Determinants of dysphagia following stroke

Background:Swallowing is affected following stroke. Many studies focus on various aspects of swallowing difficulties (dysphagia) following stroke. However, there are not many studies on the determinants of dysphagia following stroke. The aim of the present study is to establish the association between various factors with the severity of dysphagia. Methods: After screening for Mann Assessment of Swallowing Ability (MASA),110 patients, post-stroke were selected using consecutive sampling to assess the common risk factors, namely the presence of diabetes mellitus, dyslipidemia, hypertension, alcohol usage and smoking habits. Additionally, other variables such as age, gender, type of lesion, side of lesion, tobacco chewing, speech disorders, arterial dysfunction, lobe involvement and Brunnstrom's stages, were also evaluated using a structured interview method. 2 (chi-squared) analysis was carried outto find out the association between the selected determinants and severity of dysphagia following stroke.Results: It was found that age and Brunnstrom's stages are the determinants of dysphagia, as analysis showed a strong association with a p value < 0.001. A marginal association between post-stroke dysphagia and type of lesion with a p value of 0.056 was also observed.Conclusions: Among15 factors evaluated, age, type of lesion and Brunnstrom's stages showed a significant association with the severity of dysphagia following stroke. This study advocates early dysphagia management for elderly patients with high Brunnstrom's grading, for those who are not expected to spontaneously recover following stroke, and for earlier and better community rehabilitation

Development and validation of a questionnaire to measure preferences and expectations of patients undergoing palliative chemotherapy: EXPECT questionnaire.

OBJECTIVE: The objective was to design and validate the questionnaire for capturing palliative chemotherapy‑related preferences and expectations. DESIGN: Single arm, unicentric, prospective observational study. METHODS: EXPECT questionnaire was designed to capture preferences and expectations of patients undergoing palliative chemotherapy. This questionnaire underwent a linguistic validation and then was tested in patients. Ten patients are undergoing chemotherapy for solid tumors who fulfilled the inclusion and exclusion criteria self‑administered the EXPECT questionnaire in regional language. After filling this questionnaire, they self‑administered quick questionnaire‑10 (QQ‑10). SPSS version 16 (IBM New York) was used for analysis. Completion rate of EXPECT questionnaire was calculated. The feasibility, face validity, utility and time taken for completion of EXPECT questionnaire was also assessed. RESULTS: The completion rate of this questionnaire was 100%. All patients completed questionnaire within 5 min. The QQ‑10 tool confirmed the feasibility, face validity and utility of the questionnaire. CONCLUSION: EXPECT questionnaire was validated in the regional language, and it’s an effective tool for capturing patient’s preferences and expectation from chemotherapy.

Efficacy and safety of 1% terbinafine hydrochloride versus 2% sertaconazole cream in the treatment of tinea corporis.

Background: Tinea corporis is a common superficial dermatophytosis seen in tropical countries. This study was done to compare the efficacy and safety of topical antifungal agents, terbinafine versus sertaconazole in the treatment of tinea corporis. Methods: This study was conducted in Babuji Hospital and Chigateri Government Hospital, Davangere. A total of 60 (n=60) patients were included and divided into two groups of 30 patients each in the study. 1st group - received topical 1% terbinafine hydrochloride and 2nd group - received 2% sertaconazole cream. Patients were advised to apply cream twice daily for 4 weeks. Improvement in clinical parameters like erythema, scaling, itching, and potassium hydroxide (KOH) mount were taken for assessing the efficacy of drugs. They were followed-up at the end of 2, 4, and 6 weeks to assess the improvement of the condition. Complete cure rate was defined as mycological cure with a complete absence of clinical signs and symptoms. For safety data of both drugs presence of any local side effects (like stinging sensation, swelling and increased erythema) were analyzed in both groups. Statistical analysis was done using students paired t-test and unpaired t-test. Results: When two groups were compared at the end of 2 weeks, complete cure rate for terbinafine was 80% as compared to 63.3% for sertaconazole (p<0.003). However, at the end of 4 weeks, sertaconazole was as effective as terbinafine and statistically non-significant (p>0.05) results were obtained. KOH mount was negative in both groups at the end of 2nd week. Local side effects like erythema, swelling, stinging sensation were not noticed during the study in both the groups. Conclusion: From this study, it was shown that 2% sertaconazole cream was as effective as 1% terbinafine cream, though 1% terbinafine had higher rates of complete cure at the end of 2 weeks as compared to sertaconazole.

Patterns of care in geriatric cancer patients – An audit from a rural based hospital cancer registry in Kerala.

BACKGROUND: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming. AIM: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India. MATERIALS AND METHODS: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided. RESULTS: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70‑95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco‑regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0‑1, primary site and clinical extent of disease. CONCLUSION: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.

An audit of febrile neutropenia cases from a rural cancer center in India.

BACKGROUND: Data of febrile neutropenia (FN) from rural cancer centers is sparse. We did a audit of outcome of patients with FN in the period of March 2013‑August 2013. The aim was to help us to develop rational antibiotic usage policies. MATERIALS AND METHODS: Retrospective analysis of all consecutive patients presenting with FN. Data regarding demographic profile, tumor type, intent of treatment, chemotherapy regimen, blood culture susceptibility details, use of antibiotics, response to antibiotics and complications of FN were noted. SPSS (Statistical Product and Service Solutions) 16 was used for analysis. RESULTS: 67 patients had FN and there were 91 episodes. The median day of presentation with FN after start of chemotherapy was 10 days. The nadir absolute neutrophil count was 161.5 and nadir platelet count 1,00,000. The median multinational association for supportive care in cancer (MASCC) Score was 24. In accordance with MASCC there were 27 high risk FN and 64 low risk FN episodes. On multivariate analysis using logistic regression MASCC score strata was the only significant variable that predicted failure to 1st line antibiotics (P = 0.03) and mortality (P = 0.01). Nine patients (9.9%) had positive isolates on blood cultures. The blood culture isolates were predominantly Gram negative (66.7%). CONCLUSION: The importance of developing local guidelines for rational antibiotic usage is highlighted.

Growth response of Casuarina equisetifolia Forst. rooted stem cuttings to Frankia in nursery and field conditions.

Casuarina equisetifolia Forst. is a tree crop that provides fuel wood, land reclamation, dune stabilization, and scaffolding for construction, shelter belts, and pulp and paper production. C. equisetifolia fixes atmospheric nitrogen through a symbiotic relationship with Frankia, a soil bacterium of the actinobacteria group. The roots of C. equisetifolia produce root nodules where the bacteria fix atmospheric nitrogen, which is an essential nutrient for all plant metabolic activities. However, rooted stem cuttings of elite clones of C. equisetifolia by vegetative propagation is being planted by the farmers of Pondicherry as costeffective method. As the vegetative propagation method uses inert material (vermiculite) for rooting there is no chance for Frankia association. Therefore after planting of these stocks the farmers are applying 150 kg of di-ammonium phosphate (DAP)/acre/year. To overcome this fertilizer usage, the Frankia-inoculated rooted stem cuttings were propagated under nursery conditions and transplanted in the nutrient-deficient soils of Karaikal, Pondicherry (India), in this study. Under nursery experiments the growth and biomass of C. equisetifolia rooted stem cuttings inoculated with Frankia showed 3 times higher growth and biomass than uninoculated control. These stocks were transplanted and monitored for their growth and survival for 1 year in the nutrient-deficient farm land. The results showed that the rooted stem cuttings of C. equisetifolia significantly improved growth in height (8.8 m), stem girth (9.6 cm) and tissue nitrogen content (3.3 mg g−1) than uninoculated controls. The soil nutrient status was also improved due to inoculation of Frankia.

Prevalences of oligozoospermia and azoospermia in male partners of infertile couples from different parts of India / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To determine whether there was any regional variation in the prevalence of azoospermia, oligozoospermia and mean sperm counts in male partners of infertile couples from different parts of India.</p><p><b>METHODS</b>Data on 16,714 semen samples analyzed over the past five years from six different laboratories located in five cities of India were collated and evaluated.</p><p><b>RESULTS</b>There was a regional variation in the prevalence of azoospermia. The prevalence of azoospermia was extremely high in Kurnool and Jodhpur (38.3% and 37.4%, respectively). There was also a regional variation in the prevalence of oligozoospermia (51%) in Kurnool. There was no significant difference in the mean sperm counts in normospermic men.</p><p><b>CONCLUSION</b>There is a regional variation in the prevalence of azoospermia and oligozoospermia in the male partners of infertile couples from different regions of India. The prevalence of azoospermia in Kurnool and Jodhpur is higher than any other worldwide reported literature. Further studies need to be carried out to determine the cause of this.</p>

Glutaraldehyde cross-linking of lectins to marker enzymes: protection of binding site by specific sugars.

The role of bound specific sugars in protecting the sugar binding activity of several galactose binding proteins during their covalent conjugation to horse radish peroxidase by glutaraldehyde-mediated cross-linking was examined by: a) affinity matrix binding of the conjugate, b) enzyme linked lectin assay and c) hemagglutination assay. During conjugation using 1% glutaraldehyde, protection of jack fruit (Artocarpus integrifolia) lectin (jacalin) activity depended on concentration of specific sugar present during conjugation; optimum protection was offered by 50 mM galactose. This indicated the presence of one or more primary groups at the binding site of jacalin, which is (are) essential for sugar binding. On the other hand, such essential amino group(s) was not indicated at the sugar binding site of the peanut lectin, bovine heart galectin or of the human serum anti alpha-galactoside antibody, since exclusion of sugar during their conjugation to HRP did not diminish sugar binding activity. The differential behavior is discussed in the light of reported differences in sugar specificities. Results indicated that sugar mediated blocking of active site may be used in characterization of the latter in lectins.

Separation of bovine heart galactose lectin from endogenous glycoproteins co-purified with the lectin during affinity chromatography.

During affinity chromatographic purification of bovine heart 14 kDa galactose-binding lectin (galectin 1) on lactose-Sepharose, several high molecular weight non-lectin glycoproteins were co-purified with the lectin. Glycoprotein binding to the affinity matrix was neither hydrophobic nor ionic, but galactose-dependensti nce lactose abolished binding. Purification of galectin from the co-purified glycoproteins by affinity electrophoresis in presence of the specific sugar lactose increased agglutination activity about 65-fold, indicating that a complex containing galectin molecules bound sugar specifically to endogenous glycoproteins with sugar binding sites still available had been retained on lactose-Sepharose.

Anomer specificity of the 14 kDa galactose-binding lectin: A reappraisal.

A β-anomer preference among galactosides has been attributed to the S-type 14 kDa galactose binding lectin. Here the anomeric preference of this lectin from bovine brain (BBL) is reexamined using inhibition of lectin-mediated haemagglutination, binding of the lectin to dot-blotted glycoproteins and affinity electrophoresis of the lectin through polysaccharide-containing gels. 1·0-methyl α-D-galactoside was 8 times better inhibitor of BBL than the corresponding ß-anomer. The terminal galactose in bovine thyroglobulin (exclusively. α-linked) were also nearly 8 times more inhibitory than those in asialofetuin (exclusively ß-linked). The terminal α-galactose-containing endogenous glycoproteins of bovine brain were nearly 4 times better inhibitors of BBL than laminin. Removal of terminal α-galactose units by α-galactosidase fully abolished the BBL binding of thyroglobulin and endogenous glycoproteins. BBL was also sugar-specifically retarded by polyacrylamide gel containing guar galactommannan which bears only α-linked galactose. Data indicated that α-galactosides were sometimes better than their β-anomers in binding to BBL. The significance of this observation to the physiological role of galactose-binding lectins is discussed.