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   2013| April-June  | Volume 3 | Issue 2  
    Online since June 3, 2013

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Biosynthesis, mechanism of action, and clinical mportance of neuroactive steroids: Pearls from literature
Pratishtha Vijaykumar Banga, Chetan Yuvraj Patil, Gaurav Anil Deshmukh, Kantilal Chainkaran Chandaliya, Mirza Shiraz Baig, Sudhakarrao Malhar Doifode
April-June 2013, 3(2):77-86
Aim: To review the biosynthesis, mechanism, and important effects of neurosteroids on brain functions and brain disease by modulating synaptic and extrasynaptic transmission. Materials and Methods: This article is based on a comprehensive database search on the internet. Full-text articles in English, published between 2001 and 2012, were searched for, using the terms 'neuroactive steroids', 'neurotransmitter agents', 'molecular mechanism', 'depression', 'anxiety' 'neuropsychopharmacology', 'interactions with receptors', 'neuroprotection', and 'neuroendocrinology' to identify potential therapeutic targets. The reference lists of leading review articles identified during this search were checked for additional publications. Results: Neurosteroids regulate physiological functions of the central nervous system (CNS) and help in the neurodevelopmental functions relating to their neuroprotective effects in brain injury and possible therapeutic potential in brain lesions and other diseases of the nervous system. Neurosteroids have been shown to affect neuronal excitability via their interaction with the ligand-gated ion channel family, such as the GABA A and 5-HT 3 receptors, by acting genomically as well as nongenomically. By virtue of these properties, neurosteroids appear to be relevant to pathophysiology and pharmacological treatment of many psychiatric disorders, including not only the notable mood and anxiety disorders, but also psychotic disorders, childhood dementia and stress disorders. They have also been found to be involved in the pathophysiology and treatment of epilepsy, alcohol and substance abuse. Conclusion: Neurosteroids may become potential targets for pharmacological intervention in the future, with further research at the basic science level as well as in the context of large double-blinded placebo-controlled investigations to elicit their role fully in the understanding and management of various psychiatric conditions.
  7,518 276 1
L-arginine improves vascular function in patients with systemic lupus erythematosus
Hima Bindu Gujjarlamudi, Liza Rajasekhar, MUR Naidu
April-June 2013, 3(2):131-134
Objective: Systemic lupus erythematosus (SLE) is a chronic, inflammatory disorder, experiencing an excess of cardiovascular morbidity and mortality. Arterial stiffness (AS) and Endothelial dysfunction are key events in the initiation, progression, and rupture of atheromatous plaque. L-arginine corrects derangements in the vascular endothelial nitric oxide dependent signaling pathway. Thus, the aim of our study was to evaluate the effect of L-Arginine on AS and endothelial function in patients with SLE. Materials and Methods: Twenty-Five (22F, 3M) SLE patients, demographic data, associated risk factors, disease activity, and treatment regimen were collected. Pulse Wave Velocity (PWV) and Reflection index (RI) was determined non-invasively by PeriScope and Autodicrowin, respectively. PWV reflects large artery stiffness, whereas RI represents small artery tone. Patients were randomized to receive either placebo or L-arginine (3 g t.i.d) for 2 weeks. Paired Student 't' Test and percentage change was used for statistical comparison. Results: L-arginine treatment improved Carotid femoral PWV (P < 0.002) and excellent improvement in change in RI (P < 0.0001). There was significant change in hemodynamic parameters. In placebo group, neither there was statistical change in carotid femoral PWV nor change in RI. Conclusion: L-arginine supplementation has been shown to restore vascular function and to improve the clinical symptoms in SLE patients with vascular dysfunction.
  7,490 145 -
Pemphigus vulgaris of oral cavity: A case report with its treatment strategies
Seema Kapoor, Pranav Sikka, Geet Priya Kaur
April-June 2013, 3(2):146-149
Pemphigus vulgaris (PV), a rare autoimmune mucocutaneous blistering disorder, has been reported with incidence of 0.1-0.5 cases per 100,000 individuals worldwide per year. It is slightly more common in women and occurs primarily in adults during the 5 th or 6 th decade of life. The etiology of PV is uncertain but is supposed to be mediated by circulating immunoglobulin G (IgG) autoantibodies against the desmosomal cadherins, desmoglein 1 and 3. Biopsy, light microscopic examination, and additional adjuvant tests, such as immunofluorescence studies can be used to establish the diagnosis. In most cases (70-90%), the first signs of disease appear on the oral mucosa but most patients with oral lesions are initially misdiagnosed and treated improperly for months or years. If these patients are misdiagnosed or left untreated, PV may be fatal with a mortality rate ranging from 60% to 90%. Therefore, here we are trying to discuss basics of diagnosing and treating PV with oral lesions with the help of a case report.
  7,132 478 1
Impact of training workshop on knowledge about new WHO growth chart, severe acute malnutrition, and Infant and Young Child Feeding among final-year medical students
Purushottam A Giri, Jayant D Deshpande, Deepak B Phalke
April-June 2013, 3(2):121-125
Background: According to reports of the Food Agricultural Organization (FAO), malnutrition is prevalent among nearly 460 million people, which is 15% of the world's population, and 300 million in Southeast Asia where they constitute one-third of the population. According to the report of the National Family Health Survey (NFHS-III), only one-fourth of the infants started breastfeeding within the first half hour of birth and 57% of mothers gave fluids in addition to breast milk within three days of delivery. Objectives: The present study was conducted to assess the knowledge about the new growth chart of the World Health Organization (WHO), severe acute malnutrition (SAM), and Infant and Young Child Feeding (IYCF) among final-year medical students. Materials and Methods: An interventional study was conducted from June 2010 to September 2010 by interviewing 118 final-year medical students. A predesigned and pretested questionnaire was used to collect the pre-workshop and post-workshop data. Questions were based on the knowledge about the new growth chart, SAM, and IYCF.The results were analyzed statistically using percentages, proportions, and Chi-square test. Results: In this study, only 15.2% students knew about the number of reference curves as per the new growth chart of the WHO, but after the workshop, 94.1% became aware of it ( P < 0.0001). Before the workshop, 21.2% students knew thedifference between marasmus and kwashiorkor, but after the workshop 88.1% were aware of it ( P < 0.0001). Only 51.7% students knew about the appropriate age for weaning, but after the workshop 97.5% were aware of it ( P < 0.0001). After the workshop, 87.3% students were aware of the type of feeding to be given during illnessfor infants older than 6 months ( P < 0.0001). Conclusion: Such interventional studies are important to increase the knowledge amongst the students, as the topic chosen was closely related to everyday life with respect to treatment of children, and advice on feeding, proper nutrition, and growth.
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Antieosinophilic activity of various subfractions of leaves of Vitex negundo
Jignesh I Patel, Shrikalp S Deshpande
April-June 2013, 3(2):135-141
Aim: The present study was undertaken to isolate and identify active constituent of leaves of Vitex negundo for their actions on bronchial hyperresponsiveness. Materials and Methods: Effects of aqueous subfraction, acetone subfraction, and chloroform sub-fraction on bronchial hyperresponsiveness and serum bicarbonate level were studied using egg-albumin-induced asthma in guinea pigs. The structure of aqueous subfraction of leaves of Vitex negundo was determined by various spectroscopy methods like UV spectroscopy, FT-IR spectroscopy, EI-mass spectroscopy, and H 1 NMR spectroscopy. Results: Animals pretreated with aqueous subfraction of leaves of Vitex negundo showed significantly lesser serum bicarbonate level, when compared with untreated sensitized animals. Animals pretreated with aqueous subfraction showed significant lesser eosinophils count (9.50 ± 1.5044; P < 0.05) when compared with untreated sensitized animals (29.50 ± 2.5074; P < 0.05). Histopathology of lungs in sensitized guinea pig showed infiltration of inflammatory cells like eosinophils and neutrophils which is due to marked inflammation in lungs. Histopathology of lungs in animals pretreated with aqueous subfraction (200 mg/ kg) showed normal airway, blood vessels, and bronchoalveolar space. Conclusion : It can be concluded that aqueous subfraction of leaves of Vitex negundo possesses antieosinophilic activity. It reduces bronchial hyperresponsiveness. As per UV, EI-Mass, FT-IR, and H 1 NMR spectra analysis, the structure of aqueous subfraction is determined as a 5-hydroxy-3,6,7,3',4'-pentamethoxy flavone. It may be useful in the treatment of asthma and various inflammatory, allergic, and immunologic diseases.
  6,708 280 1
Dementia with Lewy bodies: Enigmatic presentation
Ahmed Al-Harrasi, M Shanmugapriya Aravazhi, Hamed Al-Sinawi
April-June 2013, 3(2):156-159
Illness may present clinically in different ways causing misdiagnosis of the case and inappropriate treatment; an example of this is dementia with Lewy bodies. This neurodegenerative disorder has overlapping features with both Alzheimer's disease and Parkinson's disease dementia, which tends to confuse the clinician to arrive at the right diagnosis. It is important that clinicians update their knowledge of the diagnostic criteria of dementia with Lewy bodies in order to provide suitable pharmacological and non-pharmacological management for its cognitive, neuropsychiatric, motor and sleep disturbances without causing distressing side effects by inappropriate drug prescription. This article will describe a case of dementia with Lewy bodies with literature review.
  6,845 142 1
Thyroid: Disorders, disruptors and drugs
Mangala B Murthy, Suyog S Jain, Karuna B Ramteke, Girish T Raparti
April-June 2013, 3(2):87-95
Thyroid disorders are one of the most common endocrine disorders. In India, estimated prevalence of thyroid disorders is more than 42 million, hypothyroidism being commonest. Drugs play an important role, both as adjuncts and as critical molecules, in managing thyroid problems including emergencies. This review emphasizes the role of drugs in the treatment of thyroid diseases. A detailed review of the symptomatology, investigations, and diagnosis of thyroid disorders is beyond the scope of this article. Hence, due consideration is give to the appropriate medical management of thyroid disorders with the help of goal-oriented algorithms. An additional note has been added on the concept of selective thyroid receptor modulators and thyroid disruptors. The cause of thyroid disease is more often primary in nature and originates from the thyroid itself. Hence, primary hypothyroidism and hyperthyroidism are considered in detail, and readers are referred to endocrinology reference books for a review of causes and treatment of secondary thyroid disorders. Medical management of thyroid disorders includes use of drugs, and drugs available for treatment of thyroid disorders are either synthetic preparations similar to natural hormones for replacement therapy in case of thyroid hypofunction or antithyroid drugs used to reduce the functional capacity of the gland during thyroid hyperfunction.
  6,369 290 3
Evaluation of anxiolytic activity of vanillin in wistar albino rats
Vani Bhagwat, Mukta N Chowta, Ahasan Shoeb, Rakshita Maskeri, V Venkatesh, Amrita Rai
April-June 2013, 3(2):96-101
Background and Objectives: Vanillin is one of the primary chemical components of the extract of the vanilla bean. Vanillin has been claimed to possess various beneficial effects like anti-mutagenic, anti-nociceptive, anti-invasive and metastasis inhibiting potential by suppressing enzymatic activity of matrix metalloproteinase-9. However, literature research revealed no scientific data on its anxiolytic activity. Hence, this study was designed to evaluate the anxiolytic activity of vanillin in wistar albino rats. Materials and Methods: The rats were divided into five groups (n = 6). Vanillin administered at the dose of 10,100,200 mg/kg/day, orally was compared with the standard drug Diazepam (1.0 mg/kg/day, oral) fed for the latter 10 days. The two pharmacologically validated models, elevated plus maze and bright and dark arena were used. The data presented was analyzed using Kruskal Wallis followed by Mann-Whitney Test. P <0.05 was considered as statistically significant. Result: Vanillin significantly reduced the time spent in closed arm, increased the entries into open arm both in chronic and acute model of elevated plus maze (P < 0.05) in all three doses (10,100,200 mg/kg) used. Time spent in open arm, percentage ratio of open arm entries and number of rears in open arm also increased. Maximum effect was seen with 100 mg/kg. In bright and dark arena test there was an increase in number of entries, time spent and rears in bright chamber both in acute and chronic study at all doses (P < 0.05). Conclusion: The present study demonstrates the anxiolytic activity of vanillin in wistar albino rats.
  5,145 285 6
Analysis of hemogram profile of elderly diabetics in a tertiary care hospital
Mukta N Chowta, Nithyananda K Chowta, Prabha Adhikari, Ashok K Shenoy
April-June 2013, 3(2):126-130
Background: Anemia is a common concern in geriatric health, but its exact incidence and prevalence are unclear. Several studies have addressed this issue with discrepant results. Recent findings have shown that anemia can lead to cardiovascular and neurological complications, such as congestive heart failure and impaired cognitive function. Objective: To evaluate the hemogram profile in elderly diabetic patients and compare the same with younger diabetic patients. Materials and Methods: A retrospective chart review of type 2 diabetic patients who participated in clinical trials on diabetes mellitus was carried out. The clinical trials have been approved by the institutional ethics committee. Patient population included both males and females. Patients who underwent baseline hemogram profile were included for the study. Laboratory parameters collected include hemoglobin, hematocrit value, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), glycosylated hemoglobin, serum creatinine, and urine albumin. Results: A total of 127 elderly patients with age >60 years and 122 patients with age below 60 years were included in the study. Mean hemoglobin concentration in elderly was 13.1 g/dL and in younger patients was 14.8 g/dL. The differences in the hemogram values among the two populations showed statistical significance only for hematocrit (P = 0.03) and RDW (P = 0.002). There was significant positive correlation between hemoglobin level and creatinine clearance (P = 0.019) and between hemoglobin and urine albumin concentration (P = 0.035) among elderly patients. Among the elderly patients 25 (19.7%) had anemia (hemoglobin below 12 g/dL), and 18 (14.8%) younger patients had anemia. Chi-square analysis did not show significance for distribution of anemia among the two populations. Conclusion: There was significant difference in the hemogram profile of elder and younger diabetics; levels were much less in elderly patients.
  5,152 206 -
Effect of Vimliv on lipid profile and histopathology in ethanol-induced hepatotoxicity in albino Wistar rats
Nagamani Samundeeswari, Murugan Rajadurai, Palanisamy Ganapathy, Sukumaran Rexlin Shairibha
April-June 2013, 3(2):114-120
Background: Liver disease is considered to be a serious health problem, as the liver is an important organ for the detoxification and deposition of endogenous and exogenous substances. Objective: The present study is carried out to investigate the effect of Vimliv in ethanol-induced hepatotoxicity. Materials and Methods: Ethanol (3 g/kg) was dissolved in water and injected intragastrically, for a period of 35 days. Vimliv was dissolved in carboxy methyl cellulose and administered to rats at doses of 25 and 50 mg/kg for a period of 35 days as coadministration. Results: Administration of Vimliv resulted in significant reduction of blood glucose, serum urea, creatinine, lipid profile and increase in albumin. Administration of Vimliv also shows better pathological effects on liver and kidney. Conclusion: Therefore, this study suggests that Vimliv has the hepatoprotective effect and consequently may alleviate liver and renal damage associated with ethanol-induced hepatotoxicity in rats.
  4,986 214 2
Non-convulsive status epilepticus presenting with catatonia and suicidal behavior
Balaji Bharadwaj, Sugaparaneetharan Ayyanar, Jayant Mahadevan, Ravi P Rajkumar
April-June 2013, 3(2):153-155
Non-convulsive status epilepticus (NCSE) is an uncommon clinical entity. An electroencephalogram (EEG) helps in diagnosis of NCSE, in cases without overt motor manifestations of seizures such as automatisms. We describe an 18-year-old patient with NCSE, who had presented with catatonia and suicidal attempts. There were no automatisms or eye signs indicative of seizure. He had an episode of tonic neck deviation followed by incontinence, which first alerted us to the possibility of epilepsy. An abnormal EEG and a clinical response along with correction of EEG abnormalities with diazepam clarified the diagnosis. Management and hospital course are described in brief. The patient had residual symptoms, suggestive of a postictal state at discharge. The case shows the importance of keeping NCSE as a differential diagnosis, in cases presenting with catatonic symptoms, perplexity, and confusion. The presence of fleeting hallucinations and behavioral disturbances indicate limbic seizures in such cases, presenting in a catatonic state.
  4,980 143 1
A study on the hematological parameters and brain acetylcholine esterase activity in immobilization induced stress and co-treatment with Centella asiatica leaves extract to wistar rats
Arumugam Sarumathi, Nadanam Saravanan
April-June 2013, 3(2):102-107
Aim: Our aim was to evaluate the anti-stress activities of aqueous leaf extract of Centella asiatica (CA) in immobilization-induced stress in rats. The anti-stress activities of CA were assessed by monitoring the changes in the behavior, counts of red blood cells (RBCs) and white blood cells (WBCs) (Lymphocytes, Monocytes, Neutrophils, Esinophils) and change in the level of brain acetylcholine esterase (AChEs) activity in immobilization-induced stress in male albino Wistar rats. Materials and Methods: Immobilization stress was induced in rats by placing in 20 cm × 7 cm plastic tubes for 2 h/day for 21 days. Aqueous leaf extract of CA was co-administered orally to the experimental rats at a dose of 200 mg/kg body weight daily for the 21 days. Results: Stress induced by immobilization in the rats for 21 days decreased the passive avoidance behavior, total counts of RBCs, WBCs and brain AChEs activity. Upon co-administration of CA leaves extract to the stressed animals significantly reverted the changes to near normal levels when compared to control animals. Conclusion: Aqueous extract of CA leaves significantly reverted the changes due to immobilization induced stress which may be due to the anti-stress activities of CA leaves.
  4,660 372 4
Wernicke's encephalopathy and Hyperemesis gravidarum
Ummunissa Firdous, Hussein Attia Sharara, Fareed Abou Nahia, Mariam Al Saqqa, Samawi Musaed
April-June 2013, 3(2):142-145
Recent research is concentrated around micronutrients and antioxidant's role in degenerative neurological disorders; but still the vitamin deficiency in special situations can lead to life threatening medical emergencies. Hyperemesis gravidarum rarely leads to Wernicke's encephalopathy. It is a medical metabolic neurological emergency. Wernicke's encephalopathy is manifested by triad of confusion, opthalmoplegia and ataxia. Early detection and proper supplementation of thiamine is essential for treatment. Clinical manifestations of Wernicke's encephalopathy are due to the involvement of specific area of the brain where thiamine content and turnover is maximized. We report a case of Wernicke's encephalopathy in a pregnant woman known to have thyroid disorder, hyperemesis gravidarum; she was managed with intravenous dextrose infusion. The condition was diagnosed early by clinical manifestations and improved dramatically with thiamine supplementation. Wernicke's encephalopathy occurring due to hyperemesis gravidarum and hyperthyroidism is rare. High index of suspicion is essential for early diagnosis and proper supplementation of thiamine.
  4,138 145 2
New-onset seizures with cerebral edema as a direct effect of antipsychotic medications
Atul S Phillips, Ashu Sara Mathai
April-June 2013, 3(2):150-152
Patients developing hyponatremia while on antipsychotic medications may have widely varied clinical presentations, ranging from being asymptomatic to developing altered sensorium, cerebral edema, or even death. In these patients, hyponatremia may develop secondary to over-dosage of medications, psychogenic polydipsia or due to the syndrome of inappropriate antidiuretic hormone secretion (SIADH). There have been reports of hyponatremia occurring as a direct adverse effect of antipsychotic medications although not severe enough to cause cerebral edema and seizures. Unusual neurological symptoms presenting in patients on antipsychotic medications are often mistaken for the psychiatric illness itself and a diagnosis of hyponatremia can be overlooked, resulting in delayed treatment. We would like to report one such case of severe symptomatic hyponatremia in a patient on antipsychotic medications.
  3,666 120 -
Knowledge of Sri Lankan government medical practitioners and medical students on standard treatment guidelines; regional cross sectional survey
Lukshmy Menik Hettihewa, Inoka Wimalasena, Tharanga Dadallage
April-June 2013, 3(2):108-113
Introduction of module of rational use of medicine (RUM) to pharmacology curriculum requires analysis of existing knowledge among health care workers. We conducted this study to evaluate the knowledge and attitude of medical practitioners (MPs) and medical students (MSs) on Standard Treatment Guidelines (STG) as an initial tread. 42 MPs and 120 MSs were selected and for this study and pretested structured questionnaire on STG and core policies of RUM were used to evaluate the key testing parameters. Results showed that only 78% of MPs were confident about their knowledge in STG and 7% of them were not attentive. Knowledge of MPs and MSs showed 78% and 84% on contents of STG while the knowledge in core policies was 73% and 34% respectively. More than 99% of MSs and 71% of MPs were attentive on the inclusion of clinical features of the illness in STG. Knowledge on updating and significance of STG as guidance for new prescribers of MPs were 84% and 88% respectively while 96% of MSs had acquainted in those two areas. Both groups had good knowledge on STG and they showed that STG were prepared with accordance with personnel experience (MPs-71%, MSs-74%). 80% of MSs and 75% MPs discerned that common treatment practices is not an inclusion criteria for STG. We found that MSs had good knowledge on contents of STG but skills in application in RUM were limited. MPs had good knowledge on core policies and application of STG but not familiar with principles of STG. We conclude that MPs need repetitive in-service training programs to ensure the adherence to STG and MSs are in need of skill development program to pertain STG in clinical practice.
  3,311 161 1