Morbidity pattern of out-patient attendance

Summary The incidence of various diseases seen in children attending the O.P.D. has been analyzed, by month. Gastroenteritis and respiratory infections were common. Prevention of these and of malnutrition and infectious diseases is suggested through health education and immunization. From the Department of Medicine, Medical College, Bankura.     

Differential molecular interactions between the crystalline and the amorphous phases of celecoxib

We have investigated the differences in molecular interactions between the crystalline (ordered) and amorphous (disordered) phase of a poorly soluble drug, celecoxib. Molecular interactions in the crystalline phase were investigated with the help of Mercury software, using single crystal X-ray diffractometric data for celecoxib. A simulated annealing molecular dynamics approach was used for the assessment of altered molecular interactions in the amorphous phase. Crystalline celecoxib was found to contain an ordered network of H-bonding between all its electron donors (-S=O group, 2-N of pyrazole ring and -C-F) and the acceptor (-N-H). Amorphous celecoxib retained all these interactions in its disordered molecular arrangement, with a relatively stronger H-bonding between the interacting groups, as compared with crystalline celecoxib. However, these inter-molecular interactions differed in strength in the two solid-state forms. The altered configurations of the molecular arrangement in the two phases were supported by the shifts observed in the Fourier-transform infra-red vibrational spectra of respective states. These interactions could have strong implications on devitrification kinetics of amorphous celecoxib, and could further guide the choice of stabilizers for the amorphous form.     

Testosterone replacement therapy after primary treatment for prostate cancer

PURPOSE: A history of prostate cancer has been an absolute contraindication for testosterone supplementation. We studied a cohort of hypogonadal patients treated with radical retropubic prostatectomy (RRP) for organ confined prostate cancer to determine if testosterone replacement therapy (TRT) could be efficacious and administered safely without causing recurrent prostate tumor. MATERIALS AND METHODS: Ten hypogonadal patients previously treated with RRP for organ confined prostate cancer were identified. They presented with low serum total testosterone (TT) and symptoms of hypogonadism after RRP. Patients had baseline serum determinations of prostate specific antigen (PSA) and TT, and were started on testosterone supplementation. They were assessed periodically for changes in PSA and TT, and for symptomatic improvement using the hormone domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire. RESULTS: At a median followup of 19 months no patient had detectable (greater than 0.1 ng/ml) PSA. TT increased significantly after starting TRT from a mean +/- SD of 197 +/- 67 to 591 +/- 180 ng/dl (p = 0.0002). The Hormone Domain of the Extended Prostate Inventory Composite Health Related Quality of Life questionnaire increased significantly from 38 +/- 5 to 49 +/- 3 (p = 0.00005), primarily due to a decrease in hot flashes and an increase in energy level. CONCLUSIONS: At a median of 19 months of TRT hypogonadal patients with a history of prostate cancer had no PSA recurrence and had statistically significant improvements in TT and hypogonadal symptoms. In highly select patients after RRP TRT can be administered carefully and with benefit to hypogonadal patients with prostate cancer.     

Cadmium Level in Blood and Milk from Animals Reared Around Different Polluting Sources in India

No abstract available.     

Understanding the biology of compressive neuropathies

Compressive neuropathies are highly prevalent, debilitating conditions with variable functional recovery after surgical decompression. Chronic nerve compression injury induces concurrent Schwann cell proliferation and apoptosis in the early stages of the disorder, independent of axonal injury. These proliferating Schwann cells locally demyelinate and remyelinate in the region of injury. Furthermore, Schwann cells upregulate vascular endothelial growth factor secondary to chronic nerve compression injury and induce neovascularization to facilitate the recruitment of macrophages. In contrast to Wallerian degeneration, macrophage recruitment occurs gradually with chronic nerve compression injury and continues for a longer time. Schwann cells change their gene and protein expression in response to mechanical stimuli as shear stress decreases the expression of myelin associated glycoprotein and myelin basic protein mRNA and protein for in vitro promyelinating Schwann cells. The local down-regulation of myelin associated glycoprotein in the region of compression injury creates an environment allowing axonal sprouting that may be reversed with intraneural injections of purified myelin associated glycoprotein. These studies suggest that while the reciprocal relationship between neurons and glial cells is maintained, chronic nerve compression injury is a Schwann cell-mediated disease.     

Single lesion borderline lepromatous leprosy

A patient is reported who presented with a single lesion on the face which, on histopathological examination, was found to be borderline lepromatous leprosy. The importance of doing skin smears as a routine in all patients to differentiate Multibacillary from Paucibacillary disease is emphasized.     

Randomized prospective study comparing high-dose-rate intraluminal brachytherapy (HDRILBT) alone with HDRILBT and external beam radiotherapy in the palliation of advanced esophageal cancer

PURPOSE: HDRILBT is one of the best methods of palliation for advanced esophageal cancer (AEC) by improving dysphagia-free survival (DFS) and overall survival (OS). This study examines if the addition of EBRT would further improve the outcome by improving DFS in AEC. METHODS AND MATERIALS: Patients with inoperable AEC were entered into a randomized prospective study. HDRILBT of 16 Gy/2 fractions/3 days was given initially to all patients. Following treatment, patients were randomized to receive no further treatment (Group A) or additional EBRT of 30 Gy/10 fractions/2 weeks (Group B) and were followed for 1 year. Statistical analysis of the data was done using the SAS statistical software package (SAS Institute, Cary, NC). Prognostic variables were analyzed using the chi(2) and log-rank tests and survival curves were drawn using the Kaplan-Meier method. Multivariate survival analysis was done using the Cox proportional hazards model. RESULTS: Sixty patients were entered into the study. Patient and tumor characteristics were comparable among the groups. Of 30 patients in Group B, 2 refused additional EBRT (no dysphagia). At 6 months, >50% had DFS in both groups and this was comparable. There was no difference statistically (p >0.05) in the DFS and OS between the two groups at the end of 12 months. Median survival for Group A was 7.23 months and 7.5 months for Group B. Additional EBRT did not improve DFS or OS. Eleven patients developed strictures related to radiotherapy and were dilated successfully (Group A, 7; Group B, 4; p >0.05). Four patients had progressive luminal disease which progressed to fistula (Group A, 3; Group B, 1; p >0.05). There was no effect of any patient or treatment parameter on DFS. Presenting weight and ECOG score had an impact on OS. CONCLUSIONS: From the preliminary analysis, additional EBRT to HDRILBT does not improve DFS or outcomes in inoperable AEC.     

Survival of patients with hormone refractory prostate cancer in the prostate specific antigen era

PURPOSE: The historically reported 12 to 18-month duration of survival of patients with hormone refractory prostate cancer is not consistent with current clinical experience. Furthermore, to our knowledge patient survival after serum prostate specific antigen (PSA) progressively increases from a nadir despite castrate testosterone has not been previously reported. For this reason we studied overall survival and the clinical variables that influence survival in patients with hormone refractory prostate cancer. MATERIALS AND METHODS: The study focused on 254 patients with prostate cancer on androgen deprivation therapy. Hormone refractory prostate cancer was defined as the first in a series of PSA elevations despite castrate levels of testosterone. The duration of survival in the hormone refractory phase was calculated from the date of the first PSA elevation to the date of death. RESULTS: Median survival after hormone refractory prostate cancer developed in patients initially staged with and without skeletal metastasis was 40 and 68 months, respectively. Six of more than 25 input variables were retained as significant in the final Cox model. Variables associated with longer survival were lower nadir PSA, younger age, higher pretreatment testosterone, no history of obstructive uropathy, no history of tobacco use (past or current) and lower alkaline phosphatase. CONCLUSIONS: Historical reports of survival in hormone refractory prostate cancer underestimate current survival observations. The likely explanations of this observation include delayed enrollment in clinical trials from which most survival data are derived, PSA lead time in staging and improved supportive care. Models predicting survival in patients with hormone refractory prostate cancer should consider multiple variables.