Vestibular Rehabilitation of the Persons affected by Benign Paroxysmal Positional Vertigo (BPPV) by Physical Therapy and Repositioning Maneuvers.

Vestibular rehabilitation therapy (VRT) mainly comprises physical therapies that encourage head, eye, and truncal movements, accelerating the recovery of patients with acute peripheral labyrinthine dysfunction. VRT aims to improve vestibular hypofunction by reinforcing vestibulo-ocular, vestibulospinal, and vestibulocollic reflexes. An asymmetry in peripheral vestibular inputs from the pair of membranous labyrinths to the central nervous system frequently results from vestibular lithiasis, causing benign paroxysmal positional vertigo (BPPV). The article discusses the pathophysiology, subtypes, and diagnostic oculomotor patterns generated during positional tests in each subtype of BPPV. Accurate identification of the pathophysiology (canalolithiasis versus cupulolithiasis) as well as the involved semicircular canal (localization and lateralization) is crucial for the unerring VRT of BPPV by physical therapies and/or repositioning maneuvers. The article elaborates the currently known variants of BPPV, the anatomico-physiological correlation between otoconial location and oculomotor patterns generated during the diagnostic positional tests in terms of the direction, latency, and duration of the elicited positional nystagmus [Figures 1 and 2; Table 2]. A detailed description of the treatment of different BPPV subtypes with repositioning maneuvers and/or physical therapy is given [Figures 3-8; Table 3].

Anxiety level among students of different college and universities in India during lock down in connection to the COVID-19 pandemic.

Objectives: COVID-19 incidence became a pandemic immediately after its origin and spread. Apart from death because of coronavirus infection, the pandemic brought unbearable psychological pressure to all. We assessed the psychological pressure on college and university students in India through cluster sampling. Methods: The students responded (n = 209) to an online questionnaire following the Generalized Anxiety Disorder Scale (GAD-7) and Hamilton Anxiety Rating Scale (HAM-A) with some other basic information. Results: According to GAD-7 scoring, we found the respondent students had severe anxiety (1.44%), moderately severe anxiety (14.35%), moderate anxiety (36.36%) and mild anxiety (47.85%). Following HAM-A scoring, anxiety level among the students could be scaled as severe (0.96%), high (4.31%), moderate (13.40%) and mild anxiety (34.93%) level. Age of the students was a confounding factor (p = 0.049, HAM-A) of experiencing anxiety, students <20 years of age were more anxious. We found female students to be more anxious than the males following the HAM-A scoring tool. Academic delays (R2 = 0.996, p = 0.036) and impact on daily life (R2 = 0.996, p = 0.117) were positively associated with anxiety symptoms, while social support was marginally correlated (R2 = 0.726, p = 0.069) with the anxiety level. Conclusions: As the study found almost all the students are experiencing anxiety because of the current pandemic situation, continuous observation of psychological health for all is recommended as well as establishing psychological intervention during the preparedness phase.

Anti-Bacterial, Anti-Diarrheal, and Cytotoxic Activities of Edible Fruits in the Sundarbans Mangrove Forest of Bangladesh.

This study evaluated anti-bacterial, anti-diarrheal, and cytotoxic activities of ten edible fruits (Aegiceras corniculatum, Avicennia officinalis, Bruguiera gymnorrhiza, Ceriops decandra, Heritiera fomes, Nypa fruticans, Phoenix paludosa, Sarcolobus globosus, Sonneratia caseolaris, and Xylocarpus mekongensis) in the Sundarbans mangrove forest of Bangladesh. Highest antibacterial activity was shown for ethanol:methanol (1:1) extracts of S. caseolaris (2 mg/disc), which demonstrated inhibition zones of 16.7, 17.0, 14.7, 15.7, and 15.7 mm against Escherichia coli, Klebsiella sp., Shigella boydii, Shigella sonnei, and Staphylococcus aureus, respectively. In mice with castor oil-induced diarrhea, S. caseolaris extract (250 mg/kg body weight) showed the highest inhibition (87.7%) and delayed the onset time (273 min) of diarrheal episodes, followed by A. corniculatum extract (inhibition, 83.6%; delayed onset time, 187.4 min). S. caseolaris and A. corniculatum fruit powders were successively fractionated into n-hexane, diethyl ether, chloroform, ethanol, and methanol. Antidiarrheal activity significantly increased with increasing polarity of these fractions. In brine shrimp lethality assay, S. globosus extract demonstrated the highest cytotoxicity (59.2 µg/mL), followed by H. fomes (74.1 µg/mL) and C. decandra (116.7 µg/mL); however, lowest cytotoxicity was shown for A. corniculatum, A. officinalis, and S. caseolaris extracts. Mice treated with A. corniculatum extract did not experience any acute toxicity. These results demonstrate that S. caseolaris and A. corniculatum fruits have potential to treat diarrhea and may act as useful nutraceuticals.

Arsenic contamination in Kolkata metropolitan city: perspective of transportation of agricultural products from arsenic-endemic areas.

Arsenic exposure route for humans is through the drinking of contaminated water and intake of arsenic-contaminated foods, particularly in arsenic-exposed areas of Bengal delta. Transport of the arsenic-contaminated crops and vegetables grown using arsenic-contaminated groundwater and soil in arsenic-exposed areas to the uncontaminated sites and consequent dietary intakes leads to great threats for the population residing in non-endemic areas with respect to consumption of arsenic through drinking water. We have studied the food materials collected from 30 families and their dietary habits, apparently who consume arsenic-free drinking water as well as 9 well-known markets of Kolkata city. The total and inorganic arsenic intake has been estimated from the collected foodstuffs from the market basket survey (n = 93) and household survey (n = 139), respectively for human risk analysis. About 100% of the collected samples contained detectable amount of arsenic (range 24-324 µg/kg), since the origin of the food materials was somewhere from arsenic-endemic areas. The daily consumption of inorganic arsenic (iAs) from rice grain and vegetables for adult and children is 76 µg and 41.4 µg, respectively. Inorganic arsenic (mainly arsenite and arsenate) contributes approximately 88% of the total content of arsenic in vegetable. In most of the cases, insufficient nutrient intake by the studied population may lead to arsenic toxicity in the long run. An independent cancer risk assessment study on the same population indicates that the main risk of cancer might appear through the intake of arsenic-contaminated rice grain and cereals.

A Systematic Review on Arsenic Bio-Availability in Human and Animals: Special Focus on the Rice-Human System.

The present systematic review synthesizes the diverse documentation of research on the occurrence of arsenic in soil-water systems and the human and animal bio-availability scenarios related to food chain contamination by arsenic. Humans and animals may drink arsenic-contaminated groundwater in addition to consuming foods that have been grown in arsenic-contaminated groundwater and soils. Rice grain is a potential arsenic carrier and the staple food in many parts of the world, particularly in Southeast Asian countries. Data have been summarized from 183 articles describing different aspects of arsenic flow in the food chain, that is, the soil-water-rice-human system and the water-crops-animals system and the bio-availability of arsenic to humans and animals. The phyto-availability of arsenic depends on the physicochemical and biological conditions of soil and water. In humans, the bio-accessibility of inorganic arsenic is 63-99%. Arsenic is more bio-available from rice than from other foods: different food materials differ in bio-accessible potential. Additionally, the review identifies trends in research on arsenic contamination and food chain flow considering arsenic species, toxicity assessment, and bio-accessibility studies. This systematic review provides a comprehensive assessment of the documented evidence to be used to guide future research on arsenic availability for the rice plant and subsequent availability to humans from cooked rice that can determine arsenic toxicity. The review also highlights how the focus of research on arsenic as a pollutant has changed in the past decades.

Association between skin lesion and arsenic concentration in hair by mixed bivariate model in chronic arsenic exposure.

Skin lesion is one of the important health hazards caused by high intake of arsenic through drinking water and diet, and the other hazards include several types of cancers (viz. skin, lung and urinary bladder), ischemic heart disease, hypertension, etc. Two most important biomarkers to measure arsenic intake in a human body are arsenic concentration in urine and hair. The primary interest of this paper is the association between skin lesion and arsenic concentration in hair for participants with chronic arsenic exposure from West Bengal, India, using bivariate regression model based on copula function. The result showed participants with high arsenic concentration in hair had higher incidence of developing skin lesion. Arsenic concentration in hair was significantly higher for the participants with an arsenic concentration in water > 10 mg/L.

Specific Organ Targeted Vestibular Physiotherapy: The Pivot in the Contemporary Management of Vertigo and Imbalance.

INTRODUCTION: Advancements in our understanding of vestibular physiology and how it is changes in different diseases have established that of the three therapeutic approaches to treat disorders of the vestibular system viz. pharmacotherapy, surgery and physical therapy, it is the later i.e., physical therapy which is the most efficacious modality in the management of balance disorders. The futility of vestibular sedatives in the correction of vestibular disorders and in the restoration of balance and the very limited role of surgery has now been recognised. Advancements in vestibulometry now enable us to localise any lesion in the vestibular system with utmost precision and also determine the exact cause of the balance disorder. The site of lesion and the specific organ that is defective can now be very precisely identified. Treatment modalities especially that for physical therapy hence have to be organ specific, and if possible, also disease specific. AIMS AND OBJECTIVES: The study aims at evaluating the efficacy of physiotherapy in the management of balance disorders and also assesses the efficacy of organ targeted physical therapy, a new concept in restoring balance after vestibulometry has identified the offending organ. MATERIALS AND METHODS: The study was conducted in the specialised physical therapy unit for balance and gait disorder patients which is a part of Vertigo and Deafness Clinic in Kolkata, India. Special instruments for physical therapy devised by the first author were used for stimulation of specific sense organs in the vestibular labyrinth that were found to be defective in vestibulometry. Specially made Virtual reality programs were used in patients suffering from psychogenic balance disorders. The pre and post therapy status was evaluated by different standard scales to assess balance and dizziness. RESULTS: Very promising results were obtained. Organ targeted physiotherapy where defective sense organs were specifically stimulated showed remarkable improvement in different measures. Virtual reality exercises too showed very promising results in patients of psychogenic vertigo.

Efficacy of Betahistine by Patient-Reported Outcomes and its Tolerability Profile in Indian Patients with Vestibular Vertigo.

OBJECTIVE: Patients with vestibular vertigo suffer from disabling symptoms which affect their quality of life. This article presents the efficacy and safety profile of betahistine hydrochloride in Indian patients suffering from vestibular vertigo (OSVaLD study). METHODS: Study included patients suffering from vertigo, who were prescribed betahistine (48 mg/day) according to local label. Safety and efficacy populations of this study included 80 and 75 subjects respectively. The study included three visits: an initial baseline visit, and two follow-up visits (one month and three months [final visit] post-commencement of betahistine therapy). Efficacy was assessed by administering three patient-reported outcomes (PROs) namely, Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), and Medical Outcome Study Short Form-36 version2 (SF-36®v2). Safety assessment was made by reports of Suspected Adverse Drug Reactions (SADRs) which began during the study. RESULTS: Mean changes in total DHI score for Indian efficacy population at follow-up and final visits were 31 and 44 points respectively. These changes indicated significant improvements in self-perceived impairment associated with vertigo. Similar improvements in quality of life were observed by HADS subscales (HADS-A and HADS-D) and SF-36®v2 summary scores (PCS [physical component summary] and MCS [mental component summary]). There was only one report of SADR in this study in a female subject receiving betahistine 16 mg t.i.d. This SADR was gastritis of mild severity and was probably not related to betahistine. CONCLUSIONS: A significant number of vestibular vertigo patients reported fair degree of spontaneous recovery. Betahistine treatment improved quality of life, was safe and well-tolerated by Indian patients suffering from vertigo.

Improved sensitivity of wearable nanogenerators made of electrospun Eu3+ doped P(VDF-HFP)/graphene composite nanofibers for self-powered voice recognition.

Composite nanofibers of Eu3+ doped poly(vinylidene fluoride-co-hexafluoropropylene) (P(VDF-HFP))/graphene are prepared by the electrospinning technique for the fabrication of ultrasensitive wearable piezoelectric nanogenerators (WPNGs) where the post-poling technique is not necessary. It is found that the complete conversion of the piezoelectric ß-phase and the improvement of the degree of crystallinity is governed by the incorporation of Eu3+ and graphene sheets into P(VDF-HFP) nanofibers. The flexible nanocomposite fibers are associated with a hypersensitive electronic transition that results in an intense red light emission, and WPNGs also have the capability of detecting external pressure as low as ~23 Pa with a higher degree of acoustic sensitivity, ~11 V Pa-1, than has ever been previously reported. This means that ultrasensitive WPNGs can be utilized to recognize human voices, which suggests they could be a potential tool in the biomedical and national security sectors. The capacitor's ability to charge from abundant environmental vibrations, such as music, wind, body motion, etc, drives WPNGs as a power source for portable electronics. This fact may open up the prospect of using the Eu3+ doped P(VDF-HFP)/graphene composite electrospun nanofibers, with their multifunctional properties such as vibration sensitivity, wearability, red light emission capability and piezoelectric energy harvesting, for various promising applications in portable electronics, health care monitoring, noise detection and security monitoring.

Effect of Safe Water on Arsenicosis: A Follow-up Study.

BACKGROUND: Arsenic pollution in groundwater, used for drinking purposes, has been envisaged as a problem of global concern. Treatment options for the management symptoms of chronic arsenicosis are limited. Mitigation option available for dealing with the health problem of ground water arsenic contamination rests mainly on supply of arsenic safe water in arsenic-endemic region of Indo-Bangladesh subcontinent. Limited information is available regarding the long-term effect of chronic arsenic toxicity after stoppage of consumption of arsenic-containing water. OBJECTIVE: The current study was, therefore, done to assess, objectively, the effect of drinking arsenic safe water (<50 µg/L) on disease manifestation of arsenicosis. RESULTS: Manifestations of various skin lesions and systemic diseases associated with chronic arsenic exposure were ascertained initially by carrying on baseline study on 208 participants in Nadia (Cohort-I, with skin lesion and Cohort-II, without skin lesion) using a scoring system, as developed by us, and compared objectively at the end of each year for 3 year follow-up period. All the participants who had arsenic contaminated drinking water source in their houses were supplied with arsenic removal filters for getting arsenic-free water during the follow-up period. In participants belonging to Cohort-I, the skin score was found to improve significantly at the end of each year, and it was found to be reduced significantly from 2.17 ± 1.09 to 1.23 ± 1.17; P < 0.001 at the end of 3 year's intervention study indicating beneficial effect of safe water on skin lesions. The systemic disease symptom score was also found to improve, but less significantly, at the end of 3 years in both the cohorts. Most important observation during the follow-up study was persistence of severe symptoms of chronic lung disease and severe skin lesion including Bowen's disease in spite of taking arsenic-safe water. Further, death could not be prevented to occur because of lung cancer and severe lung disease. CONCLUSION: It is, therefore, an urgent need to make arrangement for availability of safe water source among the arsenic-affected people in the district. Many of the people in the affected villages are not aware of contamination of their home tube wells with arsenic. Awareness generation and motivation of the people for testing their drinking water sources for arsenic and environmental interventions like rain water harvesting, ground water recharge, and restricting excessive use of ground water for domestic and agricultural purposes are also important to prevent further exposure of arsenic to these people.

Seasonal perspective of dietary arsenic consumption and urine arsenic in an endemic population.

Exposure to arsenic in arsenic endemic areas is most remarkable environmental health challenges. Although effects of arsenic contamination are well established, reports are unavailable on probable seasonal variation due to changes of food habit depending on winter and summer seasons, especially for endemic regions of Nadia district, West Bengal. Complete 24-h diets, drinking-cooking water, first morning voided urine samples, and diet history were analyzed on 25 volunteers in arsenic endemic Chakdah block of Nadia district, once in summer followed by once in winter from the same participants. Results depicted no seasonal variation of body weight and body mass index. Arsenic concentration of source drinking and cooking water decreased (p = 0.04) from 26 µg L(-1) in summer to 6 µg L(-1) in winter season. We recorded a seasonal decrease of water intake in male (3.8 and 2.5 L day (-1)) and female (2.6 and 1.2 L day(-1)) participants from summer to winter. Arsenic intake through drinking water decreased (p = 0.04) in winter (29 µg day(-1)) than in summer (100 µg day(-1)), and urinary arsenic concentration decreased (p = 0.018) in winter (41 µg L(-1)) than in summer (69 µg L(-1)). Dietary arsenic intake remained unchanged (p = 0.24) over the seasons. Hence, we can infer that human health risk assessment from arsenic needs an insight over temporal scale.

The impact of tinnitus on sufferers in Indian population.

Tinnitus is a very common complain and affects 7% of population and has been associated with a range of physical and emotional disorders (Hallam et al. in Br J Clin Psychol 27:213-222, 1988). Hence to understand the distress caused by tinnitus and its relationship with the nature of tinnitus so as to suggest the appropriate treatment, there is the need to study the impact of tinnitus of a group of tinnitus sufferers. This study could be done on the basis of verbal description of tinnitus, Audiological measurement of tinnitus and psychological characteristics of tinnitus in terms of distress, anxiety, depression and disturbance of personality, to understand the impact of tinnitus on sufferers. Fifty adults in the age range of 18-60 years with subjective tinnitus with bilateral normal hearing or pure SNHL ranging from mild to moderately severe were selected. An audiological profile of each subject was prepared on the basis of brief case history of subject, otoscopic examination, pure tone audiometry, impedance audiometry, frequency (pitch) and intensity (loudness) of tinnitus. A psychometric profile was developed by using Tinnitus Reaction Questionnaire and Nature of Tinnitus Questionnaire. These questionnaires were translated and adopted in Hindi and Bengali language after appropriate standardization procedure. 60% reported that they do not have any idea regarding probable cause of their tinnitus. 74% subjects of this study reported that there is no fluctuation in the pitch of their tinnitus. However, 68% reported loudness of tinnitus is fluctuating. A weak co-relation has been seen between traditional audiological measures like pitch matching, loudness matching and subject's description of pitch and loudness of tinnitus. There was a significant correlation between the impact of tinnitus and disturbance of sleep caused by it with increase in depression and anger (0.483). However, no significant co-relation was seen between distressed caused by tinnitus and duration of tinnitus (-0.034). The multiple nature/sounds of tinnitus had far more devastating effects or serious impact on 'tinnitus sufferers' than the single sound/nature. Gender differences were also found among tinnitus sufferers while assessing the audiological and psychological measures of tinnitus. Female subjects also reported a higher level of emotional reaction with a mean of 35.9 to their tinnitus as compared to males with a mean of 31.7. Tinnitus has resulted in multifold effects/impacts on tinnitus sufferers where it has made them feel unhappy, tense, irritable, depressed, annoyed, distressed and frustrated. It has interfered with their enjoyment, their relaxation, their sleep, and forced them to avoid quiet environmental and social situations. These findings should further help in the overall management of the patient suffering from tinnitus.

Dietary arsenic exposure with low level of arsenic in drinking water and biomarker: a study in West Bengal.

The authors investigated association of arsenic intake through water and diet and arsenic level in urine in people living in arsenic endemic region in West Bengal supplied with arsenic-safe water (<50 µg L(-1)). Out of 94 (Group-1A) study participants using water with arsenic level <50 µg L(-1), 72 participants (Group-1B) were taking water with arsenic level <10 µg L(-1). Multiple regressions analysis conducted on the Group-1A participants showed that daily arsenic dose from water and diet were found to be significantly positively associated with urinary arsenic level. However, daily arsenic dose from diet was found to be significantly positively associated with urinary arsenic level in Group-1B participants only, but no significant association was found with arsenic dose from water in this group. In a separate analysis, out of 68 participants with arsenic exposure through diet only, urinary arsenic concentration was found to correlate positively (r = 0.573) with dietary arsenic in 45 participants with skin lesion while this correlation was insignificant (r = 0.007) in 23 participants without skin lesion. Our study suggested that dietary arsenic intake was a potential pathway of arsenic exposure even where arsenic intake through water was reduced significantly in arsenic endemic region in West Bengal. Observation of variation in urinary arsenic excretion in arsenic-exposed subjects with and without skin lesion needed further study.

Dietary arsenic consumption and urine arsenic in an endemic population: response to improvement of drinking water quality in a 2-year consecutive study.

We assessed the association between arsenic intake through water and diet, and arsenic levels in first morning-void urine under variable conditions of water contamination. This was done in a 2-year consecutive study in an endemic population. Exposure of arsenic through water and diet was assessed for participants using arsenic-contaminated water (≥50 µg L(-1)) in a first year (group I) and for participants using water lower in arsenic (<50 µg L(-1)) in the next year (group II). Participants with and without arsenical skin lesions were considered in the statistical analysis. Median dose of arsenic intake through drinking water in groups I and II males was 7.44 and 0.85 µg kg body wt.(-1) day(-1) (p <0.0001). In females, it was 5.3 and 0.63 µg kg body wt.(-1) day(-1) (p <0.0001) for groups I and II, respectively. Arsenic dose through diet was 3.3 and 2.6 µg kg body wt.(-1) day(-1) (p = 0.088) in males and 2.6 and 1.9 µg kg body wt.(-1) day(-1) (p = 0.0081) in females. Median arsenic levels in urine of groups I and II males were 124 and 61 µg L(-1) (p = 0.052) and in females 130 and 52 µg L(-1) (p = 0.0001), respectively. When arsenic levels in the water were reduced to below 50 µg L(-1) (Indian permissible limit), total arsenic intake and arsenic intake through the water significantly decreased, but arsenic uptake through the diet was found to be not significantly affected. Moreover, it was found that drinking water mainly contributed to variations in urine arsenic concentrations. However, differences between male and female participants also indicate that not only arsenic uptake, but also many physiological factors affect arsenic behavior in the body and its excretion. As total median arsenic exposure still often exceeded 3.0 µg kg body wt.(-1) day(-1) (the permissible lower limit established by the Joint Expert Committee on Food Additives) after installation of the drinking water filters, it can be concluded that supplying the filtered water only may not be sufficient to minimize arsenic availability for an already endemic population.

Human urothelial micronucleus assay to assess genotoxic recovery by reduction of arsenic in drinking water: a cohort study in West Bengal, India.

Chronic exposure to arsenic through drinking water affects nearly 26 million individuals in West Bengal, India. Cytogenetic biomarkers like urothelial micronucleus (MN) are extensively used to monitor arsenic exposed population. In 2004-2005, 145 arsenic exposed individuals and 60 unexposed controls were surveyed of which 128 exposed individuals and 54 unexposed controls could be followed up in 2010-2011. In 2004-2005, the extent of arsenic content in the drinking water was 348.23 ± 102.67 µg/L, which was significantly lowered to 5.60 ± 10.83 µg/L in 2010-2011. Comparing the data obtained between 2004-2005 and 2010-2011, there was a significant decline in the MN frequency, when assayed in 2010-2011 compared to 2004-2005. Hence, we infer that urothelial MN can be utilized as a good biomarker in detecting remedial effects from toxicity of the low dose of arsenic through drinking water.

Evaluation of dietary arsenic exposure and its biomarkers: a case study of West Bengal, India.

Few reports are available that characterize daily arsenic exposure through water and diet among people living in groundwater-contaminated regions and correlate it with biomarkers. The present study describes the total individual arsenic exposure and arsenic level in urine and hair of such an arsenic-exposed population in West Bengal. Demographic characteristics and the total daily arsenic intake through water and diet were determined in 167 (Group-1 participants selected from arsenic endemic region) and 69 (Group-2 participants selected from arsenic non-endemic region) in West Bengal. Out of 167 Group-1 participants 78 (Group-1A) had arsenical skin lesions while 89 Group-1B) had no such lesion. Arsenic level in water samples as well as diet, urine and hair samples, collected from all the individual participants, were estimated. The mean value of estimated total arsenic content from water and diet was 349 (range: 20-1615) µg/day in 167 (Group-1) participants living in As endemic region [As in water: mean value 54 (range:BDL-326) µg/L] and 36 (range:12-120) µg/day in 69 (Group-2) participants living in As non-endemic region (As in water: below detection level (BDL), < 0.3 µg/L). Estimated mean arsenic level in urine in these two groups of participants was 116 (range: 6-526) µg/L and 17 (range: BDL-37) µg/L and in hair was 1.0 (range: 0.22-3.98) mg/Kg and 0.16 (range: 0.06-0.37) mg/Kg, respectively. Multiple regressions analysis in Group-1 participants showed that total arsenic intake was associated significantly with urinary and hair arsenic level. The estimated regression coefficient was 0.0022 (95% confidence interval, C.I: 0.0016, 0.0028; P < 0.001) and 0.0024 (95% C.I: 0.0021, 0.003; P < 0.001), respectively. In sub group analysis, higher median urinary arsenic value relative to arsenic intake through water and diet was observed in 78 Group-1A subjects with skin lesion compared to urinary arsenic value in 89 Group-1B subjects without skin lesions, though there was a marginal difference of median total arsenic intake in these two groups. This study showed that significant elevation of arsenic level in urine and hair was associated with elevated arsenic intake through water and diet in people living in arsenic endemic region (Group-1), while these values were low in people living in non-endemic region (Group-2). Those with skin lesions were found to have higher arsenic in urine and hair compared to those without skin lesion with similar arsenic intake through water and diet.

Retrospective analysis of the clinical and demographic variables on the outcomes after second-line treatment in advanced non-small cell lung cancer.

BACKGROUND: Platinum based doublets chemotherapy are the standard of care for metastatic or advanced non-small cell lung carcinoma. This leads to modest survival advantage and improve quality-of-life. However, patients with advanced or metastatic disease eventually present disease progression and needs second-line systemic therapy in a selected group of patients or other supportive measures. There is very little knowledge available from the literature about the prognostic variables in patients, who receive second-line therapy. MATERIALS AND METHODS: We retrospectively reviewed 329 patients received second-line treatment from July 2007 to September 2011 in the Department of Radiation Oncology, Burdwan Medical College and Hospital. For statistical analysis, 12 potential prognostic variables included. Univariate and multivariate regression analysis carried out to identify the prognostic variables associated with survival. RESULTS: The results of univariate analysis for overall survival (OS) and survival after second-line therapy identified to have prognostic significance: Age, sex, performance status, smoking history, serum lactate dehydrogenase, histopathology, first-line chemotherapy and its response and second-line therapy except the stage at diagnosis and site of failure after first-line therapy. The multivariate Cox regression analysis has shown that only performance and second-line therapy were independent prognostic variables for survival after second-line treatment and above these prognostic factors; age, smoking status and progression free survival also for OS. CONCLUSION: The performance status has shown consistent result as a prognostic factor in univariate and multivariate analysis for OS and survival after second-line therapy. These findings may also facilitate pretreatment prediction of survival and be used for selecting patients for the correct choice of cytotoxic therapy.

Nutritional deficiency and arsenical manifestations: a perspective study in an arsenic-endemic region of West Bengal, India.

OBJECTIVE: To assess whether nutritional deficiency increases susceptibility to arsenic-related health effects. DESIGN: Assessment of nutrition was based on a 24 h recall method of all dietary constituents. SETTING: Epidemiological cross-sectional study was conducted in an arsenic endemic area of West Bengal with groundwater arsenic contamination. SUBJECTS: The study was composed of two groups ­ Group 1 (cases, n 108) exhibiting skin lesions and Group 2 (exposed controls, n 100) not exhibiting skin lesions ­ age- and sex-matched and having similar arsenic exposure through drinking water and arsenic levels in urine and hair. RESULTS: Both groups belonged to low socio-economic strata (Group 1 significantly poorer, P<0·01) and had low BMI (prevalence of BMI<18·5 kg/m2: in 38% in Group 1 and 27% in Group 2). Energy intake was below the Recommended Daily Allowance (set by the Indian Council of Medical Research) in males and females in both groups. Increased risk of arsenical skin lesions was found for those in the lowest quintile of protein intake (v. highest quintile: OR=4·60, 95% CI 1·36, 15·50 in males; OR=5·62, 95% CI 1·19, 34·57 in females). Significantly lower intakes of energy, protein, thiamin, niacin, Mg, Zn and choline were observed in both males and females of Group 1 compared with Group 2. Significantly lower intakes of carbohydrate, riboflavin, niacin and Cu were also observed in female cases with skin lesions compared with non-cases. CONCLUSIONS: Deficiencies of Zn, Mg and Cu, in addition to protein, B vitamins and choline, are found to be associated with arsenical skin lesions in West Bengal.

Risk from winter vegetables and pulses produced in arsenic endemic areas of Nadia District: field study comparison with market basket survey.

Arsenic contaminated groundwater uses for irrigation potentially lead the incidence of arsenic into food chain. In present study we examined total arsenic concentrations in 32 types of vegetables and 7 types of pulses. Range of total arsenic concentration in edible parts of vegetables collected from grown fields was 0.114-0.910 mg/kg. Highest arsenic values were in spinach 0.910 mg/kg. Vegetable samples were grouped into leafy, non-leafy-fruity, root-tubers. 18 common types of vegetables and pulses were collected through market basket survey, total arsenic were approximately 100 mg lower than those observed for the vegetables collected from the fields.

Leptospirosis: an institutional experience.

Leptospirosis, a common zoonotic disease, may present with variable clinical manifestations in between two extremes. Possibility must be excluded in any febrile patient with hepatorenal derangement. There are different reports regarding prevalence pattern, presentations and case fatality rate from different parts of the country. The purpose of this study was to find out the mode of presentation, biochemical profile and complications of leptospirosis cases in an apical level and make a comparison of same with other parts of India. Fifty-one consecutive cases of leptospirosis were selected for this study. Thorough clinical examination was done. ELISA test was done in the second week of illness. Haemogram, liver and renal function tests, coagulation profile, creatine phosphokinase (CPK), chest xray, ECG were done in all patients. Presenting features were fever (100%), myalgia (78.4%), headache (41.2%), jaundice (17.6%), oliguria (29.4%), respiratory distress (25.5%), bleeding manifestations (9.8%), altered sensorium (21.6%). Icterus was found in 74.5% of patients, hepatosplenomegaly in 72.5%, tachypnoea in 52.9%, bleeding manifestations in 35.3%, encephalopathy in 21.6%, hypotension in 15.7% and meningeal signs in 5.9% cases. Case fatality rate was 7.8%. From the study, it becomes evident that though severe leptospirosis has declined, mild leptospirosis has Increased. The reasons for decline of severe leptospirosis may be greater awareness, availability of better diagnostic tool along with widespread use of antibiotics. So, high index of suspicion may eventually reduce complications. It would be wise to start appropriate antibiotics empirically in suspected cases of leptospirosis.