Clinical and Scientific Research

The global D-Lemma: The vitamin D deficiency pandemic even in sun-drenched countries Michael F Holick Journal of Clinical and Scientific Research 2018 7(3):101-105

Does clinical posting in psychiatry change attitude towards psychiatry? A prospective study Animesh Sharma, GK Vankar, PB Behere, KK Mishra Journal of Clinical and Scientific Research 2018 7(3):106-113 Background: Worldwide, mental illnesses are on rise. There is an acute shortage of psychiatrists. Young medical graduates find psychiatry specialty a less attractive career option. The present study was conducted to find out attitudinal change of medical graduates to psychiatry specialty after their clinical posting. Methods: The study was carried out in a tertiary medical care centre situated in eastern Maharashtra in a rural setting. The medical graduates undergo rotation which includes clinical posting in psychiatry while they are in second year. One hundred medical students were administered Attitudes Towards Psychiatry-30 (ATP-30) questionnaire at the beginning and the end of two weeks of posting. Results: The response rate was 93% and the mean pre-rotation score on ATP-30 questionnaire was not significantly different as compared with the mean post-rotation score [107 ± 11.7 (SD) vs. 106 ± 12.4 (SD); (p=NS)]. Subgroup analysis revealed a significant decline [56 ± 6.4 vs. 54 ± 6.6 (p< 0.05)] in attitude on 15 positive questions of the questionnaire. Students with urban background [(55.8 ±6.6 vs 58.6 ± 9.3 (p=0.88)] as compared with rural background [58.1 ± 3.2 vs 53.9 ± 6.1 (p=0.03)] had significantly more decline on ATP-30 questionnaire. Conclusions: Overall, there was no change in medical students' attitude following two weeks clinical posting. Based on these findings medical curriculum including duration and frequency of clinical posting in psychiatry during undergraduate training requires change.

Three-dimensional conformal radiotherapy versus intensity-modulated radiotherapy in carcinoma cervix Revathi Badiginchala, Swapna Jilla, BV Subramanian, Prana Bandhu Das, Archana Prathipati, G Sanjeeva Kumar Journal of Clinical and Scientific Research 2018 7(3):114-118 Background: Cervical cancer is the most common gynecological cancer among Indian women. 3D-CRT treatment is associated with more acute and late toxicities, because of close proximity of bladder and rectum to the cervix. The newer technique like IMRT is associated with less toxicities. Our study is to compare 3D-CRT and IMRT in terms of dosimetric parameters, toxicities and clinical outcomes. Methods: From February 2015 to July 2016 total 40 newly diagnosed locally advanced cervical carcinoma patients were treated with concurrent chemo radiotherapy with weekly cisplatin. Those patients were randomized to arm A - 3D-CRT and arm B - IMRT. Results: The dosimetric parameters of the bladder, rectum, bowel bag, and pelvic bone marrow were significantly decreased in the IMRT arm as compared to 3DCRT arm except for V30, V50 of bowel bag and V50 of pelvic bone marrow. The acute and late toxicities were similar among both arms. All the patients were assessed for treatment response at 6 weeks after completion of the treatment. All achieved complete clinical response. Out of 40 patients only one had brain metastasis after a median follow up of 18 months. Conclusions: Though IMRT showed dosimetric reduction compared to 3D-CRT but it did not showed any clinical benefit. At present scenario in developing countries like India where the cancer centers are over loaded with the carcinoma cervix cases can be treated with the 3D-CRT technique without compromising clinical outcomes.

Anthropometric correlates of dyslipidaemia in various stages of chronic obstructive pulmonary disease G. Leela Jaya Madhuri, M Sriharibabu, Somanath Das, Y Himabindu, D Kiranmai, RK Chaitanya Reddy Journal of Clinical and Scientific Research 2018 7(3):119-123 Background: Chronic Obstructive Pulmonary Disease (COPD) is one of the major non-communicable diseases associated with increased morbidity and mortality. Even though COPD is a systemic disorder with the predominant involvement of lungs, several co-morbidities have been recognised in COPD. Both cachexia and obesity are common in COPD. This study explored the correlations between anthropometry and lipid parameters in different stages of COPD. Methods: This cross-sectional study conducted in a tertiary care teaching hospital included 120 subjects who satisfied the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria for COPD. After thorough clinical examination according to a predesigned study questionnaire all subjects underwent spirometric assessment for determination of the stage of COPD. Anthropometric measures like BMI, waist circumference, hip circumference and lipid parameters were measured in all study subjects. Pearson's correlation coefficients were calculated to see the correlation between anthropometry and lipid profile. Results: Dyslipidaemia was seen in all stages of COPD even though the pattern of dyslipidaemia varied from stage to stage. Significant positive correlations were observed between anthropometry and lipid parameters in stages III and IV COPD. Conclusions: The observations made in this study reveal that anthropometry correlates with dyslipidaemia in late stages of COPD.

Study of oxidant and anti-oxidant status in patients with chronic kidney disease A V. S S. N. Sridhar, P V. L N. Srinivasa Rao, Vishnubhotla Sivakumar, P Satish, P Shalini, MM Suchitra, Vinapamula S Kiranmayi Journal of Clinical and Scientific Research 2018 7(3):124-130 Background: Chronic kidney disease (CKD) is associated with oxidative stress (OS), which occurs even in early stages of CKD and was shown to further contribute to progression of renal dysfunction and increased cardiovascular risk in CKD patients. Majority of studies have evaluated OS in CKD patients using limited biomarkers. Present study aimed at comprehensive evaluation of oxidant and antioxidant status in CKD patients. Methods: 120 patients diagnosed with CKD who were classified into three groups of 40 each [group-1 (CKD stage1 and 2), group-2 (CKD stage3 and 4) and group-3 (CKD stage 5] based on eGFR and 30 healthy controls were recruited. Malondialdehyde (MDA), protein carbonyls (PC), ferric reducing ability of plasma (FRAP), protein thiols, superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase were measured in all subjects. FRAP was corrected for uric acid (FRAP_UA) and MDA/FRAP_UA ratio was calculated. Score for oxidative stress (SOS) was calculated using the oxidant antioxidant parameters studied. Results: MDA, PC, MDA/FRAP_UA, FRAP and SOS were higher whereas protein thiols, SOD, GPx and catalase were lower in CKD patients than controls. Further, MDA, PC and FRAP and SOS increased progressively and protein thiols, SOD and catalase decreased progressively with increasing renal dysfunction. MDA, PC, FRAP and SOS showed positive correlation with creatinine and negative correlation with eGFR, whereas protein thiols, SOD, and catalase showed positive association with eGFR and negative correlation with creatinine. Conclusions: CKD patients are prone for oxidant injury which increases progressively with worsening renal dysfunction and is associated with degree of renal impairment. Score for oxidative stress helps in comprehensive assessment of oxidative stress in CKD patients.

How to treat Vitamin D deficiency in sun-drenched India - guidelines CV Harinarayan Journal of Clinical and Scientific Research 2018 7(3):131-140 Vitamin D plays an important role in calcium and mineral metabolism. It is astonishing to find vitamin D deficiency in sun drenched country like India. This could probably due to modernisation of India-mechanization, urbanization, change in life style, dress code and revision of vitamin D adequacy range. India has the unique problem of twin nutrient deficiency- vitamin D and calcium. Low calcium in the diet coupled with vitamin D deficiency has adverse consequences in the skeletal health. Any vitamin D schedule to treat/supplement should be accompanied by adequate calcium in the diet/supplementation. There are many international guide lines for vitamin D supplementation. This review aims at highlighting the vitamin D supplementation schedule suitable in Indian context keeping in mind the cost and compliance. Studies in south India using in vitro ampoule mode with 7-dehyrocholestrol has shown adequate formation of active form of vitamin D from mid-day sun. Time of the day, latitude, and increased skin pigmentation all influence the cutaneous production of vitamin D. Exposing 12%-18% of body surface area to unprotected sunlight for 30-45 mins is equivalent to taking 600-1000 IU of vitamin D which is the dose recommended by experts for fortification of food. Vitamin D synthesized in the skin last twice as long. We as human can get Vitamin D from abundant sunshine. There are various food fortification schedules suggested. The major source of vitamin D for both children and adults is unprotected sun exposure. In the absence of sun exposure adequate amount of vitamin D from dietary sources and supplementation is a must to satisfy body's requirement. In India, adequate amount of vitamin D should be accompanied by dietary/supplemental calcium to achieve desired skeletal benefits.

Pseudopseudohypoparathyroidism: an unusual case Srinivasa P Munigoti Journal of Clinical and Scientific Research 2018 7(3):141-144 We report unusual case of a 22-year-old male patient who presented with phenotypic features of Albright's hereditary osteodystrophy, but had associated multiple hormonal deficiencies suggestive of pseudo-pseudohypararthyroidism.

Left-sided chylothorax due to tuberculosis in an adult K Gowrinath, KR R. Umamahesh Journal of Clinical and Scientific Research 2018 7(3):145-148 A spontaneous chylothorax is rare. Chylothorax as a manifestation of tuberculosis (TB) is very rare even in countries where TB is endemic. We report a case of left sided chylothorax due to TB in a 50-year-old male alcoholic who presented with hypotension and hyponatremia. TB was diagnosed through histopathological examination of mediastinal lymph node biopsy. Initial conservative treatment with four days of tube thoracostomy drainage was effective but chylothorax recurred one week later after starting anti-TB drugs. Resolution of chylothorax was achieved with repeat tube thoracostomy drainage for four weeks and daily anti-TB therapy with isoniazid, ethambutol, rifampicin and pyrazinamide for two months followed by daily isoniazid and rifampicin for four months. Patient recovered well and chylothorax did not recur during the follow up period of three months.

Pulmonary atelectasis due to organised blood clot J Harikrishna, V Pradeep, G Mounika, S Lavanya, K Hemsai, C Sunil Kumar, B Vijayalakshmi Devi Journal of Clinical and Scientific Research 2018 7(3):149-150

An unusual case of sphenoid wing meningioma and adenocarcinoma of the caecum Mahmood Dhahir Al-Mendalawi Journal of Clinical and Scientific Research 2018 7(3):151-151