Parama Sengupta

Pesticide use pattern among farmers in a rural district of West Bengal, India.

Background: A vast majority of Indian population are engaged in agriculture. While pesticides help in increasing crop production, inappropriate pesticide storage practice and inadequate protective measures frequently causes accidental poisoning among farmers. Objective: The present study was conducted to explore the pattern of pesticide use among farmers in a district of India with an attempt to identify the lacunae in their knowledge and awareness level on risks and hazards of pesticides use. Materials and Methods: A cross-sectional questionnaire based study was conducted in the district of Burdwan, West Bengal, to address the study objective. Data analysis was performed by using descriptive statistical methods: Frequency, percentage, mean, standard deviation. Results: In the present study alpha-cypermethrin (46%) was the most commonly used pesticide followed by methyl parathion (25.6%), imidacloprid (16.4%), dichlorvos (7.8%) and phorate (4.2%). The farmers used to store pesticides mostly in cowshed (48.4%) followed by storeroom (29.6%). During spraying of pesticides, farmers experienced headache (29.8%) followed by nausea (26%), burning sensation in eyes (9.8%), cough (9.2%), muscle cramps (2%). Regarding the personal protective measures taken by the farmers for spraying, covering nose, mouth with cloth combined with bath after spraying was the most common practice (27%). When asked about suggested actions to be taken if anybody becomes sick following exposure to pesticides, 86% of farmers prefer consulting a doctor. Conclusion: The study suggested that farmers of Burdwan were exposed to highly hazardous, restricted and banned pesticides, with insufficient protection. In this situation, educational and training interventions on pesticide handling and safety precautions are urgently needed.

Efficacy and safety of add on therapy of bromocriptine with metformin in Indian patients with type 2 diabetes mellitus: A randomized open labeled phase IV clinical trial

Objective: To compare the effectiveness and safety of add on therapy of bromocriptine with metformin in type 2 diabetes mellitus (DM) patients. Material and Methods: Adult type 2 DM patients fulfilling the inclusion criteria were randomized in three groups. Group A received metformin (1000 mg/ day), while group B patients were treated with metformin (1000 mg/day) plus bromocriptine (0.8 mg/day) and group C received metformin (1000 mg/day) plus bromocriptine (1.6 mg/day) for 12 weeks. Fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), and body weight were measured at week 4, 8, and 12 visits and glycosylated hemoglobin (HbA1C) at week 12 visit. Results: Metformin alone and in combination with bromocriptine in escalating dose (0.8 mg/day and 1.6 mg/day) significantly (P < 0.05) decreased FPG and PPPG levels at weeks 4, 8, and 12 compared with pretreatment values. HbA1C level in all three treatment groups significantly (P < 0.05) decreased at week 12 as compared with pretreatment baseline value. HbA1C level in groups B and C significantly (P < 0.05) decreased as compared with group A at week 12. Addition of bromocriptine to metformin also significantly (P < 0.05) decreased FPG and PPPG levels in a dose-dependent manner as compared with metformin alone. Intergroup analysis did not show any statistically significant change in weight of study subjects at different intervals. Conclusion: The combination of bromocriptine with metformin significantly decreased FPG, PPPG, and HbA1C compared with metformin alone in type 2 DM patients in a dose-dependent manner.

Isolated plexiform neurofibroma of the tongue.

Neurofibromas (NF) are benign tumors of neural origin, of which roughly 90% appear as solitary lesions. They are classified into cutaneous, subcutaneous, and plexiform subtypes. Plexiform neurofibromas are the least common variant and usually are pathognomonic for NF I. Here, we present a very rare case of isolated plexiform neurofibroma with a painless enlarging mass of the tongue of an 11-year-old girl. This rare benign tumor has the potential for malignant transformation, and the diagnosis was difficult owing to the patients age and to the insidious clinical presentation. The present case is a diffuse isolated plexiform neurofibroma of the tongue that was not associated with neurofibromatosis that was treated with intraoral surgery.

Nitroimidazole derivative-induced fixed drug eruptions: Not so uncommon

Sir, Adverse reactions to medications are common and often manifest as a cutaneous eruptions. The term fixed drug eruptions (FDE) describes the development of one or more annular or oval erythematous patches as a result of systemic exposure to a drug recurring at the same site with repeated exposure to the same drug or others of similar group, with or without residual hyperpigmentation. Most studies report FDEs to be the second or third most common skin manifestations.[1] The actual frequency may be higher than current estimates, owing to the availability of a variety of nutritional supplements that are also known to elicit FDEs. In this case series, out of ten cutaneous ADR cases, eight patients were suffering from FDEs of which five were due to nitroimidazole derivatives which were documented within a short span of one and half months, that is 12 OPD days. The suspected offending nitroimidazole derivatives were metronidazole (three cases), tinidazole (one case), and ornidazole (one case). Most of them (three cases out of 5 i.e., 60%) developed FDEs within an average of 2 days. Oral mucosal ulceration along with lip involvement was the most (three cases, i.e., 60%) common manifestation, but in two (40%) occasions blisters over the dorsum of foot [Figure 1] and glans penis were also evident along with oral lesions. The patients were treated by the dermatologists with withdrawal of the suspected agent, with or without systematic antibiotic, oral antihistaminic agents and antiseptic mouth wash in relevant cases. Most of the lesions (three cases i.e., 60%) healed with residual pigmentation (in two of the cases there was no residual pigmentation). Only two patients gave history of the occurrence of similar lesion previously following exposure to drug (probably metronidazole). Unfortunately, no supporting documentation was found. The patients were counselled regarding avoidance of the suspected drug. These were clearly mentioned in the OPD case sheets for future reference. Figure 1 FDE over dorsum of left foot healed with residual pigmentation after withdrawal of the drug Causality assessment as per Naranjos algorithm[2] showed probable ADR score within 5 to 8, whereas severity assessment as per Modified Hartwig and Siegel Scale[3] showed all the cases to be of “moderate severity” (level 3). Although nitroimidazole derivatives are known to cause FDEs,[4,5] according to standard western literature nitroimidazole derivatives, commonly used as antiprotozoal and antibacterial rarely causes FDEs. They are not routinely included in the list of causal drugs of FDEs.[6] This may not hold true in a setting, as for example in India, where use of nitroimidazole derivatives is widespread both as self-medication and as prescription drugs.

Asymptomatic cysticercosis in wistar albino rats: A note of caution to all biomedical researchers

Sir, Rat is one of the most commonly used animals in biomedical research. It can spread various types of zoonotic diseases, most commonly, rat fever (caused by Streptobacillus moniliformis), ring worm infestation, rabies, tetanus, and salmonella.[1] Hence it is important to have a thorough knowledge regarding the common zoonotic diseases transmitted by the animal, the common modes of transmission to humans as well as necessary precautionary methods during handling of the animals. The researcher should not only keep in mind the possible zoonotic diseases that can affect him, but also the asymptomatic parasitic diseases common to the animals that can erroneously affect the results of the experiments. In our setting, we conducted an experiment involving Wistar albino rats, maintained according to the Committee for the Purpose of Control and Supervision on Experiments on Animals (CPCSEA) guidelines to observe the effects of fluoxetine on rat endometrium. At the end of the study, after sacrificing the animals, one of the rats of the control group (treated only with oral 0.9% normal saline) showed cyst formation on the liver. Histopathological examination confirmed the cyst to be of cestode origin as evidenced by the presence of an outer acellular eosinophilic cuticular layer and underlying subtentacular layer along with scolex-containing hooks and suckers [Figure 1]. Some giant cell reaction along with signs of inflammation was also evident in the adjoining tissue. Figure 1 HP examination shows outer acellular eosinophilic cuticular layer, subtentacular layer along with scolex containing hooks and suckers at 100× magnification Molecular techniques like PCR-linked mitochondrial DNA sequencing were not used to confirm the species of the tapeworm larva. But it is most likely due to the encysted larval form of Taenia taeniaeformis, i.e. Cysticercus fasciolaris, as it is one of the most common cestodes affecting the livers of the rats. Sometimes it has been found to be associated with hepatic fibrosarcomas.[2,3] Hence, animal experiments which particularly involve testing of liver functions can have erroneous results if asymptomatic rats harboring C. fasciolaris are used. Although our experimental protocol did not require measurements of liver function, it most likely did not affect the outcome. Besides Wistar albino rats, other commonly used laboratory animals can have asymptomatic parasitic infestations that can act as a restricting factor for attainment of experimental protocol. Therefore, the biomedical researchers should be aware of the asymptomatic spontaneous lesions to correctly interpret the outcome of their experiments.

Olanzapine-induced hepatopathy in albino rats: A newer model for screening putative hepatoprotective agents, namely silymarin

Backgrounds: This study was conducted to establish olanzapine-induced hepatopathy in Wistar albino rats as a newer model to screen putative hepatoprotective agents namely silymarin. Materials and Methods: Albino rats were divided into three groups, namely vehicle control group (CG), olanzapine-treated group (OZ), and olanzapine plus silymarin (OZS) treated groups. Both the OZ and OZS groups were treated with the same dose of intraperitoneal olanzapine for 6 weeks and group OZS additionally received oral silymarin. Baseline and terminal hepatic enzymes (SGOT, SGPT, and ALP) were measured in all three groups. Results: Histopathological examination of livers of both OZ and OZS groups showed degenerative changes, whereas those of control group showed normal architecture. Liver enzyme levels showed statistically significant rise in comparison to the control group as well as the respective base line values in both the test groups, but the differences in the rise of liver enzymes between the two test groups were not statistically significant. Conclusion: Olanzapine-induced hepatopathy in rats can be used as a model for screening putative hepatoprotective agents and in our setting silymarin has failed to provide any hepatoprotection.

The possible role of fluoxetine in adenomyosis: an animal experiment with clinical correlations.

INTRODUCTION Fluoxetine is a commonly prescribed drug which is used in the psychiatric practice and adenomyosis is a common medical problem in women of the reproductive age group. OBJECTIVE To explore the role of fluoxetine in the causation of adenomyosis. METHODS Female Wistar rats (n=18) were divided into three groups (group I (the control), group II and group III) and they were treated with normal saline and oral fluoxetine (4mg/kg and 8 mg/kg) respectively for 100 days. Periodic serum prolactin measurements and histopathological examinations of the uterine horns of all the rats were done at the end. Comparison of the mean serum prolactin levels between the patients (n=15) who were diagnosed with adenomyosis, the healthy age sex matched controls and the female patients (n=20) who received fluoxetine for more than 3 months, before and after the fluoxetine administration, was done separately. Appropriate (paired or unpaired) t tests were used for the data analysis. RESULTS Out of the 12 test group rats, 10 rats showed the features of adenomyosis histopathologically, along with significantly (p < 0.05) raised serum prolactin levels. The mean serum prolactin levels of the patients of adenomyosis in comparison to those of the controls and of the patients who were treated with fluoxetine (before and after the fluoxetine administration), were significantly high (p=0.001 in both the cases). CONCLUSION Fluoxetine may have some role in the causation of adenomyosis; although for a stronger evidence, the follow-up of the patients who are treated with fluoxetine on a long term basis should be ideal.