A Cross-Sectional Study of Quality of Life among Subjects with Epilepsy Attending a Tertiary Care Hospital

INTRODUCTION

Epilepsy is a chronic disorder associated with profound physical and psychological consequences leading to impaired quality of life (QoL). Evaluation of the QoL among epileptics would throw light on various factors that impair or affect the QoL in such a population.

AIM

To study the QoL among epileptic patients attending outpatient departments of a tertiary care hospital and to identify various factors that affect the QoL in such a population.

MATERIALS AND METHODS

A cross-sectional observational questionnaire based study, including patients with epilepsy, who were on antiepileptic drugs, on follow-up for minimum one year, aged more than 18years, both sexes and who were seizure free in the previous 24hours. The World Health Organisation Quality of Life (WHOQOL-BREF) questionnaire was administered to those included in the study. The data was analysed using Statistical Package for Social Sciences (SPSS) version 20 and statistical tests like t-test for independent variables and Analysis of Variance (ANOVA) were used to compare the QoL scores.

RESULTS

Of the 98 subjects 61.2% were males, majority were educated upto high school level and most of them were employed in unskilled labour. The mean total QOL score was 53.9 (15.8). There was a significant lower mean total QOL score among people with low educational status and poor seizure control.

CONCLUSION

Epilepsy is a syndrome associated with chronic drug use and regular long term follow-ups to hospitals. These treatment and disease associated problems affects the QOL of the subjects significantly in various squares of life. We found that a lower education and having seizure in the recent past affected the QOL scores.

Tenofovir-induced nephrotoxicity: A retrospective cohort study

BACKGROUND

Tenofovir (TDF) has been associated with renal function deterioration, but local data regarding the incidence and risk factors for this adverse event were lacking.

OBJECTIVES

To determine the incidence of nephrotoxicity in HIV-infected patients on tenofovir-based regimens and to evaluate risk factors involved in tenofovir-associated renal function decline.

METHODS

This is a single-centre retrospective cohort study of 440 HIV-infected adults who were started on tenofovirbased antiretroviral regimens. Data were extracted from electronic medical and pharmacy records.

RESULTS

A decline in eGFR of 25% or more was seen in 67 patients (15.2%) with an estimated incidence rate of 12 per 100 person-years. Among all 440 subjects, 22 discontinued TDF-based therapy due to renal complication. From multivariate analysis, the odds of developing >25% decrease in eGFR with tenofovir-containing regimen was three times higher for patients with baseline moderate renal impairment (HR 3.19; 95% CI, 1.43-7.12; p=0.005) and 14 times higher for patients with baseline severe renal impairment (HR 14.2; 95% CI, 11.20-170.7; p=0.036) as compared to those without pre-existing renal insufficiency. Age above 50 years and CD4 cell count of less than 50 were significantly associated with >25% decrement in eGFR.

CONCLUSION

The incidence rate of tenofovir-related renal dysfunction was found to be 12 per 100 person-years. Preexisting renal impairment, age 50 and above, and CD4 cell count below 50 as were predictors for renal function decline. Given that the use of tenofovir is escalating in Malaysia, increased awareness about this adverse event is essential.

Epigenetic mechanisms drive the progression of neurofibromas to malignant peripheral nerve sheath tumors

THINKING OUTSIDE THE BOX

The polycomb repressive complex 2 (PRC2) is a histone methyltransferase complex known to repress gene expression. There is a large body of experimental evidence that supports its role in promoting tumorigenicity by suppressing tumor suppressor genes. Here, we discuss the surprising findings that, in neurofibromas, it may have a completely different role as a tumor suppressor; mutations of PRC2 lead to conversion of benign neurofibromas into malignant peripheral nerve sheath tumors (MPNSTs) by de-repressing and thereby activating genes driving cell growth and development. These findings have potentially powerful clinical applications in both diagnosing and treating MPNSTs.

HYPOTHESIS

PRC2 loss drives malignant transformation of neurofibromas.

What Works to Make Cities Good for Living?

In response to a new global coalition of more than 500 leading health and development organizations worldwide, India as a country has agreed on a roadmap to progressively ensure that all people have access to the health services they need, when they need them, without fear of financial hardship.

Organizing relevant health services, pursuing only effective interventions and monitoring specific results by geographical areas, i.e., Urban Poor, Peri-urban, Un-recognized slums and so on through a better network of independent groups is the key responsibility of the health department.

To make our cities worth livable with health and productive people, we need to address the issues of urban environment first, like providing safe water, controlling air pollution, general sanitation, sewage disposal, minimizing noise pollution, providing playgrounds, walking tracks, good roads and transport for minimizing commuting pain index.

A common lag scenario in quenching of oscillation in coupled oscillators

A large parameter mismatch can induce amplitude death in two instantaneously coupled oscillators. Alternatively, a time delay in the coupling can induce amplitude death in two identical oscillators. We unify the mechanism of quenching of oscillation in coupled oscillators, either by a large parameter mismatch or a delay coupling, by a common lag scenario that is, surprisingly, different from the conventional lag synchronization. We present numerical as well as experimental evidence of this unknown kind of lag scenario when the lag increases with coupling and at a critically large value at a critical coupling strength, amplitude death emerges in two largely mismatched oscillators. This is analogous to amplitude death in identical systems with increasingly large coupling delay. In support, we use examples of the Chua oscillator and the Bonhoeffer-van der Pol system. Furthermore, we confirm this lag scenario during the onset of amplitude death in identical Stuart-Landau system under various instantaneous coupling forms, repulsive, conjugate, and a type of nonlinear coupling.

Experimental demonstration of revival of oscillations from death in coupled nonlinear oscillators

We experimentally demonstrate that a processing delay, a finite response time, in the coupling can revoke the stability of the stable steady states, thereby facilitating the revival of oscillations in the same parameter space where the coupled oscillators suffered the quenching of oscillation. This phenomenon of reviving of oscillations is demonstrated using two different prototype electronic circuits. Further, the analytical critical curves corroborate that the spread of the parameter space with stable steady state is diminished continuously by increasing the processing delay. Finally, the death state is completely wiped off above a threshold value by switching the stability of the stable steady state to retrieve sustained oscillations in the same parameter space. The underlying dynamical mechanism responsible for the decrease in the spread of the stable steady states and the eventual reviving of oscillation as a function of the processing delay is explained using analytical results.

Computer evaluation of hidden potential of phytochemicals of medicinal plants of the traditional indian ayurvedic medicine

Applicability of our computer programs PASS and PharmaExpert to prediction of biological activity spectra of rather complex and structurally diverse phytocomponents of medicinal plants, both separately and in combinations has been evaluated. The web-resource on phytochemicals of 50 medicinal plants used in Ayurveda was created for the study of hidden therapeutic potential of Traditional Indian Medicine (TIM) (http://ayurveda.pharmaexpert.ru). It contains information on 50 medicinal plants, their using in TIM and their pharmacology activities, also as 1906 phytocomponents. PASS training set was updated by addition of information about 946 natural compounds; then the training procedure and validation were performed, to estimate the quality of PASS prediction. It was shown that the difference between the average accuracy of prediction obtained in leave-5%-out cross-validation (94,467%) and in leave-one-out cross-validation (94,605%) is very small. These results showed high predictive ability of the program. Results of biological activity spectra prediction for all phytocomponents included in our database are in good correspondence with the experimental data. Additional kinds of biological activity predicted with high probability provide the information about most promising directions of further studies. The analysis of prediction results of sets of phytocomponents in each of 50 medicinal plants was made by PharmaExpert software. Based on this analysis, we found that the combination of phytocomponents from Passiflora incarnata may exhibit nootropic, anticonvulsant and antidepressant effects. Experiments carried out in mice models confirmed the predicted effects of Passiflora incarnata extracts.

How and why of orthodontic bond failures: An in vivo study

Introduction:

The bonding of orthodontic brackets and their failure rates by both direct and in-direct procedures are well-documented in orthodontic literature. Over the years different adhesive materials and various indirect bonding transfer procedures have been compared and evaluated for bond failure rates. The aim of our study is to highlight the use of a simple, inexpensive and ease of manipulation of a single thermo-plastic transfer tray and the use the of a single light cure adhesive to evaluate the bond failure rates in clinical situations.

Materials and Methods:

A total of 30 patients were randomly divided into two groups (Group A and Group B). A split-mouth study design was used, for, both the groups so that they were distributed equally with-out bias. After initial prophylaxis, both the procedures were done as per manufactures instructions. All patients were initially motivated and reviewed for bond failures rates for 6 months.

Results:

Bond failure rates were assessed for over-all direct and indirect procedures, anterior and posterior arches, and for individual tooth. Z-test was used for statistically analyzing, the normal distribution of the sample in a spilt mouth study. The results of the two groups were compared and P value was calculated using Z-proportion test to assess the significance of the bond failure.

Conclusion:

Over-all bond failure was more for direct bonding. Anterior bracket failure was more in-direct bonding than indirect procedure, which showed more posterior bracket failures. In individual tooth bond failure, mandibular incisor, and premolar brackets showed more failure, followed by maxillary premolars and canines.

Identification and characterisation of heat shock protein 70 in thermal stressed Blastocystis sp

Protistan parasites in order to ensure their viability and demonstrate successful progression in their life cycle need to respond towards various environmental stressors. Blastocystis sp. is known to be the most commonly found intestinal protistan parasite in any human stool surveys and has been incriminated to be responsible for diarrhea and bloating stomach. The present study demonstrates for the first time the presence of HSP70 in subtypes of Blastocystis sp. when the cultures were subjected to temperature of 39 and 41 °C where the growth of parasites was reduced to a minimum to majority being granular forms. The growth of parasites exposed to higher temperatures however doubled compared to the controls when the parasites were re-cultured back at 37 °C. Upon thermal stress at 41 °C, subtype 3 and subtype 5 isolates' growth reached up to 2.97 × 10(6) and 3.05 × 10(6) cells/ml compared to their respective controlled culture tubes at 37 °C which peaked only at 1.34 × 10(6) and 1.70 × 10(6) cells/ml respectively. The designed primer set that amplified Blastocystis sp. subtype 7 HSP70 gene in subtypes 1, 3 and 5 was against a conserved region. The gene was amplified at 318 bp. The multiple sequence alignment showed that the targeted sequence length ranges from 291-295 bp. The pair wise alignment result showed that the sequence identity among the four sequence ranges from 88% to 96%. These findings were further evidenced by the up regulation of HSP70 gene in thermal stressed isolates of subtype 3 and 5 at 41 °C. Higher number of granular forms was significantly found in thermal stressed isolates of subtype 3 and 5 which implicates that this life cycle stage has a role in responding to thermal stress.

Biochemical profiling and chemopreventive activity of phloretin on 7,12-Dimethylbenz (a) anthracene induced oral carcinogenesis in male golden Syrian hamsters

OBJECTIVES

The present study was designed to examine the chemopreventive effects of phloretin against 7, 12-dimethylbenz (a) anthracene (DMBA) induced buccal pouch carcinogenesis in male golden Syrian hamsters in order to discover resources to improve the traditional medicine.

MATERIALS AND METHODS

Hamsters were divided into four groups of 10 animals each. Group I was served as an untreated control. Group II hamsters were painted with 0.5% DMBA in liquid paraffin on the left buccal pouches three times a week for 14 weeks. Group III hamsters were orally administrated with phloretin at a dose of 40 mg/kg body Weight (b.wt) on days alternate to DMBA application. Group IV hamsters were orally administrated with phloretin alone and served as the drug control. The experiment was terminated at the end of fourteenth week. The experimental animal's tumors were subjected into morphological examination and subsequently screened the pathological changes and estimate the activities of bi-products of lipid peroxidation, antioxidants enzymes and phase I and II detoxification enzyme status.

RESULTS

In DMBA alone treated hamster showed increased levels of lipid peroxidation by products, leads to decreased levels of enzymatic and non-enzymatic antioxidants status, activities of phase I and II detoxification enzyme status were altered. Normalized the neoplastic changes, decreased the levels of lipid by products, retain the antioxidants and restored the phase I and II enzymes were observed in phloretin administrated animals during DMBA induced oral carcinogenesis.

CONCLUSION

Phloretin has possible chemopreventive role in which modulating the antioxidant and detoxification enzyme status, thereby retarding DMBA induced buccal pouch carcinogenesis.

Assessment of genotoxic and molecular mechanisms of cancer risk in smoking and smokeless tobacco users

Inexpensive forms of tobacco are widely used in developing countries such as India. We have evaluated genotoxicity endpoints (chromosome aberrations, micronucleus frequency, comet assay) and polymorphisms of the XRCC1 and p53 genes among smokers and smokeless tobacco (SLT) users in rural Tamilnadu, South India. Cytogenetic, DNA damage and SNP analyses were performed on peripheral blood samples; micronucleus frequency was measured in peripheral blood and buccal mucosa exfoliated cells. Both categories of tobacco users had elevated levels of genotoxic damage. SNP analysis of tobacco users revealed that 17% carry the XRCC1 gln399gln genotype and 19% carry the p53 pro72pro genotype. Both genotypes are associated with increased risk of cancer.

Hungatella effluvii gen. nov., sp. nov., an obligately anaerobic bacterium isolated from an effluent treatment plant, and reclassification of Clostridium hathewayi as Hungatella hathewayi gen. nov., comb. nov

A Gram-stain-positive, rod-shaped, spore-forming and strictly anaerobic bacterium, designated UB-B.2(T), was isolated from an industrial effluent anaerobic digester sample. It grew optimally at 30 °C and pH 7.0. Comparative analysis of the 16S rRNA gene sequence confirmed that strain UB-B.2(T) was closely related to Clostridium hathewayi DSM 13479(T) (97.84% similarity), a member of rRNA gene cluster XIVa of the genus Clostridium, and formed a coherent cluster with other related members of the Blautia (Clostridium) coccoides rRNA group in phylogenetic analyses. The end products of glucose fermentation by strain UB-B.2(T) were acetate and propionate. The G+C content of the DNA was 51.4 mol%. Although strain UB-B.2(T) showed 97.8% 16S rRNA gene sequence identity to the type strain of C. hathewayi, it exhibited only 38.4% relatedness at the whole-genome level. It also showed differences from its closest phylogenetic relative, C. hathewayi DSM 13479(T), in phenotypic characteristics such as hydrolysis of aesculin, starch and urea and fermentation end products. Both strains showed phenotypic differences from the members of rRNA gene cluster XIVa of the genus Clostridium. Based on these differences, C. hathewayi DSM 13479(T) and strain UB-B.2(T) were identified as representatives of a new genus of the family Clostridiaceae. Thus, we propose the reclassification of Clostridium hathewayi as Hungatella hathewayi gen. nov., comb. nov., the type species of the new genus (type strain DSM 13479(T) = CCUG 43506(T) = MTCC 10951(T)). Strain UB-B.2(T) ( = MTCC 11101(T) = DSM 24995(T)) is assigned to the novel species Hungatella effluvii gen. nov., sp. nov as the type strain.

Palliative chemotherapy in head and neck squamous cell cancer - What is best in Indian population? A time without symptoms, treatment toxicity score based study

BACKGROUND

Patients with recurrent and metastatic head and neck Squamous Cell Cancer (HNSCC) have poor prognosis with limited treatment options. In view of decimal prognosis, the treatment decision should include quality of life (QOL) issues, cost-effectiveness besides the response rates and survival.

AIM

Present retrospective analysis was conducted to evaluate efficacy (disease-free survival), pharmacoeconomics, and toxicity profile of four (4) different regimens, viz. gefitinib alone, gefitinib with methotrexate, methotrexate alone, or 5-FU with cisplatin.

MATERIALS AND METHODS

Case records between 2007 September and 2008 September were analyzed, 68 patients were found suitable for analysis. Patients received gefitinib (250 mg/day), methotrexate as 50 mg intramuscular weekly or a combination of the same or 5-FU 750 mg/m(2)/day for 4 days along with cisplatin 75 mg/m(2)/day on day 1 in 21-day cycle.

RESULTS

A total of 68 patients received therapy. Fifty-one patients have clinically meaningful response (stable disease + complete + partial responses) (75%) and had symptomatic improvement. The median progression-free survival was significantly superior in responders (those who achieved partial or complete response) (8.4 months vs. 3.1 months, P=0.001). Methotrexate with gefitinib had maximum median survival and better overall QOL compared to the other treatment regimens. Weekly methotrexate is relatively cost-effective followed by methotrexate with gefitinib and gefitinib alone. 5-FU with cisplatin in our experience does not appear so attractive in view of high complication rates (when given in full doses) and prolonged hospital stay.

CONCLUSION

Based on the results of this retrospective analysis, methotrexate weekly as single agent or in combination with gefitinib appears as an attractive alternative regimen for patients with metastatic HNSCC including those having poor performance status. A prospective study was planned and submitted to the local ethics committee based on above results to validate these results and compare methotrexate and gefitinib arm with 5-FU + cisplatin.

Encephalopathy in critically ill patients

Potentially reversible encephalopathies do add to the morbidity and mortality in critically ill patients. They are commonly seen in patients above 50 years between the 6th to 20th day of illness. Wernicke's encephalopathy, osmotic demyelination, hypoglycemia and other less common conditions like non-convulsive status, cerebral venous thrombosis and acute disseminated encephalomyelitis should be looked for in the appropriate setting as to facilitate early treatment.

Rare treatable limb girdle muscle disease

We report two cases of Limb Girdle pattern of muscle weakness caused by hyperparathyroidism due to parathyroid adenoma. It can be easily missed as early symptoms are non specific but once diagnosed it is easily treatable and complete recovery occurs over a period of time.

Anticlastogenic effect of diosgenin on 7,12-dimethylbenz(a)anthracene treated experimental animals

The present investigation explores the anticlastogenic effect of diosgenin on 7,12-dimethylbenz(a)anthracene (DMBA) treated clastogenesis. The frequency of bone marrow micronucleated polychromatic erythrocytes (MnPCEs), chromosomal aberrations (CA), deoxyribonucleic acid (DNA) damage as cytogenetic markers and the levels of lipid peroxidation by-products, activities of enzymatic antioxidant and the status of detoxification agents were performed to assess the anticlastogenic effects of diosgenin on DMBA treated hamsters. Intraperitoneal injection of DMBA (30 mg/kg bw) leads to clastogenesis in hamster. Elevated MnPCEs frequencies, CA, DNA damage, enhanced lipid peroxidation by products, declined antioxidant activities and detoxification cascade were observed in DMBA treated hamsters. Oral pretreatment with diosgenin (80 mg/kg bw) daily for a period of five days significantly reduced the frequency of MnPCEs, CA, DNA damage and normalized the levels of lipid peroxidation by products with increased activities of antioxidants and detoxification agents in DMBA alone treated hamsters. Outcome of the present study revealed that diosgenin has potent anticlastogenic effects on DMBA treated hamsters.