Journal of clinical and diagnostic research

Thalassemia and Hemoglobin Disorders In Khuzestan Province of Iran

RAHIM F*,**, AHADI R***

Background and Aim:In prevalent regions, the thalassaemias often coexist with a variety of structural Hb variants giving rise to complex genotypes and an extremely wide spectrum of clinical and haematological phenotypes. Haematological and biochemical investigations, and family studies provide essential clues to the different interactions and are fundamental to DNA diagnostics of the Hb disorders. Material and Methods:A careful three tier approach involving: (1) Full blood count (2) Special haematological tests, followed by (3) DNA mutation analysis, provides the most effective way in which primary gene mutations as well as gene-gene interactions that can influence the overall phenotype can be detected. In Iran, there are many different forms of α and β thalassemias. Increasingly, different Hb Variants are being detected, and their effects per se, or in combination with the thalassaemias, provide additional diagnostic challenges. Result: We did step-by-step diagnostic workup in 800 patients of hemoglobinopathies who were referred to Research center of Thalassemia and Hemoglobinopathies in Shafa Hospital of Ahwaz Joundishapour University of Medical Sciences, respectively. We detected 173 patients as Iron Deficiency Anemia and 627 individuals as Thalassemic patients by use of different indices. We detected 75 %( 472/627) of the β-thalassemia mutations by using amplification refractory mutation system (ARMS) technique and 19 %( 130/627) of the α-thalassemia mutations by using Gap-PCR technique and 6 %( 25/627) as Hb variants by Hb electrophoresis technique successfully. Conclusion:Almost all haemoglobinopathies can be detected with the current PCR-based assays with the exception of a few rare deletions. The knowledge of α and ß-gene numbers in α and ß-thalassemia traits of any population is necessary, as it modifies the phenotype of thalassemia by altering the ratio of α and ß -chains of hemoglobin.

Spectrum of Ocular Diseases at a Military Hospital in Ladakh, North India

JHA K N

The objective of this study was to study the spectrum of patients with ocular diseases, attending a referral military hospital in a remote hilly region of north India. 793 consecutive patients were treated in the Ophthalmology Department over a four year period (Jan 2001 to Dec 2003) at a referral military hospital in Laddakh, Jammu and Kashmir. Males outnumbered females (M: F ratio 3:1), with 56.7 % patients being below 40 years age The spectrum of diseases in the descending order was: refractive errors 33.8%, cataract 21.4%, inflammatory conjunctival diseases 16.8%, pterygium 8.4 %, corneal diseases 5.5%, injuries 3.9 %, diseases of ocular adnexa 3.4%, glaucoma 2.4%, uveitis 2.1%, and miscellaneous 2.3%. Among the cases of blindness, cataract accounted for 85% of cases, refractive errors for 5.5 %, injuries for 5.5 %, corneal opacity for 1.9% , glaucoma for 0.5%, and others for 1.6 %.

The Diagnostic And Prognostic Value Of Serum Adenosine Deaminase Levels In Head And Neck Cancer

ASHOK K.J, PINTO G J O, KAVITHA A.K, PALATHRA M J

Serum adenosine deaminase (ADA) levels were estimated in 63 patients with histologically proven squamous cell carcinoma of the head and neck region of the body in different stages. Serum ADA levels were also estimated in 30 healthy controls. Serum ADA levels in cases (34.89 ± 6.80 IU/L) was significantly increased when compared to the control group (20.47 ± 3.33 I U/L). There was a highly significant correlation between the serum ADA level and the increasing disease stage (severity of the disease). The tumour status and metastasis of the tumour to the neck nodes has shown a correlation with serum ADA levels. After the treatment of head and neck cancers by different modalities, the serum ADA levels were found to be decreased (24.74 ± 3.91) when compared to the serum ADA activity before treatment (34.89 ± 6.80 IU/L).

The Effect Of Dexamethasone On Nausea, Vomiting And Pain In Parturients Undergoing Caesarean Delivery

JAAFARPOUR M*, KHANI A*, DYREKVANDMOGHADAM A*, KHAJAVIKHAN J**, SAADIPOUR Kh***

Background and Aim: Nausea, retching, vomiting and pain are common in parturients undergoing cesarean delivery which is performed under regional anaesthesia. The purpose of the present study was to evaluate the prophylactic use of dexamethasone for reducing emetic symptoms (nausea, retching, and vomiting) during caesarean section and analgesic requirements after caesarean surgery. Material and Method: This is a quasi-experimental study. In a randomized, double-blind trial, 80 parturients received IV placebo (saline) or dexamethasone 8 mg, immediately after clamping of the umbilical cord. Intraoperative, post delivery emetic episodes, severity of pain after surgery, and analgesic requirements were performed by an investigator. The patients experiencing nausea evaluated its severity on a linear numeric scale ranging from 0 (no nausea) to 10 (severe nausea). To determine severity of pain, we used the VAS scale. Results: The results of this study showed that the rate of emetic symptoms (nausea, retching, and vomiting) in an intraoperative, post delivery period, was lower in patients who received 8 mg dexamethasone than in the placebo group (p< 0.001). Requests for total requirements of opioids to relieve intolerable pain, were less in patients in the dexamethasone group, as compared with the placebo group (P<0.001). In addition, patients in group dexamethasone had significantly lower pain after caesarean than in the placebo group (p<0.05, p<0.001). Discussion and Conclusion: In the parturients undergoing caesarean delivery performed under spinal anaesthesia in this study, prophylactic use of 8 mg dexamethasone was found to be effective for reducing emetic symptoms (nausea, retching, and vomiting) and analgesic requirements after caesarean section, and is recommended for routine use.

Selecting The Cost Effective Antimicrobial : Quandary Of Medical Profession!

RATABOLI P V, DANG A, DANG S

Background: Antimicrobial costs vary tremendously. It is difficult to make a decision whilst selecting a cost-effective antimicrobial in clinical practice. Prescribing costly antimicrobials can have a negative impact on patient’s compliance. Aims: a) To compare the average retail price of different antimicrobials available in oral and parenteral dosage forms and calculate the cost of one day therapy. 2) To select and justify the use of certain antimicrobials as the most cost-effective in common microbial infections. Methods and materials: Pricelist of available antimicrobial brands was procured from IDR official site. Average price of commonly available oral and parenteral brands of antimicrobials was calculated. Cost of one day therapy was also calculated. Difference between oral and parenteral cost was observed. Results and discussion: Study revealed that doxycycline and cotrimoxazole are the cheapest antimicrobials and ceftibuten is most expensive oral antimicrobial. Aztreonam is the most expensive parenteral antimicrobial in contrast to gentamicin which is the cheapest. A lot of take home messages and strategies are discussed. In general, parenteral dosage forms are more expensive than the oral dosage forms. The cost of one tablet is not directly proportional to the cost of therapy as the dosage of different antimicrobials vary. Long acting expensive drugs may ultimately end up being cheaper than the short acting counterparts. Costly antimicrobials need not be the better ones. Reducing the antimicrobial cost should remain our prime motive, and hence cost-effective antimicrobials should be selected, based on one’s knowledge , so that the drug costs are reduced while maintaining good quality of care.

Status Of Lipid Peroxidation, Glutathione, Ascorbic Acid, Vitamin E And Antioxidant Enzymes In Neonatal Jaundice Patients

SURAPANENI K M * , VISHNU PRIYA V **

The exact pro-oxidant and antioxidant status in neonatal jaundice is still not clear. To add a new insight to the question, changes in the erythrocyte lipid peroxidation products (MDA), levels of glutathione (GSH), ascorbic acid and plasma vitamin E (non enzymatic antioxidant parameters) and activities of antioxidant enzymes super oxide dismutase (SOD), glutathione peroxidase (GPX), catalase in erythrocytes were studied in forty-eight neonatal jaundice patients and forty-eight healthy subjects. It was observed that there was a significant increase in erythrocyte MDA levels, activities of SOD, GPX and a significant decrease in erythrocyte GSH, ascorbic acid, plasma vitamin E levels and catalase activity in patients with neonatal jaundice when compared to controls. The results of our study have shown higher oxygen free radical production, evidenced by increased levels of MDA and decreased levels of GSH, ascorbic acid, vitamin E and catalase activity, supports the oxidative stress in neonatal jaundice patients. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. The decreased concentration of the glutathione and antioxidant vitamin status supports the hypothesis that neonatal jaundice is an important causative factor in the pathogenesis of lipid peroxidation. These data reveal that antioxidant defense mechanisms might be impaired in neonatal jaundice patients. These findings also provide a theoretical basis for the development of novel therapeutic strategies, such as antioxidant supplementation.

Effects of Clinical, Haematological and Immunophenotyping Factors on the Prognosis of Acute Promyelocytic Leukaemia (APL) at the Tabriz Haematology and Oncology Research Centre

KERMANI I A*, KERMANI T A**, KERMANI A A***, DOLATKHAH R****

Background: Acute Promyelocytic Leukemia is one of AML subgroups that is high lighted by coagulopathy and different mode of treatment. It is specified by district cell morphology and immunophenotyping characteristics. Aims: The aim of this study was evaluation of the effects of cytologic , clinical and biologic factors specially CD34 expression in prognosis in APL patients. Materials and Methods: In a Descriptive retrospective analysis the files of 60 APL patients reviewed and the extracted data's statistically analyzed using SPSS soft ware with Chi Square and T- test. Results:Dislike references complete remission and disease free survival (DFS) had no significant correlation with age, sex, WBC, Hb, platelet count, purpura, CD34 status, and percent of Blasts in bone marrow. There was no significantly statistical correlation between CD34 expression with morphology, age, sex, WBC, platelet count, percent of BM blasts and purpura. Cases with CD34 expression had sever anemia (5.8± 1.08) in comparison with CD34 negative APLs (P=0.020). Conclusion:In spite of the influence of known prognostic factors on prognosis, results of our study were not concordant with references, therefore it is logical to think that in APL there should be different prognostic factors .Failure in obtaining complete remission in all CD34+APLs cases may be the cause of poor prognosis of CD34 positively in these patients and needs further studies for better clarification.

The Analgesic Effect of Transcutaneous Electrical Nerve Stimulation (TENS) on Caesarean Under Spinal Anaesthesia

Background and Aim: The pain is an important concern and unpleasant outcome for delivered mothers after cesarean section which might result in problems such as poor bonding between mothers and newborn. Trans-cutaneous electrical nerve stimulation (TENS) is a non pharmacological and non-invasive method that relieves pain. The aim of this study is to assess the analgesic effect of TENS on cesarean section under spinal anesthesia. Material and Methods: This study included 108 patients from Mostafa Khomeini hospital Ilam, who have been enrolled as study subjects. 54 subjects were randomly allocated to each of study arms (TENS i.e. Intervention & Control group). A standardized questionnaire was used for data collection and Visual analogue Scale (VAS) was used to determine severity of pain. The surgery and anesthesia procedure in intervention and control groups was identical. Pain intensity and vital signs were monitored in both experimental and control group during first 24 hours. Result: The result of this study showed that intensity of pain and usage of sedative drug remarkably reduced after use of TENS (p<0.001, p<0.05). The mean blood pressure and respiratory rate four hour after surgery in intervention group was significantly less when compared to control group (p<0.001). Patient satisfaction was significantly better in intervention group than the control group (p<0.001). Conclusion: TENS may be used as an effective, non invasive and non pharmacological approach for reducing post caesarian section pain with reduced use of analgesics. This might lead to better outcomes in pain control and facilitating development of bonding between mother and baby.

Evaluation Of Urinary Abnormalities In Urolithiasis Patients From “Kathmandu Region”

KUMAR A*, SINGH S**, SINGH D***

We evaluated urinary abnormalities in 193 consecutive patients with renal stones, without any prior history, and compared them with age /sex matched healthy controls. Over a twenty four hour period, urinary oxalate, calcium, uric acid, struvite, cystine, sodium, magnesium, phosphorous and citrate were estimated. The urinary pH was also determined. In stone formers, the twenty four hour period evaluation levels of calcium (CI; 183.4–185.2), oxalate (CI; 43.4 – 43.8), uric acid (CI; 518.3-528.5) and sodium (CI; 230.9-232.1) excretion were significantly higher (p<0.001), as compared with controls. The twenty-hour urinary citrate (CI; 151.8–153.1), phosphate (CI: 241.7–245.7) and struvite (CI; 362.8–372.1) excretion was significantly lower than the control group (p<0.001). The cystine (CI; 454.3- 459.5) excretion in stone formers was significantly higher (p<0.05) as compared to the control group. The magnesium (CI; 123.1–124.3) excretion was lower in stone formers as compared to controls, and was significant (p<0.01). The pH of urinary stone formers was 5.13 ± 0.034, whereas in controls, it was 6.54 ± 0.045 (p< 0.001). Hypocitraturia is the main cause of renal calculi, along with hypomagnesuria and hypophosphaturia in the patients of Kathmandu region. On the basis of urinary abnormalities, further stone formation in the patient can be prevented by dietary modifications.

Churg-Strauss Syndrome Presented With Abdominal Pain And Foot Drop

ABBAS MT*, ERRAYES M**, MALALLAH H***, KUMAR R****, KHUDAIR RF*****

Abdominal complications are occasionally reported in the Churg-Strauss syndrome (CSS), cholecystitis, pancreatitis, and diffuse vasculitis. We report a case of a patient with CSS, with all these complications. A 33 year old man with an eight year history of asthma and recurrent sinusitis was admitted for abdominal pain. Later on, a vasculitic skin rash developed on the left foot drop.. An increasing peripheral oeosinophilia rising from 25% to 49% in the past month was detected. His pancreatic and liver enzymes increased, and abdominal ultrasonagraphy performed, disclosed a partially distended thick-walled gall bladder with diagnosis of acalculous cholecystitis. Computed tomography (CT) scan of his abdomen showed normal thickness of the bowel wall with oedema in the mesentery, suggestive of an inflammatory process, with patent major mesenteric vessels. Upper endoscopy done, showed diffuse gastritis with multiple mucosal petechiae and positive perinuclear antineutropil cytoplasmic antibody (p-ANCA) of 164 IU/Ml. Nerve conduction study showed severe prominent axonal damage of the sural and tibial nerves in the left leg, and normal peroneal nerve parameters, suggestive of Mononeuritis multiple. The diagnosis of Churg-strauss syndrome was made, with small vessel abdominal vasculitic process.Intravenous pulse methylprednisolone 250 mg/day for three days was given, and a pulse dose of cyclophosphamide was given. His condition showed dramatic improvement and was discharged on oral steroids.

An Unusual Approach For Treating A Thyroid Nodule.

ALIASGHARZEDEH A

Background: Thyroid nodules commonly occur in the general population. They are often discovered incidentally. Fine needle aspiration biopsy (FNAB) is the usual practice for correctly diagnosing these nodules. Case presentation: The patient was a 24 year female. She presented with a thyroid nodule that was discovered incidentally as an otherwise asymptomatic neck mass. When her husband noticed the nodule, he tightly pressed it between his fingers, because of which haemorrhage and a regional wound resulted. In the 2 months and 1 year follow up, there was no nodule in the thyroid, and only a hyperpigmented scar was left at the previous nodule site. Conclusion: The unusual and exceptional approach of this patient's husband to the thyroid nodule resulted in its disappearance due to external physical pressure. I have not found any report of this kind in my entire search in the medical literature data bases.

Primary Pyomyositis Of Paraspinal Muscles: A Rare Location

TAURO L F, KAMATH A, GEORGE C, HEGDE B.R, NAZARETH E

Primary pyomyositis is a rare, sub-acute, primary muscle infection that is probably the result of a transient bacteraemia in most patients. It is rarely reported in temperate climates. The quadriceps, gluteal and iliopsoas muscles are the most commonly affected anatomic sites. A case of primary pyomyositis within the paraspinal muscles of a 30-year-old man is reported with details of diagnostic evaluation, and medical and surgical treatment of the condition. Early diagnosis and complete drainage of any abscess cavity combined with appropriate antibiotic therapy, remains the mainstay of treatment. Most patients have complete recovery, with no long term sequelae. Failure to recognize this clinical entity can lead to diagnostic delay and inappropriate management.

Bioinformatics And Proteomic Approaches To Disease: In Vivo And In Silico Proteome Analysis Tools

RAHIM F

The availability of human genome sequences and transcriptomic, proteomic, and metabolomic data provides us with a challenging opportunity to develop computational approaches for systematic analysis of metabolic disorders. Mass spectrometry represents an important set of in vivo technologies for protein expression measurement. Among them, surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI TOF-MS), because of its high throughput and on-chip sample processing capability, has become a popular tool for clinical proteomics. Bioinformatics plays a critical role in the analysis of SELDI data, and therefore, it is important to understand the issues associated with the analysis of proteomic data. A variety of protein sequence databases exist, ranging from simple sequence repositories, which store data with little or no manual intervention in the creation of the records, to expertly curated universal databases that cover all species, and in which the original sequence data are enhanced by the manual addition of further information in each sequence record. As the focus of researchers moves from the genome to the proteins encoded by it, these databases play an even more important role as central comprehensive resources of protein information. In this review, we discuss such issues and the bioinformatics strategies and several leading protein sequence databases used for proteomic in silico analysis technologies associated with in vivo techniques.

Strategies And Vectors For Gene Therapy: Its Prospective Therapeutic Attributes Against Restenosis

KHANNA A*

Gene therapy is seen as one of the upcoming technologies not only against diseases which have monogenetic etiology, but also against complex diseases such as cancer and cardiovascular disorders. Amongst the cardiovascular disorders, restenosis is one of many disorders which has seen a major increase in the clinical trials, using gene therapy, in recent years. Restenosis, which is simply reoccurrence of stenosis, is seen mainly post surgically in an artery or blood vessel which had been unblocked. Importantly, even though stents have been introduced to prevent restenosis to occur post surgically, the effect seems to be limited to decreasing the statistical rate , and restenosis still persists as a problem for which a definite solution or remedy, acting on the very roots of its pathogenesis, is the need of the hour. Gene therapy, transfer of a healthy gene for curing a disorder, seems to a promising modality for the purpose. To meet this end a definite strategy, an appropriate vector and target for efficient and persistent expression of the healthy gene in the desired or localized area, is what will make gene therapy against restenosis more effective.

Malignant Fibrous Histiocytoma Of The Anterior Maxilla

RASTOGI S, MODI M, DHAWAN V

Malignant fibrous histiocytoma (MFH) is the most common soft-tissue sarcoma, but is relatively uncommon in head and neck area. Histologically, it is difficult to distinguish this tumor from other sarcomas and carcinomas. Surgery is the most reliable treatment for MFH, but the 5-year survival rate for cases of this tumor in the head and neck is low in comparison with MFH of the extremities and trunk. Around 61 cases reported in the international literature since 1974. We present a rare case of primary MFH of the maxilla in the unusual location of maxilla in a 20-year-old female. The tumor was located in the maxillary anterior region mimicking periodontal ulcer. We have described the difficulty in diagnosing the tumor along with differential diagnosis, histopathological diagnosis, and current methods in diagnosing the tumor i.e. immunohistochemical analysis. The literature was reviewed briefly along with treatment guidelines.

In Vivo Studies On The Immunomodulatory Potential Of Aqueous Oat Extracts

DHILLON P**, BHATIA A. *

A number of studies have been carried out to screen plants for their medicinal potential and isolate bioactive chemical compounds, but only a few studies have been done to find out the immunomodulatory potential of plants. Beta-glucan, one of the chemical constituents of fungi, has been shown to be an immunopotentiating agent. Beta-glucan has been reported to be found in cereals. Hence, in the present study, attempts have been made to evaluate the immunomodulatory potential of oat, a cereal containing beta-glucan. Aqueous extracts of seeds and leaves of oat were evaluated in-vivo in swiss albino mice for their immunomodulatory potential. Nitro Blue Tetrazolium reduction (NBT), Inducible Nitric Oxide Synthase (INOS), Phagocytosis (bactericidal activity) and ELISA were various tests employed to assess the effect of oat extracts on the immune status of animals. The results revealed that both the aqueous oat seed extract, as well as its leaf extract were immunopotentiating, the former being more bioactive.

Developing A Community Based Pharmacovigilance Program In Western Nepal: A Significant Initiative To Ensure Drug Safety

SUBISH P*,**, MOHAMED IZHAM MI***, MISHRA P*,**

Purtscher’s Retinopathy After Facial Trauma

Kumar S

Medical Termination Of Pregnancy With Mifepristone – Misoprostol In Rural India.

SHARMA R *, VERMA U*, KHAJURIA B ***MD

The Art Of Medicine By Kevin J Soden MD: A Personal Perspective

SHANKAR PR

Drugs and Society

SHANKAR R