Epilepsy in Ancient India

The ancient Indian medical system, Ayurveda, meaning science of life, is the oldest system of medicine in the world. Epilepsy is defined as Apasmara: apa, meaning negation or loss of; smara, meaning recollection or consciousness. Aura was recognized and was called Apasmara Poorva Roopa. A large number of symptoms indicative of aura were listed. Worthy of mention are subjective sensation of sounds, sensation of darkness, feeling of delusion, and dream-like state. An actual attack of Apasmara includes falling down; shaking of the hands, legs, and body; rolling up of the eyes; grinding of the teeth; and foaming at the mouth. Four major types of epilepsy based on the disturbance of doshas (humors) that govern the physiological and physiochemical activities of the body are mentioned. Apasmara is considered a dangerous disease that is chronic and difficult to treat. Several causes are mentioned. Treatment included correcting the etiological factors and dietary regimen and avoiding dangerous places that may result in injuries.     

Prevalence of metabolic syndrome in adolescents from a north Indian population.

AIMS: To estimate the prevalence and distribution of the metabolic syndrome (MS) in adolescents attending school in the north Indian city of Chandigarh. RESEARCH DESIGN AND METHODS: At total of 1083 adolescents attending school (aged 12-17 years) participated in a community-based cross-sectional survey. Anthropometric examination included height, weight, body mass index, waist circumference, hip circumference, waist-hip ratio and blood pressure measurement. A fasting blood sample was taken for measurement of glucose, insulin and lipid profile. Socio-demographic characteristics were investigated using a questionnaire. The metabolic syndrome was determined by the National Cholesterol Education Program Adult Treatment Panel III definition modified for age. RESULTS: The overall prevalence of MS in adolescents was 4.2%. However, the prevalence rose to 5.8% when the fasting plasma glucose cut-off was lowered to 5.5 mmol/l. There was no gender difference in the distribution of MS. When stratified by body mass index (BMI), 5.5% adolescents were overweight (BMI > or = 95th percentile), while 4% were at risk for overweight (BMI between 85th and 95th percentile). Of the overweight adolescents, 36.6% met the criteria for MS, while 11.5% at risk for overweight and only 1.9% of the normal population had MS (P < 0.0001). Low high-density lipoprotein was the most common and abdominal obesity the least common constituent of MS. There was a significant difference (P < 0.0001) between the prevalence of MS adolescents from low to high socio-economic strata. CONCLUSIONS: A substantial number (4.2%) of north Indian adolescents and 36.6% of overweight adolescents had MS. This poses a serious threat to the current and future health of these young people.     

Community survey of primary dystonia in the city of Kolkata, India.

An epidemiological study on dystonia has not been reported from India. As part of a major study to find out the prevalence of major neurological disorders in the large urban city of Kolkata, Eastern India, we planned to determine the prevalence of primary dystonia. The study design was a cross-sectional study of a sample population obtained through stratified random selection and conducted in a two-stage procedure of screening by a nonprofessional team followed by confirmation of screened positive cases by the study neurologist. A total population of 52,377 was screened, and 29 subjects with dystonia were diagnosed. Out of them 23 subjects had primary dystonias [crude prevalence rate (CPR), 43.91/100,000; 95% confidence interval (CI), 28.41-64.81; age-standardized rates to world standard population, 49.06 (95% CI,31.74-72.41)] and all cases were focal type and predominantly of limb dystonia variety. Mean onset of dystonias were earlier in women (43.5 years) as compared to men (46.6 years). Thus our study on primary dystonia shows higher prevalence when compared with that of many studies globally, predominantly of focal type, earlier onset among women, and more cases of limb dystonias when compared with more prominent blepharospasm and cervical dystonias in western reports.     

Use of epr oximetry with india ink to measure the po2 in the liver in vivo in mice

The partial pressure of oxygen (pO₂) of the liver in vivo in unanesthetized mice was determined using electron paramagnetic resonance (EPR) oximetry with India ink. The EPR spectra were obtained using a low-frequency (1.2 GHz) EPR spectrometer with a loop gap cavity resonator. The line width of the India ink used in this experiment was reversibly broadened by oxygen and was particularly sensitive to pO₂ below 30 torr. After the administration of India ink into the tail vein, the India ink particles were taken up mainly by Kupffer cells in the liver and in part by phagocytes in the spleen. The pO₂ measured in the normal liver was about 14 torr and was constant for the 2-week experimental period. The pO₂ decreased when measured at 1, 2, and 6 days after treatment with a hepatotoxin (carbon tetrachloride (CCI₄)); within 2 weeks, it returned almost to the initial level. Measurements by EPR at sacrifice of controls and CCI₄-treated mice indicated that more than 90% of the India ink went to the liver; the spleen contained 4.7% of total amount in control mice and 8.8% in CCI₄-treated mice when measured 2 weeks after the treatment. These data indicate the usefulness of India ink for measuring the pO₂ of the liver in vivo and that the pO₂ in the Kupffer cells is decreased when the liver is damaged by CCI₄.     

Candidaemia: a 10-year study in an Indian teaching hospital

Retrospective evaluation of candidaemia patients was performed in an Indian teaching hospital over a 10-year period. The incidence of patients with candidaemia increased eleven-fold in the second half of the study period (55 patients) compared with the first half (5 patients). Haematological malignancies (11 patients), neonatal septicaemia (9), cardiac abnormalities and cardiac surgery (9) were the commonest underlying diseases in these patients. Candida albicans (50%), C. guilliermondii (17%), C. tropicalis (15%) and C. parapsilosis (8%) were the most common fungal pathogens isolated from blood culture. Therapy with two or more antibiotics (92%), corticosteroid administration (25%), intravascular catheter use for over 24 h (78%) and neutropenia (48%) were the accountable predisposing factors. Prolonged hospitalization (mean average 22.2 days as compared with 11.2 days in other patients) was an added risk factor in these patients.     

Family Resources and Development of Social Competence in Disadvantaged Children in India

Family resources in terms of their qualitative (process) and quantitative (structure) nature influences the development of social competence in children/adolescents. Present study aims at exploring the relationship of family resource variables with three measures of social competence of 300 adolescent belonging to different socio-cultural status. Socio-culturally advantaged group samples were found to have healthy family environment, whereas, socio-culturally disadvantaged group perceived themselves as at disadvantages and were deprived in seeking positive intra-family support. However inspite of their disadvantages, they were found to be more self-competent. On the other hand, advantaged group adolescents were found to be more competent in the areas of peer and teacher related social competence. Product-moment coefficient correlation analysis revealed that parental education, occupation and family income were found to be significantly associated with positive peer and teacher related social competence in case of the samples belonging to the advantaged socio-cultural group. However, negative responses and outside family support was found to be positively associated with the development of disadvantaged group adolescent's self-related competence. In general, present study supports the hypothesis that Indian family system still continues to be considered as the major source of support for the adolescents, in spite of their growing tendency for independence, self-definition and autonomy.     

Sex difference in age at onset of schizophrenia: discrepant findings from India

Consecutive male (n=100) and female (n= 100) DSM-IV schizophrenics newly registered for treatment in a large psychiatric hospital were examined with regard to age at onset of the first psychotic symptom. Age at onset of the first psychotic symptom did not differ between the sexes regardless of whether schizophrenia was diagnosed by DSM-IV or by several alternative systems. Age at onset defined by other criteria, namely age at first contact with a physician, and age at first admission for psychiatric care, also did not show any differences between the sexes. Survival analysis of subjects having a documented date of birth revealed a female preponderance at younger ages. A higher positive symptom score predicted older age at onset of the first psychotic symptom in the total sample. These findings call into question the universality of the traditional view of a younger age at onset of schizophrenia among males. Tentative neurodevelopmental and cultural explanations are presented to explain why there is no sex difference in age at onset of schizophrenia in India.     

GM and KM allotypes in eight tribal populations of madyha Pradesh and Orissa, India

Summary Serum samples from eight endogamous Indian tribal populations of Madhya Pradesh (Dhurwa, Halba, Bhatra, Muria, Maria) and Orissa (Deshia Khond, Binjhal, Kisan) with a total of n=731 unrelated individuals were typed for G1M (1,2,3,17), G3M (5,10,11,13,14,15,16,21,26), and KM (1). In seven of these populations five different GM haplotypes were found:GM*1,17;21,26; GM*1,17;10,11,13,15,16; GM*1,2,17;21,26; GM*1,3;5,10,11,13,14,26; andGM*3;5,10,11,13,14,26. In the Kisan sample the haplotypeGM*1,2,17; 21,26 is absent. The intergroup variability in the distribution of these haplotypes is considerable and statistically highly significant. The reasons for that can be attributed to the ethnohistory and to the genetic isolation of these eight endogamous tribal populations. The GM haplotype distribution pattern of all these groups is quite different from that of the non-tribal populations of India, whereas it is in good agreement with that of the so far tested other tribal populations from India. This can be explained by different origin and history of the Indian tribal and non-tribal populations. In the KM system, too, remarkable variability is seen in the distribution of phenotype and allele frequencies among the eight tribal populations under study.     

Molecular epidemiology of rotaviral infection in South Indian children with acute diarrhea from 1995-1996 to 1998-1999

The distribution of VP7 (G-) and VP4 (P-) genotypes among 126 rotavirus strains from South Indian children, < 5 years of age and with acute diarrhoea, presenting to a single hospital during the months to November and December, from 1995 to 1998, was studied. Multiplex hemi-nested G- and P-typing polymerase chain reactions determined 101 (80%) G types and 78 (61%) P types, respectively. In order of frequency, the commonest G types were G1, G4, G2, G9, G3, and G8, and P types were P1B[4], P1A[8], and P2A[6] and the most common G:P combinations were G1:P1A[8], G1:P1B[4], G2P1B[4] and G4:P1A[8]. G1, G2, and G4 types were seen in all years. The single G3 isolate was seen in 1998. The single G8 isolate and the 5 G9 isolates were seen in 1997, after a period of heavy rain. Sequence analysis showed that the G8 isolate was related most closely to the bovine strain A5, and the G9 strains were distinct from the nonpathogenic Indian isolate 116E and similar to G9s isolated in Mysore and the United Kingdom described previously.     

Allele-specific PCR and Next-generation sequencing based genetic screening for Congenital Adrenal Hyperplasia in India

Genetic screening of Congenital Adrenal Hyperplasia (CAH) is known to be challenging due to the complexities in CYP21A2 genotyping and has not been the first-tier diagnostic tool in routine clinical practice. Also, with the advent of massive parallel sequencing technology, there is a need for investigating its utility in screening extended panel of genes implicated in CAH. In this study, we have established and utilized an Allele-Specific Polymerase Chain Reaction (ASPCR) based approach for screening eight common mutations in CYP21A2 gene followed by targeted Next Generation Sequencing (NGS) of CYP21A2, CYP11B1, CYP17A1, POR, and CYP19A1 genes in 72 clinically diagnosed CAH subjects from India. Through these investigations, 88.7% of the subjects with 21 hydroxylase deficiency were positive for eight CYP21A2 mutations with ASPCR. The targeted NGS assay was sensitive to pick up all the mutations identified by ASPCR. Utilizing NGS in subjects negative for ASPCR, five study subjects were homozygous positive for other CYP21A2 variants: one with a novel c.1274G>T, three with c.1451G>C and one with c.143A>G variant. One subject was compound heterozygous for c.955C>T and c.1042G>A variants identified using ASPCR and NGS. One subject suspected for a Simple Virilizing (SV) 21 hydroxylase deficiency was positive for a CYP19A1:c.1142A>T variant. CYP11B1 variants (c.1201-1G>A, c.1200+1del, c.412C>T, c.1024C>T, c.1012dup, c.623G>A) were identified in all six subjects suspected for 11 beta-hydroxylase deficiency. The overall mutation positivity was 97.2%. Our results suggest that ASPCR followed by targeted NGS is a cost-effective and comprehensive strategy for screening common CYP21A2 mutations and the CAH panel of genes in a clinical setting.