Conservation of Indigenous Cattle Breed

India, one of the twelve mega biodiversity countries in the world, is home to large diversified cattle genetic resources, having 190.9 M cattle and so far 43 registered native cattle breeds. These cattle breeds are specially adapted to different agro-climatic conditions of India and their genetic diversity is due to the process of domestication over the centuries. There is decrease of 4.10% in cattle population and 3.14% in cattle genetic resources of India as compared to the quinquennial livestock census. The exotic / crossbred population has been increased by 20.18% during the period of last census while population of indigenous cattle has been decreased by 8.94% during the same duration. The reasons for depletion of native breeds includes crossbreeding with exotic breeds, economically less viable, loosing utility, reduction in herd size and the large scale mechanization of agricultural operation. The native breeds need to be conserved for genetic insurance in future, scientific study, as a part of our ecosystem, cultural and ethical requirements and for energy sources in future. The indigenous breeds of cattle posses various unique characteristics such as the presence of unique genetic variation in HSP70 gene family, carry a ‘thermometer gene’ and presence of A2 allelic variant in cow milk, which makes them well adapted to the tropical climate. The conservation includes the preservation along with up-gradation (improvement) of the genetic potential and management of a breed for use in future. The effective management of indigenous cattle resources includes identification, characterization, evaluation, documentation and conservation. The future strategy should be to combine genetic improvement and conservation. Establishment of regional gene banks and people’s participation by involving breeders, communities, gaushalas, NGOs and other relevant stakeholders in conservation programs. For more effective conservation measures, proper coordination and integration among various agencies (ICAR, SAHD, SAUs, SVUs and Research Institutes) is highly needed. “National Consortium of Partners’ comprising different stakeholders should be formulated for conservation of indigenous breed resources with a holistic approach.

Needle aspiration in large amoebic liver abscess.

The role of percutaneous needle aspiration for therapy of uncomplicated, large amoebic liver abscess (ALA) is not defined. Twenty nine patients of ALA with a cavity larger than 5 cm were randomised to two groups: (i) metronidazole 800 mg tid for 10 days combined with needle aspiration (group A, n = 15) and (ii) metronidazole therapy alone (group B, n = 14). Clinical parameters, viz, fever, pain and abdominal tenderness were recorded daily and graded 0 to 3 (in order of increasing severity). A statistically significant benefit was demonstrated in group A for clinical parameters evaluated. Group A patients took less time to become afebrile from the grade 2 level as compared to group B (3.8 +/- 1.7 days and 5.6 +/- 2.2 days respectively; p < 0.05). Reduction in pain intensity and abdominal tenderness from grade 2 to 1 also occurred earlier in group A (0.7 +/- 0.7 days vs 2.9 +/- 0.9 days for pain, P < 0.001 and 1.7 +/- 0.8 days vs 2.9 +/- 1.2 days for abdominal tenderness, p < 0.001). The mean duration of hospitalization was significantly shorter in group A as compared to group B (5.8 +/- 0.8 days vs 7.4 +/- 1.5 days, p < 0.001). Improvement in haematological and biochemical variables was similar in both groups. We conclude that percutaneous therapeutic needle aspiration of uncomplicated, large ALA hastens clinical recovery.

Neuroticism and stressful life events in patients with non-ulcer dyspepsia.

Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), Brief Psychiatric Rating Scale and Presumptive Stressful Life Events Scale were used to measure neuroticism, psychiatric morbidity and stressful life events in 35 patients with non-ulcer dyspepsia (NUD), 22 cass of peptic ulcer disease (PUD), 65 irritable bowel syndrome (IBS) and 45 age and sex matched healthy controls. NUD subjects had significantly higher total MHQ scores (28.8 +/- 11.3; p < 0.001) and scores in subscales of somatization (7.8 +/- 3.4; p < 0.001) and hysterical personality traits (5.5 +/- 2.8; p < 0.01) compared to healthy controls. MHQ scores in IBS subjects was significantly higher than in NUD, but in PUD subjects it was in-between NUD and healthy controls. Psychiatric morbidity, as assessed by Brief Psychiatric Rating Scale, was significantly higher in patients with NUD and IBS than in normal controls. Stressful Life event score was statistically similar in all the groups.

Salmonella group-E (Senftenberg) lung abscess: a case report.

A male patient presented with complaints of fever, cough with expectoration, burning micturition and 5-6 semisolid motions per day for the past 6 days. Skiagram chest (PA view) revealed lung abscess in the left mid zone. There was no improvement, symptomatically and radiologically, after an empirical course of antibiotics (IV ampicillin and gentamycin). Sputum, urine and stool cultures grew salmonella group E organisms sensitive only to cefotaxime. The patient was treated with IV cefotaxime and responded well clinically, radiologically and bacteriologically.

Combination of anticholinergic agent and H2 receptor antagonist in duodenal ulcer treatment--a randomized, double blind multicenter study.

BACKGROUND: The acid suppressive abilities of H2 receptor antagonists and anticholinergics have been claimed to be additive. METHODS: A multicenter, double-blind, randomized trial comparing ranitidine (150 mg) plus propantheline bromide 15 mg at bedtime to ranitidine 300 mg alone at bedtime was conducted in 161 patients with endoscopically confirmed uncomplicated duodenal ulcer. RESULTS: After six weeks of therapy, ulcer healing rates in the two groups were comparable ie 80% in the combination group (ranitidine + propantheline) and 79.4% in the ranitidine group. Pain relief after one, two and four weeks of treatment was also comparable in the two groups. Side effects to drugs were minor and comparable in both the groups. CONCLUSION: A combination of 150 mg ranitidine and 15 mg propantheline bromide is as efficacious as 300 mg ranitidine in inducing healing of uncomplicated duodenal ulcers, with similar side-effects but at greatly reduced cost.

Evaluation of Manning's criteria in the diagnosis of irritable bowel syndrome.

Six symptoms of Manning et al are widely used in clinical practice to diagnose irritable bowel syndrome (IBS). We studied 123 patients to evaluate the diagnostic value of Manning's criteria, using a preformed bowel symptom questionnaire which included these six symptoms. This study included 65 patients with IBS, 35 patients with non-ulcer dyspepsia, 23 patients with organic diseases of colon and 45 healthy controls. Sensitivity of presence of three or more symptoms of Manning's criteria discriminating irritable bowel syndrome from all other groups was 66.1%. Manning's criteria discriminated irritable bowel syndrome from organic diseases of colon with specificity and positive predictive value of 66.9% and 82.6%. When irritable bowel syndrome was compared with non-ulcer dyspepsia and healthy controls, specificities of Manning's criteria were 91.4% and 93.3% and positive predictive values 93.4% and 93.4% respectively.

Obstructive jaundice--a diagnostic appraisal.

One hundred and eight suspected cases of obstructive jaundice (OJ) were analysed using ultrasonography, percutaneous transhepatic cholangiography (PTC) or Endoscopic retrograde cholangiopancreatography (ERCP) or both. Clinical evaluation had accuracy of 93% in identifying OJ and establishing aetiology in 62%, however, it lacked specificity. Ultrasonography was useful in differentiating obstructive jaundice from medical jaundice in 91% of cases. However, the cause and site of biliary obstruction could be identified in 55% and 46% respectively. PTC was helpful in detecting the site of obstruction in 80.4% and nature in 63% of cases. Its failures were mostly associated with the presence of metastasis in the liver. ERCP successfully attained cholangiography in 58% and pancreatogram in 70% of cases. Overall diagnostic yield of ERCP was 67% in view of additional endoscopic findings in 18 cases. The complications were occasional and could be managed effectively with medical treatment. This study suggests utility of clinical evaluation in OJ inspite of its poor specificity and comparative value of PTC and ERCP in establishing the site as well as nature of lesion.

Endoscopic sphincterotomy: preliminary experience at a university hospital.

Endoscopic sphincterotomy (ES) was attempted in 38 patients with biliary calculi. There were 21 patients (55.3%) with common bile duct (CBD) stones following cholecystectomy, 14 patients (36.8%) with intact gall bladder and 3 patients with retained CBD stones along with T tube in the early post-operative period. Endoscopic sphincterotomy was possible in all but one patient and duct clearance was attained in 34 (89.4%) patients. Spontaneous clearance of calculi occurred in 31 (81.6%) patients while 3 patients required instrumental extraction. Four patients failed to clear stones and required surgical intervention. Complications occurred in 4 (10.5%) patients--haemorrhage in two, pancreatitis and cholangitis in one each. One patient died of bleeding on the 4th day following ES while hemostasis was achieved in other after two units of blood. Other complications were managed conservatively without any mortality. Endoscopic sphincterotomy appears to be a simple, effective and safe therapeutic modality for the management of biliary calculi.

Autonomic reflexes in borderline hypertensives.

Autonomic reflexes were studied in 53 patients with borderline hypertension (BLH) and 25 normotensives. BLH patients had higher basal heart rate. With 2 minutes of sustained head-up passive tilt of 50 degrees or 75 degrees, the rise in heart rate was comparable in both groups but the rise in blood pressure was significantly more in the BLH group. The rise in systolic pressure with Valsalva manoeuvre as well as with sustained hand grip was significantly higher in BLH patients. The postural tachycardia index and Valsalva index were significantly lower in BLH patients probably due to higher basal heart rate.

Gastro-esophageal reflux disease (GERD): an appraisal of different tests for diagnosis.

Fifty symptomatic patients with GERD, 20 each of non ulcer dyspepsia (NUD) & duodenal ulcer (DU) and 10 healthy controls were subjected to various tests employed for diagnosis of GERD. Among these endoscopy and histology had highest sensitivities (92% & 91% respectively) followed by Bernstein's test (overall 88%; early positivity 72%) and oesophagography (70%). The specificities of various tests were: endoscopy (86%), histology (82%) and Bernstein's test (overall 80%; early positive 94%). The false positivity was mainly in DU subjects where majority (greater than 84%) had two or more of these tests offitive. Any two of the three tests (endoscopy, histology & Bernstein's test) in combination had a sensitivity of 80-91% and a specificity of 90-92%. Our observations suggest that these tests, particularly in combination, are useful in establishing the diagnosis of GERD and that subclinical oesophagitis in DU might be responsible for the false positivity of these tests.

Serodiagnosis of gut tuberculosis.

The efficacy of enzyme-linked immunosorbent assay (ELISA) in the diagnosis of gut tuberculosis was evaluated. The study included 95 patients with gut tuberculosis, 40 with pulmonary tuberculosis, 25 with non-tubercular intestinal diseases and 40 healthy controls. Mantoux response and antibody titre against PPD using ELISA were studied. The ELISA sensitivity in gut tuberculosis was 80% and in pulmonary tuberculosis 90%. It was also positive in 12% of patients with non-tubercular intestinal diseases and 5% of healthy controls. The sensitivity of Mantoux test in gut (77%) and pulmonary (84%) tuberculosis was comparable to that of ELISA. However, Mantoux test lacked diagnostic significance due to high positivity in non-tubercular disease patients (55%) and healthy controls (56%), whereas ELISA was highly specific (93%) for the diagnosis of gut tuberculosis.

Neuroticism in patients with irritable bowel syndrome.

Employing a Hindi adaptation of the Middlesex Hospital Questionnaire (MHQ), neuroticism level was assessed in 133 subjects with irritable bowel syndrome and compared with that in patients with organic bowel disease (33), healthy population (140) and known neurotics (110). Compared with healthy controls and patients with organic bowel disease, significantly higher scores were found among irritable bowel syndrome patients in all the subscales except obsession. The total of scores was midway between those of the normal population and known neurotics. Neurotic disorder was detected in 51% of irritable bowel syndrome patients compared to 24% of organic bowel disease subjects (P less than 0.05) and 7.8% of the healthy population. Cut-off points, calculated as mean + 2 SD of scores in the healthy population, were found to be reliable as shown by clinical interview.

Comparison of stool microscopy and serology (enzyme linked immunosorbent assay) in epidemiology of amebiasis.

Stools from 634 individuals from Varanasi were examined for Entamoeba histolytica (EH). Serology was done in these subjects by enzyme linked immunosorbent assay (ELISA) employing filter paper technique. Stools were positive for EH in 16.9%, and serology in 15.9%. Both the tests were positive in only 5.2%. In 72.4% both the tests were negative. In 11.7% of stool positive cases, serology was negative, and in 10.7% with positive serology stool examination did not reveal EH. A majority (92.5%) of stool positive subjects had only cysts. Additional parasites were detected in 15.3%.

Irritable bowel syndrome: therapeutic evaluation of indigenous drugs.

Among 169 patients with irritable bowel syndrome (IBS), standard therapy (with clidinium bromide, chlordiazepoxide and isaphaghulla), a compound Ayurvedic preparation (with Aegle marmelos correa plus Bacopa monniere Linn) along with a matching placebo were given in a double blind randomised trial for 6 wk. The Ayurvedic preparation in 57 patients was found effective in 64.9 per cent, while standard therapy (60 patients) was useful in 78.3 per cent. Patients on placebo (52 patients) showed improvement in 32.7 per cent only. Ayurvedic therapy was particularly beneficial in diarrhoea predominant form as compared to placebo. The standard therapy was more useful in the painful form of IBS as compared to placebo and Ayurvedic preparation. In gas predominant form the effect of standard as well as Ayurvedic therapy, was similar to placebo. Long-term follow-up (greater than 6 months) showed that both forms of therapy were no better than placebo in limiting the relapse.

Medical myotomy for achalasia cardia. Long term results.

Pneumatic dilatation was effective in relieving dysphagia in 16/17 subjects with achalasia cardia. It was also effective and safe in those with sigmoid oesophagus, although dilatation persisted in them. Recurrences were noted in one quarter of cases which were managed satisfactorily with subsequent dilatations. There were no complications. Pneumatic dilatation appears very useful in the management of achalasia cardia.