Biomedical subjects
Publications and source records attributed to V K Varma.
Pseudoaneurysm, a known complication of arterial needle puncture, is also an uncommon complication of parenteral drug abuse. India is currently witnessing an upsurge of abuse of injectable drugs. Five cases of pseudoaneurysm developing as a complication of intra-arterial drug abuse are reported. The need for early recognition and proper timely intervention is highlighted.
Cytokines, important biochemical mediators of inflammation, cause a rapid fall in the plasma concentration of cholesterol in vivo. One mechanism by which cytokines may cause acquired hypocholesterolemia is by decreasing the hepatic synthesis and secretion of apolipoproteins. To test this hypothesis, we incubated Hep G2 cells with human recombinant tumor necrosis factor-alpha, interleukin-1 beta, and interleukin-6. Each of the cytokines resulted in a dose-related reduction in the concentrations of apolipoprotein (apo) A-I, apoB, and lecithin:cholesterol acyltransferase (LCAT) activity in the medium after 24 hours of incubation. The effect of cytokines on apolipoprotein accumulation was not affected by preincubation of Hep G2 cells with fatty acids. Cytokines decreased the concentration of cellular apoA-I mRNA in a dose-related fashion but did not affect cellular concentrations of apoB mRNA. The concentrations of triglyceride and cholesterol were also reduced in the medium of cells incubated with cytokines. Total cell sterol synthesis rates were calculated by [14C]acetate incorporation. Cells incubated with interleukin-6 had a 31% increase in sterol synthesis rate but a 41% decrease in sterol secretion. These data suggest that these cytokines can decrease the hepatic synthesis and/or secretion of apolipoproteins and that this may explain, in part, the acquired hypocholesterolemia seen during acute and chronic inflammation.
Carisoprodol, a centrally acting muscle relaxant, has recently been noticed to be abused. A series of 16 cases with carisoprodol abuse or dependence is described. Carisoprodol was started by the majority of patients as a substitute for opiates, although its independent distinct effects, similar to the features of hypomania, were recognized and described by most users. The drug is currently available freely over the counter and is a much cheaper substitute for the legally prohibited "harder" drugs. Unless awareness spreads and cautionary measures are taken, carisoprodol abuse might become a great menace in the near future.
Patients admitted to the Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, were screened for HIV antibodies. Out of 116 patients, 45 (39%) were injecting drug users (IDUs), 29 (25%) were other drug users and 42 (36%) were primary users of alcohol. One IDU was HIV seropositive (2.2% of the IDUs). Analysis of HIV-related risk behaviour showed that the IDUs were at high risk, because of needle sharing as also because of having multiple sex partners. The potential for HIV infection in these persons practising high-risk behaviour calls for timely preventive measures.
Glucocorticoid hormones increase high-density lipoprotein (HDL) levels in vivo. However, there is little known about the mechanism by which glucocorticoids alter HDL metabolism. Hep G2 cells were incubated with dexamethasone to determine the effect of glucocorticoids on apolipoprotein (apo) A-I secretion. Dexamethasone increased apo A-I concentration in a dose-dependent fashion. After 24 hours, 5.5 x 10(-5) mol/L dexamethasone increased apo A-I accumulation in culture medium by 54%. Detectable increases in apo A-I concentration were noted in medium by 5 hours of incubation and persisted up to 48 hours. Cellular apo A-I mRNA concentration increased by 28% after incubation with dexamethasone for 24 hours. The increase in apo A-I mRNA concentration was detectable within 3 hours after incubation with dexamethasone. In contrast, incubation with dexamethasone decreased apo B concentration by 43% in culture medium, but it had no effect on cellular apo B mRNA concentrations. Dexamethasone had little effect on cholesterol and triglyceride accumulation in the medium. Incubation with albumin alone did not affect apo A-I concentration, but it decreased apo B concentration by 30% in the medium. Incubation with albumin and dexamethasone had no effect on apo A-I concentration in medium and had no additive effect on apo B concentration. These data suggest dexamethasone increases secretion of apo A-I by Hep G2 cells by increasing mRNA levels.
Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.
The impact of kidney donation on the psychological health of 31 living related donors was assessed by administering certain psychological tests before and after the operation (for donating the kidney). The results indicated a significant rise in the somatization subscale of the Middlesex Hospital Questionnaire (MHQ) from a mean of 1.61 to 3.23. There was no significant change in the other variables of these instruments or in the locus of control score. Only about one-fourth of the donors had prior knowledge of renal transplant. In almost all cases, the decision to donate had been voluntary and immediate, motivated by a concern for the recipient; there was virtually no second thoughts or regrets subsequently, which was apparently partly related to the opinions of other relatives who positively valued the act of donation.
Mothers of 80 children of mild (IQ 50-70) and moderate (IQ 35-49) mental retardation were selected for the present study. A carefully developed home training programme was utilized to train half of the mothers, the other half forming the control group for the study. The experimental and the control groups were matched for age and IQ of the children, and age of the mothers. The women also did not differ significantly on base-line marital adjustment and parental attitude scores and the experienced social burden of the mothers. In the experimental group there was a significant increase in the IQ and improvement in the behaviour of the children and significant improvement in the marital adjustment score, parental attitude and social burden felt by the mothers. There was no significant change in the control group in any of these variables.
Patients (200) with chronic intractable pain were evaluated to identify various psychiatric symptoms. Identifiable psychiatric illness, commonest being neurotic depression and anxiety states, was found in 72 per cent patients. The common symptoms reported on the present state examination (PSE) were worrying (77%), depression (40%), loss of interest (31.5%), hopelessness (16.5%), loss of weight (18%), and suicidal ideas (8%) and irritability (41.5%). Two thirds of patients had both anxiety and depression.
The psychological impact of the assassination of Prime Minister Indira Gandhi on psychiatric inpatients was studied. A semistructured interview indicated faulty perception of, and inappropriate reaction to, the event and its implications in the patients, often colored by their background and illness. The Modified Brief Psychiatric Rating Scale indicated a significant rise in their psychopathology soon after the event.
Psychological tests measuring intelligence, memory and other cognitive functions were given to 26 heavy cannabis users (mean duration of cannabis use 6.76 years; average daily intake 150 mg THC). Compared with a control group, the cannabis users were found to react slowly in perceptuo-motor tasks, but not to differ in intelligence or memory tests. The users suffered disability in personal, social and vocational areas and indicated higher psychoticism and neuroticism scores.
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Conventional Western-model psychotherapy is based on a number of premises regarding its rationale and technique. The increasing experience in psychotherapy globally is questioning the universality of these premises, suggesting that these could be to a large extent culture-specific, having developed in a particular culture at a particular time. Hence, the need to move from a dogmatic approach to psychotherapy to a flexible approach taking into account the socio-cultural reality. The paper identifies a number of cultural variables involving the intrapsychic mechanisms (e.g. cognitive and expressive), social relatedness (e.g. autonomy, social distance) and religious-philosophical belief systems (concept of sin, and belief in fatalism and after-life/reincarnation) and discusses their role in the approach to and process of psychotherapy, illustrating it with the situation in the Indian setting.
Comparison of imagery was made between 20 hallucinating schizophrenics, 20 non-hallucinating schizophrenics and 20 normal controls using Bett's questionnaire on the vividness of mental imagery and Gordon's test of the control of visual imagery. Hallucinating schizophrenic patients did not differ from non-hallucinating schizophrenic or normal controls with regard to the vividness or control of imagery, indicating a lack of relationship between hallucinations and mental imagery. Although it indicates that there is no disturbance in the vividness of volitional mental imagery in schizophrenia, the presence of abnormal spontaneous imagery cannot be commented upon.
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Four children who had received lithium carbonate for 3-5 years had unimpaired tubular and glomerular renal functions. Their serum lithium levels had been maintained at 0.5-1.0 meq/liter, and side effects had not been a problem.
This paper reports a study of drug use among non-students in three countries: Mexico, Canada and India. In all three countries core items from a World Health Organization questionnaire were used. The results were generally consistent with the expectation that non-students would show greater use than students. The strongest relationship was found for cannabis (all three countries) and amphetamines (Canada and Mexico). The results indicate the need for special preventive programmes for non-students in both developing and developed countries.
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