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Table of Contents
April 2011
Volume 133 | Issue 4
Page Nos. 361-452
Online since Friday, April 29, 2011
Accessed 38,055 times.
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EDITORIAL
Are we reluctant to talk about cultural determinants?
p. 361
Sanjay Chaturvedi, Narendra K Arora, Rajib Dasgupta, Ashok K Patwari
PMID
:21537086
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COMMENTARIES
Cyclin D1 over expression as a prognostic factor in patients with tobacco-related intraoral squamous cell carcinoma
p. 364
Ashok M Shenoy
PMID
:21537087
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On the emergence of atypical
Vibrio cholerae
O1 El Tor & cholera epidemic
p. 366
Ana Carolina Paulo Vicente
PMID
:21537088
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REVIEW ARTICLE
The need for obtaining accurate nationwide estimates of diabetes prevalence in India - Rationale for a national study on diabetes
p. 369
RM Anjana, MK Ali, R Pradeepa, M Deepa, M Datta, R Unnikrishnan, M Rema, V Mohan
PMID
:21537089
According to the World Diabetes Atlas, India is projected to have around 51 million people with diabetes. However, these data are based on small sporadic studies done in some parts of the country. Even a few multi-centre studies that have been done, have several limitations. Also, marked heterogeneity between States limits the generalizability of results. Other studies done at various time periods also lack uniform methodology, do not take into consideration ethnic differences and have inadequate coverage. Thus, till date there has been no national study on the prevalence of diabetes which are truly representative of India as a whole. Moreover, the data on diabetes complications is even more scarce. Therefore, there is an urgent need for a large well-planned national study, which could provide reliable nationwide data, not only on prevalence of diabetes, but also on pre-diabetes, and the complications of diabetes in India. A study of this nature will have enormous public health impact and help policy makers to take action against diabetes in India.
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ORIGINAL ARTICLES
Correlation of cyclin D1 expression with aggressive DNA pattern in patients with tobacco-related intraoral squamous cell carcinoma
p. 381
Satya N Das, Pratima Khare, Manoj K Singh, Suresh C Sharma
PMID
:21537090
Background & objectives
: Cyclin D1 has been strongly implicated in cell proliferation particularly in the G1/S checkpoint of the cell cycle, and prognoses in human malignancies. We investigated the correlation between cyclin D1 overexpression and clinicopathological features as well as cell cycle parameters to understand its clinical significance in patients with tobacco-related oral squamous cell carcinoma (OSCC).
Methods
: Immunohistochemistry for cyclin D1 and DNA flowcytometry for cell cycle parameters was done on paraffin embedded tumour samples from 45 patients with OSCC
Results
: Higher expression of cyclin D1 was observed only in 30 (66.6%) of 45 cases that correlated with advanced age (
P
<0.02), higher tumour stage (
P
<0.01), histological differentiation and lymph node metastasis (
P
<0.01). Analysis of nuclear DNA pattern revealed cyclin D1 immunoreactivity in tumours with aggressive DNA pattern such as aneuploidy (
P
<0.05) and higher S phase fraction (
P
<0.04).
Interpretation & conclusions
: Higher expression of cyclin D1 in oral cancer appears to be closely linked to cell proliferation, differentiation and lymph node invasion. Pre-operative evaluation of cyclin D1 in biopsy specimen may be useful in planning the most appropriate treatment strategies in patients with tobacco-related OSCC.
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Hybrid & El Tor variant biotypes of
Vibrio cholerae
O1 in Thailand
p. 387
M Na-Ubol, P Srimanote, M Chongsa-nguan, N Indrawattana, N Sookrung, P Tapchaisri, S Yamazaki, L Bodhidatta, B Eampokalap, H Kurazono, H Hayashi, GB Nair, Y Takeda, W Chaicumpa
PMID
:21537091
Background & objectives
: El Tor
Vibrio cholerae
O1 carrying
ctxB
C
trait, so-called El Tor variant that causes more severe symptoms than the prototype El Tor strain, first detected in Bangladesh was later shown to have emerged in India in 1992. Subsequently, similar
V. cholerae
strains were isolated in other countries in Asia and Africa. Thus, it was of interest to investigate the characteristics of
V. cholerae
O1 strains isolated chronologically (from 1986 to 2009) in Thailand.
Methods
: A total of 330
V. cholerae
O1 Thailand strains from hospitalized patients with cholera isolated during 1986 to 2009 were subjected to conventional biotyping
i.e.,
susceptibility to polymyxin B, chicken erythrocyte agglutination (CCA) and Voges-Proskauer (VP) test. The presence of
ctxA, ctxB, zot, ace, toxR, tcpA
C
, tcpA
E
,
hlyA
C
and
hlyA
E
were examined by PCR. Mismatch amplification mutation assay (MAMA) - and conventional- PCRs were used for differentiating
ctxB
and
rstR
alleles.
Results
: All 330 strains carried the El Tor virulence gene signature. Among these, 266 strains were typical El Tor (resistant to 50 units of polymyxin B and positive for CCA and VP test) while 64 had mixed classical and El Tor phenotypes (hybrid biotype). Combined MAMA-PCR and the conventional biotyping methods revealed that 36 strains of 1986-1992 were either typical El Tor, hybrid, El Tor variant or unclassified biotype. The hybrid strains were present during 1986-2004. El Tor variant strains were found in 1992, the same year when the typical El Tor strains disappeared. All 294 strains of 1993-2009 carried
ctxBC
; 237 were El Tor variant and 57 were hybrid.
Interpretation & conclusions
: In Thailand, hybrid
V. cholerae
O1 (mixed biotypes), was found since 1986. Circulating strains, however, are predominantly El Tor variant
(
El Tor biotype with
ctxB
C
).
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Rapid situation & response assessment of diarrhoea outbreak in a coastal district following tropical cyclone AILA in India
p. 395
Samiran Panda, Kamala Kanta Pati, Mihir Kumar Bhattacharya, Hemanta Koley, Sobha Pahari, G Balakrish Nair
PMID
:21537092
Background & objectives
: Cyclone AILA hit Indian States on eastern coast on May 25, 2009. An investigation was conducted to examine if AILA was responsible for increased reporting of diarrhoea cases from the district of East-Medinipur in West Bengal. Identifying causative organisms for diarrhoea and assessing their antibiotic susceptibility profile were other objectives.
Methods
: Rapid situation and response assessment technique was employed to triangulate primary and secondary data collected through field visits. Prescription audit was also conducted.
Results
: Significantly increased occurrence of diarrhoea was observed in June 2009 in two subdivisions namely Haldia and Egra (OR 1.6 and 1.3 respectively; 95% CI 1.52-1.65 and 1.21-1.32
P
<0.001) considering 2007 as baseline.
Vibrio cholerae
grew from 54 per cent of the stool samples (21/39; 17
V. cholerae
O1-Ogawa and 4 non-O1-non-O139), confirming a community outbreak of cholera.
Shigella flexneri
3a was isolated from 5 per cent stool specimens. Increased rate of admission in treatment centres due to diarrhoea in the whole district coincided with the formation of cyclone and showed over two-fold rise compared to the admission recorded 6 days ago. Haldia subdivision had the highest attack rate of 9 per 1000 in the month of June, 2009 whereas for the whole district it was 5 per 1000 in the same month. All the isolates of
V. cholerae
were resistant to ampicillin and furazolidone and sensitive to norfloxacin and azithromycin.
Interpretation & conclusions
: Pre-AILA changes in the environment, AILA and seasonality of diarrhoea in the study district interplayed towards increased occurrence of diarrhoea. Continuous tracking of 'seasonality of diarrhoea in the community with vulnerability assessment of potential hosts', 'antibiotic sensitivity profile of the causative microorganisms', and 'prescription practice of physicians' would help appropriate disaster management.
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Transient cytotoxicity of
131
I beta radiation in hyperthyroid patients treated with radioactive iodine
p. 401
P Shanmuga Sundaram, S Padma, S Sudha, K Sasikala
PMID
:21537093
Background & objectives
: Radioiodine (
131
I) or radioactive iodine in low doses is used worldwide as the first line of management in the treatment of hyperthyroidism. Information is available on the extent and severity of cell damage after a high dose radioiodine (
131
I) therapy for thyroid cancer, but information is scanty on its cellular effects, its extent and severity of cell damage after a low dose
131
I therapy. The present investigation was aimed to study the cytotoxic effects of a low dose
131
I therapy in varying doses as is normally being used in routine clinical practice in the treatment of various forms of hyperthyroidism.
Methods
: Peripheral blood lymphocytes were analyzed in 32 hyperthyroid patients. All of them received
131
I in the form of sodium iodide solution orally. Blood lymphocytes were studied for the presence of chromosomal aberrations (CA) and micro nucleus (MN) using micronucleus assay. Blood samples of these patients were drawn prior to the treatment, on 7
th
and 30
th
days after the treatment.
Results
: The results indicated a positive relationship between
131
I dose, CA and MN frequency. A statistically significant increase in CA and MN frequency in day 7 post- therapy and a decrease in mean levels of CA and MN on day 30 post-therapy were observed when compared to pre-therapy.
Interpretation & conclusions
: This study showed that the cytogenetic damage induced by
131
I in low doses
i.e.
, less than 555MBq was minimal and reversible. Patients can be motivated to undertake this safe and easy procedure as a first line of therapy in the treatment of hyperthyroidism.
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A pilot study on parvovirus B19 infection in paediatric haematological malignancies
p. 407
Janak Kishore, Manodeep Sen, Ashutosh Kumar, Archana Kumar
PMID
:21537094
Background & objectives
: Leukaemia and lymphoma are common paediatric haematological malignancies acquiring human parvovirus B19 (B19) infection. In some studies anaemia has been found in children with acute lymphoblastic leukaemia (ALL) during maintenance therapy and rarely in lymphoma. We studied frequency of B19 infection and its implications in new onset acute leukaemia (mostly ALL) and lymphoma in children.
Methods
: Seventy serum samples from 35 children (age <12 yr, 29 males) newly diagnosed with haematological malignancies (on induction therapy) were collected together with 34 controls (solid tumours). Children were examined clinically and for anti-B19 IgM antibodies by quantitative ELISA and B19 DNA by PCR (VP1-VP2) and nested-PCR (VP1 unique). Bone marrow aspirates were examined histopathologically, whenever possible.
Results
: Of the 35 children, 22 had acute leukaemia while 13 had lymphoma. B19 infection was seen in six (17.1%) of 35 children (5 ALL, 1 NHL), two at diagnosis and four during follow up compared to none in the control. Among five B19 IgM positive ALL (n=18) children, two had B19 genome and two had giant pronormoblasts (lantern cells; but one lacked B19 DNA). Of the 70 serum samples tested, eight (11.4%) had anti-B19 IgM as two children had persistent B19 infection and one showed atypical maculopapular rashes (lower limbs) while 12 (34.3%) had anti-B19 IgG antibodies. B19 infected children had unexplained anaemia (80%), required more blood transfusions (6.6 ± 4.8 Units
vs
3.0 ± 2.6 Units) besides induction chemotherapy was delayed (60%) and required longer duration of therapy (29.2 ± 20
vs
6.3 ± 7.8 days) (
P
<0.02). Five children (2 ALL, 2 AML, 1 NHL) died but none were infected with B19.
Interpretation & conclusions
: B19 infection should be considered in children with ALL as it frequently caused unexplained anaemia and delay in induction chemotherapy.
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Mortality in HIV infected individuals in Pune, India
p. 414
Manisha Ghate, Swapna Deshpande, Srikanth Tripathy, Sheela Godbole, Madhura Nene, Madhuri Thakar, Arun Risbud, Robert Bollinger, Sanjay Mehendale
PMID
:21537095
Background & objectives
: With the presence of HIV epidemic for more than two decades in India, rise in the number of HIV related deaths is expected. Data on mortality in HIV infected individuals from prospective studies are scanty in India. We report here data on mortality in a systematically followed cohort of HIV infected individuals at Pune, Maharashtra, India
Methods
: A total of 457 HIV infected individuals were enrolled in a prospective study in Pune between September 2002 and November 2004. They were evaluated clinically and monitored for CD4 counts at every quarterly visit. Mortality data were collected from the records of hospital facilities provided by the study. If the death occurred outside such hospitals; relatives of the participants were requested to inform about the death.
Results
: Median CD4 count in study participants was 218 cells/μl (95% CI: 107-373) at baseline. The median duration of follow up was 15 months (IQR: 12, 22). Mortality was higher in antiretroviral therapy (ART) naive patients compared to those who received treatment (16.59 vs. 7.25 per 100 person years). Participants above 35 yr of age, CD4 count less than or equal to 100 cells/μl at baseline, tuberculosis at any study time point and ART status were independently associated with high mortality [(RR=1.97; 95% CI: (1.23, 3.14),
P
=0.005, (RR=33.20, 95%CI (7.59, 145.29),
P
<0.001, (RR=2.38, 95% CI (1.38, 4.09),
P
= 0.002 and RR=5.60, 95% CI (3.18, 9.86),
P
<0.001, respectively].
Interpretation & conclusions
: High mortality at advanced immunosuppression highlights the importance of early detection of HIV infection. Emphasis needs to be given at timely diagnosis and management of tuberculosis and ART initiation. It is important to create awareness about availability of free antiretroviral drugs in the government ART roll out programme.
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Mycobacterial heparin-binding haemagglutinin adhesion-induced interferon & antibody for detection of tuberculosis
p. 421
Zhaogang Sun, Lihui Nie, Xuxia Zhang, Yan Li, Chuanyou Li
PMID
:21537096
Background & objectives
: Mycobacterial heparin-binding haemagglutinin adhesin (HBHA) plays an important role in humoral and cellular immune response and is a potential diagnostic tool for tuberculosis (TB) serodiagnosis. This study was carried out to assess the usefulness of HBHA in TB clinics for differential diagnosis of pulmonary and extra-pulmonary TB (PTB, EPTB).
Methods
: In this study, 165 outpatients and 133 healthy volunteers were included to investigate the role of HBHA in TB diagnosis including the serodiagnostic tests and the interferon-γ release assays (IGRAs). The healthy volunteers were all without BCG vaccination including 73 subjects with purified protein derivative (PPD) (-) and 60 ones with PPD (+) (that is P-B- and P+B-). Of all the 165 outpatients 77 were PTB and 88 were EPTB. HBHA protein was used for serodiagnostic tests and IGRAs in peripheral blood mononuclear cells.
Results
: HBHA-specific antibody levels in the serum of healthy subjects were significantly different from the patients with PTB or EPTB (
P
<0.05). HBHA specific antibody levels in PTB patients could differentiate from EPTB with limited sensitivity (77.08%; 95%CI, 62.69 to 87.97%) and specificity (87.50%; 95%CI, 74.75 to 95.27%). IFN-γ levels in the healthy (P+B- and P-B-) groups were significantly different (
P
<0.01) with a detection sensitivity of 84.8% (95%CI, 68.54 to 93.02%) and specificity of 80.7% (95%CI, 65.22 to 92.62%). The PTB and EPTB subjects showed no difference in IFN-γ production.
Interpretation & conclusions
: HBHA serodiagnostic test with IGRAs had the limited potential for use as auxiliary tools for the differential diagnosis of PTB and EPTB, since both methods showed low sensitivity and specificity.
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Efficacy of advanced odomos repellent cream (N, N-diethyl-benzamide) against mosquito vectors
p. 426
PK Mittal, U Sreehari, RK Razdan, AP Dash, MA Ansari
PMID
:21537097
Background & objectives
: Repellents are commonly used personal protection measures to avoid mosquito bites. In the present study, Advanced Odomos cream (12% N, N-diethyl-benzamide) was tested for its efficacy against mosquitoes in comparison to DEET (N,N-diethyl-3-methyl benzamide).
Methods
: Bioassays were conducted to assess the repellency of Advanced Odomos and DEET creams against
Anopheles stephensi
and
Aedes aegypti.
Their efficacy was tested on human volunteers applied with different concentrations of test creams ranging from 1 to 12 mg/cm
2
and by exposing them to mosquitoes at hourly intervals. Field evaluation was also carried out to test the duration of protection of the test creams against
Anopheles
and
Aedes
mosquitoes during whole night and day time collections, respectively on human volunteers. Mosquito collections were done using torch light and aspirator.
Results
: Complete (100%) protection was achieved at 10 mg/cm
2
cream formulation of Advanced Odomos (1.2 mg a.i/cm
2
) dose against
An. stephensi
and 12 mg/cm
2
(1.44 mg a.i./cm
2
) against
Ae. aegypti
on human baits. There was no statistically significant differences in per cent protection against mosquito bites between Advanced o0 domos and DEET cream (
P
>0.05) in respective doses. Complete protection up to 11 h was observed against
Anopheles
mosquitoes during whole night collections and up to 6 h against
Ae. aegypti
in day time collections. No adverse reactions such as itching, irritation, vomiting, nausea,
etc
. were reported by the volunteers.
Interpretation & conclusions
: Advanced odomos cream applied at 10 mg/cm
2
concentration provided 100% protection from
Anopheles
mosquitoes up to 11 h whereas about 6 h protection was recorded against
Ae. aegypti
. The laboratory and field trials indicate that for longer protection against
Anopheles
mosquitoes 10 mg/cm
2
will be appropriate and in case of
Ae. aegypti
more than 10 mg/cm
2
application is required for complete protection. In conclusion, the Advanced Odomos cream was comparable to the known repellent cream DEET for prolonged protection against malaria and dengue vectors.
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Occurrence & antibiogram of
Salmonella
Typhi &
S.
Paratyphi A isolated from Rourkela, Orissa
p. 431
SS Bhattacharya, Usha Das, BK Choudhury
PMID
:21537098
Background & objectives
: Almost round-the-year occurrence of
Salmonella
Typhi and
Salmonella
Paratyphi A has been noticed in Rourkela since last 13 and five years respectively. The incidence of infection along with the antibiogram of these two serotypes in this area were carried out.
Methods
: The study was carried out at Ispat General Hospital, Rourkela, India, between January 2005 and December 2008 with 5340 blood samples collected from patients with suspected enteric fever and pyrexia of unknown origin. Isolation, identification and antibiogram of the causative organisms were performed according to standard bacteriological procedures.
Results
: A total of 298
Salmonella
isolates showed an overall per cent positivity of 5.58. Multidrug resistance was found in 11.96 per cent and 15.62 per cent isolates of
S.
Typhi and
S.
Paratyphi A respectively. Less than 2 per cent isolates of
Salmonella
showed resistance to ciprofloxacin. A resistance of 3.0 to 6.25 per cent against third generation cephalosporins was observed among the salmonella isolates.
Interpretation & conclusion
: A round-the-year occurrence of
Salmonella spp. in Rourkela might have been due to the presence of a considerable number of carriers in the locality, poor sanitation in nearby slum areas, and inadequate and contaminated community water supply at times. Higher degree of susceptibility among
S
. Typhi isolates against various antibiotics was encouraging, but increasing trend of resistance observed among
S.
Paratyphi A isolates was a matter of concern.
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Effect of
Lactobacillus acidophilus
& epidermal growth factor on experimentally induced
Clostridium difficile
infection
p. 434
Sukhminderjit Kaur, Chetana Vaishnavi, Kaushal Kishor Prasad, Pallab Ray, Rakesh Kochhar
PMID
:21537099
Background & objectives
:
Clostridium difficile
-associated disease (CDAD) remains an important nosocomial ailment. Antimicrobial therapy used for CDAD gives inconsistent results. This experimental study was planned to investigate the beneficial effects of
Lactobacillus acidophilus
and epidermal growth factor (EGF) for CDAD management.
Methods
: Among 10 groups of BALB/c mice (6 in each), group 1 served as controls receiving no inoculum. Animals in groups 2-10 received
C. difficile
, those in groups 3, 6 and 9 received
L. acidophilus
and those in groups 4, 7 and 10 received EGF after
C. difficile
inoculation. Animals in groups 5-7 were pre-treated with ampicillin and those in groups 8-10 with lansoprazole prior to
C. difficile.
The animals were killed and investigated for colonisation by
C. difficile
and toxin production, myeloperoxidase (MPO) activity and histopathology.
Results
: Colonisation by
C. difficile
was found to be significantly different (
P
<0.001) in the various groups.
C. difficile
toxin titres and MPO activity were significantly lower in animals given
L. acidophilus
and EGF after ampicillin (groups 6 and 7) and lansoprazole (groups 9 and 10). The severity of acute inflammation was also significantly less (
P
<0.05) in caecal and colonic segments of animals in groups 6 and 7 compared to those in group 5. Although the severity of acute inflammation was less in the caecal and colonic segment of animals in groups 9 and 10, the reduction was not significant compared to group 8.
Interpretation & conclusions
: Our findings showed that the administration of
L. acidophilus
and EGF reduced the severity of
C. difficile
infection in the experimental animals.
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Utility of molecular studies in incontinentia pigmenti patients
p. 442
Seema Thakur, Ratna D Puri, Sudha Kohli, Renu Saxena, IC Verma
PMID
:21537100
The diagnosis of incontinentia pigmenti (IP) is fairly easy in the presence of classical features, but can be difficult in cases with partial or non-classical features, especially in the parents. The demonstration that the disease is caused by mutations in the
NEMO
gene, has remarkably improved genetic counselling for this disorder. We present four families of IP in whom molecular studies established an unequivocal diagnosis in the affected daughters, and showed two mothers to be carriers, thus allowing accurate genetic counselling and prenatal diagnosis.
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CORRESPONDENCE
New metallo-β-lactamase: Is its name after New Delhi helpful or harmful?
p. 446
Manoj Jain, TJ John
PMID
:21537101
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BOOK REVIEWS
Screening donated blood for transfusion-transmissible infections, recommendations
p. 448
Neelam Marwaha
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How to survive in medicine: Personally and professionally
p. 449
Rita Sood
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Randomized clinical trials design, practice and reporting
p. 450
SD Seth, Mohua Maulik
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Congenital intrauterine infections
p. 451
SV Parulekar
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