Impairments in Quality of Life and Cognitive Functions in Long-term Survivors of Glioblastoma.

BACKGROUND: The incidence of long-term survival in glioblastoma (GBM), i.e., >3 years, ranges from 3% to 5%. Although extensive research is performed in novel therapies for prolonging survival, there is a scarcity of research focusing on the impact of tumor and treatment on cognitive, psychological, and social status of survivors. This study is an attempt to look into this poorly addressed important issue. MATERIALS AND METHODS: Nine patients (six adults and three children) with GBM who had survived >3 years were included in the study. The quality of life (QOL) functions were assessed with the World Health Organization QOL Questionnaire BREF questionnaire. The neuropsychological assessment was done using the National Institute of Mental Health and Neurosciences neuropsychology battery for adults and children. The scores were compared with normative data. RESULTS: The physical and psychological health-related QOL of long-term GBM survivors were affected considerably due to fatigue, poor quality of sleep, inability to concentrate, presence of depression, financial burden with impaired personal and social relationships (P < 0.05). Different domains of cognitions such as motor speed (P = 0.0173), mental speed (P = 0.0022), sustained attention (P = 0.0001), long-term memory (P = 0.0431), mental flexibility (P < 0.05), and planning and executive functions (P < 0.05) were significantly impaired affecting personal, social, and professional lives. CONCLUSION: The health-related QOL and cognition are significantly impaired in GBM long-term survivors. As the incidence of long-term survival is very less, there is a need for larger multicenter studies to come up with definitive results, which in turn can help in formatting the rehabilitative and support programs for these patients.

Review of Results of QuantiFERON TB Gold Test in Presumed Ocular Tuberculosis in a South Indian Patient Population.

AIM: To review the results of QuantiFERON TB gold (QFT-G) in our patient population of presumed ocular tuberculosis and the effect of antitubercular therapy (ATT) on the QFT-G result. MATERIALS AND METHODS: Retrospective review of 82 cases of presumed ocular tuberculosis with a successful response to ATT and 6 months follow-up post-ATT. Appropriate statistical analysis was done for associations between QFT-G and independent variables. Pre-ATT QFT-G values were also compared to the post-ATT value. RESULTS: There were no statistically significant differences in the results of QFT-G with age (0.635), gender (0.096), history of oral steroids (0.171), or type of uveitis (0.664). There was a statistically significant association between a positive QFT-G and serpiginous-like choroiditis (0.048). The majority of our patients had positive QFT even after completion of ATT but with a significant drop in the mean values post ATT (0.010). CONCLUSIONS: Our study shows significant association of positive QFT with serpiginous-like choroiditis and persistent positivity even after completion of ATT in majority of cases in our population. There was, however, a drop in the mean values of QFT-G post-ATT.

Cascading and combined effects of cognitive deficits and residual symptoms on functional outcome in schizophrenia - A path-analytical approach.

Understanding the complex relationship among determinants of real-world functioning in schizophrenia patients in remission is important in planning recovery-oriented interventions. We explored two path-analytical models of functioning in schizophrenia. 170 Schizophrenia patients remitted from positive symptoms underwent fairly comprehensive assessments of cognition - neurocognition (NC) and social cognition (SC), residual symptoms - insight, motivation and other negative symptoms, and socio-occupational functioning. We explored (a) a cascading model, where NC predicted functional outcome through its effects on other determinants and (b) a combined model, incorporating additional direct paths from each of the determinants. The combined model, and not the cascading model demonstrated a good fit. Post-hoc trimming of the combined model by elimination of non-significant paths maintained the goodness-of-fit and was retained as the final model. In addition to the direct paths, this final model demonstrated that (a) NC influenced functioning through SC and insight and (b) SC influenced functioning through motivation and negative symptoms. This suggests that NC and SC may influence functional outcome directly, as well as indirectly, via specific impact on insight, and motivation and negative symptoms respectively.

Management of generalised convulsive status epilepticus (SE): A prospective randomised controlled study of combined treatment with intravenous lorazepam with either phenytoin, sodium valproate or levetiracetam--Pilot study.

OBJECTIVE: This study was conducted to compare the efficacy of phenytoin, valproate and levetiracetam in patients with GCSE. METHODS: This randomised controlled prospective study was conducted on 150 patients to compare the efficacy of phenytoin (n = 50), valproate (n = 50) and levetiracetam (n = 50) along with lorazepam in patients with GCSE. All recruited patients received i.v. lorazepam (0.1mg/kg) followed by one of the 3 AEDs viz. phenytoin (20 mg/kg), valproate (30 mg/kg), and levetiracetam (25 mg/kg). Those who remained uncontrolled with 1st AED, received the other two AEDs sequentially. Clinical, imaging, EEG, etiological factors were analysed. Predictors of poor seizure control and outcome at discharge and at one month follow-up were assessed. RESULTS: In the phenytoin subgroup, the seizures could be controlled in 34 (68%) with lorazepam+phenytoin infusion. In the valproate subgroup (n = 50), seizures could be controlled in 34 (68%) with lorazepam+valproate infusion. In the levetiracetam subgroup (n = 50), seizures could be controlled in 39 (78%) with lorazepam+levetiracetam infusion. There was no statistically significant difference between the subgroups (p = 0.44). Overall, following lorazepam and 1st AED, 107/150 (71.3%) were controlled; with addition of 2nd AED, 130/150 (86.7%) and by adding 3rd AED, 138/150 (92%) were controlled. Fifteen out of 110 (13.6%) expired within 1 month of SE: phenytoin-6; valproate-4; and levetiracetam-5. Interestingly, 3 patients in the levetiracetam had post-ictal psychosis. SIGNIFICANCE: Phenytoin, valproate, and levetiracetam are safe and equally efficacious following lorazepam in GCSE. The choice of AEDs could be individualised based on co-morbidities. SE could be controlled in 92% of patients with AEDs only and anaesthetics were not required in them.

Childhood autism spectrum disorders with and without epilepsy: clinical implications.

This prospective cross-sectional study compared 25 children with pervasive developmental disorder and epilepsy and 25 children having pervasive developmental disorder without epilepsy on pervasive developmental disorder scores, Childhood Autism Rating Scale scores, language disability, presence of regression, and epileptiform abnormalities. Epilepsy phenotype was also studied. Children with pervasive developmental disorder and epilepsy had higher pervasive developmental disorder scores (P = .001), higher Childhood Autism Rating Scale scores (P = .016), and lower social quotient (P = .09). More than 50% of children with pervasive developmental disorder and epilepsy and 12% of children having pervasive developmental disorder without epilepsy had epileptiform abnormalities in electroencephalography (EEG). Regression of milestones was significantly associated with epilepsy and epileptiform abnormalities. Children with pervasive developmental disorder and epilepsy might have a worse developmental trajectory requiring intensive management. A behavioral phenotype of autism may coexist often in children with epilepsy, EEG abnormalities, and regression. Seizures might be difficult to control in these children despite adequate compliance. Studies with larger sample size and longitudinal follow-up will provide better understanding.

Prevalence and sociodemographic correlates of primary headache disorders: results of a population-based survey from Bangalore, India.

BACKGROUND: Headache disorders are common and burdensome throughout the world, placing high demand on health care services. Good information on their prevalence and distribution through sectors of the population are a prerequisite for planning interventions and organizing services, but unavailable for India. OBJECTIVES: To find out the prevalence of headache disorders in Karnataka State and establish important sociodemographic associations. MATERIALS AND METHODS: Using a door to door survey technique, amongst 2997 households, 2329 individuals were interviewed with a validated structured questionnaire by randomly sampling one adult member (aged 18-65 years) from eligible households in urban (n = 1226) and rural (n = 1103) areas of Bangalore, during the period April 2009 and January 2010. STATISTICAL ANALYSIS USED: Chi-square, odds ratio (OR), and logistic regression. RESULTS: The 1-year prevalence of headache was 63.9% (62.0% when adjusted for age, gender and habitation) and 1-day prevalence (headache on the day prior to the survey) was 5.9%. Prevalence was higher in the age groups of 18-45 years, among females (OR = 2.3; 95% confidence interval: 1.9-2.7) and those in rural areas. Prevalence was higher in rural (71.2 [68.4-73.8]) than in urban areas (57.3 [54.5-60.1]) even after adjusting for gender. The proportion of days lost to headache from paid work was 1.1%, while overall productivity loss (from both paid and household work) was 2.8%. CONCLUSIONS: Headache disorders are a major health problem in India with significant burden. It requires systematic efforts to organize effective services to be able to reach a large number of people in urban and rural India. Education of physicians and other health-care workers, and the public should be a pillar of such efforts.

Similar and contrasting dimensions of social cognition in schizophrenia and healthy subjects.

Schizophrenia patients experience substantial impairments in social cognition (SC) and these deficits are associated with their poor functional outcome. Though SC is consistently shown to emerge as a cognitive dimension distinct from neurocognition, the dimensionality of SC is poorly understood. Moreover, comparing the components of SC between schizophrenia patients and healthy comparison subjects would provide specific insights on the construct validity of SC. We conducted principal component analyses of eight SC test scores (representing four domains of SC, namely, theory of mind, emotion processing, social perception and attributional bias) independently in 170 remitted schizophrenia patients and 111 matched healthy comparison subjects. We also conducted regression analyses to evaluate the relative contribution of individual SC components to other symptom dimensions, which are important clinical determinants of functional outcome (i.e., neurocognition, negative symptoms, motivational deficits and insight) in schizophrenia. A three-factor solution representing socio-emotional processing, social-inferential ability and external attribution components emerged in the patient group that accounted for 64.43% of the variance. In contrast, a two-factor solution representing socio-emotional processing and social-inferential ability was derived in the healthy comparison group that explained 56.5% of the variance. In the patient group, the social-inferential component predicted negative symptoms and motivational deficits. Our results suggest the presence of a multidimensional SC construct. The dimensionality of SC observed across the two groups, though not identical, displayed important parallels. Individual components also demonstrated distinct patterns of association with other symptom dimensions, thus supporting their external validity.

Intermittent clobazam prophylaxis in hot water epilepsy is safe and effective: a prospective study.

PURPOSE: To evaluate the role of intermittent prophylaxis with clobazam in the management of HWE in a long-term prospective study. MATERIAL AND METHODS: Two hundred and sixty patients [M:F - 194:66] with HWE were recruited. Patients were divided into: (a) 'HWE alone' (n=198) - received intermittent clobazam prophylaxis, 1-1½h prior to hot water head bath (group A); (b) 62 patients (20.4%) with 'HWE with spontaneous seizures were treated with continuous AEDs along with intermittent clobazam therapy (group B). RESULTS: Patients (n=198) in group A was followed for mean of 17.6 ± 10.6 months (range: 3-57). One hundred and forty seven patients (74.2%) had excellent response with complete seizure freedom with clobazam therapy while 12 (6.1%) had >75% reduction in seizure frequency. Remaining 39 (19.7%) required additional standard AED along with clobazam and 18 patients among them developed spontaneous/unprovoked seizure at follow up of 6.7 ± 4.1 months. Forty five patients in group B were seizure free while on continuous AEDs. CONCLUSIONS: Intermittent clobazam prophylaxis prior to head water bath might be a preferred mode of treatment of pure HWE. Additional AEDs are required if they have associated non-reflex unprovoked seizure.

The effect of phenobarbitone on cognition in adult patients with new onset epilepsy: a multi-centric prospective study from India.

OBJECTIVE: In view of the conflicting results of cognitive and behavioral consequences of PB, the present study was planned to analyze its efficacy, serial neuropsychological functions and its impact on psychosocial functioning in adults with epilepsy while on phenobarbitone (PB). METHODOLOGY: This prospective multi-centric study carried out across 4 centers in India included 75 adult patients of ≥18 years (M:F=52:23; age: 27.3 ± 8.5 years) with epilepsy who were prescribed phenobarbitone and underwent serial standardized neuropsychological assessment (NIMHANS battery for adults) at baseline, 1 month, 3 months, 6 months and 12 months. The demographic, seizure details and outcome measures were recorded. RESULTS: Of the 75 patients, 63 had completed clinical and neuropsychological assessment, i.e. visit 1 (baseline), visit 4 (6 months) and visit 5 (12 months). There was no deterioration rather an improvement during the follow visits in all the neuropsychological functions. The results indicate that 16 neuropsychological variables changed significantly, viz. mental speed (p<0.001), sustained attention (p<0.001), focused attention (p<0.002), planning (p<0.001), concept formation (p<0.05), set shifting (p<0.001), verbal learning (p<0.0001), verbal memory (p<0.0001), visual memory (p<0.0001) and intelligence (p<0.001). The scales measuring the outcome of psychosocial functioning significantly changed during follow up included happiness (p<0.002), Impact of Epilepsy on patient's life (p<0.02), A-B Neuropsychological Assessment (p<0.015), HADS anxiety (p<0.001) and emotional disorder (p<0.006). There was a significant reduction in seizure severity as measured by Liverpool Seizure Severity Scale (p<0.002) and seizure freedom was maintained. CONCLUSIONS: This study demonstrated that phenobarbitone is effective, well tolerated AED and do not have cognitive impairment over one year. There was variable but distinct improvement in cognition and psychosocial functioning, and effective seizure control could be one of the factor for it.

Clinical profile of isolated viral anterior uveitis in a South Indian patient population.

AIM: To analyze the clinic profile of polymerase chain reaction proven viral anterior uveitis in a south Indian patient population. MATERIALS & METHODS: Retrospective, nonrandomized study between January 2009 and July 2012. RESULTS: Out of the 36 patients with polymerase chain reaction (PCR)-positive viral anterior uveitis, 24 patients had varicella zoster virus (VZV) anterior uveitis, 7 patients had HSV anterior uveitis, 3 patients had cytomegalovirus (CMV) anterior uveitis, and 2 patients had chikungunya virus related anterior uveitis. Corneal involvement was seen in 21 cases (58.33%). An altered iris pattern was seen in 14 cases (38.89%). Increase in intraocular pressure (IOP) at the time of inflammation was seen in 10 cases (27.78%). Reactivations were seen in 22 cases (61.11%). A comparison of herpes simplex virus (HSV)- and VZV-related anterior uveitis did not reveal any significant factors except for a previous history of herpes zoster in VZV-associated uveitis. CONCLUSION: We see isolated viral anterior uveitis related to HSV, VZV, CMV, and chikungunya viruses in our patient population. Corneal involvement, pigmented keratic precipitates, an abnormal iris pattern, increase in IOP, and reactivations are seen as a spectrum of viral anterior uveitis in our patient population as well.

Evident stabilization of the clinical profile in HIV/AIDS as evaluated in an open label clinical trial using a polyherbal formulation.

BACKGROUND & OBJECTIVES: The complementary and alternative medicines (CAM) have not been systematically evaluated for the management of HIV/AIDS patients. In a prospective, single-site, open-label, non-randomized, controlled, pilot trial, we evaluated a polyherbal formulation (PHF) for its safety and efficacy in treating subjects with HIV-AIDS. METHODS: A total of 32 and 31 subjects were enrolled under the PHF and highly active antiretroviral treatment (HAART) arms, respectively, and followed up for a period of 24 months. Plasma viral RNA, CD4 cell count and blood chemistry were monitored at 3-month intervals. Following mid-term safety evaluation, 12 subjects from the PHF arm were shifted to HAART and were followed separately as PHF-to-HAART arm, for the rest of the period. RESULTS: The HAART arm was characterized by significant improvements in CD4 cell count (154.4 cells/µl/year, P<0.001) and reduction in plasma viral load within 3 to 6 months (-0.431+ 0.004 log 10 IU/month, P<0.001). In contrast, the PHF arm showed a profile of CD4 cell loss at remarkably slower kinetics (14.3 cells/µl/year, P=0.021) and insignificant reduction in the viral load. The PHF and HAART arms did not differ significantly in the occurrence of AIDS-related illnesses over the study period of 24 months. In the PHF-to-HAART arm, the rates of CD4 count and reduction in viral load were significant and comparable to that of the HAART group. In the PHF arm, at 1 month, a significant increase in CD4 cell count and a concomitant decrease in viral load were seen. INTERPRETATION & CONCLUSIONS: The PHF appears to have provided protection by delaying the kinetics of CD4 cell reduction. Given the several study limitations, drawing assertive inferences from the data is challenging. Future studies with a stringent study design are warranted to confirm these findings.

Social and neuro-cognition as distinct cognitive factors in schizophrenia: a systematic review.

Social cognition (SC) and neuro-cognition (NC) have emerged as predictors of functional outcome and possible endophenotype-markers in schizophrenia. The distinctiveness of these two domains is not well established. Factor analysis is used to identify distinct cognitive dimensions. This paper aims to systematically review studies reporting factor analysis of SC and NC in schizophrenia to provide empirical evidence for (a) distinctiveness of SC and NC; and (b) factor structure of SC. The review comprised 20 studies. Most of the studies were cross-sectional, involving variably defined 'stable' schizophrenia patients, using objective assessments of SC and NC. A quality check on reporting practices of factor analytic studies showed important deficiencies in reporting both exploratory and confirmatory factor analyses. There was fairly consistent evidence for the existence of distinct SC and NC factors, with eight out of nine studies supporting this separateness of the two cognitive dimensions. The results were inconsistent regarding factor structure of SC. Unitary, binary and multi-factorial constructs were reported, possibly due to variability and lack of comprehensiveness of the SC measures used. This review highlights distinctiveness of SC and NC dimensions in schizophrenia. It thus provides construct validity for cognition in schizophrenia and offers clues regarding the potential neural processes underlying these cognitive dimensions. Future studies exploring the factor structure of SC should be guided by more careful theoretical work and use comprehensive measures of SC in large homogeneous samples of schizophrenia patients.

Therapeutic efficacy of add-on yogasana intervention in stabilized outpatient schizophrenia: Randomized controlled comparison with exercise and waitlist.

BACKGROUND: Schizophrenia is a highly disabling illness. Previous studies have shown yoga to be a feasible add-on therapy in schizophrenia. AIMS: The current study aimed to test the efficacy of yoga as an add-on treatment in outpatients with schizophrenia. SETTINGS AND DESIGN: The study done at a tertiary psychiatry center used a single blind randomized controlled design with active control and waitlist groups. MATERIALS AND METHODS: Consenting patients with schizophrenia were randomized into yoga, exercise, or waitlist group. They continued to receive pharmacological therapy that was unchanged during the study. Patients in the yoga or exercise group were offered supervised daily procedures for one month. All patients were assessed by a blind rater at the start of the intervention and at the end of 4 months. RESULTS: Kendall tau, a nonparametric statistical test, showed that significantly more patients in the yoga group improved in Positive and Negative Syndrome Scale (PANSS) negative and total PANSS scores as well as social functioning scores compared with the exercise and waitlist group. Odds ratio analysis showed that the likelihood of improvement in yoga group in terms of negative symptoms was about five times greater than either the exercise or waitlist groups. CONCLUSION: In schizophrenia patients with several years of illness and on stabilized pharmacological therapy, one-month training followed by three months of home practices of yoga as an add-on treatment offered significant advantage over exercise or treatment as usual. Yoga holds promise as a complementary intervention in the management of schizophrenia.

Quality of life in anxiety disorders: its relation to work and social functioning and dysfunctional cognitions: an exploratory study from India.

The aim of the study was to examine quality of life, functioning, disability, work and social adjustment, depression, anxiety and dysfunctional cognitions in patients with anxiety disorders. One hundred patients with anxiety disorders and 98 non-clinical participants were recruited for the study. A cross sectional design was adopted. The participants were assessed on the WHOQoL-BREF, Global Assessment of Functioning (GAF), Sheehan Disability Scale (SDS), the Work and Social Adjustment Scale (WSAS) and Dysfunctional Attitudes Scale (DAS). Data was analyzed using descriptive statistics, Mann-Whitney test, Spearman's Rho and regression analysis. Patients with anxiety disorders reported significantly lower quality of life than the community sample (df=98, p<.001). A shorter duration of illness was associated with lower quality of life. QoL was significantly correlated with severity of anxiety, depression and stress as well as with measures of disability and adjustment. Partial correlations indicated that depression did not significantly impact the relationship between work and social adjustment and QoL. Work and social adjustment, depression and dysfunctional cognitions emerged as significant predictors of QoL. The findings of the study are discussed in the light of existing research and the implications for future interventions are highlighted.

Hot water epilepsy clinical profile and treatment--a prospective study.

PURPOSE: This study characterized the demographic, clinical, EEG and imaging profile, and therapeutic outcome among patients with hot water epilepsy (HWE). METHODOLOGY: This prospective study included 70 patients with HWE (M:F=55:15; age: 25.3±8.4 years). Details of demography, seizure characteristics and outcome, and imaging/EEG observations were recorded. RESULT: There was male dominance. Majority of the patients belonged to Mandya: 30.5%, Ramanagara: 30.0% and Mysore: 15.2% districts of Karnataka, India. Forty-five patients (M:F=37:8; age: 24.6±10.1 years) had features of 'HWE alone'. Twenty-five (M:F=18:7; age: 26.7±7.9 years) had HWE with spontaneous seizures. The age at onset of seizures was comparable in both the groups - HWE: 18.7±10.2 years vs. HWE with spontaneous seizure: 16.8±10.3 years (p=0.34). The duration of seizures were more in HWE with spontaneous seizure group: 119.5±66.9 months compared to HWE alone: 69.9±13.8 months (p=0.028). Inter-ictal EEG (n=70) showed epileptiform activities in 15 patients (21.4%). The therapeutic outcome after 3-8 months of follow up were - (a) HWE group: 6 stopped hot water head bath; 39 were on intermittent clobazam therapy - seizure free: 33; and 6 received AEDs; (b) HWE with spontaneous seizure group: all were on AEDs and seizure free. CONCLUSIONS: Three-fourth of patients belonged to 'Mandya-Mysore belt of Karnataka'. There was increased duration of seizures among those with additional spontaneous seizure. About 3/4th subjects with HWE alone were seizure free with intermittent clobazam and remaining patients on AEDs were seizure free, confirming the earlier observations from this center.

Temporal resolution deficits in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS).

We studied the temporal resolution ability in patients with refractory complex partial seizures and mesial temporal sclerosis (MTS) using Gaps-In-Noise (GIN) test in a prospective cross-sectional study. Thirteen patients with right MTS (age: 31±7.67 years; M:F=8:5) and 13 patients with left MTS (age: 25.76±8.26 years; M:F=9:4) having normal hearing and mini-mental state examination (MMSE) score of >23/30 were recruited. Fifty healthy volunteers (26.3±5.17 years; M:F=28:22) formed the control group. Gaps-In-Noise test demonstrated impaired temporal resolution: 69.2% of patients with right MTS (RMTS) and 76.9% of patients with left MTS (LMTS) had abnormal scores in the right ear for gap detection threshold (GDT) measure. Similarly, 53.8% of patients in the RMTS group and 76.9% of patients in the LMTS group had abnormal scores in the left ear. In percentage of correct identification (PCI), 46.1% of patients with RMTS and 69.2% of patients with LMTS had poorer scores in the right ear, whereas 46.1% of patients with RMTS and 61.5% of patients with LMTS had poorer scores in the left ear. Both patient groups, viz., RMTS and LMTS, demonstrated bilateral temporal resolution deficits.

Sodium butyrate modulates pRb phosphorylation and induces cell death in human vestibular schwannomas in vitro.

In the present study, effect of Na-Bu on the pRb phosphorylation was analysed in the primary cultures of 12 VS tumors. Primary cultures of VS tumors were established from the fresh tumor tissues removed surgically and were treated with Na-Bu. Na-Bu treatment for 48 h led to morphological changes and apoptotic cell death in VS tumor cells. Na-Bu treatment decreased level of total pRb and phosphorylated form of pRb and caused specific dephosphorylation at Ser 249/Thr 252 and Ser 567. In the untreated and Na-Bu treated cells (when present), pRb was localised in the nucleus. Moreover, in Na-Bu treated cells the nucleus appeared highly condensed as compared to untreated cells. Results of the present study indicated that Na-Bu treatment modulated pRb phosphorylation status and caused apoptotic cell death in VS tumors.

Initiating tobacco cessation services in India: challenges and opportunities.

BACKGROUND: Tobacco use contributes significantly to the diseases burden in India. Very few tobacco users spontaneously quit. Therefore, beginning 2002, a network of 19 tobacco cessation clinics (TCCs) was set up over a period of time to study the feasibility of establishing tobacco cessation services. METHODS: Review of the process and operational aspects of setting up TCCs was carried out by evaluation of the records of TCCs in India. Baseline and follow-up information was recorded on a pre-designed form. RESULTS: During a five-year period, 34 741 subjects attended the TCCs. Baseline information was recorded in 23 320 cases. The clients were predominantly (92.5%) above 20 years, married (74.1%) and males (92.2%). All of them received simple tips for quitting tobacco; 68.9% received behavioural counselling for relapse prevention and 31% were prescribed adjunct medication. At six-week follow-up, 3255 (14%) of the tobacco users had quit and 5187 (22%) had reduced tobacco use by more than 50%. Data for three, three-monthly follow-ups was available for 12 813 patients. In this group, 26% had either quit or significantly reduced tobacco use at first follow-up (three-months), 21% at the second (six-months) and 18% at the third follow-up (nine-months) had done so. CONCLUSIONS: It is feasible to set up effective tobacco cessation clinics in developing countries. Integration of these services into the health care delivery system still remains a challenge.

Predictors for tubercular uveitis: a comparison between biopsy-proven cases of tubercular and sarcoid uveitis.

AIM: To look for clinical parameters that will assist in making a diagnosis of tubercular or sarcoid uveitis in a South Indian patient population METHODS: Retrospective, nonrandomized, comparative study of 51 patients with a diagnosis of biopsy-proven tuberculosis and sarcoidosis. These patients had a minimum of 1-year follow-up after initiating treatment for either disease. Multivariate logistic regression analysis was used to determine clinical predictors of tubercular uveitis. RESULTS: The mean age group was 47.08 ± 11.19 years. There were 39 women and 12 men in the study. Multivariate logistic regression analysis shows likelihood of uveitis being tubercular in etiology using 3 variables: Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and a positive Mantoux test 76.6%. CONCLUSION: A combination of Schirmer test >10 mm, retinal vasculitis with areas of multiple, pigmented chorioretinal atrophy along blood vessels, and positive Mantoux test may be used clinically to differentiate tubercular from sarcoid uveitis in our patient population.

HLA-B57 and gender influence the occurrence of tuberculosis in HIV infected people of south India.

BACKGROUND: Substantial evidence exists for HLA and other host genetic factors being determinants of susceptibility or resistance to infectious diseases. However, very little information is available on the role of host genetic factors in HIV-TB coinfection. Hence, a longitudinal study was undertaken to investigate HLA associations in a cohort of HIV seropositive individuals with and without TB in Bangalore, South India. METHODS: A cohort of 238 HIV seropositive subjects were typed for HLA-A, B, and DR by PCR-SSP and followed up for 5 years or till manifestation of Tuberculosis. HLA data of 682 HIV Negative healthy renal donors was used as control. RESULTS: The ratio of males and females in HIV cohort was comparable (50.4% and 49.6%). But the incidence of TB was markedly lower in females (12.6%,) than males (25.6%). Further, HLA-B*57 frequency in HIV cohort was significantly higher among females without TB (21.6%, 19/88) than males (1.7%, 1/59); P = 0.0046; OR = 38. CD4 counts also were higher among females in this cohort. CONCLUSION: This study suggests that HIV positive women with HLA-B*57 have less occurrence of TB as compared to males.