Editorial

Background: Developing countries like ours are facing burden of road traffic accidents which causes unnatural deaths primarily involving the age group of 15-40 years, the most productive group. Being young generation in the community, medical students will be able to spread awareness of road safety measures to prevent RTA. Hence, the present study was focused to assess the current knowledge and practice of road safety measures among medical students. Material and Method: A questionnaire based, cross-sectional study was conducted among 300 medical students (133 Males and 167 Females). The data was analyzed for percentage, mean, standard deviation, t test and Chi-square test. Results: We observed that 295(98.3%) of the students were aware about the term road safety measures, the common source of information was media 203(67.7%). Almost all students used their own vehicles for transport instead of public transport services. In our study, we found that overall knowledge of road safety measures among medical students was satisfactory, but practice of road safety measures was not satisfactory. Conclusion: We concluded that road traffic accidents are avoidable by proper sense of road safety measures. Safe driving practices should be encouraged. Orientation programs should be conducted periodically to reinforce not only the knowledge but also the safe practices in youngsters along with strict implementation of legislative measures

Background: Melioidosis is endemic in northern Australia, South and South East Asia. Infection usually follows percutaneous inoculation or inhalation of the causative bacterium, Burkholderia pseudomallei, which is present in soil and surface water in the endemic region. Our aim was to study the clinical, radiological and laboratory presentations of pulmonary melioidosis and compare them with other sporadic cases reported from India. Method: This prospective, hospital based study was conducted during 2007 to 2015 in a tertiary care hospital situated in southern India. Diagnosis of melioidosis was confirmed by isolation of B. pseudomallei from any of the sterile or unsterile sites. Patients’ details like baseline demography, possible risk factors, clinical and radiological presentations, laboratory features, treatment and outcome were documented. Results: Atotal of 65 (65/148, 43.9%) culture confirmed cases of pulmonary melioidosis were diagnosed in eight years, most of which (80%) were acute. Majority of the patients were male (85%). Most of the patients presented with fever (91%) and productive cough (78.4%). The most common radiological feature was consolidation of the upper lobe (26.3%). There were 2 cases of co-infection with pulmonary tuberculosis, which were subsequently treated for dual infection. The most common drug of choice was ceftazidime (49%). Overall mortality rate was 21%, significantly associated with sepsis, septic shock, organ dysfunction and bacteraemia. Conclusion: Acute pulmonary melioidosis should be kept in mind by clinicians whenever a patient of acute clinical deterioration presents with symptoms and radiological diagnosis similar to tuberculosis.

A vaginal microbicide cream (Basant) formulated from diferuloylmethane (curcumin), extracts of Emblica officinalis, Sapindus mukorossi, Aloe vera and Rose water has anti-microbial, anti-human papilloma virus and anti-human immunodeficiency virus action in vitro. Pre-clinical toxicology on rabbits showed it to be safe. This study was conducted to evaluate its safety and acceptability in humans. Methods: Atotal of 30 sexually active women used it for 14 days. Clinical examination, Pap smear, colposcopy, cervicovaginal lavage (CVL) for cytokines, vaginal swabs, urine and blood samples for sexually transmitted infections, hematology and biochemistry were collected at baseline and post-cream use. The paired ‘t test’was used for intra-group comparison of means, and Wilcoxon signed ranks test for cytokine data. Results: The mean age was 31.5 years. Baseline findings were normal except vaginitis in 10/30 and inflammatory Pap smear in 11/30, they were treated before enrolement. Women with vaginitis were treated with a single oral dose of Secnidazole and Fluconazole and vaginal tablets (Clotrimazole + Tinidazole) for 6 nights. Those with inflammatory Pap were treated with vaginal tablets only. Post-cream use, examination was normal in 29/30; one had vaginal candidiasis. Hematology and blood biochemistry were similar to baseline except for mean aspartate aminotransferase and creatinine levels which were elevated significantly, though within normal range. In CVL, interleukin (IL)-6 and interferon -? (IFN-?) were elevated and IL-1-ß, IL-2, IL-12 and tumor necrosis factor -a (TNF-a) were lowered significantly from baseline. Grade 2 toxicity (division of acquired immunodeficiency syndrome) was observed in 2/30; one had candida albicans in urine and one had hyperkalemia. Grade 1 toxicity was observed in 12/30, mainly transient vaginal irritation. Penile irritation was reported by 3/26 following intercourse. The women initial acceptability score was 10/10 (100%) and follow-up was 21.83 ± 1.66 (range 19-25/25) showing acceptability of 87.32%. In men, the follow-up score (among 26/30 sexually active couples) was 4.53 ± 0.91 (range 1-5/5), showing acceptability of 90.6%. Conclusions: Basant cream was safe and acceptable. The toxicities were mild and transient. It did not increase IL-1- ß in CVL like other irritating products, though elevated IL-6 and IFN -? need to be observed in future to assess their impact on mucosal inflammation

Hyperglycemia induces increased generation of reactive oxygen species and decreased action of antioxidant enzymes which leads to oxidative stress. Antioxidant enzymes prevent the action of reactive oxygen species and protect the cells from oxidative damage. Glutathione peroxidase is one of the antioxidant enzyme. The aim of the study was to evaluate the association between antioxidant enzyme glutathione peroxidase activity in erythrocytes with elevated HbA1c levels. Material and Method: Total of 92 whole blood samples were taken based on their HbA1c levels and were divided control (n=52) and hyperglycaemic group (n=40). Glutathione peroxidase activity in erythrocyte was measured. Statistical difference between groups was analyzed using independent t test. Pearson’s correlation analysis was performed to determine the relationships between variables. Results: There was no significant difference in glutathione peroxidase activity between the groups. There was statistically significant (p <0.001) increase observed for HbA1c and blood glucose in their mean±SD values from control to hyperglycaemic group. There was no significant correlation observed between glutathione peroxidase and HbA1c as well as blood glucose. The results indicate that elevated levels of HbA1c does not alter the activity of erythrocyte glutathione peroxidase activity.

Background: Rett syndrome (RTT) is a severe and progressive neurodevelopmental disorder, affecting 1/10,000–15,000 girls. It is one of the most common causes of mental retardation in females. This disorder results in 80% of cases from mutation of MECP2 gene (methyl-CpG binding protein 2), a transcriptional repressor involved in chromatin remodeling and the modulation of RNAsplicing. MECP2 aberrations result in a constellation of neuropsychiatric abnormalities, whereby both loss of function and gain in MECP2 dosage lead to similar neurological phenotypes. Identified mutations are almost in de novo and familial cases are rare and due to X-chromosomal inheritance from a carrier mother. Material Methods: This study represents the only MECP2 molecular analyze done on Moroccan patients with RTT, in which bidirectional sequencing of the entire gene coding and the flanking intronic sequences in 8 female patients provisionally diagnosed to have RTTwas carried out. Results: Four different pathogenic mutations c.397C>T[p.Arg133Cys], c.[916C>T(;)1208dupC], p.[Arg306Cys(;)Glu404X], c.1158_1186del [p.Pro387ArgfsX8], were identified in three patients and one polymorphism c.1-220dupC. All of them were located in exon four. Conclusion: The present study allowed identification of mutations of MECP2 gene in Moroccan cohort and gave an appropriate genetic counseling to the mutation-positive patients

Background: With the growing success of anti-retroviral therapy (ART), adherence to drugs is considered a major keystone in the management of HIV/AIDS. Adherence is influenced by the determinants of behavior that reside both within and outside of the patient. The aim of the study was to gain a deeper understanding of the factors that influence the adherence to ART among HIVpatients, registered in a referral center, India, a resource-limited country. Materials and Methods: Semi-structured interviews, guided by a questionnaire based on literature review, were undertaken among two groups of twenty patients (early ART < 6 months and late ART = 6 months) and their family members focusing on the adherence factors. These factors included medication, caregiver/family/society, health care service, and patients’ beliefs related factors. These interviews were transcribed and analyzed using the qualitative methods. Results: We found that in both groups the adherence was influenced by many barriers like fear of stigma, side effects of drugs, depression, regimen complexity, disbelief, and lack of confidence on the cure. Whereas, it was facilitated by motivation and coping behaviors, reminders, family responsibility/support, seeing examples of successful treatment, and proper education. The studied factors and with the help of literature reviews, we constructed a conceptual model for our health care center to recognizing all possible influencers to adherence and promoting interventions. Conclusions: The study elucidates high level of self-reported adherence in the resource-limited settings. Both barriers and facilitators to adherence are recognized in both groups of ART, which need to be quantified in future studies. A conceptual model is created which will identify possible influencers and provide patient-centered quality services to improve ART adherence in the long run.

Objective: The objective of this study to determine the age at menarche in girls aged 11-14 and the factors which affect it. Method: This is a descriptive-analytic cross-sectional research. The study population 651 students were selected by cluster random sampling basis from elementary and grade one of high schools which conducted in 2014. The data were collected by a questionnaire, a tape measure, and a digital scale. The data were analyzed by descriptive and analytic tests. Result: The mean age of menarche was 12.93±0.51. The present weight (RR= 1.037, 95% CI 1/025-1/049), breastfeeding (RR= 0.050, 95% CI 0/012-0/209), menarche age of mother (RR= 0.802, 95% CI 0/729-0/883) had a statistically significant effect as factors related on the menarche (P<0.05). The results showed statistically significantly (P<0.05) in girls using the cell phones during the week (RR= 1.028, 95% CI 1.002-1.055) and the daily use of computers (RR=1.242, 95% CI 0.977-1.578) Conclusion: The indicator of health care planning awareness of the age of menstruation is one of the requirements for good health

Background and Aims: Controlled hypotension has been used to reduce bleeding, the need for blood transfusions and provide a satisfactory bloodless surgical field. Esmolol, a short acting cardioselective beta blocker and dexmedetomidine, a central a-2 adrenergic agonist both cause controlled hypotension. The aim was to study the effect of dexmedetomidine and compare it to esmolol for controlled hypotension, surgical field, dose requirement of induction agent, requirement of inhalational agent and muscle relaxant in middle ear surgeries. Method: This study is a prospective, open labeled, single center study. Hundred patients of American Society of Anesthesiologists physical status I and II (ASA) scheduled for middle ear surgeries lasting for 2-3 hours under general anaesthesia were included. Patients were divided into two groups of 50 each by computer generated random numbers. Group E (n=50) patients received esmolol infusion and Group D patients received dexmedetomidine infusion.Results: The two groups were comparable in terms of haemodynamic parameters and surgical field assessment. The thiopentone dose requirement was 494 ± 12.93 milligrams (mg). in group E and 354.50 ± 17.26 mg in group D ( p-0.022). The mean isoflurane concentration used in group E and group D was 45.30 ± 5.85 millilitre (ml) and 13.79 ± 4.51 ml respectively (p0.002).The requirement of vecuronium was 11.19 ± 0.71mg in group E and 4.58 ± 0.46 mg in group D (p-0.009). Conclusion: The drugs provide controlled hypotension, good surgical field and reduce pressor response equally. In addition, dexmedetomidine reduces the dose requirement of induction agent, inhalational agent and skeletal muscle relaxant.

Bioavailability and bioequivalence studies (BA/BE) basically assess the relative concentration of a particular drug (in %) entering the systemic circulation from the administered dose and to determine if it is significant or not from the reference product. Bioavailability and bioequivalence data is mandatory to be furnished while putting in application for any new drug, so it is of utmost importance that the testing methods for measuring availability and assessing equivalence of any given drug should have a scientifically tested and standardised method pertaining to the design and conduct of the given method. The studies conducted in vitro and in vivo can be helpful in generating data regarding the availability and equivalence of any given drug molecule. While, we have all the methods available for such studies, we also have set guidelines towards carrying out these studies. These guidelines are in place for maintaining the uniformity and quality of the study and also to make certain the efficacy and the lack of significant side effects (safety) of a pharmaceutical product under evaluation. These guidelines are laid down and exercised by the Food and Drug Administration (FDA) & Centre for Drug Evaluation and Research (CDER) in USA and by the Central Drugs Standard Control Organization (CDSCO) in India. This review tries to look into the guidelines laid down by the regulatory authorities, the various designs employed, the facilities supposed to be present at the site for conducting these studies and how the generated data is maintained and used for further analysis.