Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Comparative Study Of Menopausal Symptoms In Post Menopausal And Perimenopausal Women CHOWTA N K*, SEBASTIAN J **, CHOWTA M N *** <b>Introduction:</b> There is a wide variation in the frequency with which women from different ethnic groups and different socioeconomic and educational backgrounds report the occurrence of symptoms associated with their menopause. The present study is addressed to the myriad of menopausal factors that affect women’s health and to compare the menopausal symptoms among the high and low socioeconomic groups. <b>Methodology:</b> A prospective, non- interventional study was conducted in 200 females belonging to the post menopausal and perimenopausal age groups. Subjects who had hysterectomy, oophorectomy, and those who were on hormonal replacement therapy, steroids, calcium and vitamin D supplementation were excluded from the study. Detailed history was taken down from each subject. All subjects underwent complete physical examination including height and weight check. Routine investigations were done in all subjects. ECG and X-rays of vertebra and long bones were taken whenever it was necessary. <b>Results:</b> Perimenopausal women reported greater number of symptoms when compared to the postmenopausal group. Vasomotor symptoms and psychological symptoms showed a higher proportion in the perimenopausal group when compared to the post menopausal group, which was statistically significant. In the perimenopausal group, 68% reported vasomotor symptoms and 29% reported psychological symptoms. In the post menopausal group, vasomotor symptoms were reported by only 16%, and another 16% reported psychological symptoms. There was no significant difference in musculoskeletal and genitourinary symptoms between the two groups. Genitourinary and psychological symptoms were common in the middle socioeconomic group when compared to the lower socioeconomic group. Vasomotor symptoms were more common in the lower socioeconomic group. <b>Conclusion:</b> Perimenopausal women reported a greater number of menopausal symptoms when compared to post menopausal women. Women of middle socioeconomic status had more genitourinary and psychological symptoms whereas, women of the lower socioeconomic group reported more vasomotor symptoms. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=959-962&id=293 https://doi.org/10.7860/JCDR/2008/.293 Phenotypic Detection and Rate of Nasal Carriage of Heterotypic Borderline Oxacillin Resistant Staphylococcus aureus In Pre-clinical Medical Students from Malaysia Santhosh D V *,Shobha K L **,Bairy I ***,Gowrish R ****,D’Souza J ***** <b>Background:</b> We investigated the rate of nasal colonization of heterogeneous Staphylococcus aureus (Methicillin Resistant S. aureus (MRSA), borderline oxacillin resistant S. aureus (BORSA), as well as hetero-resistant patterns exhibited by S.aureus, in 157 pre-clinical medical students from Melaka Manipal Medical College, Manipal University, in order to determine the carrier profile among the student community from Malaysia before they entered the clinics during the phase I stage II of their medical program in India. <b>Methods:</b> Oxacillin agar screen technique was employed to screen for MRSA. Broth macrodilution method was used to detect Minimum inhibitory concentration (MIC)values ranging between 0.25-16&#956;g/ml. MHA broth incorporated with oxacillin antibiotic was diluted from 0.25&#956;g/ml, 0.5&#956;g/ml, 1&#956;g/ml, 2&#956;g/ml, 4&#956;g/ml, 8&#956;g/ml to 16&#956;g/ml. The Cefoxitin disc diffusion test was done in order to check if BORSA isolated were mecA negative. <b>Results:</b> Out of the 37 coagulase positive Staphylococcus aureus samples screened, 27 (72.97%) samples showed an MIC range between 0.25&#956;g/ml-1.0&#956;g/ml. Ten (27.02%) samples had the MIC range between 2&#956;g/ml-8&#956;g/ml; out of which 3 (8.10%) samples had an MIC value of 2&#956;g/ml, and 3 (8.10%) samples showed MIC as 4&#956;g/ml, while 4 (10.81%) showed the MIC to be 8&#956;g/ml in broth dilutions. None (0%) showed MIC for 16&#956;g/ml, and the Cefoxitin disk diffusion tests conducted showed that the 37 isolates of CoPS had zones of inhibition >21mm in diameter. <b>Conclusions:</b> This study revealed the asymptomatic nasal carriage of BORSA (6.49%) and coagulase positive methicillin susceptible (17.53%) Staphylococcus aureus(MSSA) in healthy student volunteers. Ten (27.02%) samples that had MIC values between 2-8&#956;g/ml showed cefoxitin susceptibility, proving the absence of the mecA gene; they were classified as BORSA; while 27 (72.97%) samples that were cefoxitin susceptible mecA negative strains showed MIC values that ranged between 0.25 &#956;g/ml to 1.0 &#956;g/ml, and were classified as MSSA. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=985-990&id=294 https://doi.org/10.7860/JCDR/2008/.294 Comparison Of Povodine-Iodine Versus Savlon For Pre-Catheterization Cleansing And The Association Of Bacteriuria With Its Antibiotic Susceptibility In Catheterised Patients Of The Surgical Ward SHOBHA K.L, RAMACHANDRA L, RAO S.P. <b>Background:</b>Urinary tract infection is one of the most common nosocomial infections, and urinary catheterization is the most frequent predisposing factor. Nosocomial infections associated with urinary catheters may increase the mortality rate upto three times. These infections also pose a considerable financial burden. Different methods for urinary tract infection prophylaxis have been proposed for patients who undergo continuous catheterization. This study compared the disinfection of the genital area with Povodine –Iodine or Savlon (Chlorhexidine and Cetrimide) before inserting the Foley’s catheter with respect to the quantitative results of the urine culture and sensitivity to commonly used antibiotics. <b>Methods:</b>Hundred inpatients who underwent clean continuous catheterization with the Foley’s catheter post operatively in the surgical ward, were divided into groups ‘A’ and ‘B’.Group ‘A’ and group ‘B’ consisted of 50 patients each. Group ‘A’ patients were directed to use povodine –iodine as a disinfectant for pre-catheterization cleansing, and group ‘B’ was directed to use savlon. The control group included 50 post operative patients, those who were not on urinary catheters. The urine sample was collected shortly after the catheter was inserted, and the samples with no growth on the culture plate were only included in the study. Patients with a previous history of urinary tract infection or with growth on the culture plates collected from urine immediately after catheterization, and patients with congenital urinary tract anomaly, were excluded from the study. Catheter samples were collected using a sterile needle and syringe. Urine samples collected on the third and fifth day of catheterization were processed and considered to be culture positives if the count was >10<a href=#fr4 name=ft4>(4)</a> organisms per milliliter of urine. Midstream urine samples were collected from the postoperative patients without urinary catheters. Organisms were identified by conventional biochemical methods, and susceptibility to antimicrobial agents was tested by the Kirby-Bauer standardized disc-diffusion technique. <b>Results:</b> 14% patients in group A and 16% in group B developed bacteriuria and candiduria by the end of the 5th day of catheterization. Females had higher rate of bacteriuria than males, following three days and five days of catheterization in both the groups (Group A female: male bacteriuria ratio on third day was 2(8%):1(4%) and on fifth day 4(16%): 3(12%).Group B female:male bacteriuria ratio on third day and fifth day were 2(7.62%):1(4.16%) and 5(19.23%:3(6.25%). None from group A and one from group B presented with symptoms. .Klebsiella species was the commonest organism isolated, followed by candida species and E.coli. Our study showed no significant difference between disinfecting with Povodine –Iodine or Savlon in the pre-catheterization cleansing procedure and the occurrence of bacteriuria..Microorganisms were sensitive to cephalosporins and amikacin, and were resistant to commonly used antibiotics like Trimethoprim-sulfamethoxazole, ampicillin and gentamicin. None of the controls had any bacteriuria. <b>Interpretation:</b> Performing catheterization by a proper aseptic procedure using available disinfectants should be thought as a preventive measure, and use of appropriate antimicrobial drug therapy with developing drug resistance should also be considered during treatment. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=991-996&id=295 https://doi.org/10.7860/JCDR/2008/.295 Thyroid Stimulating Hormone and its Correlation with Lipid Profile in the Obese Nepalese Population NAGILA A*, BHATT M *, POUDEL B*, MAHATO P*, GURUNG D*,PRAJAPATI S *,ARUN KUMAR ***, TAMRAKAR BK** <b>Background and Objectives:</b> Obesity is an epidemic across the globe, with its presence even in the developing countries. Obesity is associated with derangements in the lipid profile, which further increases the risk of coronary heart disease, diabetes mellitus, stroke and certain cancers like endometrial, colon, oesophageal and uterine. However, the association of obesity and thyroid stimulating hormone (TSH) is equivocal. The current study was undertaken (1)To establish the correlation between serum TSH level and varying degrees of obesity depending on the body mass index (BMI).(2)To evaluate the relationship between BMI and lipid profile. Materials and Methods: Two hundred and thirty seven (183 obese and 54 controls) subjects were recruited for this study, with their ages ranging from 30-65 years, attending the Western Regional Hospital, a government referral centre in the Western region of Nepal. Subjects with a history of familial hypercholesterolaemia, hyperthyroidism, diabetes, hypertension, renal disease, cardiovascular disease and cancer, were excluded from the study. Anthropometric variables, lipid profiles and TSH levels were determined in the controls and obese subjects. Blood glucose, serum urea, serum creatinine and SGPT levels were also determined in the participants. <b>Result:</b> Significant differences in the systolic blood pressure (SBP) and diastolic blood pressure (DBP) were observed between obese and non-obese subjects (SBP; p<0.05; DBP; p<0.05). Weight and WC and W/H ratios, significantly, were positively correlated with increasing BMI (p<0.001). Higher TC, TG, LDL-C and VLDL-C levels were observed in obese subjects as compared to controls, except HDL-C, which was significantly lower in obese subjects. Significant differences (p<0.05) were observed in TSH levels in controls as compared to obese subjects. When the TSH levels were correlated among the obese subjects with grade I and grade II obesity according to BMI values, a significant difference (p<0.05) in TSH levels were observed, highlighting the variation in TSH levels depending on the extent of obesity. <b>Conclusion:</b> With the current understanding of patients with thyroid disorders, the lipid profile, BMI and TSH should be well correlated among the subjects presenting with obesity. As the lipid profile is deranged with higher BMI, it impairs resistant to TSH in peripheral tissue further aggravating the thyroid problem. A closer examination of TSH is required in obese subjects, as these subjects are prone to develop cardiovascular diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=932-937&id=296 https://doi.org/10.7860/JCDR/2008/.296 Effects Of Atenolol And Nebivolol On Blood Pressure And On ECG In Patients Of Stage-1 Hypertension A Comparative Study SAWHNEY V ,KAPOOR B,SHARMA S,SHARMA R <b>Background:</b>ß-blockers are used as first line antihypertensive drugs. <b>Aim:</b>To compare the effects of atenolol and nebivolol on blood pressure and ECG in patients of Stage 1 hypertension. <b>Setting:</b> This study was conducted by the departments of pharmacology and general medicine of a tertiary care teaching hospital in India. <b>Study Design:</b>Prospective single blind randomized trial over 6 months. <b>Materials and Methods:</b>Of the 102 patients randomized for the trial (atenolol n=50, nebivolol n=52), 26 patients were lost to follow-up. The 76 patients, who attended the three reviews at 3, 6 and 12 weeks following recruitment to the trial, were included for analysis. During each of the follow up visits, blood pressure and ECG were recorded. Corrected QT interval (QTc) was calculated using the Bazett's formula. The effect of each drug at 3, 6 and 12 weeks were compared with the baseline and were analysed using the paired ¡¥t¡¦ test, whilst the comparison between the two drugs (baseline, 3, 6 and 12 weeks) was performed using the unpaired ¡¥t¡¦test. <b>Results:</b>Both the drugs significantly reduced (P<0.001) systolic and diastolic blood pressure during the follow-up visits. QTc was significantly reduced from baseline values at 3, 6 and 12 weeks of therapy with atenolol, but only at 6 weeks with nebivolol. <b>Conclusion:</b>Both atenolol and nebivolol appear to have similar antihypertensive effects in the short term. The effect of the anti-hypertensive agent on QTc appears to be more pronounced with atenolol than with nebivolol. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=925-931&id=298 https://doi.org/10.7860/JCDR/2008/.298 Anthropometric Profile In Normolipidaemic Myocardial Infarction Patients In South Asia: A Case-Control Study KUMAR A *, SIVAKANESAN R ** The objective of the study was to evaluate the changes in anthropometric variables in normolipidaemic acute myocardial infarction (AMI) patients, and to determine the significance of waist-hip ratio and basal metabolic index in assessment of risk of myocardial infarction as compared to normal healthy controls.165 normolipidaemic AMI patients from India (87 males; 22 females) and Sri Lanka (36 males; 20 females) were recruited for the study.165 age and sex matched normal healthy controls were selected carefully. Anthropometric variables such as height (H), weight (W), waist circumference (WC), hip circumference(Hp), waist-hip ratio(W/H ratio), mid arm circumference (MAC), biceps skin fold thickness (BSFT), and triceps skin fold thickness (TSFT), was measured using standardized techniques. Anthropometric profiles varied markedly among cases and controls (p<0.001). The relative risk of MI was increased by 2.6 folds in subjects whose waist /hip ratio was ¡Ý0.95 compared to those with normal waist/hip ratio. Waist-to-hip ratio is a useful phenotypic marker for determining the risk of myocardial infarction in patients in South Asia. Further research is needed from South Asia to assess the predictive ability of waist-hip ratio for cardiac disease in adults, after adjusting for potential confounders. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=997-1000&id=299 https://doi.org/10.7860/JCDR/2008/.299 Blastocystosis in Iran: Epidemiological characteristics and Clinical manifestations TAHERKHANI H*, SARDARIAN KH**, SEMNANI SH***, ROSHANDEL GH**** <b>Context:</b> Previous studies showed that blastocystis hominis may lead to some diseases and symptoms such as flatus, diarrhoea, abdominal pain and nausea. But in some others the disease causing effect of this organism has not been determined. <b>Aims:</b> The goal of this study is to determine the clinical signs and some epidemiological characteristics of blastocystis in the West of Iran in 2004 and 2005. <b>Settings and Design:</b> The study was a descriptive cross-sectional one. <b>Methods and Material:</b> The stool samples of 274 cases from Hamedan province (west) of Iran were tested for blastocystis infection. The samples positive for blastocystis were selected. These patients were asked to fill in a questionnaire to gather clinical and socio-demographic information. Statistical Analysis Used: Chi-square test was used to assess the relationship between variables. <b>Results:</b>This study has shown that 58 people (21%) were Blastocystis carriers. The most common clinical symptom was abdominal pain (84.5%). It was more common in primary and elementary schools students than in other educational levels. Diarrhoea was observed mostly in cases younger than 10 years and individuals between 11 and 20 years. <b>Conclusions:</b> This study showed that the prevalence of blastocystis infection in Iran, like other developing countries, is quite high. So, it is recommended to conduct further studies to fully determine its characteristics and consider it as a potential disease- causing parasite in approaching gastrointestinal diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=969-972&id=300 https://doi.org/10.7860/JCDR/2008/.300 Childhood Cutaneous Leishmaniasis BARI A.U <b>Background:</b> Cutaneous leishmaniasis (CL) is known for its wide variety of clinical presentations. Children are frequent victims of the disease but studies regarding clinical spectrum of the disease are sparse. <b>Objective:</b> The aim of the study was to explore clinical spectrum of CL in children. <b>Study design:</b> Case series <b>Place and Duration of Study:</b> Combined Military Hospital Muzaffarabad from January 2006 to June 2008. <b>Patients and Methods:</b> Children of all ages having lesions of cutaneous leishmaniasis anywhere on the body were included in the study. Various demographical features and clinical patterns of the lesions were recorded in all cases and subsequently categorized accordingly. Descriptive statistics were used for analysis. <b>Results:</b> Ninety six cases of childhood cutaneous leishmaniasis were seen. Age range was 4 months to 15 years (mean age = 8.72 + 4.47). Male to female ratio was 1.18:1. Majority of the patients (75%) had solitary lesions. Maximum lesion count was 4. All but one patient had lesions on face. Cheeks were most common sites followed by nose and lips. All children were treated with weekly intralesional injections of meglumine antomonate and duration of treatment ranged from 4 weeks to 16 weeks (mean = 10.58 + 2.72). Predominant clinical pattern was psoriasiform plaque. All patients responded well to treatment with out any significant side effect. <b>Conclusion:</b>Childhood cutaneous leishmaniasis makes a major portion of CL and its clinical spectrum is different from that of adult CL. Lesions are characteristically seen on face and respond favourably to weekly intralesional treatment with antimonial compound. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=973-978&id=301 https://doi.org/10.7860/JCDR/2008/.301 Reliability Of The Persian Version Of Coronary Revascularization Outcome Questionnaire (CROQ) In Cardiac Patients Undergoing CABG And PTCA Procedures SHAHALI SH *, SHATERZADEH YAZDI MJ **,GOHARPEY SH***,RAHIM F **** <b>Background and Aim:</b> The quality of life is a major goal in the context of preventive and therapeutic cardiology. Up to now, there wasn’t any validated instrument for patient based outcome measurement, before and after CABG and PTCA procedures, in Iran. In this study, we have translated and evaluated the reliability of the Persian version of coronary revascularization outcome questionnaire (CROQ). The reliability of the Persian version of coronary revascularization outcome questionnaire was not known. We therefore aimed to assess the test-retest reliability and scale internal consistency of the instrument in two groups of patients undergoing CABG and PTCA procedures. <b>Method:</b> This is a methodological study, and was conducted for the aim of: the Psychometric study of the Persian version of coronary revascularization outcome questionnaire (CROQ). The study's population was 60 patients (30 CABG and 30 PTCA). This instrument has 4 versions (2 versions for CABG and 2 versions for PTCA). It has pre and post operation versions for each group of patients. The patients were assessed 3 months after operation, by the post operation version. For testing the instrument's reliability, the assessment was repeated 1-2 weeks later. <b>Results:</b> Psychometric tests confirmed the reliability, internal consistency, construct validity and responsiveness of the Persian version of CROQ. <b>Conclusion:</b> For clinical trials evaluation, we need to compare quality of life before and after interventions, by an instrument. Disease specific measures are more responsive in detecting treatment effects than general measurements, so for this group of patients, disease specific measurement is necessary. With concern for the Psychometric test results, we encourage the use of CROQ in patients undergoing CABG and PTCA procedures. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=919-924&id=302 https://doi.org/10.7860/JCDR/2008/.302 Selective Screening For Inborn Errors Of Metabolism In Children: Single Centre Experience From Karnataka JAILKHANI R*, PATIL VS*, LAXMAN HB***, SHIVASHANKARA AR****, KULKARNI SP*,RAVINDRA MS A large number of inborn errors of metabolism (IEM) in children remain undetected in India due to lack of investigative facilities and economic restraints. We screened 50 children presenting with neurological and metabolic problems at a tertiary level teaching hospital in Karnataka for inborn errors of metabolism using a standard protocol. There was male preponderance of cases (75%). The commonest clinical presentation was convulsions (30%) followed by metabolic acidosis (15%). 15% of the cases showed history of sibling deaths. We have come across four interesting cases in the course of our study – Phenylketonuria, Methyl malonic aciduria, Mucopolysaccharidosis and Branched Chain aminoaciduria, which will be presented in detail in our paper. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=952-958&id=303 https://doi.org/10.7860/JCDR/2008/.303 The Relationship between Clinical Supervision and Burnout in the Nurse’s Job ─ an Iranian Study KHANI A*, JAAFARPOUR M*, JAMSHIDBAIGY, <b>Background and Aim:</b> Clinical nursing supervision is one way to support nurses in coping with their working situation and preventing burnout. The aim of this study was to establish the relationship between clinical supervision and levels of reported burnout in nurses in the Iranian state. <b>Material and Methods:</b> This is a descriptive correlational survey design that was performed at the ILAM general hospitals, IR, during the year 2008. The research instruments which were used were the Maslach Burnout Inventory (MBI) and the Manchester Clinical Supervision Scale (MCSS). A sample of 120 registered nurses (RN) was enrolled into the study using a simple random sample method. Data were analysed using descriptive statistics, Pearson correlations and multiple regressions. <b>Result:</b> Nurses reported moderate levels of effectiveness in clinical supervision in their workplaces, as well as moderate levels of burnout. Analysis showed that younger and male nurses were more likely to report cold negative attitudes towards their clients, as indicated by higher scores on the depersonalization subscale of the Maslach Burnout Inventory. Clinical supervision was significantly related to all burnout dimensions, most strongly to emotional exhaustion (r =-0.76, p<0.001) and depersonalization (r =-0.53, p<0.001). Emotional exhaustion and depersonalization were strongly negatively related to trust/rapport subscale (r =-0.58, P<0.001; r= - 0.42, p<0.001 respectively) and supervisor advice/support subscale (r = -0.52, P <0.001; r = - 0.40, p<0.001 respectively). Personal accomplishment was strongly positively related to supervisor advice/support subscale (r = 0.37, p<0.05). Also, there were significant correlations between the all MCSS and the all MBI subscales (p<0.001, p<0.05) <b>Discussion and Conclusion:</b> Higher levels of clinical supervision were associated with lower levels of burnout .These findings suggest that if clinical supervision is effective, then nurses are likely to report lower levels of burnout. Further research is required to determine the long-term benefits of implementing clinical supervision, and to determine which other factors have an influence on levels of burnout for nurses. These findings have important implications for nursing education administrators. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=913-918&id=304 https://doi.org/10.7860/JCDR/2008/.304 Lipase And Ca2+ Ions As Biomarkers In Blood Serum Of NIDDM VERMA N*, MITTAL M, VERMA R K** Non Insulin Dependent Diabetes Mellitus (NIDDM) is a metabolic disease characterized by insulin resistance, hyperglycemia, often associated with hypertension, lipid disturbances and obesity. Blood serum of normal healthy subject and NIDDM patients are considered for study. Lipase and Ca2+ ions concentrations have been compared in NIDDM and normal healthy subjects along with glucose concentration. Lipase activity is increased (287-325 U/L) in blood serum of NIDDM than normal healthy range (30-250 U/L). Ca2+ ions concentration has been decreased (1.5-3.4 mg/dL) below the normal range (8.9-10.4 mg / dL ). Hence lipase can be used as a biomarker for disease diagnosis and low Ca2+ ions concentrations observed in NIDDM may be alarming leading to multiple diseases. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=942-945&id=287 https://doi.org/10.7860/JCDR/2008/.287 Utilization Of Nephrotoxic Drugs In Post-Operative Patients Of Urolithiasis KUMAR A*, JAUHARI A C** <b>Background of Study:</b> Renal (or kidney) stones have been around for centuries. Egyptian mummies have been found to contain stones. Around the 5th century B.C., physicians at a medical school in Asia Minor described renal colic or pain in detail. Much information has been gathered about the condition in recent years, but more is to be learned about the cause and treatment. Urolithiasis is quite common in developing countries, especially in Nepal. This problem is particularly important in the Nepalese context, perhaps because of the climate, terrain, the living condition of the people and economic aspects. A large number of drugs are also responsible for causing urolithiasis or kidney damage. <b>Aim of Study:</b> To screen the cases of urolithiasis which were operated in the past two years, and to find and establish whether nephrotoxic drugs were used in the treatment. <b>Materials and Methods:</b> This is a retrospective study of hospital records of over two years, from January 2001- December 2002. 193 cases were operated for urolithiasis, which were the targeted cases of this retrospective study, and a prescription audit was done on the post operative prescriptions and follow up treatment given by surgeons at Nepal Medical College Teaching Hospital (NMCTH), a major teaching hospital of Katmandu valley, with a view to observe whether nephrotoxic drugs were prescribed for urolithiasis, and a suggestion for avoiding their use so that the reoccurrence of disease is prevented. <b>Results:</b> A majority of subjects (57.51%) had urolithiasis from the productive age group. Four cases of renal damage were observed among the urolithiasis subjects. 31.08% (60 out of 193) of the urolithiasis subjects were prescribed nephrotoxic drugs. Diclofenac sodium was given in 18.13% of the total subjects, including three subjects of renal damage even being given a potent nephrotoxic drug. <b>Conclusion:</b> Nephrotoxic drugs have to be avoided in pre-operative, post-operative, and follow up prescriptions in urolithiasis patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=938-941&id=289 https://doi.org/10.7860/JCDR/2008/.289 Prevalence of Methicillin Resistant Staphylococcus aureus among Diabetes Patients with Foot Ulcers and their Antimicrobial Susceptibility Pattern MURUGAN S *, MANI KR**, UMA DEVI P*** <b>Background and Objectives:</b> MRSA infection is common in diabetes patients with foot ulcers, and is associated with previous antibiotic treatment and prolonged healing. As only a few studies with a small number of samples were done in this regard in India, the present study was undertaken to report the prevalence and antibiotic susceptibility pattern of MRSA screened from diabetes patients with foot ulcers, attending tertiary care hospitals. <b>Settings and Design:</b> It was a retrospective study carried out at Department of Microbiology, Dr.N.G.P Arts and Science College, Coimbatore, Tamil Nadu, India during the period from November 2002 to October 2006. <b>Methods:</b> The present study comprised of 7354 pus specimens of diabetic foot ulcer patients collected from various tertiary care hospitals in and around Coimbatore. All the samples were subjected to gram staining and bacterial culture, and the S. aureus isolates were screened for MRSA prevalence using conventional microbiological methods. Subsequently, the antibiotic sensitivity test was performed for the confirmed MRSA isolates. <b>Results:</b> Out of 2314 (37.82 %) strains of S. aureus isolated form diabetic foot ulcers, 992 (42.86 %) were found to be methicillin resistant. More precisely, all MRSA strains (100 %) were resistant to penicillin, 90.92 % to ampicillin, 82.76 % to clotrimoxazole, 64.11 % to gentamicin, 60.08 % to erythromycin, 51.91 % to omnatax and 50.10 % to cephalexin. Multi drug resistance for about 7 to 10 antibiotics was observed among 55.0 % of the isolates. However, all the strains were sensitive to vancomycin (100 %). <b>Conclusions:</b> The determination of prevalence and antibiotic sensitivity pattern of MRSA screened from diabetic foot ulcer patients will help the clinician for first line treatment in tertiary care hospitals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=979-984&id=306 https://doi.org/10.7860/JCDR/2008/.306 A Comparative Clinical Study of the Docetaxel-Carboplatin combination and the Gemcitabine- Carboplatin combination in Patients with Non Small Cell Lung Cancer SUMANTH M *, PHILIPJ **, RADHESHYAM*** ULLA I **** <b>Back Ground:</b> Non small cell lung cancer (NSCLC) constitutes about 75-80% of all lung cancer cases. In the chemotherapy of NSCLC, a platinum drug can be combined with taxanes or Gemcitabine. <b>Aim:</b> To compare the Docetaxel-Carboplatin (DC) and Gemcitabine-Carboplatin (GC) treatment regimen in patients with NSCLC. Setting And Design: Prospective, Randomized, Open labeled double arm study <b>Methods:</b> Thirty patients with stage IIIB/IV NSCLC were randomly divided into two groups. The patients of the DC group were treated with Docetaxel (75 mg/m2, day one) and Carboplatin (calculated to give an AUC of 6 mg/ml, day one) and those of the GC group were treated with Gemcitabine (1200 mg/m2, day one and eight) and Carboplatin (day one). Treatment cycles were repeated every 21 days for a period of three cycles. Response and toxicity were assessed using WHO criteria. <b>Results:</b> The patients in both the groups were well balanced for demographics and disease. Objective responses were similar in the two groups; DC group: 20% partial response, 60% stable disease and 20% of progressive disease. GC group: 33.3% partial response, 53.3% stable disease and 13.3% progressive disease. The only significant toxicity was anemia in the DC group. The evaluation of the quality of life of patients in both the groups showed significant change in the incidence of anemia, dysphagia and peripheral neuropathy in the DC group. Alopecia was significantly higher among the patients of the GC group. <b>Conclusion:</b> The toxicity profiles of the Docetaxel-Carboplatin and Gemcitabine- Carboplatin combinations were similar. The Docetaxel-Carboplatin treatment regimen is cost effective for patients. Global quality of health is not improved in either combination, although advantages in some components of ten QOL were apparent. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=946-951&id=308 https://doi.org/10.7860/JCDR/2008/.308 qRT-PCR Compliments Immunohistochemistry In Archival Breast Cancer Samples PRABHU J S *, WANI S *, KORLIMARLA A, PAYAL K., VICTOR J M , ANAND A, SAHOO R . <b>Background:</b> Molecular characterization of tumour tissue in limited archived formalin fixed, paraffin embedded (FFPE) sample is always challenging. Better molecular characterization will not only help in accurate diagnosis but also in prognosis and guides therapeutic decisions. <b>Study Design:</b> In the present study we tested the prognostic markers of breast cancer, estrogen receptor (ER) and progesterone receptor (PgR) by immunohistochemistry and quantitative real time polymerase chain reaction (qRT-PCR) on archived FFPE samples. <b>Results:</b> High concordance was observed between the two methods for ER and PgR. <b>Conclusion:</b> We conclude qRT-PCR may be used as an alternative method for the study of prognostic factors in archived tissues. Moreover, qRT-PCR can be a high throughput method for evaluation of markers with limited archived tissue. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=963-968&id=309 https://doi.org/10.7860/JCDR/2008/.309 Biochemical Derangements In Patients With Schizophrenia: A Case-Control Study UMA DEVI P AND MURUGAN. S <b>Aim:</b>The objective of this study was to evaluate and compare the levels of non dietary antioxidants and the status of complete blood count in schizophrenia patients with positive, negative and cognitive symptoms. <b>Materials and Methods:</b> This was a prospective observational study involving samples of 60 schizophrenia patients who met the established criteria for schizophrenia, and were admitted to the mental health care center, Coimbatore district. Sixty age and sex matched control subjects were also taken. Planned assessments included the levels of uric acid, albumin, bilirubin. Creatinine and complete blood count were performed using standard biochemical methods by applying the Roche/Hitachi Modular D-P automated chemistry analyzer 112. <b>Results:</b> It is predicted from the results that there was a significant increase in uric acid levels in all the schizophrenics when compared to normal values (p<0.01), but a statistically more significant increase in the status of uric acid was found for schizophrenics with cognitive symptoms(p<0.001). It was observed that there was a significant decrease in serum bilirubin, albumin and creatinine levels in patients with schizophrenia, when compared to controls (0.01). There was no statistically pronounced difference among the levels of albumin, bilirubin and creatinine in schizophrenia patients with positive, negative and cognitive symptoms. <b>Conclusion:</b> These data reveal that non dietary antioxidant defence mechanisms might be impaired in schizophrenic patients. Understanding these basic pathological processes may yield novel targets for the development of more effective treatments. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1001-1008&id=311 https://doi.org/10.7860/JCDR/2008/.311 Sarcomatoid Carcinoma of Prostate with Alveolar Rhabdomyosarcomatous Pattern MANNAN R , CHUFAL SS , MISRA V,SINGH PA Sarcomatoid carcinoma (carcinosarcoma) is a rare type of prostatic cancer, composed of an admixture of malignant glandular and spindle cell elements. We report here a case of a 56 year old male who underwent prostatectomy for the symptoms of bladder outlet obstruction.. Histopathology showed small areas of poorly formed glands admixed with large areas of purely alveolar pattern and rossettes. A provisional diagnosis of sarcomatoid carcinoma with alveolar rhabdomyosarcomatous pattern (Gleason’s score 5+4=9/10) was made. These two patterns led to a diagnostic dilemma between primary alveolar rhabdomyosarcoma of prostate, sarcomatoid carcinoma with rhabdomyosarcomatous pattern and mixed tumour of prostate. On immunohistochemistry, a positive staining for cytokeratin and negative staining for desmin, myogenin and myoD-1, led to a diagnosis of sarcomatoid carcinoma with rhabdomyosarcomatous pattern.The case was considered worth documentation, as it describes an alveolar rhabdomyosarcomatous pattern in a sarcomatoid carcinoma of the prostate. The correct diagnosis of such a case is important, as it may affect the treatment and prognosis of the patient. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1009-1012&id=310 https://doi.org/10.7860/JCDR/2008/.310 Scraping Of Ulcer Base Hastens The Healing Of Grade 3 Shield Ulcer In Vernal Keratoconjunctivitis. KUMAR S A 10-year-old boy presented with complaints of pain and photophobia in the left eye. Slit lamp examination revealed cobble stone papillae in both tarsal conjunctivae, diffuse punctate epitheliopathy of cornea and a 3.5x1.5 mm epithelial defect in the left eye. He was diagnosed to be suffering from bilateral vernal keratoconjunctivitis, with evolving grade 3 shield ulcer in the left eye. Shield ulcer was refractory to the combined regime of topical corticosteroids, dual acting antihistamine and lubricating eye drops. After removal of plaque and scrapping of base, the ulcer re-epithelialized completely in two weeks, leaving behind an opacity which stained negatively with fluorescein dye. The patient was followed up for two months and no recurrence of ulcer was noted. Drug resistant shield ulcer with plaque re-epithelialized rapidly after removal of plaque and scrapping of base of ulcer. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1013-1016&id=307 https://doi.org/10.7860/JCDR/2008/.307 Bilateral Corporal Fracture With Urethral Rupture Following Intercourse-Case Report With Review Of Literature SINGH IQBAL *, MITTAL G ,CHAKRABORTHY S A 32-year-old man presented with complaints of pain and sudden detumescence of penis during intercourse. On examination his penis was flaccid but swollen and deviated to the left side with severe tenderness on the right side of shaft. On exploration a diagnosis of bilateral fracture penis with penile urethral rupture was confirmed. Repair of both the corpora and primary anastomotic urethroplasty was accomplished successfully. Foley’s catheter was removed after six weeks and immediate urethroscopy confirmed complete healing of urethra. At six months the erectile function and voiding was satisfactory. We present this case to highlight the rarity of bilateral corpora fracture complicated by urethral rupture and to review the current literature and it’s management. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1017-1019&id=305 https://doi.org/10.7860/JCDR/2008/.305 Macromolecular Drugs: Novel Strategy In Target Specific Drug Delivery SHARMA R* SHARMA CL ** Macromolecular drugs are polymer-conjugated drugs, polymeric micelles, liposomal drugs or solid phase depot formulations of various agents. Macromolecular drugs can target selectively, solid tumours by exploiting abnormalities of tumour vasculature, namely, hypervascularisation; aberrant vascular architecture; extensive production of vascular permeability factors stimulating extravasation within tumour tissues; and lack of lymphatic drainage. Dextrans are polysaccharide macromolecular carriers devoid of selective transport properties and may serve as one of the most promising carrier candidates for a wide variety of therapeutic agents like hormones (oxytocin and vasopressin), iron, methotraxate, etc. Bone targeting by conjugation of drugs with bisphosphates has shown promise in enhancing their effects in bones and reducing adverse drug reactions. Tetracyclin–conjugated estradiol and oligopeptide–conjugated estradiol are the other novel bone–specific drug carriers (oligopeptides) with high affinity for hydroxyapatite crystals. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1020-1023&id=283 https://doi.org/10.7860/JCDR/2008/.283 A Preclinical Study On The Gastric Ulcer Protective Activity Of The World’s Hottest Chilli, Capsicum Frutescenes DAS S, DEKA S, GOHAIN K. <b>Objective:</b> To evaluate the ulcer protective activity of the ethanolic extract of Capsicum Frutescenes (EECF) and Ranitidine on aspirin induced gastric ulcer on albino rats. <b>Materials and Methods:</b> Four groups of albino rats were taken for the study (n=6): Group I was taken as normal control (3% gum acacia orally for 7 days ),Group II as experimental control (3% gum acacia orally for 7 days),Group III (EECF 100mg/kg for 7 days ),Group IV (150 mg/kg ranitidine for 7 days).On the 7th day, the Groups II,III and IV received aspirin (400mg/kg ) as a single dose . After 24 hours of aspirin administration; pyloric ligation was done in all animal Groups and they were kept for 4 hours .Thereafter, the rats were sacrificed and their stomachs were removed to measure the(i) ulcer index (ii)pepsin activity (iii)gastric mucus (iv) free acidity (v) total acidity and (vi)gastric volume <b>Results :</b> One way analysis of variance (ANOVA) followed by Dunnett’s multiple comparison test, were used for statistical analysis of the results. Values of p < 0.05 were considered significant. The ulcer index, pepsin activity, and free and total acidity showed a significant decrease (p<.05), whereas, there was increase in gastric mucus secretion in Groups III and IV . The reverse was seen in group II. <b>Conclusion :</b> The study showed that capsicum frutescenes has an ulcer protective effect similar to that of Ranitidine. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1024-1027&id=288 https://doi.org/10.7860/JCDR/2008/.288 Investigating First Paediatric Case Of Phenylketonuria From Nepal KUMAR A https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1028-1029&id=290 https://doi.org/10.7860/JCDR/2008/.290 Lack Of Feedback Information On Referred Children From The Community Hospitals In India: Preliminary Observations Garg P https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1030-1032&id=292 https://doi.org/10.7860/JCDR/2008/.292 Safe Use of Medicines by the Consumers. SHANKAR P R, SUBISH P https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=August&volume=2&issue=4&page=1033-1034&id=282 https://doi.org/10.7860/JCDR/2008/.282