Journal of clinical and diagnostic research

Candidaemia In Disseminated TB

Context: Disseminated TB patients are invariably immunocompromised and are susceptible to opportunistic infections. Candidaemia is an under-recognised infection in India. Therefore, we planned to evaluate the prevalence, survival and risk factors for the development of this infection in disseminated TB patients in a tertiary care hospital in southern India. Aims: To assess the prevalence of invasive candidiasis / candidaemia in disseminated TB patients in India and to determine the survival of these patients and risk factors for the development of candidaemia in disseminated TB patients Settings and Design: A prospective study conducted after obtaining the institutional ethical committee’s approval. Methods and Material: Disseminated TB patients who came between February 2005 and February 2006 were included in the study after obtaining informed consent from the patients with assured confidentiality. The sources of the fungal culture were blood and ascitic fluid. Statistical analysis: Fisher’s test, the level of significance was set at < 0.05 Results: 103 disseminated TB patients were enrolled into this study, but the prevalence of candidaemia was just 5 %. Intravenous broad spectrum antibiotics (P<0.001), oral broad spectrum antibiotics (P<0.01) and indwelling catheters (P<0.01) were the three important risk factors. Non candida albicans species were predominantly present. Conclusions: Candidaemia has a low prevalence in Indian climatic conditions. If the risk factors associated with this infection are avoided, survival can be improved.

Drug utilization study in a trauma care unit of a tertiary care hospital

Objective: To evaluate drug utilization in a trauma care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwar Teaching and General Hospital (BTGH), Gulbarga and the data which was collected was analyzed for various drug use indicators. Results: A total of 220 prescriptions were collected and the average number of drugs per prescription ranged between 3.5 to 9.5 7.5% of generics and 94% of the essential drugs were prescribed. The NSAIDs and antimicrobials were prescribed to all the patients who were admitted in the trauma care unit (TCU). The (Defined daily dose) DDD/1000/day for diclofenac sodium was the highest (150), followed by cefuroxime (28.63) and that for paracetamol (2.27) was the lowest. Conclusions: Newer antibiotics and proton pump inhibitors were prescribed more often. The irrational use of higher antibiotics was also seen in the study population. Prescribing generics drugs should be promoted more for cost effective treatment. Hence, the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

Evaluation of collagen in different grades of oral squamous cell carcinoma by using the Picrosirius red stain- a histochemical study

APARNA V*, CHARU S

Oral squamous cell carcinoma is a major public health problem accounting for 94% of all oral malignancies. In this tumour, cells invade the stroma in the form of islands, strands or sheets, which are embedded in or surrounded by an extracellular matrix, thus producing reactive changes in the stroma. Collagen was studied histochemically in different grades of squamous cell carcinoma by staining tumour sections with Picrosirius red and examining them with polarizing microscopy. Polarizing colours of the collagen fibres were recorded and a gradual change from reddish orange to greenish yellow was observed from well to poorly differentiated squamous cell carcinoma, thus indicating that as the tumour progresses, there is a change from the mature form of collagen to an immature form.

A Cross-Sectional Descriptive Population-Based Study To Estimate The Prevalence Of Depression In An Urban Slum In Chennai City And The Associated Risk Factors

MUTHUKUMAR K* AND BHARATWAJ R S**

Introduction Depression has been under diagnosed and under reported in primary care settings. Various illnesses and biopsychosocial factors have been implicated as the contributing factors for depression. The overall rate of depression has increased in recent decades; depression is now being seen at younger ages and with greater frequency worldwide. Very few studies have been done in the past to estimate the magnitude of the problem of depression in the community in India, particularly so in the urban slums. Method A cross sectional descriptive study was done. An urban slum in ward 131 of Chennai city was selected by using a simple random table, from among the 155 wards in the Chennai Corporation. 700 individuals who were aged between 15 and 65 years, from the urban slum of ward 131, were chosen by simple random sampling and were screened by a General Health Questionnaire (GHQ-12), followed by assessment by using Beck’s Depression Inventory scale (BDI). Statistical analysis was done by the authors by using the SPSS 12 Version. Results The prevalence of depression in the study population was 22.8%, which included mild depression (20.7%) and moderate depression (2.1%). Female gender, illiteracy, being single after marriage in the form of being separated or divorced, widow or widower and the loss of one or both the parents before attaining 16 years of age were found to be the factors which were significantly associated with depression. Conclusion A large proportion of people in the urban slum had depression and many psychosocial factors were found to be associated with it. Health care personnel must be trained to identify the vulnerable groups and appropriate treatment should be administered at the primary care setting itself. In India, due to the scarcity of mental health services and resources, the policy makers can consider encouraging community participation in the form of the creation of self help groups with the support of the grass root level health workers.

Retrospective Analysis Of The Incidence Of Nosocomial Infections In The ICU - Associated Risk Factors And Microbiological Profile

MOHANASOUNDARAM K M*

Background Nosocomial infections, also known as health care associated infections, have become an important public health issue worldwide. Nosocomial infections pose a critical threat to patients, especially in high-risk departments such as intensive care units. Aim A retrospective review of the incidence of nosocomial infections in the ICU of a tertiary care hospital in Salem from January 2009 to December 2009 was performed. Results Among the 5680 patients who were admitted, the incidence of the nosocomial infection rate was 16%. Urinary tract infections (29.5%) were the most common ones, followed by lower respiratory tract infections occurring in 28.1% of the patients and blood stream infections in 22.8% of the patients. Klebsiella pneumoniae was the most commonly isolated pathogen (23.1%), followed by Pseudomonas aeruginosa (12.7%) and Escherichia coli (10.4%). Conclusion An increased duration of the time spent in the ICU and interventional procedures increase the risk of nosocomial infections.

A Study Of Body Mass Index In Healthy Individuals And Its Relationship With Fasting Blood Sugar

VITTAL B G*, PRAVEEN G**, DEEPAK P***

Background and objectives: Obesity is a global epidemic and is on the rise. It is defined as a body mass index (BMI) which is equal to or more than 30. It is one of the modifiable risk factors of type 2 diabetes. This study was undertaken to assess the association between BMI and fasting blood sugar (FBS) and also to verify whether BMI increases with age. Subjects and Methods: This prospective study included 400 healthy adult individuals who met the inclusion criteria. Fasting blood samples were collected to measure FBS by the glucose oxidase method. Thirty individuals were excluded from the study, as their blood glucose levels were in the diabetic range. Results: Among 370 individuals, a positive correlation was observed (Pearson’s correlation coefficient r = + 0.26) between BMI and FBS. There was a stepwise increase in the magnitude of BMI with an increase in age in decades. Although the increase in mean FBS was observed with age, a statistically significant (p = 0.00093) increase in mean FBS was observed only in the 4th decade of life. Interpretation and conclusions: The observed positive correlation between BMI and FBS reiterates the diabetogenic effect of adipose tissue and emphasizes the importance of the maintenance of normal BMI to prevent the early onset of diabetes.

Seroprevalence Of The Human Immunodeficiency Virus (HIV) 1 And 2 Infections In A Tertiary Care Hospital

SOLABANNAVAR S S*, MAHESH C B**, SURESH BS***, CHIDANAND S P****

Context: India is one of the largest and the most populated countries in the world, with over one billion inhabitants. Karnataka, a diverse state in the south west of India, has a population of around 53 million people. The districts with the highest prevalence of HIV infections tend to be located in northern Karnataka, which is known as the “Devadasi belt”. Many women from this part of the country are supplied to the sex trade in big cities such as Mumbai. Aim: The present study was done to know the seroprevalence of the Human Immunodeficiency Virus (HIV) which is the causative agent of the Acquired Immune Deficiency Syndrome (AIDS). Materials and Methods: Ten thousand seven hundred and sixty one (10761) blood samples were screened for the presence of the HIV-1 and HIV-2 antibodies by using a TRI DOT kit and third generation ELISA from August 2008 to July 2010. Results and conclusions: Out of the 10761 samples screened, antibodies to HIV-1 were present in 525 (4.9%) patients, of which 307 (58.5%) were males and 218 (41.5%) were females. No HIV-2 case was detected. The prevalence of the viral infection also varied with age, the highest prevalence rate being 262 (50%) as recorded in the age group of 21-40 years, while the age group of 1-20 years had the lowest percentage positivity with a prevalence rate of 42 (8%). The findings of this study emphasize the more urgent need for interventional measures like sex education and health and preventive education among the general population.

Sexually Assaulted Females On Their Sexual Debut: Reproductive Health Matters

PAUL A BOURNE*

Background: Previous studies which have examined reproductive health matters or sexual relationships have reported on the general population, adolescents, commercial sex workers, minors, university students, young adults, women, teenage mothers and males, but little is known about such issues among females who were sexually assaulted on their first sexual encounter. The present study seeks to elucidate information on reproductive health matters regarding those who were sexually assaulted on their first sexual encounter; and factors which influence their current method of contraception. Methods: The sample for this research was 747 women of reproductive age. A descriptive, cross-sectional design was employed for this study. Multiple logistic regressions were utilized to model the factors which explain the current contraceptive usage of the sample. Result: Ten in every 100 females of reproductive age in Jamaica have been raped; and about 15% of the men did not use a condom. Four variables emerged as the statistically significant predictors of the current contraceptive usage in this sample: age at first sexual initiation (OR = 1.16, 95% CI = 1.03 – 1.31); frequent church attendees (OR = 0.43, 95% CI = 0.25 – 0.77); number of pregnancies that resulted in live births (OR = 1.26, 95% CI = 1.05 – 1.52); and shared sanitary conveniences (OR = 0.55, 95% CI = 0.31 – 1.00). Conclusion: The ordeal which was identified by the current study is usually committed by close associates and family members, suggesting that many rapes are under-reported by females and as such, something must be done to address this silent killer.

Histochemical Study Of Salivary Mucins In Normal And Neoplastic Salivary Glands

NAAG S* , ADI R P**

Background: Salivary glands include major and minor salivary glands which are important components of the oral cavity and theirsecretions directly bathe the tissues. The biochemical and histochemical analysis of saliva revealed the presence of mucins as the main component, which showed sugar moieties and amino acids. The histochemical properties of mucins show the presence of glycoproteins andproteoglycans which differ in their chemical and structural natures. Mucins are altered in their normal and pathological states. Using special stains like Periodic Acid Schiff Reagent [PAS], Alcian Blue [AB], Aldehyde Fuchsin [AF], Mucicarmine [MC] they can be categorized into acidic, neutral, sulpho and sialomucins. Aims: The present study was carried out to assess different staining patterns of mucins in normal salivary glands and their neoplastic counterparts, to interpret type of mucin and change in their expression in normal and neoplastic counterparts. Methods and Materials: The study comprised of 19 salivary gland neoplasms which include 9 pleomorphic adenoma [PA], 4 adenoid cystic carcinoma [ADCC] and 6 mucoepidermoid carcinoma[MEC] and 10 normal salivary glands[1 parotid, 7 sub mandibular, 2 sub lingual] which were analyzed with special stains. Results: The results showed varied heterogeneity of mucin expression in mucous acini and change in mucin expression from benign to malignancy. Summary and Conclusion: The study concluded in considering the probable role of mucins in tumorigenesis and also its usage as an adjunct to diagnosis.

The Bacterial Profile Of Neonatal Septicaemia In A Rural Hospital In South India

EDWIN DIAS* AND VIGNESHWARAN P**

Introduction: Neonatal sepsis is the most common cause for neonatal deaths in the NICU. Newborn blood culture and sensitivity testing are important tools in the diagnosis of neonatal sepsis and in the institution of early antibiotic treatment. Material and Methods: This study was conducted by analyzing the blood cultures and the sensitivity reports of 100 newborns who were admitted to the NICU over a period preceding one year. Results: Of the 100 newborns, 32 (32%) showed positive blood culture reports. Out of the 32 positive blood cultures, 19 (59.4%) showed positivity for Coagulase negative Staphylococcus, 7 (21.9%) showed positivity for Staphylococcus aureus, 3 (9.4%) showed positivity for Pseudomonas aeruginosa, 1 (3.1%) showed positivity for Enterococci, 1 (3.1%) showed positivity for Micrococci and 1 (3.1%) showed positivity for Flavobacteria. Overall, most of the neonatal sepsis was caused by Coagulase negative staphylococcus. The sensitivity pattern of the first line of antibiotics was as follows; out of the 19 Coagulase negative staphylococcus strains, 13 (68.42%) showed sensitivity to amikacin and ciprofloxacin, 15 (78.95%) to sparfloxacin, 9 (47.37%) to erythromycin, 10 (52.63%) to azithromycin, 12 (63.16%) to gentamicin and cephalexin and 5 (26.32%) to penicillin. Out of the 7 Staphylococcus aureus strains, 6 (85.71%) showed sensitivity to amikacin, 5 (71.43%) to erythromycin, 4 (57.14%) to sparfloxacin and ciprofloxacin, 3 (42.86%) to azithromycin and cephalexin and 1(14.29%) to penicillin and gentamicin. Out of the 3 Pseudomonas aeruginosa strains, 2 (66.7%) were sensitive to ciprofloxacin and amikacin and 1 (33.3%) was sensitive to to sparfloxacin, azithromycin and gentamicin. Enterococci showed sensitivity to sparfloxacin, cephalexin, and ciprofloxacin. Flavobacteria showed sensitivity to gentamicin, erythromycin, ciprofloxacin, sparfloxacin and amikacin. Their resistance patterns were also studied. Conclusion: Coagulase negative staphylococcus is the most common cause for neonatal sepsis in the NICU. Most of the organisms were sensitive to Amikacin.

Oxidative Stress And Ascorbic Acid Levels In Cavitary Pulmonary Tuberculosis

RAJINDERJIT SINGH AHI*, ARORA D**, RAKENDRA SINGH***

Abstract: Oxidative stress is implicated in the pathogenesis of many diseases. It has been evidenced by various studies that free radicals are involved in the progression of pulmonary tuberculosis and also, in the damage caused to the lung tissue. Aim: The present study was conducted to assess the severity of oxidative stress (MDA) and the levels of antioxidants (vitamin C) in advanced (cavitary) pulmonary tuberculosis by comparing it with the non cavitary cases. Methodology: 50 cases and 30 controls were included in this study. The cases were further divided into cavitary and non-cavitary on the basis of the chest X-ray reports. The levels of lipid peroxidation (MDA) were estimated by the method of Stocks and Dormandy and those of vitamin C were estimated by the method of Varley. Result: The levels of lipid peroxidation increased significantly in the cavitary cases and also, the levels of the antioxidants (vitamin C) were found to be decreased significantly in the cavitary cases as compared to the non-cavitary cases. Conclusion: Oxidative stress was found to be increased highly significantly in cavitary pulmonary tuberculosis. The levels of the antioxidants (vitamin C) decreased highly significantly with an increase in lipid peroxidation levels.

Plasma Protein Oxidation And Total Antioxidant Power In Premenstrual Dysphoric Disorder And Menstruating Young Adult Females

TULADHAR ET*, KAMATH A**, RAO A***

Purpose: Oxidative damage has been associated with many human diseases encompassing mood affective disorders. Premenstrual dysphoric disorder (PMDD) has features which are similar to these, along with physical symptoms of stress. The purpose of the present study was, to assess whether oxidative stress has any role in PMDD. Method: Female subjects suffering from PMDD , in the age group of 20-24 years, were compared to their eumennorhic counterparts and also with those with premenstrual syndrome (PMS), in the follicular phase and in the late luteal phase for the ferric reducing antioxidant power of plasma (FRAP), plasma protein thiol (PPT) and protein carbonyl (PPC) levels. Results: There were no significant changes in the FRAP and PPC levels in the controls, in the PMS and the PMDD groups, but PPT levels decreased significantly in the luteal phase of the PMS (P=0.015) and the PMDD groups (P= 0.018) when compared to those in the follicular phase. Besides, PPT levels exhibited a significant increase (P=0.015) in the follicular phase of the PMDD subjects. Conclusion: A marked decrease in PPT levels in the luteal phase of the PMS and the PMDD groups may be due to the pro-oxidant nature of oestrogen - active in this phase of PMS, leading to the consumption of the sacrificial antioxidant – protein thiol. Further, to compensate this loss, a large reserve of PPT gets accumulated in the follicular phase of the PMDD group, thus indicating a dynamic turnover of this antioxidant between the two phases.

A Study Of Serum Electrolyte Levels During Nebulised Salbutamol Therapy

VITTAL B G*, RUDRESHA B M*, ALIYA N*, PRIYADARSHINI K S*

Background and objectives: Asthma is a very common disease with immense social impact. Nebulised salbutamol is the mainstay of therapy in acute severe asthma. This prospective study was done to determine the magnitude of changes in serum magnesium, potassium, phosphate and calcium during the treatment of acute severe asthma with nebulised salbutamol alone in a larger sample size, as previous studies were carried on a smaller sample size and yielded ambiguous results. Subjects and Methods: Sixty patients who met the inclusion criteria were included and their baseline electrolyte levels were measured. Nebulised salbutamol was administered every thirty minutes till the symptoms subsided and repeat serum levels of electrolytes were determined after 90 minutes. Results: Serum magnesium levels decreased significantly (p < 0.001) from 2.058 ± 0.0263 mg/dl to 2.048 ± 0.0268 mg/dl. Serum potassium levels decreased from 4.053 ± 0.0485 mEq/L to 3.983 ± 0.0482 mEq/L (p < 0.001). Serum phosphate levels decreased significantly (p < 0.001) from 3.899 ± 0.0299 mg/dl to 3.872 ± 0.0296 mg/dl, but no statistical difference was seen in the Serum calcium levels. Interpretation and Conclusion: Nebulised salbutamol therapy is associated with statistically significant decreases in serum magnesium, potassium and phosphate levels.

Cardiac Enzymes, Total Thiols And Lipid Peroxidation In Patients With Acute Myocardial Infarction

BABU SURESH1, JEEVAN KUMAR SHETTY2, MUNGLI PRAKASH3

Background: Oxidative stress has been implicated in the pathogenesis of acute myocardial infarction. In the current work ,we have measured malondialdehyde (MDA), total thiols, total creatine kinase (CK), creatine kinase-MB isoenzyme (CK-MB) and aspartate aminotransferase ( AST) in electrocardiogram (ECG) proven acute myocardial infarction (AMI) patients at 12 hours after the onset of chest pain and also in healthy controls. Methods: Blood samples from 25 AMI patients and 25 age and sex matched healthy controls were obtained for the measurement of cardiac enzymes like total CK, CK-MB and AST by using an automated analyzer. Serum MDA and total thiols were determined by using spectrophotometric methods. Results: We have found a significant increase in MDA, total CK, CK-MB and AST (p< 0.001) and a significant decrease in total thiols (p<0.001) in AMI patients as compared to the healthy controls. MDA correlated negatively with total thiols (r = - 0.573, p<0.01) and positively with CK-MB (r = 0.845, p<0.01) and AST (r = 0.676, p<0.01) in the AMI patients. Conclusions: Reactive oxygen species play a role in the pathogenesis of atherosclerosis, thus leading to acute coronary events and their levels are further elevated by the ischaemic event itself.

A Comparative Study on the Effects of Adding Fentanyl and Buprenorphine to Local Anaesthetics In Brachial Plexus Block

DHRUBAJYOTI SARKAR*, GURJEET KHURANA**,AMIT CHAUDHARY***, J P SHARMA****

Objective: To evaluate the efficacy of fentanyl and buprenorphine in improving the blockade characteristics when used as an additives in supraclavicular block. Study Design: Prospective, randomized, double blind trial conducted over a period of twelve months (July 09- June 10). Material and Methods: A total 75 adult patients of either sex with ASA health status I-III, who were selected for elective upper limb surgery under supraclavicular brachial plexus block were randomly divided into three equal Groups A, B and C. Group A received a mixture of lignocaine (2%) with adrenaline (1:2,00,000) 10ml + bupivacaine (0.5%) 20 ml + distilled water 10 ml, to make a total volume of 40 ml. Group B received 1 ml (0.3 mg) buprenorphine and Group C received 1ml (50 µgm) fentanyl in addition to the above local anaesthetics in the same volumes and concentrations. The onset time of the sensory and motor blocks; the time required for complete sensory and motor blocks; the total duration of analgesia, the haemodynamic changes and side effects were noted and compared in both the groups. Results: The onset time of the sensory and motor blocks was delayed in the fentanyl group (4.4 ± 1.41 min and 3.04 ± 1.31 min respectively), with no significant benefits on the duration of analgesia. In group C, buprenorphine, when added to local anaesthetics, prolonged the duration of analgesia by more than 1.5 times as compared to group A. Addition of fentanyl and buprinorphine to local anaesthetics in the brachial plexus block had no significant effects on the respiratory and haemodynamic parameters, except with minimal incidence (5.33%) of nausea and vomiting with the use of buprenorphine. Conclusion: We conclude that the addition of buprenorphine to local anaesthetics provides long lasting analgesia without any significant increase in complications and recommend its incorporation in the routine anaesthesia practice.

A Prospective Study On Evaluation Of Antibiotic Prescription Practices In An Intensive Care Unit Of A Tertiary Care Hospital

BALINGA SHRIKALA*, KOSARAJU KRANTHI**, NAFISA***

Objective: Antibiotics are the most commonly prescribed drugs in hospitals and their irrational use is one of the important factors for the development and spread of resistance in the hospitals. The prescribing of antibiotics in the Intensive care unit (ICU) is usually empirical, given the critical condition of the patients who are hospitalized there. Since there is wide diversity in the prevalence of predominant pathogens and their antimicrobial susceptibilities, especially within individual ICUs, there is a need to formulate appropriate prescription practices, based on studies and research within the ICUs. Therefore, an audit of the antibiotic prescription practices in our Intensive care unit was planned. Design: Prospective Hospital based cross sectional study Setting: Intensive care unit of a tertiary care centre (Kasturba Medical College Hospital, Attavar, Mangalore) Patients: All patients receiving a therapeutic antibiotic for the clinical suspicion of bacterial infections through to ICU discharge were included. Interventions: Data was collected on patient demographics, date of the hospital and ICU admission, reason for the ICU admission, white cell count and the proposed site of infection. Results: The respiratory system was the single most common site for infections in the ICU. Infections caused by Gram negative organisms were more common than those caused by Gram positive organisms. Antibiotics were administered empirically in 64% of the cases and in the rest, after microbiological confirmation. Conclusions: The inappropriate and ineffective use of antibiotics is commonly observed in the health care system, especially in developing countries. In 32.03% of the patients who are treated on an empirical basis, microbiological reports on the antibiotic susceptibility patterns were contrary to the treatment which was given. Hence, there is a compelling reason to change the current prescribing practices by a multidisciplinary approach, in order to curtail the spread of multi-resistant pathogens in the ICUs.

Impaired Antioxidant Defence Mechanism In Diabetic Retinopathy

Background Oxidative stress resulting from enhanced free-radical formation and a defect in antioxidant defences, has been implicated in the pathogenesis of diabetes and its complications include neuropathy, retinopathy, nephropathy, etc. Aims The aim of the present study was to evaluate the levels of selected oxidation and the antioxidant status with relevance to diabetic retinopathy and to correlate the antioxidant status with glycaemic control. Materials and Methods Thirty patients of type-2 diabetes mellitus (DM) without retinopathy, 30 patients of diabetic retinopathy and 30 normal subjects were included in this study. The degree of lipid peroxidation in terms of serum malondialdehyde (MDA) by the thiobarbituric acid method along with antioxidant defences, erythrocyte superoxide dismutase (SOD), reduced glutathione (GSH) and serum vitamin C was estimated in healthy controls and non-insulin dependent diabetes mellitus (NIDDM) subjects with and without retinopathy. Fasting blood glucose was also estimated and correlated with the antioxidant status. The statistical analysis was done by using the Students unpaired ‘t’ test and the correlation was done by using Pearson's correlation coefficient. Results The levels of serum MDA were found to be increased significantly in the diabetic retinopathy cases as compared to those in the cases with diabetes without retinopathy and in the healthy controls. The levels of superoxide dismutase (SOD), reduced glutathione (GSH) and vitamin C were significantly reduced in all diabetic patients, i.e., those with and without retinopathy. However, the lowest levels were found in the diabetic patients with retinopathy. A negative correlation was found between FBS and antioxidant enzymes in the diabetic retinopathy cases. Conclusion The results suggest that antioxidant deficiency and excessive peroxidation damage appear in NIDDM, and the severity is more with the development of complications. Therapeutic measures to increase the antioxidants and to control lipid peroxidation are warranted for the effective control of its complications.

The Impact of Poorly Controlled Hypertension on Ambulatory Care Resources in Malaysia

QAIS AEFAN , M I M IBRAHIM,TARIQ A RAZAK ,AZIZI AYUB

Aim: Since many Malaysians with hypertension have poor control rates of blood pressure, this study wasconducted to determine the impact of uncontrolled hypertension on the utilization of ambulatory care resources. Setting: The study took place at the Jaya Gading Polyclinic in Kuantan city, Pahang, Malaysia. Methods: This was a1year follow-up of 600 hypertensive patients who were classified into groups, based on average blood pressure. The monthly direct and indirect costs and the differences in costs were determined. Main outcome measure: Data analysis using the Mann-Whitney test was performed to compare the direct costswhich were associated with controlled and uncontrolled blood pressure. Results: The direct costs were significantly higher in the uncontrolled blood pressure groups as compared to the controlled blood pressure groups. Medication costs represented the major portion of the total direct costs in both the controlled and the uncontrolled blood pressure groups. Conclusion: Poor control of uncomplicated hypertension is associated with the higher utilization of the ambulatory care resources in Malaysia. Aggressive strategies are needed to control hypertension and to reduce the utilization of the ambulatory care resources.

Species Prevalence And Antimicrobial Resistance Pattern Of Enterococcal Isolates In A Tertiary Health Care Centre

Context: Enterococci are one of leading causes of nosocomial and community acquired infections and in recent years, they have become increasingly resistant to a wide range of antimicrobial agents. Aim: The present study was done to determine the species distribution and antimicrobial resistance pattern of enterococcal isolates. Material and Methods: 120 enterococcal isolates from different clinical samples were included in the study. They were identified by the standard microbiological methods and their antimicrobial susceptility was done by the Kirby-Bauer disc diffusion method. Vancomycin resistance was detected by the disc diffusion method and the agar dilution method and MIC testing was done by the macrobroth dilution method. High level aminoglycoside resistance (HLAR) was detected as per the CLSI guidelines. Results: E. faecium was the predominant species (47.50%) which was detected, followed by E.faecalis (44.16%) and others. E. faecium strains displayed a higher degree of drug resistance. The E.gallinarum species expressed low level vancomycin resistance, which was not detected by the disc diffusion method. More than 70% resistance was seen for ampicillin, erythromycin and tetracycline. 9(7.5%) isolates were found to be resistant to vancomycin. 5(4.16%) isolates were resistant to teicoplanin. All the isolates were susceptible to linezolid. HLAR was seen in 73(47.18%) isolates. Conclusion: E.faecium is now emerging as the predominant enterococcal species which causes infections and most of the enterococcal isolates (>77%) are multidrug resistant. Vancomycin resistance and HLAR in enterococci are rising rapidly. This study emphasizes the need for routinely carrying out a detailed speciation and antibiotic susceptibility testing of the enterococcal isolates in the bacteriology laboratory.

The Performance Of Haematological Screening Parameters And CRP In Early Onset Neonatal Infections

RAMESH BHAT Y* AND AMITHA RAO**

Background: In neonates with early onset sepsis (EOS), the haematological screening parameters and C-reactive protein (CRP) have wide variations in performance. Objective: To evaluate the performance of haematological screening parameters and CRP in blood culture positive neonatal EOS. Methods: We retrospectively studied the neonates who were suspected to have bacterial infections within the first 48 hours of life, based on the risk factors and/or the clinical features in whom haematological screening parameters, CRP and blood cultures were obtained. The screening parameters included total leukocyte count (TLC), the ratio of immature to mature neutrophil count (B: N), micro-ESR, platelet count (PLT), toxic granules (TG) and cytoplasmic vaccuolations (CV) in peripheral smear, and CRP. The screening parameters were assessed for individual performance and in combination in culture positive neonates. Results: Of the 1291 neonates who were screened for EOS, 212 (16.4%) had positive blood cultures. The male to female ratio was 1.08:1. Preterm, small for gestational age and symptomatic newborns constituted 33.9%, 17.9% and 39.2% of the total number of neonates respectively. Coagulase negative Staphylococcus, Klebsiella and Pseudomonas were the predominant culture isolates. Among the haematological parameters, the positivity was best with micro-ESR (44.8%) and the least with TG/CV (2.8%). Any 2 or more parameters were positive in one third of the subjects. TLC and micro-ESR had significantly more positivity among the symptomatic than the asymptomatic neonates (P<0.01). Odds of any 2 or more parameters which were positive for symptomatic relatives to the asymptomatic neonates was 3.89 (95% CI: 2.14 - 7.06; P <0.001) Conclusion: The sensitivities of the traditional haematological screening parameters and CRP were not satisfactory in identifying the neonates with EOS. A relatively better performance is expected in the symptomatic than in the asymptomatic neonates.

The Study Of 50 Cases Of The Foreign Body Of The Tracheobronchial Tree

GOYAL D K*

Background and Aim.: The lower respiratory tract extends from the vocal cords to the bronchus. Any type of foreign body can accidentally lodge at this site and it can become a life endangering emergency. This study was done in the region of Bikaner, Rajasthan, where the people are involved in the farming of peanuts and watermelon, and their children are prone to the inhalation and the lodging of peanuts and the seeds of watermelon in the respiratory tract. The adults and the elderly are used to chewing supari and they keep supari in their mouth while sleeping. So, they are prone to the inhalation and the lodging of supari in the respiratory tract. Material and Methods: This is a prospective study which has been done on 50 cases of foreign body lodging in the respiratory tract. The patients who had symptoms of respiratory distress, stridor, the intercoastal retraction of the muscles and a history of chocking, underwent clinical examination of the chest for unequal air entry. Chest X-ray and rigid bronchoscopy were done in these patients. These patients were classified according to their age incidence, gender, rural/ urban status and the type of foreign body and its location. Results: The minimum age of the patients was 1.5 years and the maximum age was 75 years. 78% patients were males and 22% patients were females, while 83% patients were from rural areas and 17% were from urban areas. The most common type of foreign bodies which were lodged, were peanuts, followed by supari, watermelon seeds, stones and balloons. The commonest location of lodging was the right bronchus. Discussion: The bronchus is the commonest location for foreign body lodging in Bikaner due to the life style of the people in that place. The people of this region grow peanuts in their farms and their children are prone to choking by the lodging of peanuts in their bronchus. The adults and the elderly are used to chewing supari and they keep supari in mouth during sleeping.

Serum Amikacin Levels And Hearing In Very Low Birth Weight (VLBW) Infants

RUCHI N NANAVATI R *,M A HAKEEM *, NITHYA GAGTEY**, B D SWAR **

Objectives: To assess hearing in the very low birth weight infants receiving amikacin for 7 and 14 days; and to study the relationship of serum amikacin levels with hearing. Study design: Single Centre, Non Randomized Prospective Parallel Group, Assessor Blind Study. Setting: Tertiary care neonatal unit of a teaching hospital. Participants: 30 VLBW infants who received amikacin for 7 days, 30 VLBW infants who received amikacin for 14 days and 30 VLBW infants who did not receive amikacin. None had any other risk factor for hearing impairment. Intervention: Amikacin administration as per their setting of indication. Outcome measures: Serum amikacin levels and hearing assessment. Results: Mean trough serum amikacin level (μg/ml) was 6.85±2.49 in 7 days amikacin group; and 15.2±3.41 in 14 days amikacin group. Mean peak serum amikacin level (μg/mL) was 14.5±3.16 in 7 days amikacin group; and 24.8±3.95 in 14 days amikacin group. All were normal on hearing assessment. Conclusion: Use of amikacin is safe in VLBW infants in therapeutic dosages in the absence of any other risk factors for hearing impairment and the monitoring of serum amikacin levels is advisable but not mandatory.

Antimicrobial Sensitivity Pattern Among Organisms Which Were Isolated From The Endotracheal Aspirates Of Patients With Ventilator Associated Pneumonia

PETER GEORGE1 AND ANITHA SEQUIERA2

Ventilator associated Pneumonia (VAP) is seen in 9 to 27% of all endo-trachealy intubated patients. Aim and objectives: To study antimicrobial sensitivity among organisms isolated from endo-tracheal (ET) aspirates of patients with VAP. Materials and methods: This retrospective study is designed to collect with data from medical records of patients admitted to the ICU of a tertiary referral hospital in the previous calendar year. 50 cases with VAP admitted to ICU were randomly selected and assessed for their clinical parameters (history and clinical examination) and investigations. Results: ET aspirate culture and sensitivity sampling done in 50 subjects, only 32 samples yielded significant growth. Acinetobacter were isolated in 37.5%(12), Pseudomonas in 21.87%(7), Klebsiella in 15.6%(5), Enterobacter in 12.5%(4), Citrobacter in 6.25%(2 )and Staphylococcus in 6.25%(2 ). Acinetobacter were sensitive to Amikacin (44.66 %), Gatifloxacin & Imipenem (33.33%), Meropenem &Cefaperazone (25 %). Pseudomonas were sensitive to Amikacin, Pipercillin, Cefaperazone (85.71%), Ceftriaxone (71.42 %), Imipenem, Meropenem and Gatifloxacin (57.14 %). Conclusion: The commonest organism isolated ET aspirate cultures were Acinetobacter, as seen in similar Indian studies. The infections can be reduced by practicing aseptic measures in ICU. The overall outcome of VAP varies with the antibiotic policies of individual centers.

The Role Of The Jess (Joshi’s External Stabilization System) Fixator In The Management Of Tibial Plateau Fractures Which Are Associated With Severe Soft Tissue Injuries

OBJECTIVES: The treatment of high-energy tibial plateau fractures which are associated with severe soft tissue injuries remains contentious and challenging. In this study, we assessed the results of Joshi’s External Stabilization System (JESS) by using the principle of ligamentotaxis for managing high-energy tibial plateau fractures which were associated with severe soft tissue injuries. MATERIAL AND METHODS: Between July 2007 and June 2009 (24 months), 21 consecutive patients who were aged 21–50 (mean, 26) years, underwent the JESS fixation for high-energy tibial plateau fractures which were associated with severe soft tissue injuries. 13 of them had injured the right knee and 8 of them, the left knee. 14 were closed and 7 were open injuries (compound grade II-4 cases; compound grade III-3 cases). The closed fractures were associated with bruising and marked swelling in 8, blebs formation in 5 and compartment syndrome in one. The injury mechanisms were motor vehicle accidents (n=15) and fall from a height (n=6). The fractures were classified according to Schatzker’s classification system. RESULTS: There were 9 type-VI and 12 type-V Schatzker’s tibial plateau fractures. The mean interval between the injury and surgery was 4 (range, 0–14) days. The mean hospital stay was 13 (range, 7–22) days. The mean interval between the surgery and full weight bearing was 16 (range, 13–19) weeks. The mean range of knee flexion was 130º (range: 100-140). The normal extension of the knee was observed in 16 patients, and an extensor lag of 5-10º was noted in five patients. The complications included superficial infections (n=3), pin tract infections (n=2), the restricted range of knee movement (n=1) and non-union (n=1). CONCLUSION: JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status. In a nutshell, JESS along with screw fixation offers a promising alternative treatment for high-energy tibial plateau fractures which are associated with severe soft tissue injuries.

A Study On Lipid Profile, Oxidation Stress And Carbonic Anhydrase Activity In Patients With Essential Hypertension

UTPAL KUMAR BISWAS1 AND ARUN KUMAR2

BACKGROUND OF THE STUDY: The incidence of cardiovascular diseases (CVDs) is rising and they are predicted to be the biggest causes of death by 2020 in India. Various epidemiological studies have highlighted the increasing incidence of hypertension, which is assumed to be one of the major risk factors in CVD. Even though effective treatment measures have been extended against hypertension, it still remains inadequately managed. Increased levels of serum cholesterol, TG and VLDL have been observed in patients with hypertension. Considering the view points and the relationship between hypertension, lipid profile and carbonic anhydrase modulation in diuretic therapy and scanty literature reports in this region, the current study was focused to determine the association of lipid profile and carbonic anhydrase activity in essential hypertension patients. AIMS AND OBJECTIVES: The aim of the present study was to determine the serum lipid profile, malondialdehyde levels and carbonic anhydrase activity in known cases of essential hypertensive patients and to compare the results with age-sex matched healthy controls in our community. MATERIALS AND METHODS: One hundred fifty-six participants (107 males; 49 females) were enrolled for the present study, with their ages ranging from 32 to 66 years. Seventy hypertensive patients (42 men and 28 women, 32- 64 yrs of age) and 86 normotensive healthy controls (65 men and 21 women, 32-66 yrs of age) were recruited for the study. Patients with essential hypertension were included in the study. Smokers, obese subjects and patients on anti-hypertensive drugs for >3 months were excluded from the study. Also, patients on lipid lowering drugs and antioxidant vitamin supplements were also excluded. Lipid profile, malondialdehyde levels and carbonic anhydrase activity were analyzed by standard methods in both the groups of subjects. The data from the patients and controls were compared by the Student’s t-test. The values are expressed as mean ± standard deviation (SD). Microsoft Excel for Windows 2003 was used for statistical analysis. P-values <0.05 were considered to indicate statistical significance. RESULTS: The lipid profile variables were significantly higher when compared to the healthy controls. The differences were highly significant in total cholesterol and triglycerides, but were not significant in HDL-C, LDL-C and VLDL. The study also observed higher levels of malondialdehyde in hypertensive patients (p<0.005) as compared to the levels in the normotensive controls. The carbonic anhydrase activity in hypertensive patients was also observed to be highly significant (p<0.001) as compared to that in the healthy controls. CONCLUSION: The lipid profile is bound to be altered in essential hypertension cases, along with increased oxidative stress and is associated with an increased activity of carbonic anhydrase.

Students’ attitudes towards the use of audio visual aids during didactic lectures in pharmacology

LALIT MOHAN1, RAVI SHANKAR P2, ASHWIN KAMATH3 , MANISH MS4, EESHA BR1

Introduction Students favour teaching methods employing audiovisual aids over didactic lectures not using these aids. However, the optimum use of audiovisual aids is essential for deriving their benefits. This study was done to know the students’ preference regarding the various audiovisual aids, with an aim to improve their use in didactic lectures. Methods Two hundred and fifty seven fifth semester medical students were invited to participate in a questionnaire based study. Two hundred and twenty four (87.2%) students completed the questionnaire and their responses were analyzed. The first part of the questionnaire included demographic and educational details. The second part consisted of 12 statements regarding the preference of audiovisual aids for various aspects of learning. Results 41.1% were female students. 85.3% of the students preferred the use of audiovisual aids during didactic lectures. A mixture of audiovisual aids during didactic lectures was preferred (42.4%), especially for understanding a particular topic. Females were more likely to take notes during the class lecture (p<0.001). Males preferred handouts over self made notes (p<0.001). Students from government institutions preferred power point presentations for understanding the subject matter (p=0.03), while those from private schools preferred the blackboard (p=0.04). Conclusion Our study demonstrates that lectures delivered by using a mixture of audio visual aids are more appreciated by the students. Furthermore, the lecture should be constructed in a fashion so as to enable the students to gather factual information easily and in a concise manner. Teachers should note that the students preferred a combination of visual aids and were interested in taking notes during lectures.

Aerobic Micro-Organisms In Post-Operative Wound Infections And Their Antimicrobial Susceptibility Patterns

AMRITA SHRIYAN*, SHEETAL R**, NARENDRA NAYAK***

Purpose: Post-operative wound infections have been an important cause of morbidity and cost burden for the patients. (1) The objective of this study was to evaluate the antimicrobial susceptibility pattern among the most common bacteria which are associated with post-operative wound infections. Method: 84 isolates were obtained from 100 pus samples / wound swabs which were collected from clinically suspected post-operative wound infections. The bacteria were cultured on Blood agar, Mac Conkey’s agar and Nutrient agar, followed by the identification of the isolates based on their cultural characteristics and their reactions in standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by the disk diffusion technique according to the Clinical and Laboratory Standards Institute (CLSI) guidelines on Muller Hinton Agar. The screening for extended spectrum beta lactamase (ESBL) production was done by the phenotypic confirmatory test by using ceftazidime discs in the presence and absence of clavulanic acid.(2),(3),(4) Result: Staphylococcus aureus was the most frequently isolated pathogenic bacteria from post-operative wounds. A majority of the isolates were resistant to ampicillin and amoxicillin. 1.8 % of the Staphylococcus aureus isolates were methicillin resistant Staphylococcus aureus (MRSA). Most of the gram-negative bacteria which were isolated, ie Escherichia coli, Proteus mirabilis, Klebsiella species and Pseudomonas aeruginosa were sensitive to quinolones and aminoglycosides, but were resistant to cephalosporins (40%). ESBL production was noted in 64.2 % of the isolates which were tested. ESBL production was detected in 60% strains of Escherichia coli and in 75 % strains of Klebsiella species. All the extended spectrum beta lactamase (ESBL) producer isolates were found to be sensitive to the beta-lactam and beta lactamase inhibitor combinations. Conclusion: This study has shown that a majority of the isolates were gram positive bacteria and that there was an increase in the incidence of ESBL producing Escherichia coli and Klebsiella strains. Tests for the detection of ESBL producing bacteria should be carried out routinely and the use of third generation cephalosporins should be restricted. Hence, there is a need for continuous monitoring to determine the susceptibility pattern of the common isolates which are found in the hospital. To emphasize precise empiric therapy, policies on prescription patterns should be reviewed, which will ensure reduced patient stay, morbidity and cost per day in the hospital.

A Study Of The Risk Factors And The Prevalence Of Hypertension In The Adolescent School Boys Of Ahmedabad City

KHAN M I1, LALA M K2, PATIL R 3, MATHUR H N4, CHAUHAN NT5

Background: Hypertension is one of the diseases which is less commonly diagnosed and treated, but its actual prevalence is high. The association between the presence of risk factors and the development of disease has been well documented. The present study was conducted to find out the risk factors and to evaluate the prevalence of hypertension among the adolescent school boys of Ahmedabad city. Aims: 1.To study the distribution of blood pressure among the adolescent boys who were aged 12-19 years. 2. To find out the association between the prevalence of hypertension and it’s risk factors. Settings and Design: A cross sectional study was conducted from Feb. 2007 to August 2008 in secondary and higher secondary schools in 5 zones of the Ahmedabad Municipal Corporation. Methods and Material: A predesigned and pretested proforma was filled by the students after the purpose of the study was explained to them. Anthropometric measurements and blood pressure were recorded as per the standard WHO guidelines.1093 proformas were analyzed after excluding the incomplete proformas. Hypertension was diagnosed when the BP exceeded two standard deviations (i.e.95th percentile) above the mean pressure for the population. BMI was used as a measure of obesity and it was derived by using the standard formula for it. Statistical Analysis: The collected information was analyzed by using the Microsoft Excel and the Epi info 3.4 softwares. Chi-square test was used for analysis. Results and Conclusions: Out of 1093 adolescent boys, 107 (9.78 %) were found to be hypertensive. The highest prevalence was found at 19 years of age (21.7 %). Of the 107 hypertensive boys, 42 (39.2 %) had both systolic and diastolic hypertension. The mean SBP among the participants was 109.6 mm Hg and the mean DBP was 69.3 mmHg. The family history of HT and the presence of overweight and obesity in boys were found to be associated significantly. No association was found between hypertension and other risk factors like added salt, junk food and the socioeconomic class. Among the hypertensive adolescents, the risk factors which were found to have the highest prevalence were the intake of junk food (90.6%), followed by higher socio-economic class (48.5%), extra salt in the diet (29.9%) and overweight and obesity (20.3%).

A Cross Sectional Study On The Coverage Of Immunization In The Slums Of Western Uttar Pradesh, India

Context: A growing focus on the growing urban slums and the worsening health problems among the slum dwellers. No current information is available on the status of immunization coverage in the slums of Meerut. Aims: To determine the immunization coverage in the slums of Meerut, and to study the awareness and utilization of the immunization services. Settings and Design: The entire slums of Urban Meerut, a cross-sectional study Methods and Material: By the WHO 30 cluster sampling technique, 30 slums were selected from the list of all the slums in Meerut. 216 mothers with children in the age group of 12-23 months were selected, with 7 mothers from each slum. Interviews were held with the selected mothers by using a pretested questionnaire. Statistical Analysis: Descriptive statistics Results: More than half of the children (51.9%) were un-immunized. One third of the mothers (34.7%) had no idea about the place of immunization. Among the children who were either partially or fully immunized, 77.9% had received immunization from the government health facility. The most common reason for partial or no immunization was the lack of information (77.2%). The dropout rate for complete immunization was found to be 32.7% Conclusions: The immunization coverage was very poor and the most common reason was the lack of information about the need of immunization, which indicates the importance of Information Education and Communication (IEC) activities in the slums.

The Study Of Age And Sex Related Changes In The Brainstem Auditory Evoked Potential

HARINDER J S*, RAM SARUP S*, SHARANJIT K**

Auditory evoked potential responses were recorded in 150 normal healthy subjects of different age groups (G1 = 15-29 years, G2 = 30-45 years, G3 = 46 years onwards), with a matched number of males and females in each group. These potentials were recorded by using EEG electrodes on an RMS EMG, EP MARC II (PC-based) machine. The data was statistically compared between the different age groups and between the males and females and regression analysis was done. Absolute latencies of the waves III, IV and V and the interpeak latency of the waves, I-III and I-V showed significant increase with age, thus suggesting degenerative changes in the auditory pathway and synaptic delay. There were significantly increased values of the latencies of the waves III, IV and V and interpeak latencies of the waves, I-III, I-V and III-V in males as compared to the females. Thus, age and sex have an effect on latency and interpeak latency in Brainstem auditory evoked potentials.

Females Of The Reproductive Ages Who Have Never Used A Condom With A Non-Steady Sexual Partner

PAUL A BOURNE*

Background: Previous studies have demonstrated that those with multiple sexual partners are more likely to be unmarried, younger (in adolescence years), and have a greater risk of contracting a sexually transmitted infection than those with single sexual partners. Yet, no studies have examined the females who are involved in multiple sexual relationships, who have never used a condom with their non-steady partners. Aims: The aim of the current study is: to elucidate (1) the socio-demographical characteristics of the females who have never used a condom with a non-steady partner, (2) the factors which account for their method of contraception, and (3) the factors that explain the age at the first sexual intercourse of this cohort. Methods: The data for this analysis was taken from the 2002 Reproductive Health Survey. The current study extracted a sample of 109 female respondents who were aged 15-44 years, who indicated having never used a condom with their non-steady sexual partners, from a sample of 7,168 individuals. Results: One and one half percentage of the females aged 15-49 years indicated having never used a condom with a non-steady sexual partner. Almost 81% of the sample had sex in the last 30 days, and the mean age was 30.4 years (SD = 8.1 years). Two variables emerged as the statistically significant factors of the ages at the first sexual intercourse of the samples, and they explained 38.8% of the variance. Three variables emerged as the statistically significant factors which explained the ages at which the females never used a condom with their non-steady sexual partner and this explained 40.1% of the variability. Conclusion: A multi-level approach to intervention has to be used to address polygamy and the inconsistent condom use among females who have non-steady partners in Jamaica; otherwise this risky behaviour will not be changed.

Treatment Of Anaphylaxis In Adults: A Questionnaire Survey At S. Nijalingappa Medical College Hospital, Bagalkot, India

PRABHU S B* AND YASMEEN M**

Objective: To identify as to which medications medical students, interns and casualty medical officers are likely to prescribe when treating an adult patient with anaphylaxis, and to ascertain the dose and route of administration of adrenaline that they would use. Design: A questionnaire study survey. Setting: S. Nijalingappa Medical College (SNMC) and H.S.K. Hospital, Bagalkot (Bagalkot District) and public health centers (PHCs) of the Bagalkot district, Karnataka. Methods: The medical students, interns and casualty medical officers of the S.N.M.C and H.S.K. Hospitals and doctors of various grades, working at the public health centers of the Bagalkot district, were asked to anonymously complete a questionnaire detailing a hypothetical case of anaphylaxis. The data were collected from 52 second year medical students, 35 interns and 25 casualty medical officers. Main outcome measure: To determine the percentage of the use of adrenaline for the treatment of anaphylaxis in the correct dose, strength and route. Results: 90% of the participants said that they would give adrenaline as a first-line treatment to a patient with anaphylaxis, but only 38% knew the correct dose and route of administration. 52% of the doctors who were surveyed stated that they would give adrenaline by the intravenous (IV) route as the first-line treatment. 67.85% and 20.53% of the participants preferred to use corticosteroids and antihistamines respectively. 3.57% said that they would give antibiotics as second line drugs. Conclusion: Most of the doctors who were surveyed were not clear about the current anaphylaxis treatment guidelines. In particular, they were unsure of the recommended dose and route of the administration of adrenaline. This confusion applied to all medical students, interns and medical officers. To ensure that the first-line treatment of anaphylaxis is safe, we recommend that intramuscular (IM) adrenaline should be used in the majority of situations like anaphylaxis. We recommend that all doctors should receive regular education concerning the treatment of anaphylaxis.

Does The Effect Of Pranayama Differ In Yoga Practitioner And Naive?

VARUN MALHOTRA ,KSHITIZ UPADHYAY DHUNGEL**, JAI GANGA*

The effect of Chandra nadisuddhi pranayama was studied on a yoga practitioners and a naïve subject. Chandra nadisuddhi pranayama is simply a left nostril breathing exercise. The heart beat rate was taken immediately before and immediately after each session, which consisted of twelve cycles of Chandra nadisuddhi pranayama. The mean heart beat rate of the yoga practitioners dropped from 73.94 ± 2.71 to 65.89 ± 2.02 and that in the naïve subject dropped from 79.83 ± 3.26 to 76.14 ±2.31 after Chandra nadisuddhi Pranayama. The drop was significant at p<0.001 in both the cases. But the drop was high in case of the yoga practitioners. So, it has been concluded that the effect of pranayama is the same in all, but to a higher degree in experienced yoga practitioners than in a naïve person.

Intraosseous lipoma of the calcaneum: A case report

ROMIT GUPTA*, AMIT THAKUR**, VISHALI KOTWAL***, DEEPAK ARORA****

A forty year old man presented with left heel pain with difficulty in walking for the past two and a half years. The patient had received multiple injections in the heel, with no relief. A skiagram of the foot was advised, which revealed a well concealed cystic lesion in the calcaneum. Curettage was done and histopathology revealed intrasseous lipoma of the calcaneum.

Nasopharyngeal Malt Lymphoma- A Case Report Of Rare Entity With Review Of Literature

Mucosa associated lymphoid tissue confers the first line of defense in case of membranes which are directly exposed to the external environment. MALT lymphomas arising at these sites present diagnostic and therapeutic challenges, especially if arising from areas such as the nasopharynx, where adenoid hyperplasia is very commonly present as a mass. In the present case report, a 55 year old male presented to the medical emergency department with complaints of severe respiratory distress. Radiological and clinical evaluation revealed a mass; the biopsy was taken and sent for histopathological examination, which suggested a possibility of MALT lymphoma. This was subsequently proven on immunohistochemical studies, which showed positive staining for CD 20 and negative staining for CD 3, CD 5 and CD 43. Hence, a final diagnosis of low grade B-cell MALT lymphoma was made. A quick and comprehensive diagnosis of MALToma is desirable, as it is amenable to chemotherapeutic therapy.

Neurofibromatosis (NF1) Associated With Optic Nerve Pathway Glioma. –A Case Report

Neurofibromatosis (NF) is a distinct condition with a multitude of clinical manifestations. It has been classified recently into two subtypes, NF1 and NF2. NF1 is an autosomal dominant disorder, affecting about 1 in every 3000-4000 persons from all races and from both the genders. We present here, a case of 36 year old male NF1, who was associated with multiple papulo-nodular lesions involving the left eye optic nerve, presenting as optic nerve pathway glioma.

Think Twice Before You Blow—Case Report And Review Of Literature

MAHESH BHAT*, GEORGE J.O.PINTO**, KULDEEP MORAS***, PRATHIMA CONCESSAO****

We present here, an interesting case of a patient who came with swelling of the left eye. This was secondary to the forceful blowing of the nose. Orbital emphysema is the abnormal presence of air in the loose subcutaneous tissues of the orbit. The medial orbital wall (lamina papyracea) which is known theoretically to be the weakest point of the orbital wall, has been reported to be the most common site of pure orbital fractures.

Pure Primary Intraosseous Meningioma: A Case Report And Review Of Literature

SUSHILA JAISWAL ,AWADESH KUMAR JAISWAL*, SANJAY BEHARI *, RAKESH PANDEY

A 60 year old lady presented with progressive increasing swelling over the scalp for 1 year and mild headache for 2 months. Examination revealed a non tender bony hard mass over the left parietal region. CT scan showed localized hyperostosis and thickening of the left parietal bone, with normal underlying brain parenchyma. The mass was surgically excised. Histopathology was suggestive of meningothelial meningioma. The case is discussed in the light of relevant literature.

Immature Mesenteric Teratoma In An Infant: A Case Report

JYOTI SRIVASTAVA* AND RAJENDRA K GHRITLAHAREY**

We report a case of a large mature teratoma with rare microscopic foci of the immature elements of the mesentery of the jejunum and ileum, which were diagnosed by histology in an infant. She presented with an abdominal lump since birth. Her clinical examination revealed a non tender, mobile, mass, occupying the right hypochondrium and the epigastric and the umbilical areas. USG and CT scan of the abdomen confirmed a heterogeneous mass of a size of 10 x 8 x 6 cm, with calcification seen in the intra peritoneum and displacing the intestinal loops to the left side. Exploratory laparotomy and complete excision of the tumour was done from the mesentery of the jejunum and the ileum. She was advised chemotherapy, as the biopsy was having immature elements and her serum alpha foetoprotein levels were markedly raised, but her parents refused chemotherapy. She is on regular follow up and is doing well.

Intestinal Taeniasis

RENU MATHEW*, KANNAN R**, KALYANI M***, JAYAKUMAR S****, BINESH LAL*****

Primary Tuberculosis Of Skin- A Nodular Variant Rare Case Report

GIRISH L DANDAGI*

Tuberculosis (TB) is familiar to human beings since the prehistoric ages. India has more tuberculosis patients than any other country has. In the year 2000 alone, an estimated 8.3 million new cases of TB has been noted in India. TB is an important public health problem in India, and considerable effort is being devoted to the diagnosis and management of this condition An attempt is being made to lower the overall disease burden in the community. Delay in the diagnosis and treatment often prolong the infectious phase for these patients. Suboptimal treatment (Improper drug Regimens, poor adherence to treatment, drug availability, etc) often compounds this problem. An unusual case of tuberculosis of the skin on the lower chest wall was recently noted in our department, the diagnosis of which was made, based on the clinical symptoms, culture of the pus and on the histological examination of the skin. The lesion resolved in response to chemotherapy.

An Unusual Cause Of Pulmonary Oedema And Its Successful Management: A Case Of Phosphorus Poisoning

PETER GEORGE*

Acute phosphorus poisoning is a grave clinical situation because of its toxicity and multiple system effects. The absence of a specific antidote makes the associated fatalities very high. In this report, a 22 year old woman presented with the clinical and radiological features which were characteristic of acute pulmonary oedema, after the consumption of phosphorus paste as a suicidal attempt. The initial echocardiography showed low ejection fractions and with aggressive haemodynamic monitoring and ionotropic support, she recovered within 48 hours of admission

Ameloblastic Fibroma

MEET KAMAL*

Ameloblastic fibroma is defined as – a true mixed tumour and a relatively uncommon neoplasm of odontogenic origin. It is characterised by the simultaneous proliferation of both epithelial and mesenchymal tissue without the formation of enamel or dentin. This tumour tends to occur in the first two decades of life, with a male predilection. Here, we report a case of Ameloblastic fibroma in a 9 year old girl, which was associated with unerupted 47.

A rare case of Bilateral Anterior Dislocation of the shoulder

AMIT THAKUR*, ROMIT GUPTA**, VISHALI KOTWAL***, DEEPAK ARORA***

We report an unusual case of simultaneous bilateral anterior dislocation of the shoulder following fall in a bathroom. There was no associated fracture, and no motor or sensory deficit. The dislocation was treated by closed reduction under intravenous sedation, followed by immobilisation for four weeks.

Chikungunya- An Update

SUJATA M BYAHATTI* AND GIRISH L DANDAGI**

Chikungunya is an arboviral disease which is transmitted by the bite of the Aedes mosquito, which recently reemerged as a massive epidemic in the Indian Ocean islands and India. Chikungunya is generally considered as a self-limiting disease and has been reported to be non-fatal. The Chikungunya virus (CHIKV) was isolated in Tanganyika (now Tanzania) in 1953. Chikungunya outbreaks were reported in India in 2005, and 1.4 million Chikungunya cases were reported from different states. This disease has reemerged in India after 32 years. It should be pronounced as CHICK_EN_GUN_YAH not as CHICKENGUINEA. There are many cases which have been noted, but very few deaths have been reported. The lack of any official reports of the deaths could remain as a poor recording of the ‘Causes of Death’ in India. Correct reporting, recording and monitoring are essential for the screening of this disease for the purpose of the proper management and the prevention of the spread of this disease.

Misdiagnosis In Exodontia-Our Experience

SHALLU BANSAL* ,RAJESH SINGHLA**

Exodontia is a common dental procedure which is routinely dispensed in our practice. Although the extraction of the tooth has become, in most of the cases, the last resort of treatment, dentists often consider tooth extraction as a minor and unimportant procedure. Sometimes dental surgeons attempt extraction without doing proper diagnosis, hoping that all will go well, but it can become an expensive lesson in ‘chasing without catching’. This paper is designed for general dental practitioners who desire to improve and want to obtain a wide variety of practical clinical information. In this paper, we are presenting the cases which are misdiagnosed and are negligently handled by the local dental practitioners.

An Unusal Case Of Unicystic Ameloblastoma Involving The Anterior Of Maxilla

MEETKAMAL* AND PARWINDER KAUR**

Unicystic ameloblastoma is believed to be less aggressive lesion and responds well to a conservative surgery than a solid ameloblastoma or multicystic ameloblastoma. Unicystic ameloblastoma predominantly occur in the mandibular 3rd molar region Here in our case we report Unicystic ameloblastoma in the anterior of maxilla in female patient who was treated by conservative surgery under the suspicion of radicular cyst .But the neoplastic behavior of the lesion was seen histopathologically

The Association Of Dental Plaque And Helicobacter Pylori Infection In Dyspeptic Patients Undergoing Endoscopy

DEEPIKA BALI*,JOSEPH ROSAMMA**, AMIT BALI***

Objective and Background The aim of this study was to analyze whether there is any association between dental plaque, oral hygiene and periodontal disease and Helicobacter pylori gastric infection. H.pylori, a spiral shaped microaerophilic bacterium, is responsible for peptic ulcer diseases, gastritis and gastric malignancies. Among various reports on the transmission of H. pylori, the faecal oral and oral-oral routes have been suggested to be the most plausible ones. Although it may be transmitted through the oral cavity, it is unknown whether the dental plaque acts as a permanent reservoir of H. pylori. Methods In this case control study, 124 dyspeptic patients with dyspepticsymptoms were categorized into the cases (60) and the controls (64) on the basis of the rapid urease test (RUT) and the histopathological results of the antral biopsy specimens. Patients with either of the tests positive or with both the tests positive were categorized as the cases and those with both the tests negative were taken as the controls. Results A high prevalence of H. pylori in dental plaque was found among the cases than in the controls. Among the cases, 52 patients out of the 60 (86.6%), had a positive rapid urease test in the dental plaque and among the controls, 12 out of 64 (18.75%) showed positive results. A highly significant association was found between poor oral hygiene status and periodontal disease (probing pocket depth) with H.pylori infection. Conclusion Triple / quadruple therapy has no effect on plaque associated H.pylori and it may continue to act as a reservoir. Plaque control measures and pocket eradication therapy are highly beneficial in eliminating and preventing the colonization of H.pylori in the oral cavity.

Evaluation Of Correlation Between Periodontitis And Rheumatoid Arthritis In An Indian Population

FARAH VAKAR M*, SYED AFROZ A**, ATHER S A***

Background and Objective: Considering the hypothesis that generated a link between joint diseases and periodontitis many centuries back, and the renewed interest lately in association between periodontitis and specifically rheumatoid arthritis, this study was undertaken in an Indian population. A correlation was done between the degree of periodontal disease in subjects with rheumatoid arthritis (RA) and non rheumatoid arthritis (NRA). Materials and Methods: The study comprised of 202 subjects, who were divided into rheumatoid arthritis and non rheumatoid arthritis groups of 101 subjects each. The periodontal status was evaluated through an inclusion criteria by evaluating the probing pocket depth (PPD), clinical attachment loss (CAL), bleeding scores and plaque scores. The degree of periodontal disease was compared to the severity of rheumatoid arthritis. Results: There was no statistically significant prevalence and severity of periodontal disease in the RA and NRA groups. Interpretation and Conclusion: Thus, as per this study, RA is not a risk indicator for periodontal disease, as both these diseases were not associated significantly in the Indian population.

Awareness Of Dental Implants As A Treatment Modality Amongst People Residing In Jaipur (Rajasthan)

PRAGATI KAURANI*, MAYANK KAURANI*

AIM: To determine the level of awareness of implants as a dental treatment modality and the willingness of the people to undergo dental implants as a treatment if needed. Method: A survey was conducted on 200 patients across Jaipur in private dental clinics and hospitals in the form of a printed questionnaire to evaluate the awareness about dental implants. RESULTS: Out of the 200 urban dental patients, only 38% had heard about dental implants as a dental treatment modality, most of them being in the age group of 25- 44 years (35.5%), with no statistical significance difference between males and females. Out of these, 55.2% had heard it from their dentist and the rest had heard it from other sources like magazines and electronic media. 29% of the people were willing to undergo the treatment if needed and 61.1% cited high costs as the main reason for refusal of the treatment if needed. CONCLUSION:The survey concluded that only 38 % of the urban population residing in Jaipur had heard about the dental implants as a treatment option, with only 29% of people willing to undergo the treatment if needed.

Prosthetic Rehabilitation Of Cleft Compromised Newborns: A Review

RIZWAAN A S*, SUJOY B**, RAJLAKSHMI B***, ATIF K****,

Cleft lip and palate is the most common congenital defect which affects the orofacial region. The treatment objective for patients with these defects is to restore the normal anatomy and function of the affected structures. Surgical closure of the defect is a viable option, but often, the approximation of the palatine halves has to be first achieved with orthopaedic appliances. A variety of appliances have been described for maxillary orthopaedics in infants. For the fabrication of such appliances, an impression of the defect is necessary. Impression making in infants with cleft lip and palate is a challenging task. This article briefly describes the appliances which are used for infant maxillary orthopaedics and the impression procedure for recording the defect.

Intra-Radicular Rehabilitation Of Weakened Anterior Root - A Case Report

SUNANDAN MITTAL*, RAMTA BANSAL**, TARUN KUMAR***, DILPREET KAUR****

The thin-walled roots of the anterior teeth with wide flared canal spaces, requiring restoration, are at a high risk of getting fractured if they are traditionally restored by using conventional cast metal post-cores. Such root canals can be reinforced by using materials which are capable of bonding to the dentinal tooth structure within the root canal, thus enabling the defective endodontically treated root which is capable of supporting a post and core. Such adhesive materials create a potential for the reconstitution and rehabilitation of the lost dentinal tissue in order to save and ensure the continued function of the badly damaged tooth, which otherwise would have been extracted. This case report describes a case where GIC TYPE 9 was used as intra-radicular reinforcement material.

Multiple Supernumerary Teeth Associated With Missing Lateral Incisor In A Patient Who Was Treated For Cleft Lip And Palate: A Case Report

RANGEETH B N*, JOYSON MOSES**, SANGEETHA DURAIVELU***

Multiple supernumerary teeth are usually associated with syndromes and non-syndromic ones are rare. Anomalies in the dentition are usually seen in patients with cleft lip and palate, and literature reports on a combination of the anomalies are rare. This rare case report aims to highlight the association of unerupted supernumerary teeth which were associated with a missing lateral incisor in a patient who had undergone surgical correction for cleft lip and palate during the first and second years after birth.

Concomitant occurrence of hypodontia and microdontia in a single case

SUJATA.M. BYAHATTI*

Developmentally missing teeth may also be the result of numerous independent pathological mechanisms that can affect the orderly formation of the dental lamina, failure of a tooth germ to develop at the optimal time, the lack of necessary space imposed by a malformed jaw, and a genetically determined disproportion between the tooth mass and the jaw size. Clinically, hypodontia in the permanent dentition, excluding the third molars, is found in 3-10% of the population. Hypodontia is more frequently found in Asians and Native Americans. One of the commonest forms of localized microdontia is that which affects the maxillary lateral incisor, a condition called Peg laterals. The next tooth which can be affected is the third molars. Few cases of microdontia in canines have been reported. The following article throws light on the Concomitant occurrence of hypodontia and microdontia in a single case.

Aesthetic Management Of Proclined Maxillary Central Incisors With All-Ceramic Crowns : A Case Report

SHARMA A K, BHANOT R, BANSAL P, KAPOOR D

Maxillary anterior crowns provide an exciting challenge to our artistic and technical abilities and call upon our knowledge of the smile design principles of proportion, symmetry, harmony and tooth morphology. Smile rejuvenation can positively impact a patient's self-esteem and emotional health through an improved appearance. Metal-free crowns can allow for highly aesthetic solutions such as colour correction/ matching and allow us to reshape malformed teeth, or reshape teeth which are in incorrect arch positions, to more closely approximate their correct shapes. The development of reinforced ceramics and non-metallic post systems has made possible the generation of metal-free ceramic restorations in severely compromised anterior and posterior teeth. This article will describe a case where all-ceramic crowns were utilized to restore proclined discoloured central incisors.

Expectations From Orthodontic Treatment Patient / Parent Perspective

ROHIT DUGGAL* AND SUMIT BANSAL**

The purpose of this study was to investigate the expectations of children and their parents towards orthodontic treatment. A total of 200 subjects (100 patients and 100 parents) who were attending for their first visit, completed the questionnaire in the Department of Orthodontics at the Dasmesh Institute of Research and Dental Sciences, Faridkot. The children were aged between 10 to 15 years. The response of the children and one of the parents was examined by using parametric statistical methods. The patients and their parents had different expectations, as shown by the statistical analysis. Hence, effective communication between the orthodontist and the patients and their parents is considered to be essential.

Evaluation Of Micronuclei Using Papanicolaou And May Grunwald Giemsa Stain In Individuals With Different Tobacco Habits – A Comparative Study

PALASKAR S*, JINDAL C**

Aims: To compare the Papanicolaou’s (Pap) and May Grunwald’s Giemsa (MGG) staining techniques which are done to detect micronuclei (MN) in exfoliated buccal mucosal cells in individuals with different tobacco habits. To determine the severity of human buccal cell changes which are associated with smoking and smokeless (‘‘chewing’’) tobacco (SLT). Methods and Material: A total of 45 male subjects (15 smokers, 15 smokeless tobacco users and 15 non users/ non smokers) were examined. Two cytological smears were taken from the apparently normal buccal mucosa from each individual. 45 smears (1 per individual) were wet fixed and stained with Pap and the remaining 45 smears were air dried and stained with the MGG stain. All the smears were assessed for cellularity and were scored for MN. Statistical analysis used: The ANOVA (one way analysis of variance) was used to analyse the frequency of cells with micronuclei. Bonferroni multiple comparisons were done to determine the significance (p<0.05) of the mean difference. Results: MNs were easily seen in the clear cytoplasm in the Pap smears. Regarding the MGG smears, bacteria and cell debris masked the effect of the MNs as compared to the Pap smears, where the fixative destroyed the bacteria and clearly demarcated the cell boundaries. The score of the MN frequency decreased as we moved from the smokeless tobacco chewers to the smokers and then to the non users and the non smokers. Conclusions: Pap is a better stain as compared to MGG for counting micronuclei. Smokeless tobacco chewers showed an increased number of MNs as compared to the smokers, thus laying emphasis on the greater carcinogenic potential of tobacco which was used in the chewable form.

Birth Of A Mermaid In The Coastal Region!-Sirenomelia

NIRUPAMA M*, ARAVIND P**, RUCHI S***, SANDHYA I****