Hungry for tobacco: an analysis of the economic impact of tobacco consumption on the poor in Bangladesh

OBJECTIVE

To investigate the extent of tobacco expenditures in Bangladesh and to compare those costs with potential investment in food and other essential items.

DESIGN

Review of available statistics and calculations based thereon.

RESULTS

Expenditure on tobacco, particularly cigarettes, represents a major burden for impoverished Bangladeshis. The poorest (household income of less than $24/month) are twice as likely to smoke as the wealthiest (household income of more than $118/month). Average male cigarette smokers spend more than twice as much on cigarettes as per capita expenditure on clothing, housing, health and education combined. The typical poor smoker could easily add over 500 calories to the diet of one or two children with his or her daily tobacco expenditure. An estimated 10.5 million people currently malnourished could have an adequate diet if money on tobacco were spent on food instead. The lives of 350 children could be saved each day.

CONCLUSION

Tobacco expenditures exacerbate the effects of poverty and cause significant deterioration in living standards among the poor. This aspect of tobacco use has been largely neglected by those working in poverty and tobacco control. Strong tobacco control measures could have immediate impact on the health of the poor by decreasing tobacco expenditures and thus significantly increasing the resources of the poor. Addressing the issue of tobacco and poverty together could make tobacco control a higher priority for poor countries.

Randomized controlled study of laparoscopic total extraperitoneal versus open Lichtenstein inguinal hernia repair

BACKGROUND

Whereas open anterior inguinal herniorrhaphy is a time-tested, safe, and well-understood operation with a high success rate, laparoscopic techniques of inguinal hernia repair are fairly recent. Consequently, short- and long-term outcomes are still being evaluated. Few studies have compared laparoscopic extraperitoneal inguinal hernia repair with tension-free open hernia repair. The current study was conducted to compare complications, operative time, postoperative pain, length of hospital stay, and return to work between open tension-free mesh Lichtenstein (open) repair and laparoscopic total extraperitoneal (TEP) repair.

METHODS

In a prospective randomized study, open hernia repair was performed in one group (n = 25), and TEP repair using a large mesh was performed in another (n = 25). Then intraoperative and postoperative complications and results were compared.

RESULTS

The mean operative time in the TEP group was 75.72 +/- 31.6 min, which was significantly longer than the mean operative time in the open group (54 +/- 15) min (p <0.001). The mean pain scores in the TEP group were 2.64 +/- 1.4 at 12 h and 1.76 +/- 1.4 at 24 h. These scores were significantly lower than the corresponding scores of 3.52 +/- 1.7 (p <0.04) and 2.74 +/- 1.5 (p <0.01) in the open repair group. The mean postoperative analgesic dose was 2.6 +/- 2.3 in the TEP group, which was significantly lower than in the open group 5.76 +/- 3.5 (p <0.001). There was no major complication in either group. The time until return to work was significantly lower in the TEP group (12.8 +/- 7.1) days versus 19.3 +/- 4.3 days; than in the open group (p <0.001). In terms of cosmetics, all 25 patients (100%) in TEP group rated themselves as "highly satisfied," as compared with 7 patients (28%) in the open group (p <0.001). After a mean follow-up period of 13 months (range, 9-18 months), no recurrence was seen in either of the two groups.

CONCLUSION

In terms of complications and short-term recurrence, TEP repair is comparable with open repair. Moreover, TEP is significantly less painful in the early postoperative period, leading to earlier ambulation than open repair. Additionally, TEP results in significantly earlier return to work and better cosmetic results. Currently, TEP seems to be a better alternative than the existing open repair, provided the long-term recurrence rates are comparable. Despite the fact that TEP was a new procedure for the surgeon and the study was conducted during the learning phase, the results are comparable with those in the world literature.

Early and long-term results of subclavian angioplasty in aortoarteritis (Takayasu disease): comparison with atherosclerosis

PURPOSE

To compare the early and long-term outcomes of subclavian artery angioplasty in patients with aortoarteritis and atherosclerosis.

METHODS

Sixty-one subclavian artery angioplasties were performed in 55 consecutive patients with aortoarteritis (n = 32) and atherosclerosis (n = 23) between 1986 and 1995. An arch aortogram followed by a selective subclavian artery angiogram was done to profile the site and extent of the lesion, its relation to the vertebral artery, and the distal circulation. Percutaneous transluminal angioplasty (PTA) was performed via the femoral route for 56 stenotic lesions and 5 total occlusions.

RESULTS

PTA was successful in 52 (92.8%) stenotic lesions and 3 (60%) total occlusions. Three patients (5.4%) had complications, that could be effectively managed nonsurgically. Compared with atherosclerosis, patients with aortoarteritis were younger (27.4 +/- 9.3 years vs 54.5 +/- 10.5 years; p < 0.001), more often female (75% vs 17.4%; p < 0.001), gangrene was uncommon (0% vs 17.4%; p < 0.05), and diffuse involvement was seen more often (43.8% vs 4.4%; p < 0.001). The luminal diameter stenoses were similar before PTA (88.6 +/- 9.7% vs 89.0 +/- 9.1%; p = NS). Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9 +/- 4.6 ATM vs 5.5 +/- 1.0 ATM; p < 0.001). This group had more residual stenosis (15.5 +/- 12.4% vs 8.3 +/- 9.4%; p < 0.05) after PTA. There were no neurological sequelae, even in PTA of prevertebral lesions. On 3-120 months (mean 43.3 +/- 28.9 months) follow-up of 40 patients, restenosis was more often observed in patients with aortoarteritis, particularly in those with diffuse arterial narrowing. These lesions could be effectively redilated. Clinical symptoms showed marked improvement after successful angioplasty.

CONCLUSION

Subclavian PTA is safe and can be performed as effectively in aortoarteritis as in atherosclerosis, with good long-term results. Long-term follow-up shows that it provides good symptomatic relief.

Behavioral profiling as a translational approach in an animal model of posttraumatic stress disorder

Diagnosis of psychiatric disorders in humans is based on comparing individuals to the normal population. However, many animal models analyze averaged group effects, thus compromising their translational power. This discrepancy is particularly relevant in posttraumatic stress disorder (PTSD), where only a minority develop the disorder following a traumatic experience. In our PTSD rat model, we utilize a novel behavioral profiling approach that allows the classification of affected and unaffected individuals in a trauma-exposed population. Rats were exposed to underwater trauma (UWT) and four weeks later their individual performances in the open field and elevated plus maze were compared to those of the control group, allowing the identification of affected and resilient UWT-exposed rats. Behavioral profiling revealed that only a subset of the UWT-exposed rats developed long-lasting behavioral symptoms. The proportion of affected rats was further enhanced by pre-exposure to juvenile stress, a well-described risk factor of PTSD. For a biochemical proof of concept we analyzed the expression levels of the GABAA receptor subunits α1 and α2 in the ventral, dorsal hippocampus and basolateral amygdala. Increased expression, mainly of α1, was observed in ventral but not dorsal hippocampus of exposed animals, which would traditionally be interpreted as being associated with the exposure-resultant psychopathology. However, behavioral profiling revealed that this increased expression was confined to exposed-unaffected individuals, suggesting a resilience-associated expression regulation. The results provide evidence for the importance of employing behavioral profiling in animal models of PTSD, in order to better understand the neural basis of stress vulnerability and resilience.

Hip fracture patients in India have vitamin D deficiency and secondary hyperparathyroidism

SUMMARY

This study evaluated the parameters of bone mineral homeostasis including 25(OH)D and PTH in 90 Indian patients with hip fracture and 90 controls. Hypovitaminosis D, secondary hyperparathyroidism, and biochemical osteomalacia was present in 77, 69, and 50 % patients, respectively, significantly higher compared to controls. Vitamin D deficiency is an important risk factor for hip fracture.

INTRODUCTION

The prevalence of vitamin D deficiency is not well known in hip fracture patients from India. Therefore, the present study was conducted to evaluate the parameters of bone mineral homeostasis including 25(OH)D and intact PTH in hip fracture from North India.

METHODS

Ninety consecutive patients with hip fracture and similar number of age- and sex-matched controls were enrolled in the study. The fasting venous samples were analyzed for 25-hydroxyvitamin D (25-OHD), intact parathyroid hormone (PTH), alkaline phosphatase (ALP), calcium, and phosphorus. Vitamin D deficiency was defined as serum 25-OHD of <20 ng/dl.

RESULTS

The mean age of hip fracture subjects was 65.9 ± 12.6 which was comparable in men and women. Majority of study subjects were women (70 women and 20 men). The serum 25(OH)D and calcium levels were significantly lower, whereas the intact PTH and ALP levels were significantly higher in patients compared to controls. There was significant negative correlation between serum 25(OH)D and PTH. In the hip fracture group, 76.7 % of the subjects had vitamin D deficiency, and 68.9 % had secondary hyperparathyroidism. In the control group, vitamin D deficiency and elevated PTH levels were seen in 32.3 and 42.2 %, respectively.

CONCLUSION

About three fourths of hip fracture patients have vitamin D deficiency, and two thirds have secondary hyperparathyroidism. Therefore, the serum 25-OHD level may be a useful index for the assessment of risk of hip fracture in India.

Dopamine promotes aggression in mice via ventral tegmental area to lateral septum projections

Septal-hypothalamic neuronal activity centrally mediates aggressive behavior and dopamine system hyperactivity is associated with elevated aggression. However, the causal role of dopamine in aggression and its target circuit mechanisms are largely unknown. To address this knowledge gap, we studied the modulatory role of the population- and projection-specific dopamine function in a murine model of aggressive behavior. We find that terminal activity of ventral tegmental area (VTA) dopaminergic neurons selectively projecting to the lateral septum (LS) is sufficient for promoting aggression and necessary for establishing baseline aggression. Within the LS, dopamine acts on D2-receptors to inhibit GABAergic neurons, and septal D2-signaling is necessary for VTA dopaminergic activity to promote aggression. Collectively, our data reveal a powerful modulatory influence of dopaminergic synaptic input on LS function and aggression, effectively linking the clinically pertinent hyper-dopaminergic model of aggression with the classic septal-hypothalamic aggression axis.

Multiphasic denaturation of the lambda repressor by urea and its implications for the repressor structure

Urea denaturation of the lambda repressor has been studied by fluorescence and circular dichroic spectroscopies. Three phases of denaturation could be detected which we have assigned to part of the C-terminal domain, N-terminal domain and subunit dissociation coupled with further denaturation of the rest of the C-terminal domain at increasing urea concentrations. Acrylamide quenching suggests that at least one of the three tryptophan residues of the lambda repressor is in a different environment and its emission maximum is considerably blue-shifted. The transition in low urea concentration (midpoint approximately 2 M) affects the environment of this tryptophan residue, which is located in the C-terminal domain. Removal of the hinge and the N-terminal domain shifts this transition towards even lower urea concentrations, indicating the presence of interaction between hinge on N-terminal and C-terminal domains in the intact repressor.

GABAergic Synapses at the Axon Initial Segment of Basolateral Amygdala Projection Neurons Modulate Fear Extinction

Inhibitory synaptic transmission in the amygdala has a pivotal role in fear learning and its extinction. However, the local circuits formed by GABAergic inhibitory interneurons within the amygdala and their detailed function in shaping these behaviors are not well understood. Here we used lentiviral-mediated knockdown of the cell adhesion molecule neurofascin in the basolateral amygdala (BLA) to specifically remove inhibitory synapses at the axon initial segment (AIS) of BLA projection neurons. Quantitative analysis of GABAergic synapse markers and measurement of miniature inhibitory postsynaptic currents in BLA projection neurons after neurofascin knockdown ex vivo confirmed the loss of GABAergic input. We then studied the impact of this manipulation on anxiety-like behavior and auditory cued fear conditioning and its extinction as BLA related behavioral paradigms, as well as on long-term potentiation (LTP) in the ventral subiculum-BLA pathway in vivo. BLA knockdown of neurofascin impaired ventral subiculum-BLA-LTP. While this manipulation did not affect anxiety-like behavior and fear memory acquisition and consolidation, it specifically impaired extinction. Our findings indicate that modification of inhibitory synapses at the AIS of BLA projection neurons is sufficient to selectively impair extinction behavior. A better understanding of the role of distinct GABAergic synapses may provide novel and more specific targets for therapeutic interventions in extinction-based therapies.

Near miss maternal morbidity and maternal mortality at Kathmandu Medical College Teaching Hospital

Background: Maternal mortality traditionally has been the indicator of maternal health all over the world. More recently review of the cases with near miss obstetric events has been found to be useful to investigate maternal mortality. Cases of near- miss are those in which women present with potentially fatal complication during pregnancy, delivery or the puerperium, and survives merely by chance or by good hospital care. Objectives: The objective of this study is to determine the prevalence and nature of near miss obstetric cases and maternal deaths at Kathmandu Medical College Teaching Hospital. Material and methods: This was a descriptive study done for the period of 24 months (1 January 2008 to 31 December 2009). Cases of severe obstetric morbidity were identified during daily morning meetings. All the cases were followed during their hospital stay till their discharge or death. Five factor scoring system was used to identify the near miss cases from all the severe obstetric morbidity. For each case of maternal death, data were collected from records of maternal death audit. Results: During the study period, 1562 women delivered at the institution and 36 women were identified as near-miss obstetrical cases. The prevalence of near miss case in this study was 2.3%. Five maternal deaths occurred during this period, resulting in a ratio of maternal death of 324 maternal deaths per 100,000 live births. Of the five maternal deaths three were due to pregnancy complicated with hepatitis E infection, one each due to Eclampsia and amniotic fluid embolism. Fifteen cases of near miss were due to haemorrhage (41.66%) and hypertensive disorder of the pregnancy was the cause in 10 (27.77%). Dystocia was the cause in 1(2.77%) case and infections in 7(19.4%) cases. Rare causes like anaesthetic complications were the cause in one case and dilated cardiomyopathy was the cause in two cases. Conclusion: The major causes of near-miss cases were similar to the causes of maternal mortality of Nepal. Need for the development of an effective audit system for maternal care which includes both near-miss obstetric morbidity and mortality is felt. Key words: Near-miss obstetric morbidity; Maternal mortality; Five factor scoring system DOI: 10.3126/kumj.v8i2.3563 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 222-226

Mental health status of runaway adolescents

There are 47.22 million homeless and runaway adolescents roaming on the streets of our country (Voluntary Health Association of India - VHAI) of which one lakh are in Delhi.1 Very little is known about them, their needs or their experiences.

OBJECTIVE

(1). To assess the psychological problems amongst the runaway adolescent boys. (2). To determine possible risk factors.

METHODS

This study was cross-sectional in design and done at a child observation home for boys in Delhi. All runaway boys aged 10 to 16 years of age were included in the study. The study was conducted from 15th June to 15th July 2001. A comprehensive schedule consisting of five parts, viz identification data, hopelessness scale for children by Kazdin, Beck depression inventory, Psychological survey questionnaire and RUTTER-B2 scale were used to assess various mental health problems.

RESULTS

20.7% of children were found to have high hopelessness and 8% of children had depression. 2% of children revealed that they had attempted suicide at any point of time in life. Among children with high hopelessness, 3.2% had ever attempted suicide. 8.3% of the depressed children gave history of suicidal attempts. 38% of children gave history of physical abuse, 14.6% of sexual abuse and a large number reported substance abuse. 69.33% were found to have behavioral problems (i.e. scored above the recommended cut off score of 9). 81% of children had antisocial behavior, 7.8% were neurotic and 10.5% remained undifferentiated.

CONCLUSION

Runaway adolescents suffer from a wide array of mental health problems and there is a need for a broad based psychosocial intervention programme.

Awareness and perception about tuberculosis in the general population of Delhi

The present study was conducted to assess awareness and perception regarding tuberculosis among the general population of Delhi. A total of 1008 adults, selected by multistage stratified systematic sampling, were interviewed using a pre-tested proforma. The majority had heard about tuberculosis (99.1%) and most (89.2%) perceived it to be an infectious disease. The correct mode of transmission i.e. airborne (coughing/sneezing) was known to 71.8% study subjects. The majority (90.1%) knew cough as a symptom. Nearly all (98.2%) perceived Tuberculosis to be a preventable disease, citing the treatment of patients as the mainstay of preventing spread of the disease. However, responses like separation of utensils or hospitalisation of the patient to prevent the spread of the disease indicate persistence of stigma and discrimination in a small proportion of the population. There is a need to widen the scope and intensify the information and education being provided to the population based on gaps identified.

Cross-Modal Reinstatement of Thalamocortical Plasticity Accelerates Ocular Dominance Plasticity in Adult Mice

Plasticity of thalamocortical (TC) synapses is robust during early development and becomes limited in the adult brain. We previously reported that a short duration of deafening strengthens TC synapses in the primary visual cortex (V1) of adult mice. Here, we demonstrate that deafening restores NMDA receptor (NMDAR)-dependent long-term potentiation (LTP) of TC synapses onto principal neurons in V1 layer 4 (L4), which is accompanied by an increase in NMDAR function. In contrast, deafening did not recover long-term depression (LTD) at TC synapses. Potentiation of TC synapses by deafening is absent in parvalbumin-positive (PV+) interneurons, resulting in an increase in feedforward excitation to inhibition (E/I) ratio. Furthermore, we found that a brief duration of deafening adult mice recovers rapid ocular dominance plasticity (ODP) mainly by accelerating potentiation of the open-eye responses. Our results suggest that cross-modal sensory deprivation promotes adult cortical plasticity by specifically recovering TC-LTP and increasing the E/I ratio.

Plasticity of thalamocortical (TC) synapses is limited in adults. Rodríguez et al. demonstrate that a brief period of deafening adults recovers LTP at TC synapses in visual cortex and accelerates ocular dominance plasticity. These results suggest that cross-modal sensory deprivation may be an effective way to promote adult cortical plasticity.

Subcutaneous mycoses caused by Rhytidhysteron species in an immunocompetent patient

Subcutaneous mycoses are chronic fungal infections of the skin and subcutaneous tissues caused by variety of fungal agents and usually occur following trauma with vegetative matter. We report a case of subcutaneous mycoses caused by rare fungus belonging to the genus Rhytidhysteron, in an immunocompetent male who presented with a subcutaneous nodule on left foot. This unusual species was identified and confirmed by molecular methods.

Effect of Some Non Functional Surfactants and Electrolytes on the Hexavalent Chromium Reduction by Glycerol: A Mechanistic Study

Hexavalent chromium is a widespread environmental contaminant and a known human carcinogen. Kinetics of reduction of hexavalent chromium by bio-molecule glycerol in micellar media have been studied spectrophotometrically. The cytoplasmic reduction of hexavalent chromium to trivalent chromium occurs in micro-heterogeneous systems. In vitro, the micelles are considered to mimic the cellular membranes. The electron transfer processes occurring in the micellar systems is considered as model to obtain insight into the electron transport process prevailing in biological systems. Micellar media is also a probe to establish the mechanistic paths of reduction of hexavalent chromium to trivalent chromium. Effects of electrolytes common to biological system are studied to establish the proposed reaction mechanism strongly.

Coenzyme Q10 ameliorates cadmium induced reproductive toxicity in male rats

This study aimed at investigating the protective role of CoQ10 against cadmium (Cd)-induced reproductive toxicity in male rats. Adult male Wistar rats were exposed to an acute dose of Cd (25 mg/kg bwt; Cd group), Cd+CoQ10 (25 mg/kg bwt Cd+10 mg CoQ10; Cd-Q10 group) and distilled water (control) in vivo for 15 consecutive days and semen quality was assessed. A significant reduction was noted in sperm concentration, progressive motility, morphology and DNA integrity in both Cd- and Cd-Q10 groups in comparison to control indicating Cd-induced testicular lipid per oxidation (LPO) and decline in indigenous antioxidant defense system as measured by total antioxidant capacity (TAC) (p<0.05). However, simultaneous co-administration of CoQ10 along with Cd (Cd-Q10 group) was able to improve sperm concentration, motility, progressive motility, morphology, DNA integrity, and testicular TAC as well as lower LPO compared to Cd group (p<0.05). Results indicate that used dose of CoQ10 is capable of moderately ameliorating reproductive toxicity of Cd by improving semen quality and reducing testicular oxidative stress.

Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis

Background:

Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed excreting system.

Aim:

To compare the result and advantages of both endonasal endoscopic and external DCR regarding the patency rate, patient compliance and complications.

Study Design:

Prospective non-randomized comparative study.

Materials and Methods:

Study was conducted for 16 months duration in a teaching hospital with 50 cases of endoscopic and 30 cases of external DCR with a follow-up of minimum 6 months. Data regarding surgical outcome and complications were analysed and compared using χ² test.

Results:

Total 72 patients were included in the study with six having bilateral involvement, out of which 20 were male and 52 were female. The mean age for endoscopic and external DCR was 33.6 years and 46.0 years, respectively. Right eye (63.8%) was involved more commonly than left eye (36.2%). Epiphora was the commonest presenting symptom (63.7%). Mean duration of surgery was much lengthier in external (mean 119.6 minutes) than endoscopic (mean 49.0 minutes) DCR. Bleeding was the most common immediate postoperative complication seen in 33.3% and 10.0% of external and endoscopic DCR cases, respectively. Primary surgical success rate was 90% and 96.7% for endoscopic and external DCR, respectively (P = 0.046). Among the endoscopic DCR group, four patients underwent revision surgery giving a total successful surgical outcome of 98% at third month of follow-up. However, at 6 month of follow-up, success rate was 92% for endoscopic DCR and 93.3% for external DCR. The difference was not statistically significant (P = 0.609).

Conclusion:

Intranasal endoscopic DCR is a simple, minimally invasive, day care procedure and had comparable result with conventional external DCR.

Involvement of extracellular signal-regulated kinase (ERK1/2)-p53-p21 axis in mediating neural stem/progenitor cell cycle arrest in co-morbid HIV-drug abuse exposure

Neurological complications in opioid abusing Human Immunodeficiency Virus-1 (HIV-1) patients suggest enhanced neurodegeneration as compared to non-drug abusing HIV-1 infected population. Neural precursor cells (NPCs), the multipotent cells of the mammalian brain, are susceptible to HIV-1 infection and as opiates also perturb their growth kinetics, detailed mechanistic studies for their co-morbid exposure are highly warranted. Using a well characterized in vitro model of human fetal brain-derived neural precursor cells, we investigated alterations in NPC properties at both acute and chronic durations. Chronic morphine and Tat treatment attenuated proliferation in NPCs, with cells stalled at G1-phase of the cell cycle. Furthermore HIV-Tat and morphine exposure increased activation of extracellular signal-regulated kinase-1/2 (ERK1/2), enhanced levels of p53 and p21, and decreased cyclin D1 and Akt levels in NPCs. Regulated by ERK1/2 and p53, p21 was found to be indispensible for Tat and morphine mediated cell cycle arrest. Our study elaborates on the cellular and molecular machinery in NPCs and provides significant mechanistic details into HIV-drug abuse co-morbidity that may have far reaching clinical consequences both in pediatric as well as adult neuroAIDS.

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium by a novel metal–organic complex

Selective picomolar level fluorometric sensing of the Cr(vi)-oxoanion in a water medium has been achieved by a novel metal–organic complex.