INDIAN JOURNAL OF MEDICAL SCIENCES

Indian Journal of Medical Sciences INDIANJOURNAL VOLUME 62 ISSN 0019-5359 OF Indian Journal of Medical Sciences is a monthly journal published as a NUMBER 1 medium for the advancement of scientifi c knowledge in all the branches MEDICAL SCIENCES of Medicine and allied Sciences and publication of scientifi c investigation JANUARY 2008 in these fi elds. It is also indented to present this as a form suitable to the general practitioner and primary care physician. ORIGINAL CONTRIBUTIONS

Psychological distress and associated risk factors in bronchial patients in Kuwait The journal is owned by the Indian Journal of Medical Sciences Trust, a N. R. Panicker, P. N. Sharma, A. R. Al-Duwaisan ...... 1 Late Dr. J. C. Patel registered charitable organisation and published by Medknow Publications, Identifi cation of enteroaggregative escherichia coli in infants with acute diarrhea based on biofi lm Founder Editor Mumbai, India. production in Manipal, South India Editor (1947-2003) Raju Bangar, Ballal Mamatha ...... 8

The journal is indexed/listed with Index Medicus (Indian J Med Sci), A study of bone marrow failure syndrome in children V. Gupta, S. Tripathi, T. B. Singh, V. Tilak, B. D. Bhatia ...... 13 MEDLINE, PubMed, EMBASE, CAB Abstracts, Global Health, Health and Wellness Research Center, Health Reference Center Academic, InfoTrac LETTERS TO EDITOR One File, Expanded Academic ASAP, Journal Articles Database (JADE), Editor-in-Chief after childbirth in a mother Dr. B. C. Mehta Indian Science Abstracts and PubList. Mohammad Hossein Rahimi-Rad ...... 19

Editor Immediate effect of highfrequency yoga on attention Dr. D. K. Sahu All the rights are reserved. Apart from any fair dealing for the purposes of Shirley Telles, P. Raghuraj, Dhananjay Arankalle, K. V. Naveen ...... 20 research or private study, or criticism or review, no part of the publication can be reproduced, stored, or transmitted, in any form or by any means, without PRACTITIONERS’ SECTION the prior permission of the Editor, Indian Journal of Medical Sciences. Metabolic comorbidity in schizophrenia Correspondence: Rajesh Jacob, Arabinda Narayan Chowdhury ...... 23 Dr. D. K. Sahu A-109, Kanara Business The information and opinions presented in the Journal refl ect the views Center, Off Link Road, Ghatkopar (E), of the authors and not of the Indian Journal of Medical Sciences Trust or Mumbai - 400075, India. Tel: 22-66491818/1816 the Editorial Board. Publication does not constitute endorsement by the Fax: 22-66491817 E-mail: [email protected] journal.

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Indian J Med Sci, Vol. 62, No. 1, January 2008 Indian J Med Sci, Vol. 62, No. 1, January 2008 19 20 LETTERS TO EDITOR

Mason RJ, Broaddus VC, Murray JF, et al., LETTERS TO EDITOR or parenchymal involvement were seen in CT scan after 3 years. editors. Murray and Nadel’s textbook of respiratory medicine. Elsievier Saunders: Philadelphia; 2005. CHYLOTHORAX AFTER With chylothorax, the main dangers to the p. 1961-88. CHILDBIRTH IN A MOTHER patient are malnutrition and a compromised 2. Banerjee D. Nontraumatic chylothorax: Revisited. J Indian Assoc Pediatr Surg 2007;12:96-8. immunologic status caused by the removal of 3. Kairamkonda VR. A rare cause of chylo- Sir, large amounts of protein, fat, electrolytes and in a preterm neonate. Indian J Chylothorax is the most common type of [1,2] lymphocytes. Chyle is bacteriostatic, so Med Sci 2007;61:476-7. neonatal ,[1-3] but a Medline complication by empyema is rare. However, 4. Tornling G, Axelsson G, Peterffy A. Chylothorax as search revealed only three case reports of the presence of chyle causes a gross pleural a complication after delivery. Acta Obstet Gynecol [4,5] chylothorax after childbirth in the mother. reaction, which becomes greatly thickened and Scand 1987;66:381-2. covered by exudates. This can lead to loss of 5. Honguero Martinez AF, Arnau Obrer A, Perez A 32-year-old woman presented with dyspnea chest-wall and -parenchymal function.[2] Alonso D, Estors Guerrero M, Cortes Alcaide CM, 11 days after normal vaginal delivery. She Canto Armengod A. Bilateral Chylothorax had no history of recent obvious trauma or Figure 1: Chest CT scan shows left-sided effusion with Management strategies of chylothoraces are after delivery: An infrequent case treated with extension to right side constitutional complaints. Physical examination (1) maintaining nutrition and reducing the videothoracoscopic talc . Cir Esp 2006;80:400-2. revealed a healthy-appearing female without DISCUSSION chyle fl ow with parenteral hyperalimentation peripheral lymphadenopathy, palpable spleen and low-fat diet (Octreotide, a somatostatin or anemia. There was dullness over one-third Tornling et al.[4] reported the first case of analogue, has been reported to be effective IMMEDIATE EFFECT OF of left hemithorax base with diminished breath chylothorax after delivery and described its in hastening the closure of thoracic duct leak); HIGH-FREQUENCY YOGA sounds. Chest roentgenogram showed left mechanism as follows: ‘During labor throes, (2) relieving dyspnea by removing the chyle by BREATHING ON ATTENTION pleural effusion. yielded milky there is initially an increased intrathoracic and repeated thoracentesis or tube thoracostomy fl uid. Analysis documented chylous nature of intra-abdominal pressure followed by a rapid and pleuroperitoneal shunts; (3) closure of the Sir, fl uid with a protein level of 6.8 g/dl, triglycerides decrease to negative intrathoracic pressure defect with chemical pleurodesis, lymphatic Kapalabhati (KPB) is a yoga breathing 562 mg/dl, cholesterol 7.0 mg/dl, glucose 98 mg/ with persistent high intra-abdominal pressure. embolization and blockade and video-assisted technique characterized by forceful exhalation dl and LDH 116 IU/l. The fl uid white blood cell In the thoracic part of the duct, high stretching thoracoscopic surgery (VATS).[1,5] and high-frequency breathing, whose name count was 6,300/cu.mm with 98% lymphocytes. forces thus occur on the ductal wall due to high (kapala = forehead, bhati = shining, in Sanskrit) Fluid was negative for malignant cells and acid intraluminal and low extraluminal pressure.’[4] In summary, this is a report of chylothorax after suggests that it stimulates the brain.[1] KPB fast bacilli. She rejected any evaluation due to childbirth, with its relatively benign course. is being practiced throughout India for health poor socioeconomic condition. In two previous reports, chylothorax was promotion and disease prevention.[2] MOHAMMAD HOSSEIN RAHIMI-RAD found after prolonged vaginal delivery where Department of Respiratory Medicine, Urmia University After 32 months, she accepted the request extensive external pressure was applied to of Medical Sciences, Urmia, Iran The alpha- and beta-1 activity in the EEG for revisit, and new chest X ray and CT scan the abdomen.[4,5] However, in our patient, Correspondence: increased during the first 5 minutes of a [Figure 1] showed left pleural effusion that in no external pressure was applied to the Dr. Mohammad Hossein Rahimi-Rad, Bronchoscopy Unit, 15 minute KPB session in 11 advanced Imam-Khomeini Hospital, 57157-81351, Urmia, West [3] comparison with previous X ray extended to abdomen. Azerbaijan, Iran. E-mail: [email protected] yoga practitioners. When practiced at high right hemithorax. Ultrasonographic examination frequencies (i.e., approximately 120 breaths per confirmed the fluid nature of both sides’ More than one possible etiology of chylothorax REFERENCES min), autonomic changes, based on the heart opacities. Thoracentesis and analysis of the may be present, such as occult mediastinal rate variability spectrum, suggested increased pleural effusion confi rmed again the presence lymphomas or lymphangiomyomatosis; 1. Light RW, Garry Lee YC. Pneumothorax, sympathetic and reduced vagal activity.[4] of chylothorax. however, no signs of mediastinal lymphoma chylothorax, and fibrothorax. In: However, despite the supposed effect on the

Indian J Med Sci, Vol. 62, No. 1, January 2008 Indian J Med Sci, Vol. 62, No. 1, January 2008