An Unusual Case of Telangiectasias

Background: Telengiectasias are defined as persistent dilatation of small capillaries in the superficial dermis Case: A 26-year-old woman presented with red lesions, epistaxis, joint pains, color changes of the hands, and breathlessness. On clinical examination and investigations, a final diagnosis of mixed connective tissue disease (MCTD), with interstitial lung disease (ILD), with telangiectasias, and epistaxis was made. Telangiectasias and epistaxis are rare presentations of MCTD.

Assessment of mental well-being in first year medical students

Background: Mental health is one of the most important domains of the overall health of an individual and has received a worldwide concern as an important public health issue. In the present times, health professionals have to face a lot of issues regarding the work stress for providing the best healthcare to the needed ones. Hence, the foundation for emerging as an efficient health-care provider starts from the time when one enters into a medical college. Aim and Objectives: The aim of the study was to assess the status of mental health in first medical students. Materials and Methods: A self-administered questionnaire based on Depression, Anxiety, and Stress Scale-21 (DASS-21) scale was provided to the participants who were willing to participate in the study. Percentage of total subjects enrolled was categorized into normal, mild, moderate and severe degrees of depression, anxiety, and stress depending on feedback provided by them based on DASS-21 scale. Results: Mild depression was present in 40% and moderate degree of depression was seen in 50% of total subjects taken. About 70% of students reported a state of moderate anxiety and 20% students reported severe anxiety. Severe stress was seen in 30% of total subjects taken and 60% of subjects reported moderate degree of stress. Conclusion: It was reported that moderate level of depression, anxiety, and stress is present in a significant percentage of 1st year medical students as indicated by the score of DASS-21 scale.

Knowledge, preferences, practices, and attitudes about breastfeeding among postnatal mothers in Uttarakhand, India: a cross-sectional study

Background: Breastmilk is the natural and safest first food for the newborn. It has nutritional, immunological, behavioural, and offers mother-infant bonding. Objective: The objective of the study was to explore the knowledge, practice, and attitudes of mothers towards breastfeeding. Material & Methods: A cross-sectional study was conducted among conveniently selected 950 postnatal mothers attending the immunization clinic and paediatric OPD with their children for vaccination and treatment of other minor illnesses from April 2018 to November 2019 in selected hospitals of Rishikesh, Uttarakhand. Mothers were face-to-face interviewed using structured knowledge, preference, practices, and attitude questionnaires about newborn breastfeeding. Tools were validated and tested for reliability. Results: The average knowledge scores (11.72±1.78) indicated that mothers have good knowledge about breastfeeding. Most mothers (81.45%) fed their babies with colostrum, and 82% were exclusively breastfeeding. It was also reported about top feeds like honey, coconut water, grape water, ghuttee, lactogen among about 20% of the participants. The average score of the Iowa Infant Feeding Attitude Scale (IIFAS) (58.11±6.44) lay in the range of neutral attitudes related to breastfeeding practices among the mothers. Conclusion: Breastfeeding practices were adequate among many mothers, but there were practices of throwing colostrum, topfeed baby and early initiation of weaning. Thus, it is necessary to create awareness among the mothers and their families about the correct practices of feeding the newborn baby; eventually, the attitude will change.

Evaluation of phytoaccumulation potential of toxic metals from sewage sludge by high- value aromatic plant geranium

Aim: The present study aimed to assess the phytoextraction potential of plant geranium (CIM BIO-171) to remove metals from sewage sludge and to investigate the growth, yield and quality of essential oil of this aromatic plant grown in contaminated sludge.Methodology: The experiment was conducted at research farm of CSIR-CIMAP, Lucknow during 2017-18 in vertical cemented column pots dug into soil. Six treatment groups of sewage sludge and soil were taken with four replication, i.e., T1-100% sewage sludge, T2-80% sewage sludge + 20% soil, T3-60% sewage sludge + 40% soil, T4-40% sewage sludge + 60% soil, T5-20% sewage sludge + 80% soil and T6-soil (only soil). Experimental soil was analysed at pre-harvest and post-harvest stage for soil characters. All plant attributes were recorded at the time of harvesting. Results: Result of the present study showed reduction in the heavy metals in the soil at harvest in comparison to the contents observed in soil at initial stage. All the parameters of growth, yield, biomass and essential oil were found to increase with the application rate of sewage sludge in geranium (CIM BIO-171). Interpretation: The results of the present study clearly indicate the phytoextraction capability of geranium plant (CIM BIO-171). Furthermore, the plants grown in contaminated sludge has all the beneficial impact on growth, yield and quality of essential oil.

A prospective study of non-tuberculous mycobacterial disease among tuberculosis suspects at a tertiary care centre in north India

Background & objectives: The burden of non-tuberculous mycobacterial (NTM) disease is increasing worldwide. The disease shares clinicoradiological features with tuberculosis (TB), Nocardia and several fungal diseases, and its diagnosis is frequently delayed. The present study was performed to determine the frequency of NTM disease among TB suspects in a tertiary care centre in north India. Methods: In this prospective study, mycobacterial culture isolates from pulmonary and extrapulmonary specimens among TB suspects were tested with immunochromatographic assay (ICA). All ICA-negative isolates were considered as NTM suspects and further subjected to 16S-23S rRNA internal transcribed spacer gene sequencing for confirmation and species identification. Patients with active disease were treated with drug regimen as per the identified NTM species. Follow up of patients was done to determine clinical, radiological and microbiological outcomes. Results: Of the 5409 TB suspects, 42 (0.77%) were diagnosed with NTM disease. Patients with active disease consenting for treatment were treated and followed up. Thirty four patients had NTM pulmonary disease (NTM-PD) and the remaining eight had extrapulmonary NTM (EP-NTM) disease. Mycobacterium intracellulare and M. abscessus, respectively, were most frequently isolated from NTM-PD and EP-NTM patients. Fifteen NTM-PD and seven EP-NTM patients successfully completed the treatment. Ten patients died due to unrelated causes, five were lost to follow up and another four declined the treatment. Interpretation & conclusions: Our study showed that the frequency of NTM disease was low among TB suspects at a large tertiary care centre in north India and this finding was similar to other Indian studies. More studies need to be done in other parts of the country to know the geographical variation in NTM disease, if any.

Impact of tuberculosis on glycaemic status: A neglected association

Background & objectives: Diabetes mellitus (DM) is an important risk factor for tuberculosis and has received increasing emphasis. However, the reverse association of tuberculosis impacting blood sugar levels has not been well studied. The present study was conducted to evaluate the prevalence of hyperglycemia in patients with tuberculosis and assess its resolution following successful treatment of tuberculosis. Methods: In this prospective study, a total of 582 patients with tuberculosis were evaluated for hyperglycaemia [DM or impaired glucose tolerance (IGT)] with random blood sugar (RBS) and all patients with RBS >100 mg/dl were subjected to a 75 g oral glucose tolerance test (OGTT). All patients received thrice weekly intermittent Directly Observed Treatment Short Course (DOTS) for tuberculosis. Patients with hyperglycaemia were re-evaluated at the end of anti-tuberculosis treatment with an OGTT and glycated hemoglobin (HbA1c) levels to assess for glycaemic status. Results: In the present study, 41 of the 582 patients were found to have DM [7%, 95% confidence interval (CI) (5.2, 9.4)] while 26 patients were found to have IGT [4.5%, 95% CI (3, 6.5)]. Three patients were lost to follow up. Of the 26 patients with IGT, 17 [65.4%, 95% CI (46.1, 80.7)] reverted to euglycaemic status following successful treatment of tuberculosis, while the blood sugar levels improved in all patients with DM following treatment of tuberculosis. Interpretation & conclusions: Our study results show that tuberculosis adversely impacts glycaemic status with improvement in blood sugar levels at the end of successful treatment of tuberculosis. Longitudinal studies with large sample size are required to confirm these findings.

High degree of fluoroquinolone resistance among pulmonary tuberculosis patients in New Delhi, India

Background & objectives: The fluoroquinolones (FQs) group of antibiotics is the backbone drugs for the management of drug-resistant tuberculosis (TB). In routine clinical practice, drug susceptibility testing (DST) for FQs is not performed, and the patients are empirically treated. A limited information exists regarding FQs resistance among pulmonary TB cases. The present study was conducted to determine the FQs resistance among drug sensitive and drug-resistant pulmonary TB patients in a tertiary care centre in north India. Methods: A total of 1619 sputum/smear-positive specimens of pulmonary TB patients were subjected to DST for first-line drugs (FLDs) and second-line drugs. In addition, FQs DST was also performed using automated Mycobacterial Growth Indicator Tube-960 liquid culture technique. The immuno-chromatographic assay was performed to distinguish Mycobacterium tuberculosis complex (MTBC) from non-MTBC. Results: Mycobacterium tuberculosis (Mtb) was isolated in 1499 sputum specimens; 1099 culture specimens were sensitive to FLDs, 249 grew as multidrug-resistant (MDR) Mtb and the remaining 151 isolates revealed any drug resistance to FLDs. While FQs monoresistance among the FLD sensitive isolates was 3.1 per cent (35/1099), 27.3 per cent (68/249) among MDR Mtb isolates had additional FQs resistance. Interpretation & conclusions: FQs resistance among drug sensitive and MDR Mtb isolates was high in Delhi, India. Based on these findings, it is recommended that the DST for FQs should be routinely performed to avoid further amplification of drug resistance.

A four year experience in narcolepsy from a sleep clinic at a tertiary care centre with a short review of contemporary Indian literature

Narcolepsy is a common sleep disorder in Western countries but rarely reported from India. Here, we report a small case series of four narcolepsy patients seen over a four year period in the sleep clinic of a tertiary care hospital in north India. The diagnosis was established by clinical history and two or more sleep-onset rapid eye movements (SOREMs) on multiple sleep latency tests (MSLTs) following overnight polysomnography (PSG). The mean age of patients was 26.2±6.4 yr; one patient had associated cataplexy and another one had all four cardinal symptoms of narcolepsy. All these patients had a history of excessive daytime sleepiness (EDS). The mean body mass index was 24.2±4.7 kg/m[2]. The mean sleep latency during MSLT was 2.7±1.3 min, and the mean REM latency was 5.7±2.9 min. Narcolepsy, although rarely reported from India, should be suspected in young non-obese patients complaining of EDS and confirmed by performing MSLT following overnight PSG.

Effect of salinity and use of stress indices of morphological and physiological traits at the seedling stage in rice.

Rice (Oryza sativa L.) is the most important cereal crop and a major staple food for majority of the human populations worldwide. Rice crop is sensitive to salinity. In spite of large number of studies on salinity tolerance of rice, our knowledge on the overall effect of salinity on rice seedling growth is limited. Improvement in salt tolerance of crop plants remains indescribable, largely due to the fact that salinity is a complex trait which affects almost every aspect of the physiology, biochemistry and genomics of plants. The present investigation was conducted to establish the relationship between various morphological, physiological traits and stress indices. A set of 131 rice accessions was evaluated in two levels namely, non-stress (EC ~ 1.2 dS/m) and saline stress (EC ~ 10 dS/m) in hydroponics at seedling stage. Root length and shoot lengths were reduced by 52 and 50%, respectively in saline stress compared to non-stress conditions. There was a significant correlation between various morphological and physiological parameters in non-saline in addition to saline stress as well as non-stress. The effect of the increased Na+ concentration in the medium is detrimental to root length and shoot length as observed by reduction in root length and a concomitant reduction in shoot length. Increased concentration of Na+ led to augmented Na+/K+ ratio with increased stress in the medium and decreased expression of traits. A significant positive correlation (r=0.60) was noticed between stress tolerance index (STI) of root and shoot length. The stress susceptibility index (SSI) for root length was expressed significant positive correlation with SSI for shoot length (r=0.43). SSI for K+ content was registered significant negative correlation with STI for Na+ content (r=-0.43). The three accessions namely, IC 545004, IC 545486 and IC 545215 were found to be the best performers adjudged on the morphological and physiological criteria in saline stress situation. These three rice accessions could be used as a donor parent or for genotypic studies in future breeding programs.

Dengue virus infection.

Dengue, an illness caused by dengue virus (an arbovirus), is one of the neglected tropical diseases.1 The infection is endemic in more than 100 countries. Of the estimated 390 million dengue viral infections that occur worldwide annually,2 around 1% require hospital admission.3 Since the isolation of the dengue virus in India in 1945, an upsurge has been reported in the number of cases,2 with 99 913 cases during 2015.4 Although the mortality rate of dengue is low (0.3%–0.4%),1 large financial resources required for its control5 pose a huge challenge in developing countries such as India. The dengue virus has four serotypes (DENV 1–4) and a fifth one has been reported recently.6 The most common vectors for this virus are female Aedes aegypti (A. aegypti) mosquitoes; other mosquito species that are known to transmit this virus include Aedes albopictus, Aedes polynesiensis, and Aedes niveus. Outbreaks of dengue are seasonal as the climate influences the survival of this vector.7 Transmission of dengue is facilitated by the increase in urbanization, air travel, global trade, and use of materials that support collection of water, e.g. non-biodegradable plastic products, paper cups, coconut shells, air coolers, flower pots and discarded tyres. Water collected in any receptacle makes for breeding of mosquitoes.3 Illness caused by dengue virus infection ranges from the asymptomatic non-specific viral variety to the life-threatening dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS). The typical dengue illness has three phases.3 The incubation period is followed by a febrile phase with high-grade fever accompanied by facial flushing, myalgia, arthralgia and retro-orbital pain. The ‘critical phase’ may have complications such as plasma leakage, shock and end-organ dysfunction. The ‘recovery phase’ is characterized by the resolution of symptoms and return of extravasated fluid into the intravascular compartment. Circulatory fluid overload and pulmonary oedema can occur during this period, especially in patients with comorbid conditions and due to overzealous administration of intravenous fluids.8 ‘Expanded dengue syndrome’ in some people may unusually manifest with severe involvement of organs, such as the heart, liver, kidneys and brain.1

Panchagavya Ghrita, an Ayurvedic formulation attenuates seizures, cognitive impairment and oxidative stress in pentylenetetrazole induced seizures in rats.

Panchagavya Ghrita (PG), according to Ayurvedic formulary of India (AFI), is used to treat epilepsy (apasmara), fever (jvara), mania (unmade) and jaundice (kamala). In the present study, we examined its effect on convulsions, oxidative stress and cognitive impairment in pentylenetetrazole (PTZ) induced seizures in rats. PG @ 250, 500, 1000, 2000 and 4000 mg/kg was administered orally for 7 days to male Wistar rats. On day 7, PTZ (60 mg/kg) was injected intraperitoneally 2 h after the last dose of PG. Sodium valproate (300 mg/kg) was used as positive control. Latency to myoclonic jerks, clonus and generalized tonic clonic seizures (GTCS) were recorded for seizure severity. Cognitive impairment was assessed using elevated plus maze and passive avoidance tests. Malondialdehyde and reduced glutathione levels were measured in rat brain. The results have shown that pretreatment with PG @ 500, 1000, 2000 and 4000 mg/kg exhibited 16.6, 33.3, 50 and 100% protection against occurrence of GTCS. The pretreatment with PG has significantly improved cognitive functions and the oxidative stress induced by seizures demonstrating its protective effect against PTZ induced seizures, and further, use of PG as an anticonvulsant in Ayurvedic system of medicine.

Larvicidal activity of few select indigenous plants of North East India against disease vector mosquitoes (Diptera: Culicidae)

Mosquitoes are the vectors of several life threatening diseases like dengue, malaria, Japanese encephalitis and lymphatic filariasis, which are widely present in the north-eastern states of India. Investigations on five local plants of north-east India, selected on the basis of their use by indigenous communities as fish poison, were carried out to study their mosquito larvicidal potential against Anopheles stephensi (malaria vector), Stegomyia aegypti (dengue vector) and Culex quinquefasciatus (lymphatic filariasis vector) mosquitoes. Crude Petroleum ether extracts of the roots of three plants viz. Derris elliptica, Linostoma decandrum and Croton tiglium were found to have remarkable larvicidal activity; D. elliptica extract was the most effective and with LC50 value of 0.307 μg/ml its activity was superior to propoxur, the standard synthetic larvicide. Half-life of larvicidal activity of D. elliptica and L. decandrum extracts ranged from 2-4 days.

Evaluation of Random Urine Sample Protein-Cretinine Ratio as an Index of Quantitative Proteinuria

The present study was conducted to find out a correlation between protein to creatinine (PC) ratio in random sample and 24 hr. urinary protein (UP) in patients with proteinuria with normal renal functions (serum cretinine<1.5 mg %) -group-I, with impaired renal functions, mild to moderate (s.cretinine 1.5-4.0mg%) group-II and advance renal failure (s.cretinine >4.0mg%) -group-III. 24 hr. and a random urine sample was taken for each patient and was tested for protein and creatinine. PC ratio was found in each random sample. The mean 24 hr.UP (g/24 hr.) estimated by 24 hr. urine collection was 1.15± 0.97, 3.26 ±1.34 and 7.39±2.19 in group I, II and III respectively. However, the mean UP estimated by random sample was 1.35±1.09, 3.94±1.93 and 10.38±3.70 in group-1, group-II and group-III respectively. P value was statistically insignificant in group 1 & II. However, there was significant difference in values in group-III (P=0.012). Coefficient of correlation on univariate analysis was r=0.889 in group-I, 0.788 in group-II and 0.375 in group-III indicating a significant correlation in results in groupI and II and not in group-III. The results in the study have shown that single voided urine method of estimating quantitative proteinuria holds its value in patients with normal, as well as in mild to moderately impaired renal functions. However, this method does not hold good for patients with severely impaired renal functions.