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   Table of Contents - Current issue
Coverpage
December 2018
Volume 148 | Issue 6
Page Nos. 671-784

Online since Tuesday, February 12, 2019

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EDITORIAL  

HIV prevention & treatment strategies - Current challenges & future prospects Highly accessed article p. 671
Jayanta Bhattacharya
DOI:10.4103/0971-5916.252150  
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COMMENTARY Top

How should one tackle prediabetes in India? p. 675
Jacob Jose, Nihal Thomas
DOI:10.4103/ijmr.IJMR_1785_18  
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PERSPECTIVE Top

Statistical fallacies & errors can also jeopardize life & health of many p. 677
Abhaya Indrayan
DOI:10.4103/ijmr.IJMR_853_18  
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REVIEW ARTICLES Top

Carcinogenicity of smokeless tobacco: Evidence from studies in humans & experimental animals p. 681
Saman Warnakulasuriya, Kurt Straif
DOI:10.4103/ijmr.IJMR_149_18  
A Working Group of the Monographs programme of the International Agency for Research on Cancer has classified smokeless tobacco as carcinogenic to humans (Group 1). This review article summarizes the data that support the evaluations of sufficient evidence in humans and in experimental animals for the carcinogenicity of smokeless tobacco whether used alone or with betel quid. It also identifies compounds of smokeless tobacco relevant to carcinogenicity (prominently tobacco-specific nitrosamines) and addiction (nicotine). The epidemiological evidence is summarized for oral cancer, other cancers associated with smokeless tobacco and oral potentially malignant lesions with a focus on analytical studies from the SEARO Region. Studies on cancer in experimental animals are summarized with a focus on studies applying smokeless tobacco products typical for the regions, such as mishri and naswar.
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Cervical cancer screening in rural India: Status & current concepts p. 687
Anand Narain Srivastava, Jata Shankar Misra, Shruti Srivastava, Bhudav C Das, Shilpi Gupta
DOI:10.4103/ijmr.IJMR_5_17  
Cervical carcinoma is one of the most common and dreaded diseases of women, and in India, it accounts for 16 per cent of total cervical cancer cases occurring globally. The situation is more alarming in the rural areas where the majority of women are illiterate and ignorant about the hazards of cervical cancer. Different screening strategies such as rural cancer registries and camp approach for cancer detection have been found useful in minimizing the problem of cervical cancer in the villages. Various screening techniques such as visual inspection with acetic acid, visual inspection with Lugol's iodine, visual inspection with magnification devices-magnavisualizer, Pap smear and HPV-DNA testing have been suggested and tried under low-resource settings of our country, and cervical cytology screening has been found effective in reducing incidence of the disease. In the present review, feasibility of different screening methods has been assessed to find out the most suitable mode applicable at the rural level. Single lifetime screening particularly of high-risk women along with analysis of cost-effective tumour markers such as Argyrophilic nucleolar organizer regions (AgNOR) counts to discriminate high-risk dysplasia cases appears to be an appropriate approach in fighting against cervical cancer.
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Nutrition-pollution interaction: An emerging research area p. 697
Dinesh Kumar Bharatraj, Srinivasa Reddy Yathapu
DOI:10.4103/ijmr.IJMR_1733_18  
The impact of environmental pollution, especially chronic low exposures of heavy metals (Pb, Cd, Hg, As, Cr, etc.) on nutritional status and health of human and livestock, has become a cause of concern. It is established that malnutrition inhibits enzyme system, alters neurotransmitter levels, degenerate myelin, glial and neural elements, lowering of IQ scores as well as impairment of fine and gross motor coordination. Chronic low-level exposure to heavy metals also results in similar type of deformities at sub-clinical level. However, additive impact of undernutrition and adverse effects of heavy metal exposure is emerging as a serious threat to health in developing countries. High blood Pb/Cd levels and low nutrient levels cause subclinical damage of organ system such as haemopoietic, renal, nervous systems in neonates, children, post-partum women, and occupationally exposed population. This could be due to chronic low-level heavy metal exposures and vis-à-vis interaction between pollutants and nutrients. Our studies are focused on the utility of biomarkers for early subclinical detection of haemopoietic and rental toxicity. Lead exposure from non-conventional sources such as toys, pet/glass bottles, etc. suggest long-term investigation. The present review compiles result of studies conducted in this area highlighting the importance of pollution-nutrition interaction. This may facilitate policymakers on developing the strategies to counter the heavy metal exposure of humans/livestock and their consequences.
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ORIGINAL ARTICLES Top

Effect of intensive lifestyle modification & metformin on cardiovascular risk in prediabetes: A pilot randomized control trial p. 705
Shruthi Kulkarni, Denis Xavier, Belinda George, Soumya Umesh, Saba Fathima, Ganapathi Bantwal
DOI:10.4103/ijmr.IJMR_1201_17  
Background & objectives: Prediabetes is associated with increased prevalence of cardiovascular disease (CVD). In participants with prediabetes, the effects of exercise and metformin were evaluated on high-sensitivity C-reactive protein (hsCRP) and carotid intima-media thickness (CIMT), surrogate markers of atherosclerosis and CVD compared with standard care. Methods: In a pilot randomized control trial, the participants were randomized in to three arms: standard care (STD), intensive lifestyle modification (ILSM) or ILSM and metformin (ILSM+Met) and followed up for six months. Monitoring of ILSM was done by a trained healthcare facilitator. hsCRP, CIMT and other relevant parameters were measured before and after intervention. Results: A total of 103 participants were randomized into three arms and followed up for six months. At six months, there was a reduction from baseline in weight and fasting blood sugar (FBS) (P <0.01) in all three arms and a reduction in haemoglobin A1c (P =0.03) only in the ILSM+Met arm. The differences in hsCRP over six months within the STD, ILSM and ILSM+Met arms were −0.12 (95% confidence interval, −1.81, 2.08), −0.58 (−2.64, 0.43) and −0.11 (−1.84, 1.56), respectively. There was no difference in hsCRP, CIMT (right) or CIMT (left) between the three arms at six months. Interpretation & conclusions: There was a reduction in weight and FBS from baseline in all three arms. There was, however, no difference seen in hsCRP and CIMT in the two intervention arms compared to standard care. Larger studies with long-term follow up need to be done to detect differences in risk markers for CVD in prediabetes.
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Molecular genotyping of clinically important blood group antigens in patients with thalassaemia p. 713
Swati Kulkarni, Bhavika Choudhary, Harita Gogri, Shashikant Patil, Mamta Manglani, Ratna Sharma, Manisha Madkaikar
DOI:10.4103/ijmr.IJMR_455_17  
Background & objectives: In multitransfused thalassaemic patients, haemagglutination fails to phenotype the patient's blood group antigens due to the presence of donor-derived erythrocytes. DNA-based methods can overcome the limitations of haemagglutination and can be used to determine the correct antigen profile of these patients. This will facilitate the procurement of antigen-matched blood for transfusion to multitransfused patients. Thus, the aim of this study was to compare the serological phenotyping of common and clinically important antigens of Rh, Duffy, Kell, Kidd and MNS blood group systems with molecular genotyping amongst multitransfused thalassaemic patients. Methods: Blood samples from 200 patients with thalassaemia and 100 'O' group regular blood donors were tested using standard serological techniques and polymerase chain reaction-based methods for common antigens/alleles (C, c, D, E, e, Fya, Fyb, Jka, Jkb, K, k, M, N, S, s). Results: Genotyping and phenotyping results were discordant in 77 per cent of thalassaemic patients for five pairs of antithetical antigens of Rh, Duffy, Kell and Kidd blood group systems. In the MNS blood group system, 59.1 per cent of patients showed discrepancy. The rate of alloimmunization among thalassaemics was 7.5 per cent. Interpretation & conclusions: Molecular genotyping enabled the determination of the actual antigen profile in multitransfused thalassaemia patients. This would help reduce the problem of alloimmunization in such patients and would also aid in the better management of transfusion therapy.
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Frequency & predictors of pancreatitis in symptomatic primary hyperparathyroidism p. 721
Ashutosh Kumar Arya, Sanjay Kumar Bhadada, Soham Mukherjee, Priyanka Singh, Surinder S Rana, Divya Dahiya, Ashwani Sood, Uma Nahar Saikia, Mahesh Prakash, Deepak Kumar Bhasin, Arunanshu Behera, Rama Walia, Anil Bhansali
DOI:10.4103/ijmr.IJMR_353_16  
Background & objectives: The frequency and predictors of pancreatitis in primary hyperparathyroidism (PHPT) are not well understood. The objective of the present study was to evaluate the frequency of pancreatitis in patients with PHPT and its association with clinical and biochemical parameters of the disease. Methods: In this retrospective study all consecutive patients with PHPT registered in the PHPT registry (www.indianphptregistry.com) from the year 2004 to 2013 were included. The clinical, biochemical and radiological parameters related to pancreatitis were evaluated in histologically proven PHPT patients. Results: A total of 218 patients (63 men; mean age: 40.6±14.4 yr) underwent surgery for PHPT during the study. Pancreatitis occurred in 35 [16%, 18 acute and 17 chronic pancreatitis (CP)] patients and male:female ratio was 1:0.94. Skeletal manifestations were seen less frequently in PHPT with pancreatitis as compared to that of PHPT without pancreatitis. PHPT with pancreatitis had significantly higher serum calcium (12.4±2.0 vs. 11.7±1.5 mg/dl, P <0.05) in comparison to PHPT without pancreatitis. PHPT with acute pancreatitis (AP) had higher serum calcium (P <0.05) and parathyroid hormone (PTH) (P <0.05) levels than PHPT with CP. Curative parathyroidectomy improved the symptoms associated with pancreatitis as there was no recurrence in AP group, whereas recurrence was observed only in about 10 per cent patients of the CP group. Interpretation & conclusions: Pancreatitis was observed in 16 per cent of PHPT patients with male predominance in the study population. No recurrence of AP was observed after curative surgery. It may be proposed that serum amylase with calcium and PTH should be measured in all patients of PHPT with pain abdomen to rule out pancreatitis.
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Clinical significance of galectin-3 expression in malformed hepatic venous tissue p. 728
Junbo Qiao, Yongwei Chen, Changxian Dong, Jin Li
DOI:10.4103/ijmr.IJMR_500_17  
Background & objectives: Hepatic venous malformation gradually develops over time and exhibits the malignant biological behaviours of being locally invasive, causing morphological and functional damage to local tissue, and may even cause systemic coagulopathy. Studies show that galectin-3(Gal-3) expression is closely associated with local invasion of malignant tumours. In this study an attempt was made to assess the clinical significance of Gal-3 in local invasion during hepatic venous malformation in patients. Methods: Gal-3 protein and its mRNA expression were examined using immunohistochemistry and in situ hybridization in a total of 126 patients with hepatic venous malformation. For control tissue, 20 cases of normal tissue distal to surgical margins were also examined. In addition, the association between Gal-3 expression and pathological parameters was analyzed in hepatic venous malformation patients. Results: Gal-3 mRNA positivity was observed in 65.08 per cent (82/126) of hepatic venous malformation tissue samples, which was higher than the rate of 20 per cent (4/20) (P <0.05) seen in control tissues. Gal-3 protein positivity was observed in 58.73 per cent (74/126) of hepatic venous malformation tissue samples, which was higher than the rate of 15 per cent (3/20) (P <0.05) seen in the normal tissue. Gal-3 expression was not significantly associated with age or gender. However, there was a significant association between Gal-3 positivity and lesion size, local invasion depth, and involvement with the hepatic vein and the portal system. Interpretation & conclusions: Local tissue invasion and destruction by hepatic venous malformation may be related to the upregulation of Gal-3. Gal-3 expression and the development of venous malformation may be related and needs to be studied further.
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Estimation of plasma levels of bisphenol-A & phthalates in fertile & infertile women by gas chromatography-mass spectrometry p. 734
Prajakta Parag Pednekar, Rahul Krishnaji Gajbhiye, Anushree D Patil, Suchitra Vishwambhar Surve, Ajit Ganesh Datar, Geetha Dharmesh Balsarkar, Anahita R Chuahan, Geeta Ramesh Vanage
DOI:10.4103/ijmr.IJMR_2077_16  
Background & objectives: Bisphenol-A (BPA) and phthalates are utilized widely in consumer products. Due to their ubiquitous presence in the environment, a concern is expressed worldwide about their possible effect on human reproductive health. This study was conducted to compare the internal exposure of BPA and phthalates (using their metabolites as biomarkers) in plasma samples of infertile and fertile women. Methods: A sensitive gas chromatographic-mass spectrometric (GC-MS) method was developed to simultaneously quantify BPA and four phthalate monoester metabolites [namely mono-methyl phthalate (MMP), mono-benzyl phthalate (MBzP), mono-2-ethylhexyl phthalate (MEHP) and mono-(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP)] in human plasma. The method was validated using charcoal-stripped human plasma. Activated charcoal was also utilized to reduce contamination from reagents. The method was designed to account for and/or eliminate background contamination from all sources. Results: The limit of quantification for the method was 5 ng/ml for MMP and MBzP, while 1 ng/ml for BPA, MEHP and MEHHP, respectively. The precision and accuracy were well within the acceptable range. BPA was detectable in 77 per cent of plasma samples of infertile women and 29 per cent of fertile women. All the four phthalate metabolites were detected in plasma samples of both fertile and infertile women. Interpretation & conclusions: A GC-MS was developed and validated to estimate the BPA and four phthalate monoester metabolites in human plasma. It was utilised to analyse the plasma samples from fertile and infertile women. The infertile women showed significantly higher plasma concentrations of MBzP, BPA and MEHHP as compared to fertile women. The levels of MMP and MEHP were not significantly different between the two groups. Further studies need to be done to confirm these preliminary findings.
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Effect of anti-inflammatory activity of ranolazine in rat model of inflammation p. 743
R Naveena, Nayana K Hashilkar, Reshma Davangeri, Suneel I Majagi
DOI:10.4103/ijmr.IJMR_1504_16  
Background & objectives: Inflammatory processes are a recognized feature of atherosclerotic lesions. Ranolazine inhibits the inflammatory markers such as C-reactive protein, interleukins-1 and -6 and tumour necrosis factor-alpha. The present study was planned to evaluate the effect of anti-inflammatory activity of ranolazine in acute and sub-acute models of inflammation in rats and compare the same with that of control (gum acacia 1%) and aspirin (standard anti-inflammatory drug). Methods: Adult male Wistar rats (150-180 g) were used for the study. They were divided into three groups (n=6). One per cent gum acacia (control), aspirin (200 mg/kg body weight) and ranolazine (180 mg/kg body weight) were given orally. Acute inflammation was induced by injecting carrageenan in the left hind paw. Paw oedema volume and percentage inhibition were measured. Subacute inflammation was induced by implanting foreign bodies subcutaneously. Percentage inhibition of granuloma dry weight and haematoxylin and eosin stained sections of granulation tissue were studied. Results: In acute and subacute model study, ranolazine significantly (P <0.01) decreased the paw oedema volume and granuloma dry weight as compared to control and it was comparable to that of aspirin and histopathological sections showed a decrease in granulation tissue formation as compared to control. Interpretation & conclusions: Ranolazine demonstrated significant anti-inflammatory activity in acute and subacute models of inflammation and needs further evaluation for its use in reducing atherosclerosis.
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A four year experience in narcolepsy from a sleep clinic at a tertiary care centre with a short review of contemporary Indian literature p. 748
Animesh Ray, Kewal Kanabar, Vishwanath Upadhyay, Surendra Kumar Sharma
DOI:10.4103/ijmr.IJMR_888_16  
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.
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CORRESPONDENCES Top

A cross-sectional study on pre-hypertension & its association with anthropometric indices among undergraduate medical students in Andhra Pradesh, India p. 752
P Likhita Bhavani, Sandhya Gupta, Sharmilakrishna Thanikonda, Venkatarao Epari
DOI:10.4103/ijmr.IJMR_678_17  
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Molecular characterization of chikungunya virus from urbanized villages of Pune, Maharashtra, India, 2016 p. 756
Gururaj Rao Deshpande, Bipin Tilekar, Supriya L Hundekar, Kirtee Khutwad, Rashmi S Gunjikar, Shankar Vidhate, Gajanan N Sapkal
DOI:10.4103/ijmr.IJMR_558_17  
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CLINICAL IMAGES Top

Emphysematous pyelonephritis: Diagnostic pearls in imaging p. 759
Anirudh V Nair, PV Ramachandran
DOI:10.4103/ijmr.IJMR_114_17  
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Comb sign in a patient with ankylosing spondylitis p. 761
Yu-Hisu Chen, Hsiang-Cheng Chen
DOI:10.4103/ijmr.IJMR_1256_17  
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BOOK REVIEWS Top

Presenting medical statistics from proposal to publication p. 763
P. S. S. Sundar Rao
DOI:10.4103/0971-5916.252167  
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Essentials of dermatology and sexually transmitted diseases: An illustrated synopsis p. 764
Arun C Inamadar
DOI:10.4103/ijmr.IJMR_1960_18  
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PANEL OF REVIEWERS (2018) Top

Panel of Reviewers (2018) p. 766
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