Prevalence of major neurological disorders among geriatric population in the metropolitan city of Kolkata

Well-conducted neuroepidemiological studies for the geriatric population are rare in India. In view of the growing aging population, we planned to determine the prevalence of common neurological disorders among the elderly population in the city of Kolkata. This was a cross-sectional study of a stratified random sample of the city population and carried in two stages through house to house survey. Initially, trained non-medical workers screened the cases with a validated family questionnaire and then a neurologist examined all the screened positive cases. A validated neuropsychological screening test was also applied among the elderly population with cognitive complaints. Results showed prevalence rates (per 1000 elderly population--> or = 60 years) of following disorders in decreasing order: stroke--33.93, essential tremor--13.76, dementia--7.89, Parkinsonism--3.30 and epilepsy--2.57. Sex-specific prevalence showed that stroke was commoner among men and that of other disorders among women. Age-specific prevalence recorded progressive increase in the rates of all disorders among both genders, though not uniformly among women. Overall the crude prevalence of neurological disorders was 60.9 per 1000. The present study shows higher rate of stroke as compared to other neurological disorders among elderly population in India, which needs urgent attention.

Hepatoprotective and antioxidant effects of Argyreia speciosa in rats

The present study has been designed to evaluate the liver protective and in-vivo antioxidant role of Ethanolic extract (EtAS) and Ethyl acetate extract (EAAS) of roots of Argyreia speciosa, an important 'rasayana' herb in Indian System of medicine, in CCl(4)-induced hepatotoxicity and oxidative stress in rats. Animals were treated with EtAS and EAAS at doses of 200 mg and 400 mg/kg body weight p.o. along with CCl(4) (0.7 ml/kg in olive oil, 1:1 v/v i.p. on every alternate days) for seven days. Serum biochemical parameters such as SGOT, SGPT, ALP, cholesterol, total and direct bilirubin were determined. Antioxidant status in liver was determined by measuring the activities of Super oxide dismutase (SOD), catalase and peroxidase. Histopathological study of isolated liver specimens was also carried out to know the protection offered by the extracts. There was a significant rise in the levels of serum GOT, GPT, and ALP and other biochemical parameters, decrease in the levels of SOD, catalase and peroxidase after administration of CCl(4). Suspensions of EtAS and EAAS (200 and 400 mg/kg) successfully prevented the alterations of these effects in rats (p< 0.001). Histopathological examination demonstrated that CCl(4) treated group induces ballooning degeneration and centrilobular necrosis. Groups treated with EtAS and EAAS showed recovery on ballooning degeneration and centrolobular bridging necrosis was occasionally present. Data also showed that these extracts possessed strong antioxidant activity, and were comparable to Silymarin, a well known liver protecting herbal formulation.

Socio-demographic characteristics of children infested with scabies in densely populated communities of residential madrashas (Islamic education institutes) in Dhaka, Bangladesh

BACKGROUND

Outbreaks of scabies in institutions and the socio-economic consequences have not been reported from overpopulated countries such as Bangladesh.

STUDY DESIGN

A community-based study among children from six residential Islamic education institutes (madrashas) in Dhaka. Multistage random sampling was used.

OBJECTIVES

To study the socio-economic profile, water-sanitation facilities, personal hygiene and living conditions of these children.

METHODOLOGY

Direct interviews were used to collect the data and clinical check up was performed in all children.

RESULTS

In total, 492 children received clinical check-ups; 92.5% were boys (mean age: 11.2+/-2.4 years). 63.4% of fathers and 98.5% of mothers were either illiterate or had only received primary education, 55.1% of fathers were in low-paid labouring jobs, and 99% of mothers were housewives. Of the 98% of children who had scabies, 71% had been re-infected (96% during the winter). Randomly assigned anti-scabies drugs revealed an average cure rate of 85.5%. Seventy-four percent of children were living in poorly ventilated buildings with overcrowded sleeping arrangements. They had poor personal hygiene: 21% shared towels; 8% shared undergarments; 30% shared bed linen; and 81% kept their used clothes on a communal line or shelf. Sanitation was also poor: 39% bathed infrequently, although 97% carried out mandatory ablution. Most children (61%) washed their clothes (including undergarments) two or three times a fortnight, 35% did so every 2-3 days, and 3.7% washed their clothes on alternative days. Disease severity and re-infection were associated with infrequent washing of clothes (P<0.001) and bed linen (P<0.001), overcrowded sleeping arrangements (P<0.001) and infrequent bathing (P<0.001) with soap (P<0.001). This was further related to household income (P<0.001 for both).

CONCLUSION

The study findings have potentially dangerous implications for public health. Immediate attention should be given to developing a sustainable long-term intervention programme to combat scabies hyperendemicity, and to save thousands of children from impending complications.

Randomized controlled trial of supervised exercise to evaluate changes in cardiac function in patients with peripheral atherosclerotic disease

INTRODUCTION

Peripheral atherosclerotic disease (PAD) is a condition characterized by low functional capacity which is associated with impaired free living, ambulation and low exercise tolerance. The purpose of this randomized controlled study was to evaluate whether changes in maximal walking time are associated with adaptations in cardiovascular function following supervised exercise.

METHODS

After ethics approval, 28 patients (63 +/- 11 years) completed a graded treadmill test (2 min stages, 3.2 km h(-1), with gradient increasing 2% every 2 min) until they reached level three or four on the claudication pain scale. Peak oxygen consumption was assessed on a breath-by-breath basis, by online expiratory gas analysis. Following a 40-min recovery period, peak cardiac output was measured using the non-invasive carbon dioxide rebreathing method described by Defares (J Appl Physiol, 13, 1958, 159). Peak cardiac power output was then computed using the equation described by Cooke et al. (Heart, 1998, 79, 289). Patients were randomly assigned to one of two groups: supervised, who exercised at the hospital twice weekly for 12 weeks or control, who received normal treatment which included encouragement to walk regularly.

RESULTS

After 12 weeks, there were no significant changes in body mass, peak oxygen consumption, peak cardiac output, peak heart rate, peak cardiac power output, respiratory exchange ratio or rating of perceived exertion in both the supervised and control group. There was a significant improvement (91%) in maximal walking distance following the supervised exercise programme. Although patients' peak cardiovascular measurements were unchanged, the patients in the supervised exercise group were able to complete a higher workload at the end of the 12 weeks of exercise, for the equivalent demands on the circulation system.

CONCLUSIONS

The findings from this study suggest that a short-term period of supervised exercise training results in an improved walking time in patients with limiting claudication because of PAD. It also demonstrated that the cardiovascular system becomes more efficient in meeting the demands of exercise. It is recommended that individuals with PAD should undertake exercise as a form of treatment.

Cercarial dermatitis in central India: an emerging health problem among tribal communities

Although cercarial dermatitis is an emerging disease world-wide, cases of such dermatitis may often go undiagnosed, especially in communities that are affected by various skin infections. Between August 2001 and July 2002, 1336 individuals from tribal villages in central India were examined for dermatitis. Skin scrapings were collected and examined for Sarcoptes scabiei and each subject's response to antiscabies treatment was recorded. Freshwater snails were collected from the local ponds used for bathing, and examined for cercariae. The recorded prevalence of dermatitis ranged between 2.1% and 12.5% during the study year, peaking at the end of winter (February-March) and during the rainy season (August-October). Snail positivity for cercariae peaked in the rainy season. The prevalence and the severity of dermatitis were both higher in children than in adults. As most recorded cases of dermatitis were associated with a rash that developed soon after bathing in the local pond, all the skin scrapings were negative for itch mites, and the response to antiscabies treatment was poor, most if not all of the dermatitis observed was probably cercarial. Cercarial dermatitis therefore appears to be a significant health problem among the tribal populations of central India.

Limbic encephalitis--an uncommon presentation of systemic malignancy

A 46 years, nondiabetic, nonhypertensive woman presented with headache, vomiting, low grade intermittent fever, behavioral abnormality and seizures for last three months. Clinically she had meningism with bilateral papilloedema. Based on CSF analysis, normal CT scan of brain and suspicious lesion in X-ray chest, she was put on anti-tuberculosis therapy. As the patient further deteriorated clinically, MRI of brain was carried out and revealed bilateral increased signal intensities in both medial temporal lobes in T2 and flair sequences. Inj. acyclovir was added considering the diagnosis of herpes simplex encephalitis. In spite of receiving treatment patient gradually became more drowsy and repeat X-ray chest with CT guided FNAC showed picture of adenocarcinoma of lung. So finally, we concluded it to be a case of limbic encephalitis.

Bioturbation-induced phosphorous release from an insoluble phosphate source

The influence of bioturbation caused by common carp fry in 5 L jars (5 L each) in the laboratory and in 150 L outdoor vats in increasing the fertilizer value of phosphate rock was evaluated. Soluble reactive phosphate (SRP) was determined to quantify the effects of bioturbation, fish excrements and soil. The level of SRP was always lowest in the control series. Introduction of common carp fry resulted in a net increase of 0.09-0.10 mg L(-1) of SRP attributable to the effect of fish excrement. Bioturbation caused by common carp resulted in a 64.8-90% influx of phosphate from bottom soil in the presence of phosphate rock but only about 6.3-7.2% in the absence of phosphate rock. The bioturbation that occurred in these treatments resulted in a significant release of phosphorous into the overlying water from the apatite source. The results confirm the benefits of the application of environmentally friendly phosphate rock in fish farming ponds at low cost.

Transcription factor 7-like 2 polymorphisms and type 2 diabetes, glucose homeostasis traits and gene expression in US participants of European and African descent

AIMS/HYPOTHESIS

We sought to determine: (1) the role of previously described transcription factor 7-like 2 (TCF7L2) variants in type 2 diabetes in African American individuals and in participants of European ancestry; (2) the physiological impact of these variants on glucose homeostasis; and (3) whether the non-coding variants altered TCF7L2 expression in adipocytes and transformed lymphocytes.

METHODS

Association studies were conducted by genotyping 932 Europid and African American diabetic and control participants. Family studies were conducted in 673 members of 68 Europid families ascertained for at least two diabetic siblings. Metabolic studies were conducted in 585 non-diabetic individuals who had undergone frequently sampled intravenous glucose tolerance tests to determine insulin sensitivity and insulin secretion. Gene expression studies were conducted in 74 adipose samples and 64 muscle samples from non-diabetic individuals with known genotypes and also in 55 lymphoblastoid cell lines.

RESULTS

TCF7L2 variants were associated with type 2 diabetes in a Europid case-control population and in families, but not in African Americans. Risk alleles increased the 60 min post-challenge glucose value in Europid families and reduced insulin sensitivity by 45% in Europids, but did not alter insulin secretion. TCF7L2 expression was not altered by genotype and did not correlate with insulin sensitivity or BMI.

CONCLUSIONS/INTERPRETATION

We confirmed TCF7L2 as a risk factor in a population of European descent, where it reduced glucose tolerance and insulin sensitivity, but not insulin secretion. We found no role in African Americans and could not explain the association by altered adipocyte or muscle gene expression.

A study of pulmonary tuberculosis in the elderly

The incidence of tuberculosis (TB) is increasing globally. The diagnbsis of TB in elderly is often delayed due to the atypical presentation. There is also therapeutic problems because of presence of comorbidity, nutritional and socio-economic factors and increased incidence of adverse drug reactions and mortality. A prospective study was conducted among patients presenting with pulmonary tuberculosis at the department of TB and respiratory medicine in a tertiary care hospital between January, 2006 to July, 2006. Thirty patients aged more than 65 years were studied for their clinical characteristics, comorbid illnesses, sputum status, radiological features and adverse drug reactions. They were contrasted against the same parameters in 40 patients aged 65 years or less. The study showed that pulmonary TB in the elderly is characterised by (a) atypical symptoms, (b) more extensive radiological lesion with lower zone preponderance, (c) higher sputum positivity, (d) more frequent comorbidity, (e) more frequent side-effects and (f) higher mortality.

Cloning, sequencing and expression of cDNA of bovine neutrophil beta-defensin from water buffalo (Bubalus bubalis)

Neutrophil beta-defensins have been identified as naturally occurring potent antibacterial cationic peptides serving as effector molecules of innate immunity that provide a first line of defence against pathogens. Considering the broad-spectrum antimicrobial activity against microorganisms and role in innate immunity of the neutrophil beta-defensins, it has been characterized in many livestock species including cattle, sheep, caprine and porcines. Here we report the isolation, cloning, sequencing and expression of precursor bovine neutrophil beta-defensin isolated from Indian water buffalo. Full-length cDNA was amplified using reverse transcription polymerase chain reaction (RT-PCR). The cDNA contained an open reading frame of 192 bp encoding a putative polypeptide of 63 amino acids. Deduced amino acid sequence of buffalo BNBD4 showed varying amino acid identity with the published sequences of related beta-defensins of other domestic ruminant species ranging from 67.18 to 79.68%. Recombinant buffalo defensin was produced in Escherichia coli as fusion protein.

An epidemiologic study of mild cognitive impairment in Kolkata, India

OBJECTIVES

To estimate the prevalence of two types of mild cognitive impairment (MCI)-amnestic and multiple domain types-among nondemented and nondepressed elderly subjects aged 50 and older.

METHODS

The study was carried out in Kolkata, the eastern metropolis of India. A cross-sectional community screening was carried out, and 960 subjects were selected by systematic random sampling for the assessment of cognitive function with the help of a validated cognitive questionnaire battery administered through house-to-house survey. A case-control study was also undertaken to identify potential risk factors through univariate analysis.

RESULTS

Ultimately, full evaluation of cognitive function was possible in 745 of 960 subjects. An overall prevalence of MCI detected based on neuropsychological testing was 14.89% (95% CI: 12.19 to 17.95). Prevalence of the amnestic type was 6.04% (95% CI: 4.40 to 8.1) and that of the multiple domain type was 8.85% (95% CI: 6.81 to 11.32). Adjusted for age, education. and gender, the amnestic type was more common among men and the multiple domain type among women with advancement of age. Rates differed considerably with educational attainment. Hypertension and diabetes mellitus were the major risk factors for both types of MCI.

CONCLUSION

In this first community-based study of mild cognitive impairment (MCI) from India, prevalence of the amnestic type is comparable with and that of the multiple domain type is less than the prevalence in developed countries. Variations in age, education, and gender specific prevalence of MCI of both types were encountered. The putative risk factors identified merit further study.

The Surgical Management of Aortic Root Vessel Anomalies Presenting in Adults

Anomalies of the aortic root vessels may present in adults and are common incidental findings during standard vascular imaging. Knowledge of their presentation and management is important for surgeons dealing with vascular pathology within these anomalous vessels. A comprehensive literature search was conducted and a review of the current opinion performed on the embryology, clinical features, and surgical treatment of aortic root vessel anomalies, with particular emphasis on their management in adults. A classification system for aortic arch anomalies based on arch configuration is presented: (1) double aortic arch, (2) right aortic arch, (3) left aortic arch with abnormal branching, and (4) interrupted aortic arch. Anomalies of the aortic root vessels may be classified based on their presence or absence, their anomalous size or course, or their atypical origin, bifurcation, or subsequent branching pattern. A symptomatic aberrant right subclavian artery may be encountered by vascular surgeons, and a right supraclavicular approach would appear the most appropriate method of repair. Knowledge of aortic arch and root vessel anomalies is important for any clinician dealing with cardiothoracic, head and neck, or intracranial pathology. Vascular surgeons may encounter these anomalies during routine practice and may need to deal with their clinical sequelae.

Food cravings and energy regulation: the characteristics of craved foods and their relationship with eating behaviors and weight change during 6 months of dietary energy restriction

OBJECTIVE

To examine characteristics of craved foods in relation to dietary energy restriction (ER) with high (HG) and low glycemic load (LG) diets.

DESIGN

Assessments of food cravings before and during a randomized controlled trial of HG and LG diets provided for 6 months.

SUBJECTS

Thirty-two healthy, overweight women aged 20-42 years.

MEASUREMENTS

Self-reported food cravings and dietary intake, body weight, weight history and measures of eating behaviors.

RESULTS

Foods craved at baseline were more than twice as high in energy density as the habitual diet (3.7+/-1.5 vs 1.7+/-0.3 kcal/g; P<0.001), and on average were lower in protein (P<0.001) and fiber (P<0.001) and higher in fat (P=0.002). There were no statistically significant changes in nutritional characteristics of craved foods after 6 months of ER. There was a significant relationship between reported portion size of craved food consumed at baseline and lifetime high body mass index (r=0.49, P=0.005). Additionally, there was a significant association between susceptibility to hunger and craving frequency at baseline, and there were significant relationships between hunger score, craving frequency, strength and percentage of time that cravings are given in to after 6 months of ER. In multiple regression models, subjects who lost a greater percentage of weight craved higher energy-dense foods at month 6 of ER, but also reported giving in to food cravings less frequently (adjusted R (2)=0.31, P=0.009).

CONCLUSION

High energy density and fat content, and low protein and fiber contents were identifying characteristics of craved foods. The relationships between craving variables and hunger score suggest that the relative influence of hunger susceptibility on cravings may be important before and especially after ER. Portion size of craved foods and frequency of giving in to food cravings appear to be important areas for focus in lifestyle modification programs for long-term weight loss.

Accident due to release of hydrogen sulphide in a manufacturing process of cobalt sulphide - case study

An accident occurs during the manufacture of cobalt sulphide unit due to liberation of hydrogen sulphide. Problems associated with the hydrogen sulphide and the recommended preventive measures have been discussed.

Adsorption of nickel on husk of Lathyrus sativus: Behavior and binding mechanism

Husk of Lathyrus sativus (HLS) has been found to be a good sorbent for the removal of nickel(II) from its aqueous solution. The adsorption process depends on pH of the solution with an optimum at 5.0, and follows Langmuir isotherm model (correlation coefficient 0.998). Initial adsorption rate is very fast and reaches equilibrium following pseudo-second order kinetics within 60 min. Amino, carboxyl, hydroxyl and phosphate groups of the biomass are involved in chemical interaction with nickel ions as revealed from SEM-EDX and FTIR studies. Chemical modifications of the functional groups of the biosorbent show that amino groups contribute largely (approximately 57%) for the binding of nickel ions and probably undergo chelation through dative bond formation. HLS biomass has been found to adsorb both nickel and cadmium equally from their mixed solution to the extent of approximately 70% indicating the importance of this sorbent in industrial effluent treatment.

Characterization of cytotoxin-producing Aeromonas caviae (strain HT10) isolated from a sulfur spring in Orissa, India

During a study of microbial diversity, a bacterial strain designated HT10, was isolated from sediment collected from an unexplored sulfur spring at Athamallik, Orissa, India. Various biochemical tests and 16S rDNA sequence analysis revealed that strain HT10 is Aeromonas caviae. The growth temperature of this strain ranged from 12 to 43 degrees C and the optimum temperature was 30 degrees C. The strain HT10 showed cytotoxic and alpha-hemolytic activity. This is the first report on the isolation of Aeromonas caviae from sulfur spring.

Genotypic characterisation of Indian cattle, buffalo and sheep isolates of Echinococcus granulosus

Twelve isolates of Echinococcus granulosus, collected from domestic animals, including cattle, buffalo and sheep were analysed for DNA nucleotide sequence variation within mitochondrial cytochrome c oxidase I (coxI), NADH dehydrogenase subunit I (nadI) and internal transcribed spacer gene I (ITS1). After analysis of sequence information this was found that the fragment size of ITS1 of buffalo isolate was more in comparison to cattle and sheep isolates. Based on the nadI genotype this was found that Indian cattle, buffalo and sheep isolates could be grouped into E. granulosus sensu stricto. Based on coxI genotype two sheep isolates and one buffalo isolate were homologous to G2 genotype. Rests of the isolates were microvariants of G2 genotype. Presence of G2 genotype in buffalo is the first report of this genotype from this host.

Chlorine emission during the chlorination of water--case study

This paper deals with the incident of the excessive use of chlorine and leakage of unused chlorine from an industrial chlorination cistern and the lesson learned.

Kikuchi's disease: an important cause of cervical lymphadenopathy

Kikuchi's disease is a form of necrotising lymphadenitis typically presenting in young women with lymphadenopathy. A case of Kikuchi's disease is reported in order to highlight the diagnostic confusion that is often associated with the condition. The possibility of the disease should be taken into account in any patient presenting with unexplained lymphadenopathy, and consideration of the diagnosis is particularly important before the introduction of potentially inappropriate drug therapy.

A polyherbal vaginal pessary with spermicidal and antimicrobial action: evaluation of its safety

A polyherbal vaginal pessary (Praneem) has been formulated that has antimicrobial properties against genital pathogens in addition to spermicidal action. Thus, it has dual potential as a barrier method for contraception and for providing protection against some sexually transmitted infections. The present study reports the findings of a multicentre trial that was conducted to evaluate the safety of this product. Trials were carried out in 23 women in three centres in India: the Postgraduate Institute of Medical Education and Research, Chandigarh; Safdarjang Hospital, New Delhi; and Kamla Nehru Memorial Hospital, Allahabad. Thorough clinical and pelvic examinations were carried out as well as cervical cytology, blood biochemistry and haematology before and after use of the polyherbal pessary intravaginally once daily for 7 consecutive days. No toxicity was observed on clinical examination or by laboratory investigations. Daily intravaginal use of this pessary for 7 days had no adverse effects on cervical cytology or on metabolic and organ functions.

Subcortical white matter abnormalities related to drug resistance in Wilson disease

Wilson disease (WD) produces typical lesions in the brain, which can aid in diagnosis and therapy. The authors present a drug-resistant WD case with atypical cerebral lesions with marked involvement of white matter as visualized on MRI scans. The diagnosis was confirmed by identification of mutations in the ATP7B gene. The case demonstrates an uncommon pathology-related cerebral copper accumulation and emphasizes the importance of genetic screening in the diagnosis of WD.