International Journal of Medical and Pharma Research (IJMPR)

Index Copernicus Journal id: 7526

ISSN 2277-2413

Volume 2 (1) December 2012

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Research Papers

1. Role of Citicoline in Traumatic Brain Injury: A Randomized Controlled Study
Dr. Deepak Krishna¹, Dr. I.D. Chaurasia², Dr. Umesh Jethwani³
Postgraduate Student^1,3, Assistant Professor²
Department of General Surgery, Gandhi Medical College, Bhopal, India
Vol. 2(1) : pp 1-5 (2012)
Abstract: Introduction: Traumatic brain injuries (TBI) are a leading cause of morbidity, mortality, disability and socioeconomic losses in India. It is estimated that nearly 1.5 to 2 million people are injured in which 35,000 persons die and 1,25,000 persons are disabled every year. Despite numerous prior clinical trials no standard pharmacotherapy for the treatment of TBI has been established. Cytidine-5-diphosphocoline (Citicoline), a naturally occurring endogenous compound, offers the potential of neuroprotection, neurorecovery, and neurofacilitation to enhance recovery after TBI.
Materials and Methods: This study was undertaken at surgical unit of medical College hospital to evaluate the effect of citicoline on functional and cognitive outcome in patient with moderate and severe TBI with age group 13-70 yrs in a randomized, single-blind, placebo-controlled ,single-center, prospective trials of 90 days. In all, 100 patient recruited over an estimated 12 months from single clinical site with random assignment to citicoline (1000 mg twice a day) or placebo (twice a day), administered enterally or orally for 60 days. Functional and cognitive outcomes are assessed at discharge, 30, 90 days. The primary outcomes include survival, rate of recovery and toxicity. The secondary outcome disability assessed by modified Rankin test for disability and Glasgow outcome score.
Results: Mean duration of stay in control group is 9.28 days versus 7.81 days in study group (p=0.09). In study group patients gain full conscious mean days 4.83 versus 6.25; (p=0.045) than control group. At 1 month in study group 20 (60%) of 30 patients versus 28 (93%) of 30 patients (p<0.001.) in control group having cognitive symptoms.
Conclusion: Rate of recovery is earlier in study group in prospect of less duration of stay, early gaining of full consciousness and relief from cognitive symptoms. No significant difference found in primary outcome (survival) and disability measurements.
Keywords: Citicoline, Clinical trial, Traumatic brain injury, TBI, Cytidine-5-diphosphocoline, Brain injury.

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2. Preparing Health Care Providers for Disaster Response: Experience from Selected Countries
A Nurul’Ain^1,2, WP Sharifa Ezat², A Siti Nurul Akma²
Kulliyyah of Nursing¹, International Islamic University Malaysia,
Department of Community Health², Universiti Kebangsaan Malaysia Medical Center,
Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
Vol. 2(1) : pp 6-12 (2012)
Abstract: Introduction: Disaster occurs unexpectedly, without warning. Health care providers (HCPs) as a front-liner in providing health services to the affected population shall be prepared with the knowledge and skills in response to disaster and managing disaster victims effectively.
Objective: The purpose of this article is to identify experience of selected countries in preparing HCPs for managing the disaster.
Methodology: English language articles on disaster response among health care providers were reviewed, focusing on United States of America and Japan, and literature search via electronic databases which were identified by using keywords.
Findings: Japan is known as well-prepared country in the world in terms of disaster management. However, during Great Eastern Japan Earthquake hits recently, the country unable to manage appropriately due to central government seems stunned and slow to respond as the events come one to another in a short time. The similar situation occurs in U.S. whereby the government requires local and state organizations to adopt the federal incident command. It is recommended that better national government disaster coordination agency is required, as well as improvements at the local authority levels and there should be a single agency for handling all disasters at every government level.
Conclusion: Despite habitually struck by disaster, Japan and U.S remain not fully prepared as disasters occur unpredicted. However, literatures showed that both countries actively prepared their HCP in terms of disaster-related education and training localizes their disaster response and integrated with the private sector. Many health care organization and universities had established education and training program as to equip their HCPs with disaster management training program as a result to reduce death toll and minimize aftermath of the disaster.
Keywords: Disaster, Disaster response, Disaster preparedness, Japan Earthquake, Health Care Providers, HCP.

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3. Comparision of Elisa Test and Immunochromatography Tests Devices for Hiv Antibodies in Pregnant Females
Raksha¹, Dr. Anahita Bhesania Hodiwala², Sharvari Samant³
Student¹, Professor², Lecturer³
Department of Microbiology, MGM Medical College, Kamothe, Sector-18, Navi Mumbai-410209, Maharashtra, India
Vol. 2(1) : pp 13-16 (2012)
Abstract: Purpose of Study: The human immunodeficiency virus (HIV) pandemic has become one of the greatest infectious disease threats to human health and social stability that the world has ever faced. Every year around 6 lakh new-born children get infected with the HIV virus worldwide. A pregnant woman with HIV infection has an approximately 30% chance of passing the virus on to her newborn baby. Prevention of Parent-To-Child Transmission (PPTCT) is a specific programme that provides a comprehensive, family-centred spectrum of support and clinical services along with other public health initiatives, to prevent the transmission of HIV from parents to their baby.
Material and Methods: 100 samples from pregnant female attending the antenatal clinics of MGM Hospital, Kalamboli, were subjected to test for detection of HIV antibodies.
Results: Out of 2984 patients visiting antenatal clinics 17 (0.56%) were reactive to HIV. The specificity of Comb AIDS-RS advantage-ST: HIV1+2, SD-Bioline and Pareekshak test was found to be same. The sensitivity and specificity of all three immunochromatography tests was 100% as compared to ELISA.
Conclusion: These results indicated that all three rapid tests, inspite of its rapidity and simplicity have same sensitivity and specificity as ELISA. The need of the hour is to provide PPTCT services in as many PHCS and private sector hospital as possible utilization of these services can be improved by creating awareness among the pregnant woman regarding the need and benefits of getting tested.
Keywords: PPTCT, HIV, ELISA, Comb AIDS, Pareekshak, SD Bioline.

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4. Comparison of Conventional Methods, Bact/Alert and Nested Pcr for the Diagnosis of Tuberculous Arthritis
Apurba Sankar Sastry¹, Sandhya Bhat K², Anand Sankar Sastry³
Assistant Professor^1,2, Department of Microbiology, Meenakshi Medical College and Research Institute, Kanchipuram, India
Assistant Professor³, Department of Medicine, Karpaga Vinayaga Medical College, Kanchipuram, India
Vol. 2(1) : pp 17-21 (2012)
Abstract: Introduction: Early laboratory diagnosis of tuberculous arthritis (TBArt) is crucial to start antitubercular chemotherapy and to prevent its complications. However conventional methods are either less sensitive or time consuming. Hence the diagnostic potential of BacT/ALERT and nested polymerase chain reaction (PCR) was evaluated in this study.
Method: The study group comprised of 14 cases and 12 controls. The cases were divided into confirmed sub group (three cases) – smear or culture or histopathologically proven and probable subgroup (11 cases) - clinically suspected cases. Ziehl Nielsen (ZN), Auramine Phenol (AP) staining, LJ culture, BacT/ALERT and nested Polymerase Chain Reaction (PCR) targeting IS6110 were carried out on synovial fluid collected from all the patients.
Results: Sensitivity of ZN, AP staining was found to be 14.2% each and that of LJ culture was 21.4%. BacT/ALERT showed a sensitivity and specificity of 50.0% and 100% and that of nested PCR was found to be 64.2% and 91.67% respectively. The mean detection time of growth by LJ culture was 32.10 days where as that of BacT/ALERT was 21.28 days. The contamination rate in LJ culture and BacT/ALERT were 14.2% and 7.1% respectively.
Conclusion: Nested PCR is found to be more sensitive followed by BacT/ALERT compared to LJ culture and smear microscopy. As both false negative and false positive results are reported on nested PCR, so alone it should not be used as a criterion for initiating or terminating the therapy but should be supported by clinical, radiological, cytological and other microbiological finding.
Keywords: Tuberculous arthritis, Nested PCR, BacT/ALERT, IS6110, Ziehl–Nielsen technique, Auramine phenol staining technique.

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5. A Study on Bacterial Uropathogens Causing Urinary Tract Infection in Females in Allahabad District
Gurjeet Singh¹, Raksha², Dr. Anahita V. Bhesania Hodiwala³, Satya Dev Sharma⁴
Student^1,2, Professor³
Department of Microbiology, MGM Medical College, Kamothe, Sector-18, Navi Mumbai-410209, Maharashtra, India
Professor⁴, Faculty of Health, Medical Sciences, Indigenous and Alternative Systems of Medicine, Allahabad-211007, Uttar Pradesh, India
Vol. 2(1) : pp 22-25 (2012)
Abstract: Purpose: This study was undertaken to detect the incidence of Urinary tract infection (UTI) in females and to determine the factors responsible for the development of UTI. UTI is the most common acute infection which occurs in females. Females are more frequently affected by UTI (particularly cystitis) due to (1) colonization of urethra by colonic Gram-negative bacilli, (2) close proximity of urethra to anus, (3) short length of urethra (about 4cm) and (4) sexual intercourse (Introduction of bacteria into the bladder). Three quarter of Urinary tract infections occur in pregnant women and one quarter in non-pregnant women.
Materials and Methods: 100 urine samples from females were processed for detection of UTI and antibiotic sensitivity test performed.
Results: 10% patients showed UTI of which maximum (60%) were found to be in age group of 26-30 years, also (60%) were in lower socio economic strata. It was observed that incidence of UTI was twofold in pregnant females, i.e. (16.67%) as compared to the non-pregnant females (7.15%).
Conclusions: In present study the factors favouring development of UTI were (1) sexually active age group 26-30 years, (2) lower socio economic strata and (3) pregnancy. Of the organisms isolated, all showed sensitivity to ampicillin+sulbactam, sparfloxacin and gatifloxacin.
Keywords: Urinary tract infection, Escherichia coli, Staphylococcus aureus, Antibiotic sensitivity pattern, Bacterial Uropathogens, UTI.

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6. An Evaluation of Role of Ultrasonography in Appendicular Pathology
Dr. Mahendra Kumar Jalthania
Senior Resident (General Surgery), Department of Surgery, VMMC & Safdarjung Hospital, New Delhi, India
Vol. 2(1) : pp 26-31 (2012)
Abstract: Whenever probe tenderness in right iliac fossa was present, all cases later proved to be of appendicitis except 4.76% cases which were detected as right ureteric calculus. In almost half the cases appendix could be visualized and its position, diameter, wall thickness could be detected on USG. The commonest finding by USG, when appendix was visualized were blind ended tubular structure, non compressible and target lesion. During USG, decrease in probe tenderness was found to be an important finding as all these cases had perforated appendix.
Maximum number of cases as detected by USG and operation had retrocaecal appendix. Histopathologically, 85% cases had acute appendicitis and rest of the cases had chronic appendicitis. Thus, in the present era, it could be said that USG is an essential investigation in a suspected case of appendicitis.
Keywords: Appendicitis, USG, Retrocaecal appendix, Pathology, Appendicular Pathology, Ultrasonography.

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7. Prevalence of Staphylococcus aureus Phage-Types and Their Correlation to Anti-Microbial Resistance
Sharvari Amol Samant¹, Dr. Chitra Pai²
Assistant Professor¹, Professor²
Department of Microbiology, MGM Medical College, Sector-18, Kamothe, Navi Mumbai-410209, Maharashtra, India
Vol. 2(1) : pp 32-37 (2012)
Abstract: Staphylococcus aureus is a major cause of nosocomial and community acquired infections. The increasing prevalence of multiple drug resistant strains cause failure of treatment of patients resulting into prolonged hospital stay. Phagetyping is a successful method of strain characterization in S. aureus and can be applied when studying the spread of staphylococcal infection and its origin in an outbreak.
The present study was conducted to identify the currently existing phage groups of S. aureus, their prevalence and resistance to antibiotics. A total of 99 isolates of S. aureus were phage typed and their antibiotic resistance was determined using standard microbiological procedures. Of these, 72.72% isolates were typable. Phage group III was the most predominant (54.54%) out of which 66.66% were typed by phage type 42 E and 38.88% were typed by phage type 47. MSSA strains were more sensitive as compared to MRSA strains. Phage group II isolates were resistant to penicillin.
Keywords: Staphylococcus aureus, MRSA, MSSA, Phage-grouping, Phage-typing, Antimicrobial resistance.

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8. A Study on Human Immunodeficiency Virus-1 (Hiv-1) Protease Inhibition by Extracts of Fresh Water Mussel
Dr. Estari Mamidala¹, Dr. Venkanna Lunavath²
Assistant Professor¹, Lecturer²
Department of Zoology, Kakatiya University, Warangal-506009, Andhra Pradesh, India
Vol. 2(1) : pp 38-42 (2012)
Abstract: Human immunodeficiency virus type-1 (HIV-1) is the cause of acquired immune deficiency syndrome (AIDS). Failure in anti-AIDS treatment is observed due to the emergence of resistant viruses, cross-resistance to drugs and cell toxicity. The objective of this study is “To study the in vitro HIV-1 protease activity of fresh water mussel extract”. Live freshwater mussels (Lamellidens marginalis Li.) were collected from various places of Godavari river, Adilabad district, Andhra Pradesh. Bioactive crude extract from the animal tissue samples was extracted with using protein extraction buffer. Partially purified extract (PPE) prepared by ammonium sulphate precipitation from crude extract. The PPE tested for cytotoxicity on cultured PBMCs and was assayed for HIV-1 protease inhibitory activity. Cytotoxicity became prominent (>50% cell death) on day 4 at extracts concentration of 400 µg/ml and higher. On day 4, >70% inhibition in protease titer was seen with extract at 100 µg/ml.
Keywords: HIV-1, AIDS, Lamellidens marginalis, Protease, HIV-1 protease, Cytotoxicity.

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Case Reports

1. Spontaneous Rupture of Bleeding Pancreatic Pseudocyst into Gastrointestinal Tract: A Report of Two Rare Cases
Dr. Navneet Kaur¹, Dr. Pankaj Panwar², Dr. Shajib Faridi¹, Dr. Arun Gupta¹, Dr. Nitin Agarwal¹
Department of Surgery¹, University College of Medical Sciences & GTB Hospital, Delhi, India
Department of Surgery², Safdarjung Hospital & VMMC, New Delhi, India
Vol. 2(1) : pp 43-45 (2012)
Abstract: Bleeding pancreatic pseudocyst’s rupture into adjacent organs is a rare, but potentially fatal complication of pancreatitis requiring quick management. Timing of the rupture cannot be accurately predicted but prompt diagnosis and surgical management is essential to prevent further bleeding.
We describe two cases of bleeding pseudocysts with spontaneous rupture into colon and stomach, respectively, which were successfully treated with emergency surgery.
Keywords: Bleeding Pseudocyst, Recurrent Pancreatitis, Spontaneous Rupture, Gastrointestinal Tract, Contrast CT scan, Bleeding Pancreatic Pseudocyst.

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2. Idiopathic Portal Hypertension in Association with Hashimoto’s Thyroiditis - A Case Report
Dr. H.K.Dutta¹, Dr. A. Verma², Dr. J. Teron²
Associate Professor¹, Department of Pediatric Surgery,
Post graduate student², Department of Surgery,
Assam Medical College & Hospital, Dibrugarh, Assam, India.
Vol. 2(1) : pp 46-47 (2012)
Abstract: Few recent studies have suggested an immunological basis for pathogenesis of idiopathic portal hypertension (IPH). The smaller venous radicles in the small and medium-sized portal tracts are thought to be targets of immunologic attack in IPH. We report a 22 year old Indian woman who presented with features of portal hypertension, hypersplenism and hypothyroidism. Investigations for hypothyroidism confirmed Hashimoto’s thyroiditis. Splenectomy and proximal lieno-renal shunt was done after the patient became euthyroid after a month of thyroxine therapy. This association of IPH and Hashimoto’s thyroiditis is very rare and strongly supports the possibility of immunological basis for etiopathogenesis of IPH.
Keywords: Portal Hypertension, Idiopathic Portal Hypertension, Hashimoto’s Thyroiditis, Autoimmune Disease, IPH, Thyroiditis.

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3. Social Phobia in a Case of Parkinson’s Disease: A Case Report
Dr Amitabh Saha
Department of Psychiatry, 92 Base Hospital, Srinagar, J&K, India.
Vol. 2(1) : pp 48-50 (2012)
Abstract: Parkinson’s disease is an illness affecting the geriatric age group resulting in debilitating and disfiguring disease associated with the presence of resting tremor, bradykinesia and postural instability. Psychiatric disorders like anxiety and depression are common in patients with Parkinson’s disease. Patients with Parkinson’s disease are noted to have significant distress in social interaction, and they may also develop social anxiety related to or secondary to Parkinson’s disease.
The prevalence of social phobia in these patients is noteworthy which further compounds the overall improvement of the patient and determines his drug response to antiparkinsonian drugs. Patients are needed to be managed on a comprehensive basis, in which he can receive psychiatric management along with his medical advice and prescription. This study was aimed to examine the association between social anxiety related to Parkinson’s disease in a patient.
Keywords: Parkinson’s disease, Social phobia, Anxiety disorder, Anxiety, Phobia, Psychiatric disorders.

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