West Bengal University of Health Sciences

Synapses are essential components of neurons and allow information to travel coordinately throughout the nervous system to adjust behavior to environmental stimuli and to control body functions, memories, and emotions. Thus, optimal synaptic communication is required for proper brain physiology, and slight perturbations of synapse function can lead to brain disorders. In fact, increasing evidence has demonstrated the relevance of synapse dysfunction as a major determinant of many neurological diseases. This notion has led to the concept of synaptopathies as brain diseases with synapse defects as shared pathogenic features. In this review, which was initiated at the 13th International Society for Neurochemistry Advanced School, we discuss basic concepts of synapse structure and function, and provide a critical view of how aberrant synapse physiology may contribute to neurodevelopmental disorders (autism, Down syndrome, startle disease, and epilepsy) as well as neurodegenerative disorders (Alzheimer and Parkinson disease). We finally discuss the appropriateness and potential implications of gathering synapse diseases under a single term. Understanding common causes and intrinsic differences in disease-associated synaptic dysfunction could offer novel clues toward synapse-based therapeutic intervention for neurological and neuropsychiatric disorders. In this Review, which was initiated at the 13th International Society for Neurochemistry (ISN) Advanced School, we discuss basic concepts of synapse structure and function, and provide a critical view of how aberrant synapse physiology may contribute to neurodevelopmental (autism, Down syndrome, startle disease, and epilepsy) as well as neurodegenerative disorders (Alzheimer's and Parkinson's diseases), gathered together under the term of synaptopathies. Read the Editorial Highlight for this article on page 783.

INTRODUCTION: To mitigate the spread of the pandemic coronavirus infection (COVID-19), governments across the world have adopted "lockdowns" which have confined many individuals to their homes. This disrupts normal life routines, elements of which are important circadian cues. The pandemic is also associated with new stressors, altered roles, and uncertainties about health and economic security, which are also likely to affect sleep. The current study is an online survey of sleep experience, routines, physical activity, and symptoms of anxiety and depression, to study the alterations associated with the lockdown. MATERIALS AND METHODS: The survey was conducted in early May 2020 using a questionnaire circulated through social media platforms. Questions related to demographic characteristics, current and previous sleep schedules, routine, and working patterns. Insomnia (Insomnia Severity Index - 4), Stress (Perceived Stress Scale - 4), anxiety and depressive symptoms (Patient Health Questionnaire - 4) and physical activity (International Physical Activities Questionnaire) were assessed using standardized instruments. RESULTS: A total of 958 valid responses were received. Compared to the prelockdown period, there was a shift to a later bedtime and waking time, with a reduction in night-time sleep and an increase in day-time napping. These effects were visible across occupational groups, but mostly affected working individuals except health professionals. Sleep quality deteriorated across groups. Reductions in sleep duration were associated with depressive symptoms. CONCLUSIONS: The COVID-19 lockdown is associated with changes in sleep schedule and in the quantity and quality of night-time sleep. Although these changes are associated with elevated rates of emotional symptoms, it is unclear from these cross-sectional results, whether sleep deterioration produces psychological distress, or vice versa.

CONTENTS: Part I. Cell Physiology. Cellular Membranes and Transmembrane Transport of Solutes and Water. Ionic Equilibria and Resting Membrane Potentials. Generation and Conduction of Action Potentials. Synaptic Transmission. Membrane Receptors. Part II. Nervous System. Cellular Organization of the Nervous System. The General Sensory System. Special Senses. The Motor System. The Automatic Nervous System and its Control. Higher Functions of the Nervous System.Part III. Muscle. The Molecular Basis of Contraction. Muscles Acting on Skeleton Muscle in the Walls of Hollow Organs. Part IV. Cardiovascular System. Blood and Hemostasis. Overview of the Circulation. Electrical Activity of the Heart. The Cardiac Pump. Regulation of the Heartbeat. Hemodynamics. The Arterial System. The Microcirculation and Lymphatics. The Peripheral Circulation and Its Control. Control of Cardiac Output: Coupling of the Heart and Blood Vessels. Special Circulations. Interplay of Central and Peripheral Factors in the Control of the Circulation. Part V. Respiratory System. An Overview of the Respiratory System. Mechanical Aspects of Breathing. Pulmonary and Bronchial Circulations and the Distribution of Ventilation and Perfusion. Transport of Oxygen and Carbon Dioxide Between Lungs and Cells of the Body. Control of Breathing. Part VI. Gastrointestinal System. Motility of the Gastrointestinal Tract. Gastrointestinal Secretions. Digestion and Absorption. Part VII. Renal System. Elements of Renal Function. Solute and Water Transport Along the Nephron: Tubular Function. Control of Body Fluid Volume and Osmolality. Renal Regulation of Potassium, Calcium, Magnesium, and Phosphate Balance. Role of the Kidney in Acid-Base Balance. Part VIII. Endocrine System. General Principles of Endocrine Physiology. Whole Body Metabolism. Hormones of the Pancreatic Islets. Endocrine Regulation of the Metabolism of Calcium and Related Minerals. The Hypothalamus and Pituitary Gland. The Thyroid Gland. The Adrenal Cortex. The Adrenal Medulla. Overview of Reproductive Function. Male Reproduction. Female Reproduction.

BACKGROUND: Despite recent achievement in economic progress in India, the fruit of development has failed to secure a better nutritional status among all children of the country. Growing evidence suggest there exists a socio-economic gradient of childhood malnutrition in India. The present paper is an attempt to measure the extent of socio-economic inequality in chronic childhood malnutrition across major states of India and to realize the role of household socio-economic status (SES) as the contextual determinant of nutritional status of children. METHODS: Using National Family Health Survey-3 data, an attempt is made to estimate socio-economic inequality in childhood stunting at the state level through Concentration Index (CI). Multi-level models; random-coefficient and random-slope are employed to study the impact of SES on long-term nutritional status among children, keeping in view the hierarchical nature of data. MAIN FINDINGS: Across the states, a disproportionate burden of stunting is observed among the children from poor SES, more so in urban areas. The state having lower prevalence of chronic childhood malnutrition shows much higher burden among the poor. Though a negative correlation (r = -0.603, p < .001) is established between Net State Domestic Product (NSDP) and CI values for stunting; the development indicator is not always linearly correlated with intra-state inequality in malnutrition prevalence. Results from multi-level models however show children from highest SES quintile posses 50 percent better nutritional status than those from the poorest quintile. CONCLUSION: In spite of the declining trend of chronic childhood malnutrition in India, the concerns remain for its disproportionate burden on the poor. The socio-economic gradient of long-term nutritional status among children needs special focus, more so in the states where chronic malnutrition among children apparently demonstrates a lower prevalence. The paper calls for state specific policies which are designed and implemented on a priority basis, keeping in view the nature of inequality in childhood malnutrition in the country and its differential characteristics across the states.

Moringa oleifera is a valued medicinal plant in traditional folk medicine. Many pharmacological studies have shown the ability of this plant to exhibit analgesic, anti-inflammatory, antipyretic, anticancer, antioxidant, nootropic, hepatoprotective, gastroprotective, anti-ulcer, cardiovascular, anti-obesity, antiepileptic, antiasthmatic, antidiabetic, anti-urolithiatic, diuretic, local anesthetic, anti-allergic, anthelmintic, wound healing, antimicrobial, immunomodulatory, and antidiarrheal properties. This review is a comprehensive summary of the phytochemical and pharmacological activities as well as the traditional and therapeutic uses of this plant. M. oleifera has wide traditional and pharmacological uses in various pathophysiological conditions. We will review the various properties of M. oleifera (drumstick tree) and focus on its various medicinal properties. We think that it is an attractive subject for further experimental and clinical investigations.

BACKGROUND: COVID-19 pandemic poses a unique medical challenge to the humanity in recent times. The psychological impact of the pandemic itself and the lockdown in particular is likely to be huge. AIM: To assess the psychological impact of COVID-19 pandemic on general population in West Bengal. MATERIALS AND METHODS: It was an online survey which was conducted using Google Forms with link sent using WhatsApp. A 38-item self-designed questionnaire was used for the study. The survey questionnaire would take around 5-7 min to complete. Total 507 responses were received by the stipulated time. RESULTS: Near about five-seventh (71.8%) and one-fifth (24.7%) of the respondents felt more worried and depressed, respectively, in the past 2 weeks. Half of the respondents (52.1%) were preoccupied with the idea of contracting COVID-19 and one-fifth (21.1%) of the respondents were repeatedly thinking of getting themselves tested for the presence of COVID-19 despite having no symptoms. Majority (69.6%) of the respondents were worried about the financial loss they were incurring during the period of lockdown. One-fourth (25.6%) and one-third (30.8%) of the respondents found that COVID-19 pandemic had threatened their existence and they found it difficult to adjust to the new routine during 21-day lockdown period, respectively. CONCLUSION: The index survey suggested that worry and sleep disturbances were common among the respondents in the past 2 weeks. The pandemic threatened the existence of the respondents to a great extent and affected their mental status negatively.

Critical limb ischemia (CLI) due to Buerger's disease is a major unmet medical need with a high incidence of morbidity. This phase II, prospective, nonrandomized, open-label, multicentric, dose-ranging study was conducted to assess the efficacy and safety of i.m. injection of adult human bone marrow-derived, cultured, pooled, allogeneic mesenchymal stromal cells (BMMSC) in CLI due to Buerger's disease. Patients were allocated to three groups: 1 and 2 million cells/kg body weight (36 patients each) and standard of care (SOC) (18 patients). BMMSCs were administered as 40-60 injections in the calf muscle and locally, around the ulcer. Most patients were young (age range, 38-42 years) and ex-smokers, and all patients had at least one ulcer. Both the primary endpoints-reduction in rest pain (0.3 units per month [SE, 0.13]) and healing of ulcers (11% decrease in size per month [SE, 0.05])-were significantly better in the group receiving 2 million cells/kg body weight than in the SOC arm. Improvement in secondary endpoints, such as ankle brachial pressure index (0.03 [SE, 0.01] unit increase per month) and total walking distance (1.03 [SE, 0.02] times higher per month), were also significant in the group receiving 2 million cells/kg as compared with the SOC arm. Adverse events reported were remotely related or unrelated to BMMSCs. In conclusion, i.m. administration of BMMSC at a dose of 2 million cells/kg showed clinical benefit and may be the best regimen in patients with CLI due to Buerger's disease. However, further randomized controlled trials are required to confirm the most appropriate dose. Stem Cells Translational Medicine 2017;6:689-699.

INTRODUCTION: Hypertension is one of the major public health problem affecting the whole world so its accurate measurement is of utmost importance for its early diagnosis and management. Concerns related to the potential ill effects of mercury on health and environment, has led to the widespread use of non-mercury sphygmomanometers. AIM: A study was conducted to compare the accuracy of readings of aneroid and digital sphygmomanometers in reference to mercury sphygmomanometers and determine the hypertensive classification agreement between the mercury and non-mercury devices. MATERIALS AND METHODS: The study was conducted in an OPD of a health centre in a rural community of West Bengal which is the rural field practice area of our institute. An aneroid and a digital sphygmomanometer were compared to a properly calibrated mercury sphygmomanometer. All the subjects above the age of 25 years, in two days per week, selected randomly from five working days per week in a period of one month were selected. Two blood pressure readings of each of 218 study subjects was recorded with each pretested sphygmomanometer. Paired t-test, Kappa coefficients, sensitivity and specificity tests were done. Receiver Operating Characteristics curve analysis was done and Youden index was estimated to detect the optimal cut off point for the diagnosis of hypertension by non-mercury sphygmomanometers. RESULTS: Data analysis of 218 study subjects showed the mean difference of the mercury reading and the test device was much less for aneroid than that of the digital device for both systolic and diastolic blood pressure. More than 89% of aneroid readings and less than 44% of the readings by digital device had absolute difference of 5mm Hg. when compared with the mercury readings for both systolic and diastolic blood pressure. Sensitivity and specificity of aneroid device was higher (86.7% and 98.7%) than digital device (80% and 67.7%). Receiver Operating Characteristic curve had larger area under the curve for aneroid device than digital device for both SBP and DBP. CONCLUSION: The aneroid device had better accuracy than the digital device as compared to mercury sphygmomanometer and should be used for proper and better management.

BACKGROUND: Nalbuphine has been used intrathecally as an adjuvant in previous studies, but none clearly state the most effective dose of nalbuphine. The purpose of our study was to establish the effectiveness of intrathecal nalbuphine as an adjuvant, compare three different doses and determine the optimum dose with prolonged analgesic effect and minimal side-effects. MATERIALS AND METHODS: In this prospective, randomized, double-blinded, controlled study, 100 ASA I and II patients undergoing lower limb orthopedic surgery under subarachnoid block (SAB), were randomly allocated to four groups: A, B, C and D, to receive 0.5 ml normal saline (NS) or 0.2, 0.4 and 0.8 mg nalbuphine made up to 0.5 ml with NS added to 0.5% hyperbaric bupivacaine 12.5 mg (total volume 3 ml), respectively. The onset of sensory and motor blockade, two-segment regression time of sensory blockade, duration of motor blockade and analgesia, visual analogue scale (VAS) pain score and side-effects were compared between the groups. RESULTS: Two-segment regression time of sensory blockade and duration of effective analgesia was prolonged in groups C (0.4 mg nalbuphine) and D (0.8 mg nalbuphine) (P<0.05), and the incidence of side-effects was significantly higher in group D (P<0.05) compared with the other groups. CONCLUSION: Nalbuphine used intrathecally is a useful adjuvant in SAB and, in a dose of 0.4 mg, prolongs postoperative analgesia without increased side-effects.

INTRODUCTION Menstruation is a normal physiological phenomenon that women and adolescent girls experience every month. Ability to manage menstruation hygienically is fundamental to the dignity and well-being of women and constitutes an integral component of basic hygiene, sanitation, and reproductive health services. Poor awareness of the physiology, unscientific attitude, myths, and misconceptions including the notion that menstruating women are “contaminated,” “dirty,” and “impure” adversely affect their health and social lives. Unfortunately, it continues to be treated as a taboo in many societies, shrouded in a culture of silence and shame. Issues and challenges related to menstrual hygiene management (MHM) in low and middle-income countries are gaining increased recognition in the water, sanitation, and hygiene (WASH) sector globally. WHO and UNICEF(2014) have defined MHM as “Women and girls are using clean menstrual hygiene management material to absorb or collect blood, that can be changed in privacy as and when necessary for the duration of the menstrual period, using soap and water for washing the body as required and having access to facilities to dispose of used menstrual management materials.”[1] Since 2014, May 28 is observed as the Menstrual Hygiene Day worldwide to raise awareness regarding the challenges women and girls face to deal with menstrual cycles and highlight solutions implementable at global, national, and local levels to address these issues.[2] Although there is no direct mention of any goal or indicator of menstrual health and hygiene in the UN Sustainable Development Goals (SDGs), it is well recognized that poor MHM practices will adversely affect the initiatives and performances of the countries toward achieving a number of important developmental goals (SDGs 3, 4, 5, 6, 8, and 12).[3] Menstrual hygiene management initiatives in India In India, number of women in the reproductive age group (15–49 years) is more than 31 crores (Census 2011).[4] Taking cognizance of the quantum of morbidity and poor quality of life that a woman would have to bear in the absence of proper MHM perception and practices in the country, Government of India has incorporated MHM into national policies and programs as part of initiatives for improving health, well-being, and nutritional status of adolescent girls and women, as well as for reducing school absenteeism of adolescent girls. UNICEF has also been instrumental in providing technical guidance and support toward raising awareness, addressing behavior change, capacity building of frontline community cadre, sensitization of key stakeholders, and creation of WASH facilities including safe disposal options. “Swachh Bharat: Swachh Vidyalaya” campaign has been launched to ensure that every school in India has a set of functioning and well-maintained WASH facilities including soap, private space for changing, adequate water for washing, and disposal facilities for used menstrual absorbents.[5] MHM has been made an integral part of the Swachh Bharat Mission Guidelines. Ministry of Drinking Water and Sanitation has published operational guidelines to be implemented by state governments, district-level officials, engineers, and school teachers for improved MHM in the country.[6] Ministry of Health and Family Welfare has also focused MHM as a priority area in National Health Mission[7] and in the RMNCH+A strategy.[8] High quality and highly subsidized sanitary napkins are being made available to the adolescent girls in rural areas by Accredited Social Health Activists (ASHAs)[9] and “Training Module for ASHA on Menstrual Hygiene” are also used for their capacity building.[10] The SABLA program of Ministry of Women and Child Development has incorporated awareness generation on MHM as an important initiative to improve health, nutrition, and empowerment for adolescent girls.[11] Efforts are being made to provide sanitary napkins to school-going girls by installing napkin-vending machines at schools and to increase accessibility of environmentally safe disposal mechanisms such as low-cost incinerators attached to the girls' toilets in schools for disposal of used MHM products. Very recently, on International Women's Day on March 8, 2018, Government has launched 100% oxy-biodegradable sanitary napkins “Suvidha” in packs of four priced at Rs. 10 which will be available shortly at Pradhan Mantri Bhartiya Janaushadhi Pariyojana Stores.[12] Despite the array of initiatives put up so far, a myriad of challenges still remain to be addressed. Ensuring healthy MHM for women would require a clear understanding of the intricacies related to the problem, the needs, and the influencing factors that could potentially affect the perception and practices of Indian women. The challenges Menstrual hygiene management awareness: Minimizing barriers Access to accurate and pragmatic information is an essential prerequisite to hygienic menstrual practices. Studies from different parts of the country have revealed that awareness and understanding of menstruation as a normal biological phenomenon is abysmally poor in different sections of the society.[13] Prevailing sociocultural norms, beliefs, and practices make it difficult for women and girls to talk freely about menstruation without fear or shame. It is such a taboo subject in the society that not only girls and women feel shy about menstruation, school teachers, and even health workers also feel uncomfortable to discuss MHM related issues. All-out efforts are needed to change the age-old social attitude toward menstruation and to break the culture of silence and inertness. Puberty education needs to include MHM at curricular level for healthy development of adolescents. Innovative IEC approaches like utilization of community contact opportunities (e.g. VHNDs) and proactive involvement of mass media and social media would further minimize barriers to MHM awareness. Capacity building of school teachers and health service providers including AWWs to disseminate timely and accurate information to both boys and girls on the biological and psychosocial aspects of puberty, menstruation, and MHM customized to local contexts, rather than focusing only on the practical aspects of managing menstruation, i.e. product use, would holistically improve the effectiveness of the awareness programs. Male sensitization at community level to increase their understanding and thereby foster supportive attitude will have stronger effect in removing discriminatory practices faced by women. Involvement of key cultural influencers, that is, social and religious leaders in countering the negative myths and misconceptions, would also help to build up support system at societal level. However, the challenge is to build on appropriate and effective communication methods to open dialog and make the stakeholders realize the importance of MHM. Furthermore, evaluation of the existing ongoing awareness interventions at programmatic level in shifting the community norms about menstruation would help in better understanding of the critical gaps that need to be filled in future for sustainable scaling up of MHM awareness. Improving access to hygienic menstrual hygiene management products Accessibility of hygienic menstrual absorbents at affordable cost is an important determinant of healthy menstrual management practice. Over the years, various initiatives have been taken in this direction, and the recent National Family Health Survey 4 (NFHS 4) data show that overall 57.6% of women are using hygienic methods for menstrual protection.[14] However, availability and accessibility of clean and safe menstrual absorbents for all women seem to be a distant dream in the current Indian context. NFHS 4 also reveals that about 62% women are using cloth which can be reused after washing, cleaning, and drying. However, these reusable materials are often not sanitized properly with soap and clean water in compelling circumstances or due to lack of awareness and social taboos also restrict women to dry them indoors, away from sunlight. Compostable disposables (e.g., sanitary pads made out of locally grown materials such as bamboo, banana stem fiber, and sugarcane waste, and reusable cloth pads) have limited availability and higher cost while noncompostable disposables (e.g., cellulose-based sanitary pads with plastic barriers) with the largest market share are a double-edged sword. Although they provide safe and hygienic MHM, they remain unaffordable for women from low-income household. In spite of government initiatives to provide low-cost disposable sanitary pads, for example, “Free Days” and “Suvidha,” requirement for safe MHM products far outweigh their availability and accessibility. Decentralized models for production of low-cost sanitary napkins by community-based organizations/self-help groups might be promoted as a viable solution to match the requirement. Corporate sectors can effectively contribute by supporting behavior change initiatives and manufacturing and/or disposal of low-cost sanitary pads. Importantly, mechanism for monitoring the quality of the products should be put into operation. Exemption from the goods and services tax: The need Sanitary napkins in no way can be considered as luxury items for women. However, the unfair bracketing of sanitary napkins for tax purposes limits access to this essential commodity to a large section of the needy women.[15] The government has declared Hindu marital signifiers such as sindoor, bangles, and bindis as tax exempt; condoms and contraceptives are already tax exempt, but sanitary napkins continue to be taxed. Removing the tax on sanitary napkins will not only increase their accessibility but also will facilitate a positive change in the personal hygiene of millions of women. Disposal infrastructure: Limited capacity Used napkins need to be disposed safely in environment-friendly manner. However, disposal of used napkins has become an increasing problem in India. It is not yet decided whether soiled absorbents will be classified as hazardous solid waste (due to the presence of plastic in disposable napkins) or as biomedical waste as it is contaminated with blood and body fluid. The decision will have implications in planning and implementing appropriate menstrual waste management in the country. Currently, about 42% of Indian women of 15–24 years are using sanitary napkins (NFHS 4) and it is obvious that the use of commercial sanitary products will continue to grow with time. If an estimated 121 million girls and women in India are currently using an average of eight disposable sanitary pads in a month, generation of waste load is estimated to be 1.021 billion pads per month, the safe disposal of which in an environment-friendly manner is a real challenge to the nation.[16] Due to lack of efficient disposal mechanism at the community and institutions (schools, colleges, work places, and hospitals), used sanitary pads are dumped into the urban sewerage system, landfills, rural fields, and water bodies.[16] Since the usual disposal practice at community level is along with the household garbage, appropriate innovations need to be designed to make the menstrual waste materials easily identifiable for segregation during routine waste collection, keeping exposure of the waste collectors in mind. While incinerators are favored options in schools and institutions, challenges still exist in terms of designing cost-effective incinerators without emission of toxic fumes from burning of plastics (e.g., furans and dioxins). Menstrual hygiene management in special situations Menstrual hygiene management often remains as a low-priority component in any emergency/humanitarian crisis situation, as it is not considered life-threatening and women and girls face formidable challenges to manage their menstruation safely and comfortably and with dignity. There is a strong need for international consensus and improved guidance across all relevant sectors for improving MHM response in emergency context. Database to influence program or policy: The gap Formulation and implementation of any national program is heavily dependent on availability of strong evidence base for effective advocacy, program planning, implementation, and evaluation at all levels of health care. MHM practices are known to be influenced by factors such as knowledge about the process, socioeconomic characteristics, cultural acceptability, personal preferences, perception of risks, and access to funds and WASH facilities, etc. Available data from isolated studies portray a curtailed picture of the pattern of usage and methods of disposal of used absorbents, emphasizing the urgent need of incorporating MHM related data generation through national-level surveys. Very recently, NFHS 4 has generated some data on the type of menstrual protection used by women of 15–24 years age;[14] but no nationally representative or state-specific data on methods of disposal of used absorbents are available till date. CONCLUSION Good menstrual hygiene triggers health, confidence, and self-esteem of women and is linked to gender equality and basic human rights. Concerns are manifold and calls for concerted multisectoral inputs and interventions to break the social taboos, myths, and misconception; support innovative sustainable solutions to manufacture and distribute low-cost, yet high-quality sanitary pads; and address the burgeoning problem of disposing menstrual waste in an environmentally safe manner. Ensuring menstrual hygiene for girls and women should be at the top of developmental agenda which calls for urgent and intensive action from all relevant stakeholders to change the scenario of menstrual hygiene in India. There is also emerging need for development of indicators under Swachh Bharat Mission Guidelines to measure the extent of achievement in MHM in India. Furthermore, setting up realistic time bound targets to indicate successful implementation of existing policy and programs would be a welcome endeavor for providing basic hygiene and reproductive services to girls and women.

India is a vast country depicting wide social, cultural and sexual variations. Indian concept of sexuality has evolved over time and has been immensely influenced by various rulers and religions. Indian sexuality is manifested in our attire, behavior, recreation, literature, sculptures, scriptures, religion and sports. It has influenced the way we perceive our health, disease and device remedies for the same. In modern era, with rapid globalization the unique Indian sexuality is getting diffused. The time has come to rediscover ourselves in terms of sexuality to attain individual freedom and to reinvest our energy to social issues related to sexuality.

In West Bengal, India, at present, more than 26 million people are exposed to arsenic through drinking water. Among them, only 15-20% manifest arsenic-induced noncancerous, precancerous, and cancerous skin lesions, indicating that genetic variants play important role in arsenic susceptibility. Chronic arsenic exposure has been associated with impairment of immune systems in the exposed individuals. Because cytokines are important immune mediators, alteration in expression of these gene products may lead to arsenic-specific disease manifestations. The aim of the present work was to investigate the association between the TNF-α-308G>A (rs1800629) and IL10 -3575T>A (rs1800890) polymorphisms and arsenic-induced dermatological and nondermatological health outcomes. A case-control study was conducted in West Bengal, India, involving 207 cases with arsenic-induced skin lesions and 190 controls without skin lesions having similar arsenic exposure. The polymorphisms were determined using conventional PCR-sequencing method. ELISA was done to determine the serum levels of the two cytokines tumor necrosis factor α (TNF-α) and interleukin 10 (IL10). Associations between the polymorphisms studied and nondermatological health effects in the study subjects were determined from our epidemiological survey data. Individuals with GA/AA (-308 TNF-α) and TA/AA (-3575 IL10) genotypes were at higher risk of developing arsenic-induced skin lesions, ocular, and respiratory diseases. Also the -308 TNF A allele corresponded to a higher production of TNF-α, and -3575 IL10 A allele corresponded to a lower production of IL10. Thus, the polymorphisms studied impart significant risk toward development of arsenic-induced dermatological and nondermatological health effects in the chronically exposed population of West Bengal, India.

AIM: To assess the phenomenology and associated beliefs in patients with Dhat syndrome. METHODS: A total of 780 male patients aged more than 16 years were recruited from 15 centers spread across the country and were assessed on Dhat Syndrome Questionnaire. RESULTS: The most commonly reported reasons for passage of Dhat were excessive masturbation (55.1%), sexual dreams (47.3%), excessive sexual desire (42.8%) and consumption of high energy foods (36.7%). The most common situation in which participants experienced passage of Dhat were as 'night falls' (60.1%) and 'while passing stools' (59.5%). The most common consequence due to passage of Dhat was weakness in sexual ability (75.6%). In terms of psychological and somatic symptoms, the common symptoms included bodily weakness (78.2%); feeling tired or having low energy (75.9%); feeling down, depressed, or hopeless (67.9%); and little interest or pleasure in doing things (63.7%). In terms of treatment expectations, about half of the patients (49.1%) expected that energizing medications like vitamins/tonics/tablets were required and more than one-third (38.2%) expected that there was a need for taking energizing injections. CONCLUSION: Present study shows that Dhat syndrome is a distinct clinical entity seen all over India, with its characteristic features.

BACKGROUND: Hirayama disease (HD) is benign focal amyotrophy of the distal upper limbs, often misdiagnosed as motor neuron disease. Routine magnetic resonance imaging (MRI) is often reported normal. OBJECTIVE: To study the clinicoradiological profile of hand wasting in young males. MATERIALS AND METHODS: Patients presenting with insidious-onset hand wasting from March 2008 to May 2011 were evaluated electrophysiologically. Cervical MRI in neutral position was done in 11 patients and flexion contrast imaging was done in 10 patients. RESULTS: All patients were males less than 25 years of age, with median age 23 years, except one patient who was 50 years old. Duration of illness was 3 months to 3 years. All (100%) had oblique amyotrophy, four (36%) cold paresis, 10 (91%) minipolymyoclonus and three (27%) had fasciculations. Regional reflexes were variably absent. Two patients (18%) had brisk reflexes of lower limbs with flexor plantars. Electromyography (EMG) showed chronic denervation in the C7-T1 myotomes. Neutral position MRI showed loss of cervical lordosis in 10/11 (91%), localized lower cervical cord atrophy in 9/11 (82%), asymmetric cord flattening in 11/11 (100%) and intramedullary hyperintensity in 2/11 (18%); flexion study showed loss of dural attachment, anterior displacement of dorsal dura, epidural flow voids in 9/10 (90%) and enhancing epidural crescent in 10/10 (100%). Clinical profile, imaging and electrophysiological findings of the patient aged 50 years will be described in detail as presentation at this age is exceptional. Collar therapy slowed progression in most cases. CONCLUSION: Clinical features of HD corroborated well with electrophysiological diagnosis of anterior horn cell disease of lower cervical cord. While dynamic contrast MRI is characteristic, routine studies have a high predictive value for diagnosis. Prompt diagnosis is important to institute early collar therapy.

The contamination of groundwater by leached out arsenic has assumed an alarming proportion in several countries. Continued and prolonged ingestion even at a very low level can lead to serious arsenic-related diseases. Strong epidemiological evidence of arsenic carcinogenicity has forced the World Health Organization (WHO) to lower the maximum permissible contaminant limit (MCL) in drinking water to 10 ppb from earlier limit of 50 ppb. This has thrown a big challenge to the scientific community to devise efficient methods to purify contaminated water to such a high level. Though literature abounds in occurrence of groundwater contamination by arsenic and its removal from drinking water by laboratory techniques, millions of people continue to suffer, particularly in the developing countries like India (Bangladesh, West Bengal). Through a comprehensive review of the existing literature on the occurrence, causes, impacts and remedial measures, this article finds out what has gone wrong and what is to be done with special emphasis on membrane-based separation that seems to be highly promising in purifying arsenic-contaminated groundwater to a WHO-prescribed level.

One of the most common disorders of the salivary glands is sialolithiasis. A history of pain or/and swelling in the salivary glands, especially during meal suggests this diagnosis. For small and accessible stones conservative therapies like milking of ducts with palliative therapy can produce satisfactory results. Surgical management should be considered when the stone/stones are inaccessible or large in size as conservative therapies turned out to be unsatisfactory. In this paper, we present three cases of sialolithiasis in the submandibular gland along with a review of existing literature. The purpose of this paper is to add three more cases to the literature and review the theories of etiology, clinical features, available diagnostic and treatment procedures.

Arsenic in drinking water is of critical concern in West Bengal, India, as it results in several physiological symptoms including dermatological lesions and cancers. Impairment of the DNA repair mechanism has been associated with arsenic-induced genetic damage as well as with several cancers. ERCC2 (Excision Repair Cross-Complementing rodent repair, complementation group 2), mediates DNA-repair by interacting with Cdk-activating kinase (CAK) complex, which helps in DNA proof-reading during transcription. Arsenic metabolism alters epigenetic regulation; we tried to elucidate the regulation of ERCC2 in arsenic-exposed humans. Water, urine, nails, hair and blood samples from one hundred and fifty seven exposed and eighty eight unexposed individuals were collected. Dose dependent validation was done in vitro using HepG2 and HEK-293. Arsenic content in the biological samples was higher in the exposed individuals compared with the content in unexposed individuals (p < 0.001). Bisulfite-modified methylation specific PCR showed a significant (p < 0.0001) hypomethylation of the ERCC2 promoter in the arsenic-exposed individuals. Densitometric analysis of immunoblots showed a nearly two-fold increase in expression of ERCC2 in exposed individuals, but there was an enhanced genotoxic insult as measured by micronuclei frequency. Immuno-precipitation and western blotting revealed an increased (p < 0.001) association of Cdk7 with ERCC2 in highly arsenic exposed individuals. The decrease in CAK activity was determined by observing the intensity of Ser(392) phosphorylation in p53, in vitro, which decreased with an increase in arsenic dose. Thus we infer that arsenic biotransformation leads to promoter hypomethylation of ERCC2, which in turn inhibits the normal functioning of the CAK-complex, thus affecting DNA-repair; this effect was highest among the arsenic exposed individuals with dermatological lesions.

OBJECTIVES: The study was conducted to assess knowledge, attitude, and practice regarding insulin use among diabetic patients in tertiary care hospitals. MATERIALS AND METHODS: Type 1 and 2 diabetic patients, aged 18 years and above, attending the Medicine/Endocrinology out-patient department or admitted as in-patients in three hospitals in and around Kolkata were enrolled. A pretested structured questionnaire comprising of 51 items was administered through face-to-face interview. Responses from 385 subjects were analyzed. RESULTS: Both higher educational and higher economic standards were associated with better understanding of insulin use. Longer duration of diabetes and its treatment (oral anti-diabetic drugs and insulin) were associated with better knowledge of some parameters. Female subjects were less aware of HbA1c as a monitoring tool. Among current insulin users, 70% had never used a glucometer; only 27.33% carried simple carbohydrates for use in hypoglycemic attacks; and 32% failed to rotate sites for insulin injection. CONCLUSION: Knowledge and attitude were satisfactory on the whole but deficiencies in practice were pronounced, which can potentially be removed through appropriate counseling.

Arsenic (As) induces pre-malignant and malignant dermatological lesions, non-dermatological health effects and cancers in humans. Senescence involves telomere length changes and acquisition of senescence-associated secretory phenotype (SASP), which promotes carcinogenesis. Though in vitro studies have shown that As induces senescence, population based studies are lacking. We investigated the arsenic-induced senescence, telomere length alteration and its contribution towards development of As-induced skin cancer. The study participants included 60 each of As-exposed individuals with skin lesion (WSL), without skin lesions (WOSL) and 60 unexposed controls. Exposure assessment of drinking water and urine was done. SA β-gal activity, ELISA, and quantification of senescence proteins, alternative lengthening of telomere (ALT) associated proteins and telomerase activity were performed. Relative telomere length (RTL) was determined by qPCR. A significantly higher number of senescent cells, over-expression of p53 and p21 were observed in the As-exposed individuals when compared to unexposed. SASP markers, MMP-1/MMP-3 were significantly higher in the WSL but not IL-6/IL-8. A significant increase of RTL was observed in the WSL group, which was telomerase-independent but exhibited an over-expression of ALT associated proteins TRF-1 and TRF-2 with higher increase in TRF-2. An increased risk for developing As-induced skin lesions was found for individuals having RTL greater than 0.827 (odds ratio, 13.75; 95% CI: 5.66-33.41; P < 0.0001). Arsenic induces senescence in vivo, but the SASP markers are not strictly over-expressed in the As-induced skin lesion group, whereas telomerase-independent elongation of telomere length might be useful for predicting the risk of development of As-induced skin lesions.

The study was designed to evaluate the role of various plant polyamines (PAs) on in-vitro multiplication and regeneration in the Ayurvedic memory enhancer Bacopa monnieri (L.) Wettst. Natural populations of B. monnieri were collected, sterilized and micropropagated in Murashige and Skoog (MS) media supplemented with different concentration and combination of plant growth regulators (PGRs) and PAs. MS media supplemented with 6-benzylaminopurine (BAP) (2.0 mg/l) + spermidine (spd) (1 mM) and in another set, kinetin (kin) (2.0 mg/l) + spd (1 mM) were found to be the best multiplication media whereas MS + indole-3-butyric acid (IBA) (1.0 mg/l) + spermine (spm) (1.0 mM) produced highest average number of roots per shoot. After 4–6 weeks of incubation, nodal explants cultured in MS media supplemented with various PGRs and PAs produced green compact or white friable nodular base calli (NBC). The NBC showed organogenic potential when subjected to MS media supplemented with cytokinins and PAs. Clonal fidelity of the regenerated plants was assessed using inter-simple sequence repeat (ISSR) and random-amplified polymorphic DNA (RAPD) markers. Out of the 60 clear and reproducible bands recorded, 54 were found to be monomorphic displaying high degree of monomorphism (90%) and lower polymorphic level (10%) between the mother plant and in-vitro regenerants. High-performance liquid chromatography (HPLC) revealed total bacoside content in B. monnieri grown in-vitro (PA-treated) and the mother plant (MP) grown in nature to be 27.89 and 25.46 mg/g respectively. The phytochemical analysis of the PA-treated micropropagated plants also revealed significantly higher levels of phenolics and flavonoids with comprehensively higher antioxidant potentials in PA-treated in-vitro grown plants (PATP) and the subsequently acclimatized plants (PATP-A) over the PA-untreated in-vitro grown plants (with/no PGR) (PAUP) and the mother plant (MP).