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   2015| March  | Volume 141 | Issue 3  
    Online since May 7, 2015

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Stress, anxiety & depression among medical undergraduate students & their socio-demographic correlates
Shawaz Iqbal, Sandhya Gupta, E Venkatarao
March 2015, 141(3):354-357
DOI:10.4103/0971-5916.156571  PMID:25963497
Background & objectives: Presence of psychological morbidity in medical undergraduate students has been reported from various countries across the world. Indian studies to document this burden are very few. Therefore, the presence of depression, anxiety and stress among medical undergraduate students was assessed using a previously validated and standardized instrument, Depression Anxiety Stress Scale (DASS 42) and the associations with their socio-demographic and personal characteristics were identified. Methods: In a cross-sectional survey, a self-administered, pre-designed, pre-tested anonymous questionnaire including DASS 42 was used to collect information on basic socio-demographic (age, gender, semester) and personal characteristics (alcohol and tobacco use, academic performance). All students present on the day of survey were contacted for participation after obtaining informed written consent. Scores for each of the respondents over each of the sub-scales (Depression, Anxiety and Stress) were calculated as per the severity-rating index. Results: More than half of the respondents were affected by depression (51.3%), anxiety (66.9%) and stress (53%). Morbidity was found to be more in 5 th semester students rather than students of 2 nd semester. Females reported higher score as compared to their male counterparts. Perception of self assessment in academics was strongly associated with the higher score. Conclusions: A substantial proportion of medical undergraduate students was found to be depressed, anxious and stressed revealing a neglected area of the students' psychology requiring urgent attention. Student counselling services need to be made available and accessible to curb this morbidity.
  9,219 2,008 72
Use of maggot therapy for treating a diabetic foot ulcer colonized by multidrug resistant bacteria in Brazil
Marilia A.R.Q. Pinheiro, Julianny B Ferraz, Miguel A.A. Junior, Andrew D Moura, Maria E.S.M. da Costa, Fagner J.M.D. Costa, Valter F.A. Neto, Renato M Neto, Renata A Gama
March 2015, 141(3):340-342
DOI:10.4103/0971-5916.156628  PMID:25963495
This study reports the efficacy of maggot therapy in the treatment of diabetic foot ulcer infected with multidrug resistant microorganisms. A 74 year old female patient with diabetes for over 30 years, was treated with maggot therapy using larvae of Chrysomya megacephala. The microbiological samples were collected to evaluate aetiology of the infection. The therapy done for 43 days resulted in a reduction of necrosis and the ulcer's retraction of 0.7 cm [2] in area. Analysis of the bacteriological swabs revealed the presence of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Further studies need to be done to confirm the role of maggot therapy in wound healing using a large sample and a proper study design.
  3,503 906 13
Evaluation of procalcitonin, C-reactive protein, interleukin-6 & serum amyloid A as diagnostic biomarkers of bacterial infection in febrile patients
Junyan Qu, Xiaoju Lü, Yanbin Liu, Xiaohui Wang
March 2015, 141(3):315-321
DOI:10.4103/0971-5916.156617  PMID:25963492
Background & objectives: Early identification of bacterial infection in patients with fever is important for prompt treatment. However, the available parameters such as C-reactive protein (CRP) and leukocyte counts are not very specific. This study was aimed to assess the diagnostic value of procalcitonin (PCT), CRP, interleukin-6 (IL-6) and serum amyloid A (SAA) for bacterial infection in febrile patients. Methods: Serum samples were collected from febrile patients between January and December 2012 and processed for blood cultures. PCT, IL-6, CRP and SAA levels were measured. The patients were divided into three groups according to the final diagnosis: bacteraemia group (group1), bacterial infection with negative blood culture (group 2) and non-bacterial infection group (group 3). Results: There were significant (P<0.05) difference in the levels of PCT, CRP, IL-6 and SAA among the three groups. The PCT levels of patients with g0 ram-positive bacterial infections were lower than g0 ram-negative bacterial infections (0.53 vs 2.13, P < 0.01). The best cut-off value to detect bacterial infections was 0.26 ng/ml for PCT. PCT, CRP, IL-6 and SAA had areas under the curve of 0.804, 0.693, 0.658 and 0.687, respectively. Interpretation & conclusions: Our results showed PCT as a valuable marker of bacterial infections in febrile patients. PCT was superior to CRP, IL-6 or SAA in the early identification of bacterial infection. More prospective and large scale studies are warranted to confirm these findings.
  3,349 903 24
Vitamin A as a key regulator of obesity & its associated disorders: Evidences from an obese rat model
Shanmugam M Jeyakumar, Ayyalasomayajula Vajreswari
March 2015, 141(3):275-284
DOI:10.4103/0971-5916.156554  PMID:25963488
During the last century, vitamin A has evolved from its classical role as a fat-soluble vitamin and attained the status of para-/autocrine hormone. Besides its well-established role in embryogenesis, growth and development, reproduction and vision, vitamin A has also been implicated in several other physiological processes. Emerging experimental evidences emphasize adipose tissue as an active endocrine organ with great propensity to continuous growth (throughout life). Due to various genetic and lifestyle factors, excess energy accumulates in adipose tissue as fat, resulting in obesity and other complications such as type 2 diabetes, hypertension, and cardiovascular disease. Recent in vitro and in vivo studies have shed light on vitamin A metabolites; retinaldehyde and retinoic acid and participation of their pathway proteins in the regulation of adipose tissue metabolism and thus, obesity. In this context, we discuss here some of our important findings, which establish the role of vitamin A (supplementation) in obesity and its associated disorders by employing an obese rat model; WNIN/Ob strain.
  3,034 800 23
Predictors of early neurological deterioration in patients with acute ischaemic stroke with special reference to blood urea nitrogen (BUN)/creatinine ratio & urine specific gravity
Kunal Bhatia, Smita Mohanty, BK Tripathi, B Gupta, MK Mittal
March 2015, 141(3):299-307
DOI:10.4103/0971-5916.156564  PMID:25963490
Background & objectives: Early neurological deterioration (END) occurs in about 20 to 40 per cent of patients with acute ischaemic stroke and results in increased mortality and functional disability. In recent studies relative dehydration has been found to be associated with END in patients with acute ischaemic stroke. This study was conducted to identify factors useful for predicting END and to assess the role of blood urea nitrogen/creatinine ratio (BUN/creatinine) and urine specific gravity (USG) as predictors of END in patients with acute ischaemic stroke. Methods: The present study was an observational prospective study. Various parameters comprising demographic, clinical, laboratory and radiological variables along with stroke severity were assessed and studied as predictors of early neurological deterioration in 114 consecutive patients presenting to the Emergency department during 2012. BUN/creatinine >15 and USG >1.010 were studied as markers of relative dehydration contributing to END. Results: Of the 114 patients enrolled in the study, END was observed in 25 (21.9%) patients. National Institutes Health Stroke Scale score (NIHSS) ≥ 12 at admission was found to be an independent risk factor for END. Amongst markers of relative dehydration, BUN/creatinine >15 at admission was found to be an independent risk factor for END, as also USG >1.010. Also, cerebral oedema and size of hypodensity >1/3 rd of the middle cerebral artery territory on cranial CT were observed to be independent risk factors for END. Interpretation & conclusions: Our study findings highlighted a possible association of relative dehydration, as indicated by BUN/creatinine ratio >15, with END along with other parameters like stroke severity at presentation, extent of hypodensity >1/3 rd of the middle cerebral artery (MCA) territory and cerebral oedema. Dehydration being a treatable condition, the use of BUN/creatinine >15 as a marker of relative dehydration, can be helpful in detecting patients with dehydration early and thus play a role in preventing END.
  2,426 721 19
The End TB Strategy : India can blaze the trail
Madhukar Pai
March 2015, 141(3):259-262
DOI:10.4103/0971-5916.156536  PMID:25963483
  2,546 580 11
Occurrence of osteoporosis & factors determining bone mineral loss in young adults with Graves' disease
Dibakar Biswas, Deep Dutta, Indira Maisnam, Satinath Mukhopadhyay, Subhankar Chowdhury
March 2015, 141(3):322-329
DOI:10.4103/0971-5916.156620  PMID:25963493
Background & objectives: There is a paucity of data with conflicting reports regarding the extent and pattern of bone mineral (BM) loss in Graves' disease (GD), especially in young adults. Also, interpretation of BM data in Indians is limited by use of T-score cut-offs derived from Caucasians. This study was aimed to evaluate the occurrence of osteoporosis in active treatment naive patients with GD and determine the factors predicting BM loss, using standard T-scores from Caucasians and compare with the cut-offs proposed by the Indian Council of Medical Research (ICMR) for diagnosing osteoporosis in Indians. Methods: Patients with GD, >20 yr age without any history of use of anti-thyroid drugs, and normal controls without fracture history, drugs use or co-morbidities underwent BM density (BMD) assessment at lumbar spine, hip and forearm, thyroid function and calcium profile assessment. Women with menopause or premature ovarian insufficiency and men with androgen deficiency were excluded. Results: p0 atients with GD (n=31) had significantly lower BMD at spine (1.01±0.10 vs. 1.13±0.16 g/cm 2 ), hip (0.88±0.10 vs. 1.04±0.19 g/cm 2 ) and forearm (0.46±0.04 vs. 0.59±0.09 g/cm 2 ) compared with controls (n=30) (P<0.001). Nine (29%) and six (19.3%) patients with GD had osteoporosis as per T-score and ICMR criteria, respectively. None of GD patients had osteoporosis at hip or spine as per ICMR criteria. Serum T 3 had strongest inverse correlation with BMD at spine, hip and femur. Step-wise linear regression analysis after adjusting for age, BMI and vitamin D showed T 3 to be the best predictor of reduced BMD at spine, hip and forearm, followed by phosphate at forearm and 48 h I 131 uptake for spine BMD in GD. Interpretation & conclusions: Osteoporosis at hip or spine is not a major problem in GD and more commonly involves forearm. Diagnostic criterion developed from Caucasians tends to overdiagnose osteoporosis in Indians. T 3 elevation and phosphate are important predictors of BMD. Baseline I 131 uptake may have some role in predicting BMD.
  2,310 501 3
Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease
Sravan Kumar, Ritesh Agarwal, Amanjit Bal, Kusum Sharma, Navneet Singh, Ashutosh N Aggarwal, Indu Verma, Satyawati V Rana, Vivekanand Jha
March 2015, 141(3):308-314
DOI:10.4103/0971-5916.156609  PMID:25963491
Background & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD). In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA) and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA), nucleic acid amplification tests (NAAT) and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64)]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.
  2,142 582 10
Nanoimaging in cardiovascular diseases: Current state of the art
Suryyani Deb, Kanjaksha Ghosh, Shrimati Dharmapal Shetty
March 2015, 141(3):285-298
DOI:10.4103/0971-5916.156557  PMID:25963489
Nanotechnology has been integrated into healthcare system in terms of diagnosis as well as therapy. The massive impact of imaging nanotechnology has a deeper intervention in cardiology i.e. as contrast agents , to target vulnerable plaques with site specificity and in a theranostic approach to treat these plaques, stem cell delivery in necrotic myocardium, etc. Thus cardiovascular nanoimaging is not limited to simple diagnosis but also can help real time tracking during therapy as well as surgery. The present review provides a comprehensive description of the molecular imaging techniques for cardiovascular diseases with the help of nanotechnology and the potential clinical implications of nanotechnology for future applications.
  2,026 419 11
Impact on prevalence of intestinal helminth infection in school children administered with seven annual rounds of diethyl carbamazine (DEC) with albendazole
IP Sunish, R Rajendran, A Munirathinam, M Kalimuthu, V Ashok Kumar, J Nagaraj, BK Tyagi
March 2015, 141(3):330-339
DOI:10.4103/0971-5916.156622  PMID:25963494
Background & objectives: One third of the world's population is infected with one or more of the most common soil-transmitted helminths (STH). Albendazole (ALB) is being administered with diethyl carbamazine (DEC) in filariasis endemic areas to eliminate lymphatic filariasis (LF) and helminth infections. In this study, the cumulative impact of seven annual rounds of mass drug administrations (MDA) of DEC and ALB on STH infection in school children in selected villages in southern India was determined. Methods: During 2001-2010, seven MDAs were implemented by the Tamil Nadu s0 tate h0 ealth d0 epartment, India. LF and STH infections were monitored in school children from 18 villages of the two treatment arms (viz, DEC alone and DEC+ALB). Kato-Katz cellophane quantitative thick smear technique was employed to estimate STH infections at three weeks, six months and one year post MDA. Results: Prior to treatment, an overall STH prevalence was 60 per cent. After each MDA, infection markedly reduced at three weeks post-treatment in both the arms. The prevalence increased at six months period, which was maintained up to one year. After seven rounds of MDA, the infection reduced from 60.44 to 12.48 per cent in DEC+ALB arm; while the reduction was negligible in DEC alone arm (58.77 to 52.70%). Interpretation & conclusions: Seven rounds of MDA with DEC+ALB reduced the infection load significantly, and further sustained low level of infection for 10 years. However, complete parasite elimination could not be achieved. To curtail STH infection in the community, MDA should be regularized and environmental sanitation measures need to be improved by effective community-based campaigns.
  1,918 424 7
Biomarkers for the diagnosis of bacterial infections: in pursuit of the 'Holy Grail'
Alladi Mohan, J Harikrishna
March 2015, 141(3):271-273
DOI:10.4103/0971-5916.156551  PMID:25963487
  1,742 456 11
Exudative pleural effusion in chronic kidney disease: An aetiological dilemma
Gautam Ahluwalia
March 2015, 141(3):269-270
DOI:10.4103/0971-5916.156548  PMID:25963486
  1,721 425 1
Nutrition for sport and exercise: A practical guide
Seema Puri
March 2015, 141(3):373-375
  1,709 387 -
Pentacyclic triterpenes combined with ciprofloxacin help to eradicate the biofilm formed in vitro by Escherichia coli
Dorota Wojnicz, Dorota Tichaczek-Goska, Marta Kicia
March 2015, 141(3):343-353
DOI:10.4103/0971-5916.156631  PMID:25963496
Background & objectives: Ciprofloxacin is commonly used in clinical practice for the treatment of recurrent urinary tract infections caused by Escherichia coli. However, very often these recurrent infections are due to a failure in a complete eradication of the microorganisms colonizing the urinary tract, especially in catheterized patients. To enhance the bactericidal activity of ciprofloxacin against biofilm-forming uropathogenic E. coli (UPECs), we examined its effect in combination with two pentacyclic triterpenes - asiatic and ursolic acids. Methods: The anti-biofilm activity of ciprofloxacin and pentacyclic triterpenes - asiatic acid (AA) and ursolic acid (UA), as well as their synergistic effect were tested on two types of surfaces - polystyrene microtiter plates and silicone catheters. It was investigated using the time-killing and biofilm assays. Results: a0 nti-biofilm activity of ciprofloxacin was not observed on microtiter plates or on the catheters. Ciprofloxacin combined with ursolic acid inhibited the biofilm formation on microtitre plates. This mixture, however, did not express such a strong activity against the synthesis of biofilm on the surface of catheters. Ciprofloxacin combined with asiatic acid had very weak inhibiting effect on the synthesis of biofilm mass on microtitre plates as well as on the catheters. Despite this, both mixtures - ciprofloxacin and asiatic acid, as well as ciprofloxacin and ursolic acid, exhibited strong and significant impact on the eradication of mature biofilm (P < 0.05). Interpretation & conclusions: Although ciprofloxacin is recommended in the treatment of urinary tract infections caused by UPECs, but its efficacy is arguable. Subinhibitory concentrations of ciprofloxacin did not inhibit the formation of biofilm. Pentacyclic triterpenes used in combination with ciprofloxacin enhanced its anti-biofilm effectiveness. However, this anti-biofilm activity was found to depend on the type of surface on which biofilm was formed.
  1,572 400 8
Early neurological deterioration, easy methods to detect it
Elisa Cuadrado-Godia
March 2015, 141(3):266-268
DOI:10.4103/0971-5916.156547  PMID:25963485
  1,431 435 4
Family history & the risk for adult onset asthma
Parisa Davoodi, PA Mahesh, Amrutha D Holla, Nallur B Ramachandra
March 2015, 141(3):361-363
DOI:10.4103/0971-5916.156577  PMID:25963499
  1,304 287 2
Presence of common mental disorders in patients with diabetes mellitus using a two-stage evaluation method
Ajit Avasthi, Sandeep Grover, Anil Bhansali, Natasha Kate, Vineet Kumar, E Mohan Das, Sunil Sharma
March 2015, 141(3):364-367
DOI:10.4103/0971-5916.156580  PMID:25963500
  1,267 289 6
Responding to the ebola virus disease in West Africa: Lessons for India
Jai Prakash Narain
March 2015, 141(3):263-265
DOI:10.4103/0971-5916.156539  PMID:25963484
  1,154 399 1
A rare case of bilateral nasal block
Upasana Ranga, Senthil Kumar Aiyappan
March 2015, 141(3):371-372
DOI:10.4103/0971-5916.156589  PMID:25963503
  1,129 235 -
Cat's whiskers & corneal verticillata secondary to amiodarone intake
Aniruddha K Agarwal, Jagat Ram
March 2015, 141(3):370-370
DOI:10.4103/0971-5916.156586  PMID:25963502
  1,062 286 1
Association between red blood cell parameters & atrial fibrillation after acute myocardial infarction
Kazuhiko Kotani, Masanari Kuwabara, Toshiyuki Yamada
March 2015, 141(3):358-359
DOI:10.4103/0971-5916.156573  PMID:25963498
  946 265 -
Genetic environment of OXA-2 beta-lactamase producing Gram-negative bacilli from a tertiary referral hospital
Anand Prakash Maurya, Anupam Das Talukdar, Debadatta Dhar (Chanda), Atanu Chakravarty, Amitabha Bhattacharjee
March 2015, 141(3):368-369
DOI:10.4103/0971-5916.156584  PMID:25963501
  898 243 1
Authors' response
K Distelmaier, Gerald Maurer, G Goliasch
March 2015, 141(3):359-360
  798 165 -
Phosphate and vitamin D in chronic kidney disease
Jai Prakash
March 2015, 141(3):374-375
  620 211 -
Human papillomavirus - Bench to bedside
Dipanwita Banerjee, Partha Basu
March 2015, 141(3):375-375
  550 225 -