Biomedical subjects
Publications and source records attributed to S Jain.
Ever since the introduction of itraconazole and terbinafine in the management of onychomycosis, there has been a revival of interest in the latter. In order to comprehend the intricate emerging scenario, an endeavor has been made to form a distinct outline in the shape of an overview on several of their facets. The review, therefore, envisages forming and facilitating instant decision-making.
BACKGROUND: An association between plasma homocysteine and essential hypertension and their non-hypertensive siblings is controversial. METHODS AND RESULTS: Plasma homocysteine levels were measured in subjects with essential hypertension (n = 50), their normotensive siblings (n = 50) and normotensive controls (n = 50). All the subjects were non-diabetic, had no past history of myocardial infarction, stroke or peripheral vascular disease and had normal renal functions. The mean homocysteine values were 18.96 +/- 8.08 micromol/L in patients, 14.84 +/- 5.55 micromol/L in siblings and 10.50 +/- 4.92 micromol/L in controls. Plasma homocysteine level were found to be significantly higher in patients with hypertension (p < 0.0001) and their normotensive siblings (p < 0.0001) when compared to controls. Also patients with hypertension had their higher plasma homocysteine levels compared to their siblings (p < 0.0036). CONCLUSION: Plasma homocysteine levels are significantly elevated in Indian patients with essential hypertension and their normotensive siblings. Thus, plasma homocysteine may serve as a marker for the development of essential hypertension.
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A 21-year-old male presented with sudden onset of right-sided third nerve paresis. Angiogram showed a fenestrated posterior communication artery on the right side and no other vascular anomalies. There was no other lesion that could suggest a cause for the third nerve weakness. Fenestration of the posterior communicating artery has not been reported till date. The case is discussed and the literature on the subject is reviewed.
Intra-abdominal migration of the catheter and formation of a cerebrospinal fluid pseudocyst are both rare complications of a ventriculoperitoneal shunt. Traditionally, each condition is treated by a formal laparotomy. Laparoscopic management of the complications in two patients is described.
The association of internuclear ophthalmoplegia (INO) with torsional nystagmus is rare. We report a case of a 72-year-old male who developed brainstem stroke and was found to have left INO with torsional nystagmus. An MRI correlation in this case has been described.
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AIM: To describe clinical, biochemical and electrophysiological profile in Indian patients with Restless Legs Syndrome. MATERIAL AND METHODS: A total of 84 patients with sleep disorders were evaluated. Eight patients were diagnosed to have RLS. All underwent series of hematological, biochemical investigations and electrophysiological studies. Severity was assessed before and after specific treatment RESULTS: Eight patients presenting with clinical features of RLS formed the study group. The mean age was 51.6 +/- 13.8 years. The male : female ratio was 7:1. Six cases were primary and two were of secondary type of RLS. Seven patients reported significant improvement in symptoms after treatment CONCLUSION: RLS can be diagnosed purely on clinical criteria; and appropriate treatment results in significant relief. Thus, the recognition of this entity is essential.
Neuronal migration disorders are an important differential diagnosis to be considered in the evaluation of intractable epilepsy. Though the underlying causative factors which govern their development are many and varied, genetic factors have been found to be contributory in a few forms of these disorders. An X-linked association with lissencephaly has recently been discovered and there are a few families described till now with this entity.
We describe a 30-year-old male who presented with acute onset of breathlessness, tachycardia, and palpitations associated with distension of jugular vein and clear lungs on physical examination. The chest X-ray was normal and ECG was showing S1Q3T3 and right ventricular strain pattern. His 2-D echocardiography was showing dilated right atrium, right ventricular dilatation and moderate pulmonary arterial hypertension. He was found to have thrombosis involving left side of deep venous system with normal superficial venous system (Doppler proved). All routine blood investigations for etiology of recurrent DVT were normal except serum homocyteine level, which was significantly raised. Megaloblastic anemia on peripheral smear and hyperhomocysteinemia prompted us to search for its cause, which was subsequently found to be vitamin B12 deficiency. Such an association of megaloblastic anemia due to vitamin B12 deficiency leading to hyperhomocysteinemia and subsequent thrombosis in left venous system presenting as acute pulmonary embolism has not been described earlier in the medical literature.
INTRODUCTION: Obstructive sleep apnoea (OSA), is characterized by loud snoring and excessive daytime sleepiness. Though the gold standard for diagnosis is overnight polysomnography (PSG), sleep questionnaires have also been used to diagnose this with good predictive value. MATERIAL AND METHODS: A pre-designed proforma with clinical details, symptom-specific questions for diagnosis of OSA, and Epworth Sleepiness Scale (ESS) was administered to 20 patients presenting to the Sleep Disorder Clinic of our hospital and to 40 age and sex-matched relatives (control group). The students 't-test' and chi-square were used as the statistical tests. RESULTS: There were 20 patients with a mean age of 41+/- 8 years, and 40 controls with a mean age of 41 +/- 6 years (P=>0.05). Seven had family history of snoring in the study group and 3 in the control group (P=0.02). Four had met with road traffic accidents in the study group and none in the control group (P=0.001). The body mass index (BMI) was 29.9 (SD 4.4) in the study group and 24.5 (SD3.5) in the controls (P=0.001). The mean ESS was 13.3 +/- 6 in the patients and 4.2+ 4 in the controls (P=0.001). A larger number of patients with OSA had hypertension: 5/20 vs. 3/40 (P=0.01). CONCLUSION: Patients with OSA had significantly higher BMI and ESS score, and were more likely to have hypertension and road traffic accidents. Increased awareness of this entity is essential.
A 46 year old male presented with progressively increasing dysphagia and weight loss. Esophagoscopy showed a large polypoidal growth involving the middle segment of esophagus. Histologically bulk of the tumour had a sarcoma-like appearance composed of spindly pleomorphic cells along with extensive areas of bone formation. The epithelial element was represented by a small area of squamous cell carcinoma. One of the draining lymph nodes also showed small islands of squamous cell carcinoma. A diagnosis of sarcomatoid carcinoma was made. Sarcomatoid carcinoma of the esophagus, also termed carcinosarcoma, pseudosarcoma, and spindle cell carcinoma is an unusual malignant tumour of the esophagus. The proportion of carcinomatous and sarcomatous component may vary from case to case. Rarely, the sarcomatous component may exhibit osseous differentiation as in our case.
Heavy metal pollution due to Fe, Ni, Pb, Cd, Co and Zn in the water of major canals originating from the river Yamuna in Haryana was studied. All these metals except Zn were found to be present in the Western Yamuna Canal (WYC) exceeding the maximum permissible limits. In the Sunder branch (SB), the heavy metal concentration was relatively more. Concentrations of the metals were, however, relatively less in the highly eutrophicated waters of Agra canal and Gurgaon canal as compared to that in WYC but Fe concentration were much higher. Except Zn and Ni the metal concentrations exceeded the standard permissible limits in these canals also.
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BACKGROUND: Relatives of early-onset bipolar probands have greater risk for affective disorders than those of adult-onset bipolar probands. METHODS: Relatives of 50 adolescent bipolar I probands and 36 adult-onset bipolar probands (onset > or = 25 years) were assessed using the Family Interview for Genetic Studies (FIGS) by a qualified psychiatrist blind to the proband status. Morbid risk was calculated using Weinberg's method of age correction. RESULTS: Relatives of early-onset probands had significantly greater risk for affective disorders compared to the relatives of adult-onset bipolar probands. CONCLUSIONS: Early-onset bipolar disorder is more familial than the adult bipolar disorder. IMPLICATIONS: Subdivision of bipolar disorder according to age-at-onset may identify homogeneous subtypes useful for genetic studies. LIMITATIONS: Patients were recruited from a major psychiatric hospital. The family history method was used to collect information about relatives.
BACKGROUND: Most investigators accept that schizophrenia and bipolar disorders are distinct entities. The proponents of continuum model have challenged this dichotomy model. METHODS: Information about the first-degree relatives of probands with DSM-IV diagnosis of schizophrenia (n=90), bipolar disorder (n=90), and epilepsy (n=60) was collected by using the Family Interview for Genetic Studies (FIGS). A trained psychiatrist blind to the status of index probands obtained the information. Morbid risk in relatives was calculated using abridged Weinberg's method of age correction. RESULTS: Rates of schizophrenia and bipolar disorder were elevated in the relatives of schizophrenia and bipolar probands, but there was no evidence of coaggregation. The risk for major depression was significantly elevated in the relatives of schizophrenia probands and was comparable to the risk in the relatives of bipolar probands. LIMITATIONS: Family history method was used to obtain information about relatives. Schizoaffective disorder patients were not included in the study and this may have amplified the distinction between schizophrenia and bipolar disorder. CONCLUSIONS: The findings suggest that schizophrenia and bipolar disorders are familially independent, but there could be a familial relationship between the predisposition to schizophrenia and to major depression.
Two middle-aged women presented with excessive daytime sleepiness. Examination revealed features of myotonic dystrophy with a positive family history. Sleep studies revealed frequent awakenings, central apnoeas with significant oxygen desaturation.