Journal of clinical and diagnostic research https://www.jcdr.net/back_issues.asp JCDR Clinical Profile And Management Pattern Of Vitiligo Patients In A Teaching Hospital In Western Nepal RAJPAL S*, ATAL R **, PALAIAN S***, PRABHU S **** The present study analyzed the clinical profile and management pattern of vitiligo patients in a teaching hospital in western Nepal. The list of vitiligo patients who visited the dermatology outpatient department was collected. Based on the list, the patients’ files were taken from the medical record department and were analyzed as per study objectives. Vitiligo was found to be more common in the age group of 11- 20 years (41.7%) and in urban population (64%). It generally started at teen and pre-teen ages. Most of the patients were given Psoralen ultraviolet –A (PUVA) therapy and corticosteroids. Most patients had no history of prolonged drug intake prior to onset of lesions. Concurrent dermatological diseases were found in 12.17% of the patients with vitiligo, 48.68% of patients had no other illness and the rest had unrelated diseases affecting gastrointestinal, gynecological and respiratory systems. Similar studies covering larger number of patients are needed to confirm our findings. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1065-1068&id=332 https://doi.org/10.7860/JCDR/2008/.332 Serum Paraoxonase Activity In Normolipidaemic Patients With Acute Myocardial Infarction KUMAR A *,SIVAKANESAN R **,NAGTILAK S*** <b>Background:</b> Although studies have demonstrated that HDL-C associated paraoxonase is involved in protection of LDL-cholesterol and other lipoproteins from the deleterious effects of oxygen free radicals in ischaemia and reperfusion, there are controversial data on the correlation between paraoxonase activity and the ischaemia process. <b>Aim:</b> The present study was planned to evaluate the paraoxonase activity in patients with acute myocardial infarction (AMI), with normal lipid profile. <b>Setting and Design:</b>Serum paraoxonase activities were determined in 165 normolipidaemic patients diagnosed with AMI, and 165 age and sex matched healthy volunteers served as controls. <b>Material and Methods:</b> Serum Paraoxonase activities were measured by using an enzymatic kit manufactured by the Zeptomatrix Corporation, New York, USA, for AMI patients and controls. Also, the lipid profile was analyzed enzymatically in these subjects. <b>Statistics:</b> The values were expressed as means ± standard deviation (SD), and data from patients and controls was compared by using student’s ‘t’-test. <B>Results and Conclusion:</b> Serum paraoxonase activity was significantly decreased in AMI patients as compared to controls (p<0.001). Also, total cholesterol levels, TC/ HDL-C ratio, triglyceride levels, LDL-cholesterol levels, LDL-C/ HDL-C ratio and TG/HDL-C ratio were significantly higher (p<0.001), and HDL-cholesterol levels were significantly lower in AMI patients (p<0.001). No correlation was observed between PON1 activity and HDL-C levels in patients and controls. These findings suggest that decreased paraoxonase activity could be due to increased oxidative stress in AMI. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1052-1056&id=333 https://doi.org/10.7860/JCDR/2008/.333 Results Of Two Multicentric, Comparative, Randomized, Parallel Group Clinical Trials To Evaluate The Efficacy And Safety Of Dexketoprofen Trometamol In The Treatment Of Dental Pain And Dysmenorrhoea In Indian Patients BALANI M, GAWADE P, MAHESHGAURI S, GHOLE S, SHINDE V, SATHE V <b>Background:</b> Dexketoprofen is the active enantiomer of the popular NSAID Ketoprofen which is a 50:50 mixture of S (+) and R (-) enantiomers. <b>Aims:</b> To demonstrate therapeutic efficacy and safety of Dexketoprofen 25 mg as compared to Ketoprofen 50 mg in patients undergoing dental surgery and in patients with dysmenorrhoea. <b>Study Design:</b> Multicentric, comparative, randomized, parallel group studies. Materials and Methods: Out patients undergoing third molar extraction were randomized to receive either Dexketoprofen or Ketoprofen. In a separate study, patients with dysmenorrhoea were randomized into similar two groups. Pain intensity as recorded on Visual Analogue Scale before therapy and at regular intervals after therapy was quantified and statistically analysed. <b>Materials and Methods:</b> Out patients undergoing third molar extraction were randomized to receive either Dexketoprofen or Ketoprofen. In a separate study, patients with dysmenorrhoea were randomized into similar two groups. Pain intensity as recorded on Visual Analogue Scale before therapy and at regular intervals after therapy was quantified and statistically analysed. <b>Results:</b> In both the studies, the groups were comparable in demographics and baseline pain intensity. Dexketoprofen was as effective as Ketoprofen in relieving pain during menstruation. In case of dental pain, Dexketoprofen provided early onset of statistically significant analgesia as compared to Ketoprofen. <b>Conclusions:</b> Dexketoprofen (25mg) is as effective as Ketoprofen (50mg) in the treatment of dysmenorrhoea and is a faster and equally safe analgesic in the treatment of acute pain of dental surgery. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1086-1091&id=338 https://doi.org/10.7860/JCDR/2008/.338 Antioxidant Enzymes And Vitamins In Gestational Diabetes. SURAPANENI K M*, VISHNU PRIYA V** The exact pro-oxidant and antioxidant status in gestational diabetes is still not clear. To add a new insight to the question, levels of erythrocyte antioxidant vitamin Ascorbic acid and plasma vitamin E (non enzymatic antioxidant vitamin parameters) and activities of antioxidant enzymes Super Oxide Dismutase (SOD), Glutathione Peroxidase (GPX) and Catalase in erythrocytes were studied in patients with gestational diabetes and compared to controls. Statistical analysis between controls and patients was performed by Mann Whitney U test using stat - view package. It was observed that there was a significant increase in activities of SOD, GPX and a significant decrease in erythrocyte ascorbic acid, plasma vitamin E levels and Catalase activity in patients with gestational diabetes when compared to controls. Results of our study depict higher oxygen free radical production, evidenced by increased levels of MDA and decreased levels of GSH, ascorbic acid, vitamin E and Catalase activity, supporting the evidence of oxidative stress in gestational diabetes patients. Increased activities of antioxidant enzymes might be a compensatory regulation of body in response to increased oxidative stress. Decreased concentrations of antioxidant vitamins support the hypothesis that gestational diabetes is an important causative factor in pathogenesis of lipid peroxidation. These data reveal that antioxidant defense mechanisms might be impaired in patients with gestational diabetes. These findings also provide a theoretical basis for development of novel therapeutic strategies, such as antioxidant supplementation. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1081-1085&id=340 https://doi.org/10.7860/JCDR/2008/.340 Information Seeking Behaviour Of Clinicians In a Semi Urban Town In Southern India RAJAN MSV *, SREEDHAR**, KHAN S A ***, THIYAGU R****, RAO PGM ***** <b>Background:</b> Newer drugs are entering market at a faster rate and information on medicines is expanding at a tremendous pace, making it difficult for clinicians to keep abreast. Drug Information Centers across world help clinicians in their information needs. Kasturba Hospital Drug Information center would like to extend its services to community based clinicians. Better understanding of clinicians’ needs and preferences on drug information can help to serve them better. <b>Objectives:</b>To study information-seeking behaviour of community based clinicians, specifically on drug information and their other related needs to improve quality of care for patients. <b>Methodology:</b>An 11-item survey questionnaire was designed, based on kirkelas model of information seeking behaviour. The survey questionnaire was distributed personally and filled questionnaire were collected. <b>Results:</b>57 filled questionnaires were collected back out of 60 questionnaires distributed. Only 18% of clinicians were found to use the services of Drug Information Centers. Clinicians use textbooks and drug indexes as their main references. Journals and Internet is not widely utilized. Majority of clinicians felt that information provided by pharmaceutical companies is biased and inadequate. Almost all clinicians felt that there is need for drug information service. <b>Conclusion:</b>This study throws light on information needs and related issues of community-based clinicians in a semi urban town. This study highlights the need for independent unbiased source of drug information for clinicians practicing in communities. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1069-1073&id=350 https://doi.org/10.7860/JCDR/2008/.350 Knowledge, Attitude And Behaviour Towards Sleep Among Fourth Semester Medical Undergraduates In Pokhara, Nepal SHANKAR P.R <b>Context:</b> Sleep disturbances are a common problem and exert a significant economic burden. Sleep medicine has not been emphasized in medical schools. Studies on the knowledge, attitude and practice (KAP) towards sleep among medical students are lacking. <b>Methods:</b> The present study was carried out at Manipal College of Medical Sciences, Pokhara, Nepal among three successive batches of fourth semester medical students using a previously developed and validated questionnaire. The mean knowledge, attitude and practice scores were calculated and compared among various subgroups of respondents. <b>Results:</b> A total of 189 of the 225 students (84%) participated. Ninety-seven students (51.3%) were male. The mean +/- SD knowledge, attitude and practice scores were 86.5 +/- 14.6 (maximum score 120), 69.4 +/- 18.7 (maximum score 130) and 184.3 +/- 27.5 (maximum being 240) respectively. No significant differences in scores were seen among various subgroups of respondents. <b>Conclusions:</b> The knowledge of the respondents regarding sleep was satisfactory but the attitude scores were low. The practice of sleep was average to good. Further studies among clinical students and in other medical schools are required. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1074-1080&id=355 https://doi.org/10.7860/JCDR/2008/.355 Developing A Protocol For Empirical Antibiotics For Neonatal Sepsis Based On Data On Antibiotic Sensitivity Patterns At Two Tertiary Neonatal Units In Southern India DIWAKAR KK*, ANANTHEN KS** Sepsis continues to be a major challenge in neonatal care. The choice of first –line antibiotics to be commenced in at-risk neonates has always been a matter of debate. <b>Objective</b> To compare the bacteriological profiles of isolates from blood cultures at two neonatal centers situated in different states of India, and evaluate if a common ‘first-line combination’ of antibiotics could be recommended for infants at-risk for sepsis. <b>Method</b> Isolates obtained from neonatal blood culture done at the Kasturba Medical College, Manipal, Karnataka (Center A) and the Malankara Orthodox Syrian Church Medical College, Kochi, Kerala (Center B) were retrospectively analyzed. The sensitivity of common antibiotics and their combinations was analyzed in relation to the bacteriological profile and age of onset of sepsis (Early or late). <b>Results</b> Six ninety seven isolates from 3077 samples of blood cultures done in at-risk neonates were retrospectively evaluated. Five twenty nine isolates were obtained from Center A and 168 from Center B. Coagulase negative staphylococcus (CONS) constituted the largest group (37.6%) of these isolates. Klebsiella species (18.5%), Pseudomonas (14.1 %), Acinetobacter sp. (7 %), Enterobacter sp. (4.9 %) were the other common isolates. The combination of Ampicillin + Amikacin covered 49% isolates, followed by Ciprofloxacin + Gentamicin (46.4%), Ciprofloxacin + Amikacin (44%) and Ampicillin + Gentamicin (38.6%). The types of isolates and the sensitivity pattern of isolates to combination antibiotics was found to be similar at both the centers (r = 0.81). Addition of a ‘third’ antibiotic Cefotaxime to the combination of Ampicillin + Amikacin did not reveal any significantly increase in the number of isolates covered. The antibiotic sensitivity patterns were similar among EOS and LOS and correlated at r= 0.9 (p<0.01) for individual antibiotics and at r = 0.97 (p < 0.01) for combination antibiotics. <b>Conclusion</b> The combination of Ampicillin + Amikacin , covers the maximum numbers of isolates and could be the best first-line antibiotics in neonatal sepsis. Addition of more antibiotics does not necessarily result in wider coverage of isolates. The initial combination of antibiotics could be the same for EOS and LOS. Blood cultures are mandatory in all neonatal sepsis for seeking specific sensitivity patterns and accordingly modifying the antibiotic therapy. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1057-1064&id=356 https://doi.org/10.7860/JCDR/2008/.356 An Unusual Case Of Bladder Adenocarcinoma With Involvement Of The Upper Urinary Tract KAUR N, SAHA S, AMRATASH, ARORA H, WADHWA N A 13 year young boy presented with complaints of abdominal pain and haematuria. His CT scan showed a growth in the bladder, with extension into the right ureter and pelvis. Cystoscopic biopsy was reported as papillary adenocarcinoma of urinary bladder. The patient underwent radical cystectomy, right nephroureterctomy and left ureterosigmoidostomy. He received 6 cycles of chemotherapy comprising of methotrexate, adriamycin, vinblastine and etoposide. Two years later, he presented with acute intestinal obstruction due to a growth in the ileum. Eight months later, the patient died due to metastatic disease. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1092-1094&id=342 https://doi.org/10.7860/JCDR/2008/.342 Respiratory Failure Secondary To Obstructive Uropathy Abbas MT *, KhanFY**,Baidaa A***,Errayes M****, Haleem Al H Al***** A 34 year-old male patient who presented for the first time with quadriparesis and type 2 respiratory failure, was found to have severe hypokalaemia (1.1 mmol/L) associated with renal failure, normal anion gap metabolic acidosis and respiratory acidosis .Imaging studies showed left hydronephrosis secondary to urinary bladder neck obstruction. Diagnosis of respiratory failure due to hypokalaemia, which resulted from obstructive uropathy, was established. After relief from obstruction and administration of intravenous fluid and oral potassium supplement, his renal function and his serum potassium level was normalized, and his condition improved. On one of the following days, the patient was discharged. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1107-1109&id=343 https://doi.org/10.7860/JCDR/2008/.343 A Case Report Of Leptospirosis Induced Acute Pancreatitis THUNGA G *, MALLAYASAMY SR** ,MANGASULI S*** ,BHAT R**** Leptospirosis may rarely present with acute pancreatitis along with classical manifestations. In this study, we report a case in which, leptospirosis presented with symptoms of acute pancreatitis as the prevailing manifestation. In addition, the presence of acute pancreatitis in leptospirosis is reviewed. Patient was managed with conventional therapy and the outcome was favourable. <b>Key Message:</b> Rare case of leptospirosis induced acute pancreatitis. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1100-1102&id=348 https://doi.org/10.7860/JCDR/2008/.348 Primary Retroperitoneal Teratoma Presenting As Diabetes Mellitus In A Child ANSARI M A*,** , SHARMA P*, SHUAIB I L**, PRADHAN S* Primary retroperitoneal teratoma is a rare entity which has a distinctive imaging appearance. To our knowledge, this is the first reported case of teratoma causing diabetes mellitus in a 9-year old boy who was put on insulin. On clinical examination, there was a large tender mass with a well defined margin, caudally in the epigastrium. Ultrasound of abdomen revealed a huge retroperitoneal multiseptated predominantly cystic mass in the upper abdomen. Plain abdominal computed tomography revealed a large well defined cystic mass in the same region. Contrast enhanced abdominal CT revealed a mass with peripheral rim enhancement. It has multiple septa which also enhanced. Clefts containing fat were present adjacent to the septa. Laparotomy with tumour resection was performed. Pathology of the mass disclosed a retroperitoneal cystic teratoma. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1103-1106&id=336 https://doi.org/10.7860/JCDR/2008/.336 Myoepithelioma Of Palate- A Case Report And Review Of Literature RASTOGIS*, MODI M **, DHAWAN V ***, KUMAR A **** https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1095-1099&id=337 https://doi.org/10.7860/JCDR/2008/.337 HIV Entry Inhibitors: Current Status SAHA L Current therapeutic intervention in HIV infection relies upon 20 different drugs. Despite the impressive efficacy shown by these drugs, we are confronted with an unexpected frequency of adverse effects such as mitochondrial toxicity, lipodystrophy and resistance, not only to individual drugs, but to entire drug classes. Thus, there is now a great need for new antiretroviral drugs with reduced toxicity, increased activity against drug-resistant viruses and a greater capacity to reach tissue sanctuaries of the virus. Two different HIV molecules have been selected as targets of drug inhibition so far: reverse transcriptase and protease. Drugs that target the interactions between the HIV envelope and the cellular receptor complex are a `new entry’ into the scenario of HIV therapy, and have recently raised great interest because of their activity against multi-drug resistant viruses. There are several compounds that are at different developmental stages in the pipeline to counter HIV entry<a href="tableview.asp?id=341&img_src=310-image 2.JPG" target=_blank>(Table/Fig 2)</a>, some of which include: i) the attachment inhibitor dextrin – 2 – sulfate; ii) the inhibitors of the glycoprotein (gp) 120/CD4 interaction PRO 542, TNX 355 and BMS 488043; iii) the co-receptor inhibitors subdivided in those targeting CCR5 and those targeting CXCR4 and iv) fusion inhibitors enfuvirtide (T-20) and tifuvirtide (T-1249). https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1119-1125&id=341 https://doi.org/10.7860/JCDR/2008/.341 Crippled Pharmacovigilance: A Qualm of Medical Profession! MUDIGANTY S S P*, DANG A**,RATABOLI PV*** Drug prescribing is the most essential practice of medical professionals. A single drug to be marketed has to undergo rigorous processes and drug trials before it is labelled as safe for use in humans. However, all the adverse effects and toxicities cannot be elicited in the limited number of volunteers used in the phased trial. A lot of dangerous rare toxicities come to light only when drugs are marketed and prescribed to thousands of people. Drug regulatory bodies should be aware of these facts and take prompt initiatives to withdraw their sale. Similarly useless and irrational combinations flow the markets without any additional benefits to the patient. This review is an attempt to create awareness about drugs that are no longer used due to lack of safety, those once banned but reintroduced, those that are still used despite toxicities and doubtful efficacy and drugs surrounded by controversies. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1110-1118&id=349 https://doi.org/10.7860/JCDR/2008/.349 Novel Anticancer Monoclonal Antibodies SHARMA R The recent clinical success of anticancer antibodies like rituximab and trastuzumab has created great interest in antibody-based therapeutics for hematopoietic and solid tumor malignancies. The objective of this study is to review monoclonal antibodies (MAbs) used in oncology and to describe their pharmacological characteristics. Prominent general/internal medicine journals (MEDLINE, EMBASE, PUBMED between 2000 and 2007) were searched for review papers and clinical trials published on MAbs as novel anticancer drugs. These anticancer MAbs act by inducing lysis of cancer cells (rituximab, alemtuzumab), by targeting receptors involved in cell growth and proliferation of cells (trastuzumab, cetuximab, bevacizumab) and by delivering radioisotopes to cancer cells (tositumomab conjugated with I<sub>131</sub>) and cytotoxic molecule (gemtuzumab). Therapy with MAbs has been recognized as a promising therapeutic tool in the field of oncology and a large number of molecules are currently undergoing clinical trials. It is hoped that rational development of combination of multiple therapies directed at different targets, along with unique chemotherapy agents, MAbs and antisense or other cytokines will lead to more effective approaches for cancer patients. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1126-1132&id=344 https://doi.org/10.7860/JCDR/2008/.344 Hepatoprotective Activity Of Aqueous Extract Of Fruit Pulp Of Cassia Fistula (AFCF) Against Carbon Tetrachloride (CCL4) Induced Liver Damage In Albino Rats. DAS S*, SARMA G**, BARMAN S*** <b>Objective:</b> To evaluate Hepatoprotective activity of aqueous extract of fruit pulp of Cassia fistula (AFCF) against Carbon tetrachloride (CCL4) induced liver damage in albino rats and compared to standard drug silymarin. <b>Materials And Methods:</b> Healthy albino rats of either sex weighing 150-200gm were divided into four groups of six animals each. <i>Group A (Normal control)</i> – 3% gum acacia (2ml/kg/day) orally and olive oil s.c. <i>Group B (Exp.Control) –</i> 3% gum acacia orally and CCL4 and olive oil (1:1 v/v) s.c. <i>Group C (Test) –</i> AFCF (200mg/kg/day) orally and CCL4 s.c. <i>Group D (Standard) -</i> Silymarin (100mg/kg/day) and CCL4 s.c. Hepatic injury was induced to animals belonging to group B, C and D by giving CCL4 & olive oil mixture s.c on 2nd and 3rd day of experiment. Standard and test drugs were administered for 5 days. Blood samples were collected on 6th day for determination of enzyme markers viz, aspartate transaminase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), total bilirubin (TB) and total protein (TP). Histopathological examinations of liver tissues were also performed. <b>Results:</b> One way ANOVA followed by Dunnett’s multiple comparison test were used for statistical analysis. Values of p < 0.01 were considered significant. There was significant (p<0.01) increase in all serum marker enzymes and total bilirubin and significant (p<0.01) decrease in total protein in group B. The AFCF and Silymarin resulted in significant (p<0.01) reduction in serum levels of AST, ALT, ALP, TB and increase in TP as compared to group B. Fatty changes, necrosis and fibrosis were observed in group B on histopathology, while in group C and D it was near normal. <b>Conclusion:</b> As revealed by the study aqueous extract of fruit pulp of Cassia fistula possesses significant hepatoprotective activity. https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1133-1138&id=353 https://doi.org/10.7860/JCDR/2008/.353 Is There Any Relationship Between Coronal Displacement And Age In Impacted Teeth RAI B*, ANAND S C** https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1141-1142&id=339 https://doi.org/10.7860/JCDR/2008/.339 Therapeutic Efficacy Of Generic Anti Diabetic Drugs SABITHA P*,ADHIKARI PMR**,KAMATH A***,SAHANA SR**** https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1139-1140&id=334 https://doi.org/10.7860/JCDR/2008/.334 Promoting Health or Pushing Drugs? SHANKAR PR https://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2008&month=October&volume=2&issue=5&page=1143-1144&id=352 https://doi.org/10.7860/JCDR/2008/.352