Screening for diabetes among tuberculosis patients registered under revised national tuberculosis control program, Bhopal, India.

CONTEXT: Tuberculosis (TB) and diabetes mellitus (DM) remain a global public health problem. India has the largest number of TB cases; in 2015, out of total global annual incidence of 9.6 million TB cases, 2.2 million were estimated from India. There are 62.4 million people with type 2 diabetes and 77 million people with prediabetes in India, and these numbers are projected to increase to 101 million by the year 2030. Diabetes and TB affect each other at many levels. Screening for diabetes in patients with TB will not only help in early case detection but also better management of both comorbidities. AIMS: (i) To determine the prevalence of diabetes and prediabetes among diagnosed cases of TB registered under RNTCP in Bhopal district. (ii) To determine additional yield of previously unknown DM and the number needed to screen (NNS) to find out a new case of DM. (iii) To find out the factors associated with diabetes among patients diagnosed with TB registered under RNTCP in Bhopal district. SETTINGS AND DESIGN: This study was a cross-sectional study conducted on registered patients with TB under RNTCP in two TB units of Bhopal district. MATERIALS AND METHODS: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested performa during the period of 1st October 2014 to 30th March 2015 for a period of 6 months. STATISTICAL ANALYSIS USED: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. RESULT: Of the total 528 patients with TB, 296 was male and 232 were female. Of the total, 63 (11.9%) patients were diagnosed as diabetic. NNS to diagnose a new case of DM was 22.1. Significant association was found with six variables which are age, sex, body mass index, type of TB, category of TB, and smoking. CONCLUSION: This study shows feasibility and importance of screening of patients with TB in existing program settings.

Clinical characteristics of renal cell carcinoma: Five years review from a tertiary hospital in Eastern India.

BACKGROUND: Renal cell carcinoma (RCC) is the one of the dreadful urological carcinoma. In comparison to the West, it is very rarely seen in Asia as well in India. Very small number of studies is available in this geographical area. AIMS: We studied the demographic pattern, presentation, risk factors and survival of RCC in an Eastern Indian institution. We characterized and compared these data with available literature Settings and Design: Retrospective study. MATERIALS AND METHODS: A total of 81 patients of RCC from January 2008 to December 2012 were enrolled. Their pre-operative data were reviewed. They were followed as per institutional follow-up protocol. STATISTICAL ANALYSIS USED: Kaplan-Meier plot was constructed for survival analysis. Comparison of survival curves was performed by Logrank test. P < 0.05 was considered to be significant. RESULTS: A total of 75 patients were analyzed with a mean follow-up of 26.3 ± 17.7 months. The mean age of presentation in our study was 52.79 years with a peak at 5th decade. Nearly 73.33% patients having one or more risk factors. 9 out of 10 had presented with some symptoms. The survival for localized RCC was 100% and significantly greater than advanced RCC (P < 0.0001). Similarly in the stage III, significant greater survival (P < 0.0001) was noted compare to stage IV. CONCLUSIONS: The age of presentation of RCC in India has been found in 5th decade, which is a decade earlier than the western countries. Symptomatic RCC is still majority in India. Organ confined tumors have good prognosis. When it metastasizes to lymph node or distant organ, the outcome is poor. Our results may form the basis for further studies and it may be used as future reference.

Evidence for linkage of migraine in Rolandic epilepsy to known 1q23 FHM2 and novel 17q22 genetic loci.

Migraine headaches are a common comorbidity in Rolandic epilepsy (RE) and familial aggregation of migraine in RE families suggests a genetic basis not mediated by seizures. We performed a genome-wide linkage analysis of the migraine phenotype in 38 families with RE to localize potential genetic contribution, with a follow-up in an additional 21 families at linked loci. We used two-point and multipoint LOD (logarithm of the odds) score methods for linkage, maximized over genetic models. We found evidence of linkage to migraine at chromosome 17q12-22 [multipoint HLOD (heterogeneity LOD) 4.40, recessive, 99% penetrance], replicated in the second dataset (HLOD 2.61), and suggestive evidence at 1q23.1-23.2, centering over the FHM2 locus (two-point LOD 3.00 and MP HLOD 2.52). Sanger sequencing in 14 migraine-affected individuals found no coding mutations in the FHM2 gene ATP1A2. There was no evidence of pleiotropy for migraine and either reading or speech disorder, or the electroencephalographic endophenotype of RE when the affected definition was redefined as those with migraine or the comorbid phenotype, and pedigrees were reanalyzed for linkage. In summary, we report a novel migraine susceptibility locus at 17q12-22, and a second locus that may contribute to migraine in the general population at 1q23.1-23.2. Comorbid migraine in RE appears genetically influenced, but we did not obtain evidence that the identified susceptibility loci are consistent with pleiotropic effects on other comorbidities in RE. Loci identified here should be fine-mapped in individuals from RE families with migraine, and prioritized for analysis in other types of epilepsy-associated migraine.

Risk factors for breast cancer among women in Bhopal urban agglomerate: a case-control study.

BACKGROUND: Breast cancer is the most common cancer in females worldwide, and the second leading cause of cancer deaths in women. The incidence is on the rise in India, and breast cancer is the second most common malignancy in Indian women. OBJECTIVE: To assess the risk factors for breast cancer patients living in Bhopal. STUDY DESIGN AND METHOD: This case-control study was conducted in Bhopal urban agglomerate for a period of a year from October 2008 to August 2009. Demographic data and reproductive risk factor related information was collected using a structured questionnaire with analyses by Epi-info and SPSS 16. RESULTS: A history of oral contraceptive pill use (OR=2.77, 95% CI: 1.15-6.65), history of not having breastfeeding (OR=3.49, 95% CI:1.22-9.97), over weight (OR=0.11, 95%CI:0.02-0.49), obese women (OR=0.24, 95%CI: 0.06-0.88) and family history of breast cancer (OR=3.89, 95% CI: 1.01-14.92) were associated significantly with the occurrence of breast cancer on multivariate analysis. CONCLUSIONS: The findings of the present study suggests that positive family history of breast cancer and history of using OCP may be the epigenetic factors promoting the occurrence of breast cancer while breastfeeding reduces the possibility of acquiring breast cancer.

Inverted papilloma of the urinary bladder: Rigorous surveillance needed? An Indian experience.

AIMS: Inverted papilloma (IP) is an uncommon benign neoplasm of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) leads to conflicting clinical conclusions regarding its biological behavior, and hence, the need for rigorous follow-up protocols. In this study, we review all cases of urinary bladder IP in our institution and determine the need for strict follow-up. MATERIALS AND METHODS: We included consecutive patients from August 2004 to August 2008 with IP of the urinary bladder in this study who did not have prior or concurrent urothelial carcinoma. A single pathologist performed the histologic review. The patients had undergone strict a follow-up schedule every 6 months. RESULTS: In our study of the 24 patients, the mean age at presentation was 53.5 (range 22-81) years. The mean follow-up period was 25.8 months (range 6-58 months). Of the 24 patients, 21 were men and 3 were women. No patient had a synchronous or previous bladder tumor. The most common presenting symptoms were macroscopic hematuria and dysuria. All were solitary tumors except one, most commonly found at the bladder neck and trigone. The average follow-up period was 2.5 years without any evidence of recurrence. CONCLUSIONS: We conclude that when diagnosed by strictly defined criteria, IP as benign urothelial neoplasm was with extremely low incidence of recurrence and good prognosis. It does not seem to be a risk factor for TCC, especially if located in the bladder. Therefore, a good transurethral resection is adequate therapy and follow-up protocol as rigorous as those for TCC may not be necessary.

Urethrorectal fistula by bull horn injury.

Bull horn injuries are common in rural India. Here one such case causing urethrorectal fistula has been reported. The patient was presented with history of bull horn injury 6 hours back. He was examined under general anaesthesia and found to have lacerations in the anus and anterior wall of rectum. Urgent retrograde urethrography and cystography showed partial rupture of bulbar urethra and urethrorectal fistula. Initially sigmoid colostomy and suprapubic cystostomy was done. Later optical internal urethrotomy was done. The patient was catheterised for 3 weeks and the fistula healed completely.

QSAR of antineoplastics IV: Hansch analysis of N-(7-indolyl)benzenesulfonamides against KB human nasopharynx carcinoma, colon 38 murine adenocarcinoma and P388 murine leukemia cell lines.

Hansch analysis of recently reported antitumor activities of novel N-(7-indolyl)benzenesulfonamide derivatives against KB human nasopharynx carcinoma, colon 38 murine adenocarcinoma and P388 murine leukemia cell lines reveals that the pattern of receptor interactions in human KB cells differs from that in murine (colon 38 and P388 leukemia) cells. The latter two activities are autocorrelated and show similar receptor specificity. It seems that two binding sites, one interacting with the indole fragment and another with phenyl fragment of the indolylbenzenesulfonamide compounds, are present on the murine cell receptors (colon 38 and P388 leukemia) while only the latter binding site is active on the human KB cell receptors. For the activity against KB cells, a para-methyl or paramethoxy substituent on the phenyl ring of benzenesulfonamide moiety greatly enhances the activity. For the other two activities, a 3-chloro or 3-cyano substituent on indole nucleus enhances activities, while presence of bulkier meta or para substituent on the phenyl ring decreases activities. Presence of an ortho substituent on the phenyl ring appears to be detrimental for all the three activities. Equations generated by both QSAR and QAAR studies are quite robust as evidenced from cross-validation by 'leave-one-out' technique.

QSAR of antineoplastics V: Exploration of receptor interaction sites of antitumor N-(7-indolyl)benzenesulfonamides targeting GI phase using electrotopological state atom index.

Quantitative structure activity relationship (QSAR) study of antiproliferative activities of N-(7-indolyl)benzenesulfonamides with electrotopological state atom (ETSA) index corroborates the conclusions of the previously reported Hansch analysis that the structural requirements for interactions with receptors of human KB nasopharynx cell line are different from that for murine colon 38 and P388 leukemia cell lines. The study suggests that both phenyl ring and indole moiety are the important receptor interaction sites present on the ligands for the murine cell lines, while the latter site does not appear to play significant role in case of human KB cell carcinoma.

Neurocysticercosis and epilepsy in developing countries.

Neurocysticercosis is a disease of poverty and underdevelopment. Little is known about the natural history of the infection in humans, but some of the mechanisms whereby the parasite remains silent and evades the host immune response are understood. Symptomatic neurocysticercosis usually results from host inflammatory response after parasite death, and the clinical manifestations can be diverse. There is no evidence that cysticidal treatment does more good than harm in addition to conventional antiepileptic treatment. Population control measures involving immunisation or mass treatment have not shown long term effectiveness.Epilepsy, similarly to neurocysticercosis, is a largely unrecognised but increasing burden on the welfare and economies of developing countries. The technology of drug treatment and psychosocial rehabilitation is well known but requires widespread and effective dissemination at low cost. There is little epidemiological data on risk factors for epilepsy in developing countries on which to base prevention strategies. The public health prioritisation of chronic disorders such as epilepsy remains a challenge for policy and practice in developing countries. For both neurocysticercosis and epilepsy, there is a dilemma about whether limited public resources would better be spent on general economic development, which would be expected to have a broad impact on the health and welfare of communities, or on specific programmes to help individual affected people with neurocysticercosis and epilepsy. Either approach requires detailed economic evaluation.

Evaluation of best surgical procedures in typhoid perforation--an experience of 60 cases.

The results of treatment of 60 cases of typhoid perforation were reviewed over a period of 4.5 years. Closure of the perforation was the method of treatment in 28 (46.66%) cases and closure of the perforation with side-to-side ileotransverse anastomosis was done in 32 (53.33%) cases. Faecal fistula was the most severe post-operative complication following simple closure of the perforation, causing death in all patients and leading to a 25% mortality in those treated by this technique. No fistula was found following closure of the perforation with side-to-side ileotransverse anastomosis, leading to a much lower mortality of 6.22%. The overall mortality in this series was 15%. Apart from toxaemia, surgical failure was the main contributory factor to such a high mortality. In this series, closure of the perforation with side-to-side ileotransverse anastomosis was the better surgical procedure.

Simple renal cyst: an observation.

In the present study 1500 patients having abdominal ultrasonography were included. Unsuspected renal cysts were detected in 76 patients (5.06%). The age range was between 8 and 86 years with a maximum incidence being at 41-60 years age group. These asymptomatic cysts were observed commonly in the upper pole of right kidney. Incidence as well as size increased with age. Usually these cysts do not require any surgical intervention unless complicated.

Possible antineoplastic agents: Part XIII. Synthesis, biological evaluation and QSAR studies of some 1-(substituted benzenesulphonyl)-5-oxopyrrolidine-2-carboxylic acid derivatives.

Twelve analogues of 1-(substituted benzenesulphonyl)-5-oxopyrrolidine-2- carboxylic acid have been synthesized and tested for antineoplastic activity in Swiss albino mice with an Ehrlich ascites carcinoma (EAC) cell line. The values of percent inhibition of growth, both in ascitic cell count and fluid weight, have been taken as activity parameters. Quantitative structure-activity relationships (QSAR) have been studied using the LFER model. The best correlation (R2 = 93.0%) was found using molar refractivity (MR), which measures the molar volume and polarizability of the substituents.

Correlation of phospholipid loss in goat whole blood with solvochromic properties of antiamebics like emetine, metronidazole and diloxanide furoate.

Phospholipid content of whole blood lipid decreases significantly when goat blood is incubated for different length of time with different amebicidal agents (e.g., emetine, metronidazole and diloxanide furoate). The plots of relative per cent phosphate loss against incubation period show biphasic nature and suggest that the rates of phospholipid loss bears some relation with the drug's lipophilicity (log P in 1 octanol/water system). The absolute phospholipid loss seems to be governed by the drug's aquasolubility. Implication of these finding were discussed in terms of their clinical profiles assuming that the loss of phospholipid is due to drug's binding with the phospholipid layer in amebic cyst-coat, being the first step which may trigger a chain of events leading to the onset of drug action.

Beryllium-10 in australasian tektites: evidence for a sedimentary precursor.

Each of seven Australasian tektites contains about 1 x l0(8) atoms of beryllium-10 (half-life, 1.53 x 10(6) years) per gram. Cosmic-ray bombardment of the australites cannot have produced the measured amounts of beryllium-10 either at the earth's surface or in space. The beryllium-10 contents of these australites are consistent with a sedimentary precursor that adsorbed from precipitation beryllium-10 produced in the atmosphere. The sediments must have spent several thousand years at the earth's surface within a few million years of the tektite-producing event.