Title: Rapid Identification of Clinically Important Aerobic Microorganisms by Automated Blood Culture System and their Antimicrobial Resistance Pattern at Tertiary Care Hospital at Western Rajasthan India
Authors: Dr. R.S. Parihar, Dr. Ramesh Agrawal, Dr. P.K.Khatri, Dr. Priyanka Soni, Dr. Swati Duggal, Dr. Ritu Dhoundyal
The rapid identification of clinically important microorganisms from positive blood culture provides important diagnostic and therapeutic information. Blood stream infections can lead to life threatening sepsis, require rapid diagnosis and rapid antimicrobial treatment. Aim of our study was isolation and identification of aerobic pathogens causing bacteremia & septicemias and their antibiotic resistance patterns in a tertiary care hospital western Rajasthan. 628 blood samples collected from clinically suspected cases of bacteremia and septicemias were studied by (BacT/ALERT) automated blood culture system. The isolates were identified by standard phenotypic methods and antimicrobial resistance patterns were determined by CLSI guidelines. Positive blood cultures were obtained in 182 (28.9%) of cases. Among gram positive Staph aureus (39.5%) whereas gram negative Klebsiella (16.48%) were predominant isolates, and 3.8% were Candida species. Among staph aureus methicilin among klebsiella cefixime and among pseudomonas ticarcilline was the most resistance drug. The prevalence of MRSA,VRSA and VRE were 86.1%, 9.7% and 50% respectively. Overall high positive rates of blood culture were observed. Rapid isolation of pathogens by automated blood culture system provide early and appropriate treatment to seriously ill patients leading to reduce mortality and duration of hospital stay.
Keywords: Antibiotics resistance, Automated Blood culture, Bacterial isolate, ICUs, Rajasthan
Dr. R.S. Parihar
Professor, Microbiology Department, Dr. S.N. Medical College, Jodhpur
G-53, Shastri Nagar Jodhpur-342003 Rajasthan, India, 9414145627, 7568775748
Title: Efficacy of a Training Module for Self Study of Regional Anatomy of Head and Neck for Undergraduate Students
Authors: Haresh Kumar Perumallapalli, Sushil Kumar, Manish Singh Ahuja
The introduction of multimedia technology into teaching has brought important changes in teaching. This study seeks to evaluate whether the use of a structured teaching module on gross and applied anatomy of the head neck and brain improves students' understanding and performance.
This study compares the results obtained in the scores of an objective test, conducted for the 1st MBBS students. All the students were taught gross and applied Anatomy as per the conventional teaching pattern. After conclusion of the curriculum, a pre test was conducted to assess the students understanding of the subject. The students were then divided into two groups by simple random sampling. Study Group were exposed to the prepared software. Control Group were not exposed to the new methodology, their revision was conducted by traditional methods and thus acted as controls. A post-test was conducted to assess the enhancement of subject understanding by the students.
Comparison of the results and statistical evaluation revealed that students receiving prepared software input performed slightly better. It highlighted the importance of the new teaching material and its use both as a teaching aid as well as a self learning module.
In conclusion, it was found that the prepared software is an important teaching/learning module on gross and applied anatomy of the head and neck region.
Title: Impact of Supervised Nutrition Supplementation and Nutrition Education through Child Development Centers (CDC’s) for Improving Preschool Undernutrition in Primary Health Care Setting of Yavatmal District, Maharashtra, Central India
Authors: Nitin N Ambadekar, Vivekanand C Giri, K.Z. Rathod, Sanjay P Zodpey, Sunita P. Bharati
Introduction:Under-nutrition remained one of the most common causes of morbidity and mortality among children throughout the world. 1.84 to 2.4 million of deaths occurred in India. Principle of CDC was to provide supervised nutritious food to severely (G-III & G-IV) undernourished preschool children and imparting nutrition education to mother/guardian of children. The present study aims to study the impact of ‘Child Development Centers’ in improving grade of severe undernourished preschool children(G-III/IV) in primary health care setting
Materials and Methods: Present interventional study was carried out in primary health care setting in Yavatmal District. The intervention was in the form of organization of Child Development Centre’s (CDC’s) at Primary Health Centers (PHC) in which severe undernourished G-III and G-IV children were hospitalized for 21 days. There were three main interventions planned and implemented in CDC’s. First was supervised dietary supplementation. This includes providing approximately eight feeds daily. Second was growth monitoring and medical management. Third intervention is in the form of nutrition education to parents along with participation of mother in preparation of various new food supplementation and maintaining community growth charts.
Results: Severe undernourished children 547 children were admitted to CDC’s established at PHC’s in Yavatmal. At the time of discharged from CDC 274 (50.1%) children had improvement in their grade of undernutrition. There was reduction of Grade III under nutrition from 75.4% to 47.3% and Grade IV from 11.5% to 3.8% after 21 days of intervention at CDC. At the time of discharge from CDC highest average daily weight gain was seen in children aged 7 to 12 months (5.28 gm per day per kg) and in G-IV children (6.14 gm per day per kg).
Title: Wireless ECG monitoring system
Authors: Mrs. M.A. Thatte, Shushobhini Dongare, Ravi Kant Kumar, Sushant Deshmukh
The Electrocardiogram (ECG) is an essential diagnostic tool that measure and record the electrical activity of the heart. A wide range of heart conditions can be detected when interpreting the recorded ECG signals. These qualities make the ECG a perfect instrument for patient monitoring and supervision. With the recent advance in technology, there are possibilities to create a small sized wireless ECG system capable of transmitting. The result of this project is an off-the-shelf Android Bluetooth ECG monitoring device that communicates wirelessly to a computer or smart phone.
There were two parts of the project that was designed, the user interface software that controls the wireless ECG device function, set user options, and displays the data results. The wireless ECG monitoring device has components that allow for sensing heart electrical activity, signal conditioning, data conversion, data storage and wireless communication. Software code was written and tested on computer and smart phone as well as the wireless ECG monitoring device. Writing the software code took about three months to be complete and function perfectly.
Title: Factors Affecting the Usability of Mobiles in Healthcare- A Peep into the Indian Scenario
Author: Vertika Verma, Dr DNS Kumar
Mobiles today have proliferated as a ubiquitous means of communication. Every industry is depending on this medium in some or the other form. Healthcare industry is also leaping ahead with its might to come at par with other industries in terms of communication and use of information and technology. Earlier use of mobiles in healthcare was limited due to lack of memory, small screen space, poor graphical display and inability to transfer or store huge data. Emergence of tablets and smart phones has changed the overall experience of using mobiles. It has improved service delivery, empowered consumers, businesses and entrepreneurs and changed the way in which people access information and make transactions (Darrel West, 2011). The real time tailored personalized information available through mobile devices has the potential to transform healthcare. When integrated properly this technology has the potential to provide solutions to increased demands in quality, efficiency and improved workflow to help streamline healthcare operations (Beaver, 2003). In various hospitals ICT has shown improvements in adherence to guidelines, enhanced disease surveillance and reduced medication errors (Chaudhary et al., 2006).
Use of mobile in the healthcare can offer many benefits to the various stakeholders than any other ICT medium. The patients can monitor their condition, stay connected with the providers and also get involved in the decision making process about their health with the healthcare provider. The healthcare providers or organizations can reduce their cost of communication and treatment by reducing the number of hospital visits and hospital stays and enhancing the productivity and availability of staff (Gollol, et al., 2004). The providers can be offered access to patient’s records, consultation with the experts, access to medical knowledge databases anytime and anywhere and thus enhancing their productivity.
The objective of this research is to study the current status of usability of mobiles in healthcare and to analyze the factors affecting the usability of mobiles among the healthcare professionals. This study was conducted in four districts of Karnataka: two with good health indicators (Bangalore urban and Belgaum) and two with poor health indicators (Koppal and Raichur).
Keywords: ICT, mobiles in healthcare, Usability, TAM, UTAUT, PMT, EHR
Title: Study on Cardiovascular Risk Factors among Tertiary Hospital Employees
Authors: Raja Reddy P, Raveesha A, Madhavi Reddy M, Anil NS
The aim of the present study was to estimate the prevalence of cardiovascular risk factors among employees working at a tertiary hospital. Material and Methods: A cross sectional survey was conducted among a total of 503 individuals aged 30 years and above. The mean age of the study group was 48.30±2.31years. There was a high prevalence of major cardiovascular risk factors – current smoking (26.03), tobacco consumption (17.82), family history, diabetes mellitus (11.65), hypertension (21.23), hypercholesterolemia (41.12), hypertriglyceridemia (51.23), physical inactivity (46.23), body mass index (56.23), central obesity (44.14), inadequate fruits and vegetables consumption (36.13), heavy drinking (9.01). This indicates an urgent need to initiate a comprehensive health promotion and cardiovascular disease prevention Programme at working place.
Key words: Tertiary hospital employees, prevalence and cardiovascular risk factors
Title: 21 Cases of Giant Cell Rich Lesions of Bone- Cytologic Analysis of Imprint Smears
Introduction: There are many bone lesions rich in osteoclastic giant cells(GC). FNAC and Trucut biopsies are increasingly being used to diagnose bone lesions. . In our centre, imprint smears are also made at the time of trucut biopsies which often provide better cytological details. Here we have analyzed the cytological features of giant cell rich lesions diagnosed over a three year period which included GCT,ABC and CB.
Materials and Methods: The following features were evaluated in smears from each case diagnosed during three years: 1) Presence of double population of GC and mononuclear cells 2)Presence of cohesive cell groups 3)GC attached to the periphery of mononuclear cell groups 4)oval-spindle mononuclear cells 5)Round mononuclear cells with nuclear folds 6) Background material if any.
Results: there were 21 lesions which included 14 giant cell tumors (GCT) of bone, 5 aneurismal bone cysts (ABC), and 2 cases of chondroblastoma (CB).
Conclusion: GCT, ABC and CB are bone lesions containing GC. Although there are similarities, there are enough distinctive features in cytologic smears to allow their distinction with confidence and thus provide an easy and less expensive way of preoperative diagnosis.
Keywords: giant cell rich lesions, giant cell tumor, aneurismal bone cyst, chondroblastoma, imprint cytology.
Title: Upregulation of Peripheral Blood Levels of Immune-Regulatory Interleukin-10 Cytokine in Human Immunodeficiency Virus-infected Compared to Non-infected Pregnant Women
Authors: Stanslaus K. Musyoki*, Kiprotich Chelimo, Simeon K. Mining, Collins Ouma
Alterations in the cytokine status have been suggested to be at least partly responsible for the immune tolerance during pregnancy. Indeed, interleukin-10 (IL-10) cytokine is known to control inflammation-induced pathologies of pregnancy. The current study was set to investigate if HIV infection influences the production of IL-10 cytokine during pregnancy in adult asymptomatic HIV-infected pregnant women (n=44) and antiretroviral-naïve at enrolment as compared to controls (HIV non-infected pregnant women, n=44). Quantitative analysis of the IL-10 cytokines was done using Cytometry Bead Array Technology. Data analysis was performed using STATA version 13. P-value ≤0.05 was considered statistically significant. Results revealed differences in the mean of IL-10 cytokine levels between the HIV-positive and the HIV-negative participants over time across trimesters; trimester one 1.5 [(95% CI: 0.4, 2.5), P=0.008], second trimester 1.0 [(95% CI: 0.2, 1.9), P=0.019], and third trimester 1.2 [(95% CI: 0.3, 2.1), P=0.009]. These results demonstrates that, HIV infection favor the up regulation of IL-10 cytokine production in pregnancy. This upregulation of IL-10 may control inflammation-induced pathologies due to HIV during pregnancy. Further insight into the complexity of IL-10 cytokine in both HIV infections and pregnancy is greatly recommended to enable novel development of therapeutic strategies using this cytokine and targeting HIV-infected pregnant women.
Key Words: HIV infection, Pregnancy, Interleukin-10, Trimesters
Title: Atypical Stone Man Syndrome: Case Report and Literature Review
Authors: Dr. Maheshwar Lakkireddy, Dr. Prajnya Ranganath, Dr.Vijay Krishna Chilakamarri, Dr. Maria Celestina Vanaja, Dr. Ashwin B Dalal
Stone man syndrome (SMS) prominently known as Fibrodysplasia Ossificans Progressiva (FOP) is a rare genetic disorder of progressive heterotopic ossification leading to severe restriction of mobility. The misdiagnosis and mismanagement rate of FOP is quite high. Atypical presentations of FOP are even more difficult to diagnose and ultimately end up in lifelong disabilities owing to iatrogenic injury. We present a case of a 10 year old girl who came with complaints of deformity of spine and multiple swellings over the back noted since 1 year with no history of preceding trauma or illness. On examination multiple bony hard swellings of variable sizes on the back with right sided mid-dorsal scoliosis exaggerated on forward bending were noted. Skeletal survey revealed fusion of lower cervical spinous process, hallux valgus deformity in the left foot, bilateral short and broad femoral neck and pseudo-exostosis over the distal femur and proximal tibia. Sequencing of the ACVR1gene revealed p.R206H mutation associated with FOP. Confirmation of the diagnosis by genetic analysis has averted the possibility of misdiagnosis and mismanagement in this atypical presentation of SMS/FOP. Insights into the variable phenotypic expressivity of FOP may pave the way for more effective therapeutic interventions for FOP in the future.
Keywords: Myositis ossificans progressiva, Fibrodysplasia ossificans progressiva, Heterotopic ossification, ACVR1 gene, Hallux valgus deformity.
Dr. Maheshwar Lakkireddy
Flat No: A03-505, Sadbhavana Township, APRSCL, Rajiv Swagruha, Pocharam (Village), Ghatkesar (Mandal), Rangareddy (District), Telangana, India. Pin Code: 500088. Phone number: 09440634372.
Title: Prevalance of Anaemia among Children of Bangalore Rural
Authors: Dr Jaiju James Chakola, Dr Adarsh E, Dr Jenu James Chakola, Dr Ave Maria
Objective: To assess the prevalence of anemia among rural children of Bangalore.
Design: Cross sectional study. Setting: pediatric oot patient department, Rajarajeswari medical college and Hospital Subjects: 200 children of 6mo-60mo age.
Methods: Relevant history was taken and a complete physical examination done in all the children. Hemoglobin was estimated using cymnethemoglobin method and peripheral blood smears were also examined. Anemia was diagnosed when hemoglobin was less than 11 g/dl for children of 6mo-60mo age.
Results: Overall prevalence of anemia was 51.5%. Girls had a significantly higher prevalence of anemia. The prevalence of anaemia was high (38%) even in higher socioeconomic groups. Nearly half (47.6%) of well nourished children were anemic. The mean Hb also was lower than expected normal values in both nutritional groups. Compared to non-vegetarians (38%), more vegetarians (65.9%) were anemic. The commonest blood picture seen was microcytic hypochromic (55.4%).
Conclusions: The present study revealed a high prevalence of anemia among healthy rural children of higher socio- economic classes. Vegetarians and girls, were more at risk to develop anemia.
Keywords: Anemia, Children, Iron deficiency, Prevalence.
Title: Rhinosporidiosis of Male Urethra Presented with Polypoidal Lesion Along with Uerethral Fistula Complicating the Treatment Option: Case Report
Authors: Manabendra Naskar, Narendra Nath Mukherjee, Sandip Ghosh, Sukhamoy Saha, Prasenjeet Mondal
Rhinosporidiosis is a chronic granulomatous disease caused by a fungus, Rhinisporidium seeberi, a member of a group of novel aquatic parasites. Though the favoured site is the nasal mucosa, urethral involvement does rarely occur in this disease, only a few cases are reported in the literature and they are mostly from India. Here we report a case of urethral rhinosporidiosis, presenting as a protruding, polypoidal mass from the urethral orifice along with urethral fistula which after failure of medical treatment needs surgical unusual treatment option.
Keyword: Rhinosporidiosis, Polypoidal Urethral Mass, Urethral fistula
Title: Direct Pulp Capping with Mineral Trioxide Aggregate and Reattachment of Fractured Fragment Using Ribbond Fibers - A Case Report
Authors: Dr Sadanand S Kulkarni, Dr Hemalatha Hiremath
One of the options for managing coronal tooth fractures when the tooth fragment is available and there is no or minimal violation of the biological width is the reattachment of the fragment. Rebonding of the fractured fragment to the tooth retrieved in a fairly intact condition provides an ultra-conservative treatment option. Rebonding techniques provide good esthetics, restores immediate function and provides positive psychological support to the patient. This article presents a novel technique for reattachment of horizontal fractured fragment of vital maxillary left central (21) with pulp exposure. Pulp capping was done using mineral trioxide aggregate. Polyethylene fiber (ribbond) and panavia F cement were used to reattach the fractured fragment using an internal groove technique to provide high fracture strength to restored tooth.
Title: Prospective and Retrospective Study of Pattern of Tramadol Overdosed Patients Admitted to Alexandria Main University Hospital
Authors: Wafaa Mohamed El Sehly, Aida Mohey Mohamed Ali, Rania Mahmoud Gomaa, Amr Kamel Abd El Fatah Zaghloul
Background: Tramadol is one of the analgesic drugs, related to opioid. It is a centrally acting synthetic analgesic compound that is not derived from natural sources. Tramadol produces its anti-noceptive and analgesic effects via opioid and non-opioid mechanisms. The opioid component involves low affinity to μ-opioid receptors and the non-opioid component inhibits the reuptake of serotonin and norepinephrine neurotransmitters.Initially this new opioid painkiller medication was introduced as having safe and low abuse liability and widely used throughout the word. However, after a while, it was revealed that this agent has significant risks when overdose occurs. Nowadays, tramadol abuse has become a common medical emergency. An increasingly alarming phenomenon of tramadol drug abuse has been demonstrated in the Egyptian community in the last four years. Although the issue of drug abuse is not a newcomer to the Egyptian society, tramadol has been associated with a wide range of drug abuse and its illegal drug transactions had made it easily accessible and readily provided at cheap costs despite of its being a scheduled drug. The alleged sexual potency effects of tramadol had also contributed greatly to its popularity and massive use especially among Egyptian youth.
Aim of the work:This study was carried out on all patients with tramadol overdoses admitted to the Alexandria Poison Center and Intensive Care Unit (I.C.U.) at Alexandria Main University Hospital from 1/1/2012 to 30/6/2012 and from 1/10/2012 to 31/3/2013. It aimed to study the epidemiologic, clinical and laboratory patterns of tramadol over dose among users. Also, it aimed to determine the possible association between these patterns and the patients' outcome.
Keywords: Tramadol, toxicity, overdose, abuse, Alexandria.
Title: Determining Inducible Clindamycin Resistance in Staphylococcus Aureus from Various Clinical Samples by D-Zone test with Special Reference with MRSA
Authors: Sachin Mishra, Shrikant Kogekar, Nilesh Chavan, Swati Chavan
Clindamycin is used in the treatment of skin and soft tissue infections caused by staphylococcus aureus and also alternative for patients who are allergic to penicillin.
Treatment of an infection caused by as strain carring inducible erm gene using clindamycin or any non inducer macrolide can lead to clinical failture.
Thus making the need of detecting such resistance by a Disc test (D- Test).
Material & Methods: D- test was test to detect inducible clindymycin resistance with standard erythromycin and clindamycin disc. Of the 147 S. aureus isolates, 95 were methicillin resistant staphylococcus aureus . 45.26% of these were inducible clindamycin resistant. There were 52 methicillin sensitive staphylococcus aureus isolates, only 11.53% of which were inducible clindamycin resistant.
Conclusion: Performing D test regularly, the diagnostic laboratory can properly guide clinician regarding judicious use of clindamycin in skin and soft tissue infection. thus Clindamycin could be a valuable weapon against staphylococcus infection.
Title: Osteochondroma – A Rare Entity in Maxillofacial Region
Authors: Dr. Susmitha Rajmohan, Dr. Geeti Vajdi Mitra, Dr. Sarwpriya S.Bajaj
Osteochondroma, also known as Osteocartilagenous exostosis is regarded as the most common benign tumour of long bones, especially in the distal metaphysis of the femur and the proximal metaphysis of the tibia. It is relatively uncommon in the craniofacial region. Only about 1% of these occur within the head and neck region with more predilection towards females. In the Maxillofacial region both the condyle and coronoid tip are a common site of occurrence. Osteochondroma is not a true neoplasm but is thought to represent a developmental or hamartomatous process of bone. The most common clinical symptoms of Osteochondroma of condyle is malocclusion, with unilateral posterior open bite on the affected side and cross bite on the contra-lateral side and progressive facial asymmetry.
Here, we present a case of Osteochondroma of left mandibular condyle in a 30 years old female patient who reported to our institution with chief complaint of difficulty in mouth opening, deviation of lower jaw towards right side and hard swelling over left preauricular region. After clinical and radiographical diagnosis left condylectomy was performed using Alkayat Bramley incision and the mass was resected .Further histopathological examination confirmed the diagnosis of osteochondroma. Patient was followed up for 2 year and no recurrence or postoperative complications noticed.
Keywords: Osteochondroma, Condyle, bone tumor.
Dr. Susmitha Rajmohan (MDS)
Professor, Department of Oral and Maxillofacial Surgery,
Sri Aurobindo College of Dentistry, Indore-Ujjain state Highway,
Bhanwrasala, Tehsil- Sanwer, District- Indore, 453111, Madhya Pradesh, India
Title: Inflammation and Its Association with Appetite and Quality of Life of Patients on Maintenance Hemodialysis
Authors: N. Vanitha Rani*, S. Kavimani, P. Soundararajan, D. Chamundeeswari, Kannan Gopal
A study was conducted to evaluate the inflammatory status in maintenance hemodialysis (MHD) patients and correlate with self reported appetite and their health related quality of life. Ninety patients on MHD for 6 months and above (56 males and 34 females; mean age 52.6±11.7 years; mean dialysis vintage 20.99 ± 12.08 months) were studied. Serum inflammatory markers TNF-α and hs CRP, self reported appetite using Appetite and Diet Assessment Tool and health related quality of life by Health survey for dialysis patients – Short form 36 (SF 36) were assessed. The mean serum TNF-α and hs CRP levels were 39.798 ±15.19 pg/mL and 10.158 ± 2.82 mg/L respectively. Appetite was very good for 14.4% patients, good and fair for 47.8%, poor and very poor for 37.8% patients. Poorer the appetite significantly higher was the TNF- α and hs CRP levels (P < 0.0001). The mean score of total physical component of the QOL was 40.64± 10.8, total mental component was 37.56 ± 13.2 and the mean overall QOL score was 39.0 ± 11.9. TNF – α had a highly significant negative correlation with total physical component (r= -0.713; P< 0.0001), total mental component (r= -0.727; P< 0.0001), and overall quality of life scores (r= -0.735; P< 0.0001). Similarly hs CRP also had a highly significant negative correlation with total physical component (r= -0.481; P< 0.0001), total mental component (r= -0.515; P< 0.0001), and overall quality of life (r= -0.508; P< 0.0001). Poorer the appetite lower were the mean QOL scores. Patients on MHD suffer an inflammatory state which is strongly associated to anorexia and poor quality of life. Interventions to decrease inflammation may improve appetite and health related quality of life of these patients.
Keywords: inflammation, appetite, quality of life, hemodialysis.
Title: Knowledge Regarding Cervical Cancer among Women above 35 Years
Author: Mrs. A. Meena
A non experimental descriptive design with cross sectional survey approach was undertaken to assess the knowledge regarding cervical cancer among women above 35 years in Chinna seeragapadi village, Salem. It was conclued that highest percentage (50%) of women have average knowledge about cervical cancer.
Title: Clinical Study of Fournier’s Gangrene – Management and Outcome
Authors: Dr Viraj Chandrashekhar Shinde, Dr Jeevan Vitthal Shinde
Background: Fournier’s gangrene is a necrotising fasciitis of the genitalia and perineum, with associated polymicrobial infection and risk of organ failure or death.
Patients And Methods: We studied 40 during January 2012 and December 2013.
Results: the mean patient age was 48.3 years (range 28 - 66 years), with a peak age incidence of 50 - 59 years. The majority of patients were farmers and manual labourers. The site of gangrene was scrotal in 31 patients (77.5%), penoscrotal in 3 (12.5%), abdominoscrotal in 2 (5%) and scroto-perianal in 1 (5%). Systemic predisposing factors identified were diabetes mellitus in 12 patients (30%), congestive cardiac failure in 1 (2.5%) and hiv infection in 3 (7.5%). In 24 patients (60%) no systemic factor was identified. Local predisposing factors identified were chronic scrotal skin itching in 20 patients (50%), scrotal thorn injury in 2 (5%) and urethral catheterisation in 2 (5%). The common clinical features were fever, scrotal swelling/pain, and later a malodorous painless wound. Treatment involved fluid administration, correction of electrolyte imbalance, antibiotics, debridement and daily wound inspection/ dressing with hydrogen peroxide soaks and sodium hypochlorite. The mean duration of hospital stay was 40.days (range 20 - 80 days). Two patient died (5%).
Conclusion: Fournier’s gangrene is a challenging surgical problem, with significant morbidity. Diabetes mellitus is a significant systemic risk factor. Local risk factors, especially chronic scrotal itching, were contributory. With proper management, mortality is low.
Key Words: Diabetes Mellitus, Gangrene, Necrotising Fasciitis, Debridement.
Dr Viraj Chandrashekhar Shinde
Dept of Surgery, S.No. 49/1, Westerly Bypass Road,
SKNMC and GH, Narhe-Ambegaon, Pune- 411041
Residential Adress: Saket, 26, Narayan Peth, Sayantara Chowk,
Behind Narayan Peth Police Chowky, Pune 411030
Contact no.: Mob- 9175343536/9762084094, Office- 020-24106218
Title: A Study of ESBL Uropathogens in A Tertiary Care Hospital with Reference to their Antibiogram
Authors: Nagaram Punith Patak, Kandati Jithendra*, Ponugoti Munilakshmi, Shiva Prasad Reddy Basava, Madhavulu Buchineni, Rama Mohan Pathapati, Venu Gopal Sharma
Background: To Process the urine specimens received to the laboratory. The aim of the study is to determine the type of uropathogens in the region and also to study their antibiotic sensitivity in a tertiary care hospital.
Methods: A total of 7023 urine specimens of all age groups were processed in the central clinical microbiology laboratory of Narayana medical college for a period of 14 months from Sep 2012 to Oct 2013.Samples included of various type like Clean catch mid stream [CCMS], Cather collected, Suprapubic aspiration and nephrostomy. The specimens were inoculated on Nutrient agar, Blood agar and Macconkey agar and processed. Isolates identified by standard Biochemical tests and Antibiotic sensitivity was done by Kirby-Bauer disc diffusion method. ESBL isolates were identified by phenotypic disc diffusion method and antibiotic sensitivity was performed and results interpreted as per CLSI guidelines.
Results: 5538 were culture positive and females were predominant over males with 3071 number as with other studies. Maximum age group in the study was between 51-60 years. Urinary tract infection was the major clinical condition followed by renal calculus, Diabetes. Escherichia coli was the predominant uropathogen in the study , Klebsiella pneumoniae, Acinetobacter sp, Pseudomonas aeruginosa, Citrobacter sp, Proteus Sp formed the rest .Enterococci sp was predominat gram positive uropathogens and rest include CONS, Staphylococcus aureus. Candida was also isolated. Gram negative uropathogens exhibited maximum sensitivity to Imipenam, Piperacillin + tazobactam and Amoxycillin+ clavulanic acid and maximum resistance to Amoxycillin,Cephalexin. E.coli exhibited moderate degree of sensitivity to Nitrofurantoin. In our study Klebsiella pneumoniae was the major ESBL uropathogen followed by Pseudomonas aeruginosa, Escherichia coli. Piperacillin+Tazobactam followed by Imipenem exhibited maximium sensitivity to ESBL uropathogens. Gram positive uropathogens demonstrated maximum sensitivity to Vancomycin and Linezolid.
Conclusion: Monitoring and regular screening for the production of ESBL’s in the laboratory itself among uropathogens helps in prompt interventional measures in controlling ,spreading the development and dissemination of resistance in the community. The carbapnems should always be kept as reserve drugs in treatment of complicated UTI,s and in UTI,s caused by multi drug resistant uropathogens.
Keywords: Urinary tract infections, Uropathogens, ESBL, Multi drug resistant uropathogens.
Title: Effectiveness of Video Assisted Teaching Module on Prevention and Home Management of Diarrheal Diseases among Mothers with under five Children
Author: Dr. N. Sumathi. Ph.D (N)
Quasi experimental design where pre and post with control group approach was used to assess the effectiveness of video assisted teaching module on prevention and home management of diarrhea among 604 mothers of under five children, the data was collected by structured interview schedule, the finding reveals that after implementation of video assisted teaching module among mothers of under fives in experimental group had improved knowledge(75.1%) of mothers with under fives on prevention and home management of diarrhea
Dr. N. Sumathi. Ph.D (N)
Professor and Head of the Department, Community Health Nursing,
Vinayaka Mission’s Annapoorana College of Nursing,
Chinnaseeragapadi, Salem -636308, Tamil Nadu
Title: Primary Squamous Cell Carcinoma of the Renal Parenchyma with Chronic Pyelonephritis – A Rare Case Report
Authors: Dr. Priyanka Kumari, Dr Sunita Bharagava, Dr. Sonal Bhati
Primary squamous cell carcinoma of the renal parenchyma is a very rare entity.This is probably the first case of Primary squamous cell carcinoma of the renal parenchyma associated with chronic pyelonephritis in a 55 year old male, who presented with pain in right flank and nonfunctioning right sided kidney. Histopathology revealed the features of well differentiated keratinising sqamous cell carcinoma with changes of chronic pyelonephritis.
Key words-Squamous, parenchyama, renal, pyelonephritis.
Dr. Priyanka Kumari
M.D. Pathology – Resident, Department of Pathology
R.N.T. Medical College, Udaipur India
Title: Raised MPV and Thrombocytopenia Common Hematological Parameters as a Prognostic & Diagnostic Tool of Plasmodium Vivex Malaria for Acute Iillness
Authors: Dr. Ramu Thakur, Dr. Karuna Thakur
Aims & Objectives - Reduced the morbidity and mortality of malaria due to plasmodium vivex Reduced the incidence of plasmodium vivex induced acute illness and prevent the complication.
Material & Methods: Blood was collected in a sterile EDTA containing tube and processed following our established laboratory protocol. A complete blood counting including HB%, PCV, Red cell indices, platelet count with platelets indices MPV and total white cell count and differential was done by Automated blood cell counter and peripheral blood smear examination by thin film and thick film. The all cell count indices including RBC, WBC count with differential along with platelets count was further confirmed by manual oil immersion smear study method. Peripheral smears study was done with field A and B stain and leishman stain.
Conclusion- Thrombocytopenia is one of the most common complications of the P. vivax malaria and as a prognostic indicator of acute illness of malaria. Thrombocytopenia with raised Mean platelets volume hematological parameter is a adequate prognostic & diagnostic tool for acute illness and parasitimic index
Keyword- Mean platelets volume Thrombocytopenia Platelets aggregation.
Title: Effect of Omega-3 on Intraocular Pressure
Authors: Uloneme G. C*, Ozims S. J., Eberendu, I. F., Akukwu, D., Akogu, A. O.
The study investigated the effect of Omega-3 preparation (countering Omega-3 fatty acids) on the oculo-visual health of rabbits, with emphasis on the intraocular pressure. The experimental animals were separated into two groups of ‘A’ (which was control) and ‘B’ with group ‘A’ being subdivided into R1, R2, R3 and group ‘B’ subdivided into R4, R5 and R6. The twelve rabbits that constituted groups ‘A’ and ‘B’, respectively were fed liberally and medically tended to in the course of the experimentation. Group ‘A’ rabbits (control) received no Omega-3 capsules, but were placed on placebo while the group ‘B’ rabbits were treated with Omega-3 capsules, each rabbit receiving 1500mg of the preparation daily (500mg in the morning, afternoon and evening respectively) for five days. The intraocular pressure of the animals was monitored and measured once a day before the oral administration of the Omega-3 preparation, and likewise the control group on placebo. It was observed that while the intraocular pressure of the control group animals(Group A) remained fairly constant, being confined between 15.73mmHg and 15.23mmHg from day 1 to day 5, the intraocular pressure of the group ‘B’ animals treated with the omega-3 capsules widely vacillated from 17.00mmHg on day 1, to 9.17mmHg on day 5, giving a 46% decrease in intraocular pressure on the last day of experimentation (day5).
Keywords: Omega–3, Fatty Acid, Intraocular Pressure, Rabbit, Glaucoma
Title: Results of Resection of Tumors around Knee with Reconstruction Using Arthrodesis or Endoprosthetic Reconstruction
Authors: Dr. K. Nageshwar Rao, Dr. Vijay K. Chilakamarri, Dr. K.C Sreekanth, Dr .Vaddijayachandra
Juxta articular tumors are most common around knee. Wide resection and reconstruction with arthrodesis or Endoprosthesis, for patients with more biologically aggressive, recurrent tumors, is an attractive option.
Materials And Methods: 27 patients with mean age of 28.8yrs with , GCT – 21 , Ewings sarcoma – 1 , Chondroblastoma – 1 , Chondrosarcoma – 1, Fibrosarcoma – 1, Fibroma – 1, Benign fibrous histocytoma – 1, 24 benign and 3 malignant were treated from 2004 – 2013 . Wide resection and arthrodesis with dual free fibular graft and intramedullary nail for 19 patients and Endoprosthetic reconstruction for 8 patients. 17 were in distal femur and 10 were in proximal tibia. 17 were females and 10 were males. Mean follow up of 69.4 months. Functional evaluation done using modified system of Musculoskeletal Tumor Score.
Results: In Resection Arthrodesis out of 19 patients 15 patients had excellent results, 3 patients had good results.1 patient had fair result. In Endoprosthetic reconstruction out of 8 patients 6 patients had excellent results, 2 patients had good results. Out of the 19 patients who underwent resection arthrodesis 1 patient has soft tissue recurrence , 2 patients has fibular graft site fracture, 1 patient has non union at graft host interface, 1 patient has superficial infection. Out of the 8 patients who underwent endoprosthetic reconstruction 1 patient has soft tissue recurrence of tumor, 1 patient has aseptic loosening of implant , 1 patient has superficial wound infection.
Conclusion: Following wide resection of juxta articular tumors reconstruction with arthrodesis and reconstruction with endoprosthesis have good and comparable results .Both procedures give good and satisfactory results with arthrodesis being a very low cost alternative.
Keywords: Tumors around knee, Resection Arthrodesis, Endoprosthetic reconstruction.
Title: Tubercular Recto-Prostatic Fistula: A Rare Entity
Authors: Dr. Raghav Tantia, Dr Nishant Khurana, Dr T.C. Sadasukhi, Dr Devansh Arora
Recto-prostatic fistulas are rare entities in any urology outdoor. Most of the cases reported are by paediatric surgeons dealing with ano-rectal malformations or by surgeons involved in misfortunes of radical prostatectomies. There is scanty data on the inflammatory causes of recto-prostatic fistulas. Despite the prevalence of uro-genital tuberculosis in the developing world, very little literature is available on tuberculosis forming a cause of recto-prostaticurethral fistula. Prostatic biopsy clinches the diagnosis and urethroscopy may actually demonstrate the fistulous opening in the prostatic urethra. Recent studies advocate a conservative approach (ATT Regimen) with/without urinary/faecal diversion. We report a similar such case which was treated with Anti-tubercular therapy without faecal/urinary diversion. The lesion healed with minimal scarring and the patient was able to void urine normally after 6 months of Anti tubercular therapy. Based on the review of literature and our own case we propose that high grade of clinical suspicion should be kept on the tubercular cause of recto-prostatic fistulas in endemic areas and that conservative management should be the first line of treatment.
Title: Study the Association between Erythropoietin Resistance and Polymorphisms in two genes, IL-1B and ACE in Egyptian Patients on Maintenance Hemodialysis
Authors: Heba ELshair, Hanan Nomeir,Azhar Mohamed
The introduction of recombinant human erythropoietin (EPO) is effective treatment for anemia in chronic kidney disease patients The causes of inadequate response to EPO include iron deficiency, infection, chronic inflammation, and uremia. IL-1B-511C/T polymorphism has been associated with inflammation that plays important role in EPO resistance also the ACE gene polymorphism may display erythropoietic resistance. The study was conducted on 100 chronic kidney disease patients treated with hemodialysis. All participants gave informed consent .Clinical data were evaluated, including use of ACE inhibitors or angiotensin receptor blocker (ARB) prior to the time of the study. Lab investigations as Hb levels, serum albumin, total iron-binding capacity, high sensitivity C-reactive protein and Intact parathyroid hormone (PTH) levels.the aim of the study was to evaluate the association between( IL-1B-511C/T and ACE I/D gene polymorphisms) and EPO resistance index (ERI)
We found that Patients with the ACE D/D genotype had lower ERI (6.4318± 3.43 IU/kg weight/g Hb) if compared with other two genotypes (ACE I/I, 8.248±2.35 IU/kg weight/g Hb; ACE I/D, 7.30±2.92 IU/kg weight/g Hb) also ERI Values were lower in IL-1B-511C/T individuals (6.64±2.43IU/kg weight/g Hb) than in IL-1B-511CC (7.27±3.03 IU/kg weight/g Hb) and IL-1B-511TT (8.50±3.32 IU/kg weight/g Hb) and this difference was significant .we concluded that ACE genotype has predictivevalue when determining the EPO dosage, as the II/ID genotypes may be associated with a suboptimalresponse to EPO. Also patients with IL-IB C/T may require less EPO than other two genotypes IL B T/T and IL B C/C
Key words: Erythropoietin resistance, IL-1B , ACE gene, hemodialysis
Title: Secondary Hemophagocytic Lymphohistiocytosis: Morphological Findings of Spleen and Bone Marrow with Discussion of Management of an Atypical Case
Authors: Subhash Chandra Jha, Ramesh Prasad Dwivedi, Prakash Chandra Jha
Hemophagocytic lymphohistiocytosis is syndrome due to abnormal and exaggerated immune response to infectious and non-infectious agents. The most common presentation is fever with palpable splenomegaly and pancytopenia.In this case, a young thin girl presented with moderate grade fever and huge splenomegaly (spleen palpable 24 cms below left costal margin) with pancytopenia with severe normocytic anemia. All investigations including serological markers, parasitic a, fungal and bacterial cultures done to know cause of infection were negative. However, her bone marrow and splenic aspirates were strongly positive for hemophagocytosis. These morphological findings were also confirmed by biochemical results of high triglycerides and low plasma fibrinogen level. This rare case presented to hematology centre and finally diagnosed as haemophagocytic syndrome and treated with HLH -94 protocol, she became afebrile just after one cycle and her splenic size is decreased gradually and pancytopenia is corrected gradually. Now after completion of six cycles of therapy, at the time of writing of paper , she is asymptomatic from more than one year , however she still has mild splenomegaly and mild anemia, but her WBC count and platelet counts are corrected completely. She is leading normal transfusion independent and afebrile life. Importance of FNAC of Spleen and bone marrow aspirate in diagnosis of this is disease is especially shown in this paper.
Key Words: Hemophagocytosis , bone marrow, splenomegaly, HLH -94 protocol.
Title: Frequency of ABO and Rhesus Blood Groups: A Study among the donors of Sir.T.Hospital Bhavnagar, Gujarat
Authors: Dr. Bhavin Padhariya, Dr. Bharti Parghi, Dr. Pragnesh Shah
Background & Objectives: The ABO blood group system was the first human blood group system to be discovered by Landsteiner in 1900. The second type of blood group is the rhesus system. There are only two Rh phenotype such as Rh positive and Rh negative, depending on whether Rh antigen is present on the red cell or not. The frequency of ABO and Rh phenotypes in different populations has been extensively studied. The present study was done to assess the prevalence of blood groups in different categories of bhavnagar and to compare our results with other studies conducted in India and elsewhere in the world and its multipurpose future utilities for the health planner.
Materials and Method: A retrospective study was carried out on 40416 blood donors (male and female) during a period of three year from 1st January2012 to 31st December 2014, donors were selected and screened for study in the sir. T. Hospital Blood Bank, Bhavnagar Gujrat. India. . Each sample of donors was tested for ABO and Rhesus group status using antisera (Eryclone Monoclonal ABO/Rh, Tulip Diagnostic Ltd. Goa, India) combined slide and tube method
Results: The frequency of various blood group according to present study, from table -1: B+ve 33.4%, O+ve 29.4%, A+ve 21.86%, AB+VE 8.9%, B-ve 2.3%, O-ve 2%, A-ve 1.46% & rarest being AB-ve 0.7% Also from Table 2: Rh-Group positive are 93.57% and Rh –Neg less common with 6.42% prevalence Conclusion group “B” is most common Blood group in Bhavnagar population followed by “O”A,and AB Blood Group, also Rh-Group positive are 93.57% and Rh –Neg less common with 6.42% prevalence
Keywords: blood donor ,blood group ,ABO,Rhesus(Rh)
Title: Prevalence of Perceived Stress and Obesity among Women Before and After Menopause
Authors: Ammu Somanath, Ramesh Bhat.M, Nayanatara A.K, Sheila R Pai
Background: Menopause is one of the critical periods of a women’s life during which weight gain and onset or worsening of obesity are favored. At this period the prevalence of obesity is the highest.
Aim: The present study aims to find out the effect of menopause on perceived stress and obesity among women.
Material and Methods: A total of 45 female subjects constituting premenopausal women between the age group of 18–44 years and post-menopausal women between the age group of 45–60 years was included as sample. Participants were categorized into overweight/obese groups based on the body mass index overweight/obese group, BMI ≥ 25 in each group. The Perceived Stress Scale (PSS) the major tool was used for measuring the perception of stress. Chi Square Test was used for comparing the stress and obesity of women before and after menopause.
Results: Percentage of women with stress (88.8%) is much greater after menopause compared to those without stress. But the percentage of women with stress before menopause is more or less equal to those without stress. Further, menopause has significant effect on perceived stress (x2 = 6.67, p < 0.01) among women but has no effect on obesity of women (x2 = 1.57, p< 0.05)
Conclusion: Healthy lifestyles has to be recommended to prevent postmenopausal stress
Title: Abbe’s Flap for Lip Reconstruction –Report of 2 Cases
Authors: Dr. Geeti Vajdi Mitra, Dr. Tejas Motiwale, Dr. Shruti Mehta
Lip is special to the face in its morphology and position. This tissue is not found anywhere else in the body, thus making the repair of its lost structure that much more difficult to the operating surgeon. Upper lip defect caused by trauma can result in facial and functional compromise. Apart from the esthetic value, lips are also important for oral competence, emotional communication, deglutition and speech. Lip defects with more than two third involvement requires a thorough pre operative planning and pre surgical technical knowhow. Goals of the reconstruction are the maintenance of oral opening, oral competence, restoration of normal anatomic functions and cosmesis. Here we present two cases of upper lip defects where more than two third of the lip was lost and these were surgically reconstructed by Abbe’s flaps.
Dr. Geeti Vajdi Mitra
Dept of Oral & Maxillofacial Surgery, Room no.3,
Sri Aurobindo college of Dentistry, Bhawarnsala,
Sanwer Road, Indore –Ujjain Road. Indore.-453111
Title: Age and Delay Hospitalization is Most Effective Prognostic Tool for Determination of Outcome for Cerebrovascular Accident Patients
Authors: Dr. Vikas Asati, Dr. Abhilasha Goyal
Aims & Objectives:To determine the characteristic, clinical etiologies, type of stroke andhospital andpost discharge 6 month in follow up in patient admitted to medicine/ neurology services with acute stroke in M. Y. Hospital, Indore. To determine the disability related to stroke as estimated by modified Rankin score at the time of admission and 6 month follow up.
Material & Methods:This study was carried out in the Department of Medicine, MGM Medical College and M.Y. Hospital, Indore, from 2009 to 2013. We included 100 consecutive patients of strokes admitted to intensive care unit under medicine/neurology services. All patients or relative provided valid informed written consent for participation. After taking into considerations all the inclusion and exclusion criteria’s, the written consent to take part in study was obtained. Patient’s data was collected within 24 hours of the admission (including rapidly fatal stroke),1 during hospital stay and at the time of discharge using a standard Case Report Form. Data collected in the form of Baseline Characteristics, Stroke severity, Risk Factors for stroke, routine investigations like complete blood count, renal function test, serum electrolyte, lipid profile, ECG, neuroimaging like Computed Tomography (CT) Brain, Magnetic resonance imaging (MRI)may or may not accompanied with angiogram or venogram as per the patient clinical characteristic of patient. The treatment given to the patient was recorded. The improvement or deterioration in patient clinical condition was recorded and treatment was revised as per the requirement by the concern Unit.
Conclusion- The patients of stroke with age> 60 years had significantly high mortality (p value = 0.042 (<0.05).The patients of stroke who reach the hospital within 3 hours had significantly less mortality (p value =0.5)
Keyword- stroke, venogram, renal function test.
Title: Kikuchi-Fujimoto Disease: Two Case Reports from North East India
Authors: Dr Sarat Das, Dr Navanita Das, Dr Taufeequl Islam
Kikuchi-Fujimoto disease (KFD) is also known as histiocytic necrotizing lymphadenitis. Kikuchi-Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare benign, self-limiting cervical lymphadenitis of unknown etiology. The disease mainly affects young women and can closely mimic infective and immunological disorders. KFD should be included in the differential diagnosis of suspected cases of tuberculosis, lymphoma and systemic lupus erythematosus. The disease is benign and self-limiting and an excisional biopsy of an affected lymph node is necessary for diagnosis. This study reports on two cases of female patients with KFD who were presented with fever and cervical lymphadenopathy. Although the incidence of Kikuchi-Fujimoto disease is rare, clinicians should be aware of this condition as early recognition of the disease will minimize potentially harmful and unnecessary evaluations and treatments.
Keywords: kikuchi-fujimoto disease, histiocytic necrotizing lymphadenitis, cervical lymphadenopathy.
Authors: Dr Girish D Bakhshi, Dr Dayanand D Choure, Dr Kavita V Jadhav, Dr Mukund B Tayade, Dr Nimish A Jain, Dr Aniket S Deshmukh
Retroviral disease is a common condition in developing countries. Patients affected with Human Immunodeficiency Virus (HIV) are admitted in hospitals for conditions related or unrelated to HIV. This study was done to assess surgical disease spectrum in HIV infected patients and their common clinical features. A prospective observational study was carried out in a tertiary care hospital. All retroviral patients with surgical illness and above 13 years of age irrespective of their sex were enrolled after their consent. They were investigated, treated and observed in relation to response to treatment till their recovery. The study found infectious diseases as most common condition and most of them requiring emergency surgical intervention along with a good antibiotic coverage. The severity of the presentation is related to the duration of the complaints, as in non-HIV patients but also to CD4 count in this group of patients.
Title: Surgical Outcome of Composite Cartilage Perichondrial Autogaft (CCPA) in Tympano Mastoid Surgeries
Authors: *Singamsetty Kalyan Kumar, Konatham Bhaskar, Venkatapuram Mahidhar Reddy, Muvvala Vasudha, Bokkasam Haranath, Gouripeddi Sreenivas
Background: The Composite Cartilage Perichondrial Autograft (CCPA) tymponoplasty has been used in an effort to reduce recurrence or progression of middle ear disease. To this purpose we evaluated the surgical outcome of Composite Cartilage Perichondrial Autogaft (CCPA) is tympano mastoid surgeries.
Methods: This prospective case control study was conducted in the department of otorhinolaryngology, Sri Venkateswara Medical College, Tirupathi, Andhra Pradesh over a period of 2 years from August 2011 – August 2013 in patients whom were diagnosed as having recurrent CSOM with or without discharge with H/o tympanoplasty. CSOM with acute exacerbations, cases with known Eustachian tube dysfunction, cases with symptomatic DNS, Sinusitis and Cases with SND / Mixed hearing loss requiring improvements were excluded from the study. Composite Cartilage Perichondrial Autograft (CCPA) tymponoplasty done for all the cases and followed up at 1, 3, 6 and 12 months intervals. Data entered into excel spread sheet 2007.Statistical analysis was done using excel. Data was presented as Mean and SD, actual numbers and percentages.
Results: In this study, the majority of the patients who underwent surgery were in the 3rd and 4th decades of life (85%). In almost all the cases, H/o discharge from ear was since childhood and the duration ranged from minimum period of 6 months to maximum period of 20 years. 70% of cases presented with ear discharge associated with hearing loss. 2 cases of adhesive otitis media presented with only hearing loss. 90% of the cases are of recurrent CSOM and 10% of the cases are of adhesive otitis media. Among 20 cases, 18 of them had central perforation. 3 cases among the 18 had associated retraction pockets postero-superiorly. The 2 cases of adhesive otitis media had grossly retracted TM. In 95% of cases in our study, the graft has taken up. In only 1 case, the graft had not taken up.
Conclusion: CCPA tymponoplasty is an effective method to close recurrent central perforations of TM and has a high degree of graft take with satisfactory hearing results, particularly in the atelectatic ear, cartilage allowed us to reconstruct the tympanic membrane with good anatomic results compared to traditional reconstructions.
Keywords: Composite Cartilage Perichondrial Autograft (CCPA), Tymponoplasty, Chronic Suppurative Otitis Media (CSOM), Ear discharge.
Title: Cockayne Syndrome
Authors: Dr Nita R Sutay, Dr Md Ashfaque Tinmaswala, Dr Manjiri Karlekar, Dr Swati Jha
Cockayne syndrome is one of the rare genetic disorders. The pattern of inheritance is autosomal recessive. The characteristic features of cockayne syndrome include short stature, pigmentary retinopathy, birdlikefacies, poor weight gain, microcephaly and photosensitivity. Associated features may include deafness, dental decay and neurological abnormalities. Cockayne syndrome have 3 subtypes, Type I or classical form is characterized by early onset symptoms (usually within 1-2 years) and type II is severe form of disease and signs and symptoms are usually present at birth it’s also called pena-Shokeir syndrome. The mildest variety of cockayne syndrome is type III in which the symptoms are mild and usually present later in childhood. We present here a case of 7 year old female child who was admitted to us with complaints of non attainment of motor milestones like standing or walking and decrease vision and hearing since 2-3 years. The characteristic facies, microcephaly, bat like ears, dwarfism, photosensitivity and bilateral optic atrophy lead us to the diagnosis of cockayne syndrome.
Keywords: Cockayne syndrome, neuroregression, photosensitivity, bat like ears
Title: Hematological Parameters in Pregnant Women in A Rural Teaching Hospital
Authors: *Prasanthi Cherukuri, Vandhana Gangadharan, Durga Prasad Dommeti
Introduction: The hematological profile of an individual reflects to a large extent reflects their general health. The World health organization recommends that hemoglobin should ideally be maintained at or above 11.0gm/dl and should not fall below 10.5 g/dl in second trimester.
Materials and methods: Present study was conducted by pathology department of NRI institute of medical sciences, a teaching hospital in a rural area of Visakhapatnam, Andhra Pradesh. A total of 172 pregnant women attending to gynecology and obstetrics outpatient department were studied The samples were collected in Ethylenediaminetetraacetic acid vacuttainer and sent along with the requisition form to the pathology laboratory.
Results: The present study includes 172 pregnant women of which 76.7% (132) were anemic with a hemoglobin less than 11gm/dl of which 28% (38) were mildly anemic and 66%(88) were moderately anemic and 3.7%(5) were severely anemic. The hemoglobin was 10.09+/- 1.38, 9.59+/- 1.16, 9.0 +/- 1.38 in the first, second and third trimesters respectively. A steady decline in the hemoglobin was found from first to third trimester. The hematocrit in the first, second and third trimester were 30.43+/- 4.2, 29.20 +/-3.83, 29.12 +/- 5.16 respectively. Mean Corpuscular Volume declined from the first to third trimester in this study while MCH remained relatively stable through all trimesters. These findings may be a reflection of iron deficiency anemia which is responsible for 95% of anemia of pregnancy.
Conclusion: The hematological parameters early recognition of type of anemia during pregnancy and thereby improve the outcome of pregnancy
Keywords: Anemia, Hemoglobin, Hematocrit.
Title: An Unusual Delayed Complication of Central Venous Cannulation: A Case Report
Authors: Dr. Shubha N. Mohite, Dr. Swati Chhatrapati, Dr. Rochana G. Bakhshi
The venous system is a common anatomical site for a number of foreign bodies. Our case reports a central venous catheter left accidently in the venous system. The catheter was found with its one end in the right ventricle and the other in the pelvis adjacent to right utero vesical junction and bladder and traversing inferior vena cava, right iliac vein and proximal internal iliac vein. It was found as an incidental finding during investigations (CT abdomen and X ray abdomen). It was retrieved after surgical exploration. A brief case report with review of literature is presented.
Keywords: central venous catheter, complications, foreign body, right ventricle.
Title: Uterine Myoma, Epidemiology, Pathophysiologic, Reproductive, Clinical and Therapeutic
Authors: Vargas-Hernández Víctor Manuel, Tovar-Rodríguez José María, Agustín I Rodríguez Blas, Vargas-Aguilar Víctor Manuel
The Uterine leiomyomas are benign smooth muscle tumors of slow growth, most patients are asymptomatic or discovered during a routine gynecological examination. Clinical manifestations occur in 20-40% with abnormal uterine bleeding, chronic pelvic pain, pelvic heaviness and occasionally reproductive alterations related to the size and location of leiomyoma’s. The medical management is to improve symptoms or facilitate surgery, particularly if conservative avoiding the complications associated with surgery. Technological advances in minimally invasive surgery, interventional imagenological, new drugs and a better understanding of tumor biology of leiomyoma’s have replaced the traditional treatment hysterectomy. The uterine leiomyoma’s commonly found in women of reproductive age, which most do not require treatment because of their kindness and only when it interferes with their quality of life should be treated individually.
Keywords: leiomyoma’s, genetics, reproduction, pregnancy,magneticresonanceimaging, ultrasound, laparoscopy, hysteroscopy, myomectomy, hysterectomy, minimalinvasionsurgery, hormone therapy, embolization.
Title: Study Comparing Ramosetron, Granisetron and Ondansetron in Laparoscopic Surgeries Under General Anaesthesia
Authors: G. Harinath, Chandrasekhar Vemula, Radharamana Murthy
Backgound: Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications after anaesthesia and surgery.
Aim: Compare the antiemetic efficacy of intravenous Ramosetron, Granisetron and Ondansetron for prophylaxis of post operative nausea and vomiting after laparoscopic surgeries under General Anesthesia.
Methodology: It is a prospective study include 50 patients undergoing laproscopic surgery under general anesthesia. Study is done for a period of 6 months. Patients were randomly divided into three groups, Group-A received Ondansetron 8mg, Group-B received Granisetron 3 mg and Group-C received Ramosetron 0.3mg Results: However, there were no significant differences in the incidence of nausea and vomiting, severity of nausea, and required rescue PONV between the groups in first 24 hours. Between 24-48 hrs the incidence of nausea and vomiting is significantly(p value=0.05) less in Group C compared to group-A. Ramosetron is giving longer protection against PONV up to 48 hours.
Conclusion: Study therefore concludes that prophylactic therapy with Ramosetron is more effective than with Ondansetron and Granisetron for the long term prevention of PONV after laparoscopic surgeries under general anaesthesia.
Keywords: Ondansetron, Granisetron, Ramosetron, General anesthesia
Title: A Clinical Study of Complications of Intraocular Lens Implantation
Authors: Koppolu Sreedhar Reddy*, Venkata Prasanna.D.P
Objective: Main objective is to study of complications encountered with cataract extraction with IOL implantation .
Methodology: This study was on 1500 patients selected in random aged more than 40 years who underwent extracapsular cataract extraction with posterior chamber intraocular lens implantation and followed up for a period of 6 months.
Results: Incidence of Cataract was more in the age group of 40-60 years and males were predominant (64%). Senile mature cataract was the main indication for surgery. Common complication intraoperatively is posterior capsular rupture of 4.13%, most common intermediate post operative complication is straite keratitis of 51.33% and late post operative complication after cataract pseudoplakic bullous of 13.66% is observed. . Visual acuity in patients was poor with counting fingers in 76% before surgery, After follow up of 6 months patients visual acuity of 6/6 is seen in 33.6 % of operated cases.
Conclusion: Complications of PC IOL implantation can be minimized by better microsurgical techniques, magnification and the experience of operating surgeon.
Keywords: Extracapsular cataract extraction, Posterior chamber intraocular lens, Complications.
Title: Study of Prevalence of Obesity and Hypertension in Adolescent School Children and Risk Factors Associated
Authors: Kalyani Srinivas*, G.Preeti, MD Arif Ahmed
Aim: To study prevalence of obesity and its association with hypertension and risk factors associated with them in adolescents school children.
Materials and methods: Its is a Cross-sectional study carried out over a period from June 2012 to July 2013 conducted among adolescent school children belonging to the age group of 12 to 16 years of both genders.
Results: In our study, over all obesity showed a prevalence of 4.5%per 100 children. On the whole, prevalence of overweight and obesity was 13.3%. Adolescent hypertension showed a prevalence of 11.9 per 100 children. Hypertension was not significantly more in private schools compared to government schools. Hypertension is more common in overweight and obese children, Also risk factors like use of extra salt, TV watching, physical activity are associated with obesity and HTN.
Conclusion: Prevention and early treatment of obesity could go a long way in preventing the development of type-2 DM and CAD/strokes in later life.
Keywords: Adolescents, Obesity, Overweight, Hypertension.
Title: Correlation between HDL-C and Nitric Oxide in Normal Healthy Population
Authors: Ratna Priya, Uday Kumar, Anand Saran, Rekha Kumari
Prevention of coronary artery disease (CAD) and reduction of its mortality and morbidity remains a major public health challenge throughout the world. Nitric oxide (NO) plays a pivotal role in CAD (coronary artery diseases).This study was undertaken to show the correlation between HDL& NO in normal healthy population since decreased NO bioavailability is a key feature of all classic risk factors for Atherosclerosis. A cross sectional study was done with sample size 60. In this study it was found that lower Nitric oxide is significantly associated with higher level of HDL with P<0.001. We conclude that constantly low HDL-C concentration is related with endothelial dysfunction and increased oxidative stress in healthy young men, consistent with the idea that HDL particles may protect endothelium and inhibit the oxidation of LDL. These findings may offer insight into increased atherosclerosis associated with low HDL-C levels.
Key Words- Nitric oxide, HDL-C, Atherosclerosis.
Title: Aerobic Bacterial Isolates From Neonatal Septicaemia
Authors: Dr Ravindranath Gangane, Dr. Aditi Garg, Dr. Asharani S
224 clinically diagnosed neonatal septicaemia cases were studied between June 2013 and May 2014. Blood samples subjected to aerobic culture by standard techniques showed growth from 150 cases (66.69%). Predominant isolate was Staphylococcus aureus (41.33%), followed by Klebsiella pneumonia (34%) and Escherichia coli (12.66%). Enterococcus (5.33%), Pseudomonas aeruginosa (1.33%), Streptococcus pyogenes (2.33%), Micrococcus (0.66%), Proteus mirabilis (0.66%) and Listeria monocytogenes (0.66%). High degree of susceptibility to chloramphenicol, tetracycline, gentamycin and ciprofloxacin was seen. The study revealed that there is change in spectrum of infecting organisms in different places at different times. Hence antibiotic testing becomes mandatory in the treatment of neonatal septicaemia.
Keywords – neonatal septicaemia , aerobic bacterial isolates.
Title: Fetomaternal Outcome in Pregnancy with Eclampsia in Tertiary Care Hospital
Author: Dr. Pravinkumar Jadav
Objective - To assess the maternal morbidity and mortality and fetal outcome with eclampsia in pregnancy.
Study Design – Cross sectional study.
Place and Duration of Study – Emergency Department of Obstetrics and Gynecology, VS Hospital, july 2010 to june 2012.
Methodology - 300 patient with eclampsia in pregnancy presented at gynaec emergency department were studied in regard with clinical manifestations, timing, management and fetomaternal outcome.
Result – Over all incidence of eclampsia was 2.8 % with maximum number of emergency cases (85%) among which 78% patients were from low socio economic class. Maximum number of patients belonged to <=25 years (74%) of age group with 68% primigravida. Antepartum, intrapartum and postpartum eclampsia cases were 75%, 14% and 11% respectively. 156 patients had normal vaginal delivery and 144 had undergone cesarean section. Most of the patients responded well to magnesium sulphate therapy and a few required other anticonvulsant therapy. Perinatal mortality rate was 30% and neonatal mortality rate was 9%. Maternal mortality rate 6% due to lack of essential obstetric care, low socio economic status, delayed hospitalization.
Conclusion - Eclampsia is a multisystem disorder of complex origin with high maternal and fetal morbidity and mortality. Proper antenatal care, early diagnosis of preeclampsia, proper management and selective termination will improve maternal and perinatal outcome.
Key Words – Eclampsia, Maternal morbidity, Maternal mortality, Perinatal outcome.
Title: Electrophysiological Assessment of Somatic Nerves of Upper Limbs in Diabetics: A Motor Nerve Conduction study
Authors: Neelam B Prasad, Indu K Pisharody, S A Diwanji
Assessment of motor functions of somatic nerves of upper limb was carried out in diabetics by nerve conduction studies (NCS). Diabetic neuropathy is one of the major causes of morbidity and disability in the diabetic patients. Early detection is needed to prevent further complications from diabetic neuropathy. The median and ulnar motor nerves were chosen for the study. Conduction study was carried out on 100 male type 2 diabetic patients and 100 healthy male volunteers who served as control. Distal latency, Amplitude and Conduction Velocity of nerves were measured by using computerized EMG/ NCV/EP Mark II and surface electrodes. On comparing the parameters of NCS it was found that distal latency of both the nerves was more in diabetics than controls with statistically significant difference. The amplitude was significantly decreased in diabetics except right ulnar nerve. The conduction velocities of nerves of both sides in diabetics were also found to be decreased which was statistically significant.
Keywords-. Type 2 diabetes mellitus, peripheral neuropathy, median nerve, ulnar nerve, distal latency, conduction velocity
Title: Knowledge on Road Traffic Rules among Adolescence Boys in Salem
Author: Mrs. T. Puvana M.sc [N]
A descriptive cross sectional study was undertaken among adolescent boys of first, second year B.Sc., and GNM Nursing Students of Vinayaka Mission’s Annapoorana College and School of Nursing, Salem to assess the knowledge of adolescent boys on Road Traffic Rules. It can be concluded that from the present study adolescent boys had average knowledge regarding Road Traffic Rules.
Title: Ice Pack Application on the Level of Pain in Episiotomy Wound
Author: Mrs. S. Parimala M.sc [N]
True experimental design with Quantitative approach was used to assess the effectiveness of ice pack application on the level of pain in episiotomy wound among postnatal mothers reveals that the ice pack application was very effective in reduction of pain in episiotomy wound among postnatal mothers.
Title: An Estimation of Hospital Based Incidence of Neonatal Hyperbilirubinemia in Term Newborns and Associated Risk Factors in a North Indian Setting
Authors: Dr. Anil Kumar, Dr Mohd. Parvez, Dr Nasir Ansari, Dr Swatantra Kumar, Dr Pooja Kanodia
Objective:To estimate the incidence of neonatal hyperbilirubinemia in newborns and associated risk factors.
Study design: Prospective cross-sectional study.
Study site: Department of Pediatrics, Integral Institute of Medical Sciences, Lucknow, UP.
Study subjects:244 healthy full-term newborns with gestational age ≥37 and ≤42 weeks with birth weight of ≥2.5 kgs born in this hospital.
Results:Male-134 (54.9%) and female-110 (45.1%)] were included in the study. Mean birth weight was 2.76 (±0.16) kg. Nearly half (48.8%) of the newborns had ABORh B+. The neonatal hyperbilirubinemia was observed in 56 (23%) newborns. The incidence was higher in males (28.4%) than in females (16.4%). The incidence of neonatal hyperbilirubinemia was significantly higher in those newborns whose mother’s gestational age was <38 weeks (62.5%) as compared to those whose gestational age was >=38 weeks (17%) and this was statistically significant (p=0.0001). The presence of anemia in mothers was significantly associated with the neonatal hyperbilirubinemia. The risk was higher in those neonates who had history of hyperbilirubinemia in sibling.
Conclusions: Health care providers working with neonates play a key role in identifying and assessing neonates at risk for pathologic jaundice. Parents counseling is required for bringing their babies early to prevent acute bilirubrubin encephalopathy and subsequent kernicterus.
Key words:Incidence, Full-term newborns, Neonatal hyperbilirubinemia, risk factors.
Title: Post Operative Infection in Surgical Wards and Factors Influencing the Infection Rate in Tertiary Care Hospital
Authors: Dr. Basawaraj S. Patil, Dr. Asharani S, Dr. Aditi Garg, Dr. Sharanabasava
A prospective study of 1428 surgical wounds was conducted. All the wounds were examined for presence of infection and those with infection were studied bacteriologic ally. The overall infection rate is 4% (58). Klebsiellapneumoniae was commonest (36%) followed by staphylococcus aureus (24%), Escherichia coli (13.5%), Enterococcus (10%), pseudomonas aeruginosa (8.5%) and proteus mirabilis (6.5%). The two most important factors that influence the incidence of wound infection are surgical technique and the nature of the wound.
Keyword: Surgical wound, postoperative wound infection
Title: Comparative Study of Self-Perceived Subjective Evaluation of Physical, Emotional, Functional Aspect of Swallowing in Subject with Post Cerebrovascular Accident with and Without Dysphagia
Authors: Mr. Shivraj Bhimte, Mr. R Rangasayee
The incidence rates are reported to be between 29-67% in acute stroke patients. People post stroke with dysphagia are more likely to be anxious and depressed due to inability to eat. Early identification and detection through screening is an essential first step in the management to dysphagia. There are objective and subjective evaluation procedure for assessment of dysphagia. Subjective assessment tool can give an idea about how the patient perceives his/her swallowing problem and can be helpful in monitoring the patient’s prognosis. There can be discrepancy between health care perception and patient own perception of difficulty and severity. There are very limited Indian published research studies considering large number of Hindi speaking population. Therefore current study to develop tool which can measurephysical, emotional, functional aspect of swallowing.25 item questionnaire (8 emotional, 8 physical, 9 functional) was developed and translated into Hindi language. For intra test, test –retest reliability of test tool obtained .Eight subjects with CVA & dysphagia 5 males and 3 females with mean age of 51.8 years (range 45-62 years).The other research group consisted of 8 subject 4 females and 4 males with mean age of 52.44 years (range, 45-61 years). For comparing the means score of both the research group t tail was used. There high reliability was seen in both the test situation. Dysphagia group shown statistical significant high score i.e. they face significant difficulty in terms of physical, emotional, function aspect.
Key Word: Dysphagia, Non – dysphagia, CVA, Hindi, questionnaire (emotional, functional, physical aspect)
Title: Rhinosporidiosis of Penile Shaft: A Rare Case Report
Authors: Dr Abhilasha Sharma, Dr Namita Goyal, Dr Sunita Bhargava
Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi (earlier described as a fungus, now reclassified in its own class Mesomycetozoea). India and Sri Lanka are the endemic regions for rhinosporidiosis due to temperate climate and widespread custom of bathing in pond water. .
Nose and nasopharynx are involved in most (74.6%) of the cases, followed by eyes (19%). Lesions of rare sites have been reported such as bone, vagina, vulva, oropharynx, buccal mucosa, tongue, paranasal sinuses, skin and subcutaneous tissue, urethra, trachea, larynx and bronchus. Here we present a rare case report of rhinosporiodiosis of penile shaft.
Keywords- Rhinosporidiosis, penile shaft
Title: Clinical Study and Management of Parotid Tumours and Complications
Authors: P. Mallikarjun*,Vinay Sagar Cheeti, Kiran Uske
Background: The major salivary glands include the parotid glands. Parotid gland tumours account for 80% of all salivary gland neoplasms, of these, approximately 75- 80% are benign.
Materials and methods: In present retrospective study, data were evaluated referring to 42 patients who underwent parotidectomy surgery for a period of 1 year at our Institution.
Results: The peak incidence occurred in the 40 – 50 years age group. Benign tumors constituted 64.3% and malignant tumours 35.7%. The commonest benign tumor was pleomorphic adenoma and the commonest malignant tumor was mucoepidermoid carcinoma. Pain less slow growth is common feature. Surgery is the treatment of choice in all tumors of the parotid gland. Temporary facial paralysis was seen in 40.47% of patients in our study.
Conclusion: Surgery of the superficial parotid gland if performed carefully causes minimal complications.
Key words: Parotid gland tumours, Pleomorphic adenoma, Parotidectomy.
Title: To Study Awareness Level of Dysphagia and Role of Speech Language Pathologist in Dysphagia Assessment and Management among Nurses
Authors: Mr. Shivraj Bhimte, Mr. R Rangasayee
Over the years nearly every SLP department in the hospital across India has experienced a condition that poor referral from the medical professional for dysphagia management. This could be due to lack awareness among specialist and non specialist staff. Although it is widely recognized that dysphagia is a common consequence of stroke and neurological insult, it is also associated with a variety of other conditions Myasthenia gravis, ALS etc. The perception among healthcare professionals such as nurses that feeding and swallowing problems are primarily related to stroke could result in them being missed in patients who have other conditions. Objective: The objective of the present study is to find out level of awareness among nurses regarding role of speech and language pathologists in assessment and management of dysphagia and sign & symptom of dysphagia. Methods: non-experimental, descriptive survey research design was used for the purpose of this research. Purposive convenient sampling technique was used for data collection. Nurses were selected on the basis of inclusion criteria i.e. they should be having work experience more than 2 years. Nurses are working in ICU, neurological and medical wards included in sample. The total sample size was 81 nurses out of which were 76 female and 5 were male. Measures used in the study were demographic data sheet and a self-developed questionnaire.22 items questionnaire was developed in which cover swallowing assessment and management procedure done by SLP. The questionnaire was validated by 5 speech therapists who were working in hospital set up. The questions were closed ended having 1 target response with 3 distracters. Results: t tail was done for hypothesis testing. Data were analyzed using SPSS 16 (Statistical Package for the Social Sciences). Findings indicate lack of awareness in all four aspect of questionnaire (i.e. 5 items for assessment 5 items for management, 6 items for role of SLP, 6 items for general sign of dysphagia). Conclusion: Research study concluded that nurses lack of awareness about dysphagia and its sign. Nurses are not aware of role speech and language pathologist in diagnosis and management of dysphagia. Research recommends that medical hospital with otolaryngologist, neurologist and SLP should conduct camp or conferences for nurses in the area of swallowing assessment and management protocol. Hospital should make them as active member and their role should be defined for interdisciplinary team approach.
Keywords: Dysphagia, Swallowing Difficulties, Nurses, SLP, assessment and management of dysphagia.
Title: Construction and Validation of Hindi Naming Test for Person with Naming Disorder
Authors: Mr. Shivraj Bhimte, Mr. R Rangasayee
Naming ability is skill which we developed throughout our life. It need to process in different level in human mind such as short term memory, long term memory. Angular gyrus structure of brain situated place in the brain identified by mainly researcher that play significant role in person naming ability. 80% population of CVA survives after stroke; suffer with aphasia which is very high across the world. In India, we have 32 languages which are registered and mainly used for official purpose. India nearly 5 million people are using Hindi language as official or day to day communication purpose. State like Uttar Pradesh, Bihar, Rajasthan, Uttarakhand, Jharkhand Madhya Pradesh Hindi speaking population is very high in number. Considering large number of Hindi speaking population and naming skill is one of important ability which speech language communication disorder need to evaluate regularly. There is severe dearth in this area therefore current research study taken up for to construct and validate test battery for assessing naming ability. Currently we mainly relay on English test which are not suitable for our Indian population because of culture, language difference. 254 Hindi speaking control subjects were recruited for study. In this control group 36 subject were illiterate not who didn’t had any form of schooling. For experimental group consisted of 23 subjects with anomic aphasia with mean age of 46.4 years. Hindi naming test were constructed with five subsection each section as specific scoring criteria. Literate and illiterate normative value of naming test calculated .test – retest and intra tester high reliability was obtained by person correlation test. All test items were validated by Hindi speaking experienced speech therapist. This naming test has several advantages such as it is easy to administered, easy scoring, age specific norm and quick test. Test consisted items which are picturable arranged systematically from simple to most difficult words. These test findings are reliable and valid .Therefore we recommend that this naming ability test can be used in daily clinical practice to check the naming ability in Hindi of aphasic population.
Key word: Aphasia, Naming ability, Reliability & validity, anomic aphasia
Title: Plasmodium vivax Detected on Anophles punctulatus Using ELISA : A Vector Confirmation Study in Tamraw District, A Remote Area With High Incidence of Malaria, West Papua Province-Indonesia
Authors: Hana Krismawati*, Antonius Oktavian, Semuel Sandy, Jan Lewier
Background: Tamraw District is a new administrative district of West Papua Province with high incidence rate of malaria. The aim of the study was to detect Plasmodiumsp in Anophelessp using ELISA assay in Tamraw District.
Material and Methods: Mosquitoes sample collection was caried out using human landing collection method in Anopheles sp active period (18.00-06.00). The identification of species was done in situ, immediately after collection. The sandwich ELISA for detection P.falcifarum and P.vivax sporozoit was carried out.
Result: The total Anopheles punctulatus groups collected in this study were 179, consist of An. farauti (15%), An.koliensis (7%) and An.punctulatus (78%). The active period peak of Anopheles punctulatus group was on 19.00-20.00 in indoor area. The ELISA result shows that Plasmodium vivax was detected on of Anopheles punctulatus samples with the sporozoit index 3,27%.
Conclusion: Base on sporozoit detection using ELISA, Anopheles punctulatus in Tamraw District West Papua confirmed as a malaria vector.
Keywords: Plasmodium vivax, ELISA, malaria, Anopheles punctulatus
Title: The Trends of Progesterone Hormone in Advancing Pregnancy of Human Immunodeficiency Virus-infected Women: A Cohort Study in Western Kenya
Authors: Stanslaus K. Musyoki*, Kiprotich Chelimo, Simeon K. Mining, Collins Ouma
Despite many studies on Human Immunodeficiency Virus (HIV) and pregnancy, there is still insufficient information regarding the effect of HIV on progesterone in advancing pregnancy. In a prospective cohort study, 44 antiretroviral therapy naïve adult asymptomatic HIV-infected pregnant women and 44 healthy HIV-non-infected pregnant women matched by age, parity, CD4 count and gestational time were recruited in western Kenya to test for the trends of progesterone hormone levels in advancing pregnancy of HIV-infected and non-infected women. Blood sample from all study participants was collected, and progesterone hormone levels determined using Enzyme Linked Immunosorbent Assay method at first (baseline), second and third trimesters. The changes of progesterone were assessed using repeated measures regression models and presented alongside the graphical exploratory graph. Significance levels were tested at P≤0.05. The progesterone hormone levels of the HIV-negative, 26.7 ng/ml. (95% CI: 15.5-35.9) were significantly (P=0.033) higher than those of the HIV-positive, 21.7 ng/ml (95% CI: 915.8-29.9) participants at baseline. In addition, the difference of progesterone hormone levels between HIV-positive and HIV-negative participants continued to increase significantly from first (difference of -4.3(95% CI: -8.2, -0.5) ng/ml, P=0.028), second (difference of -6.6(95% CI: -10.3, -3.0) ng/ml P=0.001) and third (difference of -11.6 (95% CI: -17.2, -6.1) ng/ml, P=0.0001) trimesters. Present study findings suggest that HIV infection may lead to lower progesterone hormone levels in all trimesters of HIV infected pregnant women compared to HIV-non-infected pregnant women. The study recommend more research should be encouraged to give a clear understanding of the effect of HIV on the hormonal balances among the pregnant women for any possible effects on the outcome of pregnancy and development of strategies to manage pregnancy in HIV infection.
Keywords: HIV Infection, Pregnancy, Progesterone, Trimesters
Stanslaus K. Musyoki
School of Health Sciences, Kisii University, P.O Box 408-40200, Kisii, Kenya
Department of Biomedical Science and Technology, Maseno University, Private Bag, Maseno, Kenya
Title: Electrophysiological Changes in Uncontrolled Type-2 Diabetic People with Peripheral Neuropathy
Authors: Dr.Subbarao Goteti*, Dr.Eswara Lakshmi, Mrudula Kambhampati
Introduction:Diabetes mellitus the incidence of which is very high in our nation and presenting as a serious health problem. Some of its serious complications are retinopathy, neuropathy, nephropathy and vascular problems. Among these peripheral neuropathy is reaching 60-70% of the diabetic population especially if it is uncontrolled and of longer duration. Majority of cases of neuropathy can be delayed with judicious control of hyperglycemia and early diagnosis of neuropathy. Nerve conduction studies are of great help in the diagnosis and treatment of neuropathy.
Materials And Methods: After the judicious elimination of possible other types of neuropathies, the study group consists of 30 subjects with uncontrolled diabetes mellitus type -2 between the age groups of 40-55yrs, of both sexes. Study period is from June 2014 to June 2015.All the cases are from an endocrinology center present in Visakhapatnam. All these patients were subjected to electrophysiological studies in the neurophysiolology laboratory at Visakhapatnam. Instrument used is Neuro Perfect. The nerves selected for the study are:
· Motor- median nerve, ulnar nerve in the upper limb, lateral poplitial and posterior tibial in lower limb.
· Sensory- median nerve, ulnar nerve in upper limb and sural nerve in the lower limb.
Motor Changes: The distal latencies are increased in ulnar of the upper limb and lateral popliteal in the lower limb. Amplitude is decreased in ulnar and posterior tibial nerves. Slowing of (NCV) was prominent in all the cases.”F” wave was normal.
Sensory Changes: The Amplitude was extremely low in the sural nerve. Amplitude and NCV were moderately decreased in median and ulnar nerves.
Conclusion: In our study diabetic neuropathy most commonly manifests as symmetrical peripheral polyneuropathy, the most common manifestation being symmetrical sensory loss in the distal lower extremities and motor deficits. Upper extremity involvement is less common progressing in the duration of the disease.
Key Words: Diabetes type 2, Diabetic neuropathy, distal latency, NCV,”F” wave, Amplitude
Title: Domestic Violence Against Women: Reason For Stay
Authors: Shukla Jyoti, Singh Neetu
Domestic violence affects the lives of many women across the world. Violence against women has been clearly defined as a form of inequity innumerous documents. there are various risk factor for domestic violence present in the society but One of the main cause why domestic violence prevails and continues is the lack of alternatives among the victims. Women and children may be economically dependent on abusers. Elderly people and children may feel too powerless to escape. Language or cultural barriers may isolate victims from seeking help. Victims generally feel, it is better to suffer in silence than to be separated from loved ones. They keep hoping for improvement, but it is normally observed that, without help, violence gets worse. Victims may also feel helpless, guilty or worthless. They may feel ashamed of the poor quality of the relationship. Abusers may fear the consequences of seeking help, unaware that continuing as before may be even more dangerous. Family members may be unaware of the help that is available from the local agencies. They may also be unaware of their legal rights.
Material and method:-A community based study was conducted in Luck now city. 300 women of 15-49 years age group residing in the community were selected by stratified random sampling. A pre design and pre-tested questionnaire was used to assess the effect of domestic violence women health
Result:-finding raveled that above fifty percent of the respondent were not staying in abusive relationship.
Conclusion:- result safely concluded that there are many reasons which Hassled women to stay in abusive condition in which economical reason is upper most.
Key words-domestic violence, abusive relation ship
Department of Human Development & Family Studies, School for Home Sciences
Babasaheb Bhimrao Ambedkar University, Lucknow-226025 Uttar Pradesh, India
Title: Mild Cognitive Impairment- A Conceptual Study
Authors: Dr. Madhavi P.Mahajan, Dr. A.V.Joshi, Dr. Mahendra P.Warhade
Ageing means growing old, maturing, progressive changes related to the passage of time. .Memory complaints are ubiquitous in our aging population. Mild cognitive impairment (MCI) is considered by many as an intermediary stage for dementia. Many older adults fear that today’s forgetfulness will usher in tomorrow’s dementia. It is characterized by deterioration of memory, attention, and cognitive function that is beyond what is expected based on age and educational level. MCI does not interfere significantly with individuals’ daily activities. It may act as a transitional level of evolving dementia with a range of conversion of 10%–15% per year. The preventive interventions and appropriate treatments should improve cognitive performance, and retard or prevent progressive deficits. The avoidance of toxins, reduction of stress, prevention of somatic diseases, implementation of mental and physical exercises, as well as the use of dietary compounds like antioxidants and supplements can be protective against MCI. There is no exact cure for MCI and dementia. This is an effort to help to find better ways for prevention and treatment of cognitive impairment worldwide.
Keywords: AD, Alzheimer’s disease, cognition, dementia, MCI
Dr. Madhavi P.Mahajan
B.A.M.S.,M.D.,Ph.D.(Scholar), Associate Professor Kayachikitsa Department Bharati Vidyapeeth Deemed University College and Hospital of Ayurveda, Katraj- Dhankawadi, Pune
Title: Metachronous Keratinising Squamous Cell Carcinoma of Skin After Adenocarcinoma of Descending Colon
Authors: Anoop Handa, Mohit Singla, Nirmal Singh
Colorectal carcinoma is the most common malignancy of the GI tract, its development involving interplay between genetic and environmental influences. With advances in diagnostic techniques and treatment modalities, the number of patients identified with colorectal carcinoma who develop multiple primary malignancies during long-term follow up has been increasing. Metachronous appearance of keratinizing squamous cell carcinoma skin at an unusual location in the same patient is quite rare. This occurrence of two different unrelated carcinomas at 14 months interval is a rare presentation.
Keywords: Adenocarcinoma, Squamous cell carcinoma, metachronous.
Title: Study of Day Care Surgery in a Private Charitable Hospital
Authors: Rochana G. Bakhshi, Surekha S. Patil
Introduction: History of ‘Day Care’ or ‘Ambulatory Surgery’ is as old as medicine itself. In the present century, with the better understanding of healing process, increase in surgical skills and availability of anaesthetic drugs has led to the development of Day Care Surgery or Ambulatory Surgeries into an art in itself.
Aim: To Assess the feasibility, cost benefit and factors for strengthening the potentials of Day Care Surgery in a private charitable hospital.
Materials & Methods: This was a prospective comparative study carried over a period of 1 month involving patients between 18 years-65 years of age with ASA Grade I or II. A total of 40 patients were selected and divided into 2 groups, Group A (Patients undergoing day care surgery) and Group B (Patients not undergoing day care surgery). Group A patients were admitted on the day of surgery and discharged on the same day evening. Group B patients were discharged on Day 3 or after suture removal, depending upon their condition and social status. Patients in both the groups were analyzed with respect to wound infection, duration of stay in ward, approximate cost incurred and post-operative pain.. Post operative analgesia was also administered. All the patients were followed up for 15 days postoperatively.
Results:In Group A, there were 15 males and 5 females while in group B there were 14 males and 6 female patients. Both the groups were comparable in terms of age and operative procedures carried. Both groups had 1 complication each. Average Hospital cost was Rs 300/ patient in Group A whereas it was Rs 1185/patient in Group B.
Conclusion: Day care surgery is possible in Private charitable Hospital with a dedicated day care surgery unit and it definitely decreases the expenses, hence cost effective.
Keywords: Ambulatory surgery, Private hospital.
Dr. Rochana G. Bakhshi
M.B.B.S.; D.A.; D.N.B; M.N.A.M.S, Professor, Department of Anaesthesiology, Padmashree Dr.D.Y.Patil Medical college & Hospital, Navi Mumbai. 400706
Plot-61, Sector-7, Koper-Khairane, New Mumbai-400709, Maharashtra, India
Title: The Antibacterial Action of Moringa Olelfera on Some Wound and Enteric Pathogens
Authors: Opara, A.U., Anyanwu, G., Uloneme, G.C
The antibacterial action of aqueous and ethanol extracts of fresh and dried leaves and seeds of Moringa Oleifera against staphylococcus aureus, streptococcus pyogenes, Escherichia coli, pseudomonas aeruginosa and salmonella typhi isolated from wound infection sites and gastrointestinal tract was evaluated using Agar-gel diffusion by punch method. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MCB) of the extracts were also evaluated. Results obtained showed that dried moringa seed ethanol extract manifested the best inhibitory zones ranging from 10-38mm compared with the 14-20mm produced by fresh Moringa Oleifera seed ethanol extract. There was no resistance from any of the test bacteria at the concentration of 500m/ml. It was also observed that both the aqueous and the ethanol extract of Moringa Oleifera exhibited appreciable level of inhibition against the test bacteria though the aqueous extracts were not as effective as the ethanolic extracts.
Keywords: Pathogen, Wound, Infection, Bacteria, Moringa Oleifera
Title: Isolated Medial Rectus Palsy as a Presentation of Midbrain Infarct
Authors: Dr. Suprabhat Giri, Dr. Namita Mohanty Dr. Shashi Bhusan Sutar
Isolated ocular muscle palsy involving lateral rectus and superior oblique is very common due to individual nerve supply but isolated palsy of the remaining four ocular muscles is a very rare condition and most of the recorded cases are either due to midbrain infarct or local pathological causes. A 60 years female presenting with diplopia on left lateral gaze without any other neurological abnormality was diagnosed as isolated medial rectus palsy due to incomplete involvement of oculomotor nucleus by DWI imaging and fully recovered after treatment with antihypertensive and statin.
Dr Suprabhat Giri
Department of General Medicine, MKCG Medical College and Hospital
Room no. 19, PG Hostel 2, MKCG medical Campus, Berhampur-760004 Odisha, India
Title: Crush Smear Cytology: A Rapid Diagnostic Technique in the Intraoperative Diagnosis of CNS Tumours
Authors: Dr Sarat Das, Dr Rajesh Kr Barooah, Dr Ahmed Ali, Dr Shamim Ahmed
Cytology has been shown to be of great value in intraoperative consultations of central nervous system (CNS) pathology. Intraoperative smear cytology provides a rapid and reliable intraoperative diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. It also helps the surgeon to monitor and modify the approach at surgery. The current study was undertaken to assess the utility of intraoperative crush smear cytology and to correlate with the final histopathological diagnosis along with brief description of the cytomorphological features of commonly found brain tumours in smear preparation. It included 110 cases of CNS neoplasm which were subjected to intraoperative smear cytology. Smears were prepared from the biopsy samples sent in wet cotton pad and stained by the Haematoxylin and Eosin stain. The cytomorphological features were noted and correlated with final histopathological diagnosis. Complete correlation between intraoperative cytological and histopathological diagnosis was achieved in 89.6% of the cases. A reduction of diagnostic accuracy was seen in oligodendrogliomas and mixed gliomas (22.2%). Smear technique is a fairly accurate, relatively safe, rapid, simple, easily reproducible, and cost effective tool to diagnose brain tumours.
Keywords: Crush smear cytology; CNS tumours; intraoperative diagnosis; HPE.
Title: Red Blood Cells Morphological Changes as a Prognostic Tool for Organophosphorus Toxicity Patients
Authors: Dr. O.P.Moorjani, Dr. Amar Gangwani
Aims & Objectives- Identify and exclude the misinterpretation of peripheral blood smears examination. Identify organophosphorus induced RBC & WBC morphological changes used as a prognostic tool. Identify the organophosphorus induced peripheral blood cells changes.
Material & Methods:Blood was collected in a sterile EDTA containing tube and processed following our established laboratory protocol. A complete blood counting including HB%, PCV, Red cell indices, platelet count and total white cell count and differential was done by Automated blood cell counter with peripheral blood smear examination and further confirmed by manual oil immersion smear study method. Peripheral smears study was done with field A and B stain and leishman stain.
Conclusion-organophosphorus can cause changes on peripheral blood cell due to lipid peroxydation and oxidative stress of cell membrane. RBC shows various types changes theses may be used as a prognostic tool for severity of toxicity, monitoring of patients and follow-up and exclude the various misinterpretation of peripheral blood smear examination like hemolytic anemia and liver disease.
Keyword- Creanated RBC, Organophosphorus
Title: Sleep Quality among Elderly Residing at Selected Old Age Home at Chennai
Authors: Mrs. Lisy Joseph, M.Sc (N), Dr. T.V.Ramakrishnan, MD (Anaesthesiology), Mrs. S. Nalini, M.Sc(N)
Surviving to old age is a remarkable attainment. Basic life requirements like adequate nutrition, rest, sleep and safety needs to come across to attain a healthy aging process. All human beings need to be away from routine activity and stimulation to renew them in the form of sleep. Nearly one-third of our life-time is spent sleeping and resting. The present study aims to determine the sleep quality among elderly residing at selected old age home with 50 samples. The results revealed an overall poor quality of sleep among the residents of old age home. Sleep is a mirror which rates our state of health and well-being, hence appropriate cost-effective measures should be taken to improve the sleep quality among elderly.
Keywords: Sleep, Elderly, Old age home
Title: Holmium Laser for Retrieval of Knotted Catheter- A Series of two Unique Cases
Authors: Dr Amit Kolekar, Dr Juned Shaikh, Dr Kaveri Pai, Dr Huma Shaikh
Catheter knotting, though rare, various techniques have been described for retrieval with significant morbidities such as general anesthesia, radiation exposure during fluoroscopy and hematuria. Thisreport demonstrates knotting in 2 unique cases, with a novel idea for retrieval using holmium laser. First case represents an unusual complication of CISC in which a knot formed during the procedure, with Ryle’s tube. Other represents knotting of household tube inserted for gratification, both being large size tubes with severe entanglement. This paper aims to apprise readers of this use of holmium laser, and help reduce morbidity in such cases.
Title: Acupuncture as Additional Therapy for Modulation of Intraocular Pressure in Patient with Open Angle Glaucoma
Authors: Zizi Mohammed Ibrahim Ali, Siham Mohamed Fahmy
Objective:Primary open–angle glaucoma (POAG) is the most common type of glaucoma. It is usually insidious in onset, slowly progressive and painless. It is generally bilateral and often asymmetrical. Because the central vision is relatively unaffected until late of the disease, visual loss generally progresses without symptoms1. Therefore this study was necessary to face this problem by applying the recommended additional therapy form to reduce IOP and improve visual field SO this study aimed to evaluate the therapeutic efficacy of acupuncture therapy in managing primary open angle glaucoma
Methods:This study dealt with the eye as a separate subject. Fifty one eyes with primary open angle glaucoma treated for at least 3 months with standard topical antiglaucoma medications with high IOP, their intra ocular pressure (20 -45mmHg) were enrolled in this randomized clinical trial. Those eyes were classified randomly into 2 groups. Therapeutic intervention was started after at least 3 months of standard medical treatment. Patients were randomized to either group: Group (A) Acupuncture with medical treatment and Group (B) Control medical treatment only group. Intra ocular pressure IOP; measured by Goldman Tonometry; for the two study group was performed at The pretreatment and post 6 sessions (2 weeks), 12 sessions (4 weeks), 18 sessions (6 weeks), 24 sessions (8 weeks and end of acupuncture treatment), three months, four months, five months and six months. The study was conducted in Kobri El-Koba Military Hospital from June-2012 to Mars-2014.
Results:showed significant improvement in the study group compared to control group regarding the IOP.
Conclusion:Acupuncture therapy decreased IOP and stabilized visual field with stopping apoptosis of optic nerves for eyes with primary open angle glaucoma.
Keywords: Acupuncture; Glaucoma; intraocular pressure; Ocular perfusion pressure; Primary open angle glaucoma.
Title: Effectiveness of Assertiveness Training on Self-Esteem and Assertive Behavior among Adolescents at a Selected School
Authors: Nicholas S, Neelakshi G, Nalini.S
Aim: The aim of the study was to assess the effectiveness of assertiveness training on self-esteem and assertive behavior among adolescents at a selected school.
Background: Adolescence is a transitional stage of physical and psychological human development that generally occurs during the period from puberty to adulthood. Low self-esteem during adolescence may be expressed in the form of maladaptive behavior, body language and kind of approach to life. So they may tend to lose valuable social opportunities, where they can grow and learn newer experiences.
Design used: Pre experimental one group pretest and posttest design.
Methodology:The study was conducted at St. Annai Theresa Higher Secondary School, Iyyapanthangal, who fulfilled the inclusion criteria. Using convenient sampling technique, 60 samples were selected.
Findings: There was no statistically significant association between the level of self-esteem and assertive behavior with their demographic variables such as age, gender, family income, place of residence, academic performance and number of siblings at p>0.05 in the posttest.
Conclusion: Thus the study concludes that Assertiveness training will help to improve self-esteem and assertive behavior among adolescents.. .
Keywords:Assertiveness training, Self-esteem, Assertive behavior, Adolescents.
Title: Study on Awareness of TB, HIV and STD among Young Adults in Colleges of Pondicherry
Authors: K N Prasad, Kalaimani V, Ineyakumaran S D, Ilayaperumal G, Jayaprakash R, Hudson Samuel E
Introduction: Awareness and knowledge on highly prevalent communicable diseases in the population is important for early diagnosis, treatment and their prevention. The knowledge on Tuberculosis (TB), Human Immunodeficiency Virus infections (HIV) and Sexually Transmitted Diseases (STD) are important among young adults in India.
Aims and Objectives: To find the awareness and knowledge on cause, spread, treatment facility and social stigma about TB, HIV or AIDS and STD among young adults in colleges of Puducherry.
Materials and Methods: A Cross-sectional and descriptive study was carried out in the month of June 2015 in Puducherry among young adults in different colleges having arts, science, engineering, veterinary sciences, graduation and post graduation courses. Data was collected using pre tested semi open ended questionnaire by direct interviewing the subjects in their college premises after getting the consent.
Results: Total of 600 young adults (390 males and 210 females) were the subjects from various educational backgrounds. The overall awareness about disease, aetiology, spread, free treatment, treatment duration, complaints and social stigma for TB was 94, 72, 40, 77, 22, 75 and 72 percent respectively. Similarly they were 96,66,70,69,19,42 and 71 percent for HIV, and 40,22,22,29,1,5,and 46 percent for STDs. The overall awareness and knowledge is not adequate irrespective of their educational backgrounds. Smoking and alcohol consumption was prevalent among 20 and 26 percent of male subjects.
Conclusion: The overall TB, HIV and STD awareness is inadequate among young adults. It is necessary to improve awareness at periodic intervals by lectures and group discussions.
Key words: TB, HIV, STD, Awareness, Knowledge, College Students, Puducherry
Title: Trans Nasal Butorphanol for Post Operative Analgesia in Lower Abdominal Laparoscopic Surgeries
Authors: Abhimanyu Singh*, G. Kiran Kumar
Background:Postoperative pain is acute with complex physiological responses to tissue injury. Trans nasal Butorphanol has been found to provide better pain relief and also decreased incidence of postoperative complications.
Aim: This study was done to know onset, duration, quality of analgesia, cardio-respiratory effects and side effects of Transnasal butorphanol for the relief of postoperative pain in lower abdominal laparoscopic surgery
Methods A total of 60 patients of females, belonging to 20-60 yrs of age, ASA grade I and II admitted for lower abdominal laparoscopic surgeries were selected randomly for the study. Patients were divided into 2 groups as 30 each Group A- Butorphanol 1mg nasal spray, Group B- normal saline nasal spray was used as the study drugs for the relief of postoperative pain.Onset of analgesia, Duration of analgesia, Quality of analgesia, Level of consciousness, Cardio-respiratory effects, Side effects were recorded.
Results: In our study the mean time of onset of analgesia in Butorphanol group (group-A) was 11.3±2.25 (SD) min and the duration of action of analgesia was 4.86±1.02 (SD) hrs which are statistically significant, Quality of Analgesia (VAS) was good, with majority of the patients grading their pain relief as excellent. Sedation score was maximum at 30 mins after administration later there was gradual decrease in sedation score due decrease in analgesic action of Butorphanol. Incidence of side effects like nausea and vomiting were also negligible. No significant respiratory depression was seen in either group.
Conclusion: Transnasal Butorphanol spray is a safe and efficacious drug for post-operative analgesia. It provides a rapid, excellent but shorter duration of analgesia. It has mild sedation which is advantageous in the postoperative period.
Key words: Transnasal, Butorphanol, Laparoscopic Surgeries
Title: Role of αB Crystallin on Serum Amyloid A Fibrils with Systemic Amyloidotic Mice Liver
Authors: Asokan C* and Musthapha I
AlphaB-Crystallin is one of the heat shock proteins and its Chaperonic activity is well established. alphaB-Crystallin forms complexes with denaturing proteins thereby preventing their uncontrolled aggregation. Chaperonine process has been shown to follow a saturation type of complexing, when the ability of the available alphaB-Crystallin to bind the target protein is exceeded, the excess target protein aggregates and eventually precipitates out of solution. The effect of alphaB-Crystallin on SAA fibril formation under systemic amyloidodsis in the liver, we have determined they interact with each other. In the present study, in-vitro and in-vivo studies on the role of the interaction of SAA/SAA fibrils with chaperones were investigated by congo red stain, immune fluorescence and radio labeling methods. The results indicated that there was SAA deposits in liver, increases the SAA level in the liver and the alphaB-Crystallin could liver SAA level comes near to control. In conclusion that the implication of SAA in the liver. The significance in-vivo study has shown aB-Crystallin as a therapeutic use for SAA amyloid disease.
Key words: Serum Amyloid A, Systemic amyloidosis, Crystallin, Chaperonine, Aggregate, Amyloid Fibril.
Title: Rural-Urban and Gender Differences in Risk Factors for Acute Coronary Syndrome
Authors: Nikhil Govil, Sanjeev Kumar, Savita Kapila, Govind Sharma
An emic approach in the identification of risk factors for Acute Coronary Syndrome (ACS) is important as their relative importance may vary between genders and across different backgrounds. The current study was undertaken with the aim to determine the rural –urban and gender difference among these risk factors, if any. It was a cross sectional study conducted on 100 patients of ACS aged above 40 years. The selected participants were interviewed using a pre-designed questionnaire which included socio-demographic factors, behavioural / life –style factors, significant past and family history and self-reported conditions that are risk factors for ACS. The male to female ratio of 1.08 in the study indicated rising trends of ACS in women. Female patients (mean age 62.65 ± 11.93) were significantly older than their male counterparts (mean age 56.38 ±11.68). Hypertension (44%) was the most common risk factor followed by hypercholesterolemia (37%), while obesity was the least common risk factor (11%).Compared with male patients females had greater prevalence of hypertension, diabetes, low HDL-C and central obesity. Males outnumbered females only for smoking as risk factor. There was no significant urban –rural difference in the prevalence of any of the risk factors. The current study brings out that Coronary artery disease is no longer a disease limited to men or urban population. Since most of the risk factors for ACS are modifiable, therefore early identification is vital to set the strategy for prevention.
Key words:Acute Coronary Syndrome, Coronary Artery Disease, risk factors, gender, background
Title: A Rare Case of Brunneroma Presenting as Gastric Perforation with Review of Literature
Authors: Divya Rabindranath, Rana K Sherwani, Kafil Akhtar, Murad Ahmad, Azka Anees Khan, Shehtaj Khan, Senthil P
INTRODUCTION: Brunner`s gland adenomas are rare benign tumors usually located in the bulb of the duodenum. Very rarely, heterotopic Brunner`s gland tissue tumors have also been reported at remote locations from the duodenum, eg. pylorus, pancreas and jejunum.
CASE: We report a case of Brunneroma in a patient presenting with a prepyloric perforation with no mass lesion seen on surgery. The diagnosis was established on histopathological examination of the perforation margins.
DISCUSSION: Brunneromas are usually asymptomatic. If symptomatic, they commonly present with features of obstruction or GI bleeding. Grossly, they are usually seen as 1-2 cm pedunculated polyps; however, cases of giant Brunneromas have also been reported. To our knowledge, this is the first reported case of a Brunneroma presenting with a perforation located in the prepyloric region, and with no mass lesion identified on surgery.
KEYWORDS: Brunneroma, perforation, rare, prepyloric.
Title: Changing Trends of HIV Infection in Children Attending a Tertiary Care Hospital of Karnataka in Last Five Years
Authors: Dr Mariraj Jeer, Dr Sumaira Qayoom Beigh, Dr Rashmi MS, Dr Krishna S
Children of today are the youth of tomorrow.HIV affects this very precious generation and bear grave consequences to our future, our nation, the continent and the world at large. Inspite of being largely preventable, paediatric HIV still continues to be a growing challenge in India with an estimated 100,000 infected women giving births to about 30,000 infected infants every year. A five year retrospective study was done, which included 1492 children aged between 1-15 years who attended our tertiary care hospital from January 2010 to December 2014.HIV was confirmed in all the patients according to the NACO guidelines and the same were followed up for CD4 count testing and looked for clinically evident opportunistic infections. A significant decline in the HIV positivity rate was noted among children attending ICTC after year 2010,this trend reflects the steady expansion of services to prevent transmission of HIV to children and an increase in access to treatment for children. Opportunistic infections are the most common cause of death among HIV patients, therefore early recognition of the same will go a long way in reducing mortality associated with HIV in children.
Keywords: HIV (Human Immunodeficiency Virus),AIDS (acquired Immunodeficiency Syndrome), children, trends, prevention.
Title: Swelling of the Parotid - A Rare Case Report of Undisclosed Aetiology
Authors: Sridevi Vijayasankar, Meera Balakrishnan, Vijayalakshmi Chetlur Srinivasan
Prominent lymphoid component which occur in various lesions of salivary glands represent heterogeneous group of diseases that include both benign reactive lesions and malignant neoplasms. Occasionally, these lesions cause difficulties in the clinical and pathological diagnosis. To assess their prognosis is also difficult. Human immunodeficiency virus infection associated lymphadenitis of the salivary glands (HIVLSG), benign lymphoepithelial lesion and cysts are described as early events in HIV patients. The diagnosis is not usually made by clinical examination as it mimics a salivary gland tumor. We are presenting a rare pathological finding in the salivary gland of an individual who was diagnosed to have HIV infection. She was clinically diagnosed to have a salivary gland tumor which was cytologically diagnosed to be benign lymphoepithelial lesion.
Keywords: Parotid gland, HIV-associated salivary gland disease, Lymphoepithelial sialadenitis, Benign lymphoepithelial lesion and cyst.
Dr. Sridevi Vijayasankar MD (Pathology)
Assistant Professor, Dept of Pathology, Sri Muthukumaran Medical College Hospital & Research Institute, Affliated to Tamilnadu Dr. MGR Medical University, Guindy Campus, Chennai-600069, Tamil Nadu
194(New:48), First Street, F-Block, Anna Nagar East, Chennai:600102, Tamil Nadu, India
Title: Malignant Fibrous Histiocytoma With Giant Cell: A Cytological, Histopathological and Immunohistochemical Study of A Rare Differential
Authors: M.A. Muzaffar, Anju Singh, Amod Kumar, Mona Lisa, Subhash Chandra Jha, Shahab Raza
Malignant Fibrous histiocytoma (MFH) is now diagnosis of exclusion, comprising <5% of adult soft tissue malignant lesion. MFH predominantly is originating from extremities and retroperitoneum. Uncommon presentation can be in chest wall, bone, spermatic cord and other organs. Actually it represents >5% of adult soft tissue sarcoma. As other malignant soft tissue tumour; histologically mimics MFH, hence immunohistochemistry (IHC) is needed for final diagnosis. The IHC findings revealed strong positive staining for CD68 and negative staining for SMA, CD34. The patient was managed by wide margin surgery followed by radiotherapy. He was disease free when followed up for a year. Although MFH of the chest wall is rare, however it must be considered as a differential diagnosis of chest wall tumours.
Keywords: Malignant fibrous histiocytoma, immunohistochemistry, soft tissue sarcoma, chest wall
Title: Role of Helicobacter Pylori Infection in the Pathogenesis of Minimal Hepatic Encephalopathy and Effect of its Eradication
Authors: Perihan El Sayed Salem, Fathalla Seidkey Mohamed, Dalia Abd El Moaty El Niely, Tamer Mohamed Yousri Balbaa
Background and purpose Minimal hepatic encephalopathy (MHE) is the mildest form in the spectrum of hepatic encephalopathy (HE); it has no recognizable clinical symptoms but mild cognitive and psychomotor deficits. Neuropsychometric testing is an established methodology for quantifying cognitive impairment in MHE. Ammonia is important in the pathogenesis of MHE and H. pylori are known to produce copious amounts of ammonia, thus, it may contribute to the development of MHE in the presence of liver cirrhosis. The study aimed to detect the prevalence of H. pylori infection in cirrhotic patients with and without MHE and to establish the correlation between the presence of H. pylori infection and blood ammonia level and the results of neuropsychometric tests in these cases. Moreover, to investigate the effect of H. pylori eradication on different measured parameters.
Material and Methods 80 patients with HCV related liver cirrhosis were included in the study; patients were divided according to the presence or absence of MHE and H. pylori infection into 4 subgroups. Full history taking, routine laboratory investigations, fasting blood ammonia level and detection of H. pylori antigen in stool were done to all studied patients. Also, neuropsychometric tests were performed for diagnosis of MHE.
Results and Conclusion H. pylori infection is common among cirrhotic Egyptian patients and its role in the pathogenesis of MHE and ammonia production was proved. Screening of cirrhotic patients for detection and eradication of H. pylori is beneficial in the improvement and cure of MHE for better quality of life.
Keywords Liver cirrhosis, Minimal hepatic encephalopathy, H. pylori infection, serum ammonia level, Neuropsychometric tests, H. pylori eradication.
Title: Prevalence of Metabolic Syndrome in Type 2 Diabetes Mellitus Patientsin Tertiary care Hospital of Rohelkhand of U.P (Bareilly)
Authors: Mowar AB, Varshney Amit, Sood Tanvi, Nigam P
The present study was carried out to find out the prevalence of metabolic syndrome (MetS) in tertiary care hospital of Rohelkhand of U.P.
Materiel and Methods: A total of 200 type 2 diabetes patients (85 men and 115 women) presenting to department of medicine were selected for the study. Anthropometric (waist circumference), clinical (blood pressure) and biochemical (serum triglycerides, HDL, fasting and post-prandial blood glucose) data were recorded. Patients receiving treatment for hypertension or dyslipidemia were also included in the study and these were considered in the diagnosis of MetS even if the parameters were normal. The National Cholesterol Education Program Adult Treatment Panel III guidelines were used to diagnose MetS. The chi-square test was used to determine statistical significance, which was taken as a p value <0.05.
Results: The prevalence of MetS among urban Indian diabetic patients was 73.5% and was significantly higher in women (61.2%) as compared to men (38.8%). The most prevalent risk factors for MetS were hypertension, followed by hypertriglyceridemia, in men, and low HDL, followed by high waist circumference, in women.
Conclusions: MetS is highly prevalent in the diabetic population. More females than males had the MetS. Uncontrolled diabetes and abdominal obesity were prevalent. It should be identified by regular screening in individuals from the general population to avert or delay the progression to type 2 diabetes in order to reduce diabetes-related morbidity and mortality.
Keywords: Metabolic syndrome; Type 2 diabetes mellitus
Title: Apical Loculated Pleural Effusion: An Interesting Case
Authors: Dr Swapnil Kulkarni, Dr Kapil Iyer, Dr Mahesh Jansari
Pleural effusion is defined as the presence of fluid in the pleural cavity. It has various causes- ranging from tuberculosis, bacterial empyema to congestive cardiac failure. The workup of such patients as a rule always begins with a good history, clinical examination combined with aspiration of the fluid and doing a detailed cytochemical analysis. Rarely some patients might present with loculated forms of pleural effusion which adds on to their diagnostic dilemma. We present a case of an apical loculated pleural effusion having a very interesting etiology.
Keywords: Pleural effusion, loculated, Computed tomography, adenosine deaminase (ADA)
Title: Retrograde Urethrography In Urethral Stricture – Is It Still Relevant
Authors: Dr. N.L.N. Moorthy, Dr. V.Sudhakar, Dr. N. Anil Kumar, Dr. D.Mahesh Chander
Urethral stricture is one of the most frequent health problems affecting the adult population causing repeated urinary tract symptoms. Strictures can be following trauma or infection. Retrograde urethrography is considered as the gold standard for evaluation of stricture urethra. Voiding cystourethrography and Sonourethrography helps in improving the imaging of urethral diseases. In the present study we present the profile of radiological features in 478 cases of stricture urethra based on retrograde urethrography with clinical correlation.
Key Words: Urethral stricture, Retrogradeurethrography, Trauma
Title: Bacteriological Profile and C Reactive Protein Level of Neonatal Septicemia
Authors: Dr. B. Subitha*, Dr. B. Senthil Selvan
Neonatal Sepsis is a life threatening emergency, and any delay in the treatment may cause death. Because of the importance of this problem, the objective of the present study was to determine the etiological agents and C Reactive protein level of neonatal septicemia. Two seventy three consecutive neonates with risk factors and clinical features suggestive of sepsis were selected as per operational definition and fulfilling the inclusion and exclusion criteria. Detailed physical examination was carried out. Blood samples for culture and CRP were taken from all the patients. Results of blood culture and CRP were noted down in the Performa. Culture positivity rate was 33%. Comparing with culture positivity, sensitivity of CRP was 67% and specificity was 60% in diagnosis of neonatal septicemia. Gram negative organisms constituted 64% of the total bacterial isolates. Klebsiella pneumoniae(40%) was the most common organism in early and late onset septicemia. This was followed by Staphylococcus aureus (19%), CONS (13%), Escherichia coli (10%), Enterobacter spp (7%), Pseudomonas aeuriginosa (5%), Aceinetobacter (2%) and streptococci (2%). Escherichia coli and streptococci were more prevalent in early onset septicemia than late onset septicemia. Single CRP level measured at the onset of infection lacks sufficient sensitivity to be useful in identifying neonate with septicemia. To reduce neonatal mortality due to infections, we must expand the research activities on diagnosis, etiology, and optimal management of neonatal sepsis at all levels of the healthcare system
Keywords: Neonatal Sepsis, C reactive protein, blood culture.
Title: Gigantomastia: A Rare Complication In Pregnancy
Authors: M. Naik, R K Diwakar, Sangita Patre, Subhi Singh
Gigantomastia is a very rare condition that complicates about one of every 28,000-100,000 pregnancies (1). Only 100 cases have been reported in the literature. Gigantomastia occurs at puberty (virginal hyperplasia) or during pregnancy (gravidic gigantomastia) (2). It is characterized by massive enlargement of breasts, resulting in per breast weights of 4-6 kilograms. The diagnosis of gigantomastia is based on clinical findings. Pathologic and radiologic studies are not required if no associated disorder is present. Treatment is based on bromocriptine administration, but surgical intervention (reduction mammoplasty or simple mastectomy with posterior reconstruction is required if the disorder progresses.(1).
Keywords: Gravidic gigantomastia, Massive hypertrophy of breast, gestational gigantomastia, virginal hyperplasia, Gestational macromastia,
Title: Sodium Glucose Co-Transporter 2 (SGLT-2) Inhibitors: A Review
Authors: Alok Dixit*, Pinki Pandey, Rakesh Chandra Verma
Worldwide, the number of individuals with diabetes is projected to rise from 366 million in 2011 to 552 million by end of 2030. Despite therapeutic advances, the incidence and prevalence of diabetes continues to surge exacting a tremendous economic burden on countries. The major problem with diabetes is that just 50% of population is able to achieve target glycaemic control with available medications. Type 2 diabetes nearly doubles the risk of cardiovascular and macro vascular complications. Meeting the treatment goal is elusive for many patients. Sodium glucose co-transporter 2 (SGLT2) inhibitors are new class of antidiabetic drug with insulin-independent mechanism of action. The remarkable advantage of these drugs is to increase urinary glucose excretion without inducing hypoglycaemia and promoting body weight loss. This review focuses on physiology underlying the use of SGLT2 inhibitors, their mechanism of action and clinical pharmacology.
Keywords: Sodium glucose co-transporter 2 inhibitors, Anti-diabetic drugs, Dapagliflozin, Canagliflozin, Empagliflozin.
Title: Status of Some Hematological and Antioxidant Parameters in SCA Patients of Chhattishgarh Region
Authors: Vikas K. Gupta, Neelima Singh, S.W. Masram, S.K.B. Patil
In India, haemoglobinopathies, especially sickle hemoglobin are the commonest genetic disorders in the tribal belt of Central and Southern India. Madhya Pradesh and Chhattisgarh harbours the largest tribal population in India, which is about one fourth of the total tribal population of the country. The prevalence of sickle haemoglobin from various parts of Madhya Pradesh and Chhattisgarh varied from 15 to 30 percent. The study was carried out in Chhattisgarh Institute of Medical Sciences, Bilaspur (C.G.). Since the Eastern region of central India is prone to Sickle Cell Anemia. Hence samples preferably collected from this area. The study was conducted on 120 human subjects. out of which 40 were suffering from Sickle cell disease , 40 were Sickle Cell Trait and 40 were taken as control group. Hematological parameter & antioxidants parameters were estimated. Hb, RBC, decreased significantly ( P<0.001) while HCT (P<0.05) in Group III and in Group II also decreased significantly (P<0.05) while there is no significant change were found in the level of MCV in both group as compare to control. The level of antioxidants significant (P<0.001) decrease except SOD in group II as compare to controls. In group III the level of antioxidant decreased significantly ( P<0.05) except SOD as compare to control. In subjects with homozygous sickle cell anemia, level of Plasma Malondialdehyde (MDA) were significantly (P<0.001) increased as compare to controls. Thus our study shows elevated plasma MDA and depleted antioxidant vitamins indicate oxidative stress in SCD. Therefore supplementation with antioxidants vitamin may ameliorate some of the sickle cell symptoms and improve quality of life.
Title: Benign, Multicentric, Recurrent and Metastasizing Giant Cell Tumor of Bone: Review of Literature with Role of Immunohistochemistry in Determining Prognosis
Authors: Anshu Jain, Divya Rabindranath, Veena Maheshwari, Azka Anees Khan, Senthil P, Vivek Jain
Objective: Giant cell tumor (GCT) represents around 4-5% of all primary bone tumors. The purpose of this article is to report this unusual case of benign metastasizing GCT and simultaneously emphasize on the role of immunomarkers in predicting the aggressive behaviour of such lesions and a brief review of literature along with the proposed management strategies in these patients.
Case: We report a rare case of benign GCT in a 24 years old Asian female. Initial presentation of the disease was 9 years back with involvement of lower end of right humerus; development of a multicentric lesion in right 4th metacarpal 2 years after the humerus lesion, and elbow tumor recurrence after 6 years. In all instances en-block tumor resection with bone grafting was performed. Now, the patient presented to us with recurrent tumor at both sites; radiological types 2&3 lesions, local lymphatic involvement and metastatic nodules in bilateral upper pulmonary lobes. Right shoulder disarticulation with biopsy of pulmonary metastases was performed. Histopathology revealed a benign GCT morphology. Immunohistochemistry for Ki67 showed higher expression, while p53 showed negative staining.
Conclusion: GCT is still one of the most obscure and intensively examined tumors of bone. Histology does not predict the clinical outcome & few studies have been performed to identify new markers predictive of aggressive behaviour. A relationship between increased proliferative rate (higher Ki67 expression) and possibility of recurrence has been found. Few pilot studies have demonstrated correlation of p53 mutation with local recurrence and malignant transformation.
Keywords: GCT, multicentric, recurrence, metastases, Ki67, p53.
Title: Psychiatric Morbidity among Chronic Low Backache Patients- A Cross Sectional Study
Authors: Lakshmi Narayana Reddy I, Chinta Kumar, Mamuduru P Srikrishna, Bhaskar Singamsetty
BACKGROUND: Low backache (LBA) is one of the most common human afflictions, which leads to seek medical advice. LBA markedly reduce the quality of life of the sufferers and affect all aspects of their lives. The present study aims to compare personality profile; sense of subjective well being is likely to throw light on the planning of effective intervention strategies to enable these individuals to lead a better life. To this purpose we have evaluated the psychosocial estimates of low backache (LBA) and its impact of on employment, social performance, and comfort.
METHODS: The cross-sectional study was conducted in 100 low backache (LBA) patients visiting ACSR Hospital, a tertiary care center between January 2015 and May 2015. Each patient was assessed by Mini International Neuropsychiatric Interview (MINI), Version 6, a brief structured diagnostic interview for DSM-IV Axis I psychiatric disorders to weigh-up psychiatric morbidity.
RESULTS: A total of 100 LBA patients participated in the study. The mean duration of low backache was 3.4±0.7 years. Majority of the patient population belongs to low socio-economic status 72 (72%) ; 77% (77) of the individuals were married; 57% (57) were diagnosed with major depressive disorder and 5% (5) with depression disorders and Melancholia, 15% (15) with Dysthymia, 4% (4) with suicidal ideas, 22% (22) were with panic disorder, 7% (7) with OCD, and 70% (70) with GAD.
CONCLUSION: Depression and Generalized Anxiety Disorder (GAD) are by far the predominant psychiatric morbidity in this population.
KEYWORDS: Low backache (LBA), Psychosocial factors, Depression, MINI-6, Panic disorders.
The JMSCR is accepting manuscripts for its coming issues to be Publish May 2018 the JMSCR invites authors to submit manuscripts Reporting original medical research, original article, research article, case report, systematic reviews, or educational Innovations for publication for the coming issues that will be released in May 2018. Types of manuscripts suitable for JMSCR include: Medical research, Clinical research Educational Innovation, Brief Report, Reviews on Teaching In keeping with high quality scholarship, Read More.....