Volume 02 Issue 05 May 2014

Citation

Title: Assessment of Quality of Life,Depression,Anxiety Tendencies in Patients with Epilepsy: A Hospital Based Study

Authors: Madiha Ahmed, Ayesha Siddiua, Dr. Deepak Ph.D, Dr. Devashish

Abstract

Epilepsy is generally associated with decrease in the quality of life of patients, it causes depression, anxiety and suicidal tendencies in patients. We are conducting this study to test whether the patients are having these symptoms or not. The aim of our study is to assess the patients quality of life, To assess the depression, To assess the anxiety, To assess the suicidal tendencies, Explain the patient about their disease, Help them improve their quality of life, decrease their depression, anxiety and suicidal tendencies through counseling.Standard validated questionnaires:QOLIE-31,GRID-HAMD-17,HAMILTON ANXIETY SCALE (HAM-A),COLUMBIA-SUICIDE SEVERITY RATING SCALE(C-SSRS).Co morbidities in epilepsy are very common and the early detection of such disorders should be done and treated. If unrecognized, it would significantly affect it adversely. The following conclusions were drawn from the analysis of the data. The assessment was found to be effective as the patients were discovered with the related co morbidities of epilepsy and reported.

Citation

Title: Insensitivity To Pain Of Uterine Contractions: A Case Report At A Private Secondary Health Institution In Southern Nigeria

Authors: Babah OA, Okorie O, Ebiti MA

Abstract

Introduction: Ordinarily the labour process itself is expected to be painful as a result of the uterine contractions. However, this might not always be the case, as we have illustrated with the case presented here. This case is unique in that unlike Congenital Insensitivity to Pain with Anhidrosis (CIPA) which affects the entire pain pathways, the loss of pain sensation in this case is restricted to the uterus only. It may be considered a natural or heritable form of labour analgesia.

Case: Presented is a 29 year old primigravida with chronic hypertension who had induction of labour at term. She did not perceive the uterine contractions or felt any pain despite the fact that she was having regular uterine contractions which were clinically palpable, with peak contraction pressures of 100mmHg on cardiotocography (CTG). She only reported pain in the vagina during vaginal examinations and in later stage of labour reported sensation of pressure radiating towards the vagina. Pain sensation was intact in other parts of her body. She said her mother had similar experience in all her deliveries.

Discussion: The cause of this insensitivity to the pain of uterine contractions is unknown. However, possible aetiopathogenesis might be an intrinsic genetic defect due to the familial nature or might be related to the beta-endorphin levels, as it has been found that the level of this hormone increases during pregnancy and childbirth. It induces feelings of pleasure and euphoria during childbirth. Could excessive production of this hormone or exaggerated response of the receptors be responsible for insensitivity to labour pain?

Conclusion: Although the labour process is associated with pain, some women might have painless labour without any form of analgesia as reported here. The cause of this insensitivity to pain of uterine contractions (IPUC) is unknown but might be hereditary, due to an intrinsic genetic defect or an abnormal rise in beta-endorphin levels in labour. This calls for further research.

Key words: insensitivity, uterine contractions, labour.

Citation

Title: Effects of pregnancy on CD4 and CD8 T-lymphocyte subsets and determination of best parameter for assessing immunity in pregnancy

Authors: Babah OA, Oluwole AA, Adeyemo TA, Afolabi BB, Oye-Adeniran BA, Okorie O, Aderolu M

Abstract

Objective: The aim of this study was to assess the effect of pregnancy on CD4+ and CD8+ cell counts, CD4/CD8 ratio and CD4 and CD8 percentages and also determine which of these parameters will be most reliable in assessing immunity in pregnancy.

Study design: This was a case-control study involving 80 healthy HIV seronegative pregnant women and 81 healthy HIV seronegative non-pregnant women. Their HIV status was determined after obtaining an informed consent. Their Full Blood Count, CD4+ cell count and CD8+ cell count were measured by standard laboratory methods. CD4%, CD8% and CD4/CD8 ratio were calculated from results obtained. All data collected were subjected to statistical analysis using Epi Info.

Results: The absolute CD4 cell count was significantly higher (p = 0.00) in non-pregnant women (n = 81, 920 ± 255 cells per microlitre) than in pregnant women (n = 80, 729 ± 232 cells per microlitre). However, the CD4% did not change significantly. The mean ± SD values of CD4% was 39.5 ± 8.4% in the non-pregnant and 36.5 ± 12.2% in pregnant women (p = 0.07). This shows a decrease of 20.8% and 7.6% in the CD4 cell count and the CD4% respectively, in pregnancy from non-pregnant value. There was a 5.8% decrease in CD8 cell count and a 9.3% increase in CD8% in normal pregnancy from non-pregnant values. The CD4/CD8 ratio which combines the two major cells of the immune system (cytotoxic and helper T cells) showed a decrease of 16% during pregnancy. The established population reference range for CD4 count in this study was 262.3 – 1194.9 cells per microlitre in pregnancy and 466 – 1373 cells per microlitre in the non-pregnant state while for CD8 count it was 30 - 779 cells per microlitre in pregnancy and 107 – 752 cells per microlitre in non-pregnant state.

Conclusion: This study showed that pregnancy is a state of physiological immunosuppression and that there is a significant pregnancy effect on CD4 and CD8 T-lymphocytes subsets. Reference ranges in pregnancy differs from those in non-pregnant women and hence great care needs to be taken when interpreting results for these parameters in pregnancy. The results of this study indicate that there is a need to establish and use reference ranges determined for pregnant women. Where this is lacking, the use of CD4/CD8 ratio in pregnancy will be more appropriate as it has narrow range of values and combines the two major cellular immunologic parameters.

Key words: CD4+ cell count, CD8+ cell count, CD4%, CD8%, CD4/CD8 ratio, immunity, pregnancy, reference values.

Citation

Title: Effects of neonatal Thyroid Stimulating hormone and free T4 levels on Apgar score, Maturity and Modes of delivery

Authors: Tabassum Yasmin, Shafat Imam Siddiqui, K.R. Prasad, Naved Ahmad, Akash Gupta

Abstract

Thyroid disorders are four to five folds more common in women particularly during child bearing period. Cord blood is a source for the determination of thyroid related hormones in neonates. To find the effect of TSH and fT4 levels on apgar score of neonates, on term and preterm delivery and on mode of delivery. Total 80 pregnant and 80 non pregnant females were selected and their serum TSH and fT4 levels and cord blood of new born were estimated by ELFA technique on Minividas automated analyser. In our study we have found that there was no significant correlation of serum TSH and fT4 between the cases and controls of both the age groups, between asphyxiated and non asphyxiated neonates and the neonates born by vaginal delivery or caesarean section. Serum TSH was found to be significantly higher in the preterm neonates as compared to term neonates. Our study suggests that TSH has influence on maturity of neonates born to pregnant mothers. But TSH and fT4 does not have any influence on Apgar score and mode of delivery

Keywords – TSH, fT4, Cord Blood, Apgar score, Mode of delivery

Citation

Title: Acquisition of EEG Seizure during ECT

Authors: Kotresh.S, Mukartihal G.B , Sarojini.B.K, Jagadish.T, Gangadhar B.N, Prakash.S

Abstract

Acquisition is a process of obtaining the data from a source. Electroconvulsive therapy (ECT) in which electrical current is used to induce seizures, is an effective treatment in psychiatry. The procedure of ECT essentially involves application of a low frequency electrical stimulus across two electrodes applied over the scalp to induce a generalized seizure for therapeutic purposes. Seizure is the first sign of neurological disease or dysfunction in the newborn. An Electroencephalogram (EEG) is a commonly used non-invasive technique for studying brain activities. EEG is used to study the relationship between the changes in electric potentials in different area of cortex and sub cortical structures.

Keywords-Electroconvulsive therapy, Seizure, Sampling, Electroencephalography, Stimulus

Citation

Title: Evaluation of Oral Ketamine for Pain Relief during Normal Labour in Nigerian Parturients

Authors: Okorie O*, Ezike HA, Iroezindu MO, Obuna JA, Okike CO

Abstract

Background: We evaluated the efficacy of oral ketamine for pain relief during normal labour in Nigerian parturients.

Method: A prospective, non-placebo, single blind randomised study was carried out. Two hundred and seventy three (273) booked parturients in active phase of labour were randomly assigned to three treatment groups (A-C). The dosages of oral ketamine that they received were as follows: Group A- 4 mgkg^-1; group B- 5 mgkg^-1; and group C- 6 mgkg^-1. Pain assessment was carried out using both the visual analogue scale (VAS) and verbal rating scale (VRS). The efficacy criterion was provision of adequate analgesia (i.e. no or mild pain/discomfort) defined as VAS ≤3 and/or VRS ≤2 without anaesthesia. Baseline vital signs of the parturients were taken including pulse rate, blood pressure and respiratory rate. Foetal heart rate was also assessed. Body weight and side effects were recorded. Comparisons of the efficacy and safety of the different dosages of oral ketamine were made.

Results: The minimum sub-anaesthetic dose of oral Ketamine was 4mgkg^-1 with 93.4% efficacy. The 5mgkg^-1 and 6mgkg^-1 gave 95.9% and 98.6% efficacy respectively. Oral Ketamine was associated with a high side effect profile with a statistically significant dose-dependent pattern for dizziness (group A-59.3%, group B-71.4%, group C-75.8%, p=0.04), nausea/vomiting (group A-42.9%, group B-58.2%, group C-60.4%, p=0.03), and hallucination (group A-11%, group B-16.5%, group C-25.3%, p=0.04). Although sedation was commonly reported, it had no impact on pain assessment by VAS or VRS.

Conclusion: The sub-anaesthetic dose of 4 mgkg^-1oral ketamine provided effective labour analgesia with more tolerable side effects. The use of lower doses should be explored in order to reduce the side effects to the barest minimum.

Key words: Analgesia, Efficacy, Oral ketamine, Labour, Sub-anaesthetic

Citation

Title: Ectopic Pregnancy in the Cervix: A Case Report

Authors: Lopamudra Jena,Sasmita Sahoo,Sanghamitra Jena

Abstract

Cervical ectopic pregnancy is a extremely rare condition with potential grave consequences if not diagnosed and treated early enough.We present a case of multiparous lady with history of one cesarean section and two suction evacuations admitted with hemoperitoneum,diagnosed intraoperatively as cervical pregnancy and managed successfully by hysterectomy.

Keywords Ectopic pregnancy,cervical pregnancy,cesarean sectionhemoperitoneum,hysterectomy

Citation

Title: Willingness to Continue Human Papilloma Vaccination by Self, Following a Free First Dose Vaccination Program in Low Resource Community

Authors: Uzoma Maryrose Agwu^1*,Johnson Akuma Obuna¹, Paul Olisaemeka Ezeonu¹, Chinonyelum Thecla Ezeonu², Nnamdi Benson Onyire², Robinson Chukwudi Onoh¹, Chuma Conrad Egbuji¹

Abstract

Vaccination against the Human Papillomavirus has resulted in reduction in the incidence among those who have received the vaccine. The Vaccines is however expensive and may be an impediment to inclusion in immunization schedule. This will necessitate an off pocket purchase if girls are to receive the vaccine. This study assesses the willingness to pay and complete the remaining doses following a free first dose HPV vaccination programme. A questionnaire was distributed to all the mothers, father, relatives who brought their girls for vaccination during a free vaccination of one thousand Young girls at the Federal Teaching Hospital on the 22nd to the 25th of May 2012. Data was analyzed using Epi-info 2008 version 3.5.3 (Atlanta Georgia USA).A total of 299 adults participated. Of this, 29/299 (9.7%) were Fathers, 125/299 (41.8%) were Mother, 59/299(19.7%) were other relatives. The rest were teachers, neighbours or chairperson of local Government areas. A total of 230/299(76.9%) participants indicated the willingness to pay for the next dose of the HPV vaccine if the Federal government was unable to provide the remaining doses free of charge. There is remarkable willingness to pay for the next doses of Human Papillomavirus vaccine despite the cost.

Key words: Human Papilloma Virus, Willingness to Pay, Vaccines

Citation

Title: Sertoli –Leydig Cells Tumor : A Rare Ovarian Tumor

Authors: Aparna Khan, Sima Biswas,Tshering Sherpa, Tamal Mondal, Satyabrata Roy

Abstract

A 14 year old girl presented with 24 weeks lower abdominal lump, hirsutism, clitoromegaly and 3 month amenorrhea. Serum testosterone was 1.34 ng/ml. Ultrasonography identified a mixed echogenic right ovarian tumor of 108×71 mm. A right ovarian tumor of about 20 cm in diameter was removed. Histopathology proved sertoli-leydig cells tumor.

Keywords: ovarian tumor, sertoli-leydig cells tumor

Citation

Title: Pre-Operative Ondansetron Vs. Metoclopramide for Prevention 0f Post-Operative Nausea and Vomiting in Elective Lower-Segment Caesarean Section Under Spinal Anaesthesia

Authors: Sanjul Dandona, Neha Batra

Abstract

Introduction-Post Operative Nausea Vomiting (PONV) is the most unpleasant and distressing consequence in the immediate post-operative period . PONV can delay discharge and may result in unplanned over night hospital admissions. Antiemetic drugs play an important role in therapy of post-operative nausea and vomiting (PONV). Though many drugs have been tried as prophylaxis and treatment of PONV, no drug has been proved significantly effective and hence, the present study was undertaken to compare the efficacy and safety of IV metoclopramide and IV Ondansetron as prophylaxis for postoperative nausea and vomiting in lower-segment caesarean section (LSCS) under spinal anaesthesia.

Methods-After Approval from ethical committee, and an informed, written consent ,all participants belonged to ASA grade I or II and aged above 18 years were divided into 2 groups as, Group-I (n = 50) received Metoclopramide 10 mg i.v. and Group-II (n = 50) received Ondansetron 4 mg i.v. The incidence of vomiting and nausea as number of episodes were studied.

Results -The mean age, weight of the mother and newborns characteristics were not significantly different when compared group-1 with group-2. The episodes of emesis and nausea at different postoperative duration were significantly decreased (p<0.05) in Ondansetron group when compared to metoclopramide group at different postoperative timings..

Conclusion: Therefore the overall results indicated that ondansetrOn is more effective than metoclopromide for the prevention of PONV.

Keywords: LSCS,PONV, Ondansetron Metoclopramide.

Citation

Title: Predisposing Factors for Pulmonary Tuberculosis

Authors: Talha Saad, Jyoti Tiwari , Wahid Khan, Jamal Akhtar

Abstract

Aim of The Work: This study was intended to elucidate the role of different risk factors in the development of pulmonary tuberculosis in our locality in order to avoid exposure to possible risk factors, controlling possible risk factors and therefore decreasing numbers of new cases in our locality.

Patients & Methods This study included (150) of patients with tuberculosis (97 males and 53 females) in whom we studied the risk factors that may be of value in developing pulmonary tuberculosis using a special questionnaire asking about smoking status, family history of tuberculosis, impaired immunity, malnutrition, substance abuse, BCG vaccination, over crowding, occupational exposure, consumption of unpasteurized milk, working in residential care facility places, history of asthma, martial status. All patients passed through chest x rays (PA, Lateral views), Sputum smear for AFB positive or sputum culture for AFB if sputum smear was negative, Tuberculin test, Complete blood count, ESR, urine analysis and blood sugar .

Results and recommendations: Our study included 300 patients who were divided into 2 groups, The 1^st group included tuberculosis patients, While the 2^nd group incorporated by normal peoples (controllers). Age range from 11 to 78 years. It had been concluded that TB is a multifactorial disorder, in which environment interacts with host-related factors. This study provided information for the assessment of host and environmental factors of TB. At the end of this study we can conclude that malnutrition and over crowdness are the most important factors in the development of pulmonary tuberculosis in our locality and so peoples living in rural areas have high susceptibility of the disease than those in urban areas ,also smoking in our locality was un neglected factor although bidi smokers appeared to be more susceptible to pulmonary tuberculosis than cigarette smokers

Key Words: Risk Factors, Tuberculosis, environmental factors, social factors

Citation

Title: The Beneficial Effects of Methanol Extract of Annona Muricata Seeds on Acute Hemolytic Anemia in Albino Wistar Rats

Authors: Agbai Emmanuel Onuk ¹, Mounmbegna Pouonkoussou Emmanuel ², Professor Nwafor Arthur ³

Abstract

The effect of methanol extract of annona muricata seed on packed cell volume, hemoglobin concentration, red cell count, alanine and aspartate aminotransferases, and alkaline phosphatases was investigated using albino wistar rats. Acute hemolytic anemia was induced with phenylhydrazine. The rats packed cell volume was used to determine anemia. Only rats that exhibited anemia were used. They were treated with annona muricata extract for four weeks and these hematological and liver enzymes were investigated. The results showed that extract caused a significant increase in packed cell volume, hemoglobin concentration, and red cell count (P < 0.05), but caused a fall in alanine and aspartate aminotransferases, and alkaline phosphatases (P < 0.05) back to normal. The histopathological studies showed absence of and/or mild liver congestion and inflammation after treatment with extract. The results suggest that annona muricata seed extract is beneficial in the treatment of hemolytic anemia induced liver injury.

Keywords: annona muricata. phenylhydrazine. packed cell volume. hemoglobin concentration. red blood cell. alanine aminotransferase. aspartate aminotransferase. alkaline phosphatase

Citation

Title: Study of Auditory Reaction Time in Premenstrual Phase and Postmenstrual Phase

Authors: Sugata Jadhav ¹, Nishant Bansod ², Saroj Diwanji ³

Abstract

The hormonal changes that occur during premenstrual phase have been implicated as a causative factor for many psychological and physical symptoms. The present study was carried out to determine if there is any alteration of simple auditory reaction time in pre and postmenstrual phase. As reaction time is an indirect index of processing capability of nervous system. In this study auditory reaction time (ART) of 70 female medical students was recorded in pre and postmenstrual phase. The results were compared using paired t test and it showed there is statistically significant increase in ART in premenstrual phase as compared to postmenstrual phase. Thus ovarian hormonal fluctuation across menstrual cycle affects sensorimotor association by modulating neurotransmitter.

Key Words: Auditory reaction time, Ovarian hormones, Premenstrual phase ,Postmenstrual phase

Citation

Title: Estimation of Muscle Strength in Women During the Different Phases of Menstrual Cycle

Authors: Ayesha Juhi¹, Arunkumar VJ ²,Deepali A ³,Harika P ⁴

Abstract

In women, the menstrual cycle is associated with fluctuations in female sex hormones through thenormal 28-30 days cycle.There is a strong link between these fluctuating levels of hormones and their influence on muscle performance throughout the menstrual cycle.In present study, the muscle strength was estimated and compared during the 4 different phases of menstrual cycle in females of 18-40 years for 3 consecutive months. Material and Methods: Maximum Voluntary Contraction (MVC) indicator of muscle strength was estimated using Surface-Electromyography (S-EMG).It was measured and compared during F1(menses),F2(pre-ovulatory),L1(post-ovulatory) and L2(pre-menstrual) for 3 consecutive months.Results:The results showed statistically significant reduction in MVC during F1 and L2 phases when compared to F2 and L1 phases, during which the MVC was significantly increased. The level of significance was fixed at p < 0.05.Conclusion:The present study showed decline in muscle strength during F1 and L2 phases and relative better muscle strength in F2 and L1 phases. During the menses and pre-menstrual phase the estrogen levels are low when compared to high levels of estrogen with its two peaks occurring in pre and post ovulatory phases of menstrual cycle. Estrogen has a beneficial effect on muscle performance. Females are more prone to muscular injuries during those particular phases of menstrual cycle where there is a fall in estrogen levels. Hence, it should be a long term objective of clinicians, female athlete coaches and researchers to consider the factors that make women more susceptible to injuries during specific periods of menstrual cycle and consider changes in exercise and working modules to prevent these injuries and bring out the best performance.

Key words: Menstrual cycle, Maximum voluntary contraction, Surface-EMG, Estrogen.

Citation

Title: Cornelia De Lange Syndrome in a Torch Positive Infant: Case Report

Authors: Dr. Shubhankar Mishra¹, Dr. Sushree.S.Behura², Dr .Sunil K.Agarwalla³

Abstract

Cornelia de Lange syndrome (CdLS) is a rarely seen autosomal dominant syndrome presented with facial dismorphism ( Microbrachycephaly , synophrys, arched eyebrows, lowest ears, long eyelash, wide spaced teeth, upturned nose) ,characteristic cry ,behavioral problems ,feeding problems ,growth retardation ,motor delay, upper limb reduction defects that range from subtle phalanges abnormalities to oligodactyly (missing digits) ,systemic defects etc. Heterozygous mutation in NIPBL or cohesion structural components, SMC1L1, SMC3 identified in major number of patients. Genetic study shows the association of chromosome no. 10, 5 and X most commonly. We present a case of mild CdLS which was TORCH screen positive in her newborn period .Clear cut diagnosis was made from morphological features of the child after ruling out all systemic complication of the child it was marked mild variant of CdLS .

KeyWords: Cornelia de Lange syndrome (CdLS) ,TORCH infection ,Facial abnormality, cohesin complex

Citation

Title: Intrahepatic Cholangiocarcinoma with Hydatid Cyst: A Case Study

Authors: Prof. Dr. C.V. Kulkarni,. Dr. Meena Mittal, Dr. Narmada Prasad Tiwari

Abstract

Parasitic infection leads to cholangiocarcinoma is infection by Opisthorchis sinensis but association between hydatid disease and cholangiocarcionoma is not known. We report a case of hydatid cyst liver with intrahepatic cholangiocarcinoma. Hydatid disease caused by Echinococcus granulosus .

Keywords-- hydatid disease, cholangiocarcinoma, Opisthorchis sinensis. Parasitic infection leads to cholangiocarcinoma

Citation

Title: Alopecia Areata and Lichen Scleroses Et Atropicus - A Rare Co Association

Authors:Muktamani Gurumayum, RajashekarT.S, Jisha Pillai, Harish Prasad

Abstract

Alopecia areata (AA) frequently occursin association with other autoimmune diseases such as thyroid disorders, anemias and other skin disorders.It is thought that some possible triggers like viruses, infection, medicines, sunlight, or other environmental factors prompt the immune system to attack the body's own tissues. It may be that the same environmental trigger activates more than one form of autoimmune disease.We report a case of alopecia areata with lichen scleroses et atrophicus a rare association among the autoimmune diseases.

Key Words: Alopecia areata, Lichen scleroses et atrophicus, Autoimmunity.

Citation

Title: Evaluation of Mammography, Sonomammography in Correlation with Fine Needle Aspiration of Breast Lumps

Authors: Dr. Jayadeva Phurailatpam, Dr. Anil Sakalecha, Dr. Csbr Prasad, Dr. B.N. Kishore Kumar, Dr. Purnima Hegde

Abstract

Objectives

1.To evaluate the role of mammography and sonomammography independently and in combination and correlating with FNAC for early diagnosis of breast lesions.

2.Benign To study the characteristics of mammography and sonomammography in detecting breast lesions and differentiating from benign and malignant lesions

Methods

75 female patients attending Department of Radio diagnosis with breast lumps over a period of 18 months were assessed using mammography, sonomammography and comparing with FNAC finding.

Results

A total of 75 patients were included in the study, with age ranging from more than 30 yrs. diseases (64 %) were more common than malignant (36 %), of which fibroadenoma constituted 42.6 % of cases.

The sensitivity, specificity, positive and negative predictive values of mammography is 92.3%, 91.8%, 85.7%, 95.7%; Sonomammography is 80.7%, 100%, 100%, 90.7%; Combined imaging modality is 92.3 %, 100 %, 100 % and 96.0% respectively.

Conclusion

Combined imaging modalities of mammography and sonomammography play an important role in diagnosing palpable breast lesions.

Its applications help:

a)Better characterization of the breast lesions.

b)Avoiding unnecessary investigations or surgical procedures in which imaging findings are unequivocally benign.

c)Negative findings on combined mammographic and sonomammographic imaging studies have very high specificity and are reassuring to the patient.

Key Words: Mammography, sonomammography, FNAC, Combined imaging modalities.

Citation

Title: A Study of Pattern of Medico-Legal Cases in a Premier Hospital in Delhi

Authors: Jitesh Dhingra, Girish Arora, Paschal D’ Souza

Abstract

Employee State Insurance Hospital (ESIH) is catering to the worker population and their dependants and so occupation related medico-legal cases are expected to occur more in such a hospital.

This study was done to analyze the pattern of medico-legal cases coming to an insurance based hospital covering the worker population in an industrial area. The study revealed that fall from height and road traffic accidents are the leading causes of medico-legal cases even in ESIH rather than occupation related injuries. The study outlines the importance of effective measures to reduce home hazards as a large number of medico-legal cases were due to lack of effective care of children at home. It also highlights the importance of implementation of traffic rules and suggests measure to decrease the road traffic accidents. It reinforces the importance of ergonomics and occupational safety among the worker population.

Citation

Title: The Prevalence and Outcome of Singleton Breech Delivery in Abakaliki, South-East Nigeria

Authours: Obuna JA, Ugboma HA, Agwu UM, Ejikeme BN

Abstract

Background: Breech delivery is associated with maternal morbidity and perinatal morbidity and mortalit y especially in unplanned vaginal route. It is therefore very pertinent to carefully choose the route of delivery during antenatal care or early labour. This is even more important in our environment where there is strong aversion to caesarean section.

Objective: To determine the incidence and outcome of singleton breech delivery among parturients who delivered at Mile Four Hospital, Abakaliki.

Methods: A- 5 year retrospective study of the clinical records and delivery registers of all parturients who delivered at Mile Four Hospital, Abakaliki between January 1, 2007 and December 31, 2011.

Results: The incidence of singleton breech delivery was 4.45%. 60.8% of parturients had assisted vaginal delivery, 51.7% of which were primigravidae. 74.5% of neonates who weighed less than 2.5kg were delivered via vaginal route, while all neonates who weighed more than 4.5kg were delivered per abdomen. Maternal mortality ratio was 529.1/100,000 births. All the women that died were unbooked. The perinatal mortality rate was 8.5/1000 births. Two percent, 7.2% and 16.8% of neonates suffered severe, mild and moderate birth asphyxia respectively. All the neonates who died or suffered severe birth asphyxia were delivered via vaginal route. Complications observed were cervical tear (0.9%), perinear tear (9.7%) and primary postpartum haemorrhage (1.6%).

Conclusion: The incidence of singleton breech delivery in this study falls within the widely reported range of 3-4%. More parturients had assisted vaginal delivery. The proportion of primigravidae who had assisted vaginal breech delivery was quite high. Breech delivery in the unbooked was associated with higher maternal/perinatal morbidity and mortality.

Key Words: Breech delivery, incidence, outcome, Mile Four Hospital

Citation

Title: Introduction of Time and Stress Management Workshop in 1st Year Medical Students: Perception of Students

Authors: Dr. Shaista Saiyad, Dr. Swati Shah, Dr. Neeraj Mahajan, Dr. Kanan Shah

Abstract

Objective: One of the major reasons of stress specially among medical students is lack of proper time management. If stress and time mismanagement are not taken care of, it may lead to psychological disturbances, leading to poor academic performance among students. Stress and time workshop was designed and implemented in first year bachelor of medicine and bachelor of surgery students.

Methods: Time and stress management workshop was conducted among Ist MBBS medical students in 2012 and 2013 consecutively for two batches. Workshop included time and stress management modules as well as presentation and tips for proper stress and time management.

Results: Students felt that content and presentation of workshop was excellent. Students found the workshop very useful. All students suggested that such workshops should be conducted every year.

Conclusion: It can be concluded that time and stress management workshop is very useful and should be conducted very often for medical students.

Key Words: First year medical students, time, stress, modules, management

Citation

Title: Comparative study on clinical efficacy between Artesunte and Quinine in the treatment of Cerebral Malaria

Authors: Shafat Imam Siddiqui, PK Agarwal, Tabassum Yasmin, Syed Touseef Nawaz

Abstract

Malaria remains a serious helath problem in tropical regions causing 0.86 million death in 2009. Quinine is still effective against Plasmodium falciparum (P.f) but in recent years rising trends of resistance is emerging in sense of response time, and fever clearance time. The objective of the study was to compare the clinical efficacy of Artesunate with Quinine in the treatment of cerebral malaria. The study was conducted on 50 confirmed patients of cerebral malaria in the Department of Medicine in Katihar Medical College, Katihar, Bihar. Diagnosis was confirmed clinically on the basis of World Health Organization (WHO) criteria, positive blood films and by Parahit total rapid dipstick for malaria. Patients were randomized to receive either Artesunate or Quinine. Our study shows that 68% of patients treated with Artesunate improved with in 8-24 hrs against 16% from Quinine. There were no serious side effects noted in patients who are treated with Artesunate while 44% of the patients who are treated with Quinine developed side effects. Our study suggests that Artesunate is a good alternative to Quinine in the treatment for cerebral malaria and can be used as first line treatment.

Key words: Artesunate, Quinine, Cerebral Malaria, Plasmodium falciparum

Citation

Title: Hypofractionated Radiotherapy Induced Pulmonary Function Changes and Toxicity Analysis in Breast Cancer Patients Post-mastectomy Chest Wall Irradiation

Authors: Mohsin Khan, Manoj K Gupta, Rajeev K Seam

Abstract

Background:Pulmonary complications post-radiotherapy to chest wall are inevitable. There are plethora of studies on pulmonary complications following conventional radiotherapy delivering 50 Gy in 25 fractions boost in early stage breast cancer. However, the data on how hypofractionated regimes used post-mastectomy effects normal pulmonary tissues is still limited. In this trial we studied the impact of hypofractionated RT, used post-mastectomy, on pulmonary function tests.

Materials and methods: Between June 2011 to June 2012, 59 female patients with breast cancer post-mastectomy were treated with hypofractionated radiotherapy 40 Gy in 15 fractions or 42.5 Gy in 16 fractions depending on treating physician`s preference. All patients underwent PFTs including forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and diffusing capacity of carbon monoxide (DLCO), before start of RT, and then at three monthly intervals till last follow up. The Common Terminology Criteria for Adverse Events (CTCAE) v 3.0 was employed to evaluate early and late effects of RT on PFTs.

Results:Median age of patients was 49 years. Average length and width of tangential fields were 19.0 1.2 cm and 7 1.26 cm respectively. 15.3% of the patients developed acute grade (Gr)1 toxicity, while for late reactions, 6.8% and 1.7% had Gr2 and Gr3 adverse reactions respectively at median follow up of 19 months.

Conclusion:Use of hypofractionated RT post-mastectomy revealed no clinically significant acute or late pulmonary toxicity even at a follow up of 2 years. Thus hypofractionated RT post-mastectomy is a safe and well tolerated modality.

Keywords: Breast Cancer, HypofractionatedRadiiotherapy, Pulmonary Function Tests, Postmastectomy

Citation

Title: Dyslipidemia and Hypothyroidism in Population of East Medinipur, West Bengal

Authors: Ajay Kumar Das, Naved Ahmad, Akash Gupta

Abstract

Hypothyroidism accounts for about 2% of all cases of hyperlipidemia and is second only to diabetes mellitus as a cause of secondary hyperlipidemia. The present study was planned to determine the level of lipid profile in patients diagnosed with hypothyroidism.

Patients were screened for T3, T4 and TSH. Based on these values those who were having hypothyroidism were selected. Blood samples of these patients were drawn aseptically after 12 hours of overnight fasting for lipid profile. Out of total 260 cases 83wer subclinical hypothyroid (SCH) and 177werehypothyroid. Mean ± SD values of Total cholesterol was 213.37 ± 24.58 (for SCH) and 209.46 ± 27.43 (for Hypothyroidism) , Triglycerides was 201.41 ± 21.38 (for SCH) and 197.67 ± 29.87 (for Hypothyroidsm) and LDL –C was 143.21 ± 26.81 (for SCH) and 134.56 ± 25.77 (for Hypothyroidism). Our study demonstrated that dyslipidemia is associated with hypothyroidism.

Keywords- Dyslipidemia, Subclinical hypothyrodim, Hypothyroidism

Citation

Title: Bilateral Both Bone Leg Fracture in A Case of Hereditary Multiple Exostoses With Bilateral Proximal and Distal Tibiofibular Synostosis

Authors: Ganesh Singh, Anshuman Vijay Roy, Shailendra Singh Bhandari, Pankaj Singh

Abstract

The Hereditary Multiple Exostoses ( HME) is a neoplastic disorder affecting multiple skeletal sites in the form of bony protuberances of varying sizes and shapes . The clinical features are site specific and mostly relate to the effect of swelling on the adjacent tissues . Associated abnormalities like bowing deformities of bones , shortening and mechanical axes deviations may lead to increased risk of stresses over the bones . Associated tibiofemoral synostosis if present can further complicate the aforementioned problems .We present a rare and previously unreported case of bilateral both bone leg fracture following low energy shear and torsion mechanism in the setting of bilateral tibiofemoral synostosis . The condition was satisfactorily managed conservatively owing to minimal displaced fracture patterns and patient compliance to the treatment.

Keywords - hereditary multiple exostoses , tibial fracture , synostosis

Citation

Title: Fatal Headache – A case report

Authors: Charan Kishor Shetty, Spoorthy Sudhakar Shetty

Abstract

Sudden death as a term is used to describe deaths occurring in an apparently healthy individual within 24 hours with or without symptoms. A medicolegal investigation is crucial to identify such deaths and exclude unnatural causes.

We report an autopsy case of a 22-year-old female who was previously healthy and had complained of headache a few days back which was diagnosed as migraine and accordingly treated. But after 4 days she complained of severe headache and died unexpectedly. An autopsy was performed, which showed that the extensive bleeding into the substance of the anterior and middle portion of the Left intracerebral region. A post mortem examination, (CT) computed tomography studies of the brain, Histological studies, and anatomical dissection were performed to locate the cause of sudden death. They revealed changes due to malignant hypertension which was undiagnosed.

Keywords: Headache, sudden death, malignant hypertension, CT scan.

Citation

Title: Assessment of insulin resistance, serum adiponectin and ferritin levels in HCC patients before and after radiofrequency ablation

Authors: Fathallah Sidkey Mohamed, Magdy El-Bardiny, Amr Ali Abdel-Moety, Perihan El-Sayed Salem, Enas Fawzy Gaballah

Abstract

Hepatitis C virus (HCV) is a major cause of chronic hepatitis, hepatocellular carcinoma (HCC), and recently HCV has been identified as a cause of insulin resistance (IR). Recent studies have found that HCV-associated IR causes hepato-carcinogenesis and proliferation of HCC where IR may synergize with viral hepatitis in HCC development. The aim of the present work was to study IR, serum alpha-fetoprotein (AFP); adiponectin and ferritin levels in HCV-positive cirrhotic patients with and without HCC. Also, these markers were assessed in early stage HCC patients after successful treatment with radiofrequency ablation (RFA). Moreover, liver stiffness was measured using acoustic radiation force impulse imaging (ARFI) in all studied patients.

Key Words: Hepatitis C virus, Hepatocellular carcinoma, Insulin resistance, Alpha fetoprotein, Adiponectin, Ferritin, Acoustic radiation force impulse imaging.

Citation

Title: Phenylephrine Infusion vs. Ephedrine Infusion: Effect on Fetal Acidosis

Authors: Urvashi Yadav, Dheer Singh, Kunwar Bharat, Reena Verma

Abstract

This randomized double blind study was started with an objective of comparing the fetal effects of two commonly used vasopressors – ephedrine and phenylephrine in elective caesarean section.

Methods: One hundred patients were randomized into two groups to receive either 100 μg/ml phenylephrine (group-P, n=50) or 5mg/ml ephedrine (group-E, n=50). Immediately after spinal injection the study solution was started prophylactically in every patient at the rate of 60ml/hr. A predefined algorithm was used to adjust the infusion rate according to the systolic blood pressure (SBP). After delivery, arterial and venous blood samples were taken from a double-clamped segment of umbilical cord for immediate blood gas analysis with a blood gas analyser

Keywords: prophylactic, infusion, vasopressors, elective caesarean section, fetal acidosis.

Citation

Title: Polio Eradication in India: Need to Switch Over to IPV from OPV

Authors: Dr. Sharanjit Kaur, Dr. Anand Sharma, Dr. Harinder Jot Singh

Abstract

Vaccines have reduced the prevalence of preventable infectious diseases to a minimum level. Small pox and polio are the best examples. Vaccines could be live vaccine or inactivated vaccines. However none of these are absolutely safe. India achieved a major milestone in 2012 with the World Health Organization striking it off the list of polio endemic countries on 25 February 2012, after India completed one year without any case of polio.As the goal of wild poliovirus eradication is approached, concern has been raised about the potential for persistent transmission of oral polio vaccine (OPV) viruses, as these viruses are known to revert toward wild-type neurovirulence.The phenotypic reversion of the OPV strains to neurovirulence is thought to be the underlying mechanism for the reported cases of vaccine-associated paralytic poliomyelitis among OPV recipients or their close contacts. However, cases of VAPP have not been reported with the use of inactivated polio vaccine.The “endgame” for worldwide poliomyelitis eradication will require stepwise cessation of the use of oral poliovirus vaccine (OPV) for various strains in all countries and finally to switch over to IPV to prevent the danger of vaccine-derived polioviruses—exposing some populations to risk of poliovirus outbreaks.

Keywords: Vaccines, Polio Immunization, Oral Polio Vaccine, Inactivated Polio Vaccine, Vaccine Associated Polio Paralysis

Citation

Title: Dietary Pattern, BMI and Calcium Status of Female College Students

Authors: Monika Bhardwaj, Prabhjot kaur, Isha Babbar, Prabhjot K. Setia, Ridhima Vij,Rajiv Joshi

Abstract

Dietary habits pattern are very important for individual’s well-being the society as a whole. The prevalence of overweight and obesity has increased globally among both adults and adolescents [1]. The World Health Organization (WHO) has recommended a diet low in fat, sugar and salt, and high in fruit and vegetables in order to protect against the development of obesity [2].The association between poor diet and obesity is well established globally and regionally [3,4] indicating a low consumption of fruit and vegetables and high consumption of energy-dense food and drinks, along with irregular meal consumption and frequent consumption of snacks. Studies have examined the association between dietary patterns and weight status in primary school aged children and in adolescents

Citation

Title: A Rare and Fatal Complication of Diabetes Mellitus

Authors: Dr. Vishal Sopan Yesankar¹, Dr. Nalini R Humaney², Dr. Ramesh P Mundle³

Abstract

Emphysematous pyelonephritis (EPN) is an acute suppurative infection of the kidney. It is an uncommon infection, occurs mostly in patients with diabetes and a predilection for females. It has a high fatality rate; therefore, aggressive medical, early intervention or surgical approach is recommended. We present a case with a classical presentation with more than two risk factors and who required nephrectomy.

Keywords: pyelonephritis; diabetes mellitus; nephrectomy.

Citation

Title: Health Satisfaction among Pulmonary Tuberculosis Patients on Directly Observed Therapy in a Nigerian Tertiary Hospital

Authors: Abdullateef Gbenga Sule¹, Loius O. Odeigah², Kolawole Moradeyo Alabi², Baba A. Issa³, Razak Olatunji Shittu⁴, Suleiman Kuranga², Olagunju Fatai Abiola²

Abstract

Introduction: Tuberculosis (TB) remains a major public health concern despite the decline in its mortality rate globally. Although, the introduction of directly observed treatment strategy (DOTS) short course with its five components in Nigeria in 2003, aimed at decreasing TB-related morbidity, preventing TB death, and decreasing TB transmission has recorded significant success.

Objective: To evaluate the health satisfaction and socio-demographic profiles of pulmonary tuberculosis patients on directly observed therapy.

Methods: A cross sectional study was conducted in the tuberculosis clinic of University of Ilorin Teaching Hospital, Ilorin, Kwara state. Data were collected from 154 patients through systematic random sampling using an interviewer administered questionnaires. Statistical package for social sciences version 20 was used for the analysis.

Results: Majority of the respondents (60.1%) were less than 38 year old with a mean age of 39+13years. There was male (61%) preponderance with female to male sex ratio 1:1.5. Most respondents had formal education (79.9%) and 51.3% were married. About half of the respondents (45.5%) were in occupational class IV and none in class 1. New cases were 73.4% while others had some treatment previously. Sixty four of the respondents (41.6%) remained, sputum positive after two months of treatment. However, most of the respondents (88.3%), had certain levels of health satisfaction.

Conclusion: This study showed that tuberculosis is a disease of poverty affecting young productive adults in this area. And the cases of primary resistant among patients in this area may be on the increase. Nevertheless, the DOT treatment modality gives high level of health satisfaction among the patients.

Key Words: Health Satisfaction, Pulmonary Tuberculosis, Directly Observed Therapy, Nigeria

Citation

Title: Brig SPS Kochar’s Neovaginoplasty: Simple Technique

Authors: Gp Capt JC Sharma, MD, DNB, DCP, *Brig SPS Kochar, MD, COL Devendra Arora, MD, Dr Rupa Talukdar, MD, Dr Namrita Sandhu, DNB

Abstract

Congenital anomaly in neonate is an alarming condition for parent as well as clinician. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome a rare congenital malformation of the female genital tract, has an incidence of 1 in 4,000 newborn girls (1). The syndrome, caused by an embryologic failure of the Mullerian ducts, is characterized by complete or partial agenesis of the vagina and uterus and can be associated with urinary tract, skeletal, and other congenital abnormalities (2).Individuals with MRKH syndrome commonly present with a nor-mal female 46,XX karyotype and regular ovarian endocrine function, leading to the good development of secondary sexual characteristics and normal adolescent progress in girls . The etiology of the syndrome, which is the second most common cause of primary amenorrhea, is yet unknown ( 3). The aetiology may be due to multifactorial mode of inheritance, which including genetic andenvironmental factors, probably is the most likely explanation (4 ) . MRKH syndrome along with complete androgen insensitivity syndrome are the most common causes of vaginal agenesis.

Citation

Title: A Study on Management of Proximal –Third Tibia Fractures by Biological Plating in Adults

Authors: Dr. Sunil Kumar P, Dr. K. V. Ramana Kumar

Abstract

Fractures of the proximal –third tibia are a serious injury with ever increasing incidence in modern day life styles. Bridging osteosynthesis done by means of a plate is called bridge plating or biological plating. Biological plating is also referred as minimally invasive percutaneous plate osteosynthesis. Aims and objectives: to study fractures of proximal-third tibia and results of biological plating in those fractures. Materials and Methods: This was a two year prospective study. A series of 30 cases of proximal third tibia fractures were taken in this study. Results: Excellent results were shown in 14 cases (46.6%) and good results were shown in 11 cases (36.6%) and only one case showed poor result (3.3%). More than 80%of cases showed good to excellent results. Conclusion: Biological plating is a safe and reliable modality for the treatment of fractures of the proximal-third tibia.

Keywords: Tibia Fracture, Biological Plating, Bridge Plating.

Citation

Title: Awareness and Knowledge of Dyslexia Among Elementary School Teachers in India

Authors: Anil Shetty, B Sanjeev Rai

Abstract

Around 10% of school children have some degree of dyslexia. In developed countries and the West in particular dyslexia is recognized as a major educational and medical problem, but has not received sufficient attention in developing countries. Elementary school teachers could play a crucial role in identifying dyslexia early and in creating awareness about learning disorders in the community. There are very few studies on the knowledge of school teachers about learning disorders and hardly any involving dyslexia. The purpose of this study is to assess the knowledge of dyslexia in elementary school teachers and the variables influencing the knowledge. Therefore 314 teachers from 32 schools were given a self- report questionnaire, socio-demographic history was elicited and the teachers knowledge was assessed based on their responses about 12 signs and symptoms of dyslexia. 262 teachers were ‘aware’ of the term dyslexia, only 24 teachers had prior training. Only 1 in 3 teachers had adequate knowledge of dyslexia. Most teachers were in favor of training sessions on dyslexia and expressed their willingness to attend such sessions. Only a minority of teachers had adequate knowledge of dyslexia. Teaching experience, prior training and exposure were positively correlated with knowledge.

Key Words:Dyslexia, Learning Disorders, School Teachers

Citation

Title: Camphorated Oil Related Optic Neuritis: Review of 21 Cases

Authors: Vijaya Mishra

Abstract

21 Cases of Optic neuritis have been reported from Tertiary care hospital of Northern India. All of these patients were chronic camphorated hair oil users for more than 5 years, all had onset in summer season, with normal neuro-radiological investigation and with absence of oligoclonal bands in Cerebro spinal fluid. Author proposes a new group of these patients as "CORON" that is Camphorated oil related Optic Neuritis. All of these patients had variable response with intravenous pulse methylprednisolone therapy.

Keywords: Optic neuritis, Camphor, Hair oil, Methylprednisolone

Citation

Title: Immediate Effect of Intermittent Cervical Traction in Supine versus Sitting Position on Heart Rate and Blood Pressure in Healthy Young Individuals

Authors: Dr. Anam A. Saiyed, Dr. Mubassir Saiyad, Dr. Neepa Talati, Dr. Megha sheth

Abstract

Aim: To find out difference in heart rate and blood pressure between the two positions, sitting and supine after giving intermittent cervical traction.

Objective: This study investigated the immediate effect on heart rate and blood pressure in supine and sitting positions after giving intermittent cervical traction in healthy young individuals.
Method: A crossover study was conducted on 30 healthy male and female subjects, 20 -25 years of age by convenience sampling. Exclusion criteria were osteoporosis, malignancy, infection, cervical joint instability, carotid or vertebral artery disease and uncontrolled hypertension. Outcome measures used were heart rate and blood pressure. Baseline parameters of heart rate and blood pressure were taken. Traction force 1/8th of the body weight was given for 10 minutes in one position with neck in 20-30 degrees of cervical flexion. After 24 hours the same procedure was repeated in other position. Parameters were measured immediately after giving traction.
Results: The data were analyzed using paired t test. The study shows there was statistically significant reduction in systolic pressure (SBP), in sitting position compared with supine. Mean ± SD for SBP in supine was 110.8±9.09, in sitting was 105.8±8.94, t=2.091, p=0.04. No statistically significant difference in diastolic blood pressure (DBP) was seen. In supine, mean ± SD for DBP was 74.86±5.88 and in sitting it was 73.93±7.81, t=-0.52, p=0.60. Mean ± SD for heart rate in supine was 89.13±7.49 and in sitting it was 91.80±7.32, t=1.394, p=0.169.

Conclusion: The study supports the use of either the supine or sitting positions to give intermittent cervical traction, but the supine position proved to be a better option as there was less reduction in systolic blood pressure.

Key words:intermittent cervical traction, supine, sitting, blood pressure.

Citation

Title: Comparative study of Labetalol v/s Methyl Dopa in the Management of Gestational Hypertension

Authors: Dr. Mahfrid.N.Dharwadkar, Dr. Kanakamma MK , Dr. K Rajagopal

Abstract

Hypertensive disorders of pregnancy are one of the most common cause of maternal and perinatal mortality and morbidity affecting between 7-15 % of all pregnancies and are associated with as much as 22% of all perinatal deaths. They represent a group of conditions associated with high blood pressure, proteinuria and in some cases convulsions. The criteria for diagnosis & classification of the hypertensive disorders of pregnancy was according to the National High Blood Pressure Education Program Working Group (NHBPEP) and the American College of Obstetricians and Gynaecologists (ACOG).

A total of 40 patients were included in this study, 20 of whom were given labetalol and 20 were given methyl dopa. During this period the maternal and foetal conditions were monitored along with control of hypertension. The outcome of therapy was based on the efficacy of the drugs in effective control of blood pressure, prolongation of pregnancy, mode of termination, requirement of additional drugs, side effects, and perinatal safety and outcome.

Labetalol was found to be safer, quicker in achieving adequate control of blood pressure with considerable prolongation of the duration of pregnancy with fewer side effects on the mother as well as the neonate when used in the management hypertensive disorders of pregnancy.

Keywords: gestational hypertension labetalol methyldopa Perinatal outcome

Citation

Title: Association of Insulin Resistance and Selected Adipokines in Cardiovascular Disease with and without Metabolic Syndrome

Authors: Savita Rathore, Anil Bidwai

Abstract

Adipose tissue produces several bioactive mediators’ adipokines which influence insulin resistance, diabetes, body-weight homeostasis and inflammation. Plasma adiponectin and leptin are closely related to insulin sensitivity. In present study we measured adipokines, lipid profile, and insulin resistance in CVD patients with and without MetS. 100 patients with cardiovascular disease and 50 healthy persons as control subjects were included. Adiponectin, leptin, lipid profiles, glucose, and insulin levels were measured and insulin resistance was computed by the HOMA. Patients (n=100) and control subjects (n=50) were matched for age, BMI, WC and blood pressure category systolic and diastolic, all were (P<0.0001) highly significant. CVD patients with and without MetS had highly elevated TC, LDL-C, VLDL-C cholesterol and TG and lower HDL-C level than the control subjects, all were P<0.0001. Glucose, insulin and insulin resistance were also significantly increased in both patient groups than control subjects. Leptin level was higher and adiponectin was significantly lower in patients with MetS and without Mets compared with control subjects, (P<0.0001). We summarized that the measurement of adiponectin and leptin may have a beneficial in the treatment and prevention of cardiovascular diseases in the future.

Key words: cardiovascular disease, metabolic syndrome, adiponectin, leptin, insulin resistance, lipid profile

Citation

Title: Efficacy And Safety of Sauropus Androgynous in the Treatment of Aphthous Stomatitis- A Placebo Controlled Double Blind Trial

Authors: Dr.Ashok Shenoy K, Dr. Mukta N Chowta, Dr. Nandita Shenoy, Dr. Prabha Adhikari

Abstract

Recurrent aphthous stomatitis (RAS) is a common inﬂammatory condition of unknown aetiology, although a variety of predisposing and other risk factors have been identiﬁed. Manifestation of the disease can range from mild to severe and, in extreme cases, even hinder a person’s ability to eat, thereby compromising the patient s nutritional status¹.

The cause of RAS is unknown, although several factors are suspected including genetics, stress, nutritional deficiencies, diet, hormonal changes, and immunological disorders.^2,3 Due to its varied etiology, it is difficult to find a definitive cure and hence the current management protocol is aimed towards ameliorating the symptoms. Sauropus androgynous (SA) is a member of the family Phyllanthaceae. The aim of the present study was to carry out randomized, placebo controlled investigation into the efficacy of Sauropus androgynous leaves in patients with RAS One hundred adult patients who presented with RAU and healthy otherwise were included in the study. A clinical diagnosis of RAS was made based on the presence of painful ulcers on an erythematous base with duration less than 48 hours. Patients were excluded if they presented with any underlying systemic disorder, suffering from an uncorrected dietary defect, or had a history of probable sensitivity to mouthwash or toothpaste. Informed consent was obtained and general history, history with reference to ulcer number, duration, degree of pain. Past history of similar ulcers, time taken to heal was recorded.

SA in both forms offered advantages over steroids in our study and is safe in all patients including infants and pregnant women, in whom there may be reluctance to use steroids.

Citation

Title: Oxidant and Antioxidant Activity Alteration in Anaplastic Astrocytomas Patients Following Radiation Therapy

Authors: Mayank Baranwal, Sanjeev Kumar Singh, Akshay Nigam, Neelima Singh, Nivedita Singh

Abstract

Radiation therapy has been used in cancer treatment for many decades, although effective in killing tumor cells, ROS produced in radiotherapy threaten the integrity and survival of surrounding normal cells. Radiation damages cell by direct ionization of DNA and and other cellular targets and by indirect effect through ROS. A linkage between an increase in cellular ROS and the pathogenesis of several chronic diseases including cancer has been established. When the antioxidants control mechanisms are exhausted or overrun, the control redox potential shifts towards oxidative stress, in turn increasing the potential for damage to nucleic acids, lipids and proteins. Human cells normally function in a reduced state, but oxidative stress results in imbalance towards a more oxidised state resulting in lower levels of antioxidants. In the present study the damage caused by ROS and the effect of radiation in anaplastic astrocytomas (WHO grade III) patients were assessed by analyzing MDA levels, GPX and GR activities. Blood samples were collected before and after radiation treatment. The MDA levels showed a highly significant elevation both before and after radiotherapy which reflects increased lipid peroxidation. The activity of antioxidant enzymes GPx and GR were found to be decreased highly significantly in same patients before and after radiotherapy when compared to healthy controls which showed the lack of antioxidant defense. Radiation induces lipid peroxidation by inactivating the antioxidant enzymes, thereby rendering the system in management of the free radical attack. Hence the degree of radiation affects the extent of the depression of the antioxidant enzyme activities and increased lipid peroxidation.

Key words: Anaplastic astrocytomas, Glutathione peroxidase, Glutathione reductase, Lipid peroxidation, Radiotherapy.

Citation

Title: Role of Ultrasonography in Non-Palpable Breast Lesion and Its Correlation with Fine Needle Aspiration Cytology and Histopathology

Authors: Dr. Rikta Mallik, Dr. Souvik Ray, Dr. Abhijit Mandal, Dr. Debasis Deoghuria,Dr. Sumanta Kumar Mandal, Dr. Sujit Kumar Bhattacharyya

Abstract

Breast cancer is one of the common malignancy affecting women in the age group of 30-50 years & tumor size remains an important predictor of its survival. Regarding detection of non-palpable breast lesions, mammography and breast ultrasonography are two most prominent and available modalities. In this study conducted in a tertiary care hospital 50 patients with age group 36.1±12.05 years with lesion of BIRADS-3. 4a, 4b & 5 were taken. The mean size of lesions detected by USG was 10.72±1.67mm. 26 cases who had ultrasonographically BIRADS -3 & 4a lesion underwent US- guided FNAC and reveals 84.61% cases were benign , 11.53% borderline and 3.84% malignant. Accuracy of USG in categorization of benign lesion is 88.88% and in borderline lesion is 12.5 % only. Two cases of breast tuberculosis presenting with diffuse lumpiness and mastalgia was diagnosed by USG- guided FNAC, & treated with antitubercular drugs. 24 cases of BIRADS -3 , 4a , 4b & 5 category underwent US-guided needle localization and lumpectomy followed by histopathological examination. 58.33% cases came out to be benign, 25% borderline & 16.66% malignant in final histopathological examination. The accuracy of ultrasound diagnosis was 71.42% for benign lesion, 30.76% for borderline lesion and 75% in cases of malignant lesion. US was found to be more accurate for diagnosing benign & malignant cases.

Key Words: Ultrasonography , Mammography, Breast cancer, Non palpable lump, Tuberculosis

Citation

Title: Thrombocytopenia and Prolonged Prothrombin Time in Neonatal Septicemia

Authors: Shittu Bashirat T, Shittu Mujeeb O, Oluremi Adeolu S, Orisadare Olayiwola P, Jikeme Osemeke, Bello Lateef A

Abstract

Septicemia in neonates refers to generalized bacterial infection documented by positive blood culture in the first 28days of life and is one of the leading causes of neonatal mortality in sub-Sahara Africa. Thrombocytopenia in newborns is a result of increased platelet consumption; sepsis was found to be the most common risk factor. The objective of the study was to determine if there are organism-specific platelet responses among the 2 groups of bacterial agents: Gram-positive and Gram-negative bacteria, and also to examine the association of platelet count and prothrombin time with neonatal septicemia.

232 blood samples were collected for this study. The blood culture was performed using Bactec 9050, an instrumented blood culture system. The platelet count and prothrombin time were performed using Abacus Junior5 hematology analyzer and i-STAT 1 analyzer respectively.Of the 231 neonates hospitalised with clinical sepsis, blood culture reports were positive in 51 cases (21.4%). Klebsiella spp. (35.3%) and Staphylococcus aureus (27.5%) were the most common Gram-negative and Gram-positive isolates respectively. Thrombocytopenia was observed in 30(58.8%) of the neonates with septicemia. Of the 9(17.6%) patients with severe thrombocytopenia, seven (77.8%) had Klebsiella spp. septicemia. Out of the 21(63.6%) of thrombocytopenia produced by Gram-negative isolate, 17(80.9) had increased prothrombin time. In conclusion, Gram-negative organisms showed the highest cases of severe thrombocytopenia and prolonged PT. This study has helped to establish a disturbance in hemostatic systems in neonates with septicemia. Further studies, however, may be required to assess other hemostasis parameters in order to understand their interaction with the infectious organisms in neonates.

Keywords: Neonates, septicemia, thrombocytopenia, prolonged prothrombin time, platelet count

Citation

Title: Meta-analysis of Ado-Trastuzumab Emtansine in patients with HER2-Positive Advanced Metastatic Breast Cancer

Authors: Dr Rajat Rana, Sappa Dilip Kumar, Dr Soumadip Das, Dr Aravinda Swami, Dr Doreen Pon , Dr K K Perumal

Abstract

This study identifies and reviews randomized evidence to determine the effectiveness and safety of Ado-Trastuzumab Emtansine in patients with advanced metastatic breast cancer.Cochrane Breast Cancer Group specialized register; Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL and WHO International Clinical Registry platform were searched using the appropriate search strategy. Either recurrent or newly diagnosed women with Metastatic Breast Cancer were included. Four randomized controlled trials with 1,350 patients estimated overall survival as 64.7% in TDM1 group versus 51.8% in non TDM1 group. EMILIA study reported improved progression free survival (PFS) by 5.8 months, Overall Response Rate (ORR) as 43.6% in TDM1 group vs. 30.8% control group and low adverse events by 16.2%. Hurvitz study reported PFS 5 months longer in T-DM1 group than in control group with stratified HR of 0.59;(95% CI, 0.36 to 0.97), ORR as 64.2% (TDM 1 group) vs. 58% in control group, low adverse events by 45.2%. Single arm phase II study BURRIS & KROP reported PFS as 4.6 and 6.9 months respectively, ORR 25.9% and 34.5% respectively, and adverse events as 15.2% and 55.4% respectively. Consistent favorable outcomes with the Ado-Trastuzumab Emtansine indicate its considerable efficacy and safety in the treatment of advanced metastatic breast cancer and promising drug in combating mortality with breast cancer.

Keywords: Ado-Trastuzumab Emtansine, metastatic breast cancer, overall survival, Objective Response rate, progression free survival

Citation

Title: Lasers in Dentistry

Author: Preetha Selvan

Citation

Title: Biologic Width and Its Importance in Dentistry

Author: Preetha Selvan

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