Associations between betel nut (Areca catechu) and symptoms of schizophrenia among patients in Nepal: A longitudinal study

Betel nut is one of the mostly widely used substances in the world, particularly across Asia. Arecoline, a partial muscarinic agonist, has been hypothesized to have beneficial effects on both positive and negative symptoms of schizophrenia. This study aims to further explore associations between betel use and symptoms of schizophrenia in a 4-month longitudinal study in Nepal. Sixty Nepali patients with schizophrenia were recruited from regional outpatient clinics. The Positive and Negative Syndrome Scale (PANSS) and the Social Adaptation Self-Evaluation Scale were used to assess symptoms and social functioning in regular betel users and non-users. No significant group differences or dose–response relationships were noted on either initial or follow-up assessments. Stratifying by sex also failed to reveal an association between symptoms and betel use, which stands in contrast with previously reported data from Micronesia. There were no differences seen in social functioning other than a significantly higher proportion of betel users holding jobs. It was also noted that significantly fewer betel chewers were taking anti-cholinergic medication, which may tentatively indicate a potentially therapeutic role in the future for partial muscarinic agonists in the treatment of medication-induced movement disorders.     

Leiomyomatosis of the Esophagus: Experience over a Decade

Purpose  To assess the clinical, radiological findings, and treatment strategies in patients with esophageal leiomyomatosis. Background  Esophageal leiomyomatosis is a rare hamartomatous disorder with varied presentation. It is described mostly in children and is associated with Alport’s syndrome. Methods  A retrospective analysis of three cases managed in the Department of General Surgery at Chandigarh over a period of 10 years. Results  The study involves three female patients of different generations within the same family with age range of 10–58 years. All presented with dysphagia of 2–7 years duration. Barium swallow revealed a long-segment stricture in two patients. Computed tomography (CT) demonstrated a circumferential mass lesion in the lower esophagus in all the patients. Esophageal resection was carried out in all the patients. All patients made an uneventful recovery. Conclusions  Esophageal leiomyomatosis should be suspected in patients with long-standing dysphagia. Barium findings are suggestive but can mimic achalasia. CT scan shows a circumferential esophageal wall thickening. Surgical resection and reconstruction of the digestive passage is the optimal treatment.     

Prevalence of HIV/AIDS and Prediction of Future Trends in North-west Region of India: A six-year ICTC-based Study

Background:

The study was conducted to analyze previous six-year prevalence data of HIV infection in the Northwest region of India and predict future trends for a couple of years.

Objectives:

The study was conducted to aid SACS and NACO to plan and arrange resources for the future scenario.

Materials and Methods:

All the attendees of ICTC, Jaipur, from January 2002 to December 2007 were included and variables like age, sex, marital status, occupation, place of residence, pattern of risk behavior and HIV serostatus were studied. As per the strategy and policy prescribed by NACO, tests (E/R/S) were performed on the serum samples. Data was collected; compiled and analyzed using standard statistical methods. Future trends of HIV-prevalence in north-west India were anticipated.

Results:

The overall positivity rates among attendees of ICTC, were found to be 12.2% (386/3161), 11.8% (519/4381), 11.1% (649/5867), 13% (908/6983), 14% (1385/9911) and 17.34% (1756/10133) in the years 2002, 2003, 2004, 2005, 2006 and 2007 respectively. Future trends for the next couple of years depict further increase in prevalence without any plateau.

Conclusion:

Epidemiological studies should be carried out in various settings to understand the role and complex relations of innumerable behavioral, social and demographic factors, which will help, interrupt and control the transmission of HIV/ AIDS.     

Single-stage repair for rectovestibular fistula without opening the fourchette

Background

Anorectal malformations are one of the most common congenital defects. This study is conducted to demonstrate new technique for treatment of rectovaginal fistula without disturbing the fourchette through posterior sagittal approach.

Method

All the patients of rectovestibular fistula admitted after the neonatal age were treated with posterior sagittal anorectoplasty without opening the fourchette. The results were evaluated for cosmetic appearance and anal continence.

Result

A total of 40 patients were included in our study. All patients were more than 1 month old. Operative time ranges from 70 to 150 minutes. The cosmetic appearance was good. Anal continence was good in 72% cases and fair in 20% cases. Fifteen percent of patients had minimal constipation and 7.5% patients had mucosal prolapse.

Conclusion

Single-stage repair for vestibular anus through posterior sagittal anorectoplasty without opening fourchette has a good cosmetic appearance and good anal continence.     

Use of fibrin glue in preventing urethrocutaneous fistula after hypospadias repair

Urethrocutaneous fistula is one of the most common complications after hypospadias surgery.The incidence of fistula development has varied from 4% to 20% in larger series. We sought to investigate the role of fibrin glue (Tisseel manufactured by Baxter India Pvt Ltd, Chennai, India) to reduce the chances of fistula formation in cases in proximal penile hypospadias.

Method

A total of 120 patients with proximal penile hypospadias (patients having urethral meatus at posterior third of penile shaft and at penoscrotal junction) were included in the present study. Patients were randomly allocated into 2 groups of 60 each by using Strata 9 software random number table. In group A, fibrin glue was used as a sealant after hypospadias surgery, whereas in group B, no sealant was used. All the operations were performed by single surgeon using transverse preputial tubularized island flap urethroplasty.

Result

Fistula formation occurred in 6 cases in group A (10%) and 19 cases in group B (32%) (P = .027). The fistulae observed in fibrin glue group A were single and small in size (<1 mm). Multiple (≥2 fistulae) and larger fistulae (>2 mm) were observed in group B. Overall complication was significantly higher in group B (P = .006).

Conclusion

Fibrin glue in hypospadias repair does not eliminate fistula formation. However, it seems that it minimizes the incidence of fistula formation.     

The Impact of Short Term Supervised and Home-Based Walking Programmes on Heart Rate Variability in Patients with Peripheral Arterial Disease

The aims of the study were to determine whether heart rate variability (HRV) measured at rest and during exercise could be altered by an exercise training programme designed to increase walking performance in patients with peripheral arterial disease. Forty-four volunteers were randomised into 12 weeks of either: supervised walking training twice weekly for 30 min at 75% VO_2peak (SU), home-based walking training sessions: twice weekly, 30 min per week (HB) or no exercise (CT). HRV measures were calculated from a 5-min resting ECG. Each patient then underwent maximal, graded exercise treadmill testing. All measures were repeated after 12 weeks. The SU group showed significantly (p < 0.001) increased maximal walking time (MWT) but no change in VO_2peak. There were no statistically significant changes in any of the measures of HRV in any group. Effect sizes for change in HRV measures were all very small and in some cases negative. Improved walking performance was not accompanied by central cardiorespiratory or neuroregulatory adaptations in the present study. The lack of any change in HRV was possibly due to either the low intensity or discontinuous nature of exercise undertaken.

Key points

• It is known that exercise can positively influence heart rate variability in some cardiac patients.
• It is known that exercise can increase walking performance in peripheral vascular disease patients.
• Exercise training improved walking performance in peripheral vascular disease patients but HRV was unaltered.
• This may be due to low overall physiological demands on the cardiovascular system or the intermittent nature of the exercise.

Key words: Exercise, ischemia, autonomic nervous system     

Contribution of free radicals to Pseudomonas aeruginosa induced acute pyelonephritis

Pyelonephritis induces an inflammatory process in the renal parenchyma, which may occur as a result of excessive reactive nitrogen intermediates (RNI) and reactive oxygen species (ROS) and/or impaired antioxidant capacity. In the present investigation, contribution of free radicals to the development of acute pyelonephritis induced by planktonic and biofilm cells of Pseudomonas aeruginosa was studied. Increase in production of RNI and ROS in urine, bladder and renal tissue following infection with P. aeruginosa was observed which correlated with bacterial load, neutrophil recruitment and malondialdehyde (MDA). Evaluation of the data revealed that excessive production of free radicals causes tissue damage leading to bacterial persistence in host's tissues. Treatment of mice with N-acetylcysteine (NAC), a potent antioxidant, lead to significant amelioration of oxidative stress and subsequent decrease in bacterial titer, neutrophil influx, MDA as well as tissue pathology highlighting important role of free radicals in P. aeruginosa induced pyelonephritis. Results of the present study bring out that production of RNI and ROS contributes to the pathophysiology of pyelonephritis. These findings may be relevant for the better understanding of host–parasite interactions and may be of clinical importance in the development of preventive intervention against P. aeruginosa induced pyelonephritis.     

Impact of timing of presentation of acute pancreatitis to a tertiary care centre on the outcome

Background and objectives

Despite improvement in outcomes of acute pancreatitis (AP), some subgroups remain at increased risk. We studied the impact of onset-to-admission interval to a tertiary care centre on outcomes in AP.