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   2019| October  | Volume 150 | Issue 4  
    Online since November 29, 2019

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Association between neutrophil-lymphocyte & platelet lymphocyte ratios with prognosis & mortality in rapidly progressive glomerulonephritis
Aysun Toraman, Nalan Neşe, Beyhan Cengiz Özyurt, Seyhun Kürşat
October 2019, 150(4):399-406
DOI:10.4103/ijmr.IJMR_1234_17  PMID:31823922
Background & objectives: Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome manifested by features of nephritic syndrome and progressive loss of renal function over a short time. The objective of this study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic factors and pathological findings of renal biopsy in RPGN. Methods: Consecutive newly diagnosed RPGN patients who had follow up for at least six months were retrospectively analyzed. The estimated glomerular filtration rate (eGFR) was calculated. Albumin, C-reactive protein (CRP) levels and CRP/albumin ratio were also calculated. Results: Fifty four patients were included in the study. The mean age was 48.92±20.12 years. Clinicopathological diagnosis was pauci-immune glomerulonephritis (GN) in 40 while two had postinfectious GN, six systemic lupus erythematosus, three IgA nephropathy, two Henoch-Schönlein purpura and one membranoproliferative GN. The mean NLR was 7.02±6.34 and mean PLR was 273.90±39.15. Positive correlations between NLR and CRP levels (P=0.009, r=0.511) and CRP/albumin ratios (P=0.005, r=0.542) were observed. PLR and CRP/albumin ratios (P=0.041, r=0.412) were correlated positively. The per cent of fibrocellular crescents was negatively correlated with NLR (P=0.019, r=−0.291), and positively correlated with the lymphocyte count (P=0.05, r=0.256). In secondary crescentic subgroup, the per cent of fibrinoid necrosis had a positive correlation with PLR (P=0.013, r=0.642). Both NLR (P=0.036) and PLR (P=0.051) detected at the first month of the treatment period, were observed to be significantly correlated with mortality. Interpretation & conclusions: This study showed that NLR could predict mortality in patients with RPGN; correlated with systemic inflammation; showed a negative correlation with the per cent of fibrocellular crescents and could be regarded as a measure of glomerular inflammatory state. Moreover, PLR may be considered to be an indicator of disease severity in acute phase of crescentic GN.
  2 787 237
Challenges & issues of colistin susceptibility testing in diagnostic microbiology laboratories
Bijayini Behera
October 2019, 150(4):417-417
DOI:10.4103/ijmr.IJMR_1132_19  PMID:31823925
  1 334 175
Indian suicide data: What do they mean?
John Snowdon
October 2019, 150(4):315-320
DOI:10.4103/ijmr.IJMR_1367_19  PMID:31823911
  1 1,612 473
Incidence & management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India
Rahul Gajbhiye, Shagufta Khan, Pratibha Kokate, Iranna Mashal, Sunita Kharat, Sanjay Bodade, Arun Yadav, Smita Mahale
October 2019, 150(4):412-416
DOI:10.4103/ijmr.IJMR_1148_18  PMID:31823924
This study was undertaken to know the incidence and management practices of snakebite envenomation at the First Referral Unit - Sub-District Hospital, Dahanu, Maharashtra, India. Retrospective analysis of snakebite case records (n=145) was carried out for one-year period (January to December 2014). The annual incidence of snakebite was 36 per 100,000 population with case fatality rate of 4.5 per cent. Venomous snakebites were 76 per cent and non-venomous snakebites were 24 per cent. Overall, snakebites were more common in males (52.4%) than females (47.6%). Majority of the snakebites (66%) were in the age group of 18-45 yr. Seasonal variation was observed with highest snakebites in monsoon (58%). Lower extremities were the most common site of bites (63%). Neurotoxic and vasculotoxic envenomation were reported in 19 and 27 per cent snakebite cases, respectively. Anti-snake venom (ASV) was administered at an average dose of 7.5±0.63 vials (range 2-40, median 6). There was no uniform protocol followed for ASV administration as per the National Snakebite Management Protocol of Government of India (2009).
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Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India
Mohammad Ashraf Ganie, Vishnu Vasudevan, Imtiyaz Ahmad Wani, Mohammad Salem Baba, Tasleem Arif, Aafia Rashid
October 2019, 150(4):333-344
DOI:10.4103/ijmr.IJMR_1937_17  PMID:31823915
Polycystic ovary syndrome (PCOS) is a common endocrine disorder predominantly affecting women of reproductive age. Clinical manifestations are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction. This review provides information on the problem of PCOS in India, its pathophysiology, genetics and an overview of current management options to instigate further research in this field. Prevalence of PCOS in India ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis. Abnormalities in leptin-adiponectin (adipocyte biology), oxidative stress and autoimmunity are among the mechanisms studied regarding pathogenesis of PCOS. Many candidate gene studies have shown associations with PCOS in various studies. Studies have consistently demonstrated the relationship between the well-known manifestation of hyperandrogenism among Indian PCOS women and the metabolic morbidities including insulin resistance, glucose intolerance and cardiovascular risk. Management of individual components of PCOS can be achieved by medications or surgical methods, though further clarification regarding pathogenesis of PCOS is needed to sharpen our therapeutic armamentarium.
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Mechanisms and manifestations of obesity in lung disease
SK Kabra
October 2019, 150(4):423-423
  - 246 114
An egg in the neck: A rare case of massively calcified thyroid nodule
Alpesh Goyal, Rajesh Khadgawat
October 2019, 150(4):419-419
DOI:10.4103/ijmr.IJMR_1943_18  PMID:31823927
  - 439 226
Looking into biological markers of suicidal behaviours
Rakesh Kumar Chadda, Ankit Gupta
October 2019, 150(4):328-331
DOI:10.4103/ijmr.IJMR_227_19  PMID:31823914
  - 737 323
Authors' response
Sharmili Sinha, Suneeta Sahu, Jyotirmaya Pati, Banambar Ray, Saroj Kumar Pattnaik
October 2019, 150(4):417-418
DOI:10.4103/0971-5916.272085  PMID:31823926
  - 263 90
Is suicide prevention possible?
Saxby Pridmore, William Pridmore
October 2019, 150(4):321-323
DOI:10.4103/ijmr.IJMR_1452_19  PMID:31823912
  - 701 306
Suicide in India: A preventable epidemic
Srinagesh Mannekote Thippaiah, Muralidhara Shankarapura Nanjappa, Suresh Bada Math
October 2019, 150(4):324-327
DOI:10.4103/ijmr.IJMR_1805_19  PMID:31823913
  - 1,295 355
Prof. Coluthur Gopalan (1918-2019)
Prema Ramachandran
October 2019, 150(4):420-422
  - 574 227
Anticataractogenic effect of betaine in chick embryo hydrocortisone-induced cataract model
Reşat Duman, Tolga Ertekin, Rahmi Duman, Ayhan Vurmaz, Ersan Çetinkaya, Hilal Güzel
October 2019, 150(4):407-411
DOI:10.4103/ijmr.IJMR_50_18  PMID:31823923
Background & objectives: Cataract is one of the leading causes of blindness in the world. The aim of the present study was to investigate anticataractogenic effect of betaine in chick embryo hydrocortisone (HC)-induced cataract model. Methods: The study included 60 fertilized eggs divided into six groups each having 10 eggs: one group treated with only HC (HC group); three treated with both HC and different doses of betaine (HC/B 1.00, HC/B 0.50 and HC/B 0.25 groups) and two non-HC groups treated with only phosphate-buffered saline (PBS group) or betaine (B group). After the injections, lenses of the embryos were removed and classified into five stages according to the lens opacification. The amounts of reduced glutathione (GSH) in the removed lenses were measured. Results: All the lenses in non-HC-treated groups were clear, whereas in the HC-treated group, 90 per cent of the lenses had cataract (stages 4 and 5). The mean score of lens opacity was significantly lower in all HC/B groups compared to HC group (2.4-3.5 vs. 4.4, P<0.05). Among HC/B groups, the HC/B 0.25 group had significantly lower mean score of lens opacity compared to remaining HC/B groups treated with higher doses of betaine. In addition, the mean reduced GSH level was significantly higher in HC/B 0.25 group compared to HC, HC/B 1.00 and HC/B 0.50 groups (P<0.001). Interpretation & conclusions: The present results show beneficial anti-cataract and anti-oxidant effects of 0.25 μmol/egg betaine on HC-induced cataract in the chick embryo.
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Downregulation of apolipoprotein A-IV in plasma & impaired reverse cholesterol transport in individuals with recent acts of deliberate self-harm
Boby Mathew, Krishnamachari Srinivasan, Johnson Pradeep, Tinku Thomas, Shakuntala Kandikuppa Murthy, Amit Kumar Mandal
October 2019, 150(4):365-375
DOI:10.4103/ijmr.IJMR_1842_17  PMID:31823918
Background & objectives: The major limiting factor in the prevention of suicide is the limited knowledge on molecular insights in individuals at risk. Identification of peripheral protein markers which can classify individuals at high-risk of suicide might aid in early diagnosis and effective medical intervention. The aim of the present study was, therefore, to analyze the differential regulation of plasma proteins in individuals with deliberate self-harm compared to controls. Methods: Using two-dimensional gel electrophoresis coupled with matrix-assisted laser desorption-ionization mass spectrometry, differentially expressed plasma proteins were identified in study participants with deliberate self-harm compared to age- and gender-matched controls. The finding was validated using mass spectrometry-based isotope-labelled relative quantification and Western blot analysis in a new set of individuals with deliberate self-harm and controls. Results: The plasma proteomic analysis showed that apolipoprotein A-IV (Apo A-IV ) was downregulated by 2.63-fold (confidence interval: 1.52-4.54) in individuals with deliberate self-harm (n=10) compared to matched controls, which was consistent in mass spectrometry-based relative quantification and Western blot analysis performed in an independent set of individuals with deliberate self-harm (n=18). In addition, plasma levels of total cholesterol, esterified cholesterol and high-density lipoprotein (HDL) were observed to be significantly lower individuals with deliberate self-harm compared to controls. Interpretation & conclusions: Apo A-IV, which plays a crucial role in the esterification of free cholesterol, was found to be downregulated with concomitantly decreased levels of HDL, esterified cholesterol and total cholesterol in individuals with deliberate self-harm compared to matched controls. The present findings might provide a link between the differential regulation of plasma proteins and the previously reported results on altered cholesterol levels in individuals with deliberate self-harm.
  - 589 211
Comparison of laboratory-developed test & validated assay of programmed death ligand-1 immunohistochemistry in non-small-cell lung carcinoma
Aruna Nambirajan, Nuzhat Husain, Saumya Shukla, Sunil Kumar, Deepali Jain
October 2019, 150(4):376-384
DOI:10.4103/ijmr.IJMR_367_18  PMID:31823919
Background & objectives: Inhibitors of immune checkpoint regulators, programmed death-1 (PD-1) and programmed death ligand-1 (PD-L1), improve outcome in advanced non-small-cell lung carcinoma (NSCLC). Tumours expressing PD-L1 protein are more likely to benefit from this targeted therapy. Multiple concurrent clinical trials evaluating different anti-PD-1/PD-L1 therapies have validated five different immunohistochemistry (IHC) assays using varied antibody clones and staining conditions. This study was aimed at identification of a single harmonized PD-L1 assay for tumour tissue conservation and cost-effectiveness in patients with NSCLC. Methods: The performance of low-cost, manual, laboratory-developed technique (LDT) PD-L1 IHC assay using the easily available SP142 clone was compared with trial validated Ventana SP263 IHC performed on automated Ventana staining platform on tumour sections of NSCLCs. Results: Eighty cases of NSCLC were included. SP263 and SP142 stained both tumour cells and immune cells. The concordance rate of tumour cell staining was about 76 per cent, with SP263 detecting more tumour cells in 16 per cent of cases. The concordance rate of immune cell staining was only 61 per cent, with SP142 detecting more immune cells in 24 per cent of cases. The sensitivity, specificity, positive and negative predictive values of manual SP142 LDT assay against gold standard SP263 Ventana assay were 70, 94, 86 and 86 per cent, respectively, at positivity thresholds of ≥1 per cent tumour cell staining. Interpretation & conclusions: The study findings suggested that LDT using SP142 clone showed only moderate concordance with SP263 Ventana assay, and the two assays were not interchangeable. More such validation studies need to be done to generate information that can complement patient therapy in cases of NSCLC.
  - 667 197
Evaluation of haemoglobin cut-off for mild anaemia in Asians - analysis of multiple rounds of two national nutrition surveys
Jithin Sam Varghese, Tinku Thomas, Anura V Kurpad
October 2019, 150(4):385-389
DOI:10.4103/ijmr.IJMR_334_18  PMID:31823920
Background & objectives: The haemoglobin (Hb) cut-off is a single value for all populations. It is possible that different populations might have slightly different cut-off values; but, this needs to be evaluated in healthy populations with low possibility of inadequate dietary intakes of haematopoietic nutrients. This study was conducted to assess the existence of race-specific Hb cut-offs for mild anaemia in healthy populations and their potential implications. Methods: In this study the Hb distributions of healthy White, Black, Mexican and Hispanic and Asian non-pregnant women obtained from nine rounds of the National Health and Nutrition Examination Survey (NHANES) and two rounds of National Diet and Nutrition Survey (NDNS), was examined to check the existence of race-specific Hb cut-off for mild anaemia, by standard statistical methods. Results: The mean Hb of Blacks, Mexicans and Hispanics and Asians were lower than Whites, consistent with previous literature. The Hb cut-off for mild anaemia in Asians was lower at 11.22 g/dl. Interpretation & conclusions: Using the Hb cut-off derived in this study in place of the World Health Organization, cut-off of 12 g/dl would result in a 17.9 per cent decrease in the prevalence of anaemia in India. This points to the need for re-examining race-specific cut-off for mild anaemia and points to the need for alternative methods, perhaps linked to risk of unhealthy outcomes.
  - 684 223
Determination of individual type 2 diabetes risk profile in the North East Indian population & its association with anthropometric parameters
Purabi Sarkar, Ananya Bhowmick, Manash P Baruah, Sahana Bhattacharjee, Poornima Subhadra, Sofia Banu
October 2019, 150(4):390-398
DOI:10.4103/ijmr.IJMR_888_17  PMID:31823921
Background & objectives: Diabetes genomics research has illuminated single nucleotide polymorphism (SNP) in several genes including, fat mass and obesity associated (FTO) (rs9939609 and rs9926289), potassium voltage-gated channel subfamily J member 11 (rs5219), SLC30A 8 (rs13266634) and peroxisome proliferator-activated receptor gamma 2 (rs1805192). The present study was conducted to investigate the involvement of these polymorphisms in conferring susceptibility to type 2 diabetes (T2D) in the North East Indian population, and also to establish their association with anthropometric parameters. Methods: DNA was extracted from blood samples of 155 patients with T2D and 100 controls. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism and DNA sequencing. To confirm the association between the inheritance of SNP and T2D development, logistic regression analysis was performed. Results: For the rs9939609 variant (FTO), the dominant model AA/(AT+TT) revealed significant association with T2D [odds ratio (OR)=2.03, P=0.021], but was non-significant post correction for multiple testing (P=0.002). For the rs13266634 variant (SLC30A 8), there was considerable but non-significant difference in the distribution pattern of genotypic polymorphisms between the patients and the controls (P=0.004). Significant association was observed in case of the recessive model (CC+CT)/TT (OR=4.56 P=0.001), after adjusting for age, gender and body mass index. In addition, a significant association (P=0.001) of low-density lipoprotein (mg/dl) could be established with the FTO (rs9926289) polymorphism assuming dominant model. Interpretation & conclusions: The current study demonstrated a modest but significant effect of SLC30A8 (rs13266634) polymorphisms on T2D predisposition. Considering the burgeoning prevalence of T2D in the Indian population, the contribution of these genetic variants studied, to the ever-increasing number of T2D cases, appears to be relatively low. This study may serve as a foundation for performing future genome-wide association studies (GWAS) involving larger populations.
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The human gut resistome: Current concepts & future prospects
Shreya Singh, Nipun Verma, Neelam Taneja
October 2019, 150(4):345-358
DOI:10.4103/ijmr.IJMR_1979_17  PMID:31823916
The human gut is home to a myriad of organisms. While some are harmless commensals, others are transient, pathogenic flora. The gut microbiome is composed of diverse bacterial flora, and apart from playing a major role in protecting from various infectious and non-infectious diseases, it plays an important role in resistance to antimicrobials. The collection of genes or genetic material that confers antimicrobial resistance constitutes the gut resistome, and it may involve the pathogens or commensals of the intestinal tract. The diversity of this gut resistome is influenced by various environmental factors including the diet and antibiotic exposure. This review highlights the recent concepts pertaining to the human gut resistome, factors affecting it, how it impacts human health and diseases, methods to study the resistome and potential therapeutic approaches.
  - 953 332
Statins & risk of Clostridium difficile infection: A meta-analysis
Karn Wijarnpreecha, Panadeekarn Panjawatanan, Charat Thongprayoon, Patompong Ungprasert
October 2019, 150(4):359-364
DOI:10.4103/ijmr.IJMR_1973_17  PMID:31823917
Background & objectives: Clostridium difficile infection is one of the most common healthcare-associated infections worldwide. Recent epidemiologic studies have suggested that statin users may have a lower risk of C. difficile infection, although the results are inconsistent. This meta-analysis was conducted with the aim of summarizing all available data to assess the risk of C. difficile infection among statin users versus non-users. Methods: A literature review was performed using the MEDLINE and EMBASE databases from inception to October 2017. Cohort, case-control and cross-sectional studies that compared the risk of C. difficile infection among statin users versus non-users were included. Pooled odds ratio (OR) and 95 per cent confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results: Six case-control studies and two cross-sectional studies met the eligibility criteria and were included in this meta-analysis. The risk of C. difficile infection among statin users was significantly lower than non-users with the pooled OR of 0.74 (95% CI, 0.61-0.89). The statistical heterogeneity of this study was high (I[2]=90%). Interpretation & conclusions: This meta-analysis demonstrated a decreased risk of C. difficile infection among statin users versus non-users. Further studies are required to clarify the role of statins for prevention of C. difficile infection in clinical practice.
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