Journal of clinical and diagnostic research

A Profile of the Autopsies of Road Traffic Accident Victims in Jammu.

KHAJURIA B*, SHARMA R**, VERMA A***

BACKGROUND: RTA (road traffic accident) is the third major preventable cause of all deaths. AIMS: To study the demographic and injury profile in autopsy cases with an alleged history of RTA. DESIGN: The retrospective observational study. SETTING: Forensic Medicine and Toxicology Department of a tertiary care hospital. SUBJECTS AND METHODS: All autopsies of RTA victims which were performed between January 2000 to December 2005, were analysed for sex, age, time of RTA, type of vehicle, position of victim during RTA, nature of injury, and cause of death. STATISTICAL ANALYSIS: All parameters were expressed in percentage. RESULTS: A total of 249 RTA victims were referred for autopsy during the years 2000 to 2005. One hundred and thirty two (53.01%) victims were between 20-40 years of age, males constituted 85.14% of the total victims, and light vehicles were involved in 61.05% RTAs. 54.22% RTAs occurred during the daytime, between 9 AM to 8 PM. A total 609 type of injuries (organs involved) were reported in 249 victims. Limb injures constituted 189 (31.08%) of the total injuries, followed by injuries involving head, thorax, abdomen, pelvis and spine. Among head injuries, fractured skulls occurred in 68.85%, Subdural Haemorrhage in 79.31%, Subarachnoid Haemorrhage in 63.33%, Extradural Haemorrhage in 48.85%, Intra-cranial injuries in 21.26%, and Contusion in 35.63% of the victims. Head injury accounted for 173 (69.48%) of deaths, and haemorrhagic shock for 61 (24.49%) of deaths. CONCLUSION: Various preventive measures like speed control, helmet use, no driving under alcohol influence etc., enforcing road safety regulations, and improving emergency medical services could be used to control the increasing toll of deaths due to RTA.

Hemoglobinopathies in Dharwad, North Karnataka: A Hospital-Based Study

SHIVASHANKARA A.R* **, JAILKHANI R*, KINI A***

The inherited disorders of hemoglobin are responsible for an extremely complex series of clinical phenotypes. Sickle cell anaemia and thalassemia can cause chronic ill-health and life-threatening situations. Present study was carried out at Dharwad of North Karnataka. The practice of consanguineous marriages is an accepted socio-cultural phenomenon in this region. This study was hospital-based and the paediatric cases of hemoglobinopathies were identified based on clinical data, family history, red blood cell indices and hemoglobin electrophoresis. Out of the fifty cases , twenty chidren were carriers of beta- thalassemia trait and fifteen children were suffering from beta-thalassemia major. Two cases of sickle cell trait and lone case of a compound heterozygote for HbS/beta-thalassemia were also identified. Families of four cases of hemoglobinopathies were studied in detail to identify the carriers of abnormal hemoglobins. Ten out of fifty children of the study were products of consanguineous mating. The population of Dharwad appears to be a repository of thalassemia. An extensive screening of the population is needed to assess the prevalence of hemoglobinopathies, which will help in identification of carriers of hemoglobinopathies and further in taking adequate therapeutic and preventive measures.

Adverse Drug Event (ADE) related Medical Emergency Department visits and hospital admissions: a prospective study from a North Indian Referral Hospital

SAHA L, PANDHI P, MALHOTRA S, SHARMA N*

Objective: To analyse the contribution of adverse drug events to the overall number of visits, to the emergency medical outpatient department(EMOPD) of a tertiary care centre. The aim of the present study was also to characterise the different causes of drug related visits or admissions and the consequences of it on the cost of health care. Patients and methods: All visits to the medical emergency were recorded in a prospective, non-interventional design study, over a period of 6 months. In order to maximize uniformity and minimize interpersonal variability and bias, the correlation of suspected drug(s) causing the problem that led to the EMOPD visit and hospital admission, was assessed by using the Naranjo probability scale. The cases of suspected ADEs were followed-up to find out whether they were discharged from the EMOPD itself, or whether they subsequently required hospitalisation. Results: A total of 1200 patients were included in the study .Fifty patients (4.2%, 95% CI: 1.21 – 6.53) were considered to be related to adverse drug events. Half of all the adverse effects could be attributed to three drugs: NSAIDS associated GI bleeding (22%), antitubercular drug associated hepatitis (20%),and beta-lactam associated hypersensitivity reactions (8%). In the present study, we found that 10% of ADEs were life threatening, and 30% were serious to warrant hospitalisation .The hospital admissions that were related to adverse drug events accounted for US$6712 or US $134 per admission. Conclusion: ADEs account for a sizable proportion of all visits to a medical emergency unit, and some are serious enough to require hospitalisation .A large number of ADE related visits and admissions are preventable, which highlights the importance of public education on the proper use of drugs, and also, the need for regulation of the practice of unregistered medical practitioners in developing countries.

Role Of Reactive Oxygen, Nitrogen Intermediates, And Micro-Organisms In The Prevention Of Injuries Related To Copper Intrauterine Devices

GUPTA I, MAHAJAN U, SAHA P K, DHAWAN V*, SETHI S**, SHARMA M**, MAJUMDAR S S*

Objective: The aim was to study reactive oxygen intermediates (ROI) and reactive nitrogen intermediates (RNI) along with the microbiological flora in intrauterine device users before and after its insertion. Study and design: Fifty three women seeking a copper intrauterine contraceptive device (Cu-IUD), were included in the study. Microbiological flora were studied from endocervical and uterine aspirates along with reactive oxygen and nitrogen intermediates, before insertion of Cu IUD, and subsequently at one, four, and 12 weeks, post insertion. Twenty subjects were also followed up at 24 weeks. Results: There was a steady increase in reactive oxygen intermediates at 1, 4, and 12 weeks, though it was not statistically significant (p>0.5). On the other hand, there was a decrease in the reactive nitrogen intermediates and L-citrulline levels, which is statistically significant (p<0.5). The number of organisms grown at one week post insertion were more than those present during preinsertion, but there was a steady fall in the number observed at four and 12 weeks. The values of RNI and ROI were the same at 24 weeks follow-up as preinsertion in the 20 subjects. Conclusion: The balance between reactive oxygen and nitrogen intermediates is perhaps responsible for the action of activated macrophages on different organisms. Presence of microorganisms introduced at the time of insertion of an IUD causes a rise in ROI levels and a fall in RNI levels. Presence of copper in copper IUDs perhaps enhances these reactions.

Bacteriological Profile and their Antibiogram from Cases of Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Hospital Based Study

CHAWLA K, MUKHOPADHAY C, MAJUMDAR M, BAIRY I

Background and objectives: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are defined as presence of increased sputum volume, sputum purulence and dyspnoea. Bacteria are responsible for causing 30-50% of exacerbations. As only few studies are done in this field from India, the present study was undertaken to see the bacteriological profile and the resistant pattern of the isolates from cases diagnosed with this pathology. Settings and Design: It was a prospective study carried out at Kasturba Hospital Manipal, Karnataka from June, 2006-Dec, 2006. Methods: The present study comprised of 75 patients (53 treated as in-patients and 22 as out-patients). All the sputum samples were subjected to gram staining, bacterial culture and antibiotic sensitivity for bacterial isolates as per standard techniques. Results: Growth of pathogens was obtained from 50.94% of sputum samples in case of in-patients and 68.18% in out-patients. Gram negative bacilli outnumbered the growth of other organisms. Pseudomonas aeruginosa (25.92%) was the predominant organism in hospitalized patients, whereas Klebsiella pneumoniae (33.33%) was the most common pathogen isolated from out-patients. Haemophilus influenzae was not isolated. Quinolones were found to be the most effective antibiotics against gram negative organisms. Conclusions: The bacterial etiology of AECOPD is different in India from what has been shown in western studies. More studies involving large patient populations will provide better understanding of its bacterial etiology and thus proper management of disease.

Clinical Pattern Of Ascites Due To Malignancy In Qatar

KHAN FY*, AHMED MS**, LOTF AQ***, ALSAMAWI M****

Background: The clinical characteristics of ascites due to malignancy are not fully known, and it appears as a variable entity with different types of clinical presentation and with a difficult diagnosis. Objectives: the aim of this study is to describe the clinical pattern of ascites due to malignancy in Qatar and to evaluate the diagnostic efficacy of serum/ascitic albumin gradient in differentiating different types of ascites caused by malignancy. Methods: a descriptive prospective study of patients admitted to Hamad general hospital with ascites due to malignancy. Results: The total number of patients included in this study was 22 patients. Based on serum ascitic albumen gradient, ascites due to malignancy was divided into two main groups; first, with serum/ascitic albumin gradient < 1.1 g/dL, second, serum/ascitic albumin gradient > 1.1 g/dL. The firs group was consistent with carcinomatous peritonitis (Malignant ascites), while the second group represented tumors metastasizing to the liver leading to portal hypertension (malignancy related ascites). Ovarian carcinoma was the most common primary tumour in patients with malignant ascites while gall bladder cancer was most common primary tumour in patients with malignant related ascites. Conclusion: serum/ascitic albumin gradient is effective in differentiating between malignant and malignancy related ascites. Along with the currently available, largely unsatisfactory treatment alternatives, these data might change our present clinical management of ascites due to malignancy.

Ophthalmologic and Audiologic Problems In Beta Thalassemia Patients Treated With Prolonged Chelation therapy

Background: The main aim of chelation therapy in iron overload is to achieve an iron balance and to prevent haemosiderosis. The objective of this study was to Determine visual and hearing problems in adults with beta major and Intermediate Thalassemia who received Desferrioxamine (DFO) as chelation. Patients and Methods: Fifteen patients aged 16 to 63 years, who received DFO by intravenous and subcutaneous route on regular program, were evaluated for 5 years. Variables such as age, sex, serum ferritin, DFO dose and duration of treatment gathered by a researcher designed questionnaire. Patients were examined by ophthalmologist and otolaryngologist. Data was collected using specific questionnaire and analyzed by SPSS 11 software. Results: The mean serum ferritin level was 2025ng/ml and the mean treatment dose of DFO was 45mg/kg/day, 4 or 5 times a week. VEP (Visual Evoked Potential) and ERG (Electro Retino Graphy) ophthalmologic tests were negative in all of the patients. Two patients (13.3%) presented with cataract, and 2 others (13.3%) showed moderate visual loss. A mild, bilateral, high-frequency hearing loss developed in one patient. There was no significant relation between the serum ferritin levels and these problems. Conclusion: These findings show any significant statistical relation between visual andaudiologic abnormalities and the use of high dose DFO or lower serum ferritin levels in our cases, yet regular ophthalmologic and audiologic examinations are advised for all thalassemic patients.

Age and Gender Related Changes in Total Antioxidant Response and Oxidative Stress in Patients with Schizophrenia

UMA DEVI P *, DEVIPRIYA D*, CHINNASWAMY P **

This study aims to measure total antioxidant response (TAR) and total peroxides (TP) in schizophrenia patients using the ferric reducing activity of plasma (FRAP), and to evaluate their relationship with oxidative stress. The effect of age, gender and severity on the levels of these total antioxidants-oxidants in the selected subjects were analyzed. We measured the plasma total antioxidant potential and total peroxides in 60 schizophrenia patients and in 60 well-matched non-schizophrenic control subjects. Oxidative stress has been implicated to play a major role in aging. Total antioxidant capacity/total peroxide of the clinical samples was measured using the latest spectrophotometric measurement method. Results showed that Plasma TAR was found to be lower in patients with schizophrenia than in those of the control group. On the contrary, the patients had high total plasma peroxide levels. Oxidative stress index (OSI) values of the patients were significantly higher than those of controls (P < 0.001). Total peroxide levels were found significantly higher (p < 0.01) in the elderly subjects, as compared to the young and adult population; in addition, TAR was higher in young and adults, than in the elderly people (p < 0.001). We also found more oxidative stress in schizophrenic males than in schizophrenic females (P > 0.01). This study indicates that schizophrenia is associated with increased oxidative stress and depleted antioxidant status in elderly people, and the clinical utility of antioxidants needs to be further evaluated in schizophrenia patients.

Childhood Tuberculosis In A Community Hospital From A Region Of High Environmental Exposure In North India

GARG P*

Data on the spectrum of childhood tuberculosis at community hospitals in north India is lacking. We conducted a prospective observational study on children attending an outpatient department of a community level hospital in north India to determine the prevalence of tuberculosis in children, and highlight the spectrum of the disease at this level. All consecutive children attending out-patient department (January 15 to June 15, 2004), and diagnosed as probable or confirmed tuberculosis using World Health Organization (WHO) and Indian Academy of Pediatrics (IAP) guidelines were enrolled. The prevalence of tuberculosis, out of total attendances, was found to be 3.5% (95% CI 2.5%- 4.0%). Sixty-seven out of seventy-eight (86%) children were diagnosed to have highly probable tuberculosis while eleven (14%) cases were confirmed (bacteriological or histological) to harbor the disease. The prevalence of extra-pulmonary TB was very high (47.6%). Median duration of symptoms at the time of presentation was 4.5 months. Prevalence of tuberculosis in children at community level hospitals is high (3.5%). Spectrum of disease appears to be the same as that reported from the tertiary level institutions in north India, with almost half of the children presenting with extra-pulmonary tuberculosis, and long delays between onset of symptoms and eventual diagnosis. This highlights the need for strengthening of community hospitals, and more public awareness campaigns, especially in the vulnerable sections of society to control tuberculosis in this part of India.

Aconite Poisoning: A Clinical Review of the First Four Cases From Nepal

PAUDEL R*, PALAIAN S**,***, RAVI SHANKAR P***, PAUDEL B*, BHATTARAI S*

Aconite tubers are one of the most toxic plant products. They are taken as medication, and are occasionally confused with some other similar plants which are commonly used as medications. This manuscript describes four cases of aconite poisoning that were managed in the Manipal Teaching Hospital. The patients presented with classical symptoms of aconite poisoning such as perioral paraesthesia, generalized burning sensation, and cardiac manifestations such as hypotension and ventricular tachycardia. Since Aconite is a dangerous life threatening herb, one should be aware of this poison. We report four patients who presented with aconite poisoning after mistakenly ingesting aconite, thinking it to be related to medicinal plants.

Gastric Carcinoid Mimicking Adenocarcinoma

DAS PRAFULLA K*, SAMANTARAY S**, PATTANAYAK L***, KAKKAR S****

Background - Carcinoids are rare neuro-endocrine tumors with gastric carcinoids comprising 2% of all gastro intestinal carcinoids. Case – A 62 year old male presented with dyspepsia, loss of appetite and vomiting. On examination, a 4x3cm, irregular, slightly mobile epigastric mass was noted. Endoscopic biopsy confirmed it as Adenocarcinoma. Patient underwent subtotal radical gastrectomy. A brief review of literature was made as regards to its incidence and biological behaviour. Conclusion – Gastric carcinoid incidence is low but not uncommon. Patients with gastric mass should be evaluated closely as the incidence of Carcinoid tumors seems to be on the rise.

Idiopathic Carpal Tunnel Syndrome Presenting with Raynaud’s Phenomenon: Neurophysiological Evaluation

SHARMA V K

Carpal tunnel syndrome and Raynaud’s phenomena are common diseases and coexist in some patients while in others Raynaud’s phenomenon may be a clinical feature of carpal tunnel syndrome. I describe an interesting case with Raynaud’s phenomenon as a predominant presenting clinical feature due to an underlying mild carpal tunnel syndrome with preferential involvement of the autonomic fibers. Nocturnal wrist splinting, a common treatment for carpal tunnel syndrome, resulted in marked improvement in the symptoms.

Diagnosis And Treatment Of Cord Compression Secondary To Extramedullary Hematopoiesis In Patients With Beta-Thalassemia Intermedia

RAHIM F, KEIKHAEI B, ZANDIAN K, SOLTANI A

Background: Thalassemia is an inherited autosomal recessive hematological disorder due to genetic defect in synthesis of one of the globin chains. This results in reduced rate of hemoglobin formation and presents as anemia. Depending on whether alpha or beta globin chain is affected they are classified respectively as α thalassemia and β thalassemia. If only one β globin allele bears a mutation, the disease is called β thalassemia minor and if both alleles have thalassemia mutations, the disease is called β thalassemia major. Thalassemia intermedia(TI) is a condition intermediate between the major and minor forms. Patients with TI do not receive regular blood transfusions unlike thalassemia major patients. Extramedullary hematopoiesis (EMH) is a compensatory mechanism that occurs in patients with hematological dysfunctions such as Thalassemia Major or Thalassemia Intermedia and Sickle Cell Anemia as a result of continuous erythropoietic stress. Materials and Methods: We report two cases of TI with EMH. One is a 17 year old girl who presented with back pain and leg weakness and a 25 year old man who was referred to the hospital with back pain, paresthesia, urine frequency and impairment of gait. Results: Both the patients were successfully treated with low dose radiotherapy and Hydroxyurea (HU). At the end of the therapy, both the patients had recovered well and were ambulatory. Discussion: Surgical decompression has been the method of choice for the management of the disease. The disadvantages of surgical intervention include risk of excessive bleeding due to high vascularity of the mass. Low dose radiotherapy and hydroxyurea offer better outcomes with reduced morbidity

Holistic Insight into Health Promotion and Healing in Yoga

SHARMA N, SHARMA S R

This article is helpful to gain a comprehensive understanding of yoga and the numerous benefits, the practice has to offer. Holistic yoga offers a gentle relaxing form of yoga that doesn’t require the participants to be overly flexible. This style generates a rejuvenating effect that leaves practitioner feeling invigorated and in a deeply relaxed state .The aim is to communicate yoga in a traditional form. Practitioner therefore realize the how and why of yoga. This understanding helps to facilitate a deeper and more comprehensive insight into yoga. Holistic yoga provides clear instruction in a step by step approach following all the practitioners to integrate the techniques of yoga investing it in their souls to transform their life into a positive, more fulfilling and happier experience People would like to try yoga if it is presented in a way that is rational ,scientific and most importantly in a style that can relate to which embraces our life style in the 21st century.

Novel Dual-Acting Peroxisome Proliferator-Activated Receptor Alpha and Gamma Agonists

SHARMA R

Peroxisome proliferator-activated receptors (PPARs) are nuclear transcription factors, and play a central role in insulin sensitivity, lipid metabolism, and inflammation. PPAR -γ appears to improve glycaemic control by increasing peripheral insulin sensitivity and reducing hepatic glucose production, thereby helping to preserve beta-cell function. However, they have modest beneficial effects on lipid parameters. It has been observed that fibrate drugs which activate PPAR- α, produce significant improvements in dyslipidaemia and decrease atherosclerotic lesions, but do not affect glycaemia. Theoretically, a compound targeting both the α and γ PPARs simultaneously, might combine the benefits of thiazolidinediones (TZDs) and fibrates. Hence, there is a resurgence of interest in the development of new antidiabetic drugs that combine the insulin-sensitizing effects of PPARγ activation with the additional lipid-modifying activity of the other PPAR subtypes. Muraglitazar, Tesaglitazar, Ragaglitazar, Isohumulone, Farglitazar, and Naveglitazar are on the deck in late-stage clinical trials, and may be effective in reducing cardiovascular risk, but their long-term clinical effects are still unknown. The ongoing basic studies have elucidated the cardio protective role of PPAR delta. Therefore, further studies are on the track to develop PPA α/δ and PPARγ/ δ dual agonists and PPAR α/γ/δ pan agonists for the treatment of diabetic cardiovascular complications

Radiation Therapy and Breast Conservative Surgery: A Concise Review

JOSHI S C1, PANT I2, SHUKLA A N3, KUMAR G4

Radiotherapy has an established role in reducing the local relapses in breast cancer patients. The objective of this review was to investigate whether radiotherapy or its omission after breast surgery has measurable consequences on local tumor recurrence and patient survival. The late excess of cardiac deaths has also been published in various reports but important advances in the delivery of radiotherapy have overcome this problem to the extent that, excess cardiac deaths do not appear to be occurring in more recent trials. In this article some recent data, suggesting that radiotherapy following mastectomy and/or breast conserving surgery has a beneficial effect on survival is reviewed. Omission of radiotherapy is associated with a large increase in risk of ipsilateral breast tumor recurrence and with a small increase in the risk of patient’s mortality.

Understanding the Essentials of Pharmacogenomics- The Potential Implications for the Future Pharmacotherapy

The genetic makeup affects drug responses to a greater extend. Personalized medicine deals with the prescription of specific therapeutic agent best suited for an individual based on the pharmacogenetic and pharmacogenomic information. By understanding the genetic variations in an individual, it becomes easy for a clinician to select the appropriate drug in an adequate dose. Genetic variations can influence drug action in many ways, the common ones being the drug metabolizing enzyme (CYP450), the site of drug action (receptors), and at the drug transporter levels (p-glycoprotein). Safety and efficacy of many commonly prescribed drugs like aspirin, isoniazid, omeprazole, warfarin, hydralazine etc are affected by the genetic makeup of individuals. Similarly, the pharmacotherapy of common diseases like asthma, hypertension, depression etc is also influenced by genetic variations. Pharmacogenomics can also offer benefits like proper determination of drug dosage, and production of better vaccines and can definitely reduce the healthcare costs and helps to enable drug safety by understanding the genetic profile of an individual. Integration of pharmacogenomic information into clinical practice will also require clinical trials to assess their clinical usefulness. The usefulness of pharmacogenomic data also depends upon the affordability, ease of application, and ease of interpreting the results etc.

Cardioprotective Effect Of Momordica Cymbalaria Fenzl In Rats With Isoproterenol-Induced Myocardial Injury

RAJU K, BALARAMAN R, HARIPRASAD, VINOTH KUMAR M, Ali A

Momordica cymbalaria (M. cymbalaria) holds medicinal value and is used traditionally for treatment of various disorders. In the present study, we tested cardioprotective potential of M. cymbalaria against isoproterenol (ISO)-induced cardiac injury. Pretreatment with ethanolic extract of M. cymbalaria at 250 and 500 mg/kg prevented the elevation of serum marker enzymes, lactate dehydrogenase (LDH), creatinine kinase-MB Fraction (CK-MB), aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP) and alterations in the oxidative stress markers like lipid peroxidase (LPO), glutathione (GSH), catalase (CAT), and superoxide dismutase (SOD) caused by ISO (60 mg/kg s.c, 2days)- induced myocardial infarction in rats. The protective effect was confirmed by histological findings and was more prominent at 500 mg/kg. Hence, we conclude that pretreatment with ethanolic extract of M. cymbalaria protects against isoproterenol- induced myocardial injury.

Doing High Altitude Research in the Himalayas

SHANKAR P R

Epidemiological Reports versus Estimates-An Analysis

RAJESH P K*, SARAVANAKUMAR S**, SENGODAN B***, SIDHU H S****

Vomiting due to tramadol: a short report from the regional pharmacovigilance center, Western Nepal

PALAIAN S*,**, MISHRA P*,**, CHHETRI A K*, ALAM K*