D.R. Basannar

Adrenaline, Noradrenaline and Dopamine Level Estimation in Depression : Does it Help?

BACKGROUND Abnormalities of catecholaminergic function have been hypothesised in causation of depressive illness. Electroconvulsive therapy (ECT) is postulated to have noradrenergic mechanism of action. We studied the clinical utility of estimating catecholamines level changes after ECT. METHODS Plasma adrenaline, noradrenaline and dopamine in healthy controls and depressed patients were estimated by high performance liquid chromatography with electrochemical detection method before and after ECT. RESULT Mean ± standard deviation of plasma adrenaline, noradrenaline and dopamine in controls was 36.7 ± 13.2, 209.3 ± 76, 21.8 ± 9.5 ng/L respectively, while in depressed patients before and after ECT it was found to be 32.5 ± 12.0, 419.3 ± 167.7, 22.1 ± 16.0ng/ L and 37.2 ± 19.6, 386.1 ± 168.4, 22.3 ± 15.5ng/L respectively. Correlation of adrenaline, noradrenaline and dopamine concentration with scores of Beck Depression Inventory, Suicidal Ideation Scale and Melancholia Inventory was positive but statistically not significant and poor. Based on the cut off values of noradrenaline, only 62% cases could be categorized as abnormal, which after ECT reduced to 50%, whereas post ECT psychiatric ratings was normal in about 78% cases. CONCLUSION There is no clinical significance of estimating adrenaline, noradrenaline and dopamine in depressed patients.

Diagnostic Utility of Biomarkers in COPD

BACKGROUND: COPD will become the third leading cause of death by 2020. There are many situations in which spirometry, the primary tool for diagnosis of COPD, cannot be performed, and thus, the staging and status of these patients cannot be determined. To date, there is no known biochemical marker used for diagnosing COPD. This study aimed to explore the utility of biomarkers for diagnosis of COPD. METHODS: This was an observational study composed of 96 stable subjects with COPD and 96 subjects with normal lung function. Each group contained an equal number of smokers and nonsmokers. Serum levels of superoxide dismutase 3, glutathione peroxidase, catalase, ceruloplasmin ferroxidase activity, C-reactive protein, and surfactant protein D (SPD) were estimated. Ferroxidase activity was estimated by a kinetic method, whereas the other analytes were measured by enzyme-linked immunosorbent assay. The cutoff value, sensitivity and specificity at the cutoff value, and area under the curve for each analyte were determined from receiver operating characteristic curve. RESULTS: Significantly decreased superoxide dismutase 3 and increased ferroxidase activity, SPD, glutathione peroxidase, and C-reactive protein levels were found in subjects with COPD. For all subjects and nonsmoking subjects with COPD, the area under the curve was highest for ferroxidase activity, followed by glutathione peroxidase, SPD, and C-reactive protein, with a sensitivity and specificity of > 73%. For smoking subjects with COPD, the area under the curve was highest for SPD, followed by glutathione peroxidase, ferroxidase activity, and C-reactive protein, with a sensitivity and specificity > 67%. Some combinations of markers were found to give either a sensitivity or specificity of > 95%, which can be utilized to rule in and rule out COPD. CONCLUSIONS: Biomarkers can be reliably utilized in the diagnosis of COPD. Of all the markers, SPD appears to be the most promising in smokers, whereas ferroxidase activity shows promise in nonsmokers. To rule out COPD, ferroxidase activity or glutathione peroxidase can be potentially useful, whereas to rule in COPD, ferroxidase activity and glutathione peroxidase appear to be the most promising combination in both nonsmoking and smoking subjects.

Women empowerment and use of contraception

BACKGROUND Use of contraception is influenced by many processes most by the womens empowerment. Womens decision making power and their autonomy within the household is the most important factor affecting contraceptive use. This paper aims to analyze the relationship between these two indicators of womens empowerment and the use of contraception. METHODS This cross sectional study was conducted by personally interviewing 385 currently married women selected by systematic sampling on a pretested and validated questionnaire. Two indices, womens decision-making power index and womens autonomy index, were constructed and association with contraception use analyzed. RESULTS & CONCLUSION The study gives the evidence that decision making power is low in the respondents with 48.2% (95% CI 43.34, 53.31) of them having low level of power, while 27.6% (95% CI 23.24, 32.16) have medium level and 3.6% (95% CI 2.08, 5.88) having high level of power. 22.4% (95% CI 18.39, 26.70) of women do not have any autonomy as against 43.9% (95% CI 38.99, 48.89) with low level, 25% (95% CI 20.80, 29.44) with medium autonomy and 8.7% (95% CI 6.29, 11.98) scoring above 7 (high level of autonomy). In the study population it was found that 273 (70.7%, 95% CI 66.2, 75.28) of the respondents were using contraceptives. Womens autonomy, years of marriage and number of children were significant variables.

Interaction of media, sexual activity and academic achievement in adolescents.

BACKGROUND Adolescence is a period when the individual is vulnerable and exposure to sexually implicit/explicit programs on television and internet can influence their sexual behaviour and make them more permissive towards premarital sex, which is known to influence their academic performance. This can be modified by parental discussion on these matters with their children. There have been only few studies from India that have explored such issues therefore this study aimed to explore the impact of television, internet and parental discussion on sexual activity and academic performance. METHODS This study was conducted in two co-education schools using a self reporting questionnaire administered to students of class IX-XII. This study evaluated the relation of academic performance, exposure to media such as television & internet to sexual activity & academic performance of the students and the role of parental discussion on these. RESULTS The study sample size was 586. There is no significant association between the number of hours of watching television per day and academic performance as measured by marks in examinations. Significant positive association was found among boys between sexual contact and average score in academics & unsupervised use of internet. In both genders a significant positive association was found between those watching English serials, movies and increased chances of indulging in sexual activity while a negative relation with those watching Cartoons. There is no significant difference in occurrence of sexual contact in those who discussed sexual matters with parents and those who did not. CONCLUSION This being first of its kind of study from India and a cross sectional study, further prospective and detailed studies are warranted to delineate the interaction of media, parental discussion, academic performance and sexual activity.

Study of blood pressure profile of school children 6–15 years in a rural setting of Maharashtra

BACKGROUND High blood pressure in childhood is a major risk factor for heart disease and stroke in adulthood. There is enough evidence to suggest that the roots of essential hypertension in adults extend into childhood. There is a paucity of literature on the blood pressure measurements amongst children. This study was done to study blood pressure profile of school children in rural area of Maharashtra. AIM & OBJECTIVES This cross sectional study was carried out to determine the prevalence of hypertension in children 6-15 years and to study the association between selected variables and blood pressure. MATERIAL & METHODS This study was done using a predesigned questionnaire and making measurements of height, BMI and Blood pressure using standardized physical instruments following standard guidelines. The data was collected and analyzed using appropriate statistical tests. RESULTS The prevalence of hypertension in the study was found to be 4.4% with 3.5% in females and 5.1% in males. CONCLUSION In the study, hypertension in students was found to be significantly associated with higher BMI and with family history of hypertension. Age, height and BMI were found to correlate positively with Blood pressure levels in this study.

Emotional intelligence scale for medical students

Background: Emotional Intelligence has been associated with positive outcome process in varied professions. There is paucity of Indian literature on the subject; especially involving medical undergraduates; and presently there is no scale available to measure the same in the Indian scenario. Objective: To develop a scale to measure Emotional Intelligence among medical undergraduates. Materials and Methods: Four domains of Emotional intelligence were selected, viz. Self-Awareness, Self-Management, Social-Awareness & Social-Skills and these were included for the purpose of domains of the scale. On the basis of focused group discussions and in-depth deliberations with experts, undergraduate and postgraduate medical students a pool of 50 items was generated. The items were reduced to 27 based on expert consensus and on the basis of frequency of endorsement by expert reviews. It was followed by a pilot study of 50 undergraduates. This completed the preparation of the preliminary draft based on content analysis. The questionnaire was then administered in 480 students and the data was analyzed by appropriate statistical methods. For the purpose of concurrent validity, emotional intelligence scale developed by Dr. Ekta was used. Results: The Cronbachs Alpha for Internal Consistency Reliability was 0.68. The EIS had a significant correlation with social awareness domain of Emotional Intelligence Test (EIT) establishing Concurrent Validity. Conclusion: Emotional Intelligence Scale for medical undergraduates was constructed. Reliability and concurrent validity were also established for the same.

Biomarkers of malignant ascites—a myth or reality

BACKGROUND Ascitic fluid aspirate cytology, although reasonably specific is not a good screening tool for malignant ascites due to poor sensitivity. Simple test(s) on ascitic fluid or serum which can help differentiate between benign and malignant causes of ascites will be a boon. Ascitic fluid lactate dehydrogenase, cholesterol, and ferritin are the candidate markers evaluated in this study. METHODS Ascitic fluid cytology was done on 30 patients of malignant ascites. The modalities used for diagnosing malignant ascites were positive peritoneal biopsy or CT scan evidence of hepatic metastases. Ascitic fluid biochemistry was done in all these 30 patients as well as 30 cases of non-malignant ascites. The parameters analysed were cholesterol, lactate dehydrogenase, and ferritin. The biochemical parameters were estimated in serum as well. RESULTS Cytology had a sensitivity of 40% for the diagnosis of malignant ascites. Ascitic fluid cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 70%, 74%, and 100%, respectively. Serum cholesterol, lactate dehydrogenase, and ferritin had sensitivities of 57%, and 91%, respectively. CONCLUSION Hence, these biochemical markers in ascitic fluid as well as serum can be good screening tools for the diagnosis of malignant ascites.

Predictors of first line antiretroviral therapy failure and burden of second line antiretroviral therapy

BACKGROUND As HIV steps into the third decade, there are more number of patients living on lifelong (antiretroviral therapy) ART and facing the threat of drug resistance with subsequent treatment failure. The aim of this study was to determine predictors of first-line ART failure with the objectives to estimate the burden of 2nd line ART. METHODS A retrospective 5-year cohort of HIV patients who were initiated on first line ART in 2008-09 was studied. Patients were followed from the time of ART initiation. Kaplan-Meier methods and Cox proportional hazards regression models were used to estimate probabilities and predictors of first line ART failure. RESULTS Of the total of 195 patients initiated on first line ART, 15 patients were switched to second line ART yielding 7.69% failure rate. During the 7178 person-years of follow-up, the incidence of first line ART failure was 2.09 per 1000 person-years. The Kaplan-Meier survival analysis gave a mean survival time of 55.6 months. BMI, CD4 count at ART initiation and presence of opportunistic infections were significant predictors of first line ART failure. The burden of second line ART patients by the end of 5 years of first line ART is expected to be 151 patients. CONCLUSION Though the first line ART failure is quite low in this study, we still need to be vigilant for lower BMI, low baseline CD4 count and occurrence of opportunistic infections to efficiently manage failures on first line ART.

Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune

BACKGROUND Resistance to antimicrobial agents is emerging in wide variety of nosocomial and community acquired pathogens. Widespread and often inappropriate use of broad spectrum antimicrobial agents is recognized as a significant contributing factor to the development and spread of bacterial resistance. This study was conducted to gain insight into the prevalent antimicrobial prescribing practices, and antimicrobial resistance pattern in nosocomial pathogens at a tertiary care hospital in Pune, India. METHODS Series of one day cross sectional point prevalence surveys were carried out on four days between March and August 2014. All eligible in patients were included in the study. A structured data entry form was used to collect the data for each patient. Relevant samples were collected for microbiological examination from all the clinically identified hospital acquired infection cases. RESULTS 41.73% of the eligible patients (95% CI: 39.52-43.97) had been prescribed at least one antimicrobial during their stay in the hospital. Beta-lactams (38%) were the most prescribed antimicrobials, followed by Protein synthesis inhibitors (24%). Majority of the organisms isolated from Hospital acquired infection (HAI cases) were found to be resistant to the commonly used antimicrobials viz: Cefotaxime, Ceftriaxone, Amikacin, Gentamicin and Monobactams. CONCLUSION There is need to have regular antimicrobial susceptibility surveillance and dissemination of this information to the clinicians. In addition, emphasis on the rational use of antimicrobials, antimicrobial rotation and strict adherence to the standard treatment guidelines is very essential.

Profile of HIV patients on second line antiretroviral therapy: the Indian experience.

Background: The proportion of patients on second line in resource limited settings are estimated between 1-5%. The present study describes the profile and outcomes of Indian patients receiving second line ART. Methods: Information on HIV patients on second line ART was gathered. Socio demographic data, probable transmission route, baseline clinical parameters and comorbidities during therapy are studied along with first-line ART regimen initially introduced, its adherence and the reason for switch and components of the second-line ART regimen. Results: Out of the total 2174 HIV patients 53% were on first line ART and of these 51 patients on second line ART were studied. The average time of initiation of first line ART was 17.67 months with median of 2 months whereas switch to second line ART was in 53.75 months with median of 60 months. Almost 71% of the patients on second line ART had been diagnosed with HIV infection with low CD4 count of <200. However 54%, 67% and 58% patients show more than 50% rise in their CD4 count post switch to second line after 3, 6 and 12 months of treatment which is a substantial improvement. Twenty-five per cent of patients showed non adherence. Tenofovir based regimens had a slight advantage with lesser number of side effects being reported. Conclusion: Early diagnoses of infection, early initiation of ART and drug adherence are the cornerstones for success in managing HIV patients. Understanding the profile and drug resistance pattern is necessary for ensuring effective and long term survival.