Evaluation of drug treatment awareness among caregivers and patients of chronic kidney disease: unexplored determinant in patient care

Background: Chronic kidney disease (CKD) patients are prescribed multiple drugs to slow disease progression and prevent complications mandating adherence to therapy. Lack of awareness about drug treatment is one of the contributors to nonadherence. Hence the study was conducted to explore the awareness of patients and caregivers towards CKD treatment. Methods: The study was a cross sectional questionnaire-based study conducted among 300 CKD patients (150 dialysis/150 non-dialysis) and 100 caregivers (50 of dialysis / 50 of non-dialysis patients) attending nephrology OPD at a tertiary care hospital.Patient /caregiver awareness about drug treatment was assessed usinga prevalidated drug awareness questionnaire (8 items). The items were scored as correct response=2, no response=0 and incomplete response = -1, accounting the total awareness score as +20 to - 6 Results: The mean awareness score of patients / caregivers was 8.16±3.41 and 8.3±1.6 respectively. Majority (>70%) patients/ caregivers gave accurate responses for the items -specifying number of medicines, medication frequency and regular intake of drugs but awareness regarding action plan for skipped (27% patients, 11% caregivers) or missed doses (22% patients, 15% caregivers) and adverse effects (17% patients, 5% caregivers) was poor. Patients/ caregivers belonging to dialysis group had statistically better awareness then non-dialysis group. Conclusions: Patient /caregiver awareness regarding drug treatment is less than 50% with strikingly low awareness about dose regimen, adverse effects, action plan for missed doses and co morbidities. Patient education programs to reinforce and retain this knowledge need to be implemented in CKD patients.

Vulnerability to Mental Health Problems in Indian Population during Lockdown amidst COVID-19 Pandemic: An Alarm not to Snooze

Background: Lockdown measures are being implemented in several parts of the world to control the spread of novel coronavirus. This unprecedented crisis has significantly affected the lives of people in different ways. Aim: To understand the experiences and vulnerability to mental health problems during lockdown among the Indian population during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted using an online survey form circulated through various social media platforms from April 12 to May 3, 2020 containing self-reported questionnaires to collect lockdown related experiences and scales to assess anxiety (GAD-7) and depression (PHQ-9). A convenience sampling method was used. Results: 442 valid responses were received from different states of India. Statistical analysis revealed that one-third of the respondents suffered from some form of anxiety and depression during a lockdown. Less than 10% of them had severe levels of symptoms. The majority were males aged 18-45 years and private sector employees. Delivering essential services was involved with significant anxiety and depression. Availability of food and daily essentials was the most common problem. Difficulty in availing medicines and financial crisis were significant predictors of anxiety and depression. Worsening of interpersonal relationships was associated with higher levels of anxiety and depression. Conclusions: The study concluded that experiences during the lockdown and associated psychological outcomes are important factors to consider and appropriate preventive measures to be taken in case of any future lockdowns.

Molecular stratification of high-grade urothelial carcinoma by immunohistochemistry with its histomorphological and clinical correlation

Introduction: Urothelial carcinoma poses a significant cause of morbidity and mortality. The recent classification of Tumors of Urinary System by World Health Organization fourth edition) has elucidated its molecular subtypes and its associated prognostic significance. Methods: We used immunohistochemistry marker expression (CK5/6, CK20, CD44, EGFR) as a surrogate marker, to stratify 150 cases of high-grade urothelial carcinoma into the intrinsic molecular subtypes. A correlation was also done with immunohistochemical markers p53, p21, E-cadherin and Ki-67. Results: On subtyping, 47.3% cases were basal, 42.7% luminal and 10% remained unclassified. We did not find GATA3 useful for molecular stratification in our study. Muscle invasion was seen in 59% of basal and 31% of luminal subtype (P = 0.016). Squamous differentiation was most commonly associated with basal subtype (P < 0.001). EGFR expression was seen in 62% of basal and 38% of luminal subtype (P = 0.014), and thus can be used as an additional marker for molecular stratification. Overexpression of p53 was seen in 64% cases of muscle invasive and 36% of non-muscle invasive high-grade carcinomas (P < 0.0001). An inverse relationship was observed between p53 and p21 immunoexpression (r = –0.494) (P < .0001). The overall survival at 1- and 2-year interval was more in the luminal subtype, suggesting an early mortality in basal group, (P = 0.827), and at 6 years both the groups had almost similar results. Conclusion: High-grade urothelial carcinoma is challenging in terms of therapeutic strategy. Increased understanding of underlying molecular basis helps identifying targetable treatment options, and newer biomarkers will enhance predictive and prognostic stratification.

Attitude and perception of post-graduate residents toward thesis: A cross-sectional study

Background: To increase research productivity among post-graduate (PG) students, there is inclusion of research dissertation or thesis in their academic curriculum. However, thesis or research project during the residency remains is the last priorities due to high demands on the PG student’s energy and time in terms of patient care. There are a very few such studies conducted in our nation pertaining to perception of PG students toward thesis. Aim and Objectives: This study is to assess the attitude and perception of medical PG residents toward research dissertation or thesis during residency training. Materials and Methods: This was an observational, cross-sectional study with the 2nd and 3rd year MS/MD PG students as participants. Study tool was pre-validated questionnaire consisting 40 questions under following domains: University regulations (5), attitude toward thesis (4), perception toward benefits of thesis (15), perception toward obstacles of thesis (13), and practice in regard to thesis (3). A study was initiated after approval of Institutional Ethics Committee. After obtaining written informed consent, a questionnaire was given to each student and was collected after 25–30 min. Confidentiality of responses was ensured by maintaining anonymity of responders. Data were entered into Excel and a descriptive analysis was done. Results: Of these 55 pre/paraclinical and 70 clinical PG students (n = 125) returned completely filled questionnaire. The mean age of the students was 27.40 ± 2.20 and was in the 2nd or 3rd year of the residency. 256% participants were from clinical whereas 44% were from pre/paraclinical branches. The majority of postgraduate students preferred observational studies (80%) over interventional study for thesis (19.2%). 61.6% PG students felt that thesis should be mandatory. Majority of students agreed to benefit of thesis which helps them to develop skills such as literature search (92.8%), data processing (84%), statistical analysis (73.6%), interpretation of results, and discussion (80.8%). PG students felt that there are few obstacles in their thesis such as inadequate lab facilities (66.4%), inadequate study tools (62.4%), and incompetent technical staff (55.2%). Conclusion: A number of barriers such as lack time, funding, and poor availability of research facilities for conduct of research need to be addressed to further enhance PG student’s positive attitude toward thesis.

Detection of rifampicin resistance in tuberculosis by molecular methods: A report from Eastern Uttar Pradesh, India.

Diagnosis of drug resistance tuberculosis (TB) by the gold standard method is labour intensive and time consuming. Hence, there is an urgent need for introduction of rapid diagnostic techniques. Line probe assay (LPA) and cartridge‑based nucleic acid amplification test (CBNAAT) have been introduced in India under Revised National Tuberculosis Control Program. Spot and morning sputum samples of previously treated patients by anti‑TB drugs were subjected to LPA or CBNAAT. Total 682/1253 (54.4%) were diagnosed as rifampicin‑resistant. The patients could be diagnosed early by molecular methods and put on second line treatment.

Asymptomatic reproductive tract infections/sexually transmitted infections among HIV positive women.

This study aims to highlight the importance of screening all HIV positive women for various reproductive tract infections/sexually transmitted infections (RTIs/STIs) irrespective of symptoms and to determine its occurrence in asymptomatic HIV positive women. Relevant specimens were collected for diagnosis of various RTIs/STIs. STIs were diagnosed in nearly one‑third of the HIV positive asymptomatic patients which is quite high. The national strategy for STIs/RTIs control misses out large number of asymptomatic RTIs/STIs in HIV positive women which is responsible for silently transmitting these infections in the community. So this strategy should be modified to include screening of all HIV positives women irrespective of symptoms of STIs/RTIs.

Cutaneous T-cell lymphomas and their management strategies.

Cutaneous T-cell lymphomas (CTCLs) comprise a heterogeneous group of lymphoproliferative disorders characterized by the proliferation of skin-homing post-thymic T-cells. It is the second most common extranodal non-Hodgekin's lymphoma. Many variants of mycosis fungoides and CTCLs are known to date, differing in clinical, histological, and immunophenotypic characteristics. Oral involvement has also been reported rarely in CTCLs. Treatment depends on the disease stage or the type of variant. New insights into the disease and the number of emerging novel therapeutic options have made it an interesting area for dermatologists and medical oncologists.

Recent trends in Molecular Imaging : PET/CT in Neurology.

PET/CT is an important molecular imaging technique for the assessment of neurological disorders. The most widely used radiopharmaceutical for both clinical and research purposes is [18F] 2-fluoro-2-deoxy-D-glucose (FDG). It is extensively used owing to its favourable physical characteristics. It enables depiction of cerebral glucose metabolism, and has thus been used to study various pathological states. Despite this, FDG has its own limitations. This is owing to its limited specificity and high cortical uptake. This has paved the way for the development of several non-FDG PET radiopharmaceuticals. We present the insights gained at our institution, using these radiotracers in the assessment of neurological disease. Our study shows that the use of FDG and non-FDG novel PET radiopharmaceuticals facilitates the early diagnosis, delineation of extent, prognostication and monitoring of therapeutic response in several neuropathological states.

Stem cell therapy: A novel & futuristic treatment modality for disaster injuries.

Stem cell therapy hold the potential to meet the demand for transplant cells/tissues needed for treating damages resulting from both natural and man-made disasters. Pluripotency makes embryonic stem cells and induced pluripotent stem cells ideal for use, but their teratogenic character is a major hindrance. Therapeutic benefits of bone marrow transplantation are well known but characterizing the potentialities of haematopoietic and mesenchymal cells is essential. Haematopoietic stem cells (HSCs) have been used for treating both haematopoietic and non-haematopoietic disorders. Ease of isolation, in vitro expansion, and hypoimmunogenecity have brought mesenchymal stem cells (MSCs) into limelight. Though differentiation of MSCs into tissue-specific cells has been reported, differentiation-independent mechanisms seem to play a more significant role in tissue repair which need to be addressed further. The safety and feasibility of MSCs have been demonstrated in clinical trials, and their use in combination with HSC for radiation injury treatment seems to have extended benefit. Therefore, using stem cells for treatment of disaster injuries along with the conventional medical practice would likely accelerate the repair process and improve the quality of life of the victim.

Behavioural responses of desert gerbil, Meriones hurrianae after removal of scent marking gland.

The desert gerbil, M. hurrianae scent marks the general substratum in its territory with the sebum exudation of mid abdominal gland and urine. Having assessed number of functions, which scent marking plays in the social life of these rodents, the scent marking behaviour was studied in animals, in which the gland was surgically removed and was compared with that of intact rodents. After recovery from the operation, the scent marking frequency of both male and female M.hurrianae declined significantly and was maintained at a low level. Surprisingly, scent marking with urine also declined considerable with time. After 5 months of the operation, desert gerbils were given a choice to respond to male and female sebum odours. The frequency of their scent marking with either sebum or urine did not show any significant enhancement as compared to their initial marking rate. However, the duration of their stay and scent marking frequency near the source of the sebum odour was more that in the clean side of the cage. The role of such altering behaviors of M. hurrianae and their impact on social organization are discussed.

Genotypic variation in Brassica juncea (L.) Czern. cultivars in growth, nitrate assimilation, antioxidant responses and phytoremediation potential during cadmium stress.

Four cultivars of Brassica juncea i.e. TM-4, TM-2, RH-30 and T-59 were screened for seed germination and seedling growth up to 15 days in the presence of 0.5-1.5 mM cadmium (Cd). The exposure to Cd reduced seed germination and seedling growth (root and shoot length and dry weight) in all four cultivars; the effect being more severe in TM-2 and RH-30 than in TM-4 and T-59 and at 3 d than at 7 d and 15 d. The cultivars TM-4 and T-59, with higher tolerance to Cd toxicity, were selected for further analysis including the estimation of nitrate reductase (NR) and peroxidase (POD) activities, total organic nitrogen (TON), total soluble proteins, proline levels and Cd accumulation. The NR activity and total soluble proteins decreased upon Cd exposure in a concentration dependent manner, whereas TON increased significantly in 3 d seedlings upon Cd exposure. The activity of POD and proline level increased significantly as compared to the respective controls. The level of Cd accumulation was higher in T-59 than in TM-4. Therefore, T-59 was found to be the most tolerant cultivar to Cd than other three cultivars possibly due to a better capacity to transport Cd in their vacuolar sink. The variety T-59, thus, appears to be suitable for Cd phytoremediation.

Impact of rhizobacteria on growth and chromium accumulation in Scirpus lacustris L. grown under chromium supplementation.

Four chromate tolerant rhizobacterial strains viz., RZB-01, RZB-02, RZB-03 and RZB-04 were isolated from rhizosphere of Scirpus lacustris collected from Cr-contaminated area. These strains characterized at morphological and biochemical levels. The most efficient chromate tolerant strain RZB-03 was inoculated to fresh plant of S. lacustris and grown in 2 μg ml -1 and 5 μg ml -1 of Cr +6 supplemented nutrient solution under controlled laboratory condition. The effects of rhizobacterial inoculation on growth and chromium accumulation in S. lacustris were evaluated. The inoculation of rhizobacteria increased biomass by 59 and 104%, while total chlorophyll content by 1.76 and 15.3% and protein content increased by 23 and 138% under 2 μg ml -1 and 5 μg ml -1 concentrations of Cr +6, respectively after 14 d as compared to non-inoculated plant. Similarly, the Cr accumulation also increased by 97 and 75% in shoot and 114 and 68% in root of inoculated plants as compared to non inoculated plants at 2 μg ml-1 and 5 μg ml-1 Cr+6 concentrations, respectively, after 14 d. The chromate tolerant rhizobacteria which play an important role in chromium uptake and growth promotion in plant may be useful in development of microbes assisted phytoremediation system for decontamination of chromium polluted sites.

Effectiveness of HIV Counseling Services on Knowledge, Attitude, Behavior and Practice (KABP) Among Pregnant Women Attending PPTCT Program.

Counseling services is an important component of National AIDS Control Program which aims at creating awareness and promoting changes in reducing high risk behavior against HIV/AIDS. Pregnant women attending antenatal clinics are being counseled about HIV/AIDS under prevention of parent to child transmission (PPTCT) program. The objective of this study was to assess (KABP) regarding HIV/AIDS among pregnant women attending PPTCT program before and after counseling at Lok Nayak Hospital, New Delhi. A Quasi-experimental study was conducted. Data was collected by interviewing 600 pregnant women attending ANC clinic during May 2006 to May 2007 using a pre-test and post-test interview schedule. About 69.2% of the pregnant women had heard about AIDS before the counseling. Knowledge regarding mother to child transmission of HIV was 53.5%. 38.2% knew that mother to child transmission can be reduced by drugs. The knowledge of pregnant women about AIDS was significantly different in pre-test (mean score =15.3) and post test (mean score=35.6) (P<0.0001). Attitude of study participants towards people living with HIV/AIDS (PLWHA) indicated that individual. with HIV should be allowed to work (79.9%) and all commercial sex workers should compulsorily be tested for HIV (55.1%). There was significant difference between in pre-test and post-test attitude about PLWHA and HIV testing (p<0.0001). The condom use among the study participant significantly improved after counseling (1.2% in pre-test and 58.6% after counseling) (p<0.0001). Counseling services were effective in increasing knowledge and changes in attitude and behavior among pregnant women and the efforts needs to be sustained.

Responses of cyanobacterium Anabaena doliolum during nickel stress.

Growth and biochemical responses of heterocystous nitrogen fixing cyanobacteria Anabaena doliolum were studied upon exposure to various concentrations of nickel (0.1 to 100 mM) for duration of upto 4 days, in view of its tolerance. The growth of the cyanobacterium was increased in terms of cell density (O.D), heterocyst frequency, chlorophyll-a, carotenoid and c-phycocynin upto moderate exposure (10 mM for 96 hr of Ni treatment). Protein and total non protein thiol were measured as stress responsive metabolites and frequency of heterocyst and spores were observed in responses to Ni. The present study demonstrated that the tested cyanobacterium exhibited dose specific responses of metal towards studied different morphological, physiological and biochemical parameters.

Chromium (VI) induced phytotoxicity and oxidative stress in pea (Pisum sativum L.): Biochemical changes and translocation of essential nutrients.

Due to widespread industrial use, chromium (Cr) is considered a hazardous environmental pollutant. It is known to inhibit plant growth and development. The present study provides the evidence of the phytotoxicity of this metal on the pea (Pisum sativum L. cv Azad) plants. The plants of pea (Pisum sativum L.) were grown in refined sand under different concentrations i.e. 0.05, 0.1, 0.2, 0.3 and 0.4 mM of Cr (VI) in order to study the effect on growth and yield, photosynthetic pigments, relative water content, non-reducing sugar and protein with activity of certain enzymes like catalase, peroxidase, starch phosphorylase and ribonuclease. The analysis of the results showed that photosynthetic pigments (68.68%), relative water contents (62.77%), non-reducing sugar (66.66%) and protein (81.57%) were decrease along with reduction in plant height (52.69% ) and leaf area (50.81%) of the pea plants. However, in response to various concentration of Cr exposed plants showed significant induction of reducing and total sugars with enzymes like catalase, starch phosphorylase and ribonuclease. The translocation of Cr in various part of pea plant have been found in order of root> stem> leaves>seeds which ranged between 34.8 to 217.3 mg g-1 d.wt. (dry weight) in roots, 6.5 to 173.13 mg g-1 d.wt. in shoot, 4.2 to 74.43 mg g-1 d.wt. in leaves and 0.94 to 8.64 mg g-1 d.wt. in seeds, that is also reflected by the transfer factor of Cr from refined sand to tested species.

Etiological profile of stroke and its relation with prothrombotic states.

OBJECTIVE: To study the etiological profile of childhood stroke and its relation with prothrombotic states. METHODS: Children with acute stroke with no evidence of CNS infection or head injury were studied. Stroke was confirmed by CT scan and further evaluated by MRI. Cardiac status was assessed with transthoracic echocardiography. Test for hypercoagulable state (antithrombin III, protein C, protein S, anticardiolipin antibody IgG and IgM and lupus anticoagulant) were done in all patients. RESULTS: A total of 66 children were enrolled--36 cases and 30 controls. Presenting symptoms were motor deficit (72%), seizure (66%), altered sensorium (36%), aphasia (27%). Causes identified were antiphospholipid antibody syndrome (25%), Moya Moya disease (16.6%), cardiac disease (11.1%), vasculitis (5.5%), ATIII deficiency (5.5%), Protein C deficiency (2.7%). Etiology remained unknown in 25% of cases with infarction. Hemorrhage was seen in 8.2% of cases and they had DIC or liver disease as the underlying cause. CONCLUSIONS: Magnetic Resonance Angiography and ELISA for antiphospholipid antibody should be done in all patients with stroke without an obvious cause.

Arsenic accumulation in root and shoot vis-a-vis its effects on growth and level of phytochelatins in seedlings of Cicer arietinum L.

Arsenic (As) contamination of water and soil has become a subject of prime interest due to its direct effect on human health through drinking water and food. In present study two varieties (CSG-8962 and C-235) of chickpea, Cicer arietinum L., which is a major supplementary food in many parts of India and a valuable source of protein, has been selected to estimate the level of arsenate in root and shoot of five day old seedlings vis-à-vis effect of arsenate on seedling growth and induction of thiols including glutathione (GSH) and phytochelatins (PCs) and their homologues. Both varieties accumulated arsenate to similar levels and most of the metalloid was confined to roots, only about 2.5% was translocated to shoot. Plant growth was also not affected significantly in both the varieties. Arsenate exposure significantly induced the levels of thiols including PCs and homophytochelatins (hPCs). The induction of thiols was much higher in roots than shoots and was greater in var C-235 between the two tested ones. Thus, both varieties tolerated and detoxified arsenic through chelation with GSH, PCs and hPCs, primarily in roots, however var C-235 performed better

Advanced glycosylated end products-mediated activation of polymorphonuclear neutrophils in diabetes mellitus and associated oxidative stress.

Two important consequences of hyperglycemia in diabetes are development of oxidative stress and formation of advanced glycation end products (AGE) which are known to be associated with diabetic complications. Relationship between AGE formation and development of oxidative stress (OS) is yet to be established. In the present study, the involvement of AGE in PMN-mediated ROS generation and the associated OS were investigated in type 2 diabetic mellitus (DM) patients. We assessed OS parameters (serum MDA, FRAP and GSH), PMN oxidative functions (respiratory burst and superoxide production) and total serum AGE in 90 subjects divided equally in three groups--control group, Group I consisting of type 2 diabetic patients without microvascular complications and Group II consisting of type 2 diabetic patients with microvascular complications. PMNs isolated from both groups (I and II) exhibited higher level of respiratory burst (RB) and produced increased amount of superoxide anion as compared to the controls. The increase was more pronounced in diabetes with complications, as compared to those without. Serum malondialdehyde (MDA) level was elevated, whereas glutathione (GSH) and ferric reducing ability of plasma (FRAP) levels were significantly reduced in diabetes as compared to the controls, suggesting the presence of oxidative stress in DM. A positive correlation between PMN oxidative function and OS parameters suggested the involvement of PMN in the development of OS in DM. Serum AGE level was also elevated in diabetic groups as compared to the controls. Further, the positive correlation between serum AGE level and PMN oxidative function suggested the involvement of AGE in increased RB and generation of reactive oxygen species (ROS) by resting diabetic PMN. The results of the study indicate that AGE-PMN interaction possibly upregulates NADPH oxidase, leading to enhanced ROS generation and thus contributes to the pathogenesis in diabetes.

"Knowledge, attitude, behavior and practice (KABP) regarding HIV/AIDS among pregnant women attending PPTCT programme in New Delhi".

In India, several thousand HIV-infected babies are expected to be born every year. Despite effective intervention, the identification of HIV infected pregnant women prior to delivery is a major problem. KABP and acceptance of rapid screening of women for HIV among pregnant women attending ANC clinic and availing Voluntary Counselling and Confidential Testing services was assessed. The study was done among 90 pregnant women. There was no significant difference between one's husbands's job and income with respect to pregnant women's awareness of risk factors except that of tattooing. Education level had significant bearing on awareness level. Attitude about PLWHA indicates that 29% of the participants believed individuals with HIV shouldn't be allowed to get married, while 31% saying that they should not be allowed to have children. Participants supported compulsory HIV testing for pregnant women (39%) and couples before marriage. Almost 96% of participants had unprotected sex, though 41% casually used condom. All denied herself or her husband indulging in extramarital sex. The country is about to embark on its prevention of mother to child transmission (PMTCT) programme. This study throws some light on the level of knowledge acceptability and adoption of VCT and other PMTCT strategies among potential beneficiaries.