Prevalence of depression and anxiety in type 2 diabetes mellitus patients in tertiary care hospital

Background: The prevalence of depression and anxiety in diabetes is considerably higher than normal population and found to have a negative impact on diabetes. Objective of the study was to assess the prevalence of depression and anxiety and to identify their associated risk factors among people with type 2 diabetes mellitus.Methods: Descriptive study was done in Endocrine and medicine outpatient Department of Vijaya Hospital in Belagavi, South India. Total 384 patients with type 2 diabetes mellitus were interviewed for depression and anxiety by administering the Hospital Anxiety and Depression Scale (HADS).Results: Of the total 384 patients surveyed, depression and anxiety were found in 32.56%. (95%CI 27.8-37.2%) and 37.76% (95% CI 33.1-42.9%) respectively. In Multiple Logistic regression analysis age, unmarried, religion, duration of type II diabetes and type of treatment were significantly associated with depression symptoms, Anxiety symptoms were associated with age, Qualification, Occupation, Religion, Duration and type of treatment.Conclusions: This study found a high prevalence of depression and anxiety in patients with Type 2 DM. Therefore, the care of individuals with type 2 Diabetes Mellitus (DM) should include the screening and possible treatment of depression and anxiety in order to achieve and sustain treatment goals.

Knowledge and attitude of Indian expatriate working at Gondar, Ethiopia regarding yellow fever vaccination: a survey

Background: Ethiopia is one of the yellow fever endemic country, located in north east Africa. A large number of Indian expatriates are working in Gondar, a city located in Amhara region of country. Though yellow fever vaccination is mandatory to travel to Ethiopia but less information is available about knowledge and attitude of Indian expatriate regarding yellow fever vaccination. This study was, therefore undertaken to determine the knowledge and attitude regarding yellow fever vaccination amongst Indian expatriate working at Gondar, Ethiopia.Methods: A cross-sectional questionnaire-based study was carried out by dispensing the questionnaire to individual expatriates. 157 responses were collected from expatriate by a pre-designed standardized self-administered questionnaire.Results: The average age of expatriates was 46.62±1.28 years. Most of the expatriate (61%) were not aware of yellow fever before being advised for the vaccination. Many of them have taken the vaccine, because it was mandatory for visa process. 62 % of expatriates are aware about the duration of protection from yellow fever vaccine. Moreover 84 % of the expatriates did not know about the etiology of yellow fever. Many of them (69%) believed that yellow fever vaccine was effective in providing protection, while the remaining didn’t have adequate knowledge about its efficacy.Conclusions: So majority of expatriate didn’t have enough knowledge about yellow fever infection and the vaccination. There is need of creating awareness regarding yellow fever among expatriate.

Exposure to early childhood development interventions and its association with responsive feeding and nutritional status of 6 to 35 months old children

Background: The objective of the study was to study the association between exposure to early childhood development (ECD) interventions and responsive feeding and nutritional status among 6-35 months’ children.Methods: The present analytical cross-sectional study was conducted with 360 children from a primary health centre (PHC) area under the ECD project and 360 children from comparison PHC area. The anthropometric measurement and responsive feeding was assessed and compared among 6-35 months’ children.Results: There was significant difference in mean scores of ECD activity (p=0.001) and responsive feeding (p<0.001) in ECD area as to comparison area. In the ECD program area, the proportion of children who were malnourished (33.3%) were less as compared to control area (53.9%).Conclusions: The present study shows ECD interventions at community level delivered through frontline workers resulted in improved responsive feeding practices better nutritional outcomes for children.

Attenuation of quorum sensing-regulated behaviour by Tinospora cordifolia extract & identification of its active constituents.

Background & objectives: The pathogenicity of the nosocomial pathogens, Pseudomonas aeruginosa and Acinetobacter baumannii is regulated by their quorum sensing (QS) systems. The objective of the present study was to examine the effect of the cold ethyl acetate extract of Tinospora cordifolia stem on virulence and biofilm development in the wild type and clinical strains of P. aeruginosa and A. baumannii. The study was further aimed to identify the probable active constituents in the plant extract. Methods: P. aeruginosa virulence factors viz., LasA protease, LasB elastase and pyocyanin production were analyzed spectrophotometrically. Biofilm formation was studied using crystal violet staining-microtitre plate assay. The plant extract was fractionated using silica gel column chromatography and the most active fraction was derivatized using silylation and analyzed by gas chromatography-mass spectrometry (GC-MS). In silico testing of the molecules identified in GC-MS was performed, for binding to the P. aeruginosa LasI and LasR proteins, to predict the QS inhibitory molecules. Results: The plant extract inhibited three major virulence factors in P. aeruginosa; it exhibited enhanced biofilm formation in P. aeruginosa while decreased biofilm development in A. baumannii. The most active fraction obtained from column chromatography, exhibited suppression of virulence as well as biofilm in both the organisms. Docking scores were calculated for all the molecules identified in GC-MS, and high docking scores were obtained for 2,3,4-triacetyloxybutyl acetate, methyl 16-methyl heptadecanoate, 2-(5-ethenyl-5-methyloxolan-2-yl)propan-2-ol, methyl hexadecanoate and 2-methoxy-4-vinyl phenol. Interpretation & conclusions: The compounds showing high docking scores could probably be the QS inhibitors. These molecules can be screened further for the development of new anti-infective drugs.

Dysplasia epiphysealis hemimelica (Trevor’s disease): a rare case report with oral manifestations.

Dysplasia epiphysealis hemimelica, also known as Trevor’s disease, is an extremely rare skeletal developmental disorder of unknown etiology, characterized by an osteocartilaginous outgrowth of one or more epiphyses or of a tarsal bone during childhood. It is a rare skeletal hemimelica disorder characterized by asymmetric growth of cartilage in one or more epiphyses. Due to the unusual presentation and variability of the picture, there is no standardized treatment and outcome is very different. Also such an unusual, unique case with craniofacial manifestations has not been reported in the literature. We report a case of a 14-year-old male, who complained of irregularly placed teeth in upper and lower front teeth region. On general physical examination we noticed some skeletal abnormalities with the patient and hence we subjected him to radiographic investigations. The images were consistent with epiphyseal dysplasia hemimelica. The prognosis of DEH is variable and depends basically on its location and size. Carriers of this unusual dysplasia should be periodically monitored for the risk of recurrence.

Plexiform Neurofibroma from Palmaris Longus with Carpal Tunnel Syndrome.

Plexiform neurofibromas (NF) involving the palmaris longus tendon are rare diseases difficult to diagnose when the classical manifestations, e.g. skin pigmentation, sub cutaneous nodules, lisch nodules, family history, etc are absent. We report a case of 26 years male with plexiform NF of palmaris longus tendon which is a relatively rare site. Plexiform NF commonly involve the cranial nerves.

Magnitude of pedestrian head injuries & fatalities in Bangalore, south India: A retrospective study from an apex neurotrauma center.

Background & objectives: Pedestrians contribute to 30-40 per cent of all road traffic injuries in India. However, there is a paucity of literature on pedestrian head injury as compared to two wheeler trauma. The purpose of the present study was to study the pattern of pedestrian injuries and their outcome with a special focus on head injuries. Methods: The study was conducted in two parts in the Trauma Center at National Institute of Mental Health & Neuro Sciences, Bangalore. A retrospective study was conducted at the casualty services of the hospital in which 529 consecutive pedestrians who sustained injury in a road traffic accident were studied from June to September 2009. In the second part, records from the hospital mortuary were retrospectively analyzed from 2007 to 2009. An analysis of 326 patients who died as a pedestrian in road accidents during this period was performed. Results: Patients in both paediatric and elderly age groups constituted 47.6 per cent (252/529) of all casualty admissions. Majority of the pedestrian injuries (41.7%, 221/529) occurred between 1600 - 2100 h; 87.1 per cent of all patients received some primary care before admission. The most common offending vehicle was a two wheeler (49.1%, 260/529). At the time of admission, 55.2 per cent (292/529) patients had sustained a moderate or severe head injury (GCS 3-13), and 40.5 per cent (214/529) had an abnormal CT scan. In addition, 90.4 per cent (478/529) patients had also sustained associated injuries. Major thoracoabdominal trauma was seen in 4 per cent and spine injury in 2.3 per cent of the patients. The mortality rate was 6.6 per cent. In the postmortem group, pedestrian deaths constituted 26.2 per cent of all the postmortems conducted. Two wheelers were the offending vehicle in the majority of the fatal crashes (39.9%). Interpretation & conclusions: Pedestrian injuries form a major part of the workload of a neurotrauma emergency. Majority of them sustained moderate to severe head injury. More attention, infrastructure and strict implementation of rules may help reduce this burden.

Descemet's membrane detachment managed with perfluro-n-octane liquid.

We report the case of a 68-year-old male who developed Descemet's membrane detachment after temporal clear corneal phacoemulsification which did not settle with air or viscoelastic injection. The Descemet's membrane was successfully reattached with restoration of 20/50 vision with the help of perfluro-n-octane liquid. To our knowledge, this is the first such case to be reported.

Regional differences in constituents of gall stones.

The pathogenesis of pigment and mixed gall stone formation remains elusive. The elemental constituents of gall stones from southern states of Tamil Nadu, Kerala and Karnataka have been characterized. Our aim was to determine the elemental concentration of representative samples of pigment, mixed and cholesterol gall stones from Andhra Pradesh using proton-induced X-ray emission (PIXE) using a 3 MV horizontal pelletron accelerator. Pigment gall stones had significantly high concentrations of copper, iron and lead; chromium was absent. Except for iron all these elements were significantly low in cholesterol gall stones and intermediate levels were seen in mixed gall stones. Highest concentrations of chromium was seen in cholesterol and titanium in mixed gall stones respectively; latter similar to other southern states. Arsenic was distinctly absent in cholesterol and mixed gall stones. The study has identified differences in elemental components of the gall stones from Andhra Pradesh.

Atrioventricular septal defect--associated anomalies and aneuploidy in prenatal life.

The present study was conducted to estimate the frequency of other-cardiac, extracardiac and chromosomal anomalies in fetuses with A VSD diagnosed in a prenatal diagnosis center, analysed from the database during the 54-month period extending from November 1997 to May 2002. One hundred and three fetuses were diagnosed with A VSD. Among them other-cardiac and extra cardiac anomalies were present in 56 and 75 cases respectively. Of the 22 fetuses that had undergone karyotyping, no metaphase was seen in one case. In the remaining 21, 15 (71.4%) turned out to be normal, three (14.2%) had trisomy 18, two (9.5%) had trisomy 13 and one had trisomy 21 (4.8%). We found that AVSD almost always occurs with other-cardiac or extracardiac anomalies, though the pattern may differ between populations. It seems to be less frequently associated with chromosomal anomalies (especially trisomy 21) in South India. The genetics of AVSD underscores the importance of a thorough understanding of the target population in prenatal decision-making.

Follicular dendritic cell tumour--a case report.

Follicular dendritic cell tumors are rare entities, which are however being increasingly recognised. One such tumor in the parapharyngeal region, diagnostically challenging, and with an unusual histological feature is reported, with a short review of the literature.

Evaluation of rabies virus neutralizing antibody titres induced by intramuscular inoculation of rabies DNA vaccine in mice and Bonnet monkeys (Macaca radiata).

A rabies DNA vaccine consisting of plasmid DNA expressing the rabies virus surface glycoprotein was injected (im) twice at two week interval to outbred swiss mice or Bonnet monkeys (Macaca radiata) and the levels of rabies virus neutralizing antibody (VNA) titres were examined over a one year period. In mice, the VNA titre was maintained above the minimum protective level (0.5 I.U./ml) up to 10 months after primary immunization, while in monkeys, the titre dropped below the protective level by 6 months. An anamnestic B cell response was seen in both mice and monkeys following the administration of a booster dose, 10 and 6 months after the primary immunization, respectively. These results indicate that im injection of rabies DNA vaccine induces VNA in nonhuman primates and mice unlike intradermal (id) immunization, which was shown to induce VNA only in mice but not in monkeys. This is the first report on the induction of VNA in nonhuman primates by im inoculation of rabies DNA vaccine.

Lymphangitis carcinomatosa-diagnostic use of immunohistological staining in atypical cases

Lymphangitis carcinomatosa [LC] usually presents a typical clinical and radiological picture. However, diagnostic difficulty arises when the clinical presentation is complicated by other features or the radiological picture is atypical. This paper describes 5 atypical cases where diagnosis was established by transbronchial lung biopsy. In 2 of these cases immunohistological staining was used to determine the epithelial nature of the cancer cells or to differentiate between blood vessel capillaries and lymphatics. We believe this to be the first reported use of this staining method in LC

Craniofacial resections for paranasal malignancies

From 1984-1989, 18 patients underwent craniofacial resections for paranasal sinus malignancies involving the anterior skull base. Histologic types included 9 epidermoid cancer, 3 undifferentiated carcinoma, 3 adenoidcystic carcinoma, 2 adenocarcinoma and 1 esthesioneuroblastoma. A 44% complication rate included predominantly meningitis [22%], resulting from cerebrospinal fluid leaks [33%] and osteomyelitis [11%] An overall survival rate of 50% was recorded with follow up in all patients ranging from 26-38 months [mean 29 months]. Two surgery related deaths [11.1%] resulted from uncontrolled gram-negative meningitis. Disease free survival rate was notably better in those cases who underwent planned craniofacial surgery pre-post-operative radiation [58%] than in those in whom surgical salvage was carried for radio-recurrent tumors [33%]. Accurate pre-surgical assessment by high resolution computed tomography, satisfactory en bloc resection, meticulous repair of skull base defect and vigilant post-operative care seem to be critical factors enhancing local control sans overt morbidity

Radiorecurrent laryngeal cancers-role of salvage laryngectomy

Radiation therapy is a well established treatment for early laryngeal cancers. Recurrence after curative irradiation accounts for 15-30% of T1, T2 laryngeal cancers. Most recurrent lesions manifest in advanced stages despite close follow up and pose a challenge for surgical salvage. We recount our experience with 15 such lesions followed up over a period ranging from 18 months-4 years. Eight per cent of the lesions required upstaging with respect to clinical T stage after pathological examination. A surgical salvage rate of 86% was achieved by salvage total laryngectomy. Significant morbidity in the form of pharyngocutaneous fistula was seen in 20%. Our study re-emphasizes the utility of salvage laryngectomy even after cancericidal doses of irradiation

Treatment strategy for neck metastasis from an occult head and neck primary

This study highlights our treatment policy in 26 cases of epidemeroid metastatic carcinoma in the neck from a primary deemed occult, after exhaustive examination of the Upper Aerodigestive Tract. Planned Radical Neck Dessection and post-operative radiotherapy has been the favored approach in all neck nodes deemed resectable and a loco-regional control rate of 64% was obtained using this combined modality approach. Pre-operative Radiotherapy was utilized in three cases with nodal disease of borderline resectability and loco-regional control was achieved in one case. Three cases of massive neck matastasis initially unresectable became amenable to surgical salvage after RT with concurrently administered chemotherapy. Only one of these remained disease free. Overall loco-regional control rate of 55% could be achieved in 20 evaluable patients followed up for 2 years-3 years [mean 30.5 months]. Regional failure were noted in 25% of patients while distant spread occurred in 15%, thus accounting for an overall failure rate of 40%. Manifest primary were documented in 20%, half of which could be salvaged and successfully controlled

Rehabilitation after ablative laryngeal surgery, the kidwai experience

This study was conducted to assess the impact of total laryngectomy on the life style of thirty one [31] laryngectomized patients. Questionnaires were prepared in regional language [Kannada] which was designed to enquire about critical factors affecting successful acquisition of esophageal speech. We have observed that patients with excellent esophageal speech are motivated [100%], educated [100%], economically stable [100%] and had minimal organic defects. Seventy four percentage of patients went back to their original job though 58% of them complained of reduced income directly attributed to the loss of speech. This study emphatises that it is important to ensure regular speech therapy to facilitate satisfactory vocal rehabilitation. After two months of oncotherapy [viz., surgery and post operative RT] it is likely that patients will express their reluctance/inability to participate in such programmes owing to financial constraints and physical/mental exhaustion. Therefore it is of paramount importance to help these patients to overcome their difficulties and provide optional conditions to developed satisfactory esophageal voice

Ultrastructural abnormalities of cilia secondary to chronic pulmonary infections: a prospective study

The cilia are an essential component of the respiratory defense system. Certain ciliary abnormalities are produced by chronic infections. In this prospective study, ultra-structural features of cilia are described in 46 subjects. Thirty patients were studied for the problem of recurrent chest infections; of these, 6 showed ciliary abnormalities which were specific and diagnostic of primary ciliary dyskinesia. In 24 patients there were other abnormalities which were presumably secondary to chronic infections. This paper describes the various ciliary abnormalities seen in the latter group. It is emphasized that, as ciliary abnormalities may be the result rather than the cause of infections, a diagnosis of primary ciliary dyskinesia should be made with caution