Stress, Autonomic Reactivity and Blood Pressure among Undergraduate Medical Students

INTRODUCTION: Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to find out the level of stress, hypertension and its etiological factors among undergraduate medical students. METHOD: One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve hypertensives selected from the above subjects and twenty normotensives underwent cold pressure test to assess autonomic reactivity to laboratory induced stress. RESULTS: 10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in both the hypertensive and normotensive group but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group. The diastolic and mean BP increased significantly on CPT in subjects having family history of hypertension. The subjects taking more of junk and oily foods had a higher systolic BP. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT. CONCLUSIONS: Adolescents must be routinely screened to detect asymptomatic hypertension. Advice on risk factor modification by appropriate lifestyle changes may prevent long term effects of hypertension on target organs. Keywords: autonomic reactivity, blood pressure,  cold pressor test, medical students, stress.

Detecting aerobic bacterial diversity in patients with diabetic foot wounds using ERIC-PCR: a preliminary communication

The polymicrobial nature of diabetic foot infection is a reflection of the immune compromised state of the host.The methods of microbial identification based on colony morphology and biochemical characteristics have limitations as they may not differentiate the diverse microorganisms that infect foot wounds. The aim of the present study was to find out the bacterial diversity in diabetic foot infections at genetic level by finger printing, that is, ERIC-PCR (enterobacterial repetitive intergenic consensus -polymerase chain reaction). Nine patients with infected diabetic foot ulcers were recruited to the study. Pus and tissue samples were collected from the wound site. Aerobic bacteria were isolated employing standard microbiological culture methods and their genetic variability was analyzed using the ERIC-PCR. Sensitivity test for these isolates against commonly used antibiotics were performed using disc diffusion method. The standard microbiological culture technique yielded 38 morphotypes of bacteria and their genetic diversity was confirmed by ERIC-PCR assay. Analysis of the similarity index using NTSYSpc 2.1 software revealed 34 types of banding pattern among these isolates. Based on the similarity index these isolates were divided into 7 groups. As many as 8 types of aerobic bacterial isolates were detected from a single patient using the above technique compared with 2 on routine culture analysis. Genetically diverse isolates showed differential sensitivity pattern against commonly used antibiotics in the assay. The observed diversity at genetic level is attributed to variable sensitivity pattern of these isolates against the class of antibiotics. A molecular technique such as ERIC-PCR is a more sensitive detection method than conventional techniques, the potential of which needs to be fully understood.

The use of E-test for the drug susceptibility testing of Mycobacterium tuberculosis - a solution or an illusion?

AIM

To evaluate E-test as a tool for rapid determination of drug susceptibility against the conventional LJ method focusing on reliability, expense, ease of standardization and performance of the technique in low resource settings.

MATERIALS AND METHODS

A total of 74 clinical isolates (2004-2005) of Mycobacterium tuberculosis were tested using E-test for susceptibility to streptomycin (STM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB) by E-strip and LJ (LJPM) proportion methods.

RESULTS

The LJPM method, the gold standard, detected resistance against STM in 16.2%, INH in 40.5%, RIF in 18.9% and EMB in 27% cases. In comparison, the resistance values showed by E-test was 66.67% for STM, 57.14% for INH 71.43% for RIF and 80% for EMB. The susceptible correlation was 90.32% for STM, 73.91% for INH, 93.33% for RIF and 59.26% for EMB. E-test correctly identified only eight of the 12 (66.6%) MDR isolates and wrongly identified four isolates which were not MDR. The overall agreement between the two methods was only 48.6%. Resistant isolates showed false positive resistance observed while using E-strip towards all the drugs.

CONCLUSION

E-strips are not quite feasible as a replacement for LJ-proportion method on a large scale due to high risk of cross contamination, laboratory infection, expense associated with it and high false positive resistance observed to all first line drugs. However, the good correlation observed for RIF between the two methods indicates that E-test could contribute to the role in rapid screening of MDR TB isolates as rifampicin mutations are invariably observed in MDR TB isolates.

Stress, autonomic reactivity and blood pressure among undergraduate medical students

INTRODUCTION

Medical training is highly stressful particularly for those who are beginning their medical education. The present study was undertaken to find out the level of stress, hypertension and its etiological factors among undergraduate medical students.

METHOD

One hundred and seventeen undergraduate medical students between 17-21 years of age got examined for blood pressure and stress level. Twelve hypertensives selected from the above subjects and twenty normotensives underwent cold pressure test to assess autonomic reactivity to laboratory induced stress.

RESULTS

10.25% of the subjects were found to be hypertensive and 6.83% pre hypertensive. On the stress scale 53% had mild stress, 7% showed moderate stress while none had stress as a major problem. There was no correlation between BP and stress score. On CPT, BP increased significantly in both the hypertensive and normotensive group but came back to basal levels within 5 minutes indicating normal autonomic response. Rise of BP was higher in hypertensive group. The diastolic and mean BP increased significantly on CPT in subjects having family history of hypertension. The subjects taking more of junk and oily foods had a higher systolic BP. Forty percent of normotensive subjects had more than 20 mm Hg rise in systolic BP on CPT.

CONCLUSIONS

Adolescents must be routinely screened to detect asymptomatic hypertension. Advice on risk factor modification by appropriate lifestyle changes may prevent long term effects of hypertension on target organs.

Metal recognition by in-vitro selection

We propose an in vitro selection strategy to identify bacteriophage variants that recognize metal ions in solution. In 6 M urea, phage T7 loses 99.9% of its activity in less than 5 min. Inactivation is accelerated by gold, but slowed by zinc and magnesium. Selection of phage over five generations in the presence of gold, zinc, and magnesium increases phage half-lives 4-, 10-, and 70-fold, respectively. As selections are repeated, phage become increasingly dependent on the specific metal employed in the selection, indicating the suitability of the strategy for optimization of metal-ion recognition.

Lack of genetic association of promoter and structural variants of mannan-binding lectin (MBL2) gene with susceptibility to generalized vitiligo

BACKGROUND

Vitiligo is a common depigmenting disorder resulting from the loss of functional melanocytes in the skin. It is hypothesized to be of autoimmune origin. Mannan-binding lectin (MBL) plays an important role in innate immunity. It helps in the clearance of apoptotic cells and in complement activation. Genetic variability due to structural and promoter polymorphisms in the MBL2 gene has been reported to be associated with increased risk for several autoimmune diseases including vitiligo.

OBJECTIVES

The aim of this study was to explore whether MBL2 structural and promoter polymorphisms are associated with generalized vitiligo in Gujarat where the prevalence of vitiligo is alarmingly high.

MATERIALS AND METHODS

We undertook a case-control study to investigate the association of MBL2 gene exon 1 polymorphisms - codon 52, codon 54 and codon 57 as well as promoter -221 polymorphism in 92 patients with generalized vitiligo and 94 unaffected age-matched controls by polymerase chain reaction-heteroduplex analysis.

RESULTS

The genotype and allele frequencies of MBL2 structural and promoter polymorphisms did not differ significantly between the control and patient population (P-values: P < 0.019 for codon 52, P < 0.373 for codon 54, P < 0.855 for codon 57 and P < 0.889 for -221 promoter polymorphisms) after Bonferroni's correction for multiple testing, which suggests that there is no association of MBL2 structural and promoter polymorphisms with generalized vitiligo.

CONCLUSIONS

Our results suggest that the well-documented structural and promoter polymorphisms of the MBL2 gene may not be associated with generalized vitiligo in the Gujarat population.

Cardiac botryomycosis: an autopsy report

Visceral botryomycosis is rare, and documented sites are lung, brain, kidney, liver and prostate. This report describes a rare autopsy case of disseminated visceral botryomycosis, with bulky, grape-like botryomycotic vegetations in the heart, and similar abscesses in the lungs and bone marrow. This is the first such report in the literature to the best of our knowledge.