Cell-free epstein-barr viral loads in childhood hodgkin lymphoma: a study from South India

Cell-free Epstein-Barr viral (EBV) DNA is detectable in plasma of patients with EBV-related lymphomas. The aim of this study was to evaluate the utility of plasma EBV DNA as a biomarker of EBV association in childhood Hodgkin lymphoma (HL). Furthermore, an attempt was made to evaluate the effectiveness of viral quantitation for assessing response to chemotherapy. Thirteen cases of childhood HL were included in this study. All 13 cases were EBV associated as reflected by expression of EBV LMP1 in the tumor specimen. Eighty-five percent had detectable EBV DNA levels; viral loads ranging from 2.9 to 156.2 × 10³ copies/ml (mean 29 × 10³ copies/ml); while in 2 patients and 30 controls tested, viral DNA was undetectable. In four patients, follow-up samples were available after three cycles of chemotherapy; all had EBV DNAemia prior to chemotherapy but undetectable EBV DNA posttherapy. This corroborated with complete response in these four patients. Plasma EBV viral load quantification maybe a useful tool for detecting EBV association with lymphomas and in monitoring response to treatment in childhood HL in centers with limited resources, more so in India where majority of childhood HL is likely to be EBV associated. This is the first Indian study estimating plasma EBV viral loads in HL.

Studies on formation of unconfined detonable vapor cloud using explosive means

Certain organic liquid fuels like hydrocarbons, hydrocarbon oxides, when dispersed in air in the form of small droplets, mix with surrounding atmosphere forming vapor cloud (aerosol) and acquire explosive properties. This paper describes the studies on establishment of conditions for dispersion of fuels in air using explosive means resulting in formation of detonable aerosols of propylene oxide and ethylene oxide. Burster charges based on different explosives were evaluated for the capability to disperse the fuels without causing ignition. Parameters like design of canister, burster tube, burster charge type, etc. have been studied based on dispersion experiments. The detonability of the aerosol formed by the optimized burster charge system was also tested.

Study of Clinical Profile and Antibiotic Sensitivity Pattern in Culture-positive Typhoid Fever Cases

Background:

Salmonella enteric serotype Typhi has created a significant therapeutic problem as these strains have developed resistance to the commonly used antimicrobials for the treatment of typhoid fever.

Objectives:

To assess the clinical profile and sensitivity patterns to anti-typhoid drugs.

Materials and Methods:

A retrospective analysis of 106 culture-positive typhoid cases admitted in a tertiary care hospital during the years 2005-2008.

Results:

Records of 106 patients were evaluated, 83 (78.3%) males and 23 (21.7%) females. Fever was present in all patients. Headache in 63 (59.4%) patients and generalized body ache in 53 (32.5%) patients were the most common symptoms, while spleenomegaly in 47 (44.3%) patients and hepatomegaly in 42 (39.6%) patients were the common presenting signs. A maximum sensitivity of 96.6% was observed with cephalosporins, whereas a resistance of 29.2% was seen with fluoroquinolones.

Conclusion:

A high degree of sensitivity was noted to chloramphenicol, ampicillin and sulphonamides, showing a trend of roll-back of sensitivity to conventional antibiotics.

High blood pressure prevalence and significant correlates: a quantitative analysis from coastal karnataka, India

Hypertension is a premier risk factor for cardiovascular disease which can be recognized if sought and treated effectively. Effective management of high blood pressure is possible when the magnitude of the problem is identified. So, a cross-sectional community based survey among 1,239 respondents aged ≥30 years was designed to estimate the prevalence and the sociodemographic correlates of hypertension among adults aged ≥30 years. Data was collected by personal interviews, followed by anthropometric and blood pressure measurements. Analysis was done using Statistical Package for the Social Sciences (SPSS) version 11.5. The prevalence of hypertension was 43.3%, with the prevalence being more among males (51.6%) as compared to females (38.9%). Of the total prevalence 23.1% (287) were known cases, and 20.2% (250) were newly detected cases. Based on the seventh report of the Joint National Committee (JNC VII) on high blood pressure, prehypertension was noted among 38.7%. Advancing age, male gender, current diabetic status, central obesity, overweight and obesity as defined by body mass index, and family history of hypertension were identified as significant correlates for hypertension by multivariate logistic regression.

Practice of Physical Activity among Future Doctors: A Cross Sectional Analysis

BACKGROUND

Non communicable diseases (NCD) will account for 73% of deaths and 60% of the global disease burden by 2020. Physical activity plays a major role in the prevention of these non-communicable diseases. The stress involved in meeting responsibilities of becoming a physician may adversely affect the exercise habits of students. So, the current study aimed to study the practice of physical activity among undergraduate medical students.

METHODS

A cross sectional study was conducted among 240 undergraduate medical students. Quota sampling method was used to identify 60 students from each of the four even semesters. A pre-tested, semi-structured questionnaire was used to collect the data. Statistical Package for Social Sciences (SPSS) version 16 was used for data entry and analysis and results are expressed as percentages and proportions.

RESULTS

In our study, 55% were 20 to 22 years old. Over half of the students were utilizing the sports facilities provided by the university in the campus. Majority of students 165 (69%) had normal body mass index (BMI), (51) 21% were overweight, while 7 (3%) were obese. Of the 62% who were currently exercising, the practice of physical activity was more among boys as compared to girls (62% v/s 38%). Lack of time 46 (60.5%), laziness (61.8%), and exhaustion from academic activities (42%) were identified as important hindering factors among medical students who did not exercise.

CONCLUSION

A longitudinal study to follow-up student behavior throughout their academic life is needed to identify the factors promoting the practice of physical activity among students.

Clinical manifestations and trend of dengue cases admitted in a tertiary care hospital, udupi district, karnataka

Background:

India is one of the seven identified countries in the South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks and may soon transform into a major niche for dengue infection in the future with more and more new areas being struck by dengue epidemics

Objective:

To study the clinical manifestations, trend and outcome of all confirmed dengue cases admitted in a tertiary care hospital.

Study Design:

Record-based study conducted in a coastal district of Karnataka. Required data from all the laboratory confirmed cases from 2002 to 2008 were collected from Medical Records Department (MRD) and analyzed using SPSS 13.5 version.

Results:

Study included 466 patients. Majority were males, 301(64.6%) and in the and in the age group of 15-44 years, 267 (57.5%). Maximum number of cases were seen in 2007, 219 (47%) and in the month of September, 89 (19.1%). The most common presentation was fever 462 (99.1%), followed by myalgia 301 (64.6%), vomiting 222 (47.6%), headache 222 (47.6%) and abdominal pain 175 (37.6%). The most common hemorrhagic manifestation was petechiae 84 (67.2%). 391 (83.9%) cases presented with dengue fever, 41 (8.8%) dengue hemorrhagic fever, and 34 (7.3%) with dengue shock syndrome. Out of 66 (14.1%) patients who developed clinical complications, 22 (33.3%) had ARDS and 20 (30.3%) had pleural effusion. Deaths reported were 11(2.4%).

Conclusion:

Community awareness, early diagnosis and management and vector control measures need to be strengthened, during peri-monsoon period, in order to curb the increasing number of dengue cases.

A cross-sectional analysis of obesity among a rural population in coastal Southern Karnataka, India

BACKGROUND

Obesity is a disease condition that is highly prevalent in both developed and developing countries. Obesity accounts for 60% of cases of diabetes, 40% cases of hypertension and 20% of coronary heart disease and stroke. Although obesity is a silent killer in the third world countries, there is less focus on the problem, as the nations are still staggering with problems due to infectious and parasitic diseases. So, the current study was undertaken to highlight the problem.

METHOD

A cross-sectional community based survey, among individuals of either sex, aged 30 years and above was carried out on 1,239 respondents, using a two-stage stratified, random sampling technique. Data was collected by personal face to face interview using a pre-designed questionnaire and analyzed using Statistical Package for Social Sciences (SPSS) version 11.5.

RESULTS

The overweight category included 21.4% of the subjects. Obesity as per Body Mass Index (BMI) criteria was seen in 6.6% of the individuals but abdominal and truncal obesity was present among 51.7% and 62.1% respectively. Literacy up to secondary education and graduation were identified by the multivariate analysis to be associated with obesity.

CONCLUSION

The prevalence of central obesity was found to be high, and hence, lifestyle changes and improved physical activity needs promotion among the general population.

A study on the prevalence of type 2 diabetes in coastal Karnataka

AIM

To estimate the prevalence and study the socio-demographic correlates of type 2 diabetes among adults aged 30 years and above.

SETTING AND DESIGN

A cross-sectional community-based survey, among individuals of either sex, aged 30 years and above was carried out in the field practice area of a medical college.

METHODS AND MATERIALS

The study was carried out on 1,239 respondents, using a two-stage, stratified, random sampling technique. Data was collected by a personal, face-to-face interview followed by blood sugar estimation using a glucometer.

STATISTICAL ANALYSIS

Was performed by using the Statistical Package for Social Sciences (SPSS) version 11.5.

RESULTS

The overall prevalence of diabetes was 16%. Self-reported diabetes was 11.2%, while 4.8% of previously normal people were found to have high fasting capillary blood glucose levels. Increasing age showed two-fold, four-fold, and six-fold higher odds for 40 - 49, 50 - 59, and >/= 60 years age group, respectively, as compared to the 30 - 39 year age group (P < 0.001). Nineteen percent of the males had diabetes, (OR = 1.38, 95% CI = 1.01 - 1.88). In the high socioeconomic strata, 32% of the subjects had diabetes (P = 0.018 unadjusted odds ratio 3.29, 95% CI = 1.40 - 7.74).

CONCLUSION

The high prevalence of diabetes in this coastal population needs further evaluation.

Adequacy of two versus three sputum specimens for the diagnosis of pulmonary tuberculosis

BACKGROUND

The new guidelines issued by the Revised National Tuberculosis Control Programme for diagnosis of smear-positive tuberculosis recommend examination of only 2 sputum smears. We did a retrospective analysis of data from a designated microscopy centre to ascertain the diagnostic yield of 2 smears and the additional yield provided by the third smear.

METHODS

Data were obtained from the designated microscopy centre attached to our medical college. A total of 3257 patients with suspected tuberculosis had undergone sputum examination between September 2004 and March 2009. However, only 1762 of them had 3 sputum specimens examined. Data were entered and analysed using SPSS version 11.5.

RESULTS

Among the 1762 suspected patients, positivity in any 2 samples was found to be 17.7% while 19% were found to be positive in a single smear. A statistically insignificant association was found between the grading and positivity of the sputum samples using McNemar test. A positive third sample was found in 309 patients. If the first 2 samples were negative, the possibility of missing a third positive sample was 0.4%.

CONCLUSION

Under field conditions, 2 sputum smears are as effective as 3 smears for diagnosing smear-positive tuberculosis.

Association of primary central nervous system lymphomas with the Epstein-Barr virus

The incidence of primary central nervous system lymphoma (PCNSL), previously a rare tumor, has increased significantly over the past few decades, partly due to the AIDS epidemic but also in immunocompetent individuals. Studies from Western countries have shown a consistent association of tumors occurring in immunocompromised individuals with the Epstein-Barr virus (EBV) suggesting an important role for the virus in the pathogenesis of these tumors, but an infrequent association of the virus with PCNSL in the immunocompetent host has also been noted. We studied 11 patients with PCNSL who had no evidence of an immunocompromised state. All the tumors were aggressive B cell lymphomas. EBV association was studied using EBER in-situ hybridization. 10 out of the 11 tumors were negative for EBV, indicating that tumors in immunocompetent individuals in developing countries are also infrequently EBV associated and that a different pathogenetic mechanism is operative in the evolution of these tumors.

A note on Kalman Filter

The Kalman Filter commonly employed by control engineers and other physical scientists has been successfully used in such diverse areas as the processing of signals in aerospace tracking and underwater sonar, and statistical quality control. More recently, it has been used in some nonengineering applications such as short-term forecasting, time series, survival analysis, and so on. In all of these situations, we have a set of equations governing the true state of a system and another set connecting the observations made at any given time on the system with its true state. The problem is that of predicting the true state of the system at any given time point based on available observations. The solution proposed in the vast literature of the subject depends on the assumptions made on the initial state of the system. In this paper, a method that is independent of the initial state is proposed. This is useful when the a priori information on the initial state is not available. The method is also applicable when some observations are missing.

Association of Burkitt's lymphoma with the Epstein-Barr virus in two developing countries

The clinical presentation of Burkitt's lymphoma (BL) and it's association with the Epstein-Barr virus (EBV) varies in different geographic areas, BL in developing countries being "intermediate" between the sporadic and endemic types, both in it's clinical presentation and it's association with EBV, which varies from 25-80%. In this study we have analysed the clinical features, EBV association, subtype and prevalence of the deleted variant of the Latent Membrane Protein-1 (LMP-1) of EBV in forty-two cases from two developing countries- India (n = 25) and Argentina (n = 17). In both countries the abdomen was the site most commonly involved while jaw involvement was rare. EBV was detected by in-situ hybridization using the EBER-1 RNA probe. 47% of cases from Argentina and 80% of cases from India were EBER positive. EBV typing using EBNA-3C primers showed a predominance of Type A in both countries (India-13/16 and Argentina-(7/8)). The 30bp deletion of the LMP-1 gene was detected in all evaluated cases from Argentina while the wild type of the gene was seen in all the evaluable Indian cases. Our study highlights the similarities and differences in the clinical presentation and EBV association of BL in two developing countries and also indicates that the subtype of EBV and prevalence of the LMP-1 deletion may reflect the predominant subtype in a particular population.

A note on statistical analysis of shape through triangulation of landmarks

In an earlier paper, the author jointly with S. Suryawanshi proposed statistical analysis of shape through triangulation of landmarks on objects. It was observed that the angles of the triangles are invariant to scaling, location, and rotation of objects. No distinction was made between an object and its reflection. The present paper provides the methodology of shape discrimination when reflection is also taken into account and makes suggestions for modifications to be made when some of the landmarks are collinear.

Parotid tuberculosis simulating malignancy

An interesting case of parotid tumour simulating malignancy is reported. The rarity of this lesion and the associated clinical and diagnostic problems are emphasized together with the relevant literature.

The simultaneous estimation of the number of signals and frequencies of multiple sinusoids when some observations are missing: I. Asymptotics

The problem of simultaneous estimation of the number of signals and frequencies of multiple sinusoids is considered in the case when some observations are missing. The number of signals is estimated with an information theoretic criterion, and the frequencies are estimated with eigenvariation linear prediction. The strong consistency of the estimates of the number of signals and the frequencies is established and the rate of convergence of these estimates is provided. Besides, the limiting distributions of various estimates are given.

Geometry of circular vectors and pattern recognition of shape of a boundary

This paper deals with pattern recognition of the shape of the boundary of closed figures on the basis of a circular sequence of measurements taken on the boundary at equal intervals of a suitably chosen argument with an arbitrary starting point. A distance measure between two boundaries is defined in such a way that it has zero value when the associated sequences of measurements coincide by shifting the starting point of one of the sequences. Such a distance measure, which is invariant to the starting point of the sequence of measurements, is used in identification or discrimination by the shape of the boundary of a closed figure. The mean shape of a given set of closed figures is defined, and tests of significance of differences in mean shape between populations are proposed.

Statistical analysis of shape through triangulation of landmarks: A study of sexual dimorphism in hominids

Two objects with homologous landmarks are said to be of the same shape if the configuration of landmarks of one object can be exactly matched with that of the other by translation, rotation/reflection, and scaling. In an earlier paper, the authors proposed statistical analysis of shape by considering logarithmic differences of all possible Euclidean distances between landmarks. Tests of significance for differences in the shape of objects and methods of discrimination between populations were developed with such data. In the present paper, the corresponding statistical methodology is developed by triangulation of the landmarks and by considering the angles as natural measurements of shape. This method is applied to the study of sexual dimorphism in hominids.

Statistical analysis of shape of objects based on landmark data

Two objects with homologous landmarks are said to be of the same shape if the configurations of landmarks of one object can be exactly matched with that of the other by translation, rotation/reflection, and scaling. The observations on an object are coordinates of its landmarks with reference to a set of orthogonal coordinate axes in an appropriate dimensional space. The origin, choice of units, and orientation of the coordinate axes with respect to an object may be different from object to object. In such a case, how do we quantify the shape of an object, find the mean and variation of shape in a population of objects, compare the mean shapes in two or more different populations, and discriminate between objects belonging to two or more different shape distributions. We develop some methods that are invariant to translation, rotation, and scaling of the observations on each object and thereby provide generalizations of multivariate methods for shape analysis.

Primary central nervous system lymphoma a report of nine cases

Primary Central Nervous System Lymphoma (PCNSL) is a rare neoplasm of B cell origin and constitute less than 1% of Non-Hodgkin's lymphoma (NHL). Histology is mainly of high grade and intermediate type. Although NHL is known to be highly sensitive to both irradiation and cytotoxic drugs, being a curable malignancy, the therapeutic results remain disappointing. Clinical observations on nine cases of PCNSL seen in one of the major cancer centres in India is presented in this paper. Radiotherapy combined with Chemotherapy although yielded encouraging initial response in these patients, the long term response was unsatisfactory with median survival for these patients being only 19 months. This warrants an alternative therapeutic approach to improve the dismal prognosis of PCNSL.

Magliant melanoma of the oral cavity: report of 14 cases from a regional cancer centre

Fourteen patients with oral mucosal malignant melanomas seen at a regional cancer centre over a 10-year period were analysed. All the patients presented with symptoms of short duration, with extensive local disease at initial evaluation in 11 patients. The palate was the commonest site involved. Ten patients had regional nodal disease and of these four also had distant metastases to the liver and/or the lung. Coincidental melanosis was identified clinically in three patients and histologically confirmed in two patients. Only four patients underwent radical surgery. Of the five patients who received DTIC-based chemotherapy, only one achieved a complete response. No significant correlation between stage of the disease at presentation, histological features or type of treatment and survival could be seen as the number of cases is small.