absorption of calcium. Both of these compounds increased citric acid excretion and decreased magnesium excretion.

Effect of dietary salt (NaCl) supplementation on urinary profile of guinea pigs (Cavia porcellus).

Sodium chloride supplementation (120 mg/kg of body weight/day) for 12 days increased the urinary excretion of calcium from 91.6 +/- 9.0 to 159.4 +/- 16.0 mumol/day and of sulphate from 266.8 +/- 24.5 to 1176.9 +/- 87.2 mumol/day in guinea pigs. The stone risk due to increased urinary calcium excretion could possibly be counterbalanced by increasing urinary sulphate excretion. High salt intake, thus, could not increase the risk of stone formation.

Frequency and duration of silent myocardial ischemia in patients with unstable angina before and after intensive medical therapy.

Frequency and duration of silent myocardial ischemia (SMI) on Holter recording were determined in 20 patients with unstable angina before and after 4 weeks of intensive triple drug therapy with oral nitrates (20-80 mg daily), betablocker (metoprolol 100-200 mg/day) and calcium channel blocker (nifedipine 40-80 mg/day). The number of ischemic episodes decreased from 445 (409 silent) to 149 (140 silent) (p less than 0.001), and mean duration of silent and symptomatic ischemia per patient decreased from 5.9 +/- 3.3 minutes to 2.4 +/- 2.6 minutes (p less than 0.001) and 4.1 +/- 5.5 minutes to 1.4 +/- 2.8 minutes (p less than 0.001) respectively. Intensive medical therapy is effective in ameliorating SMI in patients with unstable angina.

A rapid method for evaluation of analgesic and anti-inflammatory activity in rats.

Carrageenin (2%) was used to produce edema and hyperalgesia; indomethacin, phenylbutazone, aspirin, ibuprofen, analgin, paracetamol and phenacetin were tested at different doses for anti-inflammatory and analgesic activity in the same rats as the peak for the edema reached at the end of 3rd hr and for the hyperalgesia at the end of 4th hr. Indomethacin, phenylbutazone and ibuprofen reduced edema and increased the pain threshold. Analgin and aspirin increased the pain threshold relatively at a low dose. Paracetamol and phenacetin were inactive in the doses tested. Carrageenin (2%) was observed to possess both phlogistic and allogenic properties.