Title: Inter-Spouse Communication and Agreement Regarding Reproductive Intentions and Contraception in Urban Bangalore, India
Authors: Hajira Saba.I, K.Kishore
Introduction: contraceptive practices are influenced by various factors and necessity for the actual practice of contraception to limit or to space births tries to relate inter-spouse communication with actual fertility.
Aim: To study the husband wife communication and contraception use among married women in urban Bangalore. Study Design: It is a community based cross-sectional study.
Study Area: Urban field Practice area of Dr. B.R. Ambedkar Medical College.
Study Population: Married women in the reproductive age group of 15-45 years.
Duration of the Study: December 2010 to December 2011.
Materials and Methods: 300 married women in the urban field practice area of Dr. B.R. Ambedkar Medical College were interviewed and examined using a pre-tested and semi-structured questionnaire after obtaining oral consent. Married women were interviewed with respect to the socio-demographic details and husband wife communication and agreement regarding contraceptive methods.
Results: 106(35.35%) were aged between 25-29 years of age.177 (59%) were Hindus, 106(35.3%) were Muslims and 17(5.7%) were Christians.215 (71.7%) were belonging to Nuclear families. 153(51.3%) had secondary level of education, 46(15.3%) were illiterates, 38(12.7%) were Degree holders.252(84%) of women were housewives and were belonging to Class III (lower middle) socio-economic status. Age at marriage in the study group for 192(64%) was between 18-23years of age and 177(59%) had duration of married life was ≤10 years. 110(36.66%) had two number of living children in the study and 172(57.36%) of women had desire for two children.
Conclusion: 176(58.6%) were currently using contraception. 126(71.59%) had undergone Tubectomy and none were found who had adopted Vasectomy 177(59%) who had children were belonging to Hindu Community. 44(25%) of current users had Secondary level of education and 180(60%) who had children were belonging to Class III socio-economic status and 82(46.59%) of current users who had children. 280 (93.4%) of husbands of study population had agreed for contraception and 20(6.6%) had disagreed.284 (94.4%) of husbands wanted same number of children as wife and 15(5%) wanted more number of children than wife. In the study group 291(97%) of women were involved in decision making for contraception usage.
Keywords: Inter-spouse communication, Agreement, Married women, urban area.
Title: A Prospective Study Of Blunt Abdominal Trauma In A Tertiary Care Center Of Northern India
Authors: Mumtazdin Wani, Muddassir Shahdhar, Shabir Ahmad Mir, Iqbal Rasool, Bilal Yousuf Mir, Hakim Adil Moheen
Background: The Present study was conducted in the background of increasing abdominal trauma throughout the world and the similar trend in Indian administrated Kashmir. Nowadays there is increasing trend towards the non-operative management for the blunt trauma of abdomen.
Introduction: Trauma, the most common cause of death for all individuals between the ages of 1 and 44 years, is the third most common cause of death regardless of age. Trauma is estimated to account for 11% of global burden of diseases as measured by the number of disability – adjusted life years experienced by the world's population
Aims: The aim of the study was to find out the magnitude and to assess various management options available in dealing with blunt abdominal trauma.
Methods: The present study, a prospective analytical one, was conducted in the department of general surgery at SMHS hospital (a tertiary care hospital in the heart of Srinagar City with bed strength of 700 beds) over a period of 17 months (from May 2012 to September 2013). A quota sample of 200 patients with blunt trauma abdomen who were admitted in this department both on routine and emergency basis were Randomly Selected For The Study.
Results: Blunt Abdominal Trauma were mainly due to Road Traffic Accidents (41%) followed by fall from heights (36%) and other causes accounted only for (23%) cases. The mean age of the patients was 23.7 years. 111 (55.5%) were managed conservatively requiring only observation and these were the patients with no intra abdominal injury, and 20 cases (10%) were managed non-operatively but with strict protocol. After emergency resuscitation, 69 patients were subjected to exploratory laparotomy.
Conclusion: In short proper history, repeated thorough clinical examination, high index of suspicion and the full utilization of preclinical investigative aids are of immense importance in the diagnosis of intra abdominal visceral injuries following blunt trauma abdomen. Emphasis is laid on the importance of carefully prearranged plan for emergency care, diagnosis, proper management of injured patients and on the value of well trained team for the care of patients with blunt abdominal trauma. It is increasingly incumbent on health care providers to ensure that treatments delivered to patients are the most efficient and effective possible. Majority of patients can be managed conservatively. All patients with injuries to solid organs of the abdomen and who are hemodynamically stable should be considered candidates for Non-operative management after their injuries have been staged by abdominal CT Scan but because the CT stage of the injury does not always predict which patients require laparotomy, these patients must remain under the care of experienced trauma surgeons who can not only recognize the presence of an associated hollow viscus injury in need of repair but also will be readily available to operate if the Non-operative approach fails. We believe, even in this initial effort to access outcomes that Non-operative management of solid viscus organs leads to favourable results.
Key Words: Blunt Trauma, Abdomen, Non Operative Management, Recustation.
Title: Pulmonary Function Tests and Diffusion Capacity in Type 2 Diabetes and Their Possible Correlation with Proteinuria
Authors: Jitendra Singh, Kamlesh K Gupta, D Himanshu, Anju Dinkar, Virendra Atam
Background-Type 2 diabetes mellitus is known to cause serious progressive macro and micro vascular complications leading to end organ damage like retinopathy, nephropathy and neuropathy. Pulmonary complications due to collagen and elastin changes as well as microangiopathy has also been demonstrated in type 2 diabetes mellitus but prevalence in most of population is unknown and its possible correlation with proteinuria is not studied more.
Aims And Objectives- To compare pulmonary function tests (PFT) and diffusion capacity for carbom monoxide (DLCO) in type 2 diabetes mellitus with control group and to evaluate possible correlation of PFTs and DLCO with proteinuria.
Methods-Consecutively consenting 120 subjects who satisfied the inclusion criteria were recruited over one year duration. These 120 subjects are categorised into two i.e. healthy volunteers recruited as controls (n=60) and type 2 diabetic patients (n=60).
Results- Both group compared and studied with each other. Diabetic patients showed a significant reduction in Forced expiratory volume in one second (FEV1), Forced vital capacity (FVC) and pulmonary diffusion capacity for carbon monoxide (DLCO) relative to their matched controls and these values were further reduced in patients with diabetic nephropathy.
Conclusions- Our study concludes that lung functions in type2 diabetes mellitus was impaired and there was restrictive pattern of respiratory abnormality. The mean reduction in FEV1, FVC and DLCO was more in diabetes as compared to their matched controls and these lung functions were further reduced in patient with diabetic nephropathy. Duration of diabetes did not influence on pulmonary functions.
Key Words: Diabetes mellitus, Pulmonary function Test, proteinuria, nephropathy, Microvascular Complications
Title: Poroid Hidradenoma: A Rare Tumor
Authors: Dr Hemant Chaudhari, Dr Chetan Rajput
Study present a case report of 36 years old male presented with 4x4 cm asymptomatic, non-tender gradually increasing swelling over left side of the chest wall since the last 5 months. Histopathology revealed a well demarcated, solid cystic lesion confined to the dermis, with no apparent connections to the epidermis. There are some cystic spaces filled with amorphous material. The tumor appeared to be made up of two types of cells; small and dark staining poroid cells, and large and paler cuticular cells; these findings were compatible with poroid hidradenoma, which is a benign dermal tumor.
Keywords: Benign, dermal Tumour,Poroid Hidradenoma.
Title: Variant Antigens Characterize Pathologic Immune Complexes in Severe Plasmodium falciparum Malaria
Authors: Erick K Mibei, Alloys S.S Orago, Jose A. Stoute, Francis M. Otieno
Introduction: Plasmodium falciparum infection is characterized by deadly complications such as severe malaria-associated anaemia (SMA) and cerebral malaria (CM). The exact mechanisms underlying pathogenesis of these severe forms of Plasmodium falciparum malaria are not fully understood yet they are associated with a lot of morbidity and mortality. Studies have shown a link between severe P. falciparum malaria and levels of circulating immune complexes (CIC) but the exact role of these CICs and the specific malarial antigens involved in the pathogenesis of severe P. falciparum malaria is still unclear.
Objectives: This study aimed to investigate the qualitative differences in P. falciparum antigens in serum immune complexes (ICs) between children with the severe forms of Plasmodium falciparum malaria and those with uncomplicated malaria. It was aimed at identifying and characterizing the predominant P. falciparum antigens that contribute to IC formation in these clinical groups.
Methods: ICs were purified using polyethylene glycol (PEG) precipitation and dissociated using an acidic buffer (Glycine-HCL pH 2.0). These were then electrophoresed on one-dimensional and two-dimensional polyacrylamide gel blotted by Western transfer and revealed using human hyperimmune sera.
Results: Six distinct P. falciparum antigens were found to be associated with severe malarial anaemia while another three antigens were associated with cerebral malaria when compared to their respective controls. An antigen with approximately 91 kDa was highly associated with SA (P < 0.01) while a slightly lighter antigen of about 87 kDa was significantly associated with CM (P < 0.01).
Conclusion: These findings may point to differences in qualitative characteristics of ICs in children with SMA and CM and give insight into potential mechanisms of the disease. The findings further suggest differing target of humoral immunity in the severe forms of malaria.
Keywords- Circulating immune complexes, Malaria, Pathogenesis, Anemia, Cerebral malaria
Title: Clinico-Serological profile of Acute Sporadic Viral Hepatitis in Kashimiri Adults: Hospital based Prospective Study
Authors: Nisar Ahmad Shah, Showkat A Kadla, Peerzada M Shafi, Ishrat H Dar, Irfan Ali, Samia Rasheed6, Faiz A Kuchay, Nazir Ahmad
Background: There is no report on Clinico-Serological Profile of Acute Viral Hepatitis from the State of J & K since the discovery of Hepatitis E and Hepatitis C.
Methods: A prospective hospital based study was conducted in a large referral hospital in Kashmir India. Fifty six patients with acute viral hepatitis were included in the study after fulfillment of already set diagnostic criteria. The various features studied included clinical presentation, etiology and outcome.
Results: Acute viral hepatitis was more common in males with MF ratio of 1.33:1. Forty (71.4%) belonged to rural and 16(28.57%) to urban areas. Most commonly involved age group was 14-20 years (25%) followed by 21-30 years (37%). Most commonly observed symptoms were Jaundice (82%), Anorexia (76.8%), and dark urine (73.2%). Only 7% patients had cholestatic features. Anictric hepatitis was present in 5.4% of patients. Hepatomegaly was observed in 68.8% and splenomegaly in 19.6%. Clinical and biochemical characteristics were not helpful in differentiating various types of Hepatotrophic viral hepatitis .Most common viral infections was Hepatitis E(50%), followed by Hepatitis B(26.7%), Hepatitis A(16%), Hepatitis C (3.5%) and dual infection of hepatitis A and E in(3.5%).
Conclusion: The common cause of acute viral hepatitis in our setup is Hepatitis E accounting for about 50% of cases. Anorexia and dark urine are major symptoms. Only 7% of patients had cholestasis and 5.4% patients had anicteric hepatitis. Acute viral hepatitis is an important public health problem in developing countries. Most cases are due to hepatitis E, and hepatitis A continues to be an important cause of acute viral hepatitis in developing countries even in adults. Clinical and biochemical characteristics were not helpful in differentiating different types of hepatotrophic viral hepatitis.
Key words: viral hepatitis, hepatitis E, hepatitis A, clinic-serological profile
Title: Evaluation of Thoraco Lumbar Fractures of Spine Managed with Pedicle Screw Fixation
Author: Krishnamurthy M.O, Sreenivasulu P.S.B, Bala krishna B, Mahaboob V.S
Background: The thoracolumbar junction is the most common area of injury to the spine. The forces through kyphotic stiff spine (thoracic) spine switch abruptly into the mobile lordotic lumbar spine at the thoracolumbar junction. Goals of treatment are to maintain the stability & balance of spine without pain along with good neurological function and maximum mobility of spine. This study evaluates the effectiveness of pedicle screw instrumentation in various fractures around the TL spine to overcome the complications encountered in the conservative line of management of these fractures.
Materials & Methodology: 20 cases of fractures around the TL spine were operated with posterior pedicle screw fixation one or two level above and below the fracture from November 2012 to March 2014. The cases were followed up for a mean of 7.5 months with radiological and neurological evaluation.
Results: The average age groups of the patients studied were 19 to 50 years majority were males, fall from height being the predominant mode of injury involving the T12 and L1 level. Commonest type of fractures are burst unstable fractures. The parameters like radiological sagittal angle & index were recorded before & after the surgery. The ASIA score is used for the grading of neurology condition. Follow-up was done for a minimum of 6 months where sagittal angle reduction achieved was 10.85° at final follow-up from 24.751 pre-operatives. The sagittal index achieved at final follow-up was 71.8% compared to the pre-operative mean of 50.6%. The neurological improvement was regarded to be fair enough for the type of injury sustained and fixation achieved.
Conclusion: After applying the posterior instrumentation resulted in a reasonable correction of the deformity with a significant reduction in recumbency associated complications; the limiting factor being the small study group and short follow-up period.
Keywords: thoracolumbar, pedicle screw and rod instrumentation.
Title: Complicated Amoebic Liver Abscess: Which is the Best Therapeutic Option?
Authors: Dr. Ketan Vagholkar, Dr. Urvashi Jain, Dr. Madhavan Iyengar
Amoebic liver abscess is one of the commonest infective lesions of liver in the developing world. The complications of amoebic liver abscess need to be diagnosed at an early stage. Closed aspiration, percutaneous and surgical drainage are the three therapeutic options for complicated lesions. A proper choice of the procedure is pivotal in reducing the morbidity and preventing mortality in complicated cases of amoebic liver abscess. The natural history of surgical complications and the various therapeutic options are discussed in this paper.
Key words: amoebic liver abscess complications treatment surgery
Title: Evaluation and Outcome of Management of Intracapsular Neck of Femur Fracture Treated With Cannulated Cancellous Screw Fixation
Authors: Krishnamurthy M.O, Sreenivasulu P.S.B,Srinivas Rao Puli, Aswin kumarP, Mahaboob V.S
Background: Fractures of neck of femur have always presented great challenges to the orthopeadic surgeons. In many ways today the unsolved fracture as far as treatment and results are concerned. Fractures of neck of femur are usually entirely intracapsular. Results depend upon the extent of injury and adequacy of reduction and fixation. Fixation with cannulated cancellous screws is usually adequate for femoral neck fractures. Lateral cortex plays a very important role in screw fixation
Materials and Methods: This study was conducted in Narayana Medical College and Hospital, Nellore, AP from Nov 2012 to Oct 2014.The patients with intracapsular fracture neck of femur are evaluated with pre-operative x-rays of the concerned hip joints both in arterio posterior and lateral views and their outcome post operatively after fixation with cancellous screws. The outcome is evaluated in terms of pain relief, extent of ambulation achieved after surgery. The classifications we followed are Pauwells and Gardens classification of fracture neck of femur. The patient will be followedup to oneyear to assess the functional outcome.
Results: A good result was obtained in 65.38% of the patients, excellent in 23.07%, fair in 3.84% and poor result in 7.69% of the patients. Complications such as Nonunion & avascular necrosis in one case, Non-union and Extrusion of screws in one case, cut through of screws into articular surface leading to painful joint in one case. Most of the cases of intracapsular neck of femur were in the age group of 31 — 40 years. There was male preponderance as shown in this study (69%).
Conclusion: By the usage of multiple cannulated cancellous lag screws, compression effect at the fracture site is achieved; it also avoids redisplacement and rotations. The implant occupies less volume in the small sized femoral necks of South Indian Patients allowing better osteosynthesis of intracapsular fracture neck of femur. Multiple cannulated cancellous screw fixations for intracapsular fracture neck of femur are an easy, safe & useful procedure with encouraging results.
Title: Juvenile Myelomonocytic Leukaemia in a Young Child– A Case Report
Authors: Dr Bhubaneswar Saikia, Dr Ivy Sharma, Dr Pakesh Baishya
Juvenile myelomonocytic leukaemia (JMML) is a unique paediatric disorders previously referred to as Juvenile Chronic Myeloid Leukemia. It is a clonal haematopoetic disorders of children that is characterized by proliferation principally of the granulocytic and monocytic lineage.
It is clinically aggressive and more similar in its course to acute myeloid leukemia.
We report a very rare case of JMML in a 8 year young child.
Keywords: JMML (Juvenile myelomonocytic leukemia),CMML (Chronic myelomonocytic leukemia), Neurofibromatosis, Philadelphia chromosome, Noonan syndrome
Title: Abdominal Manifestations of Dengue
Authors: Dr. Ketan Vagholkar, Dr. Jimmy Mirani, Dr. Urvashi Jain
Dengue fever has assumed epidemic proportions in urban India. The diverse presentations of this disease can confuse the internist. A wide range of abdominal symptoms closely mimicking an acute surgical abdomen necessitates the opinion of the gastroenterologist or a GI surgeon. Ignorance of the abdominal manifestations on the part of the GI surgeon could lead to un-indicated surgical interventions. Hence awareness of the pathophysiology of gastro intestinal manifestations of this disease can help prevent unindicated surgical procedures on critically ill patients.
Key words: Dengue Fever Abdominal Manifestations
Title: Mucocele of the Appendix
Authors: Dr. Ketan Vagholkar, Dr. Urvashi Jain, Dr. Abhishek Mahadik, Dr. Madhavan Iyengar
Mucocele is a rare entity of the appendix associated with either neoplastic or non-neoplastic mucinous lesions of the appendix. Understanding the pathology and natural history is essential for early diagnosis and prompt treatment. Surgery is the mainstay of treatment. However, the approach and extent of surgical intervention poses a technical challenge to the surgeon. The paper reviews the pathology, diagnosis and management of this condition.
Key words: mucocele, appendix, tumors, pseudomyxoma peritonei.
Title: The Bethesda System for Reporting Thyroid Cytopathology
Authors: Dr Dharmendra Kumar, Dr Gunja Dwivedi, Dr Sunita Bhargava
Background - FNAC has become the most prominent, and the easiest way, to morphologically evaluate lesions of the thyroid and may be the procedure of choice in the preoperative evaluation of thyroid nodules. In the past, ambiguous and inconsistent diagnostic criteria and terminology have hampered sample interpretation and patient management. The TBSRTC will have effect in transforming, unifying, and improving the reporting of thyroid FNA results
Aims – The aim of our study to evolve uniform reporting system for thyroid cytopathology, facilitate effective cytological & histological correlation, reduce the unnecessary surgical management of thyroid lesions, which can easily be treated medically.
Materials and Methods – FNAC was performed on two hundred patients diagnosed with thyroid lesion during a period of two years (2010-2012). The smears were prepared, stained by May-Grunewald-Giemsa stain and reported according to Bethesda system reporting of thyroid lesions. The cytological diagnosis was compared with histopathological diagnosis, wherever possible to find out the diagnostic accuracy.
Results - The statistical analysis in the present study revealed sensitivity of 95.24 percent, specificity of 78.72 percent, positive predictive value of 66.66 percent, negative predictive value of 97.37 percent and diagnostic accuracy of 83.82 percent. Sensitivity and specificity of pre-Bethesda reporting system was 75 percent and 97.95 percent respectively. Positive predictive value was 85.71 percent, negative predictive value was 95.92 percent and diagnostic accuracy was 94.64 percent.
Conclusion - After analyzing the results of the present study, it was concluded that the Bethesda System for Reporting Thyroid Cytopathology represents a reliable and valid reporting system for thyroid cytology.
Keywords – FNAC – Fine Needle Aspiration Cytology, TBSRTC – The Bethesda System Reporting of Thyroid Cytopathology.
Title: Laterally Displaced Flap – A Case Report
Authors: Balaji VR, Manikandan D, Lavanya V
Gingival recession may cause the patient to feel esthetic discomfort and dentin hypersensitivity. Obtaining predictable and esthetic root coverage has become an important goal of a periodontal surgeon. Even though there is lack of predictability and challenges with soft tissue grafting, an attempt was made to cover an isolated class II (Miller’s) defect with laterally displaced flap technique.
Keywords: recession, hypersensitivity, esthetics.
Title: A Clinico Radiological Study with Management and Outcome of Head Injury Patients in Bikaner
Authors: Dr. Dinesh Sodhi, Dr. Anand Nagar, Dr. Neelima Arora, Dr. Krishna Veer Singh Choudhary
Head injury is the leading cause of morbidity, mortality, disability and socioeconomic losses in India and other developing countries. This article indicates magnitude of the problem, causes, mode of injury, occurrence, risk factors, severity, outcome and impact of head injury on rapidly transforming societies. In India 1.5 to 2.0 million people sustain head injury and 1 million succumb to death every year. RTA are the leading cause (60%), followed by falls (20-25%) and violence (10%). Alcohol involvement and non use of helmet are known to be present in 15-20% of head injuries at the time of injury. The rehabilitation needs of the brain injured people are significantly high and increasing year to year.
Keyword: 1.RTA (Road Traffic Accidents),
2.EDH (Extra Dural Hematoma),
3. SDH (Sub Dural Hematoma),
4. ICH (Intra Cerebral Hematoma),
5. GCS (Glasgow Coma Scale),
6. GOS (Glasgow Outcome Score)
Title: A Deadly Combination of Acute Encephalitis and Gastric Hemorrhage in Dengue Fever: A Rare Case
Authors: Jitendra Singh, Anju Dinkar*, Virendra Atam, Ravi Misra, Saurabh Kumar
Dengue infection is known to present a spectrum of systemic complications ranging from general to atypical and self-limiting to fatal complications. It is caused by arvovirus and common in tropical and sub-tropical regions. We report a case of a 14-year-old, student who developed acute encephalitis followed by gastric hemorrhage. He was put on mechanical ventilation and managed conservatively. Unfortunately patient could not be saved despite our best effort.
Keywords: Dengue fever, Hemetemesis, Encephalitis, Aedes aegypti
Title: A Study of Dactylography and Cheiloscopy Patterns and their Relationship with ABO Blood Groups
Authors: Dr. Pranita R .Viveki, Dr. Kasturi B.Hunshikatti
Background: Establishing a person’s identity is a very important process in civil and criminal cases. Dental, fingerprint and DNA comparisons are probably the most common techniques allowing fast and secure identification processes. However, in certain circumstances related to the scene of the crime or due to lack of experienced personnel, these techniques might be unavailable; so there is still an increasing need for reliable alternative methods of establishing identity.
Aim: To study correlation between lip print pattern, finger print pattern and ABO blood group.
Materials and Methods: The study group consisted of 141 males and 105 females who were aged between 20–40 years. Lip prints, finger prints and ABO and Rh blood groups of each individual were recorded. Lip prints were classified, based on Suzuki’s and Tsuchihashi’s classification and finger prints were classified, based on Michael’s and Kucken’s classification. The results were statistically analyzed by using Chi–square test.
Results: Complete vertical lip print, loop finger print pattern, O+ blood group were predominant among individual groups. O+ blood group-type I lip print combination, loop finger print pattern-type IV lip print pattern combination, O+ blood group-loop finger print pattern combination and both B+ blood group-loop finger print pattern- type IV lip print pattern combination and O+ blood group-loop finger print pattern-type I lip print pattern were predominant.
Conclusion: Though lip prints, finger prints and blood groups had their own specificities, correlation of the three parameters did not show any significance.
Key words- Cheiloscopy, Blood groups, Dactylography, Personal identification
Title: A Comparative Study on Prevention of Hypotension after Spinal Anaesthesia in Hysterectomy Cases: Crystalloid (Ringer Lactate Solution) versus Colloid (Haestryl 6%).
Authors: Dr Jaya Dighe, Dr. Pallavi Dole
Background: Different strategies have been attempted to prevent spinal –induced hypotension. Prophylactic measures include pre-hydration with crystalloid or colloid or administration of vasoactie agents. Study compared two methods i.e. crystalloid & Colloid group for reducing hypotension during spinal anaesthesia in hysterectomy patients.
Method: Prospective randomized controlled study carried out at anaesthesia department during the period of six months. 60 patients scheduled for elective hysterectomy under spinal anaesthesia included for the study purpose. Cases were randomly divided into two groups i.e. Crystalloid group and colloid .Age, height and weight characteristic were comparable between two group. Mean pulse rate and SBP recorded at intervals. All data entered and analyzed.
Result: The incidence of hypotension was 12 out of 30 (40%) in the crystalloid i.e.RL group and 4 out of 30 (13.3%) in colloid group. Mean SBP with S.D. was 90.0mmhg +9.27 &104 mmhg +6.8 in crystalloid group and colloid group respectively.
Conclusion: The incidence of hypotension was significantly lower among the colloid group i.e.6% Haestryl as a preload for spinal induced anaesthesia. Hence colloid can be preferred preload solution in spinal anaesthesia.
Title: Informed Consent – A Moral Obligation
Authors: Dr Pankaj Singal, Dr Shweta Aggarwal
Informed consent is a vital legal tool for any practicing doctor, which not only acts as a tool to safeguard the doctor from legal implication but is also a moral obligation as this shows that the doctor is respecting the patients autonomy. A well informed and written informed consent is mandatory from the very first day the patient enters the clinic and should carry forward till the time the patient leaves the clinic after completion of his treatment. This present article helps us to understand the concept of informed consent in detail. It highlights the situations where the nature and form of consent can be modified keeping in mind the need of the hour. It also focuses on various types of consent and methods to help doctors improve their skills in obtaining a legally and ethically valid informed consent.
Key words: consent, patient autonomy,legal tool
Title: Long Term Results of Austin-Moore Prosthesis in Fracture Neck of Femur in Indian Context
Authors: Dr Amit Nandan Mishra, Dr Sandhya Mishra, Dr Shakeel Ahmad Qidwai
Background: In developing country like India operation and prosthesis need to be cost effective and efficacious to improve quality of life in post op period. Hemiarthroplasty with Austein-Moore prosthesis is most promising treatment modality in Indian context as per our study.
Objective:The aim of this study was to assess the outcome of hemi replacement arthroplasty in which whole of the head and variable part of neck of femur is being replaced by a metallic made prosthetic implant.
Methods: The present study comprised of 60 patients of age group 40-80 years in which 32 were males and 28 were females was conducted on patients who had undergone hemireplacement arthroplasty.
Results: More than half of the patients were between 60-69 years (53.4%). Males were 53.4%. It was observed that patients treated by hemireplacement arthroplasty were having very less or negligible amount of limb length discrepancy. Majority of the patients started walking without any aid after the treatment. Only 16.7% used single stick for walking. Most of the patient had range of movement more than critical range which permitted easy ambulation for daily routine. The Harris Hip score was good in 53.3% of the patients and excellent was in 36.7%. The fair Harris Hip score was in only10% of the patients. The radiological assessment showed that most of the patients had good results both functionally as well as radiologically.
Keywords:Prosthesis, Efficacious, Hemiarthoplasty, Neck femur
Title: Evaluation of Sperm DNA Fragmentation Index (DFI) for the Outcome of Assisted Reproductive Technique in Infertile Male
Authors: Sahini.C.K, G.Rajalakshmi, Sunil.G.Nayar
Background:The objective of this study was to determine whether there is any possible relationship between DFI with Assisted Reproductive Technique outcome and also with age and semen parameters.
Methods: This was a case study of limited number of patients .15 male infertile patients undergoing ICSI were included in the present study. SCSA and ART were performed on semen aliquots taken from the same ejaculate. Semen parameters (count & morphology), Fertilization rate, Embryo quality and Biochemical pregnancy rates were also correlated to SCSA (DFI) parameter. Statistical analysis was also performed using SPSS version.
Results:Significant difference was observed between the DFI of the subject and normality at a significant level of 1% (p= 0.000).The results showed no correlation between DFI and fertilization rates, biochemical pregnancy. But a weak correlation was observed between DFI and embryo quality and embryo quality with fertilization rate, biochemical pregnancy. For IUI, the DFI above 25% resulted in negative pregnancy. One ongoing pregnancy was achieved for ICSI with DFI levels 34.33%.
Conclusion: DFI can be used as an independent predictor of pregnancy in case of IUI. SCSA test can be considered as accessory to the standard semen analysis in infertile men. In ART, pregnancy loss and time spending can be avoided based on SCSA (DFI) and move on to ICSI for better result.
Keywords: Sperm Chromatin Structure Assay, DNA Fragmentation Index, Intra cytoplasmic Sperm Injection, Intra Uterine Insemination.
Title: Effect of Heavy Alcohol Consumption on Risk of Prostate Cancer among Middle Aged Men in Port Harcourt, Nigeria
Authors: Brown, Holy, Uzoefoh, Ebelechukwu Rosemary
Alcohol consumption is a modifiable lifestyle factor that may affect prostate cancer risk. Alcohol alters the hormonal milieu and contains chemical substances such as flavonoids (red wine), which may alter tumour cell growth. The aim of this study was to investigate the effect of alcohol on prostate-specific antigen (PSA) levels of middle-aged men and prostate cancer risk. A total of 45 male volunteers of 40 to 75 years of age participated in the study. All participants completed a questionnaire on life time alcohol consumption. Analysis was done on 20 samples of moderate alcohol consumers, 20 samples of heavy alcohol consumers and 5 samples of non-alcohol consumers which served as the control. The results were analyzed separately for alcohol consumers and non-alcohol consumers and it was significant. A significant increase in the serum level of prostate specific antigen was observed when heavy drinkers were compared with non-drinkers (P = 0.02) and also, when moderate drinkers were compared with non-drinkers (P = 0.01). There was a significant increase in the serum level of prostate specific antigen when moderate drinkers of 60yrs and above were compared with non-drinkers (P=0.02). No significant increase in the serum level of prostate specific antigen was observed when heavy drinkers were compared with moderate drinkers (p = 0.24). These results suggest that both moderate and heavy consumption of alcohol is a contributor to prostate cancer risk and that the risk increases with increase in age.
Keyword: Alcohol, Prostate, Cancers, PSA, Risk
Title: Pott’s Spondylodiscitis with Gibbus in a 5 Year Old Child – A Case Report
Authors: Dr. Farah Naaz, Dr. R.K.Gulati
A 5-year-old boy was referred to us with a 3-month history of swelling and pain on his back. On laboratory evaluation, he only had an elevated erythrocyte sedimentation rate. X-ray showed an extensive lytic lesion of the dorso lumbar spine. Chest roentgenogram was normal. The Mantuex skin test was negative. Histological examination of the biopsy tissue showed granuloma and caseating necrosis of tuberculosis. antituberculous chemotheraphy resulted in a good clinical outcome. A high index of suspicion therefore, is the key to timely diagnosis and treatment.
Keywords: potts spine,5 year old boy, att.
Title: Cytological Diagnosis of Rosai-Dorfman Disease in Region of Neck
Authors: Dr. Dipti Panwar, Dr. Abhishek Anand, Dr. Sunita Bhargava, Dr. Namita Goyal
Introduction: The disease was first described by Rosai and Dorfman in 1969. Also known as Sinus Histiocytosis with Massive Lymphadenopathy (SHML). Patients presenting with lymphadenopathy are commonly diagnosed as having tuberculosis or malignant lymphomas, whereas cases with extra nodal involvement are suspected of having various neoplasms, depending on site of involvement. Cytological features of SHML are virtually diagnostic and can obviate the need for biopsy in most cases.
Objective: To study the FNAC findings for diagnosis of this rare disease.
Case: The patient in our case was a young male who presented with massive cervical lymphadenopathy, fever, leukocytosis, hypergammaglobulinemia and raised ESR. The patient was clinically diagnosed as having lymphoma or tuberculosis.
Materials and methods: FNAC was done and the smears were stained by May-Grunwald Giemsa stain.
Observations: Smears were cellular and showed presence of mixed population of small and large lymphocytes, diffusely distributed histiocytes having single or multiple nuclei with fine chromatin , pale cytoplasm and exhibited numerous intact lymphocytes and polymorphs (Emperipolesis). Many foreign body giant cells, few plasma cells and large number of degenerated cells were also seen. Based on this characteristic cytomorphology a diagnosis of Rosai Dorfman Disease was made.
Conclusion: Thus, fine needle aspiration cytology is a useful and reliable tool for the diagnosis of Rosai-Dorfman disease due to which biopsy can be avoided.
Title: Jail Technique for the Fixation of Unicondylar Tibial Plateau Fractures
Authors: Ansarul Haq Lone, Omar Khursheed, Shakir Rashid, Munir Farooq, Naseemul Gani
Unicondylartibial plateau fractures with non-comminuted fragments can be treated using cannulated screws. We describe a new reconstructive technique of unicondylar tibial plateau fracture fixation known as “threescrew-jail technique” in place of conventional two screw osteosynthesis technique. The advantages of putting an additional “Jail screw” implanted in the proximal tibia from the anterior at an angle of 90o below the two screw reconstruction are prevention of subchondral collapse and prevention of screw cut-outs through the cancellous bone.
Keywords: Tibial plateau fractures, Jail technique, Cannulated screws.
Title: Low Frequency Ultrasonic Versus Microcurrent Effect on Tissue Healing After Tendon Suture
Authors: Sahar. M. Adel, Amira H. Draz, Amal. M. Abd El Baky
Background: Tendon injury has poor healing process. Therapeutic US has a positive role to play in providing the growth factors, also Microcurrent therapy has been used to increase the rate of healing. Purpose: this study was conducted to investigate the difference between high frequency ultrasound versus microcurrent therapy on the tissue healing of Achilles tendon after suture.
Methods: Thirty female albino rats were surgically transected Achilles tendons, were randomly and assigned into three groups with ten rats in each group (group I served as a control, group II was treated with high frequency US and group III was treated with microcurrent). The treatments were administered with ultrasound and microcurrent day other day starting immediately from the day after injury for 5 weeks. Wound size measurements were evaluated till complete healing.
Results: Both low frequency ultrasonic and microcurrent have a significant effect on decreasing wound size where the mean value of the wound treated with low frequency ultrasonic decreased from 0.2 mm ± 0.03 to 0.0 mm in the fifth time of measurement while the wound size of the control group decreased from 0.2 mm± 0.08 mm in the fifth time of measurement. Comparing wound size in Micro-currentgroup among the times of measurements Vs the control has shown a significant decrease of wound size where the mean value decreased from 0.2 mm ± 0.06 to 0.0 mm in the fifth time of measurement. The t test of group II has shown significant decrease in wound size measurement where the t value and P value showed that it was significant during 3rd and 5th times of measurement. The t test of group III has shown significant decrease in wound size measurement where the t value and P value showed that it was significant during 2nd, 3rd and 5th times of measurement.
Conclusion:low frequency ultrasonic has more significant effect thanmicrocurrenton decreasing wound size after tendon suture.
Keywords: Ultrasound, Microcurrent, Achilles tendon, Tissue healing.
Title: Lipoma Like Liposarcoma
Authors: Dr.Pragnya Chigurupati, Dr.Manuneethimaran Thiyagarajan, Dr.Rubina Singh, Dr. Shalinee Rao, Prof.A.Vikram
Soft tissue sarcomas are rare, unusual neoplasms accounting for <1% adult human cancers. They occur frequently in the extremity, followed by the trunk, retro peritoneum, head and neck respectively.
Most Retroperitoneal tumors malignant and one third are soft tissue sarcomas.
Amongst these, liposarcomas, malignant fibrous histiocytomas, leimyosarcomas are common.
Here, we are discussing a case report of our patient who presented with a retroperitoneal liposarcoma weighing 5 kgs.
Title: Women’s Empowerment and Child Health Outcomes: A Comparative Study between India and Nigeria
Authors: Asabe Ibrahim and Krishna Kumar Pandey
The indicators of women’s empowerment and its relationship to child health practices were investigated in a sample of 22,462 children in Nigeria and 45,516 in India. We examined the indicators of empowerment in two areas such as women’s decision-making autonomy and their attitude towards wife beating. Similarly, we also considered the determinants of child health in three areas: Child’s immunisation status, mortality (child is alive or not), and nutritional status (stunted or not). The influence of women’s decision-making autonomy on the child health practices appears to be paramount for a child’s well-being. The study revealed that in both populations, older women with parity 0-2 have greater decision-making autonomy more than women in the lower age categories with higher parity. In both populations, the less proportion of middle age women justified wife beating. The study also revealed that most of the children in Nigeria and India were not fully immunized. However, it has been observed from the results obtained in the study that parent’s education, wealth status and place of residents have a direct impact on child health. In conclusion, the study provides evidence for the relationship between the indicators of women’s empowerment and child health outcomes
Keywords- Women’s autonomy, child health, stunting, immunization, mortality, wife beating
Title: Herpes Zoster Ophthalmicus Infection among Eye Patients – Federal Medical Centre, (FMC), Birni Kebbi, Kebbi State Experience
Authors: Saka ES, Olatunji FO, Monsudi KF, Balarabe AH, Qudus BA, Isa A
These are reports of cases of Herpes Zoster Ophthalmicus (HZO) seen in10 Nigerian adults at the Eye clinic of Federal Medical Centre (FMC), Birni Kebbi, Kebbi State, Nigeria, some of whom tested positive to HIV infection using Elisa method with confirmation using the Western blot test. There were 6 male and 4 female patients. Four(40%) of these patients tested positive for human immunodeficiency virus, HIV. The ocular complications of HZO included corneal opacity (4/10), keratitis (7/10), uveitis (10/10), and elevated intraocular pressure (4/10). It was observed that patients who were HIV seropositive did not recover as quickly as the seronegative ones, though visual outcome among all the patients was generally poor. It could be concluded that HZO infection may indicate underlying HIV infection in adult African. Early institution of HZO antiviral therapy is recommended to reduce ocular complication and vision loss.
Keywords: Herpes Zoster Ophthalmicus, HIV, Ocular complications, visual outcome, Kebbi, Nigeria
Title: Autoamputation of Penis Following A Fournier’s Gangrene – A Rare Occurrence
Authors: Baldev Singh, Nikhil Agrawal, Mohit Singla, Sudhir Khichy, Ashish Kumar
Fournier’s gangrene is a type of polymicrobial necrotizing fasciitis involving perineal, perianal and urogenital region, especially the scrotum but rarely involves the penis. The penis is relatively spared of this life threatening condition because of its extensive vascular supply and separate fascial arrangement. We report a case of 60 year old healthy male who developed rapidly progressive necrotizing fasciitis of penis. The patient presented with sloughed off penis and was managed with repeated debridement and dressings of the wound.
Keywords: Fournier’s gangrene,autoamputation, penis
Title: Prevalence of Visual Impairment among Heavy Vehicle Drivers in Nagpur City
Authors: Dr Vikas Mahatme, Dr. Pallavi Alsi, Dr. Yogesh Jibhakate
The study was conducted in Nagpur city, India. 200 drivers of mass transport and heavy vehicles including 115 truck drivers and 85 bus drivers participated in this study. This was a cross sectional, non-comparative type of study. These drivers were tested at the outdoor campsite for distant vision, near vision and color vision. For those suspected of having problems underwent detailed checkup at base hospital. Prevalence of visual impairment in this study was found to be 64% (n=128). Refractive error was the commonest ailment amongst these drivers. Above the age of 40 years, cataract was the commonest cause (10%; n-20). The incidence of glaucoma was 3.5%, corneal lesions 5%, macular disorder 7%, while 5.5% had diminished vision due to retinopathies due to Diabetes, Hypertension and HIV etc. Driving is a job involving lot of responsibility concerning safety of the civilians. Impaired vision can be extremely dangerous and can cause major road traffic accidents. The study emphasizes the need of periodic checkup of drivers for visual problems and setting up of legal norms.
Keywords: Heavy vehicle drivers, Vision, Visual impairment, truck drivers, bus drivers, road safety, ophthalmic injuries, road traffic accidents, cataract, glaucoma, corneal disorders, retinopathies, refractive errors.
Title: Recurrent Dermatofibrosarcoma Protuberans on Anterior Abdominal Wall A Case Report and Review of Literature
Authors: Santanu Sarkar, Tamonas Chaudhuri
Dermatofibrosarcoma Protuberans (DFSP) is an uncommon, slow growing, locally aggressive cutaneous neoplasm. Incidence of DFSP is 0.8 to 4 cases per 1 million per year. Dermatofibrosarcoma protuberans accounts for less than 0.1% of all malignant neoplasms and approximately 1% of all soft tissue sarcomas.
In our case a young male presented with recurrent DFSP on his left flank region which highlights two noteworthy features. Firstly, DFSP is a very rare cutaneous soft tissue sarcoma. Secondly, it describes a local recurrence of this entity and its management.
Keywords: Skin tumour, Dermatofibrosarcoma Protuberans, Recurrence,Wide local excision.
Title: A Clinical Study on Distribution of Malignant Lesions on FNAC in a Study Population Attending a Teaching Hospital in North India
Authors: Dr. Irfan Khan, Dr. Mohsin Ul Rasool, Dr. Sajad Hamid, Dr. Imran Khan
Aim: the present study is undertaken to evaluate the distribution of malignant lesions on FNAC in Nothern Indian population.
Introduction: Clinical examination, although very accurate in most cases of thyroid lesion, is inadequate in some areas especially, in staging of thyroid malignancies and in detecting the multi-nodularity of the gland.
Material And Methods: The study was conducted in a teaching hospital for a period of 1 year. It was a prospective hospital based Study. In each case, a brief clinical history and examination was carried out. Patients were explained about whole of the procedure & the consent for the procedure was taken in all patients. FNAC of thyroid gland was done both free guided and ultrasonic- guided and the results were correlated statistically
Observation: Out of total 139 patients, 87 patients were benign; 19 were male and 68 were female. The malignant lesions were 39; 8 were male and 31 were female. The most common neoplastic lesion by ultrasound guided FNAC was Papillary carcinoma accounting for 32, 3 cases of Medullary carcinoma, 1 Anaplastic carcinoma, 2 cases of Hurthle's carcinoma and 1 Lymphoma. In Free hand FNAC, 36 out of 139 patients were cytologically diagnosed as neoplastic cases were diagnosed. Two cases of papillary carcinoma and one case of medullary carcinoma were not picked up in Free hand FNAC and was diagnosed in USG Guided FNAC, which yielded representative material for cytological study. Comparison of neoplastic lesions results both by USG guided FNAC and Free Hand FNAC in 38 patients shows difference of 2 cases in Papillary carcinoma,1 case in medullary carcinoma ,while as Anaplastic carcinoma, Hurthle’s cell carcinoma and Lymphoma were each one by both the techniques. Number of unsatisfactory smears were 4 and 1 in free and USG Guided FNAC respectively. We categorised the study sample as per Betheseda System. In USG-guided unsatisfactory were 4, benign were 87, Atypia of Undetermined Significance was none, Suscipicious for malignancy was none and malignant were 39.In Free-hand FNAC, unsatisfactory were 15,, benign were 81, stypia Of Undetermined Significance was none, suscipicious for malignancy was none and malignant were 36.In USG guided FNAC, Sensitivity was 96.96%, Specificity was 93.3%. Positive predictive value was 96.96%, Negative predictive value was 93.33% and Diagnostic accuracy was 95%.In Free Hand FNAC, Sensitivity was90.0%, Specificity was 80.0%. Positive predictive value was 90.0 %, Negative predictive value was 80% and Diagnostic accuracy was 86.66%.
Conclusion: There was significant difference in the comparison of USG- guided FNAC and Conventional FNAC in Benign and Malignant lesions. The statistical significance of USG-guded FNAC as: Sensitivity 96.96%, Specificity 93.3%, Positive predictive value 96.96%,negative predictive vale 93.33%,diagnostic accuracy 95%.The statistical significance of USG-guded FNAC as: Sensitivity 90%, specificity 80%, positive predictive value 90%, negative predictive vale 80%, diagnostic accuracy 86.66%.
Key Words: Thyroid lesions, goiter, FNAC,ultrasonic –guided FNAC
Title; Testicular Lymphoma Presenting As Epididymo-Orchitis - A Rare Case Report
Authors: Dr. Patel Bhavin, Dr. Rao Naresh, Dr. Kumar Santosh, Dr. Bapat SS
Introduction - Testis is very rare extra nodal site for lymphoma. Usually testicular lymphoma presents as a painless scrotal swelling.
Material and Method - We present a case of 60 year old patient presenting as epididymo-orchitis.
Discussion – Testicular lymphoma represents only 1% of all lymphomas. It is unusual presentation of primary testicular lymphoma which is rarely reported.
Conclusion – Such unusual case reports would greatly contribute towards understanding the disease as a whole.
Keywords - Testicular Lymphoma , Epididymo- Orchitis.
Title: Management of Peripartum Cardiomyopathy in ICU: A Case Report
Authors: Deepika Aggarwal, Suresh Singhal
A patient presenting with acute onset breathlessness in late pregnancy or immediately after delivery brings in mind a number of conditions such as pulmonary edema, pulmonary aspiration or amniotic fluid embolism.1 One of the condition presenting similarly is peripartum cardiomyopathy. A disease that can endanger the life of the mother and the baby and can cause prolonged and persistent cardiac insufficiency in mother prematurely due to decreased cardiac ejection fraction either in late pregnancy or early puerperium. A 23yr old female who had delivered vaginally the previous day came with complaints of shortness of breath for five days and cough with expectoration for five days. On examination general condition was poor, features of heart failure were present. She was shifted to ICU where she required intubation. Later on ECHO revealed dilated left ventricle with global hypokinesia, LVEF-25% and diagnosis of peripartum cardiomyopathy was made. Treatment was started with digoxin, fursemide, enalapril.
Title: Ozone Therapy in Periodontics: A Review
Authors; Dr. Ameet Mani, Dr. Prachi Shukla,Dr. Richa Patel, Dr. Tushar Bhople, Dr. Shubhangi Mani
Periodontitis is a inflammatory disease of the supporting tissues of the teeth and is caused by specific microorganisms or by a group of specific microorganisms, resulting in progressive destruction of periodontal ligament and alveolar bone with periodontal pocket formation, gingival recession.Bacteria are the prime etiological agents in periodontal disease. The mechanical removal of the biofilm and adjunctive use of antibiotic disinfectants or various antibiotics have been the conventional methods for periodontal therapy. Ozone therapy is one of the modern non-medication methods of treatment. Ozone is an unstable gas and it quickly gives up nascent Oxygen molecule to form Oxygen gas. Ozone gas has a high oxidation potential and is effective against bacteria, viruses, fungi, and protozoa. It has the capacity to stimulate blood circulation, platelets, and immune response. Ozone is used in dentistry in gaseous, ozonated water and oils. Ozone is biocompatible and can be used in all aspects of dentistry.
Title: Comparative Distribution of Squamous Cell Carcinoma in India - A 7 Year Study
Authors: Dr Shivanand Gundalli, Dr Rutuja Kolekar, Dr Kaveri Pai, Dr Amit Kolekar
The present study was a retrospective and prospective study of skin tumours during the period September 2004 to September 2011. Total 133 cases presented as skin tumours of these 53 cases (39.84%) were histologically diagnosed as benign and 80 cases (60.16%) were diagnosed as malignant lesions. The ratio of benign to malignant skin tumours was 0.66:1 indicating predominance of malignant lesions.
Total 15405 specimens were received in the histopathology section during the study period from September 2004 to September 2011. Out of these 3200 were diagnosed as cancers of various sites in the body and cancers of skin accounted for 80(2.5 %) cases.
In the present study the most common malignancy was squamous cell carcinoma with occurrence of 46.25% cases of total skin malignancies followed by basal cell carcinoma (26.25%), verrucous carcinoma (5%), adnexal carcinoma (7.5%) and malignant melanoma (11.25%).
Key words: skin tumours, malignant lesons, cancers, carcinoma.
Title: Zygomycosis and Aspergillosis of Rhinomaxillary Region
Authors: Dr. Raghavendra Rao M, Dr.Tejashree A., Dr. Rajeshwari K.G, Dr. Vidyavathi B.Chitharagi, Dr. Madhuri Kulkarni
Fungal infections has gained a remarkable interest in the past few decades, owing to increase in immune compromised conditions among the population.A variety of organisms are responsible for paranasal mycosis, Aspergillus and Zygomycetes being the commonest.. Reports of combined Zygomycosis and Aspergillosis of oro-rhinocerebral region are very rare. A female patient aged 58 years presented with 15 days history of pain and swelling in the left orbitomaxillary region. On oral examination an ulcer was noted on left side of hard palate with black crusting in left nasal cavity. A provisional diagnosis of chronic rhino sinusitis with mucormycosis was made.KOH examination of antral washing showed broad aseptate hyphae and fruiting bodies of Aspergillus. Rhizopus.arrhizus and Aspergillus. flavus were grown from sample which was inoculated on SDA media. Early diagnosis and prompt therapeutic interventions may prevent progressive tissue invasion and reduce the need for or extent of surgical resection, disfigurement and survival.
Title: Meniscal Injuries with Tibial Plateau Fractures: Role of Arthroscopy
Authors: Ansarul Haq Lone, Omar Khursheed, Shakir Rashid, Munir Farooq, Naseemul Gani
Tibial plateau fractures are complex intra-articular injuries associated with variety of intra-articular soft tissue injuries. The load bearing and shock absorbing functions of menisci makes them increasingly susceptible to injury during a traumatic event. Associated meniscal injuries should not be neglected at the time of fracture fixation. We recommendarthroscopy for the diagnosis and proper treatment of associated soft tissue injuries including meniscal injuries, so as to prevent the development of degenerative osteoarthritis.
Title: Teratogenicity of Gabapentin in Mice
Authors: Dr. Md Abu Nasar, Dr. R. P. Gupta, Dr Tarannum Fatima Subhani
Introduction: Present work aims to study and elucidate the safety profile of the antiepileptic doses of gabapentin during pregnancy, and to evaluate if any gabapentin induced murine fetotoxicity at different dose levels.
Methods: A total of 60 pregnant mice divided into a total of 12 groups, of 5 mice each were exposed to gabapentin in 4 different doses of 0 (control), or 113, 226, or 452 mg/kg body weight per day, at 3 different gestational stages including early gestation (1-6 day), mid gestation (7-12 day), and late gestation (13-17 day). The pregnant mice were euthanatized on day 18 of gestation, and foetuses were examined for teratogenic manifestations. Brains were dissected out and examined for gross changes, malformations, histological changes, and quantitative protein estimation.
Results: Foetal resorptions were observed in all treated groups with gabapentin administration at early gestation (1-6 day), and mid gestation (7-12 day); on the other hand, growth retardation along with stunting in size of live foetuses were observed in all the mid gestation (7-12 day), and late gestation (13-17 day) treated groups. Various gross malformations were observed with all the three doses (113, 226, and 452 mg/kg body weight per day) when with gabapentin was administered at mid gestation (7-12 day). Same trends were confirmed by gross and microscopic examination of brains along with quantitative protein estimation.
Conclusion: Gabapentin should not be prescribed in pregnancy, as no therapeutic dose of gabapentin is safe during pregnancy as far as the foetal risk is concerned.
Key Words: Birth defects, gabapentin, mice, pregnancy, teratogenicity.
Title: Systemic Blood Pressure Changes In Different Age Group Individualsafter Water Ingestion
Authors: Anitha Lakshmi, Nagaraja Puranik, K F Kammar
The present study was undertaken to establish the interrelationship between systemic blood pressure and water ingestion (i.e. 2% of the body weight water intake; approximately 1000 ml) in apparently healthy individuals of different age group.
Keyword: Water ingestion; Systemic blood pressure; Aging.
Title: Tuberculosis Of The Gastrointestinal Tract- The Great Mimic - A Rare Case Report
Authors: Balaji Purushotham, Sivakumar Madhu
Background: Segmental colonic tuberculosis being a rarity in sigmoid colon with limited no of cases reported so far.
Case report: A 68yrs old male presented with lower abdominal pain of 1 month duration, associated with dysuria/difficulty in micturition. There was history of loss of appetite & weight with constipation present on & off. Investigation revealed a stricture involving long segment of sigmoid colon and adherent to posterior wall of the bladder on the left side. Possibility of malignant/inflammatory etiology. Cystoscopy guided biopsy of bladder lesion showed granulomatous lesion. Diagnostic laparoscopy done and proceeded with Laparotomy/Resection of stricture segment of sigmoid colon and primary colocolic anastomosis. Histopathology report confirmed tuberculosis colitis. Patient was started on antituberculous (ATT) medication. Patient is on regular follow up.
Conclusion: Tuberculosis is known to involve any segment of gastrointestinal tract. While tuberculosis of the small bowel is common, isolated primary tuberculosis of the large bowel is quite uncommon. Tuberculosis of colon forms only 3 to 4% of intestinal tuberculosis. Tuberculosis of the colon tends to be segmental and usually obstructive symptoms dominate. However the diagnostic challenge is very high when isolated colonic segments are involved with tuberculosis.
Keywords: Tuberculosis (TB), Gastrointestinal (GI) tract, Antituberculous drug (ATT).
Title: Primary Implant Stability, a Factor for Successful Osseointegration
Authors: Dr. Abhishek N Zingade, Dr. Swati Pralhad
Dental implants are being routinely used to replace missing and compromised teeth, and are said to offer predictable, long lasting replacement outcomes while still preserving the natural tooth structure of the adjacent teeth. Primary stability achieved immediately after placement of the implant is considered to be an important requisite for successful osseointegration. The present review summarizes the factors affecting primary stability and the available methods to assess primary stability
Title: Ultrasound Biomicroscopy Study of Anterior Segment Measurements in Normal Eyes in a Tertiary Care Rural Hospital of SPRR Nellore District
Authors: Dr. R. Sudha*, Dr. P. Prabhanjan Kumar, Dr. O. Gopala Krishna, Dr. G.Chandrasekhar
Because many of the structures imaged by ultrasound biomicroscopy cannot be clearly observed by any other method, it is helpful to define a system of measurement to be used in future assessment of normal and abnormal patients. The normal eye has much variability in the position and configuration of internal structures. We attempted to define these measurement positions in a way that would allow reproducibility in the future. By this study we can in detail know the anatomy of various anterior segment structures like cornea, ciliary body and iris etc and can measure Corneal thickness, Iris thickness (Iris thickness on TCPD, 2mm away from root of iris, and maximum iris thickness at the pupillary margin), Anterior Chamber Depth, Angle and other parameters like Angle Opening Distance (AOD), Trabecular Ciliary Process Distance, Iris Ciliary Process Distance. By measuring all these 9 parameters in normal subjects, in 100 subjects, the normative data is derived for the Indian eyes in the age group of 18 to 28 years by the technique of Ultrasound Biomicroscopy for the temporal anterior segment. i.e. at 9° clock position for right eye and 3° clock position for the left eye (temporal meridian). The measurements are calculated by calipers, which is in built in the system software. Visual acuity, slit lamp examination and fundus examination with direct ophthalmoscope were done in all subjects. Ultrasound biomicroscopy examination was conducted for both eyes under topical anaesthesia. The average value of Angle Opening Distance for the Right eye is 368.64+/- 32.824 microns and for the Left eye is 375.30+/- 28.672 microns. The average value of Trabecular Ciliary Process Distance for the Right eye is 1114.00+/-98.144 microns and for the Left eye is 1100.50+/-101.169 microns. The average value of Iris Thickness 1 (ID1) for the Right eye is 416.16+/-54.281 microns and for the Left eye is 408.02+/- 54.049 microns.The average value of Iris Ciliary Process Distance for the Right eye is 306.51+/- 58.409 microns and for the Left eye is 305.60+/- 51.115 microns.The average value of Trabecular Iris Angle for the Right eye is 38.02+/ - 3.20 and for the Left eye is 37.71+/- 4.00. The average value of Iris Thickness 2 (ID2) for the Right eye is 480.00+/-48.596 microns and for the Left eye is 478.80+/- 56.466 microns. The average value of Iris Thickness 3 (ID3) for the Right eye is 518.80+/-42.221 microns and for the Left eye is 578.70+/- 36.753 microns. The average value of Central Corneal Thickness for the Right eye is 529.80 +/- 25.819 microns and for the Left eye is 530.90 +/- 20.005 microns. The average value of AC Depth for the Right eye is 3031.60 +/- 280.806 microns and for the Left eye is 3036.40 +/-229.635 microns.
Objective: To compare the normal measurements of anterior segment of the study with other studies and to derive normal values of anterior segment measurements for the defined age group.
Title: Comparison Between Inhibitive Distraction and Intermittent Cervical Traction on Pain and Disability in Patient’s With Non-Specific Neck Pain
Authors: Ranjana Dhinwa, Shaan-E-Mohd
Aim: Aim of this study is to assess and compare the effect of cervical traction or inhibitive distraction on pain and disability in Patient with non-specific neck pain.
Methodology: 27 Patients were randomly selected from the community who volunteered to participate in the study. Patients were randomly assigned in to two interventions: Inhibitive Distraction and Intermittent Cervical Traction. Group A and Group B. Group a received inhibitive distraction with isometric muscle training and Group B received intermittent mechanical cervical traction with isometric muscle training. Both the intervention was given for 4 weeks. Isometric muscle training were given for 5 repetition per session thrice a week , inhibitive distraction were applied for 3 minutes and 5 repetition thrice a week and mechanical cervical traction were applied for 15 minutes, hold and rest time was 8 second for thrice a week.
Outcome measure; Neck Disability Index (NDI) and Visual analog scale (VAS)were collected at before and after intervention.
Results; Patients in all groups improved on the NDI and VAS,.When we compaired the two groups, we found that intermittent cervical traction was far superior than inhibitive distraction . Significant improvement in neck pain and functional disability (P≤ 0.05) also out of inhibitive distraction and intermittent cervical traction, Intermittent Cervical Traction showed better improvement.
Conclusion; It can be concluded from our study that the intermittent cervical traction is better than inhibitive distraction over the neck pain and Functional disability in patients with non-specific neck pain.
Keywords; Non-specific neck pain, neck disability index( NDI), Visual analog scale(VAS)
Title: Comparitive Study between Laparoscopic Hernioplasty and Open Hernioplasty
Authors: Balaji Purushotham, Sivakumar Madhu
Background: A comparative study between Open and Laparoscopic Hernioplasty in the Department of General Surgery at Govt. Stanley Hospital, a Government run, 200 years old, 1280 bedded, under/post graduate and super specialty training institution, located in Chennai, Tamilnadu, the Southern part of India.
Introduction:Inguinal hernia repair is one of the most common operations performed in general surgery worldwide. Every fourth man is expected to have a hernia operation during his life time. It accounts for 75% of all abdominal wall hernias. 27% of men and 3% of women have a life time risk of developing inguinal hernia.
Aims:To compare Totally Extra peritoneal (TEP) Hernioplasty and Lichtenstein Open Hernioplasty in relation to primary and secondary outcome measures and determine whether laparoscopic repair of inguinal repair is equal or superior to Open Hernioplasty.
Methods:The study has been carried out over a period of 4 years from 2007-2010 after obtaining approval from the hospital Ethical Committee.
The study sample consist of 202 patients in each group who were repaired by Laparoscopic and Open method, respectively.
Results:The study clearly favours Laparoscopic Totally Extraperitoneal Repair over Open Repair with regards to postoperative pain, hospital stay, resumption of routine physical activities and work.
Conclusion: Laparoscopic repair of inguinal hernia is a safe, feasible and effective technique with less post operative pain, early return to routine activities, low recurrence rates, low post operative morbidity and low rates of wound and mesh infection in experienced hands.
Keywords-Inguinal hernia, Totally ExtraPeritoneal repair, Return to work
Title: Misoprostol Alone or In Combination with Mifepristone: The Search for a Safe and Economical Option
Author: Dr. K. Shail, Dr Harleen Grover
Background: Medical abortion provides women with a safe, less invasive method for termination of pregnancy. Regimens with mifepristone and misoprostol are expensive and not freely available throughout the world.
Aims and objectives: The objective of this study was to confirm the effectiveness, safety and cost efficacy of medical abortion up to 7 weeks (up to 49 days) using 2 different regimes.
Materials and methods: Hundred and twenty prospective patients attending our OPD for termination of pregnancy who fulfilled the inclusion criteria were included in the study after informed consent. The patients were randomly allotted to one of the following two groups: (1) group 1- mifepristone 200mg orally with 800mcg misoprostol vaginally after 48 hours; (2) group 2- 3 doses of vaginal misoprostol 1000mcg 24 hourly. Outcomes measured were (1) successful abortion (complete abortion without requiring additional procedure), (2) side effects, (3) mean time of onset of cramping, (4) mean time of onset of bleeding, (5) mean duration of bleeding, (6) mean decrease in haemoglobin and (7) mean time of menstruation returning.
Results: Medical abortion was successful in 55 of 60 (91.67%) patients in group 1 and in 54 of 60 (90%) patients in group 2 (p=1.00). The mean change in haemoglobin was 0.70+0.5g/dl in group 1 and 0.7+0.4g/dl in group 2 (p=0.713). Cramping began at 4.1 + 1.6 hours and lasted 5.2 + 3.7 hours in group 1. Cramping began at 5.1 + 3.4 hours and lasted 3.7 + 1.9 hours in group 2. Vaginal bleeding started at 3.43+1.2 hours after administration of misoprostol in group 1 and 6.46+ 1.6 hours after first dose of misoprostol in group 2. Mean duration of bleeding in group 1 was 6.23+5.3 days and 7.0+4.6 days in group 2. Time to return of menstruation was 36.9 +97.1 days in group 1 and 37 + 7.1 days in group 2.
Conclusions: The present study suggests that 1000mcg misoprostol administered vaginally at 24 hour intervals could be a more economical and viable option in situations where financial constraints restrict the use of mifepristone. Moreover the 24 hour interval improves patient compliance and allows out patient management.
Key Words: first trimester pregnancy, medical abortion, mifepristone, termination, vaginal misoprostol
Title: Management of Chronic Subdural Hematoma: A Rural Institutional Experience of 98 Patients
Authors: Vijendra Kumar, Amit Singh, Dheer Singh
BACKGROUND: Chronic subdural hematoma is a well known traumatic head injury in elderly patients. It has good prognosis if treated surgically in time. There are many operative interventional techniques for the treatment of CSDH. Burr hole craniostomy is the method of choice for evacuation of CSDH. It is the simplest and safest method with low morbidity and mortality, although it has a recurrence rate from 9.2% to 26.5%. The aim of this study is to see the effectiveness of single burr hole craniostomy without using any subdural drain.
METHODS: 98 patients of CSDH admitted during a period from August 2011 to November 2014 were included in the study. Clinical assessment was done by GCS and radiological assessment was done by CT scan. All patients were operated by making a single burr hole at maximum thickness of CSDH. Thorough saline irrigation was done until returning fluid became clear. Multiple membranes were opened up widely by using bipolar coagulation. Subdural cavity was refilled with saline and wound closed without any drain.
RESULTS: Only 2% patients had recurrence of CSDH. They were re-operated by using same burr hole. Both were improved after re-operation. Four patients readmitted with in 2 month of discharge with headache and hemi paresis. CSDH was diagnosed on CT. Two of them having history of repeated falls due to drug addiction and rest of two were on antiplatelets medication with deranged coagulation profile.
CONCLUSION: In many studies use of close suction drain was recommended in CSDH for reducing the recurrence. Closed suction drain was not used in this study and recurrence rate was only 2%. So the results were in favour of making single burr hole craniostomy without any drain for the management of CSDH.
KEY WORDS - Chronic subdural hematoma, single burr hole, subdural drain
Title: Eosinophilic Enteritis Presenting As Intestinal Obstruction – Report of Two Cases
Authors: Balaji Purushotham, Sivakumar Madhu
Eosinophilic gastroenteritis (EG) is an unusual disorder. It is characterized by eosinophil infiltration of the gut wall histologically and is manifested by gastrointestinal (GI) symptoms clinically. This disease entity preferentially affects the stomach and proximal small intestine. Transmural variety is a rare form of this disease causing stricture and intestinal obstruction.
We present two cases of Eosinophilic enteritis causing distal small intestinal stricture and proximal colonic mass both presenting as acute intestinal obstruction.
Title: Study on Styloid Process and Its Clinical Implications
Authors: Drakshayini. B. Kokati, Mallikarjun, Usha V
The styloid process (SP) is a cylindrical, long cartilaginous bone located on the temporal bone. It normally measures between 2cm and 3cm in adults.1,2,3
Elongated styloid process can be due to styloid process itself or due to ossification of stylohyoid ligament showing an overall length of more than 3 cm. In living persons, the elongated styloid process when present can produce characteristic cervicofacial and neck pain syndromes, commonly known as Eagle's syndrome. The signs and symptoms are due to the compression of the styloid process on some neural and vascular structures. It may also cause stroke due to the compression of carotid arteries. This syndrome is diagnosed by both radiographical and physical examination. Eagle’s syndrome is important clinically as it is involved in the diagnosis and treatment cervicofacial and neck pain. This article reviews the clinical importance of the elongated styloid process.
Key Words: styloid process elongated eagle’s syndrome.
Title: Schwannoma of Medial Sural Cutaneous Nerve - A Rare Entity in Orthopedics
Authors: Dr. Sonik Bharat Shah, Dr Prakash D Samant, Dr Atul Kharat
A Schwannoma is a well encapsulated, non-infiltrating, benign nerve sheath tumour arising from Schwann cells of Neuroectoderm. Schwannoma of a peripheral nerve is a rare entity and should be kept in mind as a differential diagnosis for any musculoskeletal pain.
Keywords: Schwannoma, medial Sural cutaneous nerve, neuroectodermal tumors, Schwann cells tumor, solitary Schwannoma.
Title: Dental Barotrauma and Barodontalgia
Authors: Pooja S. Rajpal, Geeta Sachdev, Mandavi Waghmare, S. S. Pagare
Barodonatalgia is defined as a pressure induced dental pain that can occur both at high and low pressures. In the orofacial region, barotrauma is manifested either as facial barotraumas (eg, barosinusitis and barotitis-media) or dental barotrauma This review outlines the etiology, clinical manifestations, differential diagnosis and recommendations for prevention and management of barodontalgia and barotrauma. When treating patients associated with aviation or diving, clinicians should cautiously examine and treat fractured cusps, caries, areas of dentin exposure and integrity of restorations and prosthesis to prevent barometric-related dental problems.
Keywords- Aerodontalgia, Barotrauma, Odontecrexis, Barodontalgia, In-flight toothache
Title: Impact of the Serum Homocysteine Levels in Patients of Vascular Dementia
Authors: Shashikala Lamani, N. Surendra Naik, H.L.Vishwanath
Background: Vascular dementia is a degenerative cerebrovascular disorder that results from ischemic or haemorrhagic brain damage. Persons with vascular dementia are at great risk of morbidity and mortality than those with Alzheimer’s disease.
Elevated serum total homocysteine level is associated with vascular dementia. Metabolism of homocysteine is closely associated with that of folic acid, vitamin B6 and B12. Homocysteine has a neurotoxic effect that could lead to neurologic disturbances. Hence, it is important to explore the status of serum homocysteine in vascular dementia to evolve the treatment strategies for the same.
Objectives: To determine the levels of serum homocysteine in cases of vascular dementia and to compare it with age and sex matched controls.
Methodology: In this case control study, 30 vascular dementia cases and 30 age and sex matched controls were selected. Serum homocysteine levels were estimated by enzymatic photometric method.
Results: Serum homocysteine levels were elevated significantly in cases with 26.28±14.22 (Mean ± SD) compared to 19.44±7.36 in controls with p = 0.023. Pearson correlation of MMSE score with homocysteine levels was found to be significant with p value of 0.009. This indicates that cases with high serum homocysteine levels had more cognitive deficit.
Conclusion: Hyperhomocysteinemia is an independent and modifiable risk factor for vascular dementia, hence vitamin B supplementation should be considered as preventive and therapeutic intervention. It is recommended to measure serum homocysteine levels in all high risk individuals who are prone for cerebrovascular accident and dementia.
Key words: Vascular dementia, homocysteine, enzymatic photometry, MMSE score
Title: Surgery induced Astigmatism following Nonphaco Manual Small incision Cataract Surgery in relation to different Postoperative period
Author: Pranda Shukla
Purpose-To find out surgery induced astigmatism following SICS at the end of first week, third week, and sixth week during the study period from 2013-2014.
Materials and Methods; Cataract surgeries were carried out in patients with no systemic diseases all senile cataracts were included and complicated cataracts were excluded from the study .Hundred patients underwent manual small incision cataract surgery 6-6.5mm incision size superior incision made about 1.5mm away from limbus and PMMA posterior chamber intraocular lens was implanted after biometry. Postoperatively patients received oral antibiotic for five days and antibiotic-steroid eye drops for six weeks. Patients were followed-up at the end of first week, third week and sixth week and postoperative astigmatism was recorded with the help of Bausch and Lomb keratometer and standard automated refractometer.
Results and Conclusions: A total 100 patients were included in this study .Postoperative average astigmatism at the end of 1st week was 2.4D, 3rdweek 2D, 6thweek 1.8D. Initially astigmatism was with the rule gradually shifted to the against the rule at the end of 6th week.
Key words: small incision cataract surgery, astigmatism, with the rule, against the rule
Title: Treatment Modalities for Basal Like Breast Cancer
Authors: Dr. Adnan Bashir Bhatti, Dr. Muhammad Usman, Dr.Zarine Anwar Gazali
Breast cancer represents a heterogeneous group of disorders with significant morbidity and mortality among female population. Basal like breast cancer represents one of the several sub types of breast cancer. It has always been considered synonymous to triple negative breast cancer but studies have repeatedly proven it and triple negative to be two separate entities having different immunohistochemistry, clinical behavior and prognosis. Basal like breast cancer represents an immunophenotype similar to triple negative breast cancer in a respect that it lacks estrogen receptors (ER), progesterone receptors (PR) and human epithelial growth factor 2 (HER2) overexpression, but is quite distinct at the same time as it represents additional biomarkers as well like cytokeratins 5/6 and epithelial growth factor receptors (EGFR). Moreover, basal like breast cancers is characterized as tumors with greater degree of atypia, higher propensity of local invasion, easy distant metastasis and grim prognosis.
Even when it represent as much as 13-37% of breast cancer burden in young female population, definite treatment protocols remain lacking. Thorough analysis of currently available data in this regard has shown that breast conserving therapy (BCT) with adjuvant radiotherapy promises the best outcomes. In addition, pre-operative use of chemotherapeutic agents like paclitaxel followed by 5-fluorouracil, doxorubicin, and cyclophosphamide and post-operative use of anthracycline (doxorubicin/cyclophosphamide or fluorouracil/doxorubicin/cyclophosphamide) and CMF based (Cyclophosphamide, Methotrexate, and Fluorouracil) adjuvant chemotherapy has shown to improve the prognosis. Furthermore, therapies that target features like dysfunction of BRCA1 and overexpression of EGFR are currently being studied as potential treatment options.
Key Words: Breast Cancer, Basal Breast Cancer, Estrogen receptor (ER), Progestrone Receptors (PR), human epithelial growth factor 2 (HER2) overexpression, BRCA1, BCT, cytokeratins, epithelial growth factor receptors (EGFR).
Title: Assessment of Tumor Cell Morphology and Peri-Tumoral Stromal Changes in Oral Squamous Cell Carcinoma
Authors: Dr Mahima Rakheja, Dr Jasleen Grover, Dr Arunima Chauhan, Dr Mary Mathew, Dr Raghu A R, Dr Vasudev Guddattu, Dr Monica Charlotte Solomon
Background: Oral squamous cell carcinomas are tumors with dissimilar behavioural patterns. Several cellular and extracellular changes take place throughout the process of carcinogenesis, which convey diagnostic and prognostic significance. This is an attempt to recognize significant indicators that convey the impending course of the tumor.
Aims: To evaluate the alteration in the morphology of tumor cells and the stromal changes occurring in OSCC. To correlate these features with clinicopathological variables of each case
Material and Methods: A total of 47 cases were included in the study. Oral squamous cell carcinomas (n=27), Leukoplakia with dysplasia (n=10), oral submucous fibrosis (n=10) cases were selected. 3 morphometrical parameters were assessed namely nuclear area (NA), cell area (CA) and their ratio (NA/CA). In addition, the birefringence patterns of collagen fibers in the peritumoralstromawere assessed.
Results: Nuclear area (P=.014) and nuclear to cell area ratio (P<.0001)showed statistically significant increase from dysplasia to increasing grades of OSCC. Collagen fibres showed a higher preponderance of the orange red (OR) birefringence in the well (66.6%) and moderately differentiated (77.7%) OSCC cases. Among the poorly differentiated OSCC cases, green yellow (GY) birefringence predominated.Follow up analysis was done.
Conclusion: Substantial nuclear and cellular morphometric alterations occur in tumor cells and in the peri-tumoralstroma during the advancing grades of oral squamous cell carcinoma. Morphometrical analysis of nuclear area and nuclear to cell area in association with birefringence patterns of stromal collagen fibres, can serve as an adjunct for more efficient prognostication of OSCC.
Key words: Oral squamous cell carcinoma (OSCC), morphometry, image analysis, collagen, picrosirius red stain, birefringence, polarising microscopy.
Title: Comparative Study of the Absolute Eosinophil Count between Jeans Washermen and Normal Individuals in Bellary
Authors: Dr Arun Kumar S*, Dr Govindaraj J, Dr Noorjehan Begum, Dr Mohammed Jaffer
Background: Allergic reactions occur normally to various substances present in nature as well as to man-made chemicals. These reactions sometime restricted to skin only and sometimes may involve multiple organs like lungs, kidneys etc. These reactions are due to formation of antibodies in the blood. This antigen- antibody combination is responsible for injury inflicted to the body. In the present study an attempt is made to study the variations of absolute eosinophil count (AEC) in the jeans washer men & normal healthy male individuals of Bellary.
Aims 1. To assess the absolute eosinophil count in jeans washer men and compare with that of healthy age matched individuals.
2. To find out the effect of duration of exposure to chemicals on in jeans washer men.
Methods - Study Design: cross sectional case control study
In the present study, 50 male workers from Jeans washing factories worked for more than 5yrs & 50 healthy security male workers from VIMS, Bellary were randomly selected. Ethical clearance & written informed consent were taken. All the subjects were subjected to 1ml blood sample tests for AEC by Dunger’s method. The data collected was tabulated and subjected to statistical analysis using SPSS software. (Standard deviation, mean and unpaired student T test)
Results: The means of AEC were significantly high in cases compared to controls. With increased duration of exposure to chemicals there was a significant increases in AEC.
Conclusion: As compared to controls increase in AEC in cases indicated that jeans washermen were allergic to industrial chemicals
Keywords: AEC, Durationof exposure.
Title: Etiologies and Outcome of Children with Purulent Meningitis at the Pediatric unit at a Tertiary Medical Centre, West Bengal
Authors: Dr. Samir Kumar Roy, Kusumita Mandal, Kamalika Mandal
Background: Bacterial meningitis is one of the most severe infections in infants and children. It is associated with high mortality and neurological sequelae. In order to improve the prognosis of infants and children with purulent meningitis, we decided to conduct this study whose main objective was to identify the main pathogens responsible and describe the outcome in infants and children aged 2 months to 8 years admitted for purulent meningitis at a tertiary medical centre..
Method: This was a cross-sectional study with retrospective data collection and consecutive sampling. Our study was conducted from 1 January 2007 to 31 December 2013. The patients included in the study were infants and children aged from 2 months to 8 years who were admitted for bacterial meningitis at the BSMCH, Bankura, confirmed by bacteriological examination of cerebrospinal fluid (CSF) with identification of the pathogen by culture. The data was analyzed using SPSS Version 18.0 and Excel 2007. The Chi-square test was used to determine the association of various variables. The significance threshold was set as P < 0.05.
Results: We selected 182 cases of purulent meningitis who represented 1.62% of admitted patients. The sex ratio was 1.3. We noted that 45% of our patients were aged 2 months to 1 year. The main presenting complaints were fever, seizures, irritability and vomiting in respectively 97.8%, 50.5% , 41.2% and 39.5% of patients. Streptococcus pneumoniae was found in 72 children (39.56%), followed by Haemophilus influenza in 54 children (29.67%) and Group B Streptococcus in 20 children (10.98%). Acute complications (status epilepticus, coma) were seen in 48.35% of patients. The statistically significant (P < 0.05) factors for poor prognosis were aged from 2 months to 1 year (P < 0.001), GCS Score<8 (P < 0.02), the pathogen (P < 0.001 Pneumococcus), a delay of more than three days between the onset of the disease and the treatment (P < 0.01). We identified 44 deaths (24.1%) and 22 cases (12%) with neurological sequelae before discharge.
Conclusion: Streptococcus pneumoniae and Haemophilus influenzae are found to be most common pathogen causing meningitis in our study. Age below one year, pneumococcal infection, delayed treatment > 3 days, the Glasgow coma scale <8 are poor prognostic factor. Wide immunization with pneumococcal conjugate and Haemophilus influenza type-b conjugate vaccines can reduces the incidences of meningitis as well as its outcome.
Keywords: Meningitis, Outcome, Etiology, children
Title: Prevalence of Gastroesophageal Reflux in Children
Authors: Mahesh Chand Meena, Yogesh Yadav, Kavita Yadav
Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. As per definition we can understand gastroesophageal refers to stomach and esophagus, and the reflex means flow back. It is very common in infants and most common cause is vomiting during infancy. Up to 67% of healthy infants manifest more than one regurgitant episode daily. The peak incidence of symptomatic infantile reflux weather pathological (GERD) or not, is 4 months of age. This resolves in most infants by 1-2 years of age, unlike the pattern in children who are older than 3 years, less than 50% of who have spontaneous resolution of symptoms 5