Journal of clinical and diagnostic research

Prevalence of Ciprofloxacin Resistance Among Gram-Negative Bacilli in a Tertiary Care Hospital

Background: Bacterial resistance to antibiotics is a growing therapeutic problem, both in the community and the hospitals, which involves all the antibiotics including fluoroquinolones. The decreased susceptibility to fluoroquinolones arises mainly due to single-step mutations in the gyrA and the parC genes, which encode the fluoroquinolones targets, the topoisomerase enzymes, thus conferring cross-resistance to the fluoroquinolones. In 1998, some mobile elements with a potential for the horizontal transfer of the quinolone resistance genes were described. The loci which are responsible for this plasmid-mediated quinolone resistance, which have been designated as qnr A, qnr B and qnr S, have been identified in the Enterobacteriaceae species. Aim: This study was undertaken to evaluate the susceptibility pattern of the isolates to various antibiotics and to know the prevalence rate of ciprofloxacin resistance in our hospital. Materials & Methods: A total of 734 gram-negative bacilli (GNB) which were isolated from various clinical samples over a period of six months, were subjected to antibiotic susceptibility testing. Isolates with resistance or with a decreased susceptibility to ciprofloxacin (≤20 mm) were then screened for their minimum inhibitory concentration (MIC) by using the E-test. Results: Out of 734 GNB, 235 (32%) isolates were resistant to ciprofloxacin. The MIC of these isolates ranged from 4 to > 32μg/ml. Conclusion: The resistance rate to ciprofloxacin was 32% in our study. Most of the ciprofloxacin resistant isolates were from urinary tract infections (UTI). The ciprofloxacin resistance was also closely associated with multi-drug resistance, thus limiting the treatment options. Ciprofloxacin resistance can be used as a general surrogate marker of multidrug resistance, thus limiting the already restricted treatment options. The considerably high MIC values for ciprofloxacin in this study reflected the extent of the treatment problems for these resistant isolates and a need for the continuous evaluation of the commonly used antibiotics.

Sonographic Evaluation of the Renal Volume in Normal Pregnancy at the University of Port Harcourt Teaching Hospital: A Pilot Study

Enighe W. Ugboma, Henry A.A. Ugboma, Nelson C. Nwankwo, Antony O.U. Okpani

Introduction: The renal system is affected by the changes that occur in pregnancy, with the renal volume being one of the most important changes that occur. The data on the renal volume changes in pregnancy in the west African sub region, including Nigeria, is apparently sparse. Objective: The purpose of this study was to sonographically establish the range of the renal volume in normal pregnant women in the University of Port Harcourt Teaching Hospital, Nigeria. Subjects and Methods: A prospective, descriptive, cross sectional study on the sonographic measurements of the renal volume was performed on 150 healthy, normal, pregnant women. The renal volume was calculated by using the ellipsoid method. The body mass index, gestational age and parity were obtained. The correlations between the variables were calculated. Results: The age distribution of the women ranged from 20-41, with a mean of 29.7 years and the parity ranged from 0-6. The gestational age ranged from 9-40 weeks, while the body mass index ranged from 19.5 to 54. A mean renal volume of 163.44cm3 +(SD) 51.3 and 141.85cm3 + 41.07 for the left and right kidneys respectively, was obtained, with a range of 100cm3-214cm3 for both the kidneys. The mean renal volume was seen to increase with an increase in the gestational age and the body mass index. It was not so with the parity. The mean renal volume significantly correlated positively with the gestational age (r=0.29 and 0.11 (p<0.001) for the left and right kidneys respectively) and the body mass index (r=0.25 and r=0.24, (p<0.001) for the right and left kidneys respectively), but not with the parity (r=0.04 and 0.07, (p< 0.17) for the left and right kidneys respectively). The left mean renal volume was found to be significantly larger in the left kidney than in the right one. Conclusion: This study was able to establish a range of sonographic measurement of the renal volume in normal pregnancy for the locality.

The Outcome of Amniocentesis at 14 Weeks of Gestation

Latika Narang, Alexandra Sawyer, Vaishali Garg, Onome Ogueh

Objective: To compare the safety and efficacy of amniocentesis at 14 weeks of gestation with amniocentesis at ≥15 weeks and chorionic villous sampling. Method: This was a retrospective study of the pregnancy outcome of 299 women who underwent invasive prenatal diagnosis by using amniocentesis at 14 weeks of gestation, amniocentesis at ≥15 weeks of gestation and chorionic villous sampling. We compared the pregnancy outcomes and the complications in the 3 groups by using the Pearson’s χ2 test or the Fisher’s exact test. Results: There was no significant difference between the women who underwent amniocentesis at 14 weeks of gestation and those who underwent amniocentesis at ≥ 15 weeks of gestation or chorionic villous sampling in terms of failed cultures, miscarriage, preterm pre-labour, rupture of membranes, preterm delivery and neonatal respiratory complications (p > 0.05). Conclusion: Amniocentesis at 14 weeks of gestation is as safe as amniocentesis at ≥ 15 weeks of gestation and chorionic villous sampling.

Prevalence of Extended Spectrum Beta Lactamase (ESBL) Producers among Gram Negative Bacilli from Various Clinical Isolates in a Tertiary Care Hospital at Jhalawar, Rajasthan , India.

Gaurav Dalela

Background and Objectives: The resistance to broad spectrum β-lactams which is mediated by the extended spectrum beta lactamase (ESBL) enzyme is an increasing problem now-a-days. This resistance mechanism has been responsible for nosocomial outbreaks, serious therapeutic failure if it is not detected on time and the outbreak of multidrug resistant, gram negative pathogens that need expensive control measures. As no data was available on the prevalence of ESBL in this region, the current study was undertaken to determine the prevalence of the ESBL producing strains in our hospital based population of Jhalawar. Aim: To know the prevalence of ESBL producing organisms at our tertiary care hospital at Jhalawar. Material and Methods: A total of 219 consecutive, non-repetitive, gram negative isolates, which were resistant to one of the third generation cephalosporins (cefotaxime, ceftriaxone or ceftazidime) were selected as “Suspicious for ESBL production” as recommended by the Clinical and Laboratory Standards Institute (CLSI). These isolates were confirmed for ESBL production by the double disc synergy test (DDST) and the phenotypic confirmatory disc diffusion test (PCDDT) and they were further confirmed by the E-test ESBL strip randomly. Result: Out of the 219 isolates which were tested, 135 (61.6%) were found to be ESBL producers by PCDDT and 126 (57.5%) were found to be ESBL producers by DDST. Twenty-eight randomly selected isolates were further confirmed by the E-test ESBL strip, which showed a highly significant correlation with PCDDT (p value <0.001). The isolates of Escherichia coli (73.5%) were the most common ESBL producers, followed by Proteus vulgaris (60%), K. pneumoniae (58.1%) and others. The maximum ESBL production was seen in urine (66.4%), followed by pus (57.3%) and others (54.2%). Imipenem (98.5%), piperacillin/tazobactum (72.6%) and amikacin (64.5%), in the decreasing order, were the most active and reliable agents for the treatment of the infections which were caused by the ESBL producing organisms. Conclusion: There is a high prevalence of ESBL production in our hospital and so, it is essential to report the ESBL production along with the routine sensitivity reports, which will help the clinician in prescribing proper antibiotics. Also, control measures which include the judicious use of antibiotics, antibiotic cycling, the implementation of appropriate infection control measures and the formulation of an antibiotic policy must be done, to prevent the spread of these strains.

Repair of a Primary Inguinal Hernia by Using a Polypropylene Mesh: A Tension Free Lichtenstein Repair in Rural Andhra Pradesh

Chandrasekhar Beeraka, Sushama Surapaneni, Ravindranath Raavi

Introduction: Inguinal hernia repair is one of the most commonly performed surgeries in the world. Inguinal hernia accounts for 75% of all the abdominal wall hernias, with a life time risk of 27% in men and 3% in women (1). The recurrences which follow inguinal hernia repair are of a significant problem. As the pathogenesis of adult inguinal hernia is a defect in the metabolism of collagen, leading to a weakening in the fascia transversalis, the use of such a weakened tissue is problematic for the hernia repair. This study was conducted in the Konaseema Institute of Medical Sciences, Amalapuram, in a rural area of Andhra Pradesh, to determine the usefulness of a polypropylene mesh for tension free repair in terms of patient comfort, affordability, return to normal activity and post operative follow up. Materials and Methods: A prospective study was conducted from April 2008-March 2009, with a follow up of 2 years, for recurrence and any other morbidity.100 Lichtsenstein tension free hernioplasties for inguinal hernia were performed by using a polypropylene mesh between. Results: The inguinal hernia was right sided in 54 cases and 28 cases had left sided hernia, while 18 were bilateral hernias. Out of these, 57 were indirect and 43 were direct hernias. The average duration of the surgery was 45 minutes, the duration of the stay in the hospital was 4 days and after a follow up for 2 years, there was no evidence of recurrence, post-operative neuralgia, delayed rejection of the mesh or testicular swelling. 2 cases had superficial wound infections. Conclusion: Lichtenstein tension free repair with a prolene mesh is an excellent approach in the management of inguinal hernia, with encouraging results in places where Laparoscopic TEP and TAPP are not within the reach of most of the patients in terms of affordability.

Ovarian Reserve Tests for Sub-fertility: When to Intervene

Kalaiselvi V.S., Saikumar P., Prabhu K.

Back ground: During the past two decades , a greater majority of women have been known to plan their pregnancies in the thirties, often because of carrier priorities and as a result, they have to face the consequences of their declining fecundity (reproductive potential). Hence, it was decided to assess the ovarian reserve, which is an estimate of the follicular pool, the production of follicles being the primary function of the ovary. Our work highlights the assessment of the ovarian reserve in sub-fertile women. Aim: To assess the ovarian reserve in subfertile women by doing hormonal assays and by using ultrasonographic methods. Materials and Methods: 50 subfertile women of the childbearing age, without an issue even after 3 years of unprotected sexual acts, were included in this study. The subjects who were under study were divided into two groups. Group 1- sub-fertile women with their ages ranging from 20-25 years and Group 2- sub-fertile women of comparatively older ages, whose ages ranged from 26-33 years. For both the groups, hormones like the Follicular Stimulating Hormone (FSH) and oestradiol (E2) were measured by ELISA. The Antral Follicular Count (AFC) and the ovarian volume (OV) were measured by transvaginal ultrasound. The correlations between the various parameters were analyzed and the StudentÂ’s t-test was performed between the two groups by using SPSS. Results: Statistically significant correlations between age and antral follicular count (AFC), ovarian volume (OV) and FSH were observed. Elevated FSH, and decreased AFC and OV were observed in sub-fertile women of comparatively older ages and their mean values were also statistically different between the two groups. Conclusion: Women with elevated FSH and E2 and decreased AFC and OV should be insisted to proceed for Assited Reproductive Technique (ART) as early as possible, irrespective of their ages, as parenthood is undeniably one of the most universally desired goals in adulthood.

H.Pylori Associated Gastritis

Dandin Archana S., Pawale Jayashree, Athanikar V.S.

Introduction: H.Pylori has been associated with various upper gastro-intestinal tract disorders including gastritis, peptic ulcer and gastric malignances. There is a paucity of literature regarding the study of morphological changes in H.Pylori associated gastritis, as H.Pylori colonized gastric mucosa is a distinct pathologic entity with a pathologic spectrum ranging from active chronic gastritis to erosions & frank ulcer. Objective: The aim of this study was to know the morphological changes seen in gastric mucosa associated with H.Pylori. And also to find out prevalence of H.Pylori in patients undergoing upper gastro-intestinal endoscopic biopsies with gastritis in the centre. Materials and Methods: A total of 100 patients who were clinically diagnosed as having acute or chronic gastritis were included for this study during the period December 1999 to December 2001. A detailed clinical history was taken as per the standard proforma. Then the patients were subjected for endoscopy. Five endoscopic biopsies were taken and processed for rapid urease test and histopathological examination. Results: Out of 100 cases of endoscopically diagnosed gastritis, 48 cases were H.Pylori positive. In this 48 H.Pylori positive cases, 43 were positive by both rapid urease test (RUT) and histopathology. 3 cases were RUT positive but negative for H pylori by histopathology, and 5 cases were negative by RUT but histopathology showed presence of H.Pylori. Morphological changes specific for H.Pylori colonization and characteristic features are irregular surface epithelium, loss of apical mucin, cell dropout, formation of pits and microerosions. Out of 100 cases, 46 were RUT positive and 54 cases RUT negative. 48 were histology positive and 52 were histology negative. Statastically, no significant difference between urease test and histopathological demonstration of H.Pylori (p>0.05). Conclusions: Prevalence of H.Pylori in the present study was 48% in patients undergoing upper gastro-intestinal endoscopic biopsies with gastritis in this centre. H.Pylori infection is associated with spectrum of histological changes in gastric mucosa, which in turn facilitates the identification of H.Pylori. RUT and histopathology are the 2 diagnostic methods which can be used with an equal importance for the detection of H.Pylori associated lesions.

Common Silent Liver Disease In and Around of Salem Population: An Autopsy Study

R. Thamil Selvi, V. Selvam, P.M. Subramaniam

Introduction: We aim to determine the prevalence of silent liver diseases and to correlate it with age, sex, life style and its other risk factors. Histopathology is an important and most useful way to find out the conditions of internal visceral organs and the unique method for diagnosis of liver diseases because the liver is the site of many diseases, of which become symptomatic while some are diagnosed only on autopsy. Histopathology study is conducted in 120 cases in VMKV. Medical College Hospital, in the department of Pathology Salem, Tamil Nadu, India. Methods: The study was conducted over a period of two years (2009-2011) as elective and prospective study. We collected samples from 120 cases for histopathology study. Samples from the right and left lobe and one in the centre of the liver as well as other morphological findings was observed and recorded. Tissue sections were made and stained with Haematoxylin and eosin were evaluated. Results: Of the 120 cases were studied, 12 cases were excluded due to autolysis. 108 cases have analysed for study, the cases ranging from 6 years to 80years. Among 108 cases, Males were 82 & Females were 26, with the mean age of 46+/-9.52 years. Fatty changes were found in 26.9% followed by normal 25.9%, congestion 16.7%, hepatitis 13.9%, cirrhosis & abscess 7.4% and malignancy 1.9%. Causes of death were RTA -51, poisoning-15, hanging-15, suspecious-11, myocardial infarction-5, drowning-4, burns and electrocution each 3 and 1 in railway. Conclusion: From this study, the most common findings were fatty changes were more prone in the age of 50 – 70 years and starts with 40 years of age due to chronic consumption of alcohol in the Population of Salem district, Tamil Nadu.

A Prospective Quasi-Experimental Study on the Effect of Sub-Lingual Immunotherapy with Multiple Allergens in Allergic Bronchial Asthma

Background: Sub-lingual immunotherapy (SLIT) has been introduced as a disease modifying agent for allergic bronchial asthma in many countries and currently practicing in India. Aims: To assess the outcome of adding multiple-allergen sublingual immunotherapy with rescue medicines in patients having allergic bronchial asthma and to document adverse events, if any. Settings and Design: This was a clinic-based prospective quasiexperimental study. Methods and Material: Patients giving consent to receive multiple-allergen SLIT and rescue medicines formed the experimental group (Group A) while patients who did not give consent to SLIT but wished to have only rescue medicines formed the comparison group (Group B). Follow-up was done up to three years. Initially 703 patients were in Group A and 313 in Group B. However, around 647 patients in Group A and 282 in Group B completed the study for three years. Statistical Analysis: Unpaired t- test was used to compare the difference between the mean symptom and medication scores in Group A and Group B, before intervention and at the end of the study. Paired t- test was applied to compare the mean scores before and after intervention for each group separately. Results: Mean symptom scores of the two groups did not vary significantly before intervention but found to be significant at the end third year [8.60 (SD 3.92) v 14.73 (SD 4.42), P=0.000). In both groups mean symptom scores decreased from the baseline but it differed significantly in Group A only [15.46 (SD 4.88) v 8.60 (SD 3.92), P=0.000]. The mean medication scores between the two groups also differed significantly at the end of the third year [1.60 (SD 0.31) v 2.98 (SD 0.44), P=0.000)]. The scores also decreased in both the groups from the baseline, but significantly only in Group A [3.10 (SD 0.50) v 1.60 (SD 0.31), P=0.000]. Around 6.4% (45/703) patients receiving SLIT complained of mouth and throat irritation and about 3.7% (26/703) complained of mild vomiting. It can be concluded that long term sub-lingual immunotherapy in addition to rescue medicines significantly improves both symptom and medication scores with a high degree of safety.

A Study on Femoral Neck Anteversion and Its Clinical Correlation

Aim: To measure the angle of anteversion of femoral neck in both gender types and on both sides and to correlate it clinically. Materials and Methods: This study was carried out to determine the average femoral neck anteversion in Indian population. The angle was measured mechanically on 164 dry femora 88 right and 76 left intact, dried adult human femora (unpaired) with 81 male type bones and 83 female type bones were studied by conventional methods. The results obtained were statiscally analysed. Results: The angle between centre head neck line to transcondylar line was measured using goniometer in 164 dry bones and the mean value was 9.8 deg. The mean value was 9.49 deg on the right side and 10.13 deg for the left side femora with a standard deviation of 1.66 and 1.50 respectively showing a higher angle in the left side femora. A statistically significant difference of 0.64 was found for the angle of anteversion between the right and left side bones with a ‘p’ value of <.001. The mean value of male type bones was 9.78 deg and 9.79 deg of female type bones with a standard devation of 1.70 and 1.54 respectively. Though the value was higher in the female type bones, no statistically significant difference was found for the angle of anteversion between the male-and female-type bones in the present study. 7.9% bones were in the range of 0-8°, 54.2% bones were in the range of 8-10°, 21.9% were in the range of 10-12°, 15.8% bones had angle more than 12° showing most bones with a value of anteversion in the range of 8-10°. Conclusion: Any increase or decrease in the angle of femoral anteversion is associated with various clinical conditions. It increases in Perthes disease, cerebral palsy, anterior poliomyelitis, postural defects, apparent genu valgum, external tibial torsion, flat foot, and intoing. The decreased femoral torsion has been shown to be associated with toing out, rickets, chondrodystrophy. The data established in this study will be useful for various orthopaedic procedures and diagnosis, in the fields of General Human Osteology and Forensic anthropology.

A Study of Non-Alcoholic Fatty Liver Disease (NAFLD) in Type 2 Diabetes Mellitus in a Tertiary Care Centre, Southern India

Jayarama N, Sudha R.

Background: Type 2 diabetes mellitus is a common disease. The spectrum of liver diseases which ranges from innocuous enzyme elevation to progressive chronic liver disease has been described in association with type -2 diabetes mellitus. Mild chronic elevations of transaminases often reflect the underlying insulin resistance. NAFLD is a liver condition that is being recognized with an increasing frequency and it may progress to end stage liver disease. Aims: To study the Non-Alcoholic Fatty Liver Disease in type 2 diabetic patients and the correlation between glycaemic control (FBS) and the duration of diabetes with respect to the ALT levels. Study Design: A randomized case control study Materials and Methods: Fifty type 2 diabetics and fifty non diabetics who were taken as age, sex and body mass index (BMI) matched controls were studied. Subjects with a history of icterus, alcohol consumption and HBsAg positivity were excluded from the study. NAFLD was diagnosed if “fatty liver” was found on ultrasonography (USG). Fasting blood sugar (FBS), post parindal blood sugar (PPBS) and liver function test (LFT) were done. The results were compared by using suitable statistical methods. (Student’s unpaired “t”-test and Pearson’s correlation co-efficient). Results: NAFLD was noted in 60% of the cases and in 20% of the controls. A body mass index of > 25kg/m2 was significantly associated with NAFLD in both the cases and the controls. The duration of diabetes was significantly associated with NAFLD (p = 0.0054). A significant relationship was found between the presence of NAFLD and the female sex in the cases (p=0.0392), but not in the controls (p = 0.2790). The levels of alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were significantly high in the cases as compared to those in the controls. There was a positive co-relation between FBS, PPBS and the duration of diabetes with respect to the ALT levels. Conclusion: Non-alcoholic fatty liver disease (NAFLD), as determined by ultrasound, is common in type 2 diabetics. There is a positive correlation between FBS (Fasting blood sugar), PPBS (post prandial blood sugar), and the duration of diabetes with respect to the ALT levels.

Prevalence of Anaemia among Pregnant Bauri Women of Bankura, West Bengal, India

Bikash Mondal, Soumyajit Maiti, Bikramjit Maity, Debidas Ghosh, Shyamapada Paul

Anaemia in pregnancy is a frequent manifestation and an important health problem in the developing countries. A hospital-based, cross-sectional study was conducted among 246 pregnant Bauri women, to assess the prevalence of anaemia. The study was carried out at the Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India during June to August 2010. Only the pregnant Bauri women who visited the hospital were enrolled in the study. Anaemia was classified as per the World Health Organization (WHO) grading criteria. The present study revealed that all the participants were anaemic and their mean haemoglobin (Hb) concentration level was low (9.72±1.98 g/dl). In a majority (72.76%) of the subjects, the Hb level was lies between 9.1 g/dl to 9.5 g/dl. In all, most of the women (91.46%) had moderately anaemic where mild anaemia and severe anaemia were 8.54% and 0.81%, respectively. This study demonstrated that anaemia was present at substantial level among the pregnant Bauri women of Bankura, West Bengal.These findings are useful for our maternal health program planners and implementers to target and evaluate the interventions.

Anti-Diarrhoeal Activity of the Aqueous Extract of the Bark of Cinnamomum Zeylanicum Linn in Mice

Hari Jagannadha Rao, Lakshmi

Purpose: The plant, Cinnamomum zeylanicum (Laureceae), is a small, ever green plant which is native to southern India and it has been reported to possess a number of medicinal properties. The purpose of the present study was to evaluate the anti-diarrhoeal activity of the aqueous extract of the bark of Cinnamomum zeylanicum which is used traditionally as folk medicine, by using a castor oil and MgSO4 (Magnesium Sulphate) induced diarrhoea model. Methods: The aqueous extract of the bark of this plant at graded doses (100mg/kg, 200mg/kg body weight) was investigated for its anti-diarrhoeal activity in terms of the reduction in the rate of defaecation and the consistency of faeces in castor oil, Mgso4 induced diarrhoea. To understand the mechanism of its anti-diarrhoeal activity, its effect was further evaluated on the gastro-intestinal transit time with charcoal meal. Results: The bark extract showed significant (p<0.05) inhibitory activity against castor oil and Mgso4 induced diarrhoea. There was a significant reduction in the gastro-intestinal motility which was observed by using the charcoal meal test in mice. Conclusion: The results which were obtained in this study substantiated the anti-diarrhoeal effects of the aqueous extract of Cinnamomum zeylanicum Linn and its use by the traditional practitioners in the treatment of diarrhoea.

Study of the Morbidity and the Mortality Patterns in the Neonatal Intensive Care Unit at a Tertiary Care teaching Hospital in Rohtas District, Bihar, India

Mani Kant Kumar, Sachida Nand Thakur, Brish Bhanu Singh

Objective: To study the morbidity and the mortality patterns in the neonatal intensive care unit at a tertiary care teaching hospital in the Rohtas district of Bihar. Design: Retrospective study. The medical records of all the neonates who were admitted to the NICU were reviewed. Settings: Neonatal Intensive Care Unit of a tertiary care teaching hospital which is located in the Rohtas district of Bihar. The study was carried out over a period of 1 year during January 2010 to December 2010. Participants: 236 neonates with some illness who were admitted to the NICU, who belonged to the Rohtas district of Bihar. Outcome: The patterns of the morbidity and the mortality among the neonates who were admitted to the NICU in the Rohtas district. ‘Survival’ was defined as the discharge of a live neonate/ infant from the hospital. Results: A total of 285 babies were admitted to our NICU, of which 258 babies belonged to the Rohtas district. Of the 258 babies, 22 babies had left the hospital against medical advice (LAMA). A total of 236 neonates were included for the data analysis. The ratio of the male (59.6%) and female (40.4%) Neonates was 1.48:1. The major causes of the morbidity were low birth weight (LBW) (39.8%), prematurity (38.6%), neonatal sepsis (23.3%), neonatal hyperbilirubinaemia (20.4%), birth asphyxia with hypoxic ischaemic encephalopathy (HIE) (18.2 %), intrauterine growth retardation (IUGR) (14 %) and hyaline membrane disease (9.7 %). The most common causes of the referral from other hospitals were severe birth asphyxia with HIE (32.5%), neonatal sepsis (22.9%), prematurity with low birth weight (13.4 %), and prematurity with respiratory distress syndrome (12%). In this study, the overall NICU mortality rate was 13.6% ( 32/236). The babies who were born outside our hospital had a 2.5 times higher mortality rate as compared to the babies who were born in our hospital. Most of the deaths were associated with low birth weight (including LBW, VLBW and ELBW) (59.2%), prematurity (46.9%), sepsis (34.4 %), hypoxic ischaemic encephalopathy (HIE) (31%), Hyaline membrane disease or Respiratory distress syndrome (RDS) (25%) and intra uterine growth retardation (IUGR) (12.5%). Conclusion: This study identified LBW, prematurity, neonatal sepsis, neonatal hyperbilirubinaemia, and HIE as the major causes of the morbidity and low birth weight, prematurity, neonatal sepsis, HIE, and Hyaline membrane diseaseor Respiratory distress syndrome (RDS) as the major contributors to the neonatal mortality. Adequate antenatal care to the at risk mothers and advances in the neonatal intensive care with the use of sophisticated technology will improve the neonatal outcome.

Study of Acute Myocardial Infarction in Young Adults: Risk Factors, Presentation and Angiographic Findings

Sricharan K.N., Rajesh Rai, Rashmi, Meghana H.C., Sanjeev Badiger, Soumya Mathew

Background: Acute Myocardial Infarction (AMI) continues to be a major public health problem in the industrialized world and it is becoming an increasingly important problem in the developing countries also. Method: The diagnosis of myocardial infarction (MI) was based on the WHO criteria. Patients who were aged <15 years and > 40 years, who did not meet the WHO criteria for the diagnosis of MI were excluded. The data were prospectively recorded as per the protocol. In all the participants, details of the age, sex and occupation were recorded, together with details of smoking, alcohol use, a known history of diabetes mellitus and hypertension and a significant family history of ischaemic heart disease. Weight, height, fasting blood glucose, cardiac enzymes (CPK- MB) and the echocardiographic status was evaluated in all the patients. Results: The mean age of the patients with myocardial infarction was 37.03 years, with a maximum number of patients (70%) in the age group of 35-40 years. There were no patients from the below 25 years age group. Smoking was most common risk factor of MI (70%) in young adults. A family history of ischaemic heart disease (IHD) was present in 13.33% of the patients. Hypertension, diabetes and a body mass index of >25kg/m2, each formed 10% of the risk factors. The most common symptom was chest pain (90% patients). Two third of the patients had anterior wall MI. A majority of the patients (57.14%) had single vessel disease, which was seen on coronary angiography. Conclusion: Smoking was most common cause of the MI (70%) in young adults. The mean time of presentation of MI after the onset of the symptoms was 20.73hrs. Two third of the patients had anterior wall MI.

Comparative Evaluation of the Rapid Slide Culture and Microscopy with the Conventional Culture Method in the Diagnosis of Pulmonary Tuberculosis

Hemavathi, Pooja Sarmah, Ramesh D.H.

Introduction: Tuberculosis (TB) is a global health problem. An early diagnosis and an effective treatment are essential to prevent the spread of infection and to reduce the disease burden. Though the causative bacterium for this disease was discovered in the eighteenth century, its diagnosis in the twenty-first century is still a dogma. Objectives: To compare of the rapid slide culture (RSC) method with the growth on Lowenstein Jensen (LJ) media and to know the sensitivity and specificity of the rapid slide culture method and the acid fast smear examination in comparison with the growth on the L J media. Materials and Methods: One early morning sputum sample was collected from 220 clinically suspected pulmonary tuberculosis cases. All the samples were subjected to three tests: 1. Zeihl Neelsen Staining 2. Rapid slide culture and 3. Culture on Lowenstein Jensen media and the results were compared. Results: Of the total 220 sputum samples which were tested by all the three methods, 51 samples (23.18 %) were found to be smear positive, 75 (34.09%) were found to be positive by the RSC method, 81 (36.81%) were found to be positive by the LJ culture method and 38(17.27%) samples were found to be positive by all the three methods and 93 (42.27%) samples were found to be positive by any one method. 127 (57.72%) samples were negative by all the three tests The sensitivity of RSC in comparison with the LJ culture was 88.88% with a specificity of 97.8%, whereas the smear showed a sensitivity of 49.4 % and a specificity of 92.1%. Discussion: The RSC method is rapid, sensitive and more specific than microscopy. Hence, this method can be adopted by any simple laboratory for the diagnosis of tuberculosis.

Effect of Occupational Exposure to Pollutants on Peak Expiratory flow Rate of Healthy Non-smoking Bus Drivers in the Age Group of 20-55 Years

Aditya Jain and Manjinder Singh

Objective: The present study was undertaken to establish the effect of pollutants in the form of auto-exhaust, gases, etc. on the respiratory airways of healthy, non-smoking bus drivers in the age group of 20-55 years, by measuring the peak expiratory flow rate (PEFR) values. Materials and Methods: One hundred healthy, non-smoking bus drivers in the age group of 20 years to 55 years. were selected randomly from a bus stand of the PRTC (Punjab Roadways Transport Corporation) in the Patiala district and their PEFR values were compared with those of one hundred healthy, non-smoking persons in the age group of 20 years to 55 years, who were engaged in professions other than bus driving. Subjects with a prior history of reactive airways or bronchodilator intake were excluded. The influence of age, height, weight, body surface area and the duration of exposure on PEFR were studied. The PEFR test was performed by using Mini Wright’s Peak Flow Meter. Results: The mean PEFR of the bus drivers was found to be less than that of the control subjects in each group and the results were found to be statistically highly significant (p<0.005). This decrease in the PEFR in the bus drivers was probably due to their continuous occupational exposure to pollutants, which may have caused an adverse effect on their respiratory functions. Conclusion: There was a significant decrease in the lung functions of the bus drivers, as compared to those of the controls.

Comparative Evaluation of the Efficacy and Side Effects of Imipramine, Sertraline and an Ayurvedic Formulation in Patients of Depression

Jyotsna Bhargava, Zafar Yab Khan

Background: Anti-depressant drugs which are used in the Allopathic system of medicine for the treatment of depression have side effects. Studies which have compared the efficacy and the side effects of Allopathic and Ayurvedic drugs in the treatment of depression have not been reported. Aims: The aim of the present study was to compare the efficacy and the side effects of imipramine and sertraline which are the commonly prescribed drugs in the Allopathic system of medicine for the treatment of depression, with an Ayurvedic formulation. Settings and Design: This study was an open labeled randomized clinical trial which involved 90 depressive patients who were divided into three groups of 30 each, for the administration of imipramine, sertraline, and an Ayurvedic formulation respectively. HAM-D scoring was done and a side effect checklist was also prepared. Materials and Methods: The Ayurvedic formulation consisted of aqueous extracts of Brahmi, Shankhpuship, Malkangni and Jatamansi which were mixed in equal proportions (250 mg each). The Ayurvedic formulation was administered at a dose of 1000 mg orally in two divided doses; and imipramine and sertraline were administered at a dose of 150 mg each per day, to separate the groups of patients. The persons who abided by the inclusion and exclusion criteria were selected randomly. The effect of the treatments on the treated patients was repeatedly assessed at a continuous interval of two weeks for three months. Results: The Ayurvedic formulation had negligible side effects and it was found to be effective at par with imipramine and sertraline at the end of three months. Conclusions: The Ayurvedic formulation was found to be better as compared to imipramine and sertraline for the treatment of patients with mild to moderate depression, due to its lesser side effects.

Microarray ELISA for Autoantibody Screening in Connective Tissue Diseases

Sarita Kumble, Lok Choi, Carlos Lopez-Muedano, Krishnanand D. Kumble

Objective: This study was performed to demonstrate the use of an ELISA-based microarray technology which is termed as ‘PictArrays’, to identify autoantibody expression patterns in patients with symptoms of autoimmune connective tissue disease. Methods: Eight commonly tested antigens were simultaneously tested on specially designed 16-well slides for their autoantibody expression patterns. The assay specificity, sensitivity and reproducibility for each of the antigens were measured. The results were analyzed by using specially developed algorithms to identify seropositive samples. Results: The multiplex assay could identify specific antigen binding by autoimmune sera on the arrays. The PictArray sensitivity was similar to that which was obtained in established immunoassays, and the assay reproducibility was within limits which were acceptable for diagnostic uses. The software could correctly identify the positive antigen reactivity at concentrations as low as 2 units/ ml of the antibody. Conclusion: The data demonstrated the use of a multiplex platform to simultaneously measure multiple autoimmune antibodies. PictArrays offer significant advantages over other multiplex technologies, which include (i) the use of document scanners to read the test results (ii) ease of operation which requires no specialized technical training beyond that which is required for using the conventional ELISA kits (iii) reduction in errors through software-based data analysis, and (iv) inclusion of internal controls to monitor the assay performance of each sample. These features permit the use of PictArrays in resourceconstrained laboratories using existing infrastructure without significant capital expenditure.

The Socio-demographic Profile, Classification and the Clinical Profile of Headache: A Semi-urban Hospital Based Study

Guruprasad Kundapura Gidibidi, Dadapeer Kareemsab, Niranjan Mambally Rachaiah

Context: Migraine and tension type headache are the two most common types of primary headaches. In spite of the internationally accepted diagnostic criteria, it is not uncommon to face difficulties in diagnosing headache in the clinical practice. Aims: Our aim was to study the socio-demographic profile, classification and the clinical profile of headache patients who attended in a hospital which was located in a semi-urban setting. Settings and Design: A prospective, cross-sectional study. Methods and Materials: Patients mainly presented with the complaint of headache who were more than 12 years of age, were included in the study. The demographic details, the onset and the lifetime duration of the illness, the pattern of headache, the associated features and the family history were recorded. The international classification of headache disorders (ICHD), version 2 was applied. Statistical Analysis: Descriptive analysis was done by using SPSS, version 17.0. Results: 74% of the patients were females and 44% of them were between 29 and 44 years of age. Migraine was the most common disorder (182 patients), followed by tension type headache (99 patients) and cluster headache (3 patients). Conclusion: A number of symptoms that are presently not included in the ICHD-2 classification may help in differentiating migraine from the tension type headache.

The Incidence of Malignancy in Multi-nodular Goitre: A Prospective Study at a Tertiary Academic Centre

Introduction: Multi-nodular goitre (MNG) is one of the common presentations of various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although MNG was traditionally thought to be at a low risk for malignancy as compared to its single-nodule counterpart, various studies have reported a significant risk. The objective of this study was to determine the incidence and the type of thyroid carcinoma (TC) in multi-nodular goitre by doing the histopathological examination of thyroidectomy specimens. Materials and Methods: This prospective, observational study was carried out in the Department of Surgery at the AJ Hospital and Research Centre (a tertiary academic referral centre), Mangalore, India from Jan 2007 to Dec 2010. All the patients with multi-nodular goitre with or without thyrotoxicosis were evaluated and they were offered surgery as the treatment for suspicious findings, cosmesis, compressive symptoms and thyrotoxicosis. The specimens were subjected to a histopathological evaluation to determine the incidence and the types of various malignancies in MNG. Results: Among the 100 MNG cases which were studied, 10 (10%) cases contained malignant foci. Among them, papillary carcinoma (60%) was the most common type of malignancy which was observed. Conclusion: The incidence of malignancy in MNG is quite significant and it is not very low as was thought before. Due to the risk of occult malignancy, all the patients with multi-nodular goitres who are treated conservatively need a close follow up for malignancy.

The Role of Biochemical Markers in the Early Detection of Osteoporosis in Women: A Comparative Study from the Western Region of Nepal

Akshay Lekhi, Mamta Lekhi, Brijesh Sathian, Ankush Mittal

Introduction: Osteoporosis is defined as the reduced bone mass per unit volume of normal mineralized bone that leads to fractures, even with minor trauma. Osteoporotic fractures are a common cause of morbidity and mortality in adult men and women. This silently increasing metabolic bone disease is extensively prevalent in developing countries like Nepal. The objective of our study was to achieve an easy and early detection of osteoporosis in postmenopausal women, detecting the more vulnerable premenopausal women also. Materials and Methods: This was a hospital based, comparative study which was carried out in the Department of Orthopedics of Manipal Teaching Hospital, Pokhara, Nepal, between 31st December 2009 and 31st July 2011. The variables which were collected were age (years), years after menopause (years), BMI (kg/m2), total serum calcium (mmol/L), ionized calcium (mmol/L), phosphorus (mmol/l), total protein (g/dl), albumin (g/dl) and ALP (units/L). The approval for the study was obtained from the institutional research ethical committee. Results: Of the 612 subjects, 306 were pre menopausal and the other 306 were postmenopausal women. The post menopausal women were further categorized into early (132) and late (174) post menopausal women. For all the subjects, the mean values and the p value was calculated with all variables which were taken into our study. There was no significant difference in the mean values of the BMI of the pre-menopausal (24.77± SD2.19) women and those of the post-menopausal women [(24.77± SD1.76) p value (0.99)]. The mean values of serum calcium were moderately reduced in post-menopausal women (2.05± SD0.11) as compared to those in the pre-menopausal women (2.22 ± SD0.20). These were found to be statistically significant (p value 0.001). Conclusion: The bone turnover markers are a better way of the early detection of the high risk women and those in the early phases of osteoporosis when the X-ray and DEXA scan changes are not prominent.

Evaluation of the Anti-nociceptive and Anti-inflammatory Activities of the Pet: Ether Extract of Portulaca Oleracea (Linn.)

Jagan Rao N., Jayasree T., Mallikarjuna Rao B., Sandeep Kumar K., Vijay Kumar S.
To investigate the ant-inociceptive and the anti-inflammatory activities of the petroleum-ether extract of Portulaca oleracea.The petroleum-ether extract of Portulaca oleracea was subjected to a preliminary phytochemical screening. Acute toxicity studies were carried out in Swiss albino mice. The analgesic activity of the petroleum-ether extract of Portulaca oleracea was evaluated by using well established models like acetic acid induced writhing, the formalin test and the tail immersion method in mice. Its acute anti-inflammatory effect was studied by the Carrageenan induced hind paw oedema method in rats. Its phytochemical evaluation revealed the presence of alkaloids, tannins, flavonoids, saponins and triterpenoids. The acute toxicity studies showed that the extract was non-toxic upto a maximum dose of 2000 mg/kg body weight. The petroleum-ether extract exhibited significant inhibition of the acetic acid induced writhing, it reduced the paw-licking response time significantly in the formalin test and it increased the withdrawal latency time in the tail immersion test. The Carrageenan induced hind paw oedema was significantly reduced in rats. The present study indicated that the petroleum-ether extract of Portulaca oleracea had potential ant-inociceptive and anti-inflammatory activities.

The Morphological Variations of the Human Spleen
Introduction: The spleen is an important lymphatic organ in the human body. Its immunological and haematological functions are being well realized now-a-days. The aim of this study was to find out the morphological variations of the spleen and to compare them with the findings of previous studies. Materials and Methods: The present study included 111 human cadaveric spleens. The morphological features of the spleen like its length, breadth, width and weight were measured. The shape, poles, borders, surfaces and the impressions on the spleen were observed. Accessory splenic tissues, if they were present, were noted. Results: The lengths of the spleens varied between 5 cm to 13 cm, with an average of 9.66 cm. Their breadth was between 3.5 and 9.5 cm. The average breadth was 6.22 cm. Their widths varied between 1.5 and 5.5 cm, with an average of 3.06 cm. The weights of the spleens showed great variations, ranging between 80 and 300 gm, with an average of 145.76 gm. Various shapes of the spleens were observed in the present study. Most of the spleens were wedge shaped [61.26%], followed by tetrahedral [21.61%] and triangular [12.61%] shapes. Additional oval and irregular shapes of the spleens were observed in 3.60% and 0.09% cases respectively. In all the spleens, two poles, two borders and two surfaces were observed. The diaphragmatic surface of the spleen showed a uniform morphology while its visceral surface showed gastric, renal, colic and pancreatic impressions. The splenic notches were present on the superior as well as on the inferior borders. In most of the cases [74.76%], the notches were found on the superior border. The number of notches varied from zero to six, but in most of the cases [58.55%], there were 1 or 2 notches. Accessory spleens were found in 4.50% cases, in the form of roundish nodules. They were observed at the hilum of the spleen. Conclusion: The findings of the present study will be of fundamental importance to the physicians, surgeons and radiologists and of course, this knowledge is very important for the anatomists during their routine classroom dissections.

Rotaviral Diarrhoea in Children: A Comparison of PAGE with ELISA
Introduction: Tuberculosis (TB) is a global health problem. An early diagnosis and an effective treatment are essential to prevent the spread of infection and to reduce the disease burden. Though the causative bacterium for this disease was discovered in the eighteenth century, its diagnosis in the twenty-first century is still a dogma. Objectives: To compare of the rapid slide culture (RSC) method with the growth on Lowenstein Jensen (LJ) media and to know the sensitivity and specificity of the rapid slide culture method and the acid fast smear examination in comparison with the growth on the L J media. Materials and Methods: One early morning sputum sample was collected from 220 clinically suspected pulmonary tuberculosis cases. All the samples were subjected to three tests: 1. Zeihl Neelsen Staining 2. Rapid slide culture and 3. Culture on Lowenstein Jensen media and the results were compared. Results: Of the total 220 sputum samples which were tested by all the three methods, 51 samples (23.18 %) were found to be smear positive, 75 (34.09%) were found to be positive by the RSC method, 81 (36.81%) were found to be positive by the LJ culture method and 38(17.27%) samples were found to be positive by all the three methods and 93 (42.27%) samples were found to be positive by any one method. 127 (57.72%) samples were negative by all the three tests The sensitivity of RSC in comparison with the LJ culture was 88.88% with a specificity of 97.8%, whereas the smear showed a sensitivity of 49.4 % and a specificity of 92.1%. Discussion: The RSC method is rapid, sensitive and more specific than microscopy. Hence, this method can be adopted by any simple laboratory for the diagnosis of tuberculosis.

Variation in the Pulmonary Functions with the Phases of the Menstrual Cycle in Adolescent Females

Nandhini R., Subhashini A.S.
Background: The dynamic changes in the level of various hormones during different phases of the menstrual cycle are known to affect various functions of the body, apart from the reproductive system. This study was intended to demonstrate the variation in the pulmonary functions during different (menstrual, luteal and follicular) phases of the menstrual cycle in adolescent girls. Methods: This was a prospective, observational study which was performed at a referral centre in India. Regularly menstruating adolescent girls who presented to the outpatients department for minor, non-respiratory ailments were included in the study. Their lung volumes were measured serially during various phases of the menstrual cycle. During the menstrual phases, various parameters were compared. Results: Over the study period, 200 girls were enrolled in the study; the complete details for the final assessment were available from 43 girls (age range- 12 -18 years, mean height- 154.1 cm and mean weight -54.5 kg). The forced vital capacity, the forced expiratory volume, the FEV1/FVC ratio and the forced expiratory flow 25% to 50% were noticed to be significantly higher during the luteal phase and the lowest during the menstrual phase. Conclusions: The pulmonary functions which were quantified as lung volumes and peak flow rates were better during the luteal phase of the menstrual cycle, thus suggesting a possible beneficial role of progesterone in the management of respiratory illnesses.

Transabdominal Saline Contrast Sonohysterography: Can It Replace Hysterosalpingography In Low Resource Countries?
Objective: The objective of the study was to assess the accuracy of transabdominal saline contrast sonohysterography (TASCSH) compared to Hysterosalpingogaphy (HSG) in an (our) environment where the gold standard modalities are not readily available. Study Design: One hundred consecutive patients referred to the radiology unit for Hysterosalpingography and who gave consent for TASCSH as well HSG were included in the study. Sensitivity specificity, positive and negative predictive values of TASCSH were calculated using the widely used HSG as the gold standard. Results: TASCSH had 100% sensitivity, specificity and positive predictive value for uterine synechiae, hydrosalpinges and bilateral tubal blockade but 31% sensitivity for unilateral tubal blockade. TASCSH also showed 100% concordance with HSG in submucous masses (polyps & Fibroids) and found to be less painful by 80% of the patients. Conclusion: The readily available, easy to interpret TASCSH is not only safer and cheaper but it’s as accurate as HSG in evaluating the fallopian tubes and uterine cavity in infertile patients. We advocate its use as replacement for HSG in environment like ours where Hysteroscopy, MRI, positive contrast sonohysterography, transvaginal probes and skill are not readily available.

Post-Operative Analgesic requirement in Non-closure and Closure of Peritoneum during open Appendectomy- A Randomized controlled study

Basarkod Suresh, Ambi Uday S, Ganeshnavar Anilkumar, Emmi Shailesh, Lamani Y P
Objectives: To assess the post-operative analgesic requirement of non-closure of the visceral and parietal peritoneum at open appendectomy as compared to suture peritonization. Design: A randomized double-blind controlled trail was performed on 100 patients who underwent open appendectomy. Main outcome measures: Post-operative pain scores as assessed by visual analogue scale and analgesic requirement. Results: Pain scores at 24 hours were less in non-closure than closure group and analgesic requirement was significantly lesser in non-closure than closure group after 24 hours. Conclusion: In conclusion, not suturing the peritoneum at the appendectomy has beneficial effects on post-operative pain and we also emphasise the absence of short term morbidity when peritoneum is not closed. Therefore we recommend the non-closure of peritoneum at appendectomy.

Achieving the Urea Reduction Ratio (URR) as a Predictor of the Adequacy and the NKF-K/DOQI Target for Calcium, Phosphorus and Ca ÃƒÂ— P Product in ESRD Patients Who Undergo Haemodialysis

V. Sunanda, B. Santosh, D. Jusmita, B. Prabhakar Rao
Introduction: Among patients with end-stage renal disease (ESRD) who are treated with haemodialysis (HD), the solute clearance during dialysis is a determinant of the mortality. Also, elevated serum calcium (Ca), phosphorus (P) or the Ca × P product is associated with cardiovascular calcification and mortality in these patients. Our study was aimed at assessing the targets to be achieved, which were laid down by the NKF-K/DOQI guidelines for the urea reduction ratio (URR), serum calcium (Ca), phosphorus (P) and the Ca × P product in ESRD patients who underwent haemodialysis. Methods: We retrospectively analyzed the pre-dialysis and post-dialysis blood samples of 35 patients who were on chronic haemodialysis. For the adequacy of the dialysis, the urea reduction ratio (URR) was calculated by (predialysisurea – postdialysisurea) divided by predialysisurea and it was expressed in %. Calcium and phosphorus were measured from the fasting blood samples and the Ca × P product was calculated. Results: The mean urea reduction rate (URR) was 66.4% (adequate URR is >65%). The Student’s t-test (paired) was done on the results of the pre-dialysis and post-dialysis serum urea, creatinine and the uric acid levels. There was a significant (p<0.001) reduction in these parameters, thus suggesting the adequacy of the dialysis. The levels of the mean serum calcium, phosphorus and the Ca × P product were 8.59 ± 0.78 mg/dL, 5.82 ± 0.98 mg/dL and 49.88 ± 8.42 mg2/dL2 respectively. There was no achievement of the target phosphorus levels but the target levels of calcium and the Ca × P product were achieved. Conclusion: The NKF-K/DOQI target of the mean urea reduction rate (URR) was achieved, thus suggesting the adequacy of the dialysis. The NKF-K/DOQI target for mean phosphorus was not achieved, thus suggesting the inadequacy of the oral phosphate binders, poor compliance or no proper dietary phosphorus reduction.

Treating Coexisting Sinusitis –Is It Beneficial In Treating Childhood Asthma?

Devaki Perumal Rajaram, Vaitheeswaran Natarajan
Background: Asthma frequently co-exists with other conditions like sinusitis, otitis media, allergic rhinitis and conjunctivitis. Sinusitis frequently triggers and affects the severity of asthma. Hence, it is necessary to diagnose and treat co morbid conditions like sinusitis. Aim and objective: To determine the effect of the treatment of sinusitis on childhood asthma (with regard to its severity) and to measure the changes in the peak expiratory flow rate (PEFR) values as an objective evidence for the improvement of the disease. Materials and methods: Two hundred and thirteen asthmatic children with symptoms which were suggestive of sinusitis, of the age group of 5-12 years were recruited for the study. They were graded for the severity of asthma on the basis of their clinical symptoms and their PEFR values. Sixty four children were diagnosed to have co-existing sinusitis, based on their clinical symptoms and on the findings of nasal scopy and radio imaging. These sixty four children were started on the treatment for sinusitis, along with asthma medication for three weeks. In the fourth week, again these children were evaluated for the severity of asthma, based on their clinical features and their PEFR values . Results: After one month, the case load in grade II and grade I increased, while there was a decrease in the case load in grade III and grade IV, since the children with higher severity had shown improvement and as they had moved down to the lower grades of severity. As compared to the basal values, the mean PEFR, at 1 month, showed a statistically significant increase, thus providing an objective evidence for improvement.

A Study Of Sexual Dimorphism In Femora Of Rural Population Of South Tamilnadu,India

Umapathy Sembian, Muhil. M, Srimathi.T, Muthukumar.T, Nalina Kumari.S.D
Aim: Assessment of human sex from skeletal parts is of particular importance in forensic osteology and relies heavily on up-to-date techniques to provide accurate information to medico- legal system. Hence this study was taken to assess the sex from an isolated bone ie femur, with as far as possible minimal parameters to ascertain the sex. Materials And Methods: This descriptive study was done in the department of anatomy CMCH&RC, Trichy and SRU, Chennai with 200 dry femur of both sexes of which 100- males( 50 right side and 50 left side) and 100 – females ( 50 right side & 50 left side). Meticulous care was taken to include bones from a homogenous population and all the bones were well documented for sex, race and all belonged to the residents of rural population of south Tamilnadu. All the bones were cleaned from soft tissue and cartilage and were thoroughly dried. Bones exhibiting obscuring pathologies were excluded from study and all the bones studied had completed femoral growth as evidenced by the complete fusion of the proximal & distal femoral epiphysis. Six Anthropometric measurements were taken on each femur: Maximum Length, Maximum Diameter Of The Head Of Femur, Mid-Shaft Circumference, Maximum Antero- Posterior Diameter Of Femoral Shaft, Antero-Posterior Of Both (Medial& Lateral) Epicondyles, Bicondylar Width. Results: All the parameters were more in the male femora than in the female femora except the medial epicondyle. Conclusion: Average width of medial epicondyle in females is more. Average width of lateral epicondyle in males is more but statistically not significant. This study will be useful in the field of Forensic Osteology and Anthropometry for the identification of skeletal remains.

Serum Adenosine Deaminase Activity and Its Correlation with Glycated Haemoglobin Levels in Patients of Type 2 Diabetes Mellitus

Amandeep Kaur, Sahiba Kukreja, Naresh Malhotra, Neha
Background: Adenosine deaminase (ADA) is suggested to be an important enzyme for modulating the bioactivity of insulin, but its clinical significance in Type 2 diabetes mellitus (Type 2 DM) is not yet characterized. The present study was undertaken to evaluate serum ADA activity and serum uric acid levels in patients of Type 2 DM. Material and Method: It is a of case control study. The subjects included in this study were divided into 3 groups. Group A consisted of 60 normal healthy individuals who served as controls with no history of DM. Group B consisted of 60 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycaemic drugs with HbA1c <7%. Group C consisted of 60 patients of Type 2 Diabetes Mellitus both males & females in the age group of 40-65 years on oral hypoglycaemic drugs with HbA1c >7 %. Serum levels of fasting blood sugar, HbA1c, ADA and uric acid were estimated in all the subjects under study. Results: All the three parameters, FBS, HbA1c and ADA levels were found to be increased in the patients of Type 2 DM as compared to controls. The mean serum uric acid levels showed a bell shaped relation with glycaemic control. Conclusion: From the present study, it is concluded that there is an increase in serum ADA levels with increase in HbA1c levels. It was found that the serum uric acid levels increased with moderately increasing levels of HbA1c <7% and then decreased with further increasing levels of HbA1c >7% (a bell-shaped relation).

Profile of the Patients Who Attended the HIV Integrated Counseling and Testing Centre in a Teaching Hospital of Rajasthan

Niraj K. Biswas, Manoj K. Saurabh, Ashish K. Yadav
Context: Community awareness is the simplest way to limit the spread of the human immunodeficiency (HIV) infection in the population. Objectives: To study the sociodemographic characteristics and the perception about the disease among the attendees of an HIV clinic. Material and Methods: It was a cross-sectional, questionnaire based, observational study which was conducted between years 2008 and 2011 at the integrated counseling and testing centre (ICTC) of a teaching hospital in Rajasthan, India. Results: Out of 7561 subjects who were screened, the seroprevalence of HIV was seen in 109 (1.44%) cases. More visits to the ICTC were made by males (5973) as compared to females (1588), but the positivity rate was higher among females (2.64%) than among males (1.12%). Among all the subjects, about 80% of the seropositives belonged to the age group 15-49 years, 38.5% were illiterate, and more than 30% of the positive cases were housewives. Heterosexual (92%) and vertical transmission (8%) were the only modes of transmission. Seropositivity was more prevalent among the subjects who belonged to the below poverty line (58.7%). More than half (52%) of the respondents considered the HIV infection to be preventable and three fourth (75.73%) had no objection in staying in the same house as the infected cases, whereas only 33.4% of them were comfortable in sharing food with the HIV patients. Two thirds of the attendees were aware of the role of barrier contraceptives in the prevention of the HIV infection. However, there was a lack of awareness about the government intervention programmes. Conclusion: The screening of females in the population needs to be strengthened, possibly by universal antenatal coverage. Despite the ongoing campaigns, there is a lack of appropriate awareness in the population and hence, there is a need of interventions which focus on the dissemination of information even to the most peripheral and unreached areas.

Laparoscopic versus Open Varicocelectomy a Prospective Study

Sunil Telkar, B.V. Goudar, Y.P. Lamani, Uday Ambi, Ramesh Koppal
Laparoscopic varicocelectomy is a safe, effective and minimally invasive technique. In addition to its better cosmetic results and its advantage in case of bilateral disease, it allows an excellent exposure and control of the affected vessel. Varicocele therapy is a controversial issue with no single approach, which has been adapted as the best therapeutic option. The patients were divided into 15 members in each group, who received 2 different modalities of treatment. Group 1 which was treated with high inguinal ligation had a long hospital stay (4.5 days) as compared to Group 2 which underwent laparoscopic varicocele ligation (1.5day). Less postoperative pain and early return to normal activities were noted in the Group 2 patients, but laparoscopic varicocele ligation was more cost effective.

The Easy and Early Diagnosis of Typhoid Fever

Kinikar Anagha, Bhalerao Deepika, Roushani Shahriar, Kulkarni Sanjeev
Background and Objective: Typhoid fever is endemic in India. Its diagnosis is usually confirmed by blood culture, clot culture, stool culture and the Widal agglutination test. In the present study, we assessed the usefulness of the Enterocheck WB test in detecting the IgM antibodies in typhoid fever. Materials and Methods: A total of 83 cases of clinically suspected typhoid fever were included in the study. A blood culture and the Widal test were done by using the standard methods. The Enterocheck WB test was done according to the manufacturer’s instructions. Results: Of the 83 cases, the blood culture was positive for Salmonella typhi in 19 (22.89%) cases, among which the Widal test was positive in 12 (14.45%) cases and the Enterocheck WB test was positive in 17 (20.48%) cases. The sensitivity & specificity of the Enterocheck WB test were found to be 89.47% and 96.87% respectively. Interpretation and Conclusion: We compared the sensitivity and the specificity of the Enterocheck WB test and the Widal test to those of the blood culture as the gold standard method in the diagnosis of typhoid fever. We found that the Enterocheck WB test for the detection of the IgM antibodies was easy to perform and that no special equipment or prior training of the para-medical staff were required for the testing and the interpretation of the results. Hence, it can be concluded that the Enterocheck WB test can be used as a complimentary test as compared to the blood culture and the Widal test for the diagnosis of typhoid fever.

Kimura´s Disease – A Diagnostic And Therapeutic Dilemma

Bharati V H, Kalaivani V, Bharathi R, Vineet Binu
Kimura’s disease (KD) is a rare, benign disorder. It is a chronic inflammatory disease of unknown aetiology. It is endemic in Asia (China and Japan) and rare in the west. It has the highest predilection for the head and neck region. The histology shows a hyperplastic lymphoid tissue and an inflammatory infiltrate. The treatment options vary from surgical excision to corticosteroids to radiation therapy. The prognosis is very good and no malignant transformation has been reported so far.

Congenital Rubella Syndrome: It Still Exists in India
We report here a case of congenital rubella syndrome in a child who presented with hearing loss, patent ductus arteriosus and coloboma of the eye. The child was evaluated and rehabilitated using high gain hearing aid. This case is reported to highlight the persistence of infections like rubella which can be eradicated by vaccination and thus are avoidable causes of congenital hearing loss.

Persistent Axis Vessels Of The Lower Limb - A Rare Anomaly

Komala Nanjundaiah, Sheshgiri Chowdapurkar, Rahe Rajan
Introduction: The persistent axis artery is a rare embryological remnant of the axis artery which supplies the limb bud. It develops as a dorsal root of the umbilical artery and supplies the lower limb. It normally involutes when the femoral artery starts developing. Observation: We encountered a large, incomplete, persistent axis artery during routine dissection in a male cadaver which was aged approximately 70-years. The artery entered the gluteal region through the greater sciatic notch, below the pyriformis muscle. It gave off the inferior gluteal branches, the branches to the hip joint, the biceps femoris muscle, the sciatic nerve and the tibial nerve (high division of the sciatic nerve was noted). Throughout its course, it was accompanied by a vein which anastomosed with the tributaries of the femoral vein. Conclusion: Such a persistent axis artery is prone for aneurysm, thrombosis and embolism.

Rare Ocular Complication in a Case of Wegener’s Granulomatosis

Naval Chandra, Subbalaxmi M.V.S., Balambika R.G., Manmadha Rao T., Raju Y.S.N.
Wegener’s Granulomatosis(WG) is a granulomatous necrotizing vasculitis characterized by a predilection to affect the upper and lower respiratory tracts and kidneys. Pulmonary involvement is seen in 85-90%, ear,nose and throat in 73%, eye in 52%, skin lesions in 46% and renal disease in 77%.We report a female aged 39 years who presented with eye involvement in the form of nodular sclerosis, subglottic stenosis, bilateral pulmonary nodules and consolidation with cavitation and glomerulonephritis.

Bilateral Papillo-oedema in a Paediatric Patient with a Cerebro-Renal Disorder

Deepa Muzumdar, Neelam Puthran, Varsha Kulkarni
A 7-year-old boy, a known case of Polycystic Kidney Disease since birth, presented with an acute onset of headache and blurring of vision, and was discovered to have systemic hypertension of 140/110 mm Hg. Further examination revealed the presence of grade IV hypertensive retinopathy in both the eyes. MRI of the brain revealed diffuse cerebellar and cortical atrophy with a prominent ventricular system, which was indicative of a variant of the Dandy Walker Syndrome. Although there was initial improvement in the vision following the control of the blood pressure, the patient developed bilateral optic atrophy shortly thereafter. This case report highlights the occurrence of papillo-oedema with visual impairment in a cerebro renal disoder and also the importance of ophthalmic screening in paediatric patients.

Submucosal Leiomyoma in a Woman with Post–menopausal Bleeding – Diagnostic Dilemma, Ultrasound vs MRI: A Case Report

Rajneesh Madhok, Neera Agarawal, RuchiCa Goel
Introduction: We are reporting a case of submucosal leiomyoma in a post-menopausal women with a history of bleeding, which mimicked endometrial hyperplasia on ultrasound and was considered as a case of endometrial carcinoma. Case Presentation: A 44-year-old female who had attained menopause 04 yrs back, presented with on and off bleeding per vagina since one month. An ultrasound which was done outside our hospital, reported a markedly hypertrophied endometrium (24mm). She was not on any hormonal medications. Endometrial carcinoma was considered as a cause. Dilatation and curettage was done and the histopathology report showed atypical cells which were suggestive of malignancy. She was referred for MRI of the pelvis for further evaluation. The MRI was suggestive of a large, pedunculated, submucosal leiomyoma which protruded into the endometrium. A panhystrectomy was performed and the histopathology reports confirmed the leiomyoma. Conclusion: Ultrasound, as an initial modality of imaging, was not able to differentiate between the marked endometrial hypertrophy which was considered as endometrial carcinoma and the submucosal leiomyoma. MRI was helpful in reaching the diagnosis.

Anomaly of Coeliaco-Mesenteric Axis: A Rare Arterial Variation
While doing a routine dissection in an 85 years old cadaver, it was observed that instead of a single coeliac trunk, two trunks originated separately from the ventral aspect of the aorta, which were situated approximately 17 mm apart from each other. The proximal one which was known as the gastro splenic trunk, divided into the left gastric and the splenic arteries, whereas the distal trunk which was known as the hepato mesenteric trunk divided into the common hepatic artery and the superior mesenteric artery. The common hepatic artery ran anterior to the portal vein. This anomalous pattern conformed to the Adachi type V, which is a very rare anomaly and it could be attributed to the developmental changes which occurred in the primitive ventral splanchnic arteries. This rare anomaly could cause a catastrophe during surgical procedures, especially laparoscopic ones, if the same was not kept in mind before contemplating pre -operative investigations. So, the reporting of such a rare case is significant.

Endophthalmitis Due to Corynebacterium Jeikeium: A Case Report

Asima Banu, Nagraj E.R., Vidyadevi M.
Endophthalmitis is a grave complication of ocular trauma. We report here a case of acute post-traumatic endophthalmitis following a penetrating injury caused by an opportunistic organism, Corynebacterium jeikeium. The patient was treated with intra-vitreal antibiotics like ceftazidime and vancomycin to control the infection.

Culture Negative Infective Endocarditis Associated with Osler’s Nodes

Suindu K.N. Dash, C. Sugunakar, M.K. Kar
Infective endocarditis is a form of endocarditis, or inflammation, of the inner tissue of the heart, such as its valves, caused by infectious agents. The agents are usually bacterial, but other organisms can also be responsible. The prototypic lesion of infective endocarditis the vegetation is a mass of platelets, fibrin, micro-colonies of microorganisms, and scant inflammatory cells. Infection most commonly involves heart valves (either native or prosthetic) but may also occur on the low-pressure side of a ventricular septal defect, on the mural endocardium where it is damaged by aberrant jets of blood or foreign bodies, or on intracardiac devices themselves. We studied one patient of rheumatic heart disease with fever, osler’s nodes and echocardiographic evidence of endocarditis but blod culture was negative. Patient was successfully treated with antibiotics. This article highlights the diagnostic utility of osler’s nodes in culture negative endocarditis.

Implant Surface Modifications: A Review

Hemlata Garg, Gaurav Bedi, Arvind Garg
The aim of the present review was to elaborate on the surface modifications of biomaterials which are used in implant dentistry. The ongoing studies on the clinical and laboratory phases and on the biomaterial sciences have largely aimed at invoking a stronger bone response and an earlier and longer functional loading. Surgical grafting procedures to improve the bone bed are used to create an ideal environment for the implant functioning. The implant selection which is based on the available bone, is also an important determiner of the long term clinical success. The interfacial zone between the implant and the bone is composed of a relatively thin layer (<100um) which consists of heterogenous metallic oxide, proteins and connective tissue. The integrity of the implant – tissue interface is dependent on the material and on mechanical, chemical, surface, biological and local environmental factors, all of which change as a function of time in vivo. Because a stable interface must be developed before the loading, it is desirable that the tissue apposition may be accelerated to the implant surface. The material developments that have been implemented in the clinical practice include the use of surface roughened implants and bioactive ceramic coatings. Osseointegration occurs around the screw threaded implants through the tissue ongrowth or through a direct apposition between the tissue and the implant surface. The alternative methods of the implant-tissue attachments, based on the tissue ingrowth into roughened or three dimensional surface layers, yield a higher bone metal shear strength and decreased implant loosening. A positive effect of various surface modifications which are illustrated in this review, has been observed and suggested by many groups.

The Effect of Capsulated Glass Ionomer Cements on the pH of a Lactic Acid Solution: An In-Vitro Study

Sridevi Krishnamurthy, Jamini Narasimhan, Rangeeth Bollam Nammalwar
Aim: This study the evaluated interactions of capsulated glass ionomer cements (GIC) with an aqueous lactic acid solution. Materials and Methods: GIC fuji cap II and GC fuji cap IX were tested and compared to vials containing a lactic acid aqueous solution with no specimen as the control group. 16 specimens of each material were made according to the manufacturer’s instructions. The pH of the solution was measured immediately after 24 hours and at the end of the week. The statistical significance in the pH of the storage solution was determined by using one–way ANOVA. Result: All the materials were able to increase the pH of the lactic acid solution and both the materials were statistically significant. Conclusion: These findings can be helpful in predicting the performance of these materials under clinical conditions.

Letter to the Editor regarding the review of literature about aplastic anaemia complicating systemic lupus rythematosus

Reza Karbasi-Afshar, Ehsan Saburi , Amin Saburi