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   2014| December  | Volume 4 | Issue 5  
    Online since December 19, 2014

 
 
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REVIEW ARTICLES
Impact of alcohol on the developing brain
Pronob Kumar Dalal, Sujita Kumar Kar
December 2014, 4(5):1-5
DOI:10.4103/2231-0738.147454  
  2,605 131 -
CASE REPORTS
Autoantibody-induced encephalitis
Gagandeep Singh, Birinder Singh Paul, Rajinder K Bansal, Gunchan Paul
December 2014, 4(5):44-50
DOI:10.4103/2231-0738.147466  
Neurologists often encounter encephalitis caused by unknown agents. Autoantibody-induced encephalitis is a new and exciting group of disorders that must be considered in the differential diagnosis as they are reversible if treated early in the course of the disease, but fatal if unrecognized. We describe the first report from the Indian subcontinent of three rare cases of different autoantibody-induced disorders, which were successfully managed with immunosuppressive therapy resulting in a good clinical outcome. Case 1 was a young woman with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, not associated with tumor, who showed significant improvement with Rituximab. NMDA receptor encephalitis occurs typically in young females with psychiatric features, followed by an altered level of consciousness, dysautonomia, hyperkinetic movement disorder, seizures, and hypoventilation. Rituximab, which aims to suppress antibody production is an effective treatment modality. Anti-voltage-gated potassium channel antibodies (anti-VGKC-Ab) cause hyperexcitability of the peripheral nerve and central nervous system. Case 2 was a patient of limbic encephalitis presenting with complex partial seizures responding dramatically to steroids. Anti-VGKC-Ab-associated limbic encephalopathy is considered to be an autoimmune, non-paraneoplastic, potentially treatable encephalitis. The clinical features of anti-VGKC-Ab-associated limbic encephalitis are: Subacute onset of episodic memory impairment, disorientation, and agitation. Case 3 presented with Morvan's fibrillary chorea. Peripheral nerve hyperexcitability is the chief manifestation of the Morvan syndrome or cramp-fascilulation syndrome. The Morvan syndrome is characterized by neuromyotonia with autonomic and central nervous syndrome (CNS) involvement. Both VGKC-Ab-associated limbic encephalitis and Morvan syndrome can be successfully treated. Therefore, when these diseases are suspected, it is important to measure the anti-VGKC-Ab level.
  2,549 138 -
ORIGINAL ARTICLES
Prevalence of overweight and obesity in urban school going adolescents in Shimla city
Anjali Mahajan, Prakash Chand Negi
December 2014, 4(5):23-28
DOI:10.4103/2231-0738.147461  
Objectives: To study the prevalence of overweight and obesity among school going adolescents in Shimla city in Himachal Pradesh. Materials and Methods: A school based cross-sectional study was carried out to determine the prevalence of overweight and obesity among urban school-going adolescents (10 to 19 years) of both sexes studying from fifth to twelfth classes in various government and private schools of Shimla city in Himachal Pradesh. Results: A sample of 3385 students comprising 1665 females (49.2%) and 1720 (50.8%) males was formed for the purpose of the study. It was observed that 39.8% subjects were underweight, 3.0% were overweight, and 0.9% obese. 5.7% adolescents were found to be centrally obese taking ninety-fifth percentile of waist circumference for age and sex as the cut off. In transition from the higher to lower socioeconomic status, there was an increase in prevalence of underweight and decrease in prevalence of overweight and obesity. Prevalence of overweight and obesity was more in females of the higher socioeconomic class. Conclusions: It is indeed ironic that a problem of 'plenty,' namely, childhood overweight and obesity has emerged, even as we are still fighting malnutrition and infectious disease. As such, conflict in public health messages is a distinct possibility and must be avoided at all cost.
  2,396 216 -
CASE REPORTS
Phenylbutazone-induced generalized bullous fixed drug eruption masquerading Stevens-Johnson syndrome/toxic epidermal necrolysis
Hari Kishan Kumar Yadalla, Anagha Ramesh Babu
December 2014, 4(5):39-43
DOI:10.4103/2231-0738.147465  
Widespread bullous fixed drug eruption (FDE) is the most severe form of FDE and may be mistaken clinically for Stevens-Johnson syndrome or toxic epidermal necrolysis (SJS/TEN). Herein, we report a case of generalized bullous fixed drug eruption (GBFDE) with extensive epidermal necrosis and detachment mimicking SJS/TEN overlap and TEN. A 50-year-old female presented with sudden-onset widespread dusky red patches and denuded areas after intake of phenylbutazone [nonsteroidal anti-inflammatory drug (NSAID)] for her arthritis. Severe FDE was suspected due to lack of involvement of two mucosal sites and presence of mild constitutional symptoms. Histopathology of the lesion showed spongiosis, basal cell degeneration with numerous necrotic keratinocytes, and a superficial and deep perivascular infiltrate containing lymphocytes and eosinophils, along with melanin incontinence. These findings were consistent with FDE. The present paper highlights the clinical importance of severe bullous FDE mimicking SJS and TEN, and the necessity of histopathologic confirmation in such cases.
  2,399 108 -
REVIEW ARTICLES
A review of the current anti-HCV therapy: Are we finally ready for interferon-free regimens
Tejus Anantharamu, Sushil Sharma, Ashok Kumar Sharma, Ajay Kumar Gupta, Navdeep Dahiya, DB Brashier
December 2014, 4(5):6-11
DOI:10.4103/2231-0738.147455  
Hepatitis C virus (HCV) continues to be a global problem but with the arrival of new drugs it is expected to move towards exile. The health care community has finally woken up to the need to tackle this infection especially because HCV-induced hepatitis in combination with HIV has turned out to be a formidable foe. So far the management of HCV has concentrated mainly on interferon-based therapies. The focus is now increasingly on drugs targeting various other components of hepatitis C, which are essential for its survival in the host like HCV non-structural (NS) 3/4A serine protease inhibitors: Boceprevir, telaprevir, simeprevir; NS5A inhibitors (daclatasvir, ledipasvir); NS5B polymerase inhibitors (sofosbuvir), cyclophilin inhibitors and many others in the pipeline like the NS4B inhibitors and the micro-RNA122 inhibitors. These new drugs have shown excellent sustained virological response (SVR) compared to the presently available drugs and their combinations. Adding to this is the new HCV vaccine which although facing various hurdles is making good inroads and expected to meet its endpoints in the near future. This review gives a brief overview of epidemiology, pathogenesis, followed by the description of current regimens in the treatment of hepatitis C and the much eagerly awaited future all new oral anti-hepatitis C regimen, which can potentially eliminate the use of painful injections of interferon.
  2,230 190 2
ORIGINAL ARTICLES
Antibacterial and Cytotoxic Activities of Alocasia fornicata (Roxb.)
Mahmuda Haque, Tanjheela Jahan, Md Abdur Rashid
December 2014, 4(5):29-33
DOI:10.4103/2231-0738.147462  
Objectives: The aim of the study was to investigate the antibacterial activity, with minimum inhibitory concentration (MIC) and cytotoxic activities of petroleum-ether, chloroform, and ethyl acetate extracts of leaves, stolons and ethanol extract of the roots of the plant Alocasia fornicata (Roxb.) from the family Araceae. Materials and Methods: The antimicrobial activity was evaluated using the disk diffusion method and then MIC was detected using the serial dilution technique. The various parts of the plant were also assessed for cytotoxic activity using the brine shrimp lethality bioassay. Results: All crude extracts, except petroleum ether extract of the leaf and stolon showed moderate-to-good levels of antimicrobial activity against most of the tested bacteria, with an average zone of inhibition of 8-20 mm. The MICs were detected using the serial dilution method and the results ranged from 64 μg/ml to 256 μg/ml. All crude extracts displayed considerable general toxicity toward brine shrimps. The chloroform extract of the leaf, ethyl acetate extract of the stolon, and ethanol extract showed good cytotoxic activity and the LC 50 values were found to be 13.98 μg/ml, 12.26 μg/ml, and 12.81 μg/ml, respectively. Conclusion : From the above context, it may be concluded that the plant A. fornicate may be a potential source for the development of traditional medicine, such as, a safer antibiotic and also as an anticancer agent.
  2,118 153 1
Beta-interferon therapy in relapsing and remitting multiple sclerosis - challenges in an emerging country
Sureshkumar Radhakrishnan, Rajeswary Kalathil Padmajan, Praveen Kumar Yadav, Emmanuel James, Anandakuttan Anandkumar
December 2014, 4(5):34-38
DOI:10.4103/2231-0738.147464  
Context: Multiple sclerosis (MS) is an immune-mediated demyelinating disease, with an increasing prevalence in India, as is seen in the recent studies. Beta-Interferon is the most widely used treatment option. There is a paucity of studies on beta-interferon in relapsing remitting multiple sclerosis (RRMS) in India. Aims: To study the efficacy, compliance, and side effect profiles of patients on beta-interferon, with a diagnosis of RRMS, and also look at other factors, such as, affordability, preference, and availability. Settings and Design: A retrospective-prospective design. Materials and Methods: Twenty patients with a diagnosis of RRMS were included in the study. They were followed up regularly while on beta-interferon. All patients underwent magnetic resonance imaging (MRI) of the brain, plain and contrast, and the expanded disability status scale (EDSS) score was assessed at regular intervals. Statistical Analysis Used: Data analysis was done using the SPSS 15.0 version. Results: The mean age was 36.25 ± 12.24 years, with a female:male ratio of 2.3:1. The majority were unemployed, and hence, were dependent on their families for treatment. There was a significant delay from diagnosis to start of interferon therapy, the mean duration being 29.95 months. Oligoclonal bands (OB) were positive in 70% of the subjects. Seventeen patients were on interferon beta 1a intramuscular and three patients on interferon beta 1a subcutaneous injections. The mean relapse rates per patient before and after starting beta interferon were 1.85 and 0.55 respectively. First dose fever was the most common side effect. Headache, myalgia, and psychiatric symptoms were also seen. Periventricular and juxtacortical lesions were the most common radiological sites. Conclusions: Beta-interferon is an effective and safe therapy in Indian patients with RRMS. However very few patients have been able to continue it as a long-term therapy, due to financial constraints.
  1,916 100 1
Effects on chrysin on lipid and xenobiotic metabolizing enzymes in l-NAME-induced hypertension
Ramanathan Veerappan, Thekkumalai Malarvili, Govindaraju Archunan
December 2014, 4(5):17-22
DOI:10.4103/2231-0738.147459  
Objective: Nω-nitro-l-arginine methyl ester (l-NAME) is a non-specific nitric oxide (NO) synthase inhibitor, commonly used for the induction of NO-deficient hypertension. Hypertension is a significant risk factor in cardiovascular complications. Materials and Methods: This study was undertaken to investigate the effects of chrysin on lipid metabolizing enzymes, xenobiotic metabolizing enzymes, and microalbuminuria and N-acetyl-β-d-glucosaminidase (NAG) in urine in l-NAME-induced hypertensive rats. Hypertension was induced in adult male Wistar rats weighing 180-220 g by oral administration of l-NAME (40 mg/kg BW) in drinking water for 4 weeks. Rats were treated with chrysin (25 mg/kg BW) for 4 weeks. Results: The activity of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase increased significantly in the liver and kidney, whereas the activities of lipoprotein lipase and lecithin cholesterol acyl transferase decreased significantly in the plasma of hypertensive rats. Conclusions: The xenobiotic phase I enzymes, microalbuminuria, and NAG significantly increased, whereas xenobiotic phase II enzymes decreased in l-NAME-treated rats. Oral administration of chrysin reduced hyperlipidemia-related risk of hypertension.
  1,644 78 3
The role of dental surgeons in combating drug resistance: A study in South India
Ravi Teja Chitturi, Venkatesan Ramesh, Reghunathan Priyanka, Natarajan Senthilnathan, Rathinam Elanagai
December 2014, 4(5):12-16
DOI:10.4103/2231-0738.147457  
Objectives: One of the reasons for an important global concern i.e., antibiotic resistance is the pattern of antibiotic prescription by doctors. Knowledge regarding essential medicines and the rational use of medicines by doctors is important to combat drug resistance. This study was designed to study the knowledge of dental surgeons in south India regarding antibiotics required for various dental infections and also to assess the various factors that affect their prescription. Materials and Methods: A total 700 private dentists were randomly selected and questionnaires were sent by post or electronic media. The replies were collected and the response to each question was analyzed and expressed as absolute frequencies. Results: Over 80% of the dental surgeons correctly recognized the need to prescribe antibiotics when there was evidence of systemic spread, but over half of the dentists prescribed antibiotics even when a localized fluctuant swelling, for which antibiotics are not required. Also, 20-30% of dentists prescribed antibiotics unnecessarily for conditions such as chronic marginal gingivitis and acute pulpitis. Very importantly we found that there were many dentists' prescriptions that were affected by non-clinical factors, such as, patients' expectation of a prescription, work pressure, lack of time, and uncertainty in diagnosis to name a few. Conclusion: The results show that knowledge and antibiotic prescription pattern among dental surgeons is suboptimal. It is very important to provide continuing dental education in this aspect, to combat the threat of drug resistance.
  1,588 104 -
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