Title: Gingival Aggressiveness during Pregnancy
Authors: Dr Arvind Garg, Dr Asmita Arora, Dr Shweta Aggarwal, Dr Arun Garg, Dr Viniti Goel
Increased circulatory hormones especially progesterone during pregnancy leads to increase in severity of gingivitis. a fibro-granulomatous lesion can sometimes develop during pregnancy and is referred to as pregnancy granuloma. Pregnancy granuloma or pregnancy tumor occurs in 0.2% to 9.6% of pregnancies. They are clinically and histologically indistinguishable from pyogenic granulomas occurring in non-pregnant men or women, appearing most commonly in second or third month of pregnancy. The authors here report a case series of pregnancy tumors depicting the hormonal influence as an important etiological factor. The hormonal changes occurring during pregnancy may be associated with generalized or localised gingival enlargement and the presence of local factors such as microbial plaque may accentuate the gingival response. Rarely the enlargement bleeds spontaneously and can cause serious complications during pregnancy.
Key words: pyogenic granuloma, pregnancy tumor, granuloma gravidarum
Title: Hemangiolymphangioma of Neck – A Rare Case with Review Report
Authors:Prof. Dr C.V. Kulkarni, Dr Parul Nema, Dr Harshul Patidar, Dr Swati Soni, Dr N P Tiwari
Hemangiolymphangioma is a very rare benign vascular neoplasm, of both the lymphatic and the blood vessels. We report a case of hemangiolymphangioma in a 3 months old female presented with multiple swellings in postauricular region measuring 2.0 x 1.5 cm in greatest dimension, present since birth, gradually increasing in size. On histological examination of excisional biopsy shows features of hemangiolymphangioma.
Keywords- Hemangiolymphangioma, rare vascular neoplasm, post auricular swelling
Title: Clinicohematological Profile of Anemia in Hospitalized Elderly Patients
Authors: N. R. Humaney, Dr. Zeeshan Ahmed, Dr. R. P. Mundle
All elderly patients more than 60 years of age admitted in a tertiary care centre over a period of two years. It is a hospital based cross-sectional study in the department of medicine over a period of two years from October 2010 to October 2012 in which 116 patients were included in the study.
Anemia is a common concern in older people and can have significant morbidity and mortality. Because anemia is a sign, not a diagnosis, an evaluation is almost always warranted to identify the underlying cause. The purpose of this study was to study the clinical profile of elderly patients with anemia and to study characteristics of haematological types of anemia in such patients as well as the closest possible etiological profile.
The maximum number of patients (49 males and 31 females) was in age group of 60-69 years. The mean Haemoglobin in present study for males was lower (8.94 ± 1.98 gm/dl) as compared with female patients (9.12 ± 1.83 gm/dl). Normocytic anaemia was the most common anaemia with 61.21% followed by Microcytic anaemia18.1% followed by Macrocytic and Dimorphic anaemia 12 (10.34%). Number of male patients were more in each type of anaemia especially normocytic anaemia though in Microcytic anaemia number of female patients were more. The most commonly observed etiological factor was Chronic Kidney Disease (43.96%), followed by Pulmonary Koch (14.65%) and Alcoholic liver disease (10.34%). Rest of the etiological factors occurred in less than 10% of the cases.
Key Words: anaemia, elderly, etiology.
Title: Prolonging the Block: Current Options
Authors: Dr. Prasanna Vadhanan , Dr. MithunBalachandran , Dr. Debendra Kumar Tripathy
Prolonged peripheral nerve blocks are desirable in several situations, and several methods are currently employed to achieve a prolonged sensory block. Additives added to single shot peripheral nerve blocks can cause modest prolongation of analgesia. continuous peripheral nerve blocks, even though costlier and technically difficult is the most effective way for prolonging the block for days. Newer formulation of local anesthetics and innovations in drug delivery systems also can help in increasing the duration of the analgesia for several hours.
Title: Combined Tissue and Mesh Repair for Midline Incisional Hernia
Auhors: Dr.Ketan Vagholkar, Dr. Abhijit Budhkar
Background: Midline incisional hernia is one of the most complex hernia to treat. A variety of repairs have been advocated. However no single repair can be called the best. A combination of repair methodologies is therefore the only hope for developing a repair which will have least recurrence rate.
Objectives: The present study aimed at evaluating a combined tissue and mesh repair for midline incisional hernias.
Materials and Methods: Fifteen patients undergoing a combined tissue and mesh repair were evaluated. The tissue repair comprised of creating flaps from the rectus sheath to create a new midline. This was followed by mesh reinforcement of the newly created midline.
Results: There were no recurrences in any of the patients at a mean follow up of 16.7 months.
Discussion: The pathophysiology and technical details are evaluated and discussed.
Conclusion: A combined tissue and mesh repair is an excellent and economical option for midline incisional hernias
Key Words: Incisional, Hernia, Open, Tissue, Mesh, Repair
Title: Anemia in Patients with Type 2 Diabetes in Absence of Renal Impairment
Authors: Salah A Argoon, AL-moataz-Bellah Safwat, Heba A Abd El-Hafeez
Objectives: this study aims to determine the prevalence of anemia in patients with type 2 diabetes in absence of renal impairment and its association with microalbuminuria and estimated glomerular filtration rate (eGFR).
Materials and Methods: this study included 100 patients with type 2 diabetes without renal impairment (eGFR≥90ml/min) and 35 healthy subjects as control group. For all studied subjects, full history, physical examination and the following laboratory investigations were done: complete blood count, fasting and postprandial serum glucose, hemoglobin A1c, serum creatinine, eGFR, spot urine analysis for microalbuminuria.
Results: the study showed that anemia was present in 34% of patients with type 2DM in absence of renal impairment. The anemic diabetic group had a significantly longer duration of diabetes , significantly lower eGFR and significantly higher urinary albumin excretion rate than the non-anemic diabetic group with P- value=0.000 for each. In the diabetic patients, the study showed that the hemoglobin level had highly significant negative correlation with the duration of diabetes (r=-0.370, P=0.000) and the urinary albumin excretion rate (r=-0. 508, P=0. 000), while it had highly significant positive correlation with eGFR (r=0. 359, P=0. 000).
Conclusions: we concluded that the prevalence of anemia in patients with type 2 diabetes in absence of renal impairment was 34%. The diagnosis of anemia in diabetic patients may be good indicator for early diagnosis of kidney injury and diabetic nephropathy, therefore hemoglobin level can be used as a simple tool for diabetic patients’ follow up.
Keywords: anemia, type 2 diabetes, normal renal function.
Title: Anticipatory Postural Adjustment of the Core Muscles during Forward Arm Reaching in Children with Spastic Diplegia
Title: Comparison of Two-Dimensional and Three-Dimensional Ultrasound Mammography to Characterize Benign and Malignant Breast Masses
Authors: Dr. Mwahib Sid Ahmed, Mohamed Osman Aldosh
The increased quality of images obtained with ultrasound has allowed investigators to define the characteristics of specific breast masses. Although various Classifications are in use ,most investigators agree to characterize masses using four categories: shape of the lesion, margin characteristics, depth : width ratio and internal echogenicity. Within these categories, individual features show variable diagnostic value, as there is known overlap between benign and malignant characteristics. In this study the value of these criteria in discriminating between benign and malignant masses were assessed. The main aim of this study is to compare and identify better diagnostic accuracy of ultrasonography, two-dimensional and three-dimensional mammography that represents an interesting adjunct to the characterization of breast lesions. And also to describe the appearance of normal breast tissue and breast masses with different ultrasound modality to evaluate the contribution of this to the diagnosis of breast masses
Keywords: Breast cancer;Diagnostic imaging; Ultrasonography; Mammography; Two-dimensional; Three-dimensional; benign ; malignant
Title: A Study of Knowledge Attitude and Practices of Biomedical Waste Management at a Tertiary care Hospital, Kolkata
Author: Dr.Reena Ray (Ghosh), Dr. Tamal Kanti Ghosh, Dr.Narendra Nath Hait, Dr. Rathindra Nath Ray, Mr. Sujit Mishra
Despite the statutory provision of Biomedical Waste Management, practice in Indian Hospitals has not achieved the desired standard even after years of enforcement of the law. In view of this, the present study on Knowledge, Attitude and Practice (KAP) on the subject was carried out in a tertiary level teaching hospital, School of Tropical Medicine. The hospital under scrutiny for KAP is a 150 bedded super specialty teaching hospital and research centre with latest facilities. The Institute has a work force of 330 doctors, nurses and other support staff. The study is based on a questionnaire designed to understand the KAP of the staff involved in direct patient care facility regarding the biomedical waste management practices. The KAP study enrolled 140 respondents, representing doctors and nurses from selected patient care areas; here, a significant gap was observed in the knowledge, attitude and practice of the consultants, residents and scientists with regard to biomedical waste disposal, to their knowledge/understanding on the subject.
The definite apathy of intellectuals towards the operational aspects of the BMW management system can be attributed to the tubular vision of the professionals that is mainly focused on the curative aspects of the patient care services, with lack of understanding towards the role of support services in the overall context of comprehensive health care delivery. Nursing professionals on the other hand, had an edge over the clinicians as far as attitude and practice of BMW mgmt. is concerned although their knowledge on the subject was relatively low. This can be attributed to their accountability and commitment in ward management and the predominance of female workforce, which is by and large more disciplined. The Para-medical staff including laboratory and housekeeping staff had least understanding on the subject, but had higher positive attitude with more practical habits, which may be attributed to strict instructions by authorities and fear for any punitive action.
Title: Antihyperlipidaemia Effect of Almond Nuts (Prunus Amygdalus) on Diabetic Rats
Authors: Brown Holy, Onwuli, Donatus Onukwufor , Okeke, Chukwubike Udoka
This study examined the antihyperlipidaemic effect of Almond seed (Prunus amygdalus) on Alloxan induced diabetic rats. Sixty male albino rats were divided into six groups (A-F) representing the positive and negative controls, and the test groups for four weeks were used. Diabetes were induced in groups C, D, E and F, except for group A and B which served as the positive control and negative control, respectively. Diabetic rats with blood glucose level greater than 11.00mmol/l were included in the study. The test groups were fed with 60g of prepared almond granules while the controls were fed with standard feed for four weeks. Lipid profile tests were performed weekly. The results of the positive and negative control gave significant increase in TC, TG and LDL, but none in HDL. There was significant decrease in the TC, TG, and LDL levels of the test group compared with the control for week1-4 (p<0.05). While there was significant increase in the HDL level of the test group compared with the control. Almond seed has the potential for improving the lipid profile in diabetic rat model.
Key word: diabetes, cardiovascular, arthrosclerosis Prunus amygdalus, almond, lipid
Title: Current Evaluation for the Frequency of Portal Vein Thrombosis and Its Impact among Egyptian Cirrhotic Patients
Authors: Soha E. Khorshed , Hala I M Husseisn , Inas M. Elfiki
Background: Development of portal vein thrombosis (PVT) is a significant milestone in the natural history of cirrhosis.
Aim of the Study: Evaluation of frequency of portal vein thrombosis in cirrhotic patients, determine the possible associated risk factors and consequence of portal vein thrombosis in cirrhotic patients.
Patients and Methods: The present study was conducted on 500 cirrhotic patients. All patients were subjected to routine investigations, upper gastrointestinal endoscopy and abdominal ultrsonography with portal doppler examination.
Results: The present study revealed portal vein thrombosis (PVT) in 89 patients with frequency 17.8% of PVT among cirrhotic patients.Hepato cellular carcinoma (HCC) was the commonest risk factors of portal vein thrombosis followed by sclerotherapy. Hepatitis C was present in 88.8% of patients with portal vein thrombosis. Elevated liver enzymes, bilirubin and alpha fetoprotein were significantly increased in patients with PVT in comparison with those without PVT. Child C class showed highly statistically significant increase in patients with portal vein thrombosis. The incidence of portal vein thrombosis in cirrhotic patients who underwent splenectomy was 50%. Portal vein and spleenic diameter,were significantly increased in patients with PVT in comparison with those without PVT. Retrograde flow, distention and increased echogenicity at the site of the thrombus in addition to cavernous transformation were significantly observed on Doppler examination of patients with PVT.
Conclusions: PVT is frequently reported in patients with liver cirrhosis especially those with advanced stages as a part from a complex scenario. HCC and sclerotherapy are the most common risk factors of PVT.
Key Words: portal vein, thrombosis, cirrhosis, risk factors, outcome.
Title: Serological Prevalence of Foot and Mouth Disease in Parts of Keffi Local Government Area in Nassarawa State Nigeria
Author: Eugenie Youngo Tchokote
About 80% of screened cattle were found to have been infected at least once with one of the seven serotypes of Foot-And- Mouth-Disease virus in areas of Keffi Local Government Area (LGA) in Nassarawa state. A total number of 108 bovine serum samples was collected from Maygaka, Angwa Ninzo and Kofar Hausa areas in Keffi LGA , with age, breed and sex of the animals recorded. Samples were collected base on previous history of foot And Mouth disease in the herd commonly called “Boro” by the herdsmen. Screening procedure was based on antibodies detection for the non structural protein mainly 3ABC protein in bovine serum regardless of the serotype of FMD virus involved using Chekit-FMD-3ABC ELISA (Bommeli Diagnostics, South Africa). Sample was said to be positive when its percentage inhibition (PI) calculated based on the kit manufacturer’s recommendation was ≥ 30 %. Categorical variables (sex, age and location) were considered. Out of the total sampled animal, 77.08% was found to have been infected at least once with FMD virus with 33.33% of this infection in Angwa Ninzo, 8.33% in Kofar Hausa and 35.42% in Maygaka. There was no sex or breed predisposition to this disease. Prevalence was calculated by dividing the number of 3ABC ELISA positive animals by the total number of animals tested. Chi-square test was used for comparison of variables and tests were considered as significant at P < 0.05.Using double reciprocal simple linear model of analysis, it was observed that there is a significant relationship between and percentage inhibition and age of animal at 95% confidence interval.
Key Words: Seroprevalence, Foot-And-Mouth Disease, Nassarawa
Title: Effect of Sensory Integration Therapy on Foot to Foot Distribution during Gait in Children with Spastic Diplegia
Authors: Nahla M.Ibrahium, Nanees E Mohamed, Kamal Shoukry, Hossam ElSabbagh
Background: The ability to walk is a major concern of the parents of children with cerebral palsy, and improving or maintaining this ability is often considered to be the primary focus of most therapeutic interventions addressing the motor problems seen in children with spastic diplegia. Purpose: to assess the effect of sensory integration therapy on foot to foot distribution during gait in children with spastic diplegia.
Subjects: Twenty spastic diplegic cerebral palsy children were randomly divided into 2 groups 10 of each: Group A (control) and Group B (study), patients of both groups had received the traditional physical therapy program with sensory integration therapy was added to the gait training program for group B.
Methods: The Biodex gait trainer2 was used to assess foot to foot distribution for all patients pre and after 3 months of treatment. Results: results revealed improvement in percent of foot to foot distribution for both groups but with significant improvement for the group B. Conclusion: sensory integration therapy is effective in improving foot to foot distribution during gait for children with spastic diplegia.
Keywords: Spastic diplegia, gait, foot to foot distribution, Biodex gait trainer2, Sensory integration.
Title: Isokinetic Shoulder Torque Development in Children Six through Twelve Years Old
Authors: Samah M. Sheha, Amira M. El Tohamy, Samah A. El Shemy
Muscle strength is necessary for optimal posture and efficient movement to occur. It enables individuals to perform everyday activities without undue fatigue. The purpose of this study was to establish a reference data of isokinetic strength measurements of shoulder flexors and extensors muscles by gender and age. One hundred healthy non-athletic children (50 boys and 50 girls) aged 8 to12 years participated in this study. They were assessed using Biodex isokinetic dynamometer at two angular velocities (60 and 180 degrees per second.). The results revealedsignificant increase in isokinetic strength with gender differences from 8 to 12 years of age.
Key words: Normative values- Isokinetic dynamometer- Shoulder joint-Children-Muscle strength
Title: Thyroid Functional Status in Relation to Hyperglycemia, Body Mass Index in Type-2 Diabetes Mellitus
Authors: Ajay Puri (MD) , Jyoti Kohli (MD), L.Vasantha (MD)
Type-2 diabetics are more prone to develop thyroid disorders. Both are interlinked with each other. A study was conducted on type-2 diabetics without any complications. It was observed that hyperglycemia is closely related to BMI and free T3 levels were significantly reduced in type-2 diabetics. Hence every type-2 diabetics have to be evaluated for thyroid function tests before any clinical manifestation.
Key words: Type-2 diabetes mellitus, Hyperglycemia, thyroid functional status, body mass index.
Title: Predictors of Admission of Patients with Bronchiolitis to the Intensive Care Unit (ICU)
Author: Dr.Adnan Handhil Tarish
Background: Bronchiolitis is a lower respiratory tract infection that occurs in children younger than two years old. It is usually caused by a virus; Bronchiolitis is a common cause of illness and is the leading cause of hospitalization in infants and young children. Bronchiolitis diagnosed clinically and can be treated by adequate fluids and oxygen therapy, but it can cause serious illness in some children and need Intensive Care Units management.
Objectives: To know the predictors of admission of the patient with bronchiolitis to the Intensive Care Unit.
Methods: A prospective, cohort study was conducted during the period from November 2011 to March of 2012 in Babylon Gynecology and Children Teaching Hospital. All our patients (251) aged less than 2 years and diagnosed as bronchiolitis according to the American Academy Of Pediatrics definition were enrolled in the study. Regular ward admission and ICU admission were compared.
Results: Two hundred fifty one patients were studied, 215 (85.7%) were admitted in regular ward and 36 (14.3%)patients were admitted in Intensive Care Unit(ICU) .Emergency department predictors of ICU admission were age less than 3 months(mean 3.15±2.5 VS 4.8±4.5: P value 0.002), formula feeding(36% VS 13% :P value 0.005), low oxygen saturation SPO2 (83.2%±7.3 VS 92.1%±4.5 :p value 0.000), rapid respiratory rate(64.3±7 VS 55.07±8.1 breaths/min :P value 0.000), and inadequate oral intake(97% VS 59% P value 0.000). Other factors like family history of asthma, eczema, sex, breast feeding, birth weight, heart rate and chest x rays finding were not associated with ICU admission.
Conclusion: Age of less than 3months, formula feeding, low oxygen saturation SPO2 (83%), rapid respiratory rate, and inadequate oral intake are all predictors of ICU admission in children with bronchiolitis.
Keywords: Bronchiolitis, Intensive care unit, Emergency Department(ED). Asthma, SPO2, RR (Respiratory rate), HR (Heart Rate).
Title: Tomosynthesis Mammography
Author: Dr. Mwahib Sid Ahmed Aldosh
Advanced digital mammographic technology such as digital breast tomosnythesis is an exciting new development for breast cancer screening and diagnostic applications. An understated but important aspect of DBT theory is that the basic technology used is mammography. To date, mammography is the only screening imaging technology which has proven itself in randomized controlled trials to show survival benefit. Improvement in mammographic technology with DBT would therefore be closer to the original mammographic methods than other competing technologies such as MR, ultrasound, or CT with the clinical implication of improved screening. This study discusses recent developments in advanced derivative technologies associated with digital mammography. Digital breast tomosynthesis – its principles, development, and theoretical aspect are reviewed. Radiographic imaging techniques ,combined imaging systems with digital mammography and ultrasound and Potential Clinical Benefits are also discussed. Although all these methods are currently research programs, they hold promise for improving cancer detection and characterization if early results are confirmed by clinical trials.
Keywords: Tomosynthesis, Breast Cancer, Digital imaging technique, Theory, Mammography,Ultrasound, Clinical Benefits
Title: Profile of Low Vision Population Attending Retina Clinic, RIMS, Imphal Manipur
Authors: Dr.Wobenthung Tsopoe,Dr.Laishram Usharani,Dr. Santosh Kumar
The main purpose of the study is to assess the cause of low vision over a period of 15 months. A retrospective study of 168 patients examined at Retina clinic, RIMS, Imphal over the period of 15 months was reviewed and information was extracted. The low vision patients in the clinic are referred from general eye OPD and from different specialty clinics in the center. Age and gender, occupation, house location, cause of visual impairment were analyzed. The majority of patients (33.93%) were from the age groups between 45-59 years of age. Older age group more than 60 years comprised of 28.57%. A significant numbers of low vision patients were also found in younger age group <16 years (8.33%). 58% patients were male and 42% were female. Male were found to be predominant in all age groups. The major cause of low vision was found to be diabetic retinopathy (23.21%) followed by other Retinal vascular diseases (11.90%), choroidal lesions (10.71%), uncorrected RE and Amblyopia (8.93%), Retinitis Pigmentosa (7.74%), and ARMD (5.35%).
Keywords: amblyopia, choroidal lesions, diabetic retinopathy, low vision, retinitis pigmentosa,
Title: HIV Threat: A Study Among Blood Donors
Authors: Dr Leena Talukdar, Dr Usha Sarma, Mrs. Bidula Sarmah
Background: The Human Immunodeficiency Virus (HIV) has been able to threaten the human population all over the world. Among the various routes of spread of HIV, blood transfusion is a major route. So, an integrated strategy for blood safety is of utmost necessity for elimination of transfusion transmitted HIV infection.
Materials and Methods: A total of 15594 blood units from both voluntary and replacement donors were screened for the presence of HIV antibodies using 3rd generation ELISA.
Results: Of the total blood units screened, 225 were found to be positive for HIV antibodies.
Conclusion: HIV seropositivity among blood donors is a challenging task for safe transfusion services. So, blood units collected for transfusion should be tested using methods with the least false negativity, so that, transfusion transmitted HIV infection can be minimized, if not eliminated.
Key words: Blood transfusion,seroprevalence,transfusion transmitted infection,blood donors.
Title: Prevalence and Predictors of Hypertension among the Elderly Population in Rural Areas of Allahabad District: A Cross Sectional Study
Authors: Naveen KH, Sumanth MM, Manjunatha SN, Hassan MA, Dwivedi S
Background: Hypertensive heart disease is one of the major reasons for the cardiovascular mortality. By age 60 approximately 60% of the population develops hypertension. With background of increasing proportion of elderly in India the study of epidemiology of hypertension among elderly is an important area for research.
Objective: To study the prevalence of hypertension and factors associated with it among elderly in rural areas of Allahabad.
Methodology: Cross sectional community based study done in rural areas of Allahabad during 2007-08. Multistage random sampling method was used. A total of 411 elderly persons aged 60 years and above were studied from the 8 villages each from 2 community development blocks Jasra and Bahadurpur area. The subjects were interviewed and examined using a predesigned and pretested proforma. Univariate and multivariate analysis was done.
Results: Prevalence of hypertension was found to be 45%. In the univariate analysis occupation, socio economic status, food habits, BMI, diabetes mellitus and anaemia were found to be significantly associated with hypertension at 5 percent level. Age group, education, family type and current tobacco use were significant at 10 percent level. On logistic regression analysis upper socio economic class, mixed food habits (consuming both vegetarian and non vegetarian diet), normal BMI (18.09-22.25) and overweight and obese BMI (>22.25) and diabetes mellitus were found to be significant predictors of hypertension among the elderly people.
Conclusion:The prevalence of hypertension was high. The significant predictors are upper socio economic class, mixed food habits overweight and obese BMI (>22.25) and diabetes mellitus.
Key words: Hypertension, prevalence, predictors, elderly, rural Allahabad
Title: Pattern of Musculoskeletal Affectation among Poliomyelitic Patients in Kano, Nigeria
Authors: Bashir Bello, Naima Umar Aliyu
Background: Poliomyelitis is a contagious and infectious disease caused by the polio virus. The disease has been eradicated from developed countries but still remains one of the most crippling diseases affecting children in the third world countries particularly in Nigeria. The purpose of this study was to determine the pattern of musculoskeletal affectation among polio patients in Kano metropolis with the aim of providing data that will help enhance and/or develop new rehabilitation strategies in the management of post polio syndrome.
Setting: All rehabilitation clinics in selected hospitals; NOHD, MMSH, MAWSH and AKTH in Kano.
Participants: Fifty patients (22 males and 28 females) with specific musculoskeletal affectations ranging from mild muscular atrophy and limb shortening to severe fixed flexion deformities involving the hip, knee and ankle joints were assessed in the study.
Materials: Standard clinical tools; the goniometer used to assess the range of motion and the tape rule to measure degree of atrophy and limb length discrepancy and a scale; Medical Research Council muscle grading scale (MRC) to assess the muscle power.
Results: Data collected was analyzed descriptively and inferentially using the statistical package for the social sciences (SPSS 15.0). The study showed that gender had no significant effect on the pattern of musculoskeletal affectation at (χ2 =2.402, p≤0.05). The study showed Fixed Flexion Deformity (FFD) of either the hip, knee or ankle joints accounted for 37(74.0%), limb length discrepancy on the other hand accounted for 47(94.00%), atrophy of the thigh muscles 47(94.0%) and atrophy of the calf muscles 46 (92.0%) of the total. The muscle power varied in each muscle group assessed ranging from (0 – 3) in general. the participants ranging from a flicker of movement, to movement of the limb against resistance.
Conclusion: Poliomyelitis is a disabling disease affecting both males and females with equal distribution, majority of patient presents with lower limb affectation. Fixed Flexion Deformity compromised range of movement mostly of the knee and ankle joints of participants while only a few had that of the hip joint.
Title: Iron Status in Preeclampsia – A Study from South India
Authors: Deepa V Kanagal, Aparna Rajesh, Ullal Harshini Devi, Harish Shetty, Prasanna kumar Shetty, Sucheta Kumari
Preeclampsia is one of the major causes of maternal and fetal morbidity and mortality. Though the etiology is obscure, studies indicate the role of increased oxidative stress due to endothelial dysfunction in preeclampsia. The aim of this study was to find out iron status parameters in preeclamptics and their comparison to normotensive pregnancies. This study was done in a medical college hospital in South India. 60 women with preeclampsia and 60 normotensive pregnant women were analyzed for serum iron, ferritin and hemoglobin levels. Pregnancy outcome in both groups were compared. Data were expressed as Mean ± Standard Deviation. Comparison of serum levels of the elements was performed by Independent t test and Chi square test and P value of < 0.05 was considered as statistically significant. Mean serum iron and ferrtin levels in preeclamptics were significantly higher compared to normotensives whereas hemoglobin levels did not show much difference. Also preeclamptic women were older, with higher BMI and lower birth weight compared to normotensives. The higher serum iron and ferritin levels might play an important role in the etiopathogenesis of preeclampsia. Therefore, pregnant women with higher serum iron and ferritin levels should be investigated for preeclampsia. Iron status of pregnant women should be assessed before giving iron supplements as these may cause more harm than benefit.
Key Words: Preeclampsia, Serum Ferritin, Serum Iron, Hemoglobin
Title: Biosafety Measures in Laboratory Services of a Tertiary Care Hospital
Authors: Malik Aubid, Yatoo G H., Malik Amina, Hamid Shahnawaz
Objective: To study the Biosafety Measures undertaken in a laboratory of a tertiary care hospital.
Material and Methods: A prospective study for a period of one year was conducted. The study encompassed collection of data regarding Biosafety measures in central laboratory of SKIMS using the following methods.
1. Observational study
2. Study of records.
Results: Study revealed that in 81% of observations “hand washing “was vigorously practiced. In 88.5% of observations use of “laboratory coats” was followed by the staff working in the central laboratory. Mouth pipetting was not common as in only 33% of observations it was practiced. There was only 0% use of goggles, masks and face shields when required. There were no biosafety cabinets. In most of the observations (98.8%) the working staff desisted from eating and drinking within working area. There were neither any protocol available for incident reporting in case of accidental needle pricks or spills nor any compliance for the same 64.5% of lab. Staff was fully immunized against HBV. The findings revealed that in most of the areas subjects to testing revealed gross contamination.
Conclusion: In 81% of observations “hand washing “was vigorously practiced. In 88.5% of observations use of “laboratory coats” was followed by the staff working in the central laboratory. There were no biosafety cabinets available in the central laboratory. In most of the observations (99.8%) the working staff desisted from eating and drinking within the working area. There was neither any protocol available for incident reporting in case of accidental needle pricks or spills nor any compliance for the same .64.5% of lab. Staff was fully immunized against HBV. There exists a standard policy for disinfection of various lab equipment and laboratory area.
KEY WORDS: Biosafety,Hand Washing,Laboratory Coats,Biosafety Cabinets
Title: A Rare Case of Central Pontine Myelinolysis
Authors: Dr. Jayadeva Phurailatpam, Dr. B.N.Kishore Kumar, Dr.Anil Kumar Sakalecha, Dr. Rajkumar
A 70 years old woman presented to emergency department with generalized weakness and altered speech since 2 weeks followed by altered sensorium. There was history of loss of consciousness and fall at home.
There is evidence of ill-defined confluent T2/ flair hyperintense signal and restriction on DWI noted at the central pons – Central pontine myelinolysis.
The earliest change is seen on DWI with restriction in the lower pons. This is seen within 24 hours of the onset of quadriplegia.
Title: Impact of Backward Gait Training on Mediolateral stability index in Children with Hemiparesis
Title: Efficacy of Unweighing System During Over Ground Walking Versus Treadmill Training on Walking Speed in Spastic Diplegic Children
Hamada S. Ayoub, Amira M. El Tohamy, Eman I. El Hadidi, Ali M. Abdulmonem
Background: The ability to walk is a major concern of the parents of children with CP, the main problem in spastic diplegia is walking difficulty. Balance disturbance, muscle weakness, spasticity and deformities result in abnormal gait patterns typical for diplegic children.
Objective: The purpose of this study was to compare the effect of unweighing system during over ground walking versus treadmill training on walking speed in children with spastic diplegic cerebral palsy.
Methods: Twenty children with spastic diplegic C.P from both sexes, with Gross Motor Function Classification System levels (II & III) and mean age 7.4 years, participated in this study. They were classified into two groups, group (A) who received partial body weight support (30% weight release) with over ground walking and selected physical therapy program, and group (B), who received partial body weight support with treadmill training and selected physical therapy program. Walking speed was measured before and two months after treatment program through using Biodex Gait Trainer II.
Results: The results revealed statistically significant improvement (P<0.05) in walking speed for both groups with insignificant difference between both groups.
Conclusion: These findings suggested that unweighing system can be used during treadmill training or over ground walking to improve walking speed in spastic diplegic children while it is better to be used with over ground gait training.
Key Words: Cerebral palsy, Diplegic, Unweighing system, Gait training.
Title: Cytological Evaluation of Premalignant and Malignant Oral Lesions by Oral Brush Cytology
Authors: Gupta Vinny, Gupta Mukesh Kumar, Bhargava Sunita, Mogra Narendra
Context - Oral brush cytology is easy, chair side non invasive, painless test that can be used to evaluate any suspicious lesion including common small white and red oral lesions to rule out dysplasia. The use of brush cytology without computer-assisted analysis using toothbrush is less expensive and may have applications in resource-challenged areas and could be a risk-free method of evaluating oral lesions.
Aims -The present study was aimed at assessing the reliability of oral brush cytology in the detection of potentially malignant disorders and malignant lesions of the oral cavity in terms of sensitivity and specificity when compared with biopsy examination.
Material and Method –The study was conducted on fifty patients with oral lesions. All patients underwent oral brush cytology using conventional tooth brush followed by punch biopsy. The cytological diagnosis was compared with histopathological diagnosis using Mann Whitney U test.
Results - The sensitivity, specificity, positive and negative predictive values of brush cytology in detecting dysplasia and oral squamous cell carcinoma were 84.21%, 83.33%, 94.12% and 62.5% respectively. Application of Mann-Whitney U test showed that there was no significant difference (p value > 0.05) between histopathology and brush cytology in assessing both premalignant and malignant oral lesions.
Conclusion - The cytological study of oral cavity cells is simple, rapid and relatively painless: it is thus well accepted by patients and suitable for routine application in population screening programmes, for early analysis of suspect lesions, and for pre and post-treatment monitoring of confirmed malignant lesions.
Key words: brush cytology, malignant lesions, oral lesions, potentially malignant disorders
Title: Evaluation of Serum Uric Acid in Hypertension
Authors: B. Anil Kishore, K. Madhavi, M.Indira, Y. Ruth Lavanya, B. Shobharani
Objective: We carried out a study in Sri Venkateswara medical college, Tirupati during a period of 12 months to examine the relationship between serum uric acid and hypertension.
Methodology: A total of 150 patients were studied of which 75 were cases and 75 as controls. The patients were included if they satisfy the JNC VII criteria for hypertension 2.
Results:The study showed that serum uric acid levels were raised in patients with hypertension in comparison to normotensives. The Mean Serum Uricacid levels between hypertensives and normotensives were 7.02± 1.12 and 4.86± 0.68 respectively. p - value = 0.001 which is shown to be significant.Our study showed significant rise in serum uric acid in hypertensives.
Conclusion High serum uric acid concentrations may increase serum sodium reabsorption at nephron sites proximal to the distal tubule, and it has been proposed that metabolic perturbations such as hyperinsulinaemia may mediate some of the effects of hypertension. Hyperuricaemia may represent the culmination a multimetabolic syndrome in which insulin-mediated renal haemodynamic abnormalities lead to hypertensive renal damage. Hyperuricemia is observed in hypertension may be due to a decrease in the renal blood flow and early nephrosclerosis.
Title: Migrated Intra-uterine Contraceptive Device: The Need for Proper Counselling
Authors: Dr Ezenwa E. V, Dr Uche-Ibe N. A
The migration of IUCD into the bladder has been reported in several literatures1,2. This sometimes occurs at the time of insertion when the uterus is perforated, but may also occur by erosion into uterus and bladder following insertion1. The device is a common method of contraception in the developing world due to its low cost, efficacy and availability3. We present the case report of a 40 year old infertile female who had an unconsented forgotten intra-uterine copper-T contraceptive device that migrated into the bladder.
Title: Prediction of Difficult Airway-Ratio of Patient’s Height to Thyromental Distance
Authors: Suresh Y V, Anupama Suresh Y, Amrutharaju C M
Preoperative evaluation is important in the detection of patients at risk for difficult tracheal intubation. Thyromental distance (TMD) is often used for these purposes, The purpose of the present study was to evaluate and compare the accuracies of the ratio of patient’s height to TMD (ratio of height to TMD = RHTMD) in the prediction of difficult tracheal intubation. Four hundred patients were evaluated preoperatively using the TMD ,Modified Mallampati test(MP),and RHTMD. The three tests were compared analyzing the area under the receiver operating characteristic curves (AUC). Difficult laryngoscopy occurred in 13 patients (3.3%). The AUC of RHTMD was significantly greater (P<0.001) when compared to TMD, indicating a more accurate prediction by the RHTMD. RHTMD has shown to be highly specific(97.1%) and also sensitive(76.9%) with accuracy(96.5%) in predicting difficult intubation. The study is more sensitive and specific incomparison with MP. Based on our results, we recommend that the RHTMD should be used instead of the TMD.
Key Words: Difficult Airway, Modified Mallampati test, Thyromental distance, Ratio of patient’s Height to Thyromental Distence
Title: Correlation between Epworth Sleepiness Score and Polysomnographic Indices in Sleep Related Breathing Disorders
Authors: Sethu Babu, Beena Thomas, Raveendran Chetambath
Background: Sleep disordered breathing is a common disorder affecting the general population carrying significant functional and physiological consequences. Excessive daytime sleepiness (EDS) is a cardinal symptom of Obstructive sleep apnea (OSA) and in many; it is the presenting symptom also. Although many objective scales are used to assess EDS, Epworth sleepiness scale (ESS) is the most popular method to quantify daytime hypersomnolence. This study is undertaken to find out the correlation between ESS Score and the polysomnographic indices and to evaluate the scientific basis in the prediction of OSA.
Materials and Methods: A total of 85 subjects were included in the study. Symptoms suggestive of OSA were sought in a structured interview. They were asked to fill up the ESS questionnaire in the presence of their partner. A complete physical examination and anthropometry followed by overnight polysomnography (OPS) were done in all patients. ESS score of more than 10 was taken as significant. OSA was diagnosed based on American Academy of Sleep Medicine (AASM) criteria. Statstical analysis was done using EPI INFO statistical software.
Results: ESS score showed positive correlation with all three major polysomnograhic indices namely Apnea-Hypopnea Index (AHI), Desaturation Index (DI) and Snore Index (SI).Linear regression showed that ESS is independently predicted by both AHI and SI.
Conclusions: We may conclude that both Apnea –Hyponea index and Snore index can independently predict ESS. Hence a positive ESS score cannot differentiate between Obstructive sleep apnea and Primary snoring. ESS should not be used as a sole screening parameter for sleep apnea but we have to look into other clinical predictors also.
Keywords: Obstructive sleep apnea, Excessive day time sleepiness, Epworth sleepiness score, Apnea-Hypopnea index, Desaturation index, Snore index
Title: Management of Posterior Urethral Injuries- Our experience
Authors: S V Krishna Reddy, Ahammad Basha
Background: The management of posterior urethral injuries is controversial and much debate continues regarding the immediate, early and delayed definitive therapy.
Objective: We report our institutional experience and long term results of early endoscopic realigment of traumatic posterior urethral injuries and its comparison with delayed realigment and delayed open urethroplasty.
Materials and Methods: A total of 112 cases of post traumatic urethral injuries were admitted between May 2002 to December 2012. Out of which only complete disruption posterior urethral injuries were included in this study, which constituded 48 patients. These patients were divided into 3 groups. All patients had initial suprapubic urinary diversion. Group-1 [n-21] included patients who underwent early primary endoscopic realigment done within 6-8 days after injury. Group-2 [n-12] included patients who were referred for delayed realigment after 4-6 weeks. Group-3 [n-15] included patients who had delayed open urethroplasty after 3 months. The frequency of urethral dilatation, optical internal urethrotomy, were evaluated over a period of 18 months.
Results: Group-1 [n-21] Patients who underwent early primary endoscopic realigment had a mean frequency of urethral dilatation of 2.6 ± 1.8 and optical internal urethrotomy at 1.4 ± 1.6 while Group-2 [n-12] patients who underwent delayed realigment had a mean of urethral dilatation of 0.8 ± 1.2 and optical internal urethrotomy at 3.6 ± 1.4. Group-3 [n-15] patients had mean frequency of urethral dilatation at 1.2 ± 0.9 and optical internal urethrotomy at 0.8 ± 0.4 over period of 18 months.
Conclusion: Early primary endoscopic realignment in our experience reduces time to spontaneous voiding, decrease the need for major reconstructive surgery and long term supra pubic urinary diversion.
Key Words: urethral injury, pelvic fracture, endoscopic realignment
Title: Clinical Profile and Etiological Parameters: Acute Febrile Illnesses in Relation With Thrombocytopenia
Authors: Krishna Sundeep A, Ramakrishna Rao M
Aims: To study etiological and laboratory parameters of acute febrile illness patients in relation with thrombocytopenia.
Material and Methods: This is a hospital based cross sectional study between October 2012 to August 2014, with the diagnosis of acute febrile illnesses with thrombocytopenia like Dengue fever (DF), malaria, leptospirosis, viral infections and typhoid fever. Their clinical and laboratory parameters were compared for the diagnostic utility in acute febrile illness with thrombocytopenia.
Results: Out of 100 cases were collected for the entire study 55 cases were dengue positive, 22 cases were unexplained fever, 11 cases were of septicemia, 7 cases were positive for Malaria and 3 cases were diagnosed as enteric based on blood culture and 2 cases were positive for leptospiral IgM. Among the total 100 cases 65 were males and 35 were females. The most common age group affected in our study was 21-40 years of age. Bleeding manifestations include petechia (55.81%), epistaxis (51.16%), Hematuria (39.53%), subconjuctival Hemorrhages (23.26%), bleeding gums (11.63%), malaena (4.65%).
Conclusion: It is a hospital based cross-sectional study showing the etiological and clinical profile of patients with acute febrile illness in relation with thrombocytopenia.
Keywords: Dengue fever, Leptospirosis, Malaria.
Title: NT-ProBNP As a Diagnostic and Prognostic Marker in Case of NSTEMI Patients.
Authors: Arghyadip Sahoo, Priyanjalee Banerjee
Background: Till date, myocardial infarction presents an alarming situation resulting in high morbidity and mortality. Non-ST elevation myocardial infarction (NSTEMI), becomes quite critical to diagnose from a specific biomarker. In this regard role of NT-proBNP as a prognostic marker in NSTEMI patients could be well considered.
Aim: Objective of this study is to highlight diagnostic and prognostic value of NT-proBNP in treatment of NSTEMI patients.
Methods: 60 NSTEMI patients from outpatient department at Institute of Post graduate Medical Education and Research, Kolkata for a period of six months starting from January 2014 to June 2014 along with 60 age matched controls were included in the study. Serum was collected by centrifugation of the samples at 1500g and stored at -80°C for further analysis. Within first 48 hrs of admission, levels of NT-proBNP was measured. Results were presented as mean ± SEM or number or percentages and further analysis was done by SPSS software.
Results: Among 60 NSTEMI patients, 7 patients expired. Rest 53 patients recovered after treatment and showed significant decline in the NT-proBNP level after treatment
(3565 ± 4261 pg/ml vs pg/ml P<.0001).
Conclusion: It can be aptly stated that for early diagnosis and further prognosis in NSTEMI patients, NT-proBNP plays a crucial role.
Keywords: NSTEMI, NT-proBNP, BNP, myocardial infarction, prognosis.