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   2013| July-December  | Volume 3 | Issue 2  
    Online since August 27, 2013

 
 
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ORIGINAL ARTICLES
Acute pancreatitis in pregnancy: A treatment paradigm based on our hospital experience
Sunil Kumar Juneja, Shweta Gupta, Satpal Singh Virk, Pooja Tandon, Vidushi Bindal
July-December 2013, 3(2):122-125
DOI:10.4103/2229-516X.117090  PMID:24083148
Background: Acute pancreatitis (AP) is a rare event in pregnancy, occurring in approximately 3 in 10 000 pregnancies. The spectrum of AP in pregnancy ranges from mild pancreatitis to serious pancreatitis associated with necrosis, abscesses, pseudocysts, and multiple organ dysfunction syndromes. As in any other disease associated with pregnancy, AP is associated with greater concerns as it deals with two lives rather than just one as in the nonpregnant population. AP is most often associated with gall stone disease or hypertriglyceridemia. Material and Methods: We present 2 years of experience during which we had eight patients of AP. Results: Of the eight patients, three underwent laparoscopic cholecystectomy and five were treated conservatively. One had multiple cysts in the abdomen which were drained. All the patients delivered at term. Prophylactic tocolysis was given for 48-72 h to only those patients who had laparoscopic cholecystectomy. All the patients recovered completely. There was no maternal or fetal mortality. Conclusion: When properly managed AP in pregnancy does not carry a dismal prognosis as in the past.
  8 7,392 782
Effect of sildenafil-induced nitric oxide on the histomorphology of cardiomyocytes in male rats
Latha V Prabhu, Rajalakshmi Rai, Anu V Ranade, Hema Kini, Ashwin Krishnamurthy, Kavitha Leigelin Bernhardt
July-December 2013, 3(2):84-87
DOI:10.4103/2229-516X.117056  PMID:24083141
Introduction: Although sildenafil citrate, one of the selective phosphodiesterase-5 (PDE5) inhibitors, is considered the best treatment for erectile dysfunction, studies have shown that it has also a beneficial effect on a variety of cardiovascular conditions. In spite of reports of a significant protective effect of sildenafil against necrosis in intact hearts, there are also contradictory reports regarding its beneficial effect on the heart. Since there are not enough reports regarding the histomorphological changes in the cardiomyocytes after exposure to sildenafil citrate, the present study was conducted to observe the same along with other biochemical parameters. Materials and Methods: Adult male albino rats of Wistar strain were used in the present study. The animals were divided into a control group and two experimental groups containing six rats each. The animals were treated with a solution of sildenafil citrate dissolved in distilled water. Histomorphological changes were observed by light microscopy and the levels of nitric oxide (NO) and PDE in the heart were measured by spectrophotometry. Results: It was observed that animals treated with sildenafil citrate showed a highly significant increase in NO and a decrease in PDE level, but the histological architecture of the cardiomyocytes did not show much change other than a slightly elongated and swollen nucleus. Conclusions: This study shows that sildenafil citrate at low dosage is well tolerated by cardiac muscle cells, but as dosage increases, it may become detrimental through its NO and PDE activity.
  8 3,491 826
Phytochemical study and screening for antimicrobial activity of flavonoids of Euphorbia hirta
Geeta Singh, Padma Kumar
July-December 2013, 3(2):111-116
DOI:10.4103/2229-516X.117082  PMID:24083146
Objective: This study aims to phytochemical and antimicrobial study of Euphorbia hirta ( Euphorbiaceae). Materials and Methods: Antimicrobial activity of flavonoids (free and bound) of Euphorbia hirta L. was determined by disc diffusion assay against four bacteria (Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, and Staphylococcus aureus) and four fungi (Aspergillus flavus, Aspergillus niger, Trichophyton mentagrophytes, and Candida albicans). Minimum inhibitory concentration (MIC) of the extract was evaluated through micro broth dilution method, while minimum bactericidal/fungicidal concentration was determined by subculturing the relevant samples. Total activity (TA) of extracts against each sensitive pathogen was also evaluated. Results: Out of fungi; A. flavus, A. niger, and T. mentagrophytes were found to be resistant, against which none of the tested extracts showed activity. Bound flavonoids extract of root showed best activity against C. albicans (inhibition zone (IZ) 27.66, MIC 0.039, minimum fungicidal concentration (MFC) 0.039). TA of free flavonoid extract of root was found to be the same for P. mirabilis and S. aureus (192.30 ml/g). Two flavonoids quercetin and kaempferol were identified in the bound flavonoids of stem extract which showed activity against all the microorganisms. Conclusion: Results of the present investigation indicate that E. hirta has good antimicrobial activity with low range of MIC, hence can be exploited for future plant-based antimicrobial drugs.
  7 4,900 913
EDUCATIONAL FORUM
A novel marker procalcitonin may help stem the antibiotic overuse in emergency setting
Kamalpreet Kaur, Rajiv Mahajan, Aparna Tanwar
July-December 2013, 3(2):77-83
DOI:10.4103/2229-516X.117051  PMID:24083140
The day the wonder drugs, antibiotics, were available for cure to humans; dramatic rise of average life expectancy has been recorded compared to past. However, disease-causing microbes that have developed resistance to antibiotics are an increasing public health problem. Recently, superbug emergence was reported in some countries including India. One of the reasons quoted was misuse of antibiotics. Clinical signs and symptoms of infection often do not point towards the etiology. The dilemma occurs as diagnosis of sepsis is difficult because of nonspecificity of clinical signs and symptoms, and frequent overlapping of symptoms with other noninfectious causes of systemic inflammation. Key for improving survival rates lies in early diagnosis and treatment. Serum procalcitonin (PCT) levels measuring in sick patients during infection may be valuable in diagnosing the conditions, and its changing levels have some prognostic value too.
  6 4,854 1,634
ORIGINAL ARTICLES
Heart rate and blood pressure response to exercise and recovery in subclinical hypothyroid patients
Sunita , Aarti Sood Mahajan, AK Jain, NP Singh, TK Mishra
July-December 2013, 3(2):106-110
DOI:10.4103/2229-516X.117076  PMID:24083145
Background: Exercise response of asymptomatic subclinical hypothyroid patients may aid in early diagnosis of cardiovascular morbidity. Aim: To study and compare the heart rate and blood pressure changes during exercise and recovery in subclinical hypothyroid patients and euthyroid controls. Materials and Methods: For the study, 30 each cases (mean age of 40 ± 7 years) of subclinical hypothyroidism and healthy controls underwent exercise as per Bruce protocol. Heart rate (HR) and blood pressure (BP) changes were compared every minute (min) till 3 min of stage II exercise, continued till maximum heart rate and thereafter on recovery, for 5 min after stoppage of exercise. Results: Both groups had normal HR and BP at rest, heart rate and BP increased with exercise and remained high even after 5 min of recovery from exercise. The increase in systolic blood pressure (SBP) with exercise was less in patients at the stage of exercise where maximum HR was achieved and up to 1 min of recovery. SBP at 5 min of recovery was higher in patients (P = 0.018). Diastolic blood pressure (DBP) increased with exercise and changes were similar in both groups during exercise and recovery. HR was higher in patients at 1 min of exercise. Changes in HR from 1 min of recovery to 2-5 min of recovery were significant in both groups. Conclusion: The present pilot study highlights that many parameters of HR and SBP during exercise and recovery in asymptomatic subclinical hypothyroid patients may differ from euthyroid, controls.
  6 3,705 496
Study of platelet aggregation in acute coronary syndrome with special reference to metabolic syndrome
Rudrajit Paul, Amit K Banerjee, Shantanu Guha, Utpal Chaudhuri, Srabani Ghosh, Jayati Mondal, Ramtanu Bandyopadhyay
July-December 2013, 3(2):117-121
DOI:10.4103/2229-516X.117086  PMID:24083147
Background/Context: Antiplatelet drug resistance increases the risk of adverse events like stent thrombosis in acute coronary syndrome (ACS). Metabolic syndrome (MS) is a prothrombotic state and presence of MS further increases the risk of antiplatelet drug resistance. Aims and Objectives: We studied platelet aggregation characteristics in patients of ACS for aspirin or clopidogrel resistance. We studied the relation of drug resistance with blood markers like high sensitivity C-reactive protein (hsCRP). We also studied for any relation of drug resistance with presence of MS. Materials and Methods: We studied platelet aggregation characteristics by optical aggregometry using platelet-rich plasma (PRP) of patients. Collagen (2 μg/mL) and adenosine diphosphate (ADP; 10 μmol) were used. Greater than 50% aggregation in PRP of patients was taken as an evidence of drug resistance. Suitable blood tests were done including newer risk markers like hsCRP, apolipoprotein B, and fibrinogen. Statistical test: Statistical tests included Student's t-test and Kendall's rank correlation coefficient. Results: We had a total of 94 patients of ACS with 47 (50%) having MS. MS patients showed higher blood levels of hsCRP and fibrinogen. Twenty-eight (59.5%) patients with MS showed antiplatelet drug resistance compared to 12 patients without MS. Serum fibrinogen showed strongest correlation with drug resistance. HsCRP levels showed correlation with aspirin resistance (r = 0.53) only in the MS group. Discussion and Conclusion: We found significantly high prevalence of antiplatelet drug resistance. Aspirin and clopidogrel resistance was comparable. MS was a significant risk factor for drug resistance. The prothrombotic and proinflammatory markers showed strong correlation with drug resistance. A larger randomized trial is needed to better characterize this clinical problem.
  5 2,494 592
CASE REPORTS
Non Peutz-Jegher syndrome associated malignant sex cord stromal tumor with annular tubules
Yasmin Altaf Momin, Medha Pradeep Kulkarni, Amitkumar Bapuso Pandav, Kalpana Ranjitsingh Sulhyan
July-December 2013, 3(2):126-128
DOI:10.4103/2229-516X.117093  PMID:24083149
Sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of malignant SCTAT in a 35-year-old lady with no associated Peutz-Jegher (P-J) syndrome.
  4 2,269 373
Giant chondroid syringoma with divergent differentiation: Cyto-histo-immuno correlation
Aparna Narasimha, R Kalyani, Harendra ML Kumar, TN Suresh, A Supreeth
July-December 2013, 3(2):129-131
DOI:10.4103/2229-516X.117097  PMID:24083150
Chondroid syringoma is a rare benign skin adnexal tumor of eccrine/apocrine origin affecting commonly the head and neck region. It is also called as mixed tumor of skin because of the presence of both the epithelial and mesenchymal components. There are very few case reports of chondroid syringoma diagnosed on fine needle aspiration cytology (FNAC). We hereby report a case of giant chondroid syringoma occurring over the lower back in a 50-year-old male, diagnosed initially on cytology and confirmed by histopathology. This case is reported for its unusual size and site of occurrence. We describe the clinical features, cytology, histopathology, immunohistochemistry, and differential diagnosis of giant chondroid syringoma along with review of literature.
  3 1,971 256
ORIGINAL ARTICLES
Effect of occupation on lipid peroxidation and antioxidant status in coal-fired thermal plant workers
Sandeep Kaur, Manmeet Singh Gill, Kapil Gupta, KC Manchanda
July-December 2013, 3(2):93-97
DOI:10.4103/2229-516X.117065  PMID:24083143
Background: Air pollution from coal-fired power units is large and varied, and contributes to a significant number of negative environmental and health effects. Reactive oxygen species (ROS) have been implicated in the pathogenesis of coal dust-induced toxicity in coal-fired power plants. Aim: The aim of the study was to measure free radical damage and the antioxidant activity in workers exposed to varying levels of coal dust. Material and Methods: The study population consisted of workers in coal handling unit, turbine unit, and boiler unit (n = 50 each), working in thermal power plant; and electricians (n = 50) from same department were taken as controls. Lipid peroxidation was measured by malondialdehyde (MDA) levels and antioxidant activity was determined by superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels. Statistical analysis was carried out by Student's unpaired t-test. Result: MDA levels showed significant increase (P > 0.001) in the thermal power plant workers than the electricians working in the city. The levels of SOD and GPx were significantly higher (P > 0.001) in electricians as compared to subjects working in thermal plant. Among the thermal plant workers, the coal handling unit workers showed significant increase (P > 0.001) in MDA and significant decrease in SOD and GPx than the workers of boiler and turbine unit workers. Conclusion: Oxidative stress due to increase in lipid peroxidation and decrease in antioxidant activity results from exposure to coal dust and coal combustion products during thermal plant activities.
  3 2,377 416
LETTERS TO THE EDITOR
Rhamnolipid production among clinical and skin isolates of healthy individuals of Acinetobacter species: The first report
Gopinath Prakasam, Rohit Anusha, Srivani S Ramesh
July-December 2013, 3(2):133-133
DOI:10.4103/2229-516X.117103  PMID:24083152
  1 1,900 241
Nature identical curcumin
Roopesh Jain
July-December 2013, 3(2):134-134
DOI:10.4103/2229-516X.117104  PMID:24083153
  1 1,536 245
ORIGINAL ARTICLES
Evaluating the effectiveness of gel formulation of irradiated seed lectin Cratylia mollis during bone repair in rats
Ralph Santos-Oliveira, Maria Helena Madruga Lima-Ribeiro, Ana Maria dos Anjos Carneiro-Leao, Adriana Ferreira Cruz, Mauricélia Firmino de Santana, Carmelita de Lima Bezerra Cavalcanti, Nicodemos Teles de Pontes Filho, Luana Cassandra Breitenbach Barroso Coelho, Maria Tereza dos Santos Correia
July-December 2013, 3(2):88-92
DOI:10.4103/2229-516X.117062  PMID:24083142
Context: Regeneration corresponds to the replacement of damaged cells with ones that have the same morphology and function. For experimental evaluation of materials that may favor the process of bone healing, defects are created with dimensions that prevent spontaneous regeneration. For the development and use of new drugs, it is necessary to study its effects in vitro, which depends on the formulation, concentration, and rate of irradiation in vivo and the route and frequency of administration; thus, it is possible to characterize the physiological and molecular mechanisms involved in the response and cellular effects. Objective: The objective of this study was to assess the effect of Cramoll-1,4 on the process of bone repair. Materials and Methods: A formulation of biopharmaceutical lectin Cramoll-1,4 at a concentration of 300 mg/100 mL was applied in a single application via gamma radiation and its effect on the process of bone repair in rats was assessed. Results: Histologically, it was observed that the bone defect is coated by loose connective tissue rich in fibroblasts, providing a range similar to the thick bone original and competing with site of new bone formation. This prevented direct contact between the formulation and experimental bone tissue, as, despite its proven effectiveness in experiments on the repair of skin lesions, the formulation used did not promote bone stimulation that would have promoted the tissue repair process. Conclusion: Because of the direct interference of loose tissue repair that prevented direct contact of the implant with the bone interface, the formulation did not promote bone stimulation.
  1 3,656 360
EDITORIAL
Will the epidemic of metabolic syndrome raise the prevalence of antiplatelet drug resistance?
Richard Kones, Umme Rumana
July-December 2013, 3(2):75-76
DOI:10.4103/2229-516X.117047  PMID:24083139
  - 1,973 9,096
LETTERS TO THE EDITOR
Health insurance: Is Indian rural population aware?
Harshal T Pandve, Chandrakant V Parulekar
July-December 2013, 3(2):132-132
DOI:10.4103/2229-516X.117100  PMID:24083151
  - 1,625 368
ORIGINAL ARTICLES
First experience with using simple polymerase chain reaction-based methods as an alternative to phenotypic drug susceptibility testing for Myobacterium tuberculosis in Iraq
Suhad Hadi Mohammed, Mohanad Mohsin Ahmed, Abdul Razak H Ahmed
July-December 2013, 3(2):98-105
DOI:10.4103/2229-516X.117069  PMID:24083144
Context: In Iraq, the time-consuming, phenotypic drug susceptibility testing (DST) on agar is the sole method available for detecting drug resistance in Myobacterium tuberculosis (TB). Furthermore, only single laboratory across Iraq is performing it on wide scale. Aims: To explore utility of rapid, polymerase chain reaction (PCR)-based systems in detection of drug resistance in under the Iraqi settings. Settings and Design: Cross-sectional study. A total of 79 nonduplicated isolates were included in this study. Multiplex allele-specific PCR was used to detect mutations at positions 531, 526, and 516 of the rpoB gene. Two simplex PCR systems were used to detect mutations in katG315 gene and inhAP-15. Statistical Analysis Used: Chi-square and crosstabs by SPSS v. 20. Results: On DST, out of 69 isolates, 55 isolates were found multidrug-resistant (MDR)-TB; six isolates were susceptible to both rifampin (RIF) and isoniazid (INH); two isolates were resistant to RIF but not to INH; and six isolates were resistant to INH but not RIF. RIF and INH resistance mutations were detected in 50 (90.9%), and 43 (78.2%) MDR cases, respectively. Combine resistance mutations to RIF and INH were detected in 40 MDR cases (72.7%). The most frequently mutated codon was the codon 531 in rpoB gene, mutated in 42 isolates. inhAP-15 and katG315 codons were found mutated in 23 and 25 MDR cases (54.8% and 58.1%), respectively. Among 57 RIF-resistant isolates, 52 (91.2%) were harboring mutations resistance to RIF. Conclusions: These PCR-based methods are potential diagnostic and/or screening tools to detect drug-resistance TB in Iraqi settings.
  - 2,776 368
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