HRV analysis in local anesthesia using Continuous Wavelet Transform (CWT)

Spectral analysis of Heart Rate Variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study Continuous Wavelet Transform (CWT) has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing axillary brachial plexus block. A new method which takes signal characteristics into account has been presented for the estimation of the variable boundaries associated with the low and the high frequency band of the HRV signal. The variable boundary method might be useful in cases when the power related to respiration component extends beyond the traditionally excepted range of the high frequency band (0.15-0.4 Hz). The statistical analysis (non-parametric Wilcoxon signed rank test) showed that the LF/HF ratio decreased within an hour of the application of the brachial plexus block compared to the values fifteen minutes prior to the application of the block. These changes were observed in thirteen of the fourteen patients included in this study.

Isolation and characterization of Klebsiella pneumoniae specific bacteriophages from sewage samples

Five bacteriophages (Kpn5, Kpn12, Kpn13, Kpn17 and Kpn22), each having specificity against Klebsiella pneumoniae strain B5055, were isolated from sewage samples and characterized in terms of growth characteristics, genetic material, morphology and structural proteins. Adsorption rate as well as single step growth curve experiments showed variation among phages. Restriction enzyme digestion of DNA confirmed the presence of double stranded DNA as well as the heterogeneous nature of genetic material. RAPD-PCR was performed to further distinguish these closely related phages. Their genome fingerprint confirmed their diversity. Transmission electron microscopy, on the other hand, showed their morphological similarity; they were assigned to family Podoviridae, order Caudovirales on the basis of their head and tail morphology. Structural proteins resolved on SDS-PAGE showed the presence of similar major outer membrane proteins. The bacteriophages, belonging to Podoviridae family with short stumpy tails, were found to be nontoxic to mice. They showed maximum count in various organs at 6 h post inoculation, which persisted till 36 h. These phages thus have the potential to be used for phage therapy.

Time-frequency analysis of HRV data from locally anesthetized patients

Spectral analysis of Heart Rate Variability (HRV) can be used for the assessment of cardiovascular autonomic control. In this study Smoothed-Pseudo Wigner-Ville Distribution (SPWVD) has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing brachial plexus block (local anesthesia) using the transarterial technique. Instead of using the fixed boundaries of the LF (0.04-0.15 Hz) and the HF (0.15-0.4 Hz) components, the center frequency and the standard deviation spectral extension was used to estimate the boundaries related to the two components of the HRV signal. The boundaries related to the HF component of the signal were estimated using the cross-spectrum between the HRV signal and the respiration signal. The LF component boundaries were estimated directly from the time-frequency representation of the HRV signal. The statistical analysis showed that the (LF)/HF amplitude ratio decreased within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. These changes were observed in eleven of the fourteen patients included in this study.

Empirical mode decomposition (EMD) analysis of HRV data from locally anesthetized patients

Spectral analysis of Heart Rate Variability (HRV) is used for the assessment of cardiovascular autonomic control. In this study data driven adaptive technique Empirical Mode Decomposition (EMD) and the associated Hilbert spectrum has been used to evaluate the effect of local anesthesia on HRV parameters in a group of fourteen patients undergoing brachial plexus block (local anesthesia) using transarterial technique. The confidence limit for the stopping criteria was establish and the S value that gave the smallest squared deviation from the mean was considered optimal. The normalized amplitude Hilbert spectrum was used to calculate the error index associated with the instantaneous frequency. The amplitude and the frequency values were corrected in the region where the error was higher than twice the standard deviation. The Intrinsic Mode Function (IMF) components were assigned to the Low Frequency (LF) and the High Frequency (HF) part of the signal by making use of the center frequency and the standard deviation spectral extension estimated from the marginal spectrum of the IMF components. The analysis procedure was validated with the help of a simulated signal which consisted of two components in the LF and the HF region of the HRV signal with varying amplitude and frequency. The optimal range of the stopping criterion was found to be between 4 and 9 for the HRV data. The statistical analysis showed that the LF/HF amplitude ratio decreased within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. These changes were observed in thirteen of the fourteen patients included in this study.

Preventive effect of crocin of Crocus sativus on hemodynamic, biochemical, histopathological and ultrastuctural alterations in isoproterenol-induced cardiotoxicity in rats

We investigated the effects of crocin, a pharmacologically active constituent of Crocus sativus L., in isoproterenol (ISO)-induced cardiotoxicity with reference to hemodynamic, antioxidant, histopathological and ultrastructural parameters. Rats were administered crocin (5, 10 and 20mg/kg/day) or vehicle orally for 21 days along with ISO (85mg/kg, subcutaneously, at 24h interval) on 20th and 21st day. On 22nd day ISO-control rats showed cardiac dysfunction as indicated by lowering of systolic, diastolic and mean arterial blood pressures. In addition, a significant decrease in maximum positive and negative rate of developed left ventricular pressure (+/-LVdp/dt(max)) and an increase in left ventricular end-diastolic pressure (LVEDP) were observed. Furthermore, a marked reduction in the activities of myocardial creatine kinase-MB (CK-MB) isoenzyme, lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase (CAT), and reduced glutathione (GSH) levels along with an increase in content of malondialdehyde (MDA) were observed. Myocardial necrosis, edema and inflammation were evident from the light microscopic and ultrastructural changes. Crocin at the dose of 20mg/kg/day significantly modulated hemodynamic and antioxidant derangements. The preventive role of crocin on ISO-induced MI was reconfirmed by histopathological and ultrastructural examinations. The effect at the dose of 20mg/kg/day of crocin was more pronounced than that of other two doses (5 and 10mg/kg/day). The results suggest that crocin may have cardioprotective effect in ISO-induced cardiac toxicity through modulation of oxidative stress in such a way that maintains the redox status of the cell.

First Report of Trichodorus variopapillatus (Nematoda: Trichodoridae) from the Czech Republic

Members of the Trichodoridae can cause substantial crop losses directly by feeding on plant roots and indirectly as vectors of tobraviruses; both vector and virus are polyphagous. In April of 2008, soil samples from the rhizosphere of Ulmus minor Mill in a deciduous broadleaf forest at Krivoklat yielded a population of Trichodorus variopapillatus Hooper, 1972. Nematodes were identified by morphological and morphometric characters as well as by molecular analysis. For classical identification, specimens were extracted from soil by a decanting-sieving method, heat killed and fixed in triethanolamine formalin, and processed and mounted in anhydrous glycerin. For molecular analysis, specimens were stored at -20°C in 1 M NaCl. Specimens largely agreed with T. variopapillatus (1,3). Average morphometric data of five male specimens are: body length 766 μm; body width 33 μm; onchiostyle length 55 μm; and spicule length 43 μm. Number of anterior ventromedian cervical papillae and number of precloacal supplements was three each. Spicules are regularly curved and the manubrium is knob-like. Morphometric data of two female specimens are: body length 663 and 858 μm; body width 29 and 38 μm; onchiostyle length 52 and 53 μm; V 54 and 57%. Refractive thickenings at the vulva are very large and quandrangular in shape in the lateral optical section. Identification of these nematodes was further verified by sequencing two regions of rDNA (18S gene and D2/D3 expansion segments of the 28S gene). Single female and male specimens from NaCl storage were transferred to 0.5-ml Eppendorf tubes containing 0.25M NaOH. Total genomic DNA was prepared by a rapid technique (4). The 18S gene was amplified in three fragments using the primer SSU_F_04 + SSU_R_09 (first fragment), SSU_F_22 + SSU_R_13 (second fragment), and SSU_F_23 + SSU_R_81 (third fragment). D2/D3 expansion segments of the large subunit of rDNA were amplified using the forward primer D2A and the reverse primer D3B (2). The regions were sequenced in both directions after purification of PCR products. The sequences of female and male specimens were identical. The sequences were deposited in GenBank with Accession Nos. GQ148719 (28S) and GQ148719 (18S). The length of 18S was 1,760 bp and D2/D3 was 786 bp. The obtained sequences were compared by BLAST in NCBI. The D2/D3 sequence is not available in GenBank for T. variopapillatus. The best BLAST hits were obtained with Trichodorus species. BLAST results of 18S sequence showed 5% divergence (76 substitutions) after trimming unequal ends with published sequence of T. variopapillatus Accession No. AY284841. All substitutions were confirmed from the chromatographs. To our knowledge, this is the first report of T. variopapillatus associated with U. minor in the Czech Republic. References: (1) W. Decraemer and P. Baujard. Fundam. Appl. Nematol. 21:37 1998. (2) P. De Ley et al. Nematology 1:591, 1999. (3) D. Hooper. Nematologica 17:59, 1972. (4) J. M. Stanton. Australas. Plant Pathol. 27:112, 1998.

First Report of the Dagger Nematode Xiphinema dentatum (Nematoda: Longidoridae) in a Deciduous Forest in the Czech Republic

Xiphinema species are migratory ectoparasitic nematodes that feed on an extensive range of hosts and several species are vectors of nepoviruses. These long nematodes are readily distinguished from most other plant parasitic nematodes by a long stylet with forked odontostyle and flanged odontophore. In May of 2005, a sample from the rhizosphere of Carpinus betulus and Acer platanoides in a forest near Silnicna, South Moravia yielded a population of Xiphinema dentatum Sturhan, 1978. X. dentatum previously has been reported to be associated with several forest and grassland species in Germany, the former Yugoslavia, and Slovakia. Specimens were extracted from soil by decanting-sieving. A few female specimens were stored at -20°C in 1 M NaCl, and the rest of the specimens were heat killed, fixed in triethanolamine formalin, and mounted in anhydrous glycerin. In 2007, nematodes from permanent slides were identified by morphological and morphometrical characters (3): female body C shaped in fixed specimens, lip region offset by a depression, reproductive system amphidelphic with the presence of well developed pseudo Z-organ, and tail broadly convex-conoid to regularly hemispherical; main average morphometric of females were body length 3.6 mm, total stylet length 220 μm, vulva position 46%, and tail ratio 0.66. Identification of these nematodes was further verified by sequencing cytochrome oxidase subunit 1 (cox1) of mtDNA and D2/D3 expansion segments of large subunit rDNA. Two individual female specimens from NaCl storage were transferred to 0.5-ml Eppendorf tubes containing 0.25 M NaOH. Total genomic DNA was prepared by a rapid technique (4). The cox1 gene was amplified using forward primer COIF (5'-GAT TTT TTG GKC ATC CWG ARG-3') and reverse primer COIR (5'-CWA CAT AAT AAG TAT CAT G-3') (2). D2/D3 expansion segments of large subunit of rDNA were amplified using forward primer D2A (5'-ACA AGT ACC GTG AGG GAA AGT TG -3') and reverse primer D3B (5'-TCG GAA GGA ACC AGC TAC TA-3') (1). The regions were sequenced in both directions after purification of PCR products from gel slices with a Qiagen gel extraction kit (Qiagen, Hilden, Germany). The sequences of two individual females were identical. The sequences were deposited in GenBank (Accession Nos. EU781537 [cox1] and EU781538 [D2/D3]). The length of cox1 was 393 bp and D2/D3 was 786 bp. The obtained sequences were compared by BLAST in NCBI. The cox1 gene sequence is not available in GenBank for X. dentatum, but the best BLAST hits were logically obtained with Xiphinema species. BLAST results of D2/D3 sequence showed strong similarities (99.6%) with X. dentatum Accession No. AY601627 and only a three nucleotide difference was observed in the beginning of the 5' end. To our knowledge, this is the first report of X. dentatum associated with deciduous forest trees in the Czech Republic. Forests are the main terrestrial ecosystems and rich in species diversity and are of great importance as natural resources. Therefore, information on these plant parasitic nematodes from forests would be useful because they are a component of the continental forest diversity. References: (1) P. De Ley et al. Nematology 2:591, 1999. (2) Y. He et al. J. Mol. Evol. 61:819, 2005. (3) P. A. A. Loof and M. Luc. Syst. Parasitol. 16:35, 1990. (4) J. M. Stanton. Australas. Plant Pathol. 27:112, 1998.

Halogen-substituted phenylalanines as enantioselective selectors for enantioselective discrimination of amino acids: effect of halogen

Halogen-substituted phenylalanines with a halogen X (X = F, Cl, Br or I) in the para position in the aromatic ring of L-phenylalanine are used as enantioselective selectors to explore the effect of the halogen substituent on the enantioselective discrimination of amino acids. Enantioselective discrimination is achieved by investigating the collision-induced dissociation spectra of the trimeric complex ion, [CuII(ref)2(A)-H]+, generated by electrospraying a solution of a mixture of D- or L-analyte amino acid (A), enantioselective reference ligand (ref) and CuCl2. The relative abundances of fragment ions resulting from the competitive loss of reference and analyte amino acids are considered for measuring the degree of enantioselective discrimination by applying the kinetic method. The enantioselectivity of the p-halogenated derivatives of L-Phe increases from fluorine to iodine for the studied amino acids (except for acidic amino acids). The validity of the present method has also been checked by cross enantioselective experiments using p-iodo-D-phenylalanine as the reference in place of p-iodo-L-phenylalanine. The enantioselectivity of fluoro-substituted L-phenylalanine is less than that obtained with L-phenylalanine. The high inductive effect of the fluorine atom decreases the strength of the pi-pi stacking interaction. The presence of halogen affects the enantioselectivity by inductive and steric effects.

Plasma MDA and antioxidant vitamins in diabetic retinopathy

Hyperglycemia and dyslipidemia in diabetes mellitus induce increased lipid peroxidation and peroxyl radical formation, an important mechanism in genesis of microangiopathy. We took up a study on oxidative stress, measured by plasma MDA and antioxidant vitamin status in type - 2 DM patients with and without retinopathy and compared them with a control non-diabetic group. Lipid peroxidation marker MDA was significantly elevated (p < 0.001) in both the diabetic groups whereas, serum vitamin E and vitamin C registered a significant fall (p<0.001) as compared to controls. Our correlation study revealed a significant positive association between plasma MDA with both fasting and 2hr post prandial plasma glucose (r=0.81, p < 0.001, r=0.92, p <0.001) suggesting the role of hyperglycemia in free radical production. Plasma MDA also depicted significant positive relation (p< 0.001) with all lipid parameters except serum HDLc pointing the role of dyslipidemia towards lipid peroxidation. Plasma MDA level was also found to be negatively correlated with both the vitamins (p<0.001, p<0.001) in the study group explaining their protective consumption in the oxidative process prevailing in diabetic retinopathy.

Changes in Heart Rate Variability in patients under local anesthesia

Spectral analysis of Heart Rate Variability (HRV) is widely used for the assessment of cardiovascular autonomic control. Several studies have shown the effect of anesthetic agents on HRV parameters. In this study a systematic approach of HRV analysis has been employed. The effect caused by the ectopic beats on the spectral measurements has been investigated and results are presented. A detrending method using Wavelet Packets has been developed which was able to remove slow varying trend from HRV signals without causing significant changes in the low frequency (LF) and high frequency (HF) component of the HRV signal. Using this methodology electrocardiogram (ECG) signals from 14 patients undergoing local anesthesia (brachial plexus block) were analyzed with parametric Autoregressive (AR) method. The results showed that the LF/HF ratio values calculated from the HRV signal decreases within an hour of the application of the brachial plexus block compared to the values at the start of the procedure. This change was noticed in approximately 80% of the patients.

Paddy straw as substrate for ethanol production

Pretreatment of paddy straw with 2% sodium hydroxide at 15 psi for 1 h resulted in 83% delignification. The hydrolysis of alkali treated paddy straw with a commercial preparation of cellulase for 2 h at 50°C resulted in release of 65% total reducing sugars. Maximum sugars were released at enzyme loading of 1.5% (v/v). The fermentation of hydrolysate supplemented with nutrients by S. cerevisiae resulted in the production of 20-30 g L(-1) ethanol after 48 h incubation which was further improved with addition of yeast nitrogen base and inoculated with 1% (w/v) yeast cells.

First Report of Trichodorus similis from the Czech Republic (Nematoda: Trichodoridae)

Members of the Trichodoridae can cause substantial crop losses directly by feeding on plant roots and indirectly as vectors of tobraviruses; both vector and virus are polyphagous. Although trichodorid nematodes are important pests of agricultural crops, no data are available on the presence or extent of these nematodes in the Czech Republic. In June 2005, three soil samples from the rhizosphere of a Quercus sp. at Cerveny Vrch yielded a population of Trichodorus similis Seinhorst, 1963. Specimens were extracted from soil by a decanting-sieving method, heat killed, and fixed in triethanolamine formalin (TAF), and processed and mounted in anhydrous glycerin. Nematodes were identified by morphological and morphometrical characters (2). Classical identification of these nematodes was further verified by molecular study. A single, male specimen was temporarily mounted in distilled water on a glass slide and relaxed with gentle heat. Measurements and photographs were taken, and the specimen was transferred to a 0.5-ml Eppendorf tube containing 0.25 M NaOH. Total genomic DNA was prepared by a rapid technique (4). Morphometric data of the male specimen used for DNA study are: body length 867 μm; body width 81 μm; onchiostyle length 44 μm; spicule length 36 μm; distance of anterior cervical papilla (CP)1 from anterior end 39 μm, CP1 to CP2 25 μm, CP2 to CP3 22 μm; posterior precloacal supplement (SP1) to cloacal opening 27 μm, distance SP1 to SP2 32 μm, distance SP2 to SP3 39 μm. The following primers were used in the PCR reaction: species-specific sense primer SIMIREV2 (5'-CACTCGTCGGACTCAAACC-3') and universal antisense primer UNIVERSAL (5'-CCCGTCGCTACTACCGATT-3') (1). A single fragment of approximately 452 bp was amplified. The D2 and D3 expansion regions of the large subunit 28S rDNA were amplified using the primer D2A (5'-ACAAGTACCGTGAGGGAAAGTTG-3') and D3B (5'-TCGGAAGGAACCAGCTACTA-3' (3). The region was sequenced after purification of PCR products from the gel slice with a Qiagen gel purification kit (Qiagen Inc., Valencia, CA). The obtained sequence was deposited in Genbank (Accession No. DQ832183). The obtained sequence was compared by BLAST in NCBI and the results showed strong similarities with T. similis (Accession No. AM180730). To our knowledge, this is the first report of T. similis associated with a deciduous forest in the Czech Republic. Taking into account the agricultural importance of trichodorids and tobraviruses as plant pathogens, there is a need for a comprehensive survey of these taxa in the Czech Republic. The damage level threshold is in the case of virus vector species equivalent to a single nematode. Therefore, information on these plant parasites would be useful for developing nematode management strategies. References: (1) K. Boutsika et al. Plant Pathol. 53:110, 2004. (2) W. Decraemer and P. Baujard. Fundam. Appl. Nematol. 21:37, 1998. (3) P. De Ley et al. Nematology 2:591, 1999. (4) J. M. Stanton. Australas. Plant Pathol. 27:112, 1998.

Evidence for the involvement of proline-directed serine/threonine phosphorylation in sperm capacitation

To become fertilization competent, mammalian sperm undergo changes in the female reproductive tract termed capacitation. Capacitation correlates with an increase in tyrosine phosphorylation; however, less is known about the role of serine/threonine phosphorylation in this process. Proline-directed phosphorylation is one of the major regulatory phosphorylation events in many cellular processes such as cell proliferation and differentiation. Using mitotic phosphoprotein monoclonal-2 (MPM-2) antibody in this study, we observed that several mouse sperm proteins in the range of 70-250 kDa underwent increased serine/threonine-proline phosphorylation during capacitation. In contrast to the time course of tyrosine phosphorylation, proline-directed phosphorylation could be observed at shorter time points of sperm incubation, and it was found to be independent of NaHCO(3) and adenosine 3'5'-cyclic monophosphate (cAMP). Similar to the regulation of the increase in tyrosine phosphorylation, cholesterol acceptors such as bovine serum albumin (BSA) or 2-hydroxypropyl-beta-cyclodextrin (2-OH-propyl-beta-CD) were essential for the regulation of proline-directed phosphorylation in mouse sperm. Furthermore, it was also found to be BSA dependent in human sperm. Among proline-directed kinases, extracellular signal-regulated kinase 1/2 (ERK1/2) is present in mammalian sperm; nevertheless, U0126 and PD098059, two inhibitors of the ERK pathway, did not block this phosphorylation in mouse sperm. In conclusion, capacitation is associated with an increase in proline-directed phosphorylation linked to cholesterol efflux in the sperm.

Nutritional status of scheduled caste pre-school children

In the present study anthropometric measurements showed that all the children of scheduled caste families under investigation were under weight and suffered from protein energy malnutrition, night blindness, angular stomatitis, enlargement of liver, anaemia, spongy bleeding gum and a few cases of bow legs, polio and keratomalacia. The haemoglobin level was below World Health Organisation (WHO) standard. Their intakes of protective foods and nutrients such as energy, calcium and iron were less than respective recommended dietary allowances (RDA). Socio-economic environment is responsible for poor nutritional status ofscheduled caste pre-school children.

Extensive arterial and venous thrombosis in a patient with ulcerative colitis--a case report

BACKGROUND

Vascular thrombosis is a rare but well-recognized extraintestinal manifestation of ulcerative colitis. Thrombosis usually involves the peripheral veins and less commonly the cerebral veins and the arterial system.

CASE REPORT

A case of a 22-year-old woman is reported who presented with an exacerbation of ulcerative colitis and developed extensive arterial and venous thrombosis. Good clinical improvement was achieved after treatment with steroids, sulfasalazine, and anticoagulation with enoxaparin followed by long-term warfarin.

CONCLUSION

Early recognition of thrombotic complications is essential in initiating lifesaving therapy.

Loss of circadian rhythm of blood pressure following acute stroke

BACKGROUND

Epidemiology of acute stroke in developing countries differs from that in the developed world, for example, the age at stroke, risk factors, subtypes of stroke and prognosis. Hypertension remains a dominant risk factor and prognostic indicator in patients with stroke in all communities. The risk of stroke is directly related to elevations of blood pressure. A number of clinical studies have shown that the control of hypertension leads to a reduction in the incidence of stroke in a community. However there is still considerable controversy surrounds the changes in blood pressure in various subtypes of strokes and problem of management of elevated BP after stroke. We studied the circadian rhythm of blood pressure in patients following acute stroke.

METHODS

To study the circadian rhythm of blood pressure, fifty consecutive patients with an acute stroke who were admitted to medical emergency within 120 hours of onset were included in the study. After a detailed history and clinical examination, a continuous blood pressure monitor (Spacelab 90207) was attached on the side ipsilateral to intracranial lesion (unaffected arm). The blood pressure was recorded for 24 hours at 15 minutes interval during daytime (6.00 am-6.00 pm) and 20 minutes interval overnight (6 pm to 6 am).

RESULTS

Risk factors for stroke in 50 patients included hypertension in 31(62%), diabetes mellitus in 4 (8%), smoking in 13 (26%) and previous history of transient ischemic attack in 7 (14%) patients. Mean systolic pressure and diastolic pressure at admission were higher in patients with hemorrhagic stroke -29 patients (177 +/- 24 mmHg and 105 +/- 19 mmHg respectively) compared to patients with ischemic strokes-21 patients (150 +/- 36 mm Hg and 89 +/- 18 mm Hg respectively, p value <0.01 in both comparisons). The normal diurnal variation in blood pressure (night time dipping of more than 10%) was abolished in 44 (88%) of patients. Out of 44 nondippers, 29 patients showed reverse dipping i.e. rise of BP during night time compared to day time levels. None of the risk factors, clinical or laboratory variables, type of stroke or blood pressure changes differed significantly between these two groups.

CONCLUSIONS

Therefore, we showed a pathologically reduced or abolished circadian BP variation after stroke. Absence of normal dipping results in a higher 24 hour blood pressure load and may have more target organ damage than those with normal diurnal variation of blood pressure.

Prevalence and pattern of use of complementary and alternative medicine (CAM) in hypertensive patients of a tertiary care center in India

OBJECTIVE

To study the prevalence and pattern of use of complementary and alternative medicine (CAM) in patients with essential hypertension.

METHOD

521 consecutive patients visiting the Hypertension Clinic at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, over a 6-month period were interviewed. Information was gathered on the patients' demographics, type(s) of CAM used, sequence of seeking CAM and conventional medicine, sources of recommendation, reasons for opting for CAM and areas of satisfaction and dissatisfaction associated with the use of CAM. Patients were also asked if they had informed their doctor about CAM use.

RESULTS

It was observed that 63.9% of patients overall used CAM. Ayurveda was the most commonly used CAM (56.7%), followed by herbal medicines (14.4%). The most commonly cited reason by patients for using CAM was fear of adverse drug reactions of conventional medicines (59.0%). However, more than half of the patients eventually became dissatisfied using CAM. Only 5.4% of CAM users had informed their medical doctors about the use of CAM.

CONCLUSION

A significant proportion of patients receiving conventional treatment for hypertension also use CAM therapies. A better understanding of the pattern of CAM use amongst these patients will help dispel prevalent misconceptions concerning CAM and, at the same time, assist conventional practitioners to critically evaluate possible gaps or omissions in their own prescribing habits.

Patterns and perceptions of complementary and alternative medicine (CAM) among leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital

PURPOSE

The use of complementary and alternative medicine (CAM) in cancer treatments is widespread with substantial number of patients deserting conventional cancer therapies in favour of unproven methods. The present study aimed at discovering the prevalence of use of CAM cancer therapies in leukaemia patients visiting haematology clinic of a north Indian tertiary care hospital.

METHODS

533 consecutive leukaemia patients were interviewed. Information was gathered about patients' demographics, types of CAM taken, sequence of seeking CAM and conventional medicine, sources of recommendation, reasons of opting for CAM, and areas of satisfaction and dissatisfaction associated with the use of CAM. Patients were also asked if they had informed their doctor about CAM use.

RESULTS

Prevalence of CAM use in leukaemia patients was found to be 56.6%. Ayurveda was the most commonly used CAM (33%). Most of the patients sought conventional medicine first, followed by CAM therapies. Fifty-two percent of the patients opted for CAM hoping for a miracle cure and 51% were dissatisfied with these therapies. Family members and neighbours constituted major source of recommendation of CAM therapy. Only 3.8% of the patients had informed their doctors about CAM use.

CONCLUSION

A sizeable percentage of patients receiving conventional treatment for leukaemia also use CAM therapies. Clinicians should not underestimate the value of hopeful attitude in their management of leukaemia patients and ought to be conversant with popular forms of CAM cancer therapies.

Epidural abscess and Staphylococcus aureus endocarditis - a rare association

Epidural abscess is a relatively uncommon disorder. Although the surgical management is the mainstay of treatment, there are case reports of it being managed conservatively in selected patients. We report a patient who presented with quadreparesis due to epidural abscess and had infective endocarditis due to Staphylococcus aureus septicemia. Both epidural abscess and infective endocarditis were managed conservatively with intravenous antibiotics given for four weeks, with complete recovery of patient.

Time trends in the prevalence of hypertension and associated risk factors in Chandigarh

To estimate the changes in the prevalence of hypertension and associated risk factors over a 30 years period a cross-sectional population survey in three randomly selected sectors of Chandigarh city was carried out. Study population consisted of 1181 individuals (570 males and 611 females) aged 35 years and above. A total of 1049 subjects were interviewed using a structured interview schedule, and 937 were examined by a physician. Blood pressure and anthropometric measurements were recorded. Physical activity was graded according to the job performed by the individual. Guidelines of the Fifth Joint National Committee (JNC-V) of USA were used for diagnosis of hypertension. Estimation of body fat from skin fold thickness was done by applying Grande's formula and the method of Pascale et al. Data were compared to that of year 1968 when a similar cross-sectional survey had been carried out in Chandigarh. Age and sex standardised prevalence of hypertension according to JNC-V criteria increased from 26.9 per cent in 1968 to 44.9 per cent in 1996-97. In 1968, 70% of the male population were engaged in sedentary and light physical activity compared to 73.7 per cent in 1996-97. Total body fat has increased in both men and women. High and high middle income groups in males were 61.2% in 1996-97 compared to 37.4% in 1968. Smoking rates, however, remained unchanged, 25.4 per cent men smoked in 1968 compared to 24.6 per cent in 1996-97. The prevalence of hypertension has almost doubled over 30 years in Chandigarh. Unfavourable change in prevalence of hypertension, physical activity and body fat makes this population highly vulnerable to cardiovascular morbidity and mortality.