New Indian Journal of Surgery

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Curcumin is a natural yellow-pigmented polyphenol component of the spice turmeric, which is derived from the roots of the plant Curcuma longa plant, indigenous to Southeast Asia. The coloring & flavoring properties of Curcumin (difeuloyl methane) have led to its wide use as a dietary additive in a variety of foods. Extracts containing Curcumin have also been used in traditional Indian medicines for generations & have been useful in treatment of inflammation, skin wounds, cough, coryza & certain tumors. Curcuminoids inhibit the generation & propagation of free radicals and act as an antioxidant, inhibiting lipid peroxidation and oxidative DNA damage . The anti-inflammatory property of Curcuminoids have been attributed to the inhibition of lipo-oxygenase and cyclooxygenase resulting in decreased arachidonic acid release and metabolism, along with the property to inhibit activation of NF-B . The role of Curcumin has been studied extensively in breast cancer lines, where it has been able to induce cell cycle arrest & apoptosis by inhibiting cyclin-dependent kinase (cdk) activity, suppressing cyclin D1 and cyclin E expression, increasing levels of cdk inhibitors p21 and p27, and inducing p53 transcriptional activity. Majority of Curcumin’s effects have been attributed to its ability to inhibit transcriptional activity of nuclear factor kappa B (NF-kB), leading to reduced expression of anti-apoptotic, proliferative, pro-angiogenic, and metastatic target genes of NF-kB, with subsequent inhibition of mammary tumorigenesis and metastasis in vivo. Importantly, apoptosis in response to Curcumin appears to be far more pronounced in cancer cell lines versus non-tumorigenic breast epithelial cells. With this background a prospective randomized control trial is being contemplated to assess the role of Curcumin in altering the response to NACT in patients with locally advanced breast carcinoma. 

We have worked out a PCR procedure for idenification of different strains of bacterial species from the rhizosphere of soyabean.The technique is more advanced and quick method of identification.It is advantageous over the traditionally used Bergey’s manual for distinguishing between different bacterial species,also in this technique inoculation of hetrogenous colonies can be done in place of homogenous colonies. Root samples of different varities of soyabean were taken this includes soyabean FYM 50%,soyabean LM 75%,soyabean VC 75%,soyabean FYM 75%, soyabean RDF and soyabean control.The procedure involves firstly,the isolation of the bacterial DNA’s and then amplification using PCR by different primers which amplifies the ribosomal DNA specifically.Amplification using F3/R3 primer and amplified all the bacterial DNA’s which were isolated from various samples, Amplification using F1/R1 primer amplified only those bacterial DNA’S which wrer isolated from soyabean FYM 50%, soyabean LM 75% and soyabean control.Amplification using F2/R2 primer amplified only those bacterial DNA’s which were isolated from soyabean FYM 50% ,soyabean LM 75%, soyabean RDF.The technique described will provide a powerfull tool for identification of different bacterial species. 

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Cancer is a disease which takes its toll on the entire family; a view which the parents of children being treated for cancer reinforce. The effect of the camcer is felt by the child suffering from the cancer leading to major emotional disturbances due to repeated admissions in the hospital. The parents also undergo a mjor emotional upheaval which leads to futher problems. The siblings of the child suffering from cancer also undergo emotional trauma as well as a feeling of neglect due to the fact that the parents are more focused on the needs of the child who is suffering from cancer. However, the trauma suffered by parents of child afflicted with cancer is not the same either for both parents or at different stages of treatment. The literature present on the subject also indicates that the experience of the parents of children with cancer vary in different cases.

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Mixed lineage leukemia is a form of acute leukemia in which morphological , cytochemical and immunophenotypic features of cells lack sufficient evidence to classify as myeloid/ lymphoid in origin. It is a rare form of acute leukemia constituting about 4% of cases. This is a case report of a 17 year old girl who presented with complaints of fever for the past one month ,bleeding from nose off and on for the past one month and swelling of gums for the past one week. On haematological investigations, Hb was 6.2gm%, total leukocyte count was 58000/mm3. Peripheral smear showed leukocytosis composed almost exclusively of blasts. The blasts were large with a high nuclear-cytoplasmic ratio and scant cytoplasm. The cells had finely distributed nuclear chromatin and prominent nucleoli. Some blasts had slight cytoplasmic granularity. Auer rods were not seen . Bone marrow aspirate showed showed numerous immature cells with round-to-convoluted nuclei, many of them containing azurophilic granules. Rare Auer rods were seen. A presumptive diagnosis of acute myelogenous leukemia was made. On performing flow cytometry though, the diagnosis was confirmed as mixed lineage leukemia. This case is being presented for its rarity and unusual presentation.

Two types of culture can be taken:Bacteria growing in culture/Broth and bacteria from biofilm.The proteins from the two can be extracted and they can be stained with different dyes Cy 3 and Cy 5 and run on the 2D gel .The dissimilar proteins of the two identified or have varied would be mapped to gene sequence analysed with the Mass Spectrometry / MALDI/DIGE . The genes identified could also be studied for Biofilm formation and induction ,gene expression,maturation of the biofilm,correlation with sporulation,antibiotic resistance.Once the genes and their gene products have been identified antibodies could be administered against the specific protein products and also to analyse the response of the biofilm forming pathogenic strains towards different concentration of antibiotics. Hence,the Comparative proteomics will help us to determine the molecular function of the various genes involved in biofilm formation and antibiotic resistance in B.anthracis

Two types of culture can be taken:Bacteria growing in culture/Broth and bacteria from biofilm.The proteins from the two can be extracted and they can be stained with different dyes Cy 3 and Cy 5 and run on the 2D gel .The dissimilar proteins of the two identified or have varied would be mapped to gene sequence analysed with the Mass Spectrometry / MALDI/DIGE. The genes identified could also be studied for Biofilm formation and induction, gene expression,maturatiproteinon of the biofilm,correlation with sporulation,antibiotic resistance.Once the genes and their gene products have been identified antibodies could be administered against the specific  products and also to analyse the response of the biofilm forming pathogenic strains towards different concentration of antibiotics. Hence,the Comparative proteomics will help us to determine the molecular function of the various genes involved in biofilm formation and antibiotic resistance in B.anthracis.

Through the ages, Forensic Medicine has evolved as a highly analytical science involving keen powers of observation and deduction. In my study , I have talked about age old mysteries , mysteries that have baffled humanity since centuries and how they were ultimately solved using the new techniques of Forensic Medicine and Toxicology. I have included the mystery of the death of egyptian king Tutankhamun , the mysterious death of Napolean Bonaparte and the mystery of the missing russian princess - Anastasia. The new advancements in Forensic Medicine and Toxicology have helped us unravel the puzzle and have succeeded in shedding some light on the truth.

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Development of taste in higher organisms always has been a very fascinating yet lesser understood among the five special senses. Many events including the development of taste receptors, neuronal connections and the gustatory cortex determine the overall advent of taste in a human foetus. Each taste bud is innervated by peripheral extensions of primary afferent neurons coming from the sensory ganglia which synapse with the taste receptor cells (TRCs) and convey information to CNS from the tongue epithelium. Hence, the neurons are postsynaptic to sensory cells (TRCs), thereby being functionally similar to CNS neuron dendrites. With an intention of studying the approximate beginning of synaptogenesis in the tongue epithelium, I used a specific marker for synaptophysin, a 38 kDa integral membrane protein found in small, round or flat synaptic vesicles. Synaptophysin being an indicator of vesicle formation is used as an indicator of neurogenesis and terminal neuronal differentiation, for studying neural dysgenesis, medulloblastomas and other neural disorders. In this study, I used sagittal sections of tongue from five human foetuses of ages ranging from 14 to 20 weeks to study the gradual appearance of taste buds using staining with haematoxylin and eosin, and the expression of synaptophysin in the tongue epithelium using immunohistochemistry with antisynaptophysin antibody. Across the ages, there was an increase in the number of papillae on the dorsum of tongue. In 16-18 weeks, primary papillae were visible which changed to secondary papillae in the later ages of 20 and 22 weeks, indicating maturation of papillae throughout the period 14 to 22 weeks. In 22 week foetus, probable taste buds were identified, which showed organisation into cells with rounded nuclei, the probable basal cells, cells with elongated nuclei, the probable sustentacular cells and elongated cells with a process, the typical neural cells. Expression of synaptophysin was not found in age groups of 14th to 18th weeks. However, there was very faint expression in the epithelium and within the muscle layer in age groups of 20th and 22nd weeks, suggesting the beginning of synaptogenesis and vesicle formation in the age groups of 20 and 22 weeks. Moreover from 16th week onwards, lingual glands were observed in the posterior part of tongue, this being significant as per taste reception. In view of presence of the protein in the muscle layer, we hypothesize that along with its expected presence in the pre-synaptic terminals of the TRCs, it is also produced in the ganglional cell bodies and is anterogradely transported to be concentrated in axonal endings of sensory neurons, where they probably participate in the regulation/ modulation of neurotransmitter release by the TRCs. This work indicates the maturation of taste buds and synaptic vesicles in human foetal tongue epithelium around 20-22 weeks age and this observation will pave the way for future understanding of the development of taste reception in utero.

 Anaemia in the antenatal period is a well documented problem. Anaemia in the postnatal period has been documented from various studies conducted outside India. It ranges from 25% in Germany to 64.4% in Uganda. The only published study on anaemia in postnatal period reported high prevalence rates (70%); but the socio-demographic correlates were not clear. So, the current study was undertaken.

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 It has been held that every High School student aims to be a doctor or an engineer. However, there is little evidence to support it. The current study aims to understand why contemporary undergraduate medical students  choose medicine as a career.

Rheumatic heart disease (RHD) is a serious medical condition recognized as an immunologically mediated complication of rheumatic fever with an autoimmune component due to molecular mimicry between the bacterial antigens and certain body tissues. In view of the prevalence and seriousness of the disorder, its prophylaxis assumes high significance and serious concern. The current attempts at the prevention of RHD do not appear very prom ising and effective. This brief paper postulates an immunomodulated prophylactic measure aimed to decrease the magnitude and intensity of the antigenic stimulation by the betahemolyticus group A streptococcus and body tissues which share heterophilic antigenecity between themselves in a hope to minimize heart damage and also prevent or delay the progression of the disease itself. 

Perforation peritonitis is associated with a severe morbidity and mortality. Patients outcome is significantly influenced by early adequate surgery and/or peritoneal drainage: moreover, even early and adequate empirical antimicrobial therapy influences patients morbidity and mortality. Surgical treatment usually consists of a laparotomy to eliminate the source of infection, peroperative peritoneal lavage to reduce the bacterial load, and prevention of persistent or recurrent infection. The open approach ie. Laparostomy, showed beneficial results as the percutaneous drainage of abscess from an open abdomen prevented penting up of infectious materials inside the abdomen and hence avoided further complications like burst abdomen, sepsis and death. Our study focuses on evaluation of scoring systems like APACHE II and MPI andcomparison of effectiveness of laparostomy vs primary closure in severe secondary peritonitis. 60 patients were randomly divided into two groups of 30 each. The two scoring systems were evaluated for their predictive power in terms of mortality; and the two surgical procedures in terms of outcome.    

Pancreatitis is a known adverse effect of the nucleoside reverse transcriptase inhibitor drugs-a major drug of the anti-retroviral therapy (ART) which causes premature termination of proviral DNA chain by inhibiting reverse transcriptase enzyme. Drug induced pancreatitis in HIV patients is presented as a sudden onset of abdominal pain, nausea, vomiting and general worsening of health. PURPOSE-To analyse whether pancreatitis presents differently in HIV-seropositive patients compared to the general population and to figure out the prevalence and Incidence of Drug induced Pancreatitis in HIV patients on ART in the tribal belt of southern Rajasthan (mewar region). 

OBJECTIVES Given the large number of nutritional supplements available in the Indian market and being one of the most prescribed drugs this study was conducted to analyse and assess these drugs and rationality of the same. METHODS Analysis of drug formulations enlisted under the category of nutritional supplements, under the subheading of vitamins, iron, zinc and tonics in the Drug Today was carried out for their dosage form, banned combinations, evidence of efficacy, cost, individual constituents and their amount per unit. RESULTS There were 2620 preparations categorized under nutritional supplements of which 2081 were found under vitamins, minerals and tonics with FDCs constituting 84.07%, 92.94% and 100% share respectively. The number of constituents in single preparation were found to be high with highest being 30. Banned combinations were found in 33%, 14% and 69% under each of the above category. Under the category of vitamins only 34% and 12% of formulations were found to be adhering to therapeutic and prophylactic range of vitamins respectively and only 30% of those also containing minerals fell within their RDA. Among iron preparations 97% were found to be FDC with maximum no of constituent being 20 of which only 23% preparations had minerals falling within RDA. 59% of all the preparations scored 5 or less on the rationality scale. CONCLUSIONS Majority of the drugs were FDCs consisting of irrational drug combinations either in the form of banned drug combinations or preparations with unproven. Most of the vitamin preparations are not suitable for prophylactic use. There are a large number of “me too” preparations. There is large heterogeneity in the amount of minerals in the formulations, mostly not abiding with their RDA. The costs of formulations are relatively high.

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 The current study was undertaken to understand the basis of development of carrier state in Salmonella species due to biofilm production and to evaluate their ability to produce exopolysaccharide glycocalyx in vitro.We examined a number of stains of salmonella species recovered from patients with acute (enteric fever,septicemia) and chronic (cholelithiasis with cholecystitis) infections for biofilm production.

Chronic diseases such as diabetes and hypertension require lifestyle modifications, in addition to pharmacological interventions. A prescription audit of patients attending diabetic and cardiac OPDs was carried out to check the type of lifestyle modification advice given (Written+verbal/ Verbal/none) and the differences in patients’ understanding and compliance with each type of advice.

Sleep is a vital, biological process essential for physical & psychological restoration. Unfortunately, sleep loss due to voluntary bedtime curtailment has become a hallmark of modern society of which the student community forms an important segment. Owing to their hectic schedules, medical students, in particular, are known to have erratic sleep patterns and suffer from sleep disturbances, fatigue and mood changes. Hence, this study was designed to record the incidence of sleep deprivation and its impact on mood disorders and recent memory. A cross-sectional study was conducted among 100 medical college students. The subjects and controls were selected on the basis of a standardized questionnaire on Sleep Pattern and Epworth Sleepiness scale Score. Both groups were administered the DASS 21 questionnaire for assessing mood disorders while recent memory was tested using the PGI-BBD questionnaire. We observed that 35% of students were sleep deprived. Also, 53% suffered from depression and 64% reported anxiety, both parameters correlating significantly (p=0.05) with sleep deprivation. Stress was seen in 59% though only mild stress had a significant correlation with sleep deprivation (p=0.05). Recent memory dysfunction was found to be positively linked to disturbances in mild and moderate sleep deprivation. Thus, our study found a large segment of students being sleep deprived and its significant correlation with mood disorders and recent memory disturbances. We hope that these results will create awareness amongst the students of the crucial importance of adequate sleep in stabilizing mood and enhancing their performance. 

 Antibacterial resistance is a global public health care concern that is impacted by both human and non human antimicrobial use. The consequences of antimicrobial resistance are particularly important when disease is caused by pathogens that are resistant to antimicrobials considered critically important in the treatment of human disease by the WHO. Fluoroquinolones have been classified as the highest priority drugs by WHO for management of infections due to Enterobacteriaceae. Fluoroquinolones with expanded spectrum of action, excellent tissue penetration and ease of administration (oral) have made them economical and important drugs for OPD practice. Hence study of resistance mechanism is of great importance in the fight against the spread of resistance genes of this class of drugs. The mechanism of Fluoroquinolone resistance is not completely understood and until recently the conventional understanding is that clinically relevant resistance to quinolones in Enterobacteriaceae is always considered to be chromosomal in origin caused by mutation(s) in topoisomerase genes (target enzymes) or affecting drug permeation and transmitted only vertically. Recently the discovery of novel plasmid mediated quinolone resistance (PMQR) mechanism has threatened the diagnostic capabilities of routine diagnostic laboratories and increased the chances of possible spread of resistance by horizontal gene transfer. There is paucity of data regarding PMQR mediated qnr gene in India. Hence the present study was undertaken to study the presence of qnr A and S in Indian isolates and the effect of qnr gene on MIC of various Fluoroquinolones. 

Evans syndrome is an unusual condition characterized by simultaneous or sequential onset of autoimmune hemolytic anemia and immunothrombocytopenic purpura with a positive Direct Coomb’s Test, in the absence of a known underlying cause. A defect in humoral and cell-mediated immunity is considered to be the most likely cause of Evans syndrome. A positive Direct Coomb’s Test confirms the diagnosis. The disease follows a chronic relapsing course, and is associated with considerable morbidity and mortality. There have been very few reports of Evans syndrome from the Indian subcontinent. We report a 30-year-old woman with Evans syndrome who presented with life threatening autoimmune hemolytic anemia and thrombocytopenia. We will be discussing the pathogenesis, clinical presentation and treatment results of Evans syndrome.
 

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Keywords: Maternal response, signs of obstetric complications, government and private hospital

Malignant pleural mesothelioma is a rare malignancy of the pleura, involving a large extent of the pleural cavity. It is associated with a poor prognosis; with an average survival of less than 2 years from diagnosis. There is a strong etiologic correlation between asbestos exposure and pleural mesothelioma, however unusual presentations are reported, though rarely. The diagnosis is suspected with a chest skiagram and CT Scan and confirmed by a pleural biopsy. Here we are reporting a case of hemorrhagic pleural effusion in a 48 year old male with no history of asbestos exposure. The rarity and implications of this unusual presentation are also discussed.

Self-medication refers to using drugs which have not been prescribed, recommended or controlled by a licensed health care specialist. In recent years there has been an increasing trend in self-medication with non-prescription drugs available in pharmacies and in retail outlets.

LBW babies carry a higher risk of perinatal and neonatal mortality and morbidity. Many factors affect the duration of gestation and of foetal growth, and thus, the birthweight. They may be related to the infant, the mother or the physical environment. Despite the enormous role of LBW in neonatal mortality and morbidity, no clinical attempt is made to predict the possibility of a LBW neonate. The need to formulate a scale to predict the probability of having a LBW infant in the Indian context was strongly felt and the present study undertaken with the objective to assess the risk factors of LBW and to formulate a scale to predict LBW in the Indian scenario.

Motivation/problem statement: Oculoplastic evaluation of patients in OPD is a highly skilled and a demanding procedure which needs meticulous recording of measurements of various oculoplastic parameters. The evaluation has immense bearing on the treatment modality and managing the post operative sequelae.The procedure is done manually which obviates its subjective errors and time consumption which motivated us to pursue an alternative to the current gold standard practice.ImageJ is a public domain, Java-based image processing program developed at the National Institutes of Health.It was developed to solve many image processing and analysis problems, from three-dimensional live-cell imaging,to radiological image processing,multiple imaging system data comparisons to automated hematology systems. Image J is a freeware and easily accessible on the internet and which can be used to analyze and measure various oculoplastic parameters from the photographs of the patients.
 

World Health Organization recommends exclusive breastfeeding till 6 months of age .It has been clearly proven that breastfeeding protects children against infections disease, allergies, adult disease and promotes physical, motor-mental development .In addition, it benefits the mother in reducing anemia, breast and ovarian cancers, is cost effective and helps fertility control. Therefore the present study was undertaken at Safdarjung Hospital (an urban care tertiary centre, catering to diverse strata of population both literate and illiterate) to study breast feeding practices among mothers and its correlation, if any, with their literacy.
 

The Pandemic H1N1/09 virus is a swine origin Influenza A virus subtype H1N1 virus strain responsible for the 2009 flu pandemic. The influenza virus has characteristics of antigenic variation due to antigenic shift and drift.The human race does not have immunity against this new reassorted and novel virus that is why it has potential to spread world wide. Epidemic started in Mexico in March, 2009 spread to whole of world within two months time.As of 24 May 2010, 10193 cases of swine flu have been confirmed with 1035 deaths.With evidence on the effectiveness of vaccination in the control and prevention of seasonal influenza, vaccination for pandemic influenza is one of the most important primary preventive measures to reduce the disease burden associated with influenza A (H1N1) infection. Several high risk groups have been identified as "the priority group" to receive the influenza A (H1N1) vaccination and among these, healthcare workers have been identified"as a first priority" to be vaccinated against influenza A (H1N1) by the World Health Organization.Also previous studies that have examined the acceptability of seasonal influenza vaccination among healthcare workers and found low acceptability. The willingness of the healthcare workers to accept the H1N1 vaccination needs to be assessed. Not only the willingness but their fears about vaccination must be known so that they can be further educated on vaccine and a good compliance can be obtained. 

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Background: In recent years, there has been a global rise of fungal infections in patients with advanced cancer. Apart from Candida, other organisms especially non Candida albicans spp. (NAC) and Aspergillus spp., have become common which were earlier used to be an infrequent cause of fungal infections. With the objective of studying the pattern of fungal infections in malignant wounds, a prospective study was conducted in Safdarjung Hospital.

Despite improvements in prevention, Surgical site infections remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. With the objective of evaluating the surgical site infections in different classes of wounds in Safdarjung Hospital and compare them with the expected international standards, to understand the risk factors associated with them and to study the microbiological profile, a study was conducted during the period (10 June 2010 to 8 August 2010).
 

Osteoporosis, a highly prevalent skeletal disorder , predisposes individuals to an increased risk of fracture. Postmenopausal women are at higher risk for developing osteoporosis and osteoporosis- elated fractures. Osteoporotic fractures are commonly asymptomatic, necessitating a need for proactive screening, diagnostic testing, and therapeutic interventions to reduce the risk of fractures in at-risk patients.
 

Lactation results in a number of physiological adaptations which exert direct effects on maternal health, some of which may confer both short and long term advantages for breast feeding mothers. It delays the return of ovulation and significantly reduces fertility during the period of lactational amenorrhoea. This process is linked with feeding patterns and may therefore be affected by practices such as scheduled feedings and the timing of introduction of complementary foods. While the evidence from epidemiologic studies is mixed, several large studies have shown that extended lactation is associated with reduced risk of premenopausal breast, ovarian and endometrial cancers.Our study reveals that almost half of ovarian cancer patients had never breastfed . Data was collected regarding cumulative breast feeding duration ,months of breast feeding per pregnancy, years since the mother\'s first and last lactation, age at first lactation, complimentary feeding characteristics such as type of milk used, age of weaning & problems associated. Further studies with larger sample size are needed for careful consideration of how such practices affect genital malignancies.

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OBJECTIVES
To find the rate of nasal carriage of Staphylococcus aureus with special reference to MRSA among the medical students.

METHODS
Nasal swabs from each anterior nare were taken from all the 50 study subjects and subjected to various conventional isolation and identification methods. All aerobic bacterial isolates obtained were then subjected to antimicrobial susceptibility tests by disc diffusion method employing the Modified Stoke’s technique against a wide range of antimicrobial agents. All the isolates of Staphylococcus aureus were screened for MRSA by Cefoxitin disc method.

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Breast cancer is one of the most extensively studied cancers and its genetic basis is well established. Dermatoglyphic traits are formed under genetic control and represent the genetic makeup of an individual and therefore his/her predisposition to certain diseases like Down’s syndrome and Kleinfelter syndrome. The prints can thus represent a non- nvasive anatomical marker of breast cancer risk and thus facilitate early detection and treatment.