Medical tourism-A New Arena

Globalisation has given birth to medical tourism. Health and medical tourism are the fastest growing segments in not only developed nations but in developing countries too. India has become a hot destination, as the Indian medical standards match up to the highly prescribed international standards at a very low cost. However, it is an unmixed blessing; along with advantages, it has many unintended side effects also.

FDG PET/CT manifestations of hematopoietic malignancies of the breast

Hematopoietic malignancies that can be encountered in the breast include lymphoma, leukemia, and multiple myeloma/plasmacytoma. These are readily imaged via [18]F-fluorodeoxyglucose position emission tomography (PET)/computed tomography (CT) and can manifest as unilateral, bilateral, single, multiple, round/oval masses, or diffuse. These malignancies can occasionally mimic primary breast cancers. Conversely, benign conditions, such as the lactating breast can resemble hematopoietic malignancies of the breast. Although uncommon, familiarity with hematopoietic malignancies of the breast is important for proper interpretation of PET/CT. In this pictorial review, the PET/CT imaging features of patients with hematopoietic malignancies of the breast will be described, including pathology-proven cases of acute myelogenous leukemia, diffuse B-cell lymphoma, follicular lymphoma, acute myeloid leukemia with neutropenic granulocytic) sarcoma, and plasmacytoma. In addition, potential pitfalls will be discussed.

Acute renal failure caused by pheniramine maleate induced rhabdomyolysis: an unusual case

Antihistamines are easily available over-the-counter medications, which are frequently involved in overdoses. The usual course is accompanied by the anticholinergic effects of these agents. We report a case of a suicide attempt in a young male, where ingestion of antihistamine pheniramine maleate was complicated by nontraumatic rhabdomyolysis and oliguric acute renal failure. Rhabdomyolysis and acute renal failure is a rarely reported but potentially serious complication among patients who present to the emergency after intentional overdoses making recognition and prompt intervention essential. We also describe the potential mechanism of muscle injury in antihistamine overdose.

Dietary profile of sportswomen participating in team games at state/national level

A cross sectional study was conducted toassess dietary profile of 100 Delhi based national / state level sportswomen, aged 18-25 years, participating in team games--volleyball, hockey, football and kabaddi. Mean energy intake was found to be 1471 +/- 479 Kcal. Only 24 percent of the sports women met the recommendations of 60-65 energy percent from carbohydrates and 87 percent were consuming more than 25 energy percent from fat. The mean macronutrients and micronutrient intakes of all the subjects were much lower than the recommendations. Improper food choices were also observed in majority. It becomes necessary to generate awareness among sports personnel regarding proper nutrition practices.

Peripheral bone mineral density and its predictors in healthy school girls from two different socioeconomic groups in Delhi

Peripheral bone density measurements are scarce and the factors, which predict bone mineral density at these sites, especially in children, are not clearly known. In this study, age, height, weight and alkaline phosphatase had a significant association on peripheral bone mineral density in healthy Indian school girls.

INTRODUCTION

Factors that lead to the attainment of peak bone mass at peripheral sites, during period of growth are not clearly known.

METHODS

Six-hundred and sixty-four randomly selected 7- to 17-year-old girls from upper and lower socioeconomic status (USES/LSES) schools were assessed clinically and a recording of their height and weight was undertaken. Serum calcium, phosphorus, total alkaline phosphatase (ALP), 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) were measured in all of them. Bone mineral density (BMD) was measured at the distal forearm (BMDdf) and calcaneum (BMDca) by peripheral dual energy X-ray absorptiometry (pDXA).

RESULTS

Girls belonging to the USES were significantly taller (149.7 +/- 12.3 cm vs 144.4 +/- 11.9 cm; P < 0.001) and weighed more (44.3 +/- 12.9 kg vs 35.9 +/- 10.0 kg; P < 0.001) than girls from the LSES. USES girls had a significantly higher mean serum calcium (9.3 +/- 0.7 mg/dl vs 9.2 +/- 0.8 mg/dl; P < 0.05) and significantly lower alkaline phosphatase (316 +/- 166 IU/l vs 423 +/- 228 IU/l; P < 0.01) and iPTH (29.9 +/- 18.4 pg/ml vs 45.7 +/- 64.6 pg/ml; P < 0.01). There was no significant difference in mean serum phosphorus and 25-OHD levels between the two groups. USES subjects had higher BMD at both sites than LSES subjects. BMDdf and BMDca increased with age and tended to plateau by 16 years and 12 years of age respectively in both the groups. Age, height and weight explained approximately 50% of the variability, while biochemical parameters explained approximately 30% of variability in BMD at both the sites. The only biochemical parameter which had a significant association with BMD was ALP at the distal forearm.

CONCLUSION

In conclusion, age, nutrition, height and weight are significantly associated with BMD at peripheral sites.

Effects of oestrogen on trigeminal ganglia in culture: implications for hormonal effects on migraine

Although migraine is more common in women than men and often linked to the menstrual cycle, few studies have investigated the biological basis of hormonal influences on the trigeminovascular system. In the present study we investigated the effect of physiological levels (10(-9) m) oestrogen on female rat trigeminal ganglia in vitro. Immunocytochemical analysis demonstrated the presence of oestrogen receptor-alpha in a predominantly cytoplasmic location and in neurites. Microarray analysis demonstrated that oestrogen treatment regulates several genes with potential relevance to menstrual migraine. The genes that were upregulated included synapsin-2, endothelin receptor type B, activity and neurotransmitter-induced early gene 7 (ania-7), phosphoserine aminotransferase, MHC-1b, and ERK-1. Down-regulated genes included IL-R1, bradykinin B2 receptor, N-tropomodulin, CCL20, GABA transporter protein, fetal intestinal lactase-phlorizin hydrolase, carcinoembryonic antigen-related protein, zinc finger protein 36, epsin 1 and cysteine string protein. Protein activity assays demonstrated that exposure of the cultured neurons to oestrogen leads to activation of ERK, which has been linked to inflammatory pain. Immunocytochemistry demonstrated that activated ERK was present in neurons containing peripherin, a marker of nociceptive neurons. Several of the genes in the present study may provide potential targets for understanding the association of oestrogen with migraine and other hormone-related orofacial pain.

Preparative High-Performance Liquid Chromatographic Separation of Naphthodianthrones from St. John's Wort

St. John's Wort (Hypericum perforatum), a perennial flowering plant, has been used medicinally for thousands of years and has most recently been identified as an effective treatment for mild to moderate depression and neuralgic disorders. This work presents a procedure for the isolation of naphthodianthrones from St. John's Wort by an accelerated extraction and separation of marker compounds by preparative high-performance liquid chromatography (HPLC) with photodiode array detection. The accelerated extraction method minimizes the extraction time and increases the yield, and the marker compounds obtained by preparative HPLC are of 98% purity. The compounds are characterized by liquid chromatography-mass spectrometry (electrospray ionization) and NMR spectra.

Comparison of growth, biomass and nutrient distribution in five promising clones of Populus deltoides under an agrisilviculture system

Variations in growth, above- and below-ground biomass and nutrient distribution were examined in five clones (G3, G48, 65/27, D121 and S7C1) of Populus deltoides grown under agrisilviculture system in sub-humid tropics of Central India. The monoclonal blocks were planted at 4x5 m in a randomized block design with three replications. Diameter at breast height (dbh) and tree height were consistently higher in clone 65/27 and lowest in clone S7C1. Mean annual increments (MAI) in dbh and height were 1.6 and 1.3 times higher in clone 65/27 compared to clone S7C1. Total biomass varied from 48.5 to 62.2 Mg ha(-1) in six-year-old clones. In rank order, the total biomass of clones was: 65/27>D121>G48>G3>S7C1. Stem wood accounted 60.4-68.9% to total biomass followed by coarse roots (12.2-18.9%), branches (12.3-15%), leaves (3.02-6.9%) and fine roots (1.5-2.7%). Root-shoot ratio ranged from 0.2 to 0.35. It was highest in clone G48 and lowest in clone S7C1. In six-year-old clones, total N ranged from 184.3 to 266.3 kg ha(-1), P from 16.8 to 31.1 kg ha(-1) and K from 81.9 to 128.7 kg ha(-1). Total N and P were highest in clone 65/27, while K in clone G48. Nutrients were lowest in clone S7C1. In general, maximum nutrients (N, P and K) were allocated to above-ground components (leaves>stem>branches) than below-ground components. Available N, P and K in the soil improved significantly after six years of planting. It was higher in 0-20 cm and decreased with soil depth. At 0-20 cm soil depth, N increased from 14.9% to 24.1%, P from 17.2% to 23.3% and K from 3.1% to 5.1% under different clones. The yield of both soybean and wheat reduced under poplar clones. Yield losses in soybean ranged from 10.1% to 33% and wheat from 15% to 30.3% under different clones. The management strategies for reducing tree-crop competition and nutrient export from the site under P. deltoides based agrisilviculture system for achieving sustainable production are discussed.

Transboundary aquifers: a global program to assess, evaluate, and develop policy

Transboundary aquifers are as important a component of global water resource systems as are transboundary rivers; yet, their recognition in international water policy and legislation is very limited. Existing international conventions and agreements barely address aquifers and their resources. To rectify this deficiency, the International Association of Hydrogeologists and UNESCO's International Hydrological Programme have established the Internationally Shared (transboundary) Aquifer Resource Management (ISARM) Programme. This multiagency cooperative program has launched a number of global and regional initiatives. These are designed to delineate and analyze transboundary aquifer systems and to encourage riparian states to work cooperatively toward mutually beneficial and sustainable aquifer development. The agencies participating in ISARM include international and regional organizations (e.g., Organization of American States, United Nations Environment Programme, United Nations Economic Commission for Europe, Food and Agriculture Organization, and South African Development Community). Using outputs of case studies, the ISARM Programme is building scientific, legal, environmental, socioeconomic, and institutional guidelines and recommendations to aid sharing nations in the management of their transboundary aquifers. Since its start in 2000, the program has completed inventories of transboundary aquifers in the Americas and Africa, and several ISARM case studies have commenced.

Pancreatic Pseudocyst Observed on F-18 FDG PET Imaging

A 72-year-old man with right lower lobe squamous cell carcinoma of the lung-status, post resection-and prostate carcinoma was referred for restaging with whole-body PET using F-18 FDG. PET images, in addition to the presence of moderate hypermetabolic activity seen in the left lower paratracheal and bilateral hilar regions, revealed a large hypometabolic space-occupying lesion in the abdomen. The appearance of this lesion was highly suggestive of a pancreatic pseudocyst. Further review of a CT scan performed 3 years ago confirmed the presence of a pancreatic pseudocyst. However, this information was not available to the nuclear medicine physician at the time of the PET examination.

Percutaneous thrombin injection for the treatment of a post-pancreatitis pseudoaneurysm

Visceral artery pseudoaneurysms are often treated surgically or by transcatheter embolisation. We report a case of a pseudoaneurysm in a patient with chronic pancreatitis, which was successfully occluded by percutaneous injection of thrombin into the pseudoaneurysmal sac as a first-line management.