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   2012| January  | Volume 135 | Issue 1  
    Online since March 1, 2012

 
 
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ORIGINAL ARTICLES
Sex worker-led structural interventions in India: A case study on addressing violence in HIV prevention through the Ashodaya Samithi collective in Mysore
Sushena Reza-Paul, Rob Lorway, Nadia O'Brien, Lisa Lazarus, Jinendra Jain, M Bhagya, P Fathima Mary, KT Venukumar, KN Raviprakash, James Baer, Richard Steen
January 2012, 135(1):98-106
DOI:10.4103/0971-5916.93431  PMID:22382190
Background & objectives: Structural interventions have the capacity to improve the outcomes of HIV/AIDS interventions by changing the social, economic, political or environmental factors that determine risk and vulnerability. Marginalized groups face disproportionate barriers to health, and sex workers are among those at highest risk of HIV in India. Evidence in India and globally has shown that sex workers face violence in many forms ranging from verbal, psychological and emotional abuse to economic extortion, physical and sexual violence and this is directly linked to lower levels of condom use and higher levels of sexually transmitted infections (STIs), the most critical determinants of HIV risk. We present here a case study of an intervention that mobilized sex workers to lead an HIV prevention response that addresses violence in their daily lives. Methods: This study draws on ethnographic research and project monitoring data from a community-led structural intervention in Mysore, India, implemented by Ashodaya Samithi. Qualitative and quantitative data were used to characterize baseline conditions, community responses and subsequent outcomes related to violence. Results: In 2004, the incidence of reported violence by sex workers was extremely high (> 8 incidents per sex worker, per year) but decreased by 84 per cent over 5 years. Violence by police and anti-social elements, initially most common, decreased substantially after a safe space was established for sex workers to meet and crisis management and advocacy were initiated with different stakeholders. Violence by clients, decreased after working with lodge owners to improve safety. However, initial increases in intimate partner violence were reported, and may be explained by two factors: (i) increased willingness to report such incidents; and (ii) increased violence as a reaction to sex workers' growing empowerment. Trafficking was addressed through the establishment of a self-regulatory board (SRB). The community's progressive response to violence was enabled by advancing community mobilization, ensuring community ownership of the intervention, and shifting structural vulnerabilities, whereby sex workers increasingly engaged key actors in support of a more enabling environment. Interpretation & conclusions: Ashodaya's community-led response to violence at multiple levels proved highly synergistic and effective in reducing structural violence.
  8,149 801 61
Assessment of effects on health due to consumption of bitter bottle gourd (Lagenaria siceraria) juice
SK Sharma, Rajesh Puri, Ajay Jain, MP Sharma, Anita Sharma, Shravan Bohra, YK Gupta, Anoop Saraya, S Dwivedi, KC Gupta, Mahadeo Prasad, Janardhan Pandey, Netar Prakash Dohroo, Neeraj Tandon, B Sesikeran, AK Dorle, Nikhil Tandon, SS Handa, GS Toteja, Spriha Rao, K Satyanarayana, VM Katoch
January 2012, 135(1):49-55
DOI:10.4103/0971-5916.93424  PMID:22382183
Background & objectives: The bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other associated benefits. However, in last few years there have been reports of suspected toxicity due to consumption of its juice. This led to the constitution of an Expert Committee by Department of Health Research at Indian Council of Medical Research (ICMR), Ministry of Health & Family Welfare, Government of India in October 2010. The committee looked into the issues related to safety of consumption of bottle gourd juice, and this paper presents the findings. Methods: Information on cases of suspected toxicity due to consumption of bottle gourd juice was collected by internet search, advertising on website of ICMR and by writing to State and district health authorities as well as to medical colleges, hospitals and private nursing homes across the country. Results: Three deaths were reported, one from Delhi and two from Uttar Pradesh after consumption of extremely bitter bottle gourd juice. Three persons who died after consumption of freshly prepared bottle gourd juice or juice mixed with bitter gourd (karela) juice were over 59 years of age and had diabetes since last 20 years. This juice was reported to be extremely bitter by all three. Twenty six persons were admitted to various hospitals of the country on complaint of abdominal pain and vomiting following consumption of freshly prepared bottle gourd juice. Diarrhoea and vomiting of blood (haematemesis) was reported in 18 (69.2%) and 19 (73.1%) patients, respectively. Biochemical investigations revealed elevated levels of liver enzymes. More than 50 per cent patients had hypotension. Endoscopic findings showed profusely bleeding stomach with excessive ulceration seen in distal oesophagus, stomach and duodenum in most of the cases. All these patients recovered fully and no sequeale was recorded for any of the cases. Interpretation & conclusions: Cucurbitaceae family, of which bottle gourd is a member contains the toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste. There is no known antidote for this toxicity and clinicians treat such cases symptomatically only. The Committee made the following recommendations: (i) The community needs to be educated that bitter tasting bottle gourd juice should not be consumed and in case there is any discomfort, nausea, vomiting, diarrhoea or any feeling of uneasiness after consumption of juice, the person should immediately be taken to a nearby hospital. (ii) Clinicians are suggested that patients coming with symptoms (discomfort, nausea, vomiting, diarrhoea, gastrointestinal bleeding after consumption of juice) should immediately be attended to and general supportive care should be provided, i.e. IV fluids/crystalloids/blood products/fresh frozen plasma to maintain the haemodynamics and electrolyte balance; Ryle's tube to be put in for gastric lavage and to assess gastrointestinal (GI) bleed- aspirate to be preserved; Proton pump inhibitors should be given for management of GI bleed and appropriate treatment for other complications should be given. (iii) The possible research areas identified are chemical composition studies on bitter and normal bottle gourd and other members of cucurbitaceae family; animal toxicity studies and studies on interaction between bottle gourd juice and other drugs.
  8,229 652 10
BOOK REVIEWS
Treatment of tuberculosis guidelines, 4 th ed.
SK Sharma
January 2012, 135(1):140-141
  5,066 1,160 -
ORIGINAL ARTICLES
Is RSBY India's platform to implementing universal hospital insurance?
David M Dror, Sukumar Vellakkal
January 2012, 135(1):56-63
DOI:10.4103/0971-5916.93425  PMID:22382184
Background & objectives: In 2008, India's Labour Ministry launched a hospital insurance scheme called Rashtriya Swasthya Bima Yojana (RSBY) covering 'Below Poverty Line' (BPL) households. RSBY is implemented through insurance companies; premiums are subsidized by Union and States governments (75 : 25%). We examined RSBY's enrolment of BPL, costs vs. budgets and policy ramifications. Methods: Numbers of BPL are obtained by following criteria of two committees appointed for this task. District-specific premiums are weighted to obtain national average premiums. Using the BPL estimates and national premiums, we calculated overall expected costs of full roll-out of the RSBY per annum, and compared it to Union government budget allocations. Results: By March 31, 2011, RSBY enrolled about 27.8 per cent of the number of BPL households following the Tendulkar Committee estimates (37.6% following the Lakdawala Committee criteria). The average national weighted premium was Rs. 530 per household per year in 2011. The expected cost of premium to the union government of enrolling the entire BPL population in financial year (FY) 2010-11 would be Rs. 33.5 billion using Tendulkar count of BPL (or Rs. 24.6 billion following Lakdawala count), representing about 0.3 per cent (or 0.2%, respectively) of the total union budget. The RSBY budget allocation for FY 2010-11 was only about 0.037 per cent of the total union budget, sufficient to pay premiums of only 34 per cent of the BPL households enrolled by March 31, 2011. Interpretation & conclusions: RSBY could be the platform for universal health insurance when (i) the budget allocation will match the required funds for maintenance and expansion of the scheme; (ii) the scheme would ensure that beneficiaries' rights are legally anchored; and (iii) RSBY would attract large numbers of premium-paying (non-BPL) households.
  3,806 603 22
An aetiological & clinicopathological study on cutaneous vasculitis
Pooja Khetan, Gomathy Sethuraman, Binod K Khaitan, Vinod K Sharma, Rajeeva Gupta, Amit K Dinda, V Sreenivas, Manoj K Singh
January 2012, 135(1):107-113
DOI:10.4103/0971-5916.93432  PMID:22382191
Background & objectives: Cutaneous vasculitis has protean clinical manifestations. It may be idiopathic or associated with a spectrum of conditions such as infections, drugs, etc. Skin is involved in both small vessel vasculitis (SVV) and medium vessel vasculitis (MVV). Overlapping features are seen between SVV and MVV. The histopathological features may not always relate with the clinical lesions. The aim of the present study was to evaluate the aetiological factors and clinicopathological association in patients with cutaneous vasculitis. Methods: In this cross-sectional study, detailed history and clinical examination were done on patients with biopsy proven cutaneous vasculitis. Two skin biopsies were taken from each patient for routine histopathology and direct immunofluorescence. Results: Of the 61 patients studied, hypersensitivity vasculitis (HSV) [23 (37.7%)] and Henoch Schonlein purpura (HSP) [16 (26.2%)] were the two most common forms. Systemic involvement was seen in 32 (52.45%) patients. Drugs were implicated in 12 (19.7%) cases, infections in 7 (11.4%) and connective tissue disorders in 4 (6.5%) cases. Histologically SVV was the most common pattern, seen in all the clinically diagnosed patients with SVV (47), and in 12 of the 14 clinically diagnosed patients with MVV. Direct immunofluorescence showed positivity for at least one immunoreactant in 62 per cent of the patients and the most common deposit was C3 followed by IgG, IgA and IgM. Interpretation & conclusions: Majority of our patients with cutaneous vasculitis were idiopathic. Histologically, SVV was seen in most of our patients. No association was seen between history of drug intake and tissue eosinophilia and also between histologically severe vasculitis and clinical severity. The presence of immunoreactant IgA was not specific for HSP.
  3,559 649 9
COMMENTARIES
Rapid molecular diagnosis of spinal muscular atrophy
Balraj Mittal
January 2012, 135(1):6-8
DOI:10.4103/0971-5916.93416  PMID:22382175
  3,188 449 1
STUDENT IJMR
Association of TNF-α with insulin resistance in type 2 diabetes mellitus
Jatla Jyothi Swaroop, Duggirala Rajarajeswari, JN Naidu
January 2012, 135(1):127-130
DOI:10.4103/0971-5916.93435  PMID:22382194
Background & objectives: TNF-α is an adipocytokine that has been implicated in the development of insulin resistance. Dysregulation of TNF-α production has been implicated in a variety of human diseases including type 2 diabetes mellitus. We aimed to find out the association of TNF-α levels with insulin resistance, body mass index and waist hip ratio; and to elicit its role with respect to duration of the disease, if any. Methods: 50 type-2 diabetic patients attending Narayana Medical Hospital, Nellore, were studied. Body mass index and Waist hip ratio were calculated. Homeostasis model assessment method was used to calculate insulin resistance (HOMA IR) and per cent β cell function (HOMA B) . Insulin was estimated by chemiluminescence method and TNF-α by ELISA method. The subjects were arbitrarily categorized into three groups based on duration of diabetes. Group 1 included subjects with diabetes of less than 5 yr duration, group 2 included diabetics of 6-10 yr duration and group 3 greater than 10 yr duration. Results: Our study revealed a significant correlation between TNF-α levels and BMI (P=0.006), the correlation being stronger in males when compared to females. A significant correlation was found between per cent β cell function and TNF-α (P=0.008). TNF-α correlated significantly with HOMA IR, HOMA B and insulin, in group 2 diabetes. Interpretation & conclusions: Our results suggest the possible role of TNF-α in the pathogenesis of type-2 diabetes mellitus and the importance of reducing obesity to prevent elevated levels of the cytokine and related complications.
  2,853 740 42
REVIEW ARTICLES
Stem cell therapy: A novel & futuristic treatment modality for disaster injuries
GU Gurudutta, Neeraj Kumar Satija, Vimal Kishor Singh, Yogesh Kumar Verma, Pallavi Gupta, RP Tripathi
January 2012, 135(1):15-25
DOI:10.4103/0971-5916.93419  PMID:22382178
Stem cell therapy holds the potential to meet the demand for transplant cells/tissues needed for treating damages resulting from both natural and man-made disasters. Pluripotency makes embryonic stem cells and induced pluripotent stem cells ideal for use, but their teratogenic character is a major hindrance. Therapeutic benefits of bone marrow transplantation are well known but characterizing the potentialities of haematopoietic and mesenchymal cells is essential. Haematopoietic stem cells (HSCs) have been used for treating both haematopoietic and non-haematopoietic disorders. Ease of isolation, in vitro expansion, and hypoimmunogenecity have brought mesenchymal stem cells (MSCs) into limelight. Though differentiation of MSCs into tissue-specific cells has been reported, differentiation-independent mechanisms seem to play a more significant role in tissue repair which need to be addressed further. The safety and feasibility of MSCs have been demonstrated in clinical trials, and their use in combination with HSC for radiation injury treatment seems to have extended benefit. Therefore, using stem cells for treatment of disaster injuries along with the conventional medical practice would likely accelerate the repair process and improve the quality of life of the victim.
  2,755 766 9
ORIGINAL ARTICLES
The normal range of body mass index with high body fat percentage among male residents of Lucknow city in north India
Chandrasekharan Nair Kesavachandran, Vipin Bihari, Neeraj Mathur
January 2012, 135(1):72-77
DOI:10.4103/0971-5916.93427  PMID:22382186
Background & objectives: Several studies have raised the suspicion that the body mass index (BMI) cut-off for overweight as defined by the WHO may not adequately reflect the actual overweight status. The present study looked at the relationship between BMI and body fat per cent (BF %) / health risks (hypertension and type 2 diabetes) in male residents of Lucknow city, north India to evaluate the validity of BMI cut-off points for overweight. Methods: One thousand one hundred and eleven male volunteer subjects (18-69 yr) who participated in different programmes organized by the Institute during 2005 to 2008 were included in the study. BF% was measured using commercially available digital weight scale incorporating bioelectrical impedance (BI) analyzer. The proposed cut-off for BMI based on BF % was calculated using receiver operating characteristics (ROC) curve analysis. Results: Forty four per cent subjects showed higher BF % (>25%) with BMI range (24-24.99 kg/m 2 ). Sensitivity and specificity at BMI cut-off at 24.5 kg/m 3 were 83.2 and 77.5, respectively. Sensitivity at BMI cut-off >25 kg/m 2 was reduced by 5 per cent and specificity increased by 4.6 per cent when compared to 24.5 cut-off. Interpretation & conclusions: The study subjects showed higher body fat percentage and risk factors like hypertension and type 2 diabetes at normal BMI range proposed by the WHO. The cut-off for BMI was proposed to be 24.5 kg/m 2 for our study population. If overweight is regarded as an excess of body fat and not as an excess of weight (increased BMI), the cut-off points for overweight based on BMI would need to be lowered. However, the confidence of estimate of the BMI cut-off in the present study may be considered with the limitations of BI analysis studies.
  2,842 396 15
Mosquito biting activity on humans & detection of Plasmodium falciparum infection in Anopheles stephensi in Goa, India
Nandini S Korgaonkar, Ashwani Kumar, Rajpal S Yadav, Dipak Kabadi, Aditya P Dash
January 2012, 135(1):120-126
DOI:10.4103/0971-5916.93434  PMID:22382193
Background & objectives: Knowledge of the bionomics of mosquitoes, especially of disease vectors, is essential to plan appropriate vector avoidance and control strategies. Information on biting activity of vectors during the night hours in different seasons is important for choosing personal protection measures. This study was carried out to find out the composition of mosquito fauna biting on humans and seasonal biting trends in Goa, India. Methods: Biting activities of all mosquitoes including vectors were studied from 1800 to 0600 h during 85 nights using human volunteers in 14 different localities of three distinct ecotypes in Goa. Seasonal biting trends of vector species were analysed and compared. Seasonal biting periodicity during different phases of night was also studied using William's mean. Results: A total of 4,191 mosquitoes of five genera and 23 species were collected. Ten species belonged to Anopheles, eight to Culex, three to Aedes and one each to Mansonia and Armigeres. Eleven vector species had human hosts, including malaria vectors Anopheles stephensi (1.3%), An. fluviatilis (1.8%), and An. culicifacies (0.76%); filariasis vectors Culex quinquefasciatus (40.8%) and Mansonia uniformis (1.8%); Japanese encephalitis vectors Cx. tritaeniorhynchus (17.4%), Cx. vishnui (7.7%), Cx. pseudovishnui (0.1%), and Cx. gelidus (2.4%); and dengue and chikungunya vectors Aedes albopictus (0.9%) and Ae. aegypti (0.6%). Two An. stephensi of the total 831 female anophelines, were found positive for P. falciparum sporozoites. The entomological inoculation rate (EIR) of P. falciparum was 18.1 and 2.35 for Panaji city and Goa, respectively. Interpretation & conclusions: Most of the mosquito vector species were collected in all seasons and throughout the scotophase. Biting rates of different vector species differed during different phases of night and seasons. Personal protection methods could be used to stop vector-host contact.
  2,366 436 15
Cytogenetic & molecular analyses in adult chronic myelogenous leukaemia patients in north India
Maninder Singh Anand, Neelam Varma, Subhash Varma, Kamer Singh Rana, Pankaj Malhotra
January 2012, 135(1):42-48
DOI:10.4103/0971-5916.93423  PMID:22382182
Background & objectives: Chronic myelogenous leukaemia (CML) is the commonest leukaemia in Asia. There is a paucity data on cytogenetic and molecular analyses of Indian CML patients. This apparently reflects the low availability of cytogenetic and molecular techniques in our country. This study aimed to document various types of BCR-ABL fusion transcripts in different phases of CML and to compare the Ph chromosome positivity/negativity vis-a-vis BCR-ABL fusion transcripts in adult CML patients. Methods: Between June 2004 and February 2009, 208 patients were diagnosed as CML in chronic phase (CP), accelerated phase (AP) and blast crisis (BC), according to standard criteria. Cytogenetic and molecular genetic analyses were performed in all patients. Various types of BCR-ABL hybrid transcripts were compared with phases of CML and cytogenetic abnormalities. Results: Among 208 CML patients, b3a2 BCR-ABL transcripts were most commonly detected (66.82%) followed by b2a2 (28.84%), b3a2 + b2a2 (3.36%), b3a2 + e19a2 (0.48%) and b2a2 + e19a2 (0.48%). b3a2 transcripts were more frequently detected than b2a2 transcripts, in the whole group of 208 as well as in 183 CML-CP patients (P<0.0001). Ph chromosome was positive in 135 of 139 patients with b3a2 transcripts and 56 of 60 patients with b2a2 transcripts, difference not being significant. Additional cytogenetic abnormalities detected in 3.8 per cent patients in CML-CP and 44 per cent patients in CML-AP/BC, did not show predilection for any BCR-ABL transcript type. Interpretation & conclusions: This study documents higher Ph positivity (96.15%) by cytogenetic analysis among CML patients, as confirmed by qualitative reverse transcriptase-polymerase chain reaction (RT-PCR) analysis in a large patient group from north India. Both the techniques contribute towards understanding the disease biology, and have important implications for diagnosis and management of CML patients.
  2,232 551 7
Chromosomal abnormalities & oxidative stress in women with premature ovarian failure (POF)
Manoj Kumar, Dhananjay Pathak, Sundararajan Venkatesh, Alka Kriplani, AC Ammini, Rima Dada
January 2012, 135(1):92-97
DOI:10.4103/0971-5916.93430  PMID:22382189
Background & objectives: Premature ovarian failure (POF) is defined as the cessation of ovarian function under the age of 40 yr and is characterized by amenorrhoea, hypoestrogenism and elevated serum gonadotrophin levels. The cause of POF remains undetermined in majority of the cases. This study was aimed to investigate the type and frequency of cytogenetic abnormalities in patients with idiopathic POF and also to study the role of oxidative stress in such cases. Methods: Seventy five women with idiopathic POF were included in this study. Chromosome analysis was done in peripheral blood lymphocytes by conventional GTG banding to identify numerical or structural abnormalities. Cytogenetically normal cases were investigated for reactive oxygen species (ROS) levels in their blood by luminol-chemiluminescence assay. Results: Eighteen chromosomal anomalies were identified in POF patients (24%). Majority of the cases were found to have X-chromosome abnormalities (28%). Overall median ROS range was found to be significantly higher (P<0.01) in POF patients [50480 (120,132966) RLU/min] compared to controls [340 (120,5094) RLU/min]. Among these, 50 per cent of the POF patients had higher ROS levels, 20 per cent had medium elevation and 30 per cent were found to have normal values comparable to controls. Interpretation & conclusions: X-chromosome anomalies were found to be the major contributor of POF. Oxidative stress may be the underlying aetiology in idiopathic premature ovarian failure. Thus the results of this study highlight the role of cytogenetic abnormalities and supraphysiological levels of ROS in causation of idiopathic POF. But the role of oxidative stress needs to be confirmed by other studies on patients from different geographical areas and from different ethnicities.
  2,183 460 6
Polymorphisms in base-excision & nucleotide-excision repair genes & prostate cancer risk in north Indian population
Raju K Mandal, Ruchika Gangwar, Rakesh Kapoor, Rama Devi Mittal
January 2012, 135(1):64-71
DOI:10.4103/0971-5916.93426  PMID:22382185
Background & objectives: Genetic variation in the DNA repair genes might be associated with altered DNA repair capacities (DRC). Reduced DRC due to inherited polymorphisms may increase the susceptibility to cancers. Base excision and nucleotide excision are the two major repair pathways. We investigated the association between two base excision repair (BER) genes (APE1 exon 5, OGG1 exon 7) and two nucleotide excision repair (NER) genes (XPC PAT, XPC exon 15) with risk of prostate cancer (PCa). Methods: The study was designed with 192 histopathologically confirmed PCa patients and 224 age matched healthy controls of similar ethnicity. Genotypes were determined by amplification refractory mutation specific (ARMS) and PCR-restriction fragment length polymorphism (RFLP) methods. Results: Overall, a significant association in NER gene, XPC PAT Ins/Ins (I/I) genotype with PCa risk was observed (Adjusted OR- 2.55, 95%CI-1.22-5.33, P=0.012). XPC exon 15 variant CC genotypes presented statistically significant risk of PCa (Adjusted OR- 2.15, 95% CI-1.09-4.23, P=0.026). However, no association was observed for polymorphism with BER genes. Diplotype analysis of XPC PAT and exon 15 revealed that the frequency of the D-C and I-A diplotype was statistically significant in PCa. The variant genotypes of NER genes were also associated with high Gleason grade. Interpretation & conclusions: The results indicated that there was a significant modifying effect on the association between genotype XPC PAT and exon 15 polymorphism and PCa risk which was further confirmed by diplotype analysis of XPC PAT and exon 15 in north Indian population.
  2,137 404 15
A pilot study on area under curve of mycophenolic acid as a guide for its optimal use in renal transplant recipients
SC Sarangi, KH Reeta, SK Agarwal, T Kaleekal, S Guleria, YK Gupta
January 2012, 135(1):84-91
DOI:10.4103/0971-5916.93429  PMID:22382188
Background & objectives: The immunosuppressants administered to renal transplant subjects are usually monitored therapeutically to prevent graft rejection and drug toxicity. Mycophenolic acid (MPA) is an immunosuppressant. The present prospective study was undertaken to establish the utility of plasma level monitoring of MPA and to correlate it with clinical outcomes in renal transplant receipients. Methods: MPA plasma level at 2, 4 and 9 h and the area under concentration-time curve (AUC) were estimated using high performance liquid chromatography in 24 renal transplant recipients receiving immunosuppressant MPA plus tacrolimus and steroid. Results: There was wide inter-individual variation in MPA plasma level and the AUC. The incidences of gastrointestinal adverse drug events (diarrhoea and acidity) were significantly more in the high MPA AUC patients. Though biopsy proven acute rejection was not found, of the six subjects with lower MPA AUC (<30 mg.h/l), three were clinically diagnosed to develop tacrolimus nephrotoxicity. The Gastrointestinal Symptom Rating Scale (GSRS) and Gastrointestinal Quality of Life Index (GIQLI) scores represented better health related quality of life in lower MPA AUC than in the higher MPA AUC (>60 mg.h/l). Interpretation & conclusions: The present findings suggest the MPA AUC of 30 - 60 mg.h/l in the maintenance stage of renal transplant patients to have optimum clinical benefit and relegated adverse events profile indicating the usefulness of AUC of MPA with limited sampling strategy in optimizing its use.
  2,019 459 14
Bone mineral density in patients of Graves disease pre- & post-treatment in a predominantly vitamin D deficient population
Viveka P Jyotsna, Abhay Sahoo, Singh Achouba Ksh, V Sreenivas, Nandita Gupta
January 2012, 135(1):36-41
DOI:10.4103/0971-5916.93422  PMID:22382181
Background & objectives: Hyperthyroidism causes bone loss, and its treatment may restore bone mass, however, concomitant vitamin D deficiency may prevent this. We undertook this study to measure the bone mineral density (BMD) 25 (OH) vitamin D levels in patients with Graves disease in our population which is predominently vitamin D deficient and how we change with when patients become euthyroid. Methods: The biochemical, thyroid functions, serum vitamin D levels and BMD were estimated in 80 consecutive patients with Graves and 80 euthyroid controls. Patients were treated and rendered euthyroid. Fifty four completed one year, and 27 completed two years of follow up. Results: Patients had significant reduced BMD during hyperthyroid state compared to normal healthy controls. The mean vitamin D levels at baseline were in the insufficient range both patients (12.67±6.24 ng/ml) and controls (10.99±7.05 ng/ml). The BMD improved at all sites with antithyroid treatment. But, the BMD adjusted for body mass index (BMI) and age at all sites showed significant decrease with time. Interpretation & conclusions: Age and body mass index positively correlated with BMD. There was improvement in absolute BMD of patients at one and two years of follow up. When the BMD was adjusted for age and BMI, there was a decrease in BMD at one year which was less in the second year including that the damage in BMD caused by thyroid hormone excess is not made up even after two years of patient being euthyroid. Whether vitamin D replacement would change this needs to be studied.
  1,905 373 5
Comparison of thrice daily biphasic human insulin (30/70) versus basal detemir & bolus aspart in patients with poorly controlled type 2 diabetes mellitus - A pilot study
G Shanmugasundar, Anil Bhansali, Rama Walia, Pinaki Dutta, Vimal Upreti
January 2012, 135(1):78-83
DOI:10.4103/0971-5916.93428  PMID:22382187
Background & objectives: Conventionally, biphasic human insulin (30/70, BHI) is used twice daily for the management of patients with diabetes. However, this regimen is suboptimal to control post-lunch and/or pre-dinner hyperglycaemia in some patients. This study was undertaken to compare the efficacy and safety of thrice-daily biphasic human insulin (30/70, BHI) versus basal detemir and bolus aspart (BB) in patients with poorly controlled type 2 diabetes mellitus (T2DM). Methods: In this open labelled randomized pilot study, 50 patients with uncontrolled T2DM on twice-daily BHI and insulin sensitizers were randomized either to BHI thrice-daily or BB regimen. HbA1c, six point plasma glucose profile, increment in insulin dose, weight gain, hypoglycaemic episodes and cost were compared between the two treatment groups at the end of 12 wk. Results: Mean HbA l c (±SD) decreased from 9.0±0.9 per cent at randomization to 7.9±0.8 per cent in BHI (P<0.001) and from 9.4±1.3 to 8.2±1.0 per cent in BB regimen (P<0.001) after 12 wk of treatment. The mean (±SEM) weight gain in patients in the BHI regimen was 1.5±0.33 kg compared to 1.4±0.34 kg in the BB regimen. Insulin dose increment at 12 wk was significantly more in the BB regimen 0.46±0.32 U/kg/day compared to 0.15±0.21 U/kg/day in the BHI regimen (P<0.001). The incidence of major as well as minor hypoglycaemic episodes was not different in both the regimen. The BB regimen was more expensive than the BHI regimen (P<0.001). Interpretation & conclusions: The thrice daily biphasic human insulin regimen is non-inferior to the basal bolus insulin analogue regimen in terms efficacy and safety in patients with poorly controlled T2DM. However, these data require further substantiation in large long term prospective studies.
  1,688 477 5
Molecular description of plasmid-mediated AmpC β-lactamases among nosocomial isolates of Escherichia coli & Klebsiella pneumoniae from six different hospitals in India
Parveen R Mohamudha, BN Harish, SC Parija
January 2012, 135(1):114-119
DOI:10.4103/0971-5916.93433  PMID:22382192
Background & objectives: Plasmid mediated AmpC β-lactamase (PMABL) resistance in Escherichia coli and Klebsiella spp. is an emerging problem worldwide. Phenotypic methods are commonly used for detection of PMABL production in Gram-negative isolates, but molecular data about the prevalence of plasmid-mediated AmpC-type resistance at the national level are needed. Hence, a prospective study was undertaken to determine the occurrence of PMABL gene and its types among clinical isolates of E. coli and K. pneumoniae obtained from six different hospitals in India. Methods: A total of 241 nosocomial isolates of K. pneumoniae (n=109) and E.coli (n=132) from six geographically distant hospitals in India were included. These were screened for cefoxitin resistance. AmpC disk test and modified three dimensional extraction test were used for phenotypic detection of PMABL production. Molecular types were determined by a multiplex PCR. Results: Among the 241 isolates, 187 (77.5%) were found to be cefoxitin resistant (K. pneumoniae n=83, E. coli n=104). AmpC activity was detectable in 153 (63.4%) isolates, (K. pneumoniae n=69, E. coli n=84). By PCR, the plasmid encoded AmpC genes were found in 92 (38.1%) isolates and the molecular types of the genes detected predominantly were DHA, CIT followed by MOX and ACC types. Interpretation & conclusions: A high percentage of plasmid-encoded AmpC enzymes was noted in E. coli and K. pneumonia isolates obtained from different parts of the country. Phenotypic methods alone may not reflect the true number of PMABL producers. Genotypic methods need to be employed in national surveillance studies.
  1,663 460 17
EDITORIALS
Elimination of leprosy & possibility of eradication - the Indian scenario
KV Desikan
January 2012, 135(1):3-5
DOI:10.4103/0971-5916.93415  PMID:22382174
  1,656 367 5
CORRESPONDENCE
Streptococcus pyogenes pharyngitis & impetigo in a rural area of Panchkula district in Haryana, India
R Kumar, A Chakraborti, AK Aggarwal, H Vohra, V Sagar, V Dhanda, YP Sharma, S Majumdar, N Hoe, RM Krause
January 2012, 135(1):133-136
DOI:10.4103/0971-5916.93437  PMID:22382196
  1,486 296 4
REVIEW ARTICLES
Expression of telomerase & its significance in the diagnosis of pancreatic cancer
Anutebeh Verdo Zisuh, Tian-Quan Han, Shen-Dao Zhan
January 2012, 135(1):26-30
DOI:10.4103/0971-5916.93420  PMID:22382179
Pancreatic cancer has one of the worst prognoses among all types of cancers. The survival rate is less than 5 per cent; this is due to difficulty in diagnosing at an early stage. Despite the improvements in diagnostic imaging techniques such as computed tomography, magnetic resonance imaging, etc., the early diagnosis of pancreatic cancer is still difficult. Alternative methods of diagnosing pancreatic cancer at an early stage are presently been explored. The detection of telomerase activity has been proposed to be a useful tool in the diagnosis of pancreatic cancer. Telomerase is made up of three major parts namely, human telomerase reverse transcriptase, human telomerase and telomerase -associated protein. Several researchers have shown telomerase activity in tissues and fluids of patients with pancreatic and other types of cancers. About 95 per cent telomerase activity has been detected in pancreatic adenocarcinoma. Since telomerase activity is present in a vast majority of human cancers, it might have a role in the diagnosis and treatment of cancer.
  1,320 392 5
EDITORIALS
Moving on with challenges & new initiatives
Anju Sharma
January 2012, 135(1):1-2
DOI:10.4103/0971-5916.93414  PMID:22382173
  1,413 264 16
ORIGINAL ARTICLES
Allele-specific PCR for a cost-effective & time-efficient diagnostic screening of spinal muscular atrophy
M Marini, TH Sasongko, MS Watihayati, AB Atif, F Hayati, Gunadi , Z.A.M.H. Zabidi-Hussin, M Ravichandran, H Nishio, BA Zilfalil
January 2012, 135(1):31-35
DOI:10.4103/0971-5916.93421  PMID:22382180
Background & objectives: Genetic diagnosis of spinal muscular atrophy (SMA) is complicated by the presence of SMN2 gene as majority of SMA patients show absence or deletion of SMN1 gene. PCR may amplify both the genes non selectively in presence of high amount of DNA. We evaluated whether allele-specific PCR for diagnostic screening of SMA is reliable in the presence of high amount of genomic DNA, which is commonly used when performing diagnostic screening using restriction enzymes. Methods: A total of 126 blood DNA samples were tested in amounts ranging 80-200 ng, referred for the genetic diagnosis of SMA using both conventional PCR-RFLP and allele-specific PCR. Results: The results from both methods showed agreement. Further, allele-specific PCR was found to be a time-efficient and cost-effective method. Interpretation & conclusions: Our study demonstrated the accuracy of our allele-specific PCR and the results were comparable compatible with that of PCR-RFLP, indicating its practical application in SMA diagnostic screening.
  1,256 389 1
COMMENTARIES
Thyroid bone disease
CV Harinarayan
January 2012, 135(1):9-11
DOI:10.4103/0971-5916.93417  PMID:22382176
  1,271 307 -
Cytogenetic study in CML
PG Subramanian
January 2012, 135(1):12-13
DOI:10.4103/0971-5916.93418  PMID:22382177
  1,139 304 -
CORRESPONDENCE
Methodological errors in screening of Yq microdeletion in Iranian azoospermic men
Kioomars Saliminejad, Hamid Reza Khorram Khorshid
January 2012, 135(1):137-138
DOI:10.4103/0971-5916.93438  PMID:22382197
  1,028 225 3
Disappearance of a deadly disease acute hepatomyoencephalopathy syndrome from Saharanpur
RS Panwar
January 2012, 135(1):131-132
DOI:10.4103/0971-5916.93436  PMID:22382195
  899 184 1
BOOK REVIEWS
Global tuberculosis control 2010
D Behera
January 2012, 135(1):142-143
  764 148 -
Textbook of pulmonary medicine
DJ Christopher
January 2012, 135(1):143-143
  589 126 -
CORRESPONDENCE
Authors response
Reza Mirfakhraie
January 2012, 135(1):138-139
DOI:10.4103/0971-5916.93439  
  526 148 -
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