Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait

Background: The heterozygous state of Beta-Thalassemia i.e. Beta-Thalassemia Trait (BTT) is usually not associated with any clinical symptoms and possesses abnormality in only a single BetaGlobin gene. Materials and methods: The present study was undertaken from October 2015 to October 2017 in the Department of Pathology of Mahatma Gandhi Medical College and Hospital. In our study, a total of 100 subjects were included with mild or no anemia (Hemoglobin >8 gm/dl) who were referred to the central lab for hemoglobin screening. Hb A2 values were determined by Capillary Hemoglobin electrophoresis for all 48 (BTT) and 52 (Normal/non BTT) subjects. The complete hemogram was done by automated hematology analyzer. The values of red cell indices TRBC, MCV and MCH and six discriminative indices were evaluated for detection of β-thalassemia trait. The results were compiled in tabular form and bar diagram. Results: In the present study, the patients in the BTT group had statistically significantly decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) and increased TRBC count as compared to those in non BTT group. Among the six discrimination indices used highest sensitivity was found for Shine and Lal index (87.5%) followed by Mentzer index (79.16%). The highest specificity was found for E and F (88.46%) followed by RDWI (84.61%). Youden’s index was highest for Mentzer index (61.85%) followed by RDWI (55.44%). Conclusion: From this study, we thus conclude that although no screening test can diagnose β− Thalassemia Trait with 100% sensitivity or specificity, among the hematological parameters MCV, TRBC and MCH most efficiently discriminates β−Thalassemia Trait from other microcytic, hypochromic anemia. Mentzer index with CBC may be the simple, low cost, rapid and can be reliably Prachi Gupta, BP Nag, Abha Mathur. Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait. IAIM, 2019; 6(3): 50-59. Page 51 used as a screening test for thalassemia as a routine. However none of the formulas are 100% sensitive and specific.

Phytomodulatory potential of lycopene from Lycopersicum esculentum against doxorubicin induced nephrotoxicity.

An elevated level of serum urea and creatinine was observed in doxorubicin (DOX) treated animals indicating DOX-induced nephrotoxicity. Enhanced lipid peroxidation (LPO) in the renal tissue was accompanied by a significant decrease in the levels of reduced glutathione (GSH), glutathione peroxidase (GPx), glutathione reductase (GR) and catalase (CAT) activities. Administration of lycopene (LycT) extracted from tomato to DOX treated mice showed a significant reduction in serum creatinine and urea levels which were associated with significantly low levels of LPO and significantly enhanced level of GSH and related antioxidant enzymes activity (GPx, GR and CAT) when compared to DOX group. Histopathological analysis revealed severe damage in the renal tissue of DOX treated animals. However, animals pretreated with LycT were observed to have reduced damage. Thus, from present results it may be inferred that lycopene may be beneficial in mitigating DOX induced nephrotoxicity in mice.

Personality Psychopathology in HIV Infected Patients.

Introduction: Given the magnitude of the problem and the multiple physical and psychological stressors that persons with HIV face in India, a study was planned to assess magnitude of substance abuse, and extent of personality psychopathology in HIV positive patients attending A.R.T. clinic at P.B.M. Hospital, Bikaner (Raj.). Aims: To assess and identify the extent of personality psychopathology in HIV patients Material and Method: 50 new seropositive patients without any severe medical illness, CD4 count above 350 and not on Antiretroviral Therapy were selected for study from ART Centre, PBM Hospital, Bikaner during 1 January 2010 to 31st December 2010. Personality psychopathology was assessed in study subjects for inter group comparison on various parameters like drug abuse, sex, etc., and other socio–demographic data on a self designed Performa and International Personality Disorder Examination (IPDE). Data were analyzed using appropriate statistical methods. Results: 77 % [14 out of 18] male HIV positive patients with substance abuse had disorder level of personality psychopathology, compared to 36% [4 out of 11] male HIV positive patients without substance abuse. 17 female patients out of 21 had only trait level of personality psychopathology. Conclusion: Majority of patients with substance abuse had co-morbid personality disorder and therefore it suggests that HIV infection may be consequent to basic personality problem.

Role of Personality and Stress in the Genesis of Bipolar Disorder - Mixed States: "Could it be a solution to the Diagnostic confusion prevailing in this disorder? (Part II)" .

Role of temperamental predisposition in the development of Mixed States is a relevant factor. Mania seems to arise from a hyperthymic background and Mixed States seems to arise from a depressive disposition. Aims: To compare the personality pathology and distribution of stress of patients of mixed states distributed according to the number of standardized criteria fulfilled and with the pure manic group. Materials and methods: Out of 214 bipolar disorder- current episode manic patients diagnosed as per DSM IV TR ,admitted in psychiatry ward of P.B.M. Hospital, Bikaner from 1st Jan 2007 to 31st Dec 2007,64 patients were randomly selected. Young’s Mania Rating Scale and Montgomery Asberg Depression Rating Scale were applied to these patients and 32 patients were assigned to mixed states on displaying one or more depressive symptom on MADRS, excluding decreased sleep. Rest 32 patient were assigned to pure manic group displaying no depressive symptoms. Presumptive Stressful Life Event Scale was applied to find out any stress in the lifestyle of the sample and International Personality Disorder Examination was applied on the third follow up visit. Results: Patients with personality psychopathology and stress met 3 or more criteria as compared to those with personality psychopathology without stress (p<0.01). Disorder level personality psychopathology, especially anxious disorder level personality, was significantly higher in mixed group patients as compared to pure manic patients(p<0.02).Meeting more criteria for mixed mania also meant higher scores on MADRS(p<0.01) Also patients meeting more than 3 criteria for mixed states had a significantly higher duration of hospital stay than those meeting less than 3 criteria(p<0.02) Conclusion: Mixed states is a dimensional diagnosis, higher the vulnerability in terms of disorder level personality psychopathology higher is the MADRS scores and greater episode duration.

Major Depressive Disorder: Part-I: Personality and Phenomenology.

Objectives: To study the phenomenological variations in context of personality psychopathology in Major Depressive Disorder patients. Methods:36 indoor patients of psychiatry ward of tertiary level service out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR) . Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS)and Presumptive Stressful Life Event Scale(PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: Sociodemographic variables by enlarge didn’t make a difference in MADRS score. MADRS score was significantly higher with increasing episodes of illness. Personality disorder patients had significantly higher MADRS score than Double traits (t=3.47, df=27, p<0.01) and Single trait (t=4.056, df=23, p<0.001) personality psychopathology. Higher level of depression in Personality disorder patients in all components of depression like sadness, reduced sleep pessimistic and suicidal thought etc were reported. Presence of stress with personality psychopathology added greater severity to depression. Conclusion: Our study brings out constitutional vulnerability with adverse environmental conditions were associated with higher level of psychopathology.

Major Depressive Disorder: Part-II -Comorbid Anxiety Disorders.

Objective: To demonstrate that Anxiety Disorder comorbidity is reflection of underlying common risk factors (Anxiety proneness) in Major Depressive Disorder patients and may not be a separate disorder. We hypothesized that “Anxious personality traits or disorders under stress take the form of state that is Anxiety Disorders”. Methods:36 indoor patients of psychiatry ward of tertiary level services, out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR). Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS) and Presumptive Stressful Life Event Scale (PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: High level of co-existence of Anxiety disorder 29(80.5%) in the study sample, 11 patients (30.55%) of Major Depressive Disorder had personality disorder level of psychopathology and 18(50%) patient of Major Depressive Disorder had double or more personality traits psychopathology and there were 7(19.45%) patients of Major Depressive Disorder had only single trait personality psychopathology. Conclusion: This work support the gene environmental diathesis where vulnerable person under stress develop Axis I disorder which are considered currently as co morbid disorders.