Study in sexuality of medical college students in India

PURPOSE

In India, talking about sex is taboo. Little is known about the knowledge, attitude, and sexual behavior of adolescents. This study was carried out with the purpose of examining: (a) the knowledge of medical students about sex, (b) the sources of learning about sex, and (c) the sexual behavior and practices of young adults.

METHODS

This study was carried out among the undergraduate students of a medical college in Delhi. A pretested, semiclosed-type questionnaire was voluntarily filled out by the students. Confidentiality and secrecy was assured.

RESULTS

Of 500 students, 73% participated in the study. Knowledge regarding sexual intercourse, masturbation, contraception, and sexually transmitted diseases was satisfactory among 70%, 74.8%, 83.5%, and 92.6% of the respondents, respectively. Common source of knowledge about sex were friends (74.5%), pornographic films (56.2%), and books and magazines (55.1%). Only one fifth could communicate with teachers, parents, and persons of the other gender about sex. About 417 of the students viewed homosexuality as normal behavior. Sexual intercourse had been experienced by 11.8% of respondents. The mean age of first sexual intercourse was 17.5 years. Eighty-five percent strongly favored introduction of sex education at school level.

CONCLUSION

Evidence is provided for the need to improve knowledge about different aspects of sex among a sample of Indian medical students.

Effective therapy for severe Henoch-Schonlein purpura nephritis with prednisone and azathioprine: a clinical and histopathologic study

OBJECTIVES

To validate a scoring system to assess the severity of renal lesions and to correlate histology with clinical findings. We also examined the efficacy of treatment with prednisone (1 to 2 mg/kg/d) and azathioprine (1 to 2 mg/kg/d) for severe Henoch-Schonlein purpura (HSP) nephritis.

METHODS

Twenty patients were evaluated retrospectively. All underwent biopsy before treatment, and 13 underwent biopsy after therapy. We developed a scale based on glomerular, tubulointerstitial (TI), and vascular changes and assigned all specimens acuity, chronicity, and TI scores. The outcomes of 17 patients were compared with those of a historical control group.

RESULTS

Chronicity score at initial biopsy increased with increasing delay between onset of renal involvement and first biopsy (rho = 0.55, P =.016) but did not progress after treatment was initiated. Both acuity (rho = 0.57,P =. 016) and TI (rho = 0.69, P =.003) scores correlated with clinical severity at first biopsy. The TI score correlated negatively with serum albumin (rho = -.60, P <.01). Significantly more patients in the study group than in the control group had a favorable outcome (15 [88%] of 17 vs 32 [54%] of 59, P =.011).

CONCLUSIONS

Our scale reflects disease activity and highlights the importance of TI changes in severe HSP nephritis. Outcome comparisons indicate that early treatment with prednisone and azathioprine prevents progression of chronic changes and improves outcome.

Comparison of the Humphrey swedish interactive thresholding algorithm (SITA) and full threshold strategies

PURPOSE

To compare the Swedish interactive thresholding algorithm (SITA) strategy with the full threshold strategy in routine clinical practice.

METHODS

Using the Humphrey visual field analyzer model 750 (Allergan Humphrey, San Leandro, CA), 108 subjects were tested with 24-2 SITA (version A9) and 24-2 full threshold strategies. Test results were compared for time taken and reliability and on the basis of seven criteria of abnormality.

RESULTS

The SITA required on average 48.8% less time than the full threshold strategy. Patient reliability parameters were somewhat better with SITA. There was a strong correlation between mean deviation and pattern standard deviation. Average threshold sensitivity at each point was increased by 1.31 dB with SITA, but greater differences were seen at points with lower sensitivity. Using the full threshold strategy as our standard for comparison, the sensitivity of SITA varied from 83.0% to 93.2% in detecting the variously defined abnormalities. Fields shown as normal with full threshold strategy corresponded with those found to be normal with SITA in 79.0 to 96.3% cases depending on criteria for abnormality. There were a few cases in which SITA suggested an early abnormality but results of full threshold testing remained normal. On average, the size and depth of scotomas decreased slightly with SITA, but this difference was not statistically significant. Of the 70 patients surveyed about their preference, 65 (92.9%) preferred SITA.

CONCLUSION

Full threshold and SITA strategies are comparable in detecting glaucomatous defects. The SITA strategy requires significantly less time to perform and is a satisfactory alternative to full threshold algorithms in clinical practice for diagnosis and management of glaucoma.

Myasthenia gravis and recurrent falls in an elderly patient

PRESENTATION

An elderly man had recurrent hospital admissions with falls.

OUTCOME

Acetylcholine receptor antibodies and single-fibre electromyogram were useful in the diagnosis of myasthenia gravis. Treatment prevented further hospital admissions.

Association of Helicobacter pylori with peptic perforation in Chattisgarh region of India

BACKGROUND

Helicobacter pylori is present in over 90% cases of peptic ulcer. There are very few reports regarding prevalence of H. pylori infection in peptic ulcer perforation which is the commonest complication of peptic ulcer disease. In the present study we have drawn this association.

PATIENTS AND METHODS

44 cases of peptic perforation were included in this study. Per-operative biopsy was taken from the margin of perforation. The criteria for H. pylori positivity were, Positive Rapid Urease Test and evidence of H. pylori infection on histological examination using Modified Giemsa and H&E stains.

RESULTS

Prevalence of H. pylori infection in peptic perforation was 61.4%. This is well above the usual prevalence in normal population of 45%. H. pylori infection was significantly more common in cases of chronic dyspepsia (> 6 months) and not significantly related to sex, blood group, addiction, family history of acid peptic disease and previous H2 blocker therapy.

INFERENCE

H. pylori is found more commonly in patients with peptic ulcer perforation than in those without.

Effect of gamma irradiation on staphylococcal thermonuclease (TNase)

Stability of staphylococcal thermonuclease (TNase) on exposure to irradiation though expected has not been experimentally established. In the present work. TNase in presence of standard growth media as well as dairy and meat products was found to be completely resistant even at a dose of 10 kGy indicating that the TNase can be used as an indicator of Staphylococcal aureus contamination even in foods in which S. aureus have been destroyed by irradiation. This new application of TNase is being reported for the first time.

Trichotillomania and trichophagia leading to trichobezoar

A 14-year-old female presented with the complaints of loss of hair, scalp pruritus, and pain in the abdomen. On careful work-up, she was found to have trichotillomania as well as trichophagia. Investigations also revealed a trichobezoar which completely filled the stomach. Hemogram showed moderate hypochromic anemia. Her detailed psychiatric profile showed a few additional features like obsessive hand washing, knuckle cracking, nose picking and body rocking. Her trichobezoar was removed surgically, and she had an uneventful post-operative recovery. She is being maintained on fluoxetine and is doing well. The role of a multi-disciplinary approach to trichotillomania patients is highlighted.

Congenital urethral fistula

A case of congenital urethral fistula with an intact glanular urethra without chordee is reported with a discussion of the possible etiology and one-stage repair.

Esophageal atresia and tracheoesophageal fistula: a review of 25 years' experience

During a 25-year period (1972-1996), 585 patients with esophageal atresia with or without tracheoesophageal fistula were treated at the Department of Pediatric Surgery, SMS Medical College, Jaipur, India. Increasing awareness of the anomaly has led to early detection and referral with fewer pulmonary complications. For purposes of analysis the period has been divided into five phases, with a steady decline in overall mortality observed from 95.4% in phase 1 to 41% in phase V. Although postoperative complications have also shown a declining trend, delay in diagnosis, prematurity, low birth weight, delayed arrival at the surgical centers, sepsis, pulmonary complications including pneumonitis, and inadequate nursing care all continue to contribute substantially to lower the survival in developing countries such as ours.

A preliminary trial of serratiopeptidase in patients with carpal tunnel syndrome

OBJECTIVES

This study was planned to assess the response of serratiopeptidase in patients with carpal tunnel syndrome (CTS).

METHODS

Twenty patients with CTS were evaluated clinically. After baseline electrophysiological studies, these patients were given serratiopeptidase 10 mg twice daily with initial short course of nimesulide. Clinical and electrophysiological reassessment was done after 6 weeks.

RESULTS

Mean age was 43.9 years with male to female ratio of 1:2.33. Sixty five percent cases showed significant clinical improvement which was supported by significant improvement in electrophysiological parameters. Recurrence was reported in four cases. No significant side effect was observed.

CONCLUSIONS

Serratiopeptidase therapy may proved to be a useful alternative mode of conservative treatment. Larger study may be further helpful to establish the role of serratiopeptidase in CTS.

Structure of oxalate-substituted diferric mare lactoferrin at 2.7 A resolution

Lactoferrin binds two Fe(3+) and two CO(2-)(3) ions with high affinity. It can also bind other metal ions and anions. In order to determine the perturbations in the environments of the binding sites in the N and C lobes and elsewhere in the protein, the crystal structure of oxalate-substituted diferric mare lactoferrin has been determined at 2.7 A resolution. The final model has a crystallographic R factor of 21.3% for all data in the resolution range 17.0-2.7 A. The substitution of an oxalate anion does not perturb the overall structure of the protein, but produces several significant changes at the metal-binding and anion-binding sites. The binding of the oxalate anion is symmetrical in both the N and C lobes, unlike in diferric dioxalate human lactoferrin, where the oxalate anion binds the metal ion symmetrically in the C lobe and asymmetrically in the N lobe.

Chromoblastomycosis in India

BACKGROUND

Four patients with chromoblastomycosis are presented. An additional 30 infected Indian patients are reviewed.

RESULTS

These 34 patients ranged in age from 12 to 80 years with a male to female ratio of 5.8 : 1. Onset before the age of 20 years was seen in 24% of cases which was comparatively high. Culture was positive in 72% of cases and sclerotic bodies were observed in 84% of cases. A relatively higher prevalence (15%) of Fonsecaea compacta was observed. Unusual cutaneous sites afflicted were the penile shaft, vulva, and ala of the nose, and unusual extracutaneous spread was seen in the pleural cavity, ileocecal region, laryngotracheal area, and tonsils. Extracutaneous involvement was seen in 24% of cases. Overlapping infection with another fungus, Geotrichum candidum, was seen in one case.

CONCLUSIONS

Combination therapy with two azoles was attempted with some success for clinical cure.

Lactoferrin-metal interactions: first crystal structure of a complex of lactoferrin with a lanthanide ion (Sm3+) at 3.4 A resolution

Lactoferrin is an important member of the transferrin family. A characteristic property of transferrins is their ability to bind very tightly (K(app) approximately/= 10(20)) but reversibly two Fe(3+) ions. The structural consequences of binding a metal other than Fe(3+) have been examined by crystallographic analysis at 3.4 A resolution of mare samarium-lactoferrin (Sm(2)Lf). The structure was refined to an R factor of 0.219 for 8776 reflections in the resolution range 17.0-3.4 A. The samarium geometry (distorted octahedral coordination) is similar in both lobes. However, the anion interactions are quite different in the two lobes. In the N lobe, the anion is able to form only two hydrogen bonds instead of the four observed in the C lobe of Sm(2)Lf and the six observed in Fe(2)Lf. This is because Arg121, Thr117 and Gly124 have moved away from the anion as a consequence of the binding of the Sm(3+) ion. The protein ligands in the binding cleft of Sm(2)Lf show large displacements, but the overall protein structure remains the same. The binding of Sm(3+) by lactoferrin shows that the protein is capable of sequestering ions of different sizes and charges, though with reduced affinity. This conclusion should be true of other transferrins also.

Descriptive epidemiology of acute respiratory infections among under five children in an urban slum area

A study was conducted in Sunderpur, Varanasi to study the magnitude of the problem of acute Respiratory Infections among under five children in an urban slum and the clinical profile of it in order to understand the pattern of disease presentation for identifying methods of early diagnosis and timely intervention. 150 under five children were selected by stratified random sampling method and were observed for 52 weeks at weekly interval to record the illnesses. In total 661 episodes were observed in 5623 child-weeks of observation giving an episode rate of 6.11 per child per year. ARI accounted for 67% of all morbidities. Mean duration of all the episodes taken together was 8.15 + 5.44 days. Majority of the episodes (88.96%) were confined to the Upper Respiratory Tract only. Most commonly occurring clinical features were rhinorrhea, nasal stuffiness and cough. 61.4% of all the episodes terminated within seven days, and only 26.2% continued for two weeks.

Serum transferrin receptor assay in iron deficiency anaemia and anaemia of chronic disease in the elderly

The most common cause of anaemia in the elderly is anaemia of chronic disease (ACD). However, iron deficiency anaemia (IDA) may coexist, and can be difficult to diagnose. The serum transferrin receptor (sTfR) blood test may be a better indicator of iron status as it is not affected by inflammation nor by advancing age. We evaluated it in four groups (10 males, 10 females each): 'young' controls, 'elderly' controls, IDA and ACD. All patients in the IDA group had elevated sTfR levels (mean +/- SD 65.2 +/- 17.7 nmol/l). All 'young' controls had normal sTfR (22.3 +/- 7.3 nmol/l) and ferritin levels (92.7 +/- 61.1 micrograms/l). Although all subjects in the 'elderly' controls and ACD group had normal, and raised or normal serum ferritin, respectively (88 +/- 62.3 micrograms/l; 631.2 +/- 509.5 micrograms/l), three (15%) 'elderly' controls and four (20%) ACD patients had raised sTfR levels, suggesting depleted iron stores. Bone-marrow aspirates were available in 3/4 ACD patients with raised sTfR. Haemosiderin was absent in two. The sTfR blood test is comparable to serum ferritin in diagnosing IDA in the elderly but also seems capable of differentiating ACD from IDA. Its potential as a non-invasive test of iron status, especially in elderly anaemic patients, deserves further evaluation.

Reliability of the Tone Assessment Scale and the modified Ashworth scale as clinical tools for assessing poststroke spasticity

OBJECTIVES

To establish reliability of the Tone Assessment Scale and modified Ashworth scale in acute stroke patients.

SETTING

A North Liverpool university hospital.

PATIENTS

Eighteen men and 14 women admitted with acute stroke and still in hospital at the study start date (median age, 74 yrs; median Barthel score, 8).

MAIN OUTCOME MEASURES

The modified Ashworth scale and the Tone Assessment Scale.

STUDY DESIGN

The 32 patients were examined with both scales on the same occasion by two raters (interrater comparison) and on two occasions by one rater (intrarater comparison).

RESULTS

The reliability of the modified Ashworth scale was very good (kappa = .84 for interrater and .83 for intrarater comparisons). The reliability of the Tone Assessment Scale was not as strong as the modified Ashworth scale, with marked variability in the assessment of posture (kappa = .22 to .50 for interrater and .29 to .55 for intrarater comparisons) and associated reaction (kappa/kappaW = -.05 to .79 for interrater and .19 to .83 for intrarater comparisons). However, those aspects of the Tone Assessment Scale that addressed response to passive movement and that are scored similarly to the modified Ashworth scale showed good to very good interrater reliability (kappaW = .79 to .92) and good to very good intrarater reliability (kappaW = .72 to .86), except for the question related to movement at the ankle where agreement was only moderate (kappaW = .59).

CONCLUSIONS

The modified Ashworth scale is reliable. The section of the Tone Assessment Scale relating to response to passive movement is reliable at various joints, except the ankle. It may assist in studies on the prevalence of spasticity after stroke and the relationship between tone and function. Further development of a measure of spasticity at the ankle is required. The Tone Assessment Scale is not reliable for measuring posture and associated reactions.

Congenital scaphoid megalourethra associated with posterior urethral valves

Megalourethra is a very rare mesenchymal congenital anomaly and its association with posterior urethral valves is still rarer. We hereby present such a rare combination and discuss its etiopatho-genesis

Three-dimensional structure of mare diferric lactoferrin at 2.6 A resolution

Lactoferrin is a monomeric glycoprotein with a molecular mass of approximately 80 kDa. The three-dimensional structure of mare diferric lactoferrin (mlf) has been determined at 2.6 A resolution. The protein crystallizes in the space group P 212121with a=85.2 A, b=99.5 A, c=103.1 A with a solvent content of 55 % (v/v). The structure was solved by the molecular replacement method using human diferric lactoferrin as the model. The structure has been refined using XPLOR to a final R -factor of 0.194 for all data in the 15-2.6 A resolution range. The amino acid sequence of mlf was determined using a cDNA method. The final refined model comprises 5281 protein atoms, 2 Fe3+, 2 CO32-and 112 water molecules. The overall folding of mlf is similar to that of other proteins of the transferrin family. The protein folds into two globular lobes, N and C. The lobes are further divided into two domains, N1 and N2, and C1 and C2. The iron-binding cleft is situated between the domains in each lobe. The N lobe appears to be well ordered and is more stable than the C lobe in mlf unlike in other lactoferrins, where the C lobe is the more stable. The opening of the binding cleft in the N lobe of mlf is narrower than those in other proteins of the transferrin family. This is very unusual and is found only in mare lactoferrin. Apart from certain hydrophobic interactions at the mouth of the cleft, one salt-bridge (Lys301 . . . . . . . . Glu216) crosses between the two walls of the cleft. The two lobes are connected covalently by a three-turn alpha-helix involving residues 334-344. The N lobe displays a highly ordered structure with appreciably low temperature factors. The iron coordination is more symmetrical in the N lobe than in the C lobe. There are only 16 intermolecular hydrogen bonds in the structure of mlf.