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   2014| June  | Volume 139 | Issue 6  
    Online since August 4, 2014

 
 
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REVIEW ARTICLES
Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements
Holly Keyt, Paola Faverio, Marcos I Restrepo
June 2014, 139(6):814-821
PMID:25109715
Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i) Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv) Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.
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Obesity-related inflammation & cardiovascular disease: Efficacy of a yoga-based lifestyle intervention
Kumar Sarvottam, Raj Kumar Yadav
June 2014, 139(6):822-834
PMID:25109716
Obesity is a global health burden and its prevalence is increasing substantially due to changing lifestyle. Chronic adiposity is associated with metabolic imbalance leading to dyslipidaemia, diabetes, hypertension and cardiovascular diseases (CVD). Adipose tissue acts as an endocrine organ releasing several adipocytokines, and is associated with increased levels of tissue and circulating inflammatory biomolecules causing vascular inflammation and atherogenesis. Further, inflammation is also associated independently with obesity as well as CVD. Keeping this in view, it is possible that a reduction in weight may lead to a decrease in inflammation, resulting in CVD risk reduction, and better management of patients with CVD. Lifestyle intervention has been endorsed by several health authorities in prevention and management of chronic diseases. A yoga-based lifestyle intervention appears to be a promising option in reducing the risk for CVD as well as management of patients with CVD as it is simple to follow and cost-effective with high compliance. The efficacy of such lifestyle intervention programmes is multifaceted, and is achieved via reduction in weight, obesity-related inflammation and stress, thereby culminating into risk reduction towards several chronic diseases including CVD. In this review, the association between obesity-related inflammation and CVD, and the role of yoga-based lifestyle intervention in prevention and management of CVD are discussed.
  2,176 652 -
Food allergy: Diagnosis, management & emerging therapies
Rachel Glick Robison
June 2014, 139(6):805-813
PMID:25109714
IgE-mediated food allergy is an important health concern with increasing prevalence worldwide. Manifestations of IgE-mediated food allergy include urticaria, angioedema, pruritus, difficulty in breathing, laryngeal oedema, vomiting, diarrhoea and/or hypotension within minutes to two hours of the offending food's ingestion. Diagnosis requires both a careful history and supportive testing with laboratory studies and possibly oral food challenges. Current treatment of food allergy focuses on avoidance of the allergen and prompt emergency management of reactions. Epinephrine autoinjectors are provided to patients for the treatment of severe reactions. More research is needed to determine the optimal timing with which to introduce common allergens into a child's diet to possibly prevent the development of food allergy. Novel therapies are under investigation given the difficulty of allergen avoidance and the potentially fatal nature of reactions. Both allergen specific therapies such as oral, sublingual and epicutaneous immunotherapy and allergen non-specific therapies such the Chinese herbal formula FAHF-2 and omalizumab show promise though more data on efficacy and long-term safety are needed before these therapies become mainstream.
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STUDENT IJMR
Antimicrobial resistance pattern in Escherichia coli causing urinary tract infection among inpatients
V Niranjan, A Malini
June 2014, 139(6):945-948
PMID:25109731
Background & objectives: Recent studies suggest an increasing antimicrobial resistance among Escherichia coli causing urinary tract infection (UTI). We undertook this study to know the resistance pattern of E. coli causing UTI in patients admitted to a tertiary care hospital in north India, and to know the treatment given and response of the patients. Methods: The details of E. coli grown from urine samples and their antibiotic sensitivity pattern were collected from the laboratory registers and the patient details were collected from the case records. The urine samples received were processed using standard methods and antibiotic susceptibility was done by Kirby-Bauer disk diffusion test. Results: Of the total 311 E. coli isolates, 119 (38.2%) were isolated from in-patients, which were considered for the study. o0 f these 119 E. coli isolates, 91 (76.51%) were multi drug resistant (MDR). The isolates showed high levels of resistance to ampicillin (88.4%), amoxicillin-clavulanic acid (74.4%), norfloxacin (74.2%), cefuroxime (72.2%), ceftriaxone (71.4%) and co-trimoxazole (64.2%). The isolates were sensitive to amikacin (82.6%), piperacillin-tazobactum (78.2%), nitrofurantoin (82.1%) and imipenem (98.9%). Ceftriaxone was most commonly used for empirical therapy for UTI among inpatients in our hospital. o0 f the 93 cases of UTI due to MDR E. coli, 73 improved on treatment and 12 worsened, which were referred to higher centres. Interpretation & conclusions: Our study showed that 76.5 per cent of E. coli isolates from urine samples of inpatients were MDR. Diabetes, chronic renal disease and catherization were some of the risk factors associated. The high rate of resistance could be because only inpatients were included and the increased usage of cephalosporins in our hospital for empirical therapy.
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ORIGINAL ARTICLES
A study of Mycobacterium tuberculosis genotypic diversity & drug resistance mutations in Varanasi, north India
Anamika Gupta, Savita Kulkarni, Nalin Rastogi, Shampa Anupurba
June 2014, 139(6):892-902
PMID:25109724
Background & objectives: One-fifth of the world's new tuberculosis (TB) cases and two-thirds of cases in the South East Asian region occur in India. Molecular typing of Mycobacterium tuberculosis isolates has greatly facilitated to understand the transmission of TB. This study was aimed to investigate the molecular epidemiology of M. tuberculosis genotypes in Varanasi, north India, and their association with clinical presentation among patients with pulmonary TB. Methods: M. tuberculosis isolates from 104 TB patients attending a tertiary referral hospital of north India were screened for susceptibility to isoniazid (INH), rifampicin (RIF), ethambutol (EMB) and streptomycin (STR) by proportion method and multiplex-allele-specific-polymerase chain reaction (MAS-PCR). These were genotyped by spoligotyping. The spoligotype patterns were compared with those in the international SITVIT2 spoligotyping database. Results: Eighty three of 104 isolates were distributed in 38 SITs, of which SIT3366 was newly created within the present study. The mass of ongoing transmission with MDR-TB isolates in Varanasi, northern India, was linked to Beijing genotype followed by the CAS1_Delhi lineage. HIV-seropositive patients had a significantly higher proportion of clustered isolates than HIV-seronegative patients and compared with the wild type(wt) isolates, the isolates with katG315Thr mutation were considerably more likely to be clustered. Interpretation & conclusions: This study gives an insight into the M. tuberculosis genetic biodiversity in Varanasi, north India, the predominant spoligotypes and their impact on disease transmission. In this region of north India, TB is caused by a wide diversity of spoligotypes with predominance of four genotype lineages: Beijing, CAS, EAI and T. The Beijing genotype was the most frequent single spoligotype and strongly associated with multi drug resistant (MDR)-TB isolates. These findings may have important implications for control and prevention of TB in north India.
  1,026 451 -
Production of a compound against methicillin resistant Staphylococcus aureus (MRSA) from Streptomyces rubrolavendulae ICN3 & its evaluation in zebrafish embryos
Rajaretinam Rajesh Kannan, Appadurai Muthamil Iniyan, Samuel Gnana Prakash Vincent
June 2014, 139(6):913-920
PMID:25109726
Background & objectives: Antibiotic resistance in pathogens has become a serious problem worldwide. Therefore, the search for new antibiotics for drug resistanct pathogens is an important endeavor. The present study deals with the production of anti-methicillin resistant Staphylococcus aureus (MRSA) potential of Streptomyces rubrolavendulae ICN3 and evaluation of anti-MRSA compound in zebrafish embryos. Methods: The antibiotic production from S. rubrolavendulae ICN3 was optimized in solid state fermentation and extracted. The antagonistic activity was confirmed against MRSA and purified in silica gel column and reverse phase - HPLC with an absorption maximum at 215 nm. Minimal inhibitory concentration of the compound was determined by broth microdilution method. Zebrafish embryos were used to evaluate the extract/compound for its minimal inhibition studies, influences on heart beat rates, haematopoietic blood cell count and lethal dose values. Results: Streptomyces rubrolavendulae ICN3 showed potent antagonistic activity against MRSA with a zone of 42 mm. The minimum inhibitory concentration was calculated as 500 μg/ml of the crude extract and the purified C23 exhibited 2.5 μg/ml in in vitro assay. The LC 50 value of the anti MRSA compound C23 was calculated as 60.49 μg/ml and the MRSA treated embryos survived in the presence of purified compound C23 at a dose of 10 μg/ml. Interpretation & conclusions: Our results suggested that the compound was potent with less toxic effects in zebrafish embryonic model system for MRSA infection. Further structural evaluation and analysis in higher mammalian model system may lead to a novel drug candidate for drug resistant Staphylococcus aureus.
  934 343 -
Effects of gamma oryzanol supplementation on anthropometric measurements & muscular strength in healthy males following chronic resistance training
Saghar Eslami, Norhaizan Mohd Esa, Seyed Mohammad Marandi, Gholamali Ghasemi, Sepehr Eslami
June 2014, 139(6):857-863
PMID:25109720
Background & objectives: Enhanced muscle strength is seen when resistance exercise is combined with the consumption of nutritional supplements. Although there is a limited number of studies available about the efficacy of gamma oryzanol supplementation with resistance exercise in humans, but its usage as a nutritional supplement for strength is common in athletes. The aim of this study was to determine the effects of gamma oryzanol supplementation during 9-week resistance training on muscular strength and anthropometric measurements of young healthy males. Methods: In this double-blind clinical trial, changes of anthropometric measurements and muscular strength were studied after chronic resistance exercise and gamma oryzanol supplementation in 30 healthy volunteers (16 in supplement and 14 in placebo). Each day, gamma oryzanol supplement (600 mg) and placebo (the same amount of lactose) were consumed after training. The participants exercised with 80 per cent 1-Repetition Maximum (1-RM), for one hour and four days/week. Anthropometric measurements and subjects' 1-RM for muscular strength were determined at the commencement and end of the 9-week study. Results: There was no significant difference between the baseline characteristics and target variables at baseline between the two groups. After gamma oryzanol supplementation, there was no significant difference in the means of anthropometric and skin fold measurements between the supplement and placebo groups. However, there were significant differences between the supplement and placebo groups for 1-RM of bench press and leg curl, which showed that gamma oryzanol improved muscle strength following resistance training. Interpretation & conclusions: Our findings indicated that 600 mg/day gamma oryzanol supplementation during the 9-week resistance training did not change anthropometric and body measurements, but it increased muscular strength in young healthy males. Further, studies need to be done in trained athletes, women, and in patients who suffer from muscular fatigue.
  897 373 -
EDITORIAL
A century after discovery of sickle cell disease: keeping hope alive!
Dipika Mohanty
June 2014, 139(6):793-795
PMID:25109713
  778 344 -
ORIGINAL ARTICLES
Role of genetic & environment risk factors in the aetiology of colorectal cancer in Malaysia
Nurul Hanis Ramzi, Jagdish Kaur Chahil, Say Hean Lye, Khamsigan Munretnam, Kavitha Itagi Sahadevappa, Sharmila Velapasamy, Nikman Adli Nor Hashim, Soon Keat Cheah, GerardChin Chye Lim, Heselynn Hussein, Mohd Roslan Haron, Livy Alex, Lian Wee Ler
June 2014, 139(6):873-882
PMID:25109722
Background & objectives: Colorectal cancer (CRC) is second only to breast cancer as the leading cause of cancer-related deaths in Malaysia. In the Asia-Pacific area, it is the highest emerging gastrointestinal cancer. The aim of this study was to identify single nucleotide polymorphisms (SNPs) and environmental factors associated with CRC risk in Malaysia from a panel of cancer associated SNPs. Methods: In this case-control study, 160 Malaysian subjects were recruited, including both with CRC and controls. A total of 768 SNPs were genotyped and analyzed to distinguish risk and protective alleles. Genotyping was carried out using Illumina's BeadArray platform. Information on blood group, occupation, medical history, family history of cancer, intake of red meat and vegetables, exposure to radiation, smoking and drinking habits, etc was collected. Odds ratio (OR), 95% confidence interval (CI) were calculated. Results: A panel of 23 SNPs significantly associated with colorectal cancer risk was identified ( p0 <0.01). Of these, 12 SNPs increased the risk of CRC and 11 reduced the risk. Among the environmental risk factors investigated, high intake of red meat (more than 50% daily proportion) was found to be significantly associated with increased risk of CRC (OR=6.52, 95% CI :1.93 - 2.04, P=0.003). Two SNPs including rs2069521 and rs10046 in genes of cytochrome P450 (CYP) superfamily were found significantly associated with CRC risk. For gene-environment analysis, the A allele of rs2069521 showed a significant association with CRC risk when stratified by red meat intake. Interpretation & conclusions: In this preliminary study, a panel of SNPs found to be significantly associated with CRC in Malaysian population, was identified. Also, red meat consumption and lack of physical exercise were risk factors for CRC, while consumption of fruits and vegetables served as protective factor.
  765 322 -
Perceptions of parental bonding in freebase cocaine users versus non-illicit drug users
Marcia Pettenon, Felix HenriquePaim Kessler, Luciano S.P. Guimaraes, Rosemeri Siqueira Pedroso, Simone Hauck, Flavio Pechansky
June 2014, 139(6):835-840
PMID:25109717
Background & objectives: Evidence has suggested that parenting styles have peculiar characteristics in families with drug-related issues. This study was undertaken to investigate the perception of crack (smoke cocaine) users and non-users about parental bonding quality regarding care and control in Brazil. Methods: A total of 198 hospitalized crack users and 104 users of any non-illicit drug were assessed using the Parental Bonding Instrument (PBI), the sixth version of the Addiction Severity Index (ASI) and Mini International Neuropsychiatric Interview (MINI). Results: Adjusted logistic regression analysis showed that crack users were more likely (OR adj = 9.68; 95% CI: 2.82, 33.20) to perceive neglectful mothers, as well as more likely (OR adj = 4.71, 95% CI: 2.17, 10.22) to perceive controlling and affectionless fathers in comparison with non-illicit drug users who were more likely to perceive optimal parenting. Interpretation & conclusions: Our findings indicate that the perception of neglectful mothers and affectionless controlling fathers may be associated with the tendency of the children to be less resilient when facing stressful events, leading them to a greater risk to use crack.
  760 312 -
Impact of referral transport system on institutional deliveries in Haryana, India
Shankar Prinja, Gursimer Jeet, Manmeet Kaur, Arun Kumar Aggarwal, Neha Manchanda, Rajesh Kumar
June 2014, 139(6):883-891
PMID:25109723
Background & objectives: Creation of a strong referral transport network across the country is necessary for improving physical access to public sector health facilities. In this study we evaluated the referral transport services in Haryana, i.e. Haryana Swasthya Vaahan Sewa (HSVS), now known as National Ambulance Service (NAS), to assess the extent and pattern of utilization, and to ascertain its effect on public sector institutional deliveries. Methods: Secondary data on 116,562 patients transported during April to July 2011 in Haryana state were analysed to assess extent and pattern of NAS utilization. Exit interviews were conducted with 270 consecutively selected users and non- users of referral services respectively in Ambala (High NAS utilization), Hisar (medium utilization) and Narnaul (low utilization) districts. Month-wise data on institutional deliveries in public facilities during 2005-2012 were collected in these three districts, and analysed using interrupted time series analysis to assess the impact of NAS on institutional deliveries. Results: Female gender (OR = 77.7), rural place of residence (OR = 5.96) and poor socio-economic status (poorest wealth quintile OR = 2.64) were significantly associated with NAS ambulance service usage. Institutional deliveries in Haryana rose significantly after the introduction of NAS service in Ambala (OR=137.4, 95% CI=22.4-252.4) and Hisar (OR=215, 95% CI=88.5-341.3) districts. No significant increase was observed in Narnaul (OR=4.5, 95% CI= -137.4 to 146.4) district. Interpretation & conclusions: The findings of the present study showed a positive effect of referral transport service on increasing institutional deliveries. However, this needs to be backed up with adequate supply of basic and emergency obstetric care at hospitals and health centres.
  778 290 -
Effect of oxytocin injection to milching buffaloes on its content & stability in milk
Raghu Pullakhandam, Ravindranadh Palika, Sudershan Rao Vemula, Kalpagam Polasa, Sesikeran Boindala
June 2014, 139(6):933-939
PMID:25109729
Background & objectives: Oxytocin (OT) injections to milch cattle for milk letdown have become a common practice amongst dairy farmers in India. Although there is no reported evidence, it is widely presumed that long term consumption of such milk leads to adverse health consequences. However, there is no information on the effect of exogenous OT injections on milk OT content and its stability during heating and gastrointestinal digestion. This study was carried out to determine the OT content in milk samples given by buffaloes with and without OT injections and to assess the stability of OT in the milk. Methods: Milk samples from milch buffaloes (Murrah buffalo) were collected from local farmers with (n=121) or without (n=120) exogenous OT injections during 3 to 5 months of lactation period. The OT content of milk samples was estimated by competitive enzyme immunoassay (EIA). The thermal and digestive stability of OT was assessed by in silico and in vitro digestion methods. Results: The OT content of the milk samples was similar regardless of OT injections used. Further, OT was found to be stable to heat treatment and gastric pepsin digestion while it was rapidly digested during the simulated intestinal digestion. r0 educed OT was digested by pepsin, implying that internal disulphide bridge of OT rendered the peptide resistant to peptic digestion. On the other hand, phenylmethylsulphonyl fluoride (PMSF), a serine protease inhibitor, abrogated the pancreatin induced digestion of OT. Interpretation & conclusions: These findings suggest that exogenous OT injections do not influence its content in milk. Further, OT present in milk is rapidly degraded during intestinal digestion, ruling out its intestinal absorption and associated adverse health consequences, if any.
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COMMENTARIES
Adiponectin & inflammatory biomarkers in coronary artery disease
Jaewon Oh, Seok-Min Kang
June 2014, 139(6):799-801
PMID:25228016
  785 254 -
CLINICAL IMAGES
Arc of Riolan
Sureka Binit, Mahesh Kumar Mittal
June 2014, 139(6):965-966
PMID:25109739
  739 257 -
ORIGINAL ARTICLES
Protective effects of glucose-6-phosphate dehydrogenase on neurotoxicity of aluminium applied into the CA1 sector of rat hippocampus
Marina D Jovanovic, Ankica Jelenkovic, Ivana D Stevanovic, Dubravko Bokonjic, Miodrag Colic, Natasa Petronijevic, Danica B Stanimirovic
June 2014, 139(6):864-872
PMID:25109721
Background & objectives: Aluminum (Al) toxicity is closely linked to the pathogenesis of Alzheimer's disease (AD). This experimental study was aimed to investigate the active avoidance behaviour of rats after intrahippocampal injection of Al, and biochemical and immunohistochemical changes in three bilateral brain structures namely, forebrain cortex (FBCx), hippocampus and basal forebrain (BF). Methods: Seven days after intra-hippocampal (CA1 sector) injection of AlCl 3 into adult male Wistar rats they were subjected to two-way active avoidance (AA) tests over five consecutive days. Control rats were treated with 0.9% w/v saline. The animals were decapitated on the day 12 post-injection. The activities of acetylcholinesterase (AChE) and glucose-6-phosphate dehydrogenase (G6PDH) were measured in the FBCx, hippocampus and BF. Immunohistochemical staining was performed for transferrin receptors, amyloid β and tau protein. Results: The activities of both AChE and G6PDH were found to be decreased bilaterally in the FBCx, hippocampus and basal forebrain compared to those of control rats. The number of correct AA responses was reduced by AlCl 3 treatment. G6PDH administered prior to AlCl 3 resulted in a reversal of the effects of AlCl 3 on both biochemical and behavioural parameters. Strong immunohistochemical staining of transferrin receptors was found bilaterally in the FBCx and the hippocampus in all three study groups. In addition, very strong amyloid β staining was detected bilaterally in all structures in AlCl 3 -treated rats but was moderate in G6PDH/AlCl 3 -treated rats. Strong tau staining was noted bilaterally in AlCl 3 -treated rats. In contrast, tau staining was only moderate in G6PDH/AlCl 3 -treated rats. Interpretation & conclusions: Our findings indicated that the G6PDH alleviated the signs of behavioural and biochemical effects of AlCl 3 -treatment suggesting its involvement in the pathogenesis of Al neurotoxicity and its potential therapeutic benefit. The present model could serve as a useful tool in AD investigations.
  663 324 -
Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India
Saptarshi Bishnu, Dipanjan Bandyopadhyay, Samiran Samui, Indrani Das, Pradip Mondal, Pramit Ghosh, Deeptarka Roy, Sukanta Manna
June 2014, 139(6):903-912
PMID:25109725
Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. Results: Mean age of patients was 36.38 ± 10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04 ± 163.49 cells/μl (males 142.19 ± 139.33 cells/μl; females 235.92 ± 185.11 cells/μl). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. Interpretation & conclusions: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.
  699 269 -
COMMENTARIES
Developmental trajectory of substance use disorders: What role do the parents play (or are perceived to play)?
Debasish Basu, Abhishek Ghosh
June 2014, 139(6):796-798
PMID:25228015
  717 230 -
ORIGINAL ARTICLES
Raising cut-off value of prostate specific antigen (PSA) for biopsy in symptomatic men in India to reduce unnecessary biopsy
Shalini Agnihotri, RD Mittal, R Kapoor, Anil Mandhani
June 2014, 139(6):851-856
PMID:25109719
Background & objectives: The characteristics of prostate specific antigen (PSA) for trans-rectal ultrasonography guided prostate biopsy in men with lower urinary tract symptoms (LUTS) are not well defined. This study was carried out to analyse the threshold of PSA for biopsy in symptomatic men in India. Methods: From January 2000 to June 2011, consecutive patients who had digital rectal examination (DRE) and PSA testing done for LUTS were included in this study. PSA was done with ELISA technique. Patients with acute or chronic prostatitis, prostatic abscess, history of surgery on prostate within the previous three months and patients on 5α-reductase inhibitors or on urethral catheter were excluded. Results: Of the 4702 patients evaluated, 70.9 per cent had PSA of less than 4 ng/ml and 29.1 per cent had PSA of more than 4 ng/ml. Of these, 875 men with a mean age of 65.72±7.4 (range 50-75 yr) had trans rectal ultrasonography (TRUS) guided biopsy. Twenty five men had biopsy at PSA level of <4 ng/ml due to positive DRE, 263 at 4.1-10ng/ml, 156 at 10.1-20 ng/ml and 431 at >20 ng/ml. Positive predictive value of PSA in ranges of 4.1-10, 10.1-20, >20 ng/ml was 15.2, 24 and 62.6 per cent, respectively with negative DRE. PSA cut-off to do biopsy was derived by ROC curve as 5.82 ng/ml for all the men. When the subjects were further stratified on the basis of DRE findings, a cut-off of 5.4 ng/ml was derived in men with normal DRE. Interpretation & conclusions: A cut-off for biopsy in symptomatic men with negative DRE could safely be raised to 5.4 ng/ml, which could avoid subjecting 10 per cent of men to undergo unnecessary biopsy.
  599 318 -
Comparison of plasma adiponectin & certain inflammatory markers in angiographically proven coronary artery disease patients with & without diabetes - A study from India
Satyavani Kumpatla, Kirubakaran Karuppiah, Sathyamurthy Immaneni, Parthiban Muthukumaran, Jayanthi Krishnan, Srinivasan Kanthallu Narayanamoorthy, Vijay Viswanathan
June 2014, 139(6):841-850
PMID:25109718
Background & objectives: The association between adiponectin and risk of cardiovascular disease is well known. The aim of the present study was to evaluate adiponectin and certain inflammatory markers and to determine the correlations between them in angiographically proven coronary artery disease (CAD) in subjects with and without diabetes. Methods: A total of 180 subjects who underwent coronary angiography for symptoms suggestive of CAD were categorised into groups based on their diabetes and/or CAD status: group1 (non-diabetic non-CAD); group2 (non-diabetic CAD); group3 (diabetic non-CAD) and group4 (diabetic CAD). Adiponectin, tumour necrosis factor α (TNF-α) and soluble form of E-selectin (sE-selectin) were estimated using quantitative sandwich enzyme immunoassay and high sensitive C-reactive protein (hsCRP) by particle enhanced immunoturbidimetric method. Results: Adiponectin levels were significantly lower in subjects with either diabetes or CAD and were much lower in subjects who had both. hsCRP was elevated in CAD and diabetes but did not differ significantly between groups. sE-selectin and TNF-α levels were elevated in CAD. Adiponectin negatively correlated with age, glucose, sE-selectin, total and LDL cholesterol. hsCRP correlated with BMI, sE-selectin and urea. sE-selectin correlated with BMI, triglycerides and VLDL cholesterol, whereas TNF-α correlated with fasting plasma glucose. In the logistic regression analysis, adiponectin had a significant inverse association with CAD. sE-selectin and TNF-α also showed significant independent association with CAD. Interpretation & conclusions: Adiponectin and other inflammatory markers such as sE-selectin and TNF-α showed a significant association with CAD. Hence, early assessment of such markers can help to identify high risk patients, and to reduce the inflammatory component of diabetes and CAD.
  609 262 -
Circulation of hepatitis A genotype IIIA virus in paediatric patients in central India
PV Barde, MK Shukla, Ruchi Pathak, BK Kori, PK Bharti
June 2014, 139(6):940-944
PMID:25109730
Hepatitis A virus (HAV) infection, a major cause of childhood hepatitis is transmitted by orofaecal route. Children mostly suffer with subclinical infection but may have serious clinical implications leading to hospitalization and mortality. IgM ELISA and nRT PCR were conducted on the blood samples collected from HAV suspected paediatric cases referred to the viral diagnostic laboratory in the Regional Medical Research Centre for Tribals at Jabalpur, Central India. The nRT PCR products were sequenced and phylogenetic analysis was done. o0 f the 195 samples tested, 41 (21%) were positive for HAV antibodies, among which 38 (92%) belonged to paediatric age group and 32 per cent of these were hospitalized. nRT PCR and sequencing confirmed the presence of HAV. Phylogenic analysis revealed circulation of genotype III A in central India. Regular serological and molecular monitoring would aid in understanding epidemiology of HAV and plan intervention strategies.
  622 224 -
Chironomid midges as allergens: evidence from two species from West Bengal, Kolkata, India
Soumi Nandi, Gautam Aditya, Indrani Chowdhury, Arijit Das, Goutam K Saha
June 2014, 139(6):921-926
PMID:25109727
Background & objectives: Arthropods of different taxonomic identity including chironomid midges are known to induce allergic response in humans. The present study was done to access two common chironomid species Chironomus circumdatus and Polypedilum nubifer for their sensitizing potential as an allergen in atopic patients and controls. Methods: Following preparation of allergenic extracts of the two chironomid species separately, 198 atopic patients attending an allergy clinic and 50 age matched controls were tested along with a routine panel of allergens to assess sensitization. Results: The skin prick test (SPT) results revealed that 189 of the 198 patients (95.4%) demonstrated sensitization to both the chironomid species. Higher levels of total IgE was observed in atopic subjects than in the control group. Interpretation & conclusions: The results suggest that the chironomid midges Chironomus circumdatus and Polypedilum nubifer can elicit sensitization in humans. A potential risk for allergic reactions by susceptible individuals exists due to these chironomid species, owing to their abundance and chances of contact with human beings. Further studies may be initiated to characterize the nature of the allergens and to assess their clinical relevance.
  592 203 -
CLINICAL IMAGES
Gollop-Wolfgang syndrome
Naresh Dhanakodi, Sujit Kumar Tripathy
June 2014, 139(6):963-964
PMID:25109738
  544 209 -
CORRESPONDENCES
Can Parvovirus B19 infection be naturally oncolytic: clinical findings raise such a possibility in leukaemic children
Janak Kishore, Divya Kishor
June 2014, 139(6):952-953
PMID:25109733
  513 233 -
COMMENTARIES
Prostate biopsy for elevated prostate specific antigen (PSA) - Indian perspective
N Ragavan
June 2014, 139(6):802-803
PMID:25228017
  512 212 -
ORIGINAL ARTICLES
Histopathological changes due to the effect of selenium in experimental cockerels
S.A.A Latheef, K Radhika, G Subramanyam
June 2014, 139(6):927-932
PMID:25109728
Background & objectives: Selenium usually acts as an antioxidant at optimal levels in the body and increased levels are toxic. In this study an attempt was made to evaluate the effect of an optimum dose (0.14 mg) of selenium on histopathological changes in experimental hypercholesterolemia in cockerels. Methods: The effect of selenium (0.14 mg) was investigated on histopathological changes in four tissues namely liver, kidney, heart, and descending aorta in cockerel animal model. Animals were either fed with stock diet (group C), stock diet with cholesterol (group CH), stock diet with selenium (group Se), stock diet, selenium and cholesterol (group CH+Se) for six months. Animals were sacrified and the tissues were isolated and subjected to histopathological study. Results: Xanthochromatic collections in liver were observed in group CH; hydropic degeneration in group Se and lobular disarray, hydropic degeneration and kuppfer cell hyperplasia in group CH+Se were observed. In kidney, mild mononuclear infiltration was observed in interstitium in groups CH, Se and CH+Se. myocyte disruption, and mononuclear infiltration in group CH and c0 H+Se, and disruption of muscle bundles with vascular congestion in group Se were observed. Smooth muscle proliferation in the media of blood vessel was observed in groups CH, Se and CH+Se. Interpretation & conclusions: The results of the present study suggested that the optimum dose of (140 ΅g/day) feeding induced atherogenesis by inflammation and smooth muscle proliferation in cockerels with experimentally induced hypercholesterolaemia.
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CORRESPONDENCES
Low rate of seropositivity (IgG) to mumps component in MMR vaccinees in Chennai, south India
Jeevan Malaiyan, Thatchayini Duraipandian, Aparna Warrier, Thangam Menon
June 2014, 139(6):949-951
PMID:25109732
  461 225 -
Does serum vitamin-D predict insulin resistance in individuals with prediabetes ?
Sunil Kumar Raina
June 2014, 139(6):956-956
PMID:25109735
  370 241 -
Insulin resistance & vitamin-D levels in prediabetics
Mehmet Agilli, Ibrahim Aydin, Fevzi Nuri Aydin
June 2014, 139(6):958-959
PMID:25109736
  364 228 -
Evaluation of the effectiveness of diagnostic & management decision by teleophthalmology for retinal diseases
Aditi Gupta, Rajiv Raman, Tarun Sharma
June 2014, 139(6):954-955
PMID:25109734
  323 193 -
BOOK REVIEWS
WHO Expert Committee on Drug Dependence
Raka Jain
June 2014, 139(6):967-968
  313 155 -
Body composition and aging
Mrinal K Poddar
June 2014, 139(6):968-969
  270 190 -
SOME FORTHCOMING SCIENTIFIC EVENTS
Some Forthcoming Scientific Events

June 2014, 139(6):970-970
  269 185 -
CORRESPONDENCES
Calculation error in estimating low HDL in women
PS Reddy
June 2014, 139(6):961-961
PMID:25109737
  276 173 -
Authors' response
Deep Dutta, Indira Maisnam, Ankit Shrivastava, Anirban Sinha, Sujoy Ghosh, Pradip Mukhopadhyay, Satinath Mukhopadhyay, Subhankar Chowdhury
June 2014, 139(6):959-960
PMID:25265650
  273 139 -
Authors' response
Deep Dutta, Indira Maisnam, Ankit Shrivastava, Anirban Sinha, Sujoy Ghosh, Pradip Mukhopadhyay, Satinath Mukhopadhyay, Subhankar Chowdhury
June 2014, 139(6):956-957
PMID:25265649
  260 148 -
Authors' response
KR Thankappan, Bela Shah, Prashant Mathur, PS Sarma, G Srinivas, GK Mini, Meena Daivadanam, Biju Soman, Ramachandran S Vasan
June 2014, 139(6):962-962
PMID:25265651
  241 150 -
Authors' response
SC Gupta, Subodh Kumar Sinha, Abhishek Dagar
June 2014, 139(6):955-955
PMID:25265648
  235 151 -
BOOKS RECEIVED
Books Received

June 2014, 139(6):969-969
  198 129 -
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