Journal of clinical and diagnostic research

Saddle Block Anaesthesia with Meperidine for Perineal Surgery

BAKHSHA F*, BEHNAMPOUR N**

Background and Aim: Regional (saddle block) anaesthesia in anorectal and some urological and gynaecological procedures provides suitable conditions for the surgeon due to the sufficiency of analgesia and decreases the side effects of spinal anaesthesia. In this study, duration of the painless period and complications after saddle block with Meperidine (pethidine) were assessed in perineal surgeries. Materials and Methods:This study was conducted on 50 cases observed by the American Society of Anaesthesiologists (ASA) class I, II 21-70 years old patients, who were scheduled to undergo anorectal surgery. All patients received 500ml of crystalloid solution. The saddle block was done with 30 mg pethidine and sub arachnoid puncture was performed with the patient in the sitting position. Vital signs were recorded 5 minutes before the block and at the 5th, 10th, 15th and 60th minutes after the block. The severity of postoperative pain was assessed by a visual analog scale. The data was analyzed by appropriate descriptive statistical methods. Results: The mean period of analgesia was more than 24 hours in 18% of the patients. The VAS pain score showed no pain in78% of the patients. Sixteen percent of the patients complained of itching in the nose, face and chest, ten minutes after injection and it continued for about two hours. Conclusions: This study showed that the haemodynamic stability and quality of postoperative analgesia with pethidine was good, without any need for additional analgesia. We suggested using low dosage pethidine (30 mg) as saddle block for perineal and anorectal surgeries.

A Potential Correlation between Systemic Oxidative Stress and Intracellular Ambiance of the Lens Epithelia in Patients with Cataract

GOYAL M M *, VISHWAJEET P*, MITTAL R** , SUNE P***

Aim: To study the correlation between systemic oxidative stress and intracellular ambiance of the lens epithelia in patients with cataract. Materials and Methods: Spectrophotometery was employed for the estimation of catalase activity and the extent of lipid peroxidation in the lens epithelial cells (LEC) and plasma. Both are markers for oxidative stress. No antioxidant medicines were used by the cataract patients enrolled in this study; otherwise, they were all healthy individuals without any systemic diseases. Results: A total of 56 patients with cataract were included in this study. The mean ages of the patients were 66.6 ± 8.3 (±SD) years for males and 62.4 ± 10.0 years for females. Catalase activity was estimated in surgically removed LEC (221.16±135.87 U/µg protein; Mean±SD) and in plasma (277.56±162.44 KU/mg Hb). MDA levels were also calculated in LEC (1.28±0.79nM/mg protein) and in plasma (537.30±238.47 nM/g protein). Linear regression analysis showed a partial positive correlation in LEC and plasma catalase activity (r: 0.701; p<0.05), but not in MDA (r: 0.248; p>0.05). Conclusion: Increased systemic oxidative stress can lead to the development or progression of cataract by affecting the intracellular ambiance of the lens epithelia. So, subjects having high systemic oxidative stress are more vulnerable for the development of cataract.

Outcome of a Post Caesarean Pregnancy in a Tertiary Center of a Developing Country

BHAT BPR **, SAVANT R *, KAMATH A***

Background: An expectant attitude and individualization with respect to the management of pregnancy and labour in patients who had one caesarean section is not only justifiable, but represents sound and conservative obstetrical practice. Aims: 1. To study the success rate of vaginal birth after caesarean delivery 2. To know the commonest indication for elective and emergency caesarean section Methods: A total of 219 cases with a history of previous caesarean section beyond 28 weeks of gestation were included in the study. The collected data was analyzed by chi-square test. Results:The incidence of post caesarean pregnancy cases were 219(8.76%). Out of these, 113 (51.6%) were selected for trial of labour and 106(48.4%) underwent elective repeat caesarean section. Of the 113 women who were allowed for a trial of labour, 73(64.6%) delivered vaginally and 40(35.4%) delivered by emergency repeat caesarean section. Thus, the success rate of VBAC was 64.6%. So a total of 146(66.7%) women underwent repeat caesarean section and 73(33.3%) delivered vaginally. Cephalopelvic disproportion was the most common indication for elective repeat caesarean section and foetal distress for emergency caesarean section. Conclusion: VBAC should be considered in cases of previous one caesarean delivery for non recurrent indications.

A Descriptive Study of the Influence of Age and Gender on Drug Utilization in Acute Myocardial Infarction

KAMATH A* , SHANBHAG T**, SHENOY S***
Introduction: Despite the presence of effective guidelines for the management of acute myocardial infarction, there is underuse of thrombolytics, antiplatelet drugs, angiotensin converting enzyme (ACE) inhibitors, beta blockers and hypolipidaemics. Gender and age based differences have been reported. Our aim was to determine the percentage of patients who were receiving these drugs during hospital admission and discharge. Method: A case record study of 349 patients who were admitted to our hospital with a diagnosis of acute myocardial infarction during the year 2004-2006, was done. The age, gender, drugs prescribed during the three days following admission and on discharge, co-morbidities, outcome and duration of stay, was noted for each patient. Results: Of the 349 patients, 81% were males and 19% were females. The average ages of presentation were 57.98 years in men and 65.02 years in women. The percentages of patients who received antiplatelet agents, thrombolytics, beta blockers, ACE inhibitors, hypolipidaemics and anticoagulants on hospital admission were 95, 42, 43, 46, 79, 85%,respectively. The prescription rate of antiplatelet agents, beta blockers, ACE inhibitors, hypolipidaemics on discharge was 98, 66, 68, 92% respectively. Conclusions: Our study showed that the initiation of treatment in both the gender and age groups varied. However, the use of drugs among the various groups was almost equal on discharge, except for hypolipidaemics. A majority of the females and elderly patients received all the drugs on hospital discharge, reflecting a lack of gender or age disparity. Although the use of thrombolytics, beta blockers and ACE inhibitors was low on admission, proper use after adjusting for confounding factors might be higher.

A Study Of Sleeping Habits And Disorders Among School Students Of Pondicherry

Role Of Cerebral Protection In Carotid Angioplasty And Stenting

KARANAM L S P * , AHLMAN P**, DEV B *** JOSEPH S ****
Aim:To study the role of protective devices in improving the efficacy of percutaneous transluminal angioplasty (PTA) and stenting, in the treatment of symptomatic atherosclerotic stenosis of carotid arteries. Materials and Methods:This study was performed in a teritiary care center in a period of 4 years, which included 66 patients. A majority of the patients presented with transient ischaemic attacks, with the youngest being 19 years and oldest was 82 years. Preprocedural workup with Doppler, MR angiogram and Digital subtraction angiogram was done in all the patients. The degree of stenoses was classified on the basis of the NASCET (North American Society Carotid Endarterectomy Trial) trial. PTA and stenting with self expandable stent and balloon was done in all the patients under local anaesthesia. Cerebral protective devices were used in all the patients and the patients were regularly followed up at intervals of 1, 3, 6 and12 months. Results:PTA and stenting with cerebral protection was done in all the patients. Technical successs was achieved in all the patients. Four patients had filter choking. Major stroke occurred in one patient. No deaths occurred in our study. Bradycardia occurred in 3 patients, hypotension in 4 patients and puncture site haematoma in 2 patients. The results of the present study were analysed and compared with the literature. Conclusion: PTA and stenting is effective for the management of carotid artery stenosis with higher success rate and less complications. The role of cerebral protection in avoiding migration of the plaque material and thus preventing cerebral circulation was emphasized.

Evaluation Of Knowledge And Perception Of Malaysian Health Professionals About Telemedicine

MOHAMED IZHAM MOHAMED IBRAHIM*, PHING C W **, PALAIAN S***
Background: Incorporation of Information Technology (IT) advancements in healthcare has been growing in the recent past. There is convincing evidence that developing countries can also benefit from telemedicine and other IT applications in healthcare. The Malaysian government, in mid-1996, launched the multimedia supercorridor (MSC) project. As a new medical technology in the country, it takes a huge effort to make professionals understand this new concept. Objectives: To evaluate the readiness of healthcare professionals in the country in accepting and providing telemedicine services and to access levels of perception and opinion towards telemedicine, and to access knowledge factors in relation to telemedicine. Materials and Methods: A cross sectional survey was carried out among various healthcare professionals using a proper sampling frame obtained from a list of health care providers in all state Department of Health in the country. The study questionnaire consists of 3 main parts; background and demography, perceptions and acceptance and knowledge level. The questionnaires were mailed to the respondents and the completed questionnaires were analyzed as per the study objectives. Results: The total response rate in this study was 32.48% (369/1136). On average, the respondents were young and with 10 years of experience.The majority of the respondents mentioned that computers are important for them for internet use (84%) and using software packages (83%). Only 31% wish to accept the reduction of face-to-face communication with patients and other health professionals. Majority of respondents have used CD ROMs (82%), e-mail (84%) and modem (76%), while more than three quarters of the respondents have no experience with using smart cards, computer assisted learning (CAL), teleradiology, telesurgery, telenursing and telepharmacy, respectively. Conclusion: The majority of respondents mentioned that their computers are important for them for internet use and using software packages. Nearly half of the respondents felt that computers are important for their profession. Most respondents have used CD ROMs and e-mail facilities. In general, the respondents have a low inclination towards working in rural areas for a telemedicine project.

Prescription Pattern in the Department Of Medicine of a Tertiary Care Hospital in South India
The study was carried out to find the prescribing behaviour in the medicine out-patient department of a tertiary care hospital in Rajahmundry, India. Prescriptions of 608 patients were collected over a period of 1 month. The analysis indicated that 57.7 % of drugs prescribed had no mention in the National and State Essential Drug List. Moreover the use of antibiotics (57.24%) and fixed dose combinations of various drugs (32.57%) was comparatively more as compared to earlier studies done in India. Irrational prescribing of drugs is a major health concern in developing countries like India. High power salesmanship also plays a key role in the prescribing behaviour of doctors. There is always scope for improving the prescribing habitsof clinicians.

Plasma Ceruloplasmin in Chronic Renal Failure Patients Undergoing Haemodialysis

ASHOK K J * , SAJIDA M P**, JOSEPH S***
Plasma ceruloplasmin levels were estimated in 42 renal failure patients undergoing haemodialysis and in 42 age and sex matched controls. Plasma ceruloplasmin levels in cases before haemodialysis (947.27 ± 458.58) was significantly increased as compared to the controls (477.95 ± 278.63). There was no statistically significant change in the plasma ceruloplasmin levels before and after haemodialysis.

Diagnosis Of Porphyria By Measuring Metabolites Of Heme Biosynthesis In Correlation With Clinical Findings

SORTE K *, PALANDURKAR K **, GOYAL M ***, SINGH A L ****, BASAK A*****.
Background: Porphyria is a group of genetic diseases which require specialized laboratory facilities for accurate diagnosis .Facilities for diagnosis of Porphyria have been established in our institution since 1996 with few biochemical investigations in correlation with clinical findings. Materials And Methods: Quantification of urinary total porphyrins was done by Double beam computerized spectrophotometer. Urine porphobilinogen (PBG) is screened by Hoesch test (1) and confirmed by Watson-Schwartz test (2). Presence of PBG in urine was further confirmed by wavelength scanning by spectrophotometer. Results And Discussion: Normal value of total porphyrins in urine: <35nmol/µmol of creatinine. In last 12 years, we have diagnosed four cases of Porphyria. The two cases were diagnosed as Acute Intermittent Porphyria (AIP) on the basis of increased levels of urine total porphyrins, increased urine PBG with symptoms of acute neurovisceral attack. In one case, there was increased level of total urine porphyrins up to 91.6 nmol/µmol of creatinine with history of photosensitivity, skin bullae with scars since childhood. The case was diagnosed as Congenital Erythropoetic Porphyria (CEP). In the other one, urinary total porphyrins was increased up to 1695 nmol/µmol of creatinine and urine PBG was absent with signs of cutaneous manifestations due to precipitating factors. This case was diagnosed as Porphyria Cutanea Tarda (PCT). Conclusion: Any Biochemistry Laboratory having spectrophotometer can diagnose porphyria with clinical correlation.

(Article Retracted).Hypertensive Disorders in Pregnancy Requiring Emergency (108) Transportation in the State of Gujarat (India): An Epidemiological Study.

PANDEY A*, RANJAN R**
This article has been retracted on 10th Oct 2012 as there was irrefutable evidence of plagiarized data.

Alveolar Rhabdomyosarcoma Of Paratesticular Tissue In An Adult

GUPTA S*, MISRA V**, SINGH P A***
Most masses encountered within the scrotal sac are in the testis and are neoplastic. However, asubset of these tumours are extratesticular and arise from the paratesticular tissue. The paratesticular region is a complex anatomical area which includes the contents of the spermatic cord, testicular tunics, the epididymis and the testis (1). Histogenetically, this area is composed of a variety of epithelial, mesothelial and mesenchymal elements. Rhabdomyosarcoma of the male genital tract is rare. If present, it is usually seen in children and adolescents and is of the embryonal type. We present here, a case of alveolar rhabdomyosarcoma in an elderly patient.

Calcium Pyrophosphate Dihydrate Crystal Deposition Disease–A Case Report

FONSECA A *, CRASTA J**, SWAMY M***
We report here, a case of calcium pyrophosphate dihydrate deposition disease, presenting as progressive bilateral knee pain that simulated osteoarthritis. A 52 year old male patient presented with gradually progressing bilateral knee pain of 2 year’s duration. Plain X-ray films showed osteoarthritic changes and osteochondral loose bodies. The nodular crystal deposits with the characteristic features of CPPD crystals in the synovium at histology, aided in arriving at the correct diagnosis.

Tubercular Cervicitis Clinically Mimicking As Carcinoma Cervix: Two Case Reports

BHALLA A * , MANNAN R ** , KHANNA M *** , BHASIN T S ****
Tuberculosis caused by Mycobacterium tuberculosis is a prevalent infectious disease in resource challenged countries such as India. Tuberculosis of the female genital tract accounts for a minority of cases. Tuberculosis can have a varied presentation and can even mimic malignancy on clinical presentation, as illustrated by the following 2 cases. The first case was that of a 58 year old female presenting with a prolapsed uterus and a decubitus ulcer which was posted for surgical repair. However, on surgery, a diagnosis of frozen pelvis was made because of adhesions and suspicion of malignancy was high. In the second case, a 38 year old female presented in the gynaecology outpatient department with complains of menometrorrhagia. Her pelvic examination revealed a friable papillary growth on the cervix. The clinical differentials in this case included neoplastic and viral aetiologies. The histopathological diagnosis in both the cases after taking into consideration the history, clinical findings and other ancillary investigations was given as tubercular cervicitis. Ancillary investigations are necessary to exclude other causes of granulomatous inflammation such as Chlamydia trachomatis, Neisseria gonorrhea, Trichomonas vaginalis and Herpes simplex. Various studies have emphasized that the presence of typical granulomas are sufficient for the diagnosis of tuberculosis if other causes of granulomatous cervicitis are excluded. A high index of suspicion for tuberculosis is justified while dealing with cervical lesions in tuberculosis endemic areas.

Mixed Endometrial Stromal Tumor With Smooth Muscle Differentiation: A Report Of Two Cases.

PANDEY P*, DIXIT A**, KAUR S***
Endometrial stromal tumours (ESTs) are the second most common mesenchymal tumours of the uterus, even though they account for < 10% of all such tumours. Their characteristic feature is that of uniform small cells closely resembling proliferative endometrial stromal cells. If sizable smooth muscle differentiation is present (one third or more of the tumour mass), the neoplasm is referred to as combined smooth muscle-stromal tumour or nodular stromomyoma. Endometrial stromal tumours (ESTs) are diagnosed in most instances by light microscopy. Often, the greatest challenge is to distinguish between different subtypes of these tumours. In this article, we report the morphological features of two cases of endometrial stromal nodule, presenting as fibroid uterus in a hysterectomy specimen.

Epidermal Inclusion Cyst Of The Ovary: A Rare Case

MISHRA S*, SINGH PA**,; MISRA V***, ,; DEY S****.
Epidermoid cysts of the ovary are rare benign, non teratomatous lesions and are usually an incidental finding in hysterectomy specimens (1). They must not be misdiagnosed as mature cystic teratomas of the ovary. Some authors believe that they are monodermal teratomas. Their histogenesis is still uncertain. Some authors believe that these epidermoid cysts arise from the Walthard cell nests, a type of epithelial cell nests. We report here, a case of an epidermoid cyst which was incidentally found in the ovary of a female who was worked up for fibroid uterus.

Primary Adenoid Cystic Carcinoma of the Breast: A Case Report

KUMAR M*, LUBNA S**, VISHWANATH A***, BARGOTYA M****
Adenoid cystic carcinoma of the breast is a rare neoplasm accounting for 0.1% of all breast carcinomas and presenting most commonly as a painful breast mass. Adenoid cystic carcinomas of the breast have a favourable prognosis, as compared to the aggressive nature of the adenoid cystic carcinoma at other sites. The treatment for this is simple mastectomy. We present here, a case of adenoid cystic carcinoma of the breast in a 48 year old female who presented with pain in the subareolar region and was managed with modified radical mastectomy, with lymph node dissection.

Sleep Strengthens Memories

UMA DEVI P, MURUGAN S, SENAPATHY J G
Sleep has been identified as a state that optimizes the consolidation of newly acquired information in memory. Many evidences prove that both procedural and declarative memories are improved during sleep. Sleep does this through neurotransmitters and neurohormone secretion between its stages. While we sleep, our bodies secrete hormones that affect our mood, energy, memory and concentration. There occur two stages of sleep that include NREM (Non-Rapid Eye Movement) and REM (Rapid Eye Movement) sleep. Hippocampus-dependent memories benefit primarily from slow-wave sleep (SWS), whereas memories not depending on the hippocampus, show greater gains over periods containing high amounts of Rapid Eye Movement sleep. During sleep, the brain rewires its circuits to make sure that all newly gained knowledge is stored for future use. The parts of the brain that we use to learn a task become active again during sleep. This activity, scientists suggest, could be the brain transferring memory from short-term to long-term storage.

Application of Lean Thinking in Pharmaceutical cGMP Training

FERNANDES F*, PANDE S** , MURTY P N***

Community Associated Methicillin—Resistant Staphylococcus aureus (CA—MRSA) —An Emerging Pathogen: Are We Aware??

BASAK S*, MALLICK SK**, BOSE S***
Methicillin-Resistant Staphylococcus aureus (MRSA) is one of the most important causes of nosocomial infections all over the world. Once prevalent in health care setup Hospital acquired MRSA (HA-MRSA) for more than 40 years, MRSA has migrated to the community in recent years. Community associated MRSA (CA-MRSA) has evolved as a novel emerging pathogen in patients who had no contact with the health care setup. The epidemiological, molecular and microbiological differences between community associated and hospital acquired MRSA, necessitate different strategies to prevent, control and treat these two types of infection.

Biochemical Markers of Bone Remodeling in Osteoporosis - Current Concepts

INDUMATI V*, PATIL V S **
Biochemical markers of bone remodeling have been developed over the past 20 years, which are more specific for bone tissue than the conventional ones. They have been widely used in clinical research and in the clinical trials of new therapies as secondary endpoints of treatment efficacy. Most of the interest has been devoted to their use in postmenopausal osteoporosis, a condition which is characterized by the subtle modification of bone metabolism that cannot readily be detected by conventional markers of bone turnover. Biochemical markers that reflect remodeling and can be measured in blood or urine include resorption markers (eg: pyridinoline, deoxypyridinoline, collagen cross links) and formation markers (eg: alkaline phosphatase, osteocalcin). The new bone remodeling markers have been found to be more sensitive in 1) Monitoring bone loss 2) To see the antiresorptive treatment efficacy 3) To predict fracture risk.

A Comparative Evaluation Of The Shear Bond Strength Of Five Different Orthodontic Bonding Agents Polymerized Using Halogen And LED Curing Lights - An In Vitro Investigation.

BANERJEE S* , SABLE R B**
Purpose: With the introduction of photosensitive (light activated) restorative materials in orthodontics, various methods were suggested to enhance the polymerization of the materials used, including use of more powerful light curing devices. Bond strength is an important property and determines the amount of force delivered and the treatment duration. Many light cured bonding materials have become popular but it is the need of the hour to determine the bonding agent that is the most efficient and has the desired bond strength. Aim: To evaluate and compare the shear bond strength for five different orthodontic light cure bonding materials cured with traditional halogen light and low intensity Light Emitting Diode light curing unit. Materials and Methods: 100 human maxillary premolar teeth, extracted for orthodontic purpose were used to prepare the samples. 100 maxillary stainless steel bicuspid brackets of 0.018 slot of Roth prescription manufactured by D-tech Company (USA) were bonded to the prepared tooth surfaces of the mounted samples using 5 different orthodontic bracket bonding light cured materials namely Enlight (Ormco Corporation), Fuji Ortho LC (GC Corporation)(Resin modified glass ionomer cement), Orthobond LC (D- tech Company), Relybond (Reliance Corporation), Transbond XT (3M Unitek ). The bond strength was tested on an Instron Universal testing machine, (model no 5582, USA) Results: In Group 1 (halogen group) Enlight showed the highest shear bond strength (16.4 MPa) and Fuji ortho LC showed the least bond strength (6.59 MPa) (p value 0.000). In Group 2 (LED group), Transbond showed the highest mean shear bond strength (14.6 MPa) and Orthobond LC showed the least mean shear bond strength (6.27 MPa) (p value 0.000). There was no statistically significant difference in the shear bond strength values of all samples cured using either halogen (mean MPa 11.49) or LED (mean MPa 11.20) as the p value is 0.713. Conclusion: Polymerization with both halogen and LED resulted in shear bond strength values which were above the clinically acceptable range given by Reynolds8. The LED light curing units produced comparable shear bond strength when compared to the halogen curing units.

Rehabilitation of a Hemimaxillectomy Patient with Innovative Interim Obturator Prosthesis – A Clinical Report

PRAKASH V*, GUPTA R**
Rehabilitation of hemimaxillectomy patients can be challenging. The most common prosthetic treatment problem with such patients is, getting adequate retention, stability and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. Obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defect, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. This clinical report describes a modified labial flange as a means of indirect retention, to minimize the rotation of the obturator prosthesis. This approach adequately increases the retention and stability of the prosthesis.

Development Of A Solid Phase Single Reagent For The Detection Of Ketone Bodies

PALANDURKAR K *,BASAK A **
Introduction: Ketone bodies are found in an increased quantity in Diabetic ketoacidosis (DKA) and in Starvation and Alcohol induced ketoacidosis. The estimation of ketone bodies is of prime importance for the proper management of these conditions. We had developed the formulation of a solid phase single reagent for the detection of ketone bodies in urine / plasma so that anyone who was interested could prepare the reagent on their own, thus, adding to the cost cutting of investigation and self- reliance. Aim: To develop a sensitive solid phase single reagent for the detection of ketone bodies in urine, to replace the commonly done, multiple step Rothera’s test. Materials And Methods: Sodium nitroprusside, glycine, disodium hydrogen phosphate and lactose for preparation of the reagent and acetone solutions of different concentrations for testing. Results: The final composition of the reagent is as follows: The maximum colour development was found with a homogeneous powder of Glycine: 2.5gm, Lactose: 1gm, Disodium hydrogen phosphate: 4 gm and Sodium nitroprusside: 400mg. It gives lavender to dark purple colour with increasing concentrations of acetone. The lowest concentration detectable by this reagent was found to be 5mg/dL of acetone. Discussion: This reagent detects acetone semi-quantitatively and acetoacetate in plasma, but not β-hydroxybutyrate. This is helpful to the patient in ketoacidosis. This preparation can also differentiate between the plasma of a normal person and a DKA patient. Conclusion: A sensitive solid phase single reagent for the detection of ketone bodies has been successfully developed.

The Anomalous Origin Of Multiple Coronary Ostia And Their Clinical Significance

GAJBE U L*, GOSAVI S**, MESHRAM S***, GAJBHIYE V M****
The anomalous origin of multiple coronary ostia from a single coronary sinus is a very rare finding. In this study of 30 hearts, we found out the origin of multiple ostia of coronary arteries from a single coronary sinus. The courses of arteries arising from these anomalous ostia were also studied in detail and the findings were correlated with clinical findings and pathophysiological conditions. Very few data exist on the clinical relevance of anomalies in different coronary arteries, which necessitate a proper management and follow up protocol. This study helps the cardiologist during routine diagnostic work up for cardiac diseases and in the management of these Diseases.

The Effect Of Acute And Chronic Administration Of The Aqueous Extract Of Triphala On Haloperidol Induced Catalepsy In Mice.
Neuroleptics that are commonly used in the treatment of schizophrenia and other affective disorders are often associated with distressing extrapyramidal side effects (catalepsy). Catalepsy induced by neuroleptics in animals has been used as a model for the extrapyramidal side effects associated with antipsychotic agents in human beings. In the present study, we have attempted to evaluate the protective effect of Triphala on haloperidol induced catalepsy in mice. Inbred albino mice were divided into five groups, each containing six animals. Both, the test drug, the aqueous extract of Triphala and the standard drug scopolamine were dissolved in 1% gum acacia solution. Catalepsy was induced with haloperidol (1mg/kg). The first group received the vehicle (10ml/kg), the second group received scopolamine (1mg/kg) and the remaining three groups of animals received the test compound, Triphala (2.5, 6.25 and 12.5 mg/kg respectively) orally. In the acute study, a single dose of vehicle and the test drug were administered, while in the chronic study, they were given once a day for seven days, 30 minutes prior to haloperidol administration. Catalepsy was determined by the standard bar test after 30 minutes of haloperidol administration and was scored as described by Ahtee and Benumbe. In the acute study, the aqueous extract of Triphala at all the doses tested, significantly (P<0.01) reduced the cataleptic score after the latency of 60 minutes. However, in the chronic study, the reduction in the cataleptic score was seen throughout the period of observations. These effects were comparable to that produced by the standard drug scopolamine. Pretreatment of Triphala decreased haloperidol induced catalepsy in mice, which is comparable to that produced by the standard drug scopolamine. Triphala seems to be more effective when it is repeatedly administered than with a single administration. It can be used as an alternative drug or with a combination of currently available drugs in treating drug induced extrapyramidal side effects.

The Promising Future Of Clinical Trials In India- New Career Opportunities For Doctors

GHOSH RK *, CHAWLA S **, GHOSH SM ***

Escobar Syndrome

VISHWANATH B*, SHYAM SUDHIR MK**

Assessing And Accessing Health Information On The Internet

SHANKAR PR*, SUBISH P**, DUBEY AK***

Invasive Candidiasis / Candidaemia in Aquired Immunodeficiency Syndrome (AIDS) – A Pilot Study.

Handling Of Fixed Dose Combinations: A Combined Responsibility

POUDEL A* , SUBISH P**, MISHRA P***, MOHAMED IZHAM MI****

Our Experiences With ‘Sparshanam’, A Medical Humanities Module For Medical Students At KIST Medical College, Nepal

SHANKAR PR*, PIRYANI RM**, THAPA TP***, KARKI BMS****
Medical Humanities (MH) uses subjects which are traditionally known as humanities in the pursuit of medical educational goals. MH programs are not common in South Asia. A voluntary module for medical students and interested faculty was previously conducted at Pokhara, Nepal. KIST Medical College is a new medical school in Lalitpur district of Kathmandu valley. A MH module for faculty members was conducted. The first year medical students joined the MBBS course in mid-November 2008. An MH module using small group and activity-based learning was conducted for all students. Case scenarios, brainstorming sessions, role plays and paintings were used to explore various aspects of MH. In this article, the authors share their experiences of conducting the module. Medical Humanities (MH) has been defined as ‘an interdisciplinary and increasingly international endeavour that draws on the creative and intellectual strengths of diverse disciplines including literature, art, creative writing, drama, film, music, philosophy, ethical decision making, anthropology and history in pursuit of medical educational goals’ (1). MH programs are common in developed nations but are not common in South Asia. Nepal is a small developing country in South Asia and many medical schools have opened in the country in the last fifteen years. The first author conducted a voluntary MH module for interested students and faculty members at Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal (2).Twenty-six students from the third, fifth and sixth semesters and interested faculty members participated. The participants enjoyed being a part of the module. They had problems with certain literature excerpts and wanted more literature and art from a South Asian context. The author’s experiences while conducting the module have been mentioned in a recent article (3). Making the module interesting and informative was the main challenge faced. Keeping an open mind and employing a flexible approach were also important.