Journal of clinical and diagnostic research

Thyroid Function and Mental Disorders: An Insight into the Complex Interaction

Objective: To assess the serum levels of Thyroxine (T4), Triiodothyronine (T3) and the thyroid stimulating hormone (TSH) in patients with depression. Methods: Sixty clinically diagnosed and drug naive depressed patients and an equal number of healthy, age and sex matched control subjects were included in this study.. The Ham-D scale was used to classify the degree of depression into the mild, moderate and the severe grades. The biochemical parameters (T3, T4 and TSH) were estimated by using commercially available kits. The data were analyzed by using the SPSS-10 software, one way ANOVA and X2 test. Result: The female depressive (n = 48) cases outnumbered the male depressive cases. The distributions of the patients in the mild, moderate and the severe categories were similar. A significant decline in the T3 level and an elevation in the T4 level were found in the depressive cases as compared to those in the healthy controls. ANOVA with multiple comparisons testing among the patient group showed no significant difference in the TSH level when the depressive cases with various degrees of depression were compared. A total of twelve depressive patients were found to have thyroid abnormalities. Conclusion: This study therefore observed the presence of thyroid dysfunction among the depressive cases, which is most often characterized as the “Lower Thyroid Syndrome”. Thus, the inclusion of the thyroid screening test among the depressive patients may be helpful in the proper management of the cases.

Plastinated Knee Specimens: A Novel Educational Tool

Neha, Sanjeev Lalwani, Renu Dhingra

Introduction: During the routine dissection of knee joints in an anatomy dissection hall, it was observed that the specimens had deteriorated overtime, due to their repeated handling and the use of high concentrations of formalin for their fixation. In order to stop their further deterioration, we decided to plastinate these specimens. Thus, the present study was undertaken to prepare plastinated knee specimens from old embalmed cadavers and to compare them with freshly fixed, plastinated specimens. Objectives: 1. To plastinate old embalmed and fresh formalin fixed knee regions. 2. To demonstrate the extra and the intracapsular structures around both the plastinated knee regions. 3. To compare their morphological features in terms of their colours, dilatation and flexibility. Methods: A total of 15 knee joint specimens from among fresh formalin (5-8%) fixed (group I) and old embalmed bodies (group II) were collected, washed and plastinated by using the standard S-10 silicon technique and they were compared for their colours, dilatation and flexibility. Results: All the plastinated specimens showed an accurate reproduction of the tissue details that were comparable to those of the natural unfixed specimens. A comparison among the two groups showed a significant difference in terms of the colour, dilatation and the flexibility of the specimens. The plastinated knee joint specimens from group I were of good quality, with negligible shrinkage, more flexibility and well preserved morphologies. Conclusion: Plastinated knee specimens can serve as an excellent educational tool for the undergraduate and postgraduate students of anatomy, radiology and orthopaedics, as they are dry, odourless and nontoxic, with a good structural preservation and a higher instructional value. The fresh knee regions, when they were plastinated, were aesthetically superior in terms of their colours, dilatation and flexibility, thus making them ideal for teaching and hands-on experiences.

A Radiological Study on the Trabecular Pattern in the Upper End of the Femur in Post-Menopausal Women

Veena Vidya Shankar, Jayanthi V, Srinath M.G., Roopa Kulkarni

Objective: Anatomically, the upper end of the femur is a common site for osteoporosis. Therefore, The trabecular pattern in the upper end of femur is analyzed on the basis of the presence or absence, the relative number and density of the trabeculae, trabecular group and also by the grading of trabeculae. The present study was undertaken to identify the trabecular pattern in the upper end of the femur radiographically in post-menopausal women and to establish that the changes in the trabecular pattern can be used for the diagnosis and the grading of osteoporosis. While osteoporosis is observed in both elderly men and women, its prevalence is much higher in post-menopausal women. The validated data from this study will be of use to all the clinicians to recognize the trabecular patterns and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages. Method: Two hundred frontal projection pelvis radiographs of women who were between 18-100 years of age were studied during 2006-2007. In this study, an attempt was made to test the presence, pattern and the grading of the trabecular pattern in pre and post-menopausal females and to find out the influence of the post menopausal age on the trabecular patterns. All the readings were tabulated and subjected to analysis. Results: The distribution of the grading of the trabecular pattern in the upper end of the femur on the left and right sides for the severity of osteoporosis showed that as the number of years increased after menopause, the grading progressed from Grade N (Normal) to Grade A to Grade B to Grade C. Conclusion: This study will be useful for anatomists, radiologists and clinicians for recognizing the trabecular pattern and it will possibly help them in detecting osteoporosis and in limiting its progress in its early stages.

Effect of Iron Deficiency on Glycation of Haemoglobin in Nondiabetics

Background: Protein glycation is a spontaneous reaction that is believed to play a key role in the pathogenesis of many clinical disorders. The glycation of proteins is enhanced by elevated glucose concentrations. The major form of protein glycation with a clinical consideration is glycated haemoglobin (HbA1c). The HbA1c fraction is abnormally elevated in chronic hyperglycaemic diabetic patients and it correlates positively with the glycaemic control. However, increased glycated haemoglobin levels have been documented in iron deficiency anaemic patients without any history of diabetes. Aims and Objective: The aim of this study was to determine the effect of IDA on the HbA1c levels in nondiabetic patients, so as to consider IDA as an important factor which influenced the HbA1c levels, while monitoring the glycaemic status of diabetics. Methodology: Fifty non-diabetic, anaemic patients and 50 age-matched healthy subjects were enrolled in this study. The patients who had glucose tolerance abnormalities (impaired glucose tolerance or diabetes mellitus), haemoglobinopathies, haemolytic anaemia, infestation, chronic alcohol ingestion and chronic renal failure were excluded from the study. Haematologic investigations were done and the fasting and postprandial glucose and HbA1c levels were measured in all the subjects. Results: The mean HbA1c (7.6 ± 0.5%) level in the patients with IDA was higher than that in the control group (5.5% ± 0.8) (p < 0.001). There were no differences in the levels of fasting and postprandial glucose between the IDA and the control groups (p > 0.05). The haemoglobin, serum ferritin, fasting and postprandial glucose, and the HbA1c levels were normal in the control group (p > 0.05). Conclusion: HbA1c is not affected by the blood sugar levels alone, and there are various confounding factors when HbA1c is measured, especially that of iron deficiency, which is the commonest of the deficiency diseases worldwide. It is hence prudent to rule out IDA before making a therapeutic decision, based on the HbA1c levels.

Altred Fructosamine and Lipid Fractions in Subclinical Hypothyroidism

Sridevi V. Udupa, Poornima A. Manjrekar, Vinit A. Udupa, Vivian D’Souza

Background: Thyroid function disorders lead to changes in the lipoprotein metabolism. Objectives: To study the lipid and the glycaemic abnormalities in the subclinical hypothyroidism cases and to compare the same with the euthyroid, overt hypothyroid and the hyperthyroid subjects. Methodology: Four groups, euthyroid (Group-I), hypothyroid (Group-II), subclinical hypothyroid (Group-III) and hyperthyroid (Group-IV), which consisted of 30 subjects each, of either sex, who were aged 25-55 years, underwent Fasting Plasma Glucose (FPG), fructosamine, lipid profile and total T3, T4 and TSH estimations. The subjects who were on lipid lowering or thyroid disorder drugs and known diabetics were excluded from the study. Results: In Group-III, all the lipid fractions were comparable to those of Group-II and they were significantly deranged, as compared to those of Group-I. The fructosamine levels were significantly higher in Group-II and Group-III (p<0.05), but the subclinical hypothyroid pool had statistically lower levels than the hypothyroid pool (376.63±54.73, 587.80±65.10). In the Group-IV patients, the LDL-C levels were significantly higher as compared to those in the euthyroid pool. The fructosamine levels were significantly lower in comparison with both the euthyroid and the hypothyroid pools (both in Groups-II and III). The FPG levels were higher in all the classes of the thyroid abnormalities (subclinical hypothyroid-not significant) but within the reference range of 70-100mg/dl. Conclusion: Since the lipid derangement in subclinical hypothyroidism is on par with that in overt hypothyrodism, the subclinical hypothyroid cases also need to be treated similarly. The fructosamine values which are largely in excess of the FPG values, indicate a higher propensity to glycation and a decreased turnover of the proteins in the hypothyroid and the subclinical hypothyroid pools. Vice versa is true of the hyperthyroid pool. Fructosamine can be included in the thyroid work up of the patients to assess the metabolic function and the subsequent response after the initiation of the therapy.

PCR Based Molecular Detection of the Gyr-B-2 Gene from the Klebsiella Sp. Isolates from Patients who were Suffering with Pneumonia and Urinary Tract Infections (UTIs)

Md. Javed Foysal, Md. Mahbubur Rahman, Md. Shamsul Haq Prodhan

Background: HIV and infertility are associated in several ways and the improved treatment options which are available for HIV patients have improved their health, increased their reproductive years and subsequently, their desire to procreate. Objective: The objective was to compare the findings on hysterosalpingography in HIV positive and negative infertile females. Study Design: All the 5250 patients who were referred to the radiodiagnosis unit of the centre in 2011, were counselled about the study, but only the two thousand and two hundred females who gave their consents had their retroviral status determined and were included in this study. Their sociodemographic histories were acquired with the aid of a structured questionnaire and their hysterosalpingography studies were reported by a radiologist. Results: Most of the patients (54.5%) were within the age group of 31-40 years, they were mainly nullparous (76.8%) and a past history of induced abortions was statistically significant in the HIV positive patients compared to HIV negative patients. Also, the uterine synechiae were significantly higher in the HIV positive than the HIV negative patients (26.5% and 9.6% respectively).Tubal abnormalities were seen in 52% and 26% of the positive and negative individuals respectively, with hydrosalpinges being the commonest pathology in the HIV positive patients and distal occlusion being the commonest in the HIV negative patients. Conclusion: Tubal infertility is the commonest cause of the infertility in the HIV positive individuals and the commonest tubal pathology is hydrosalpinges as compared to distal tubal occlusion in the HIV negative patients .There is a need to not only research further into the treatment and other options for the patients with tubal infertility, but also to make them available and affordable to provide succour to this group of patients, no matter what their retroviral status is.

The Neurobehavioural Evaluation in Schizophrenics: A Comparative Study

Kamini Ramdas Ilamkar

The Effect of Chronic Tobacco Smoking and Chewing on the Lipid Profile

Srinivasa Rao Ch., Emmanuel Subash Y.

Background: A worldwide epidemic of cardio vascular diseases is evolving, out of which atherosclerosis appears to be the most frequent underlying cause. Cigarette smoking remains the most important cause of the preventable morbidity and the early mortality. Nicotine is highly addictive, it raises the brain levels of dopamine and it produces withdrawal symptoms on its discontinuation. Aim: To study the effect of tobacco smoking &chewing on serum lipid profile. Methods: Although a genetic predis-position to atherosclerosis may be the cause, a vast majority of the atherosclerotic related diseases, which include coronary heart diseases, are acquired. Those which usually appear later in life are largely preventable. Tobacco is the major and the single most preventable risk factor for atherosclerotic related, clinical events like coronary heart disease. This study was conducted on three groups of male subjects, with each group containing 25 individuals of 25 to 35 years of age and who weighed 50-70 kgs. Group-I: non smokers and non chewers. Group-II: smokers and non chewers. Group–III: chewers and non smokers. To estimate the triglycerides, glycerol which is derived from the saponification of triglycerides is oxidized to formaldehyde, which in turn is made to react with ammonia and acetylacetone to give rise to a chromogen (3.5 diacetyle-1,4 dihydrolutidine). It is quantified spectro-photometrically (the HANTZSCH reaction). Results: The mean serum total cholesterol level in the subjects of Group II was more by about 16.94 % (p< 0.001) and that in the subjects of Group –III was more by 23.21% (p< 0.001). The mean serum VLDL level in the subjects of Group II had an increase of about 27.54% (p< 0.01) and in Group –III, it had increased by11.82% (p< 0.01). The mean serum LDL level in the subjects of Group II showed an increase of about 34.64% (p< 0.001) and in Group –III, it had increased by16.27% (p< 0.001). The mean serum HDL level in the subjects of Group II showed a decrease in the mean serum HDL level by about 9.78 % (p< 0.01) and in Group –III, it had decreased by 22.12% (p< 0.01). The mean serum Triglyceride level in the subjects of Group II showed an increase of about 25.40% (p< 0.001) and in Group –III, it was more by33.35% (p< 0.001). Conclusion: There was a significant increase in total cholesterol and LDL-C in tobacco users ,as compared to non tobacco users.

Hysterosalpingographic Tubal Abnormalities in Retroviral (HIV) Positive and Negative Infertile Females

Acoustic Radiation Force Impulse Imaging of the Liver: Measurement of the Normal Mean Values of the Shearing Wave Velocity in a Healthy Liver

AIM: To find the normal mean values of the liver elasticity/stiffness by Acoustic Radiation Force Impulse (ARFI) Elastography in healthy subjects. Material and Method: This study was conducted on 137 healthy subjects without any known liver pathology or a history of jaundice by using the Siemens Acuson S2000TM Ultrasound machine with a convex probe . A routine ultrasound was also performed in each case, and the subjects with fatty liver changes or any other signs of a chronic liver pathology were excluded. In each subject, 10 measurements were taken and the median value of the 10 measurements was calculated, which was expressed in metres/sec (m/s). The inter quartile range method was used for the interpretation of the data. Only the measurements with an IQR of < 30% and a Success Rate (SR) of >60% were considered. The measurements were taken at 1-2 cm depth from the liver capsule through an intercostal approach, with the subject lying in the decubitus position. The mean ARFI values and the mean values according to the age and gender of the subjects were evaluated. Result: Valid ARFI measurements were taken in 108/137 patients (78.83%). The mean value of the ARFI measurements in the normal individuals was 1.197±0.25 m/s. There were no significant differences between the mean ARFI values in men vs women (1.195±.25 vs. 1.199±0.26m/s, p = 0.939), and also among the different age groups (p>0.05). Conclusion: In our study, the mean liver elasticity value (shearing wave velocity) which was obtained by ARFI in the healthy subjects was 1.197±0.25 m/s.

Should the Functional Residual Capacity be Ignored?

Chandra selvi E, Kuppu Rao K.V, Malathi

Aim and Objectives: The functional residual capacity was given the least importance than the other lung volume parameters. Studies have revealed the restrictive pattern of lung disease in patients with liver cirrhosis. We aimed to analyze the importance of the functional residual capacity and other lung volumes of cirrhotic patients. Subjects and Methods: Forty (40) patients with cirrhosis (Child’s-B) were enrolled in this study. The vital capacity was measured by an instrument called V02 Max 22. The other lung volumes which were measured were derived parameters. The functional residual capacity was measured by the nitrogen wash-out method. Results: The measured value of the functional residual capacity was below normal as compared to the reference value. The total lung capacity and the vital capacity were positively correlated with the functional residual capacity. The residual volume was found to be increased in twelve out of forty cirrhotic patients. Conclusion: The functional residual capacity can be determined by the compliance of the lung and the chest wall. The patients with a reduced functional residual capacity may be suffering from dyspnoea, probably due to the restrictive pattern of the lung disease. Hence, the reduced lung volumes of the subjects may be due to the abnormalities in the mechanics of ventilation.

A Study of Association of Ankle Brachial Index (ABI) and the Highly Sensitive C - Reactive Protein (hsCRP) in Type 2 Diabetic Patients and in Normal Subjects

Background: The Ankle-Brachial Index (ABI) objectively assesses the lower extremity arterial perfusion. A low ABI suggests atherosclerosis and Peripheral Arterial Disease (PAD). PAD is more common in individuals with type2 Diabetes mellitus (Type2 DM). Inflammatory markers are found to be associated with Type2 DM. But the association of the inflammatory markers with the atherosclerotic burden remains poorly defined. Aims: To compare the ABI and the hsCRP in the Type 2 DM patients with those in the normal subjects and to study the association of serum hsCRP with ABI in the Type 2 DM patients and in normal subjects. Methods: The subjects were 40 Type2 DM and 40 age, sex and BMI matched normal subjects who were aged between 45-60 yrs. The subjects were assigned to two different groups, Group1- the Type2 DM patients and Group2- the healthy controls. The serum hsCRP levels were determined by the turbidimetry method (BIOSYSTEMS) and the ABI values were determined by using the traditional continuous wave (CW) Doppler of NICOLET VERSALAB. Statistical Analysis: The data was analyzed by using the Student’s t test (two tailed; independent) to find the significance of the study parameters between the two groups. Pearson’s Correlation was used to find the correlation of serum hsCRP with the ABI in the two groups. Results: The ABI showed a significantly low value (P=0.035*) and the serum hsCRP showed a trend towards a significant increase (p = 0.069+) in the type2diabetics as compared to those in the normals. There was a significant negative correlation between ABI and hsCRP in the Type 2 DM patients (r=-0.560, p<0.001**). However, such correlation was not observed in the normal subjects. Conclusion: As serum hsCRP is associated with ABI in the type2 DM patients, inflammation may play a role in the pathogenesis of atherosclerosis.

A Study on the Correlation Between the Body Mass Index (BMI), the Body Fat Percentage, the Handgrip Strength and the Handgrip Endurance in Underweight, Normal Weight and Overweight Adolescents

Introduction: The handgrip strength and endurance have evolved as an important tool for the assessment of the nutritional status and as a marker of the muscle quality. In underweight as well as overweight individuals, there is the possibility of a change in the muscle quality. So, we undertook this study to find out the correlation between the BMI, the Body Fat percentage and the Hand grip strength and endurance. Materials and Methods: One hundered eighty students in three BMI ranges- underweight (BMI≤ 18.49), normal weight (BMI- 18.5- 24.99) and overweight (25-29.99) were included according to the WHO guidelines. The body fat percentage was measured by using a bioelectric impedance. The handgrip strength and the handgrip endurance were recorded by using an INCO handgrip dynamometer. The statistical correlation was done by using ANOVA. Results: In males, the handgrip endurance was better in normal weight individuals, but among the females, the underweight females had a better handgrip endurance, but the difference was statistically insignificant (p>0.05). In both males and females, there was a statistically significant difference in the handgrip endurance, with the maximum grip endurance in the normal weight group and the minimum grip endurance in the overweight group (p< 0.05). The correlation between the BMI, the body fat percentage and the handgrip endurance was complex and different for males and females. Conclusion: The underweight and overweight groups had a lower grip strength and endurance than the normal weight group in males, but not in females. The correlation was weak and it suggested that on both sides of the normal BMI, the hand grip endurance tended to decrease in males as well as in females. The increase in the body fat percentage might decrease the handgrip endurance but not the handgrip strength.

The Effect of Yoga Therapy on Selected Psychological Variables Among Male Patients with Insomnia

R. Sobana, S. Parthasarathy, Duraisamy, K. Jaiganesh, S. Vadivel

Background: An estimated 30-50% of the general population is affected by insomnia and 10% have chronic insomnia. Yoga therapy is beneficial in such disorders and it has fewer side effects. Aim: The aim of this study was to find out the effect of yoga therapy on selected psychological variables among men with insomnia. Methods: Forty males with insomnia were divided randomly into 2 groups (the experimental and the control groups). The experimental group received eight weeks of yoga therapy, while the control group did not receive any therapy. The pre and post treatment stress and the self confidence scores were taken. Results: There was a significant improvement in the stress scores and the self confidence scores in the experimental group. There were neither any side effects nor any drop outs. Conclusion: We conclude that yoga is an effective treatment option for the patients with insomnia. There are no major side effects.

To Study the Prevalence of Various Enteric Parasitic Infections Among HIV Infected Individuals in the P.D.U. Medical College and Hospital, Rajkot, Gujarat, India

Background and objectives: Enteric parasites are a major cause of diarrhoea in HIV infected individuals. The present study was undertaken to detect the enteric parasites in HIV infected patients with diarrhoea, who were at different levels of immunity. Methods: This study was carried out in the P.D.U Medical College and Civil Hospital, Rajkot, India, during the period from June 2009 to June 2010.A total of 100 stool samples from HIV seropositive patients were examined for opportunistic, gastrointestinal parasitic infections.The samples were classified according to the age groups, sex, and occupation,a history of diarrhoea and different categories of the CD4 cell count.The stool samples were collected and examined for enteric parasites by microscopy and by special staining methods.The CD4 cell counts were estimated by using the FACS count Results: The intestinal parasitic pathogens were detected in 28% patients. Among all, Isospora appeared to have the highest prevalence (18%),followed by Giardia lamblia (5%), Strongyloides stercoralies (3%) and Cryptosporidium parvum (2%). In the HIV infected patients with a CD4 count of < 200 cells/ul , Isospora was the most commonly observed (56%) pathogen. The proportion of the opportunistic pathogens in the patients with CD4 counts of <200 cells/ul was significantly higher as compared to those in the other two groups of patients with CD4 counts of >200 respectively. Interpretation and conclusions: Parasitic infections were detected in 28% of the HIV infected patients and a low CD4 count was significantly associated with an opportunistic infection. The detection of the aetiologic pathogens might help the clinicians in deciding the appropriate management strategies.

The Prevalence of Inducible Clindamycin Resistance Among Staphylococci in a Tertiary Care Hospital – A Study from the Garhwal Hills of Uttarakhand, India

Objective: This study was undertaken to assess the frequency of the phenotypic expression of the inducible resistance to clindamycin which was due to the expression of the erm genes in various clinical isolates of the Staphylococcus species. Materials and Methods: This was a cross sectional study conducted in the Dept. of Microbiology and Immunology, Veer Chandra Singh Garhwali Govt. Medical Sciences and Research Institute, Srikot, Uttarakhand, from July 2010 to December 2011. A total of 373 consecutive, non duplicate strains of Staphylococci isolated from various clinical samples like pus, wound swab, blood, urine and other body fluids, were tested. The isolates which had a discordant resistance pattern (clindamycin-sensitive and erythromycin-resistant) by Kirby Bauer Disk Diffusion method were selected and subjected to the D-test for inducible clindamycin resistance, as per the Clinical and Laboratory Standards Institutes (CLSI) guidelines. Results: Among the 373 clinical isolates of Staphylococci which were studied, 134 isolates showed a discordant resistance pattern. Among these discordant strains, 45 (33.6%) isolates were D-test positive, which had inducible clindamycin resistance and belonged to the inducible macrolide lincosamide streptogramin-B phenotype (MLSBi). 89 (66.4%) isolates were D-test negative and they belonged to the macrolide streptogramin phenotype (MS). Among the MLSBi phenotypes, 6 (13.3%) isolates were methicillin-resistant Staphylococcus aureus (MRSA), 13 (28.9%) were Methicillin-sensitive S.aureus (MSSA) and 26 (57.8%) were coagulase negative staphylococci (CONS). Conclusion: The D-test is a simple, effective and an important method for the phenotypic detection of inducible clindamycin resistance and it should be used routinely, as it will help in guiding the empirical therapy. The possible clinical failures can thus be avoided.

Staphylococcus Aureus- The Predominant Pathogen in the Neonatal ICU of a Tertiary Care Hospital in Amritsar, India

Poonam Sharma,Parminder Kaur, Aruna Aggarwal

Background: An early treatment and the appropriate and the rational use of antibiotics would minimize the risk of severe morbidity and mortality in neonatal sepsis, and reduce the emergence of multi-drug resistant organisms in intensive care units. For the success of an early empiric treatment, a periodic review of the cases to assess any changing trends in the infecting organisms and their antimicrobial susceptibility is important. AIM: To study the most commonly encountered bacterial pathogens which caused neonatal sepsis and their sensitivity patterns, so that guidelines could be prepared for a rational antibiotic therapy. Setting and Design: This was a retrospective study which was conducted in the Department of Microbiology and the Neonatal Intensive Care Unit (NICU) at SGRDIMSAR, Amritsar, during June 2011 to June 2012. Methods and Materials: Blood specimens for culture were drawn from 311 newborns who were admitted in an NICU with sepsis. The specimens were inoculated into brain heart infusion broth. Subcultures were performed on days 1, 2, 3, 5, 7 and 10. The isolates were identified by doing standard biochemical tests. The antibiotic resistance patterns of the isolates were studied by the Kirby Bauer disc diffusion technique. Results: A total of 131 organisms were isolated from the 311 blood cultures. These included Staphylococcus aureus (n=68), Coagulase Negative Staphylococcus (CoNS) (n=30), Klebsiella pneumoniae (n=10), Acinetobacter baumannii (n=9), Escherichia coli (n=05), Enterobacter cloacae (n=04), Citrobacter diversus (n=02), Pseudomonas aeruginosa (n=02) and Candida (n=01). Staphylococcus aureus was the main pathogen in both early and late-onset sepsis. On antibiotic sensitivity testing, 57.35% of the Staphylococcus aureus isolates were found to be methicillin resistant. More than 90% gram negative rods were resistant to amikacin. The resistance to the third generation cephalosporins varied between 50-55%. The resistance to ciprofloxacin was quite high; however, most of the isolates were susceptible to levofloxacin. A majority of the isolates were susceptible to piperacillin-tazobactum and imipenem. Conclusion: The present study emphasized the importance of periodic surveys on the microbial flora which was encountered in particular neonatal settings to recognize the trend.

ESBL, MBL and Ampc Lactamases Producing Superbugs – Havoc in the Intensive Care Units of Punjab India

Loveena Oberoi, Nachhatarjit Singh, Poonam Sharma, Aruna Aggarwal

Background: An alarming rise in the rates of the antibiotic resistance has now become a serious and an increasingly common public health concern, with severe implications, especially in the intensive care units. A variety of ß-lactamases which include ESBLs, AmpC ß-lactamases and metallo-ßlactamases, have emerged as the most worrisome mechanism of resistance among the gram negative bacteria, which pose a therapeutic challenge to the health care settings. Materials and Methods: The present study was aimed at knowing the prevalence of various ß-lactamases in the gram negative isolates which were obtained from ICU patients. A total 273 gram negative isolates from 913 clinical samples which were received over a period of one year were processed for their identification and their antimicrobial susceptibility pattern was determined. They were then screened for the ß-lactamase production. Results: Among the 273 isolates, the ß-lactamase production was observed in 193 strains. 96 (35.16%) strains were ESBL producers, followed by 30 (10.98%) metallo ß- lactamase (MBL) producers and 15(5.4%) AmpC producers. The major ESBL and AmpC producer was Escherichia coli, while Klebsiella pneumonia was the predominant MBL producer. The co production of the ESBL/MBL/ AmpC ß- lactamases was observed in 52 (19.04%) strains and it was more common in Escherichia coli. A multidrug resistance to the fluoroquinolones and the aminoglycosides was also observed in the ß- lactamase producing organisms. Conclusion: The high prevalence of the ß- lactamases in the ICU isolates emphasizes the need for a continuous surveillance in the ICUs to detect the resistant strains, strict guidelines for the antibiotic therapy and the implementation of infection control measures to reduce the increasing burden of antibiotic resistance.

The Diagnostic Utility of Bact/ALERT and Nested PCR in the Diagnosis of Tuberculous Meningitis

Apurba Sankar Sastry, Sandhya Bhat K, Kumudavathi

Objective: The early laboratory diagnosis of Tuberculous Meningitis (TBM) is crucial, to start the antitubercular chemotherapy and to prevent its complications. However, the conventional methods are either less sensitive or time consuming. Hence, the diagnostic potentials of BacT/ALERT and Polymerase Chain Reaction (PCR) was evaluated in this study. Material and Method: The study group comprised of 62 cases and 33 controls. The cases were divided according to Ahuja’s criteria into the confirmed (two cases), highly probable (19 cases), probable (26 cases) and the possible (15 cases) subgroups. Ziehl Neelsen’s (ZN) and Auramine Phenol (AP) staining, Lowenstein Jensen (LJ) medium culture, BacT/ALERT and nested Polymerase Chain Reaction (PCR) which targeted IS6110 were carried out on all the patients. Observation and Results: The sensitivity of the LJ culture was 3.22%. BacT/ALERT showed a sensitivity and a specificity of 25.80% and 100% and those of nested PCR were found to be 40.32% and 96.97% respectively. The mean detection time of growth of the LJ culture was 31.28 days, whereas that of BacT/ALERT was 20.68 days. The contamination rate in the LJ culture and BacT/ALERT were 7.2% and 5.8% respectively. Conclusion: Nested PCR was found to be more sensitive, followed by BacT/ALERT as compared to the LJ culture and smear microscopy. As both false negative and false positive results have been reported for nested PCR, so it should not be used alone as a criterion for initiating or terminating the therapy, but it should be supported by clinical, radiological, cytological and other microbiological findings.

A Study on the Biochemical and the Morphological Changes in the Liver in Renal Transplant Recipients with an Evidence of the HBV and the HCV Infections

Context: Renal transplantation is the definitive treatment in renal failure patients. Liver disease is a known problem in renal transplant recipients. They may be consequent to immunosuppression, drug toxicity, altered immune response to viruses and hemodialysis. Aims: The aim of this study was to analyze and correlate the biochemical parameters and histopathology of liver biopsy among renal transplant recipients with both HBV and HCV infection and to correlate them. Setting: The study group had thirty cases. Enrolment criteria included coinfection with HBV and HCV ; elevated liver enzymes and recipient of renal allograft. There was acontrol group of ten patients who were HBC and HCV positive but had not undergone renal transplant. Material & Methods: Liver function tests including alkaline phosphatase, SGOT, SGPT and serum bilirubin levels were donet. Percutaneous liver biopsies were carried out using Menghini’s needle.. Stains done included hematoxylin and eosin (H & E), vanGieson, reticulin and Perl’s stain. Histopathological grading was performed using Metavir scoring system. Immunohistochemistry (IHC) was done where required for ground glass hepatocytes. Correlation of SGOT, SGPT and Alkaline phosphatase of the study group and the controls was carried out with the grading. Statistical Analysis: Statistical tests done included paired “t” test at 5% and test of probability. Results: There was no statistically significant correlation between the controls and the transplanted patients. It was concluded that serum enzyme levels could be used to predict histological grade in the control group but not in the transplant recipients (p>0.05).

The Efficiency of the Serum Prostate Specific Antigen Levels in Diagnosing Prostatic Enlargements

Ingle Sp, Ingle Ramona, Sukesh

Background: The objective of this study was to evaluate the serum PSA levels in patients presenting with enlarged prostate and to evaluate the efficiency of serum PSA to diagnose and differentiate benign and malignant enlargements. Methods: The authors evaluated the patients coming in surgical OPD with enlarged prostate and were advised to undergo serum PSA testing. Results: The efficiency of serum PSA to differentiate Benign and malignant lesions was 97.18% and 83.33% respectively.

Incidental Gall Bladder Carcinoma in Laparoscopic Cholecystectomy: A Report of 6 Cases and a Review of the Literature

Jetley Sujata, Rana S, Khan Sabina, Hassan MJ, Zeeba Shamim Jairajpuri

Background: Gall bladder carcinoma accounts for 98% of all the gall bladder malignancies and it is the sixth most common malignancy of the gastrointestinal tract worldwide. The incidence of incidental gall bladder carcinoma which is diagnosed during or after a laparoscopic cholecystectomy is reported to be around 0.19-3.3% in the literature. Aim: This study was aimed at detecting the incidence of gall bladder carcinomas which were diagnosed incidentally during or after laparoscopic cholecystectomies which were done for gall stone disease and cholecystitis. Materials and Methods: We analyzed the medical records of patients with symptomatic gallstone disease and acute or chronic cholecystitis, who underwent laparoscopic cholecystectomies at the Hakeem Abdul Hameed Centenary Hospital during the period from January 2007 to June 2012. Results: A total of 622 laparoscopic cholecystectomies were performed at our institute during the study period of five and a half years. In 6 (0.96%) cases, incidental carcinomas of the gallbladder were discovered. Conclusion: A laparoscopic cholecystectomy which is performed for benign gall bladder disease rarely results in a diagnosis of unexpected gallbladder cancer. The microscopic examination of the specimens, with special attention to the depth of invasion, range of the mucosal spread and the lymphovascular involvement, is critical in diagnosing the incidental malignancies as well as for the subsequent management of the cases.

The Red Cell Distribution Width as a Sensitive Biomarker for Assessing the Pulmonary Function in Automobile Welders- A Cross Sectional Study

A.R. Subhas hree, B. Shanthi, P.J Para measwar aswari

Context: Welding fumes are considered as a risk factor for pulmonary diseases and a periodic spirometry is essential to evaluate the lung function of the welders. The Red Cell Distribution Width (RDW) is a red cell measurement which is provided by automated haematology analyzers. It reflects the range of the red cell sizes which are measured within a sample. Few studies have shown a relationship between the RDW values and the changes in the spirometry. Aims: This study was aimed at correlating the RDW% and the spirometry FEV1/FVC ratio (%) among automobile welders (cases). Further, we have analyzed the effect of smoking on the FEV1/FVC ratio% and the RDW% in the cases. Settings and Design: A cross sectional study was done on 50 welders and 50 non-welding office workers (controls) who were working in an automobile industry on the outskirts of Chennai, india. All the cases were arc welders and the controls were from the same production unit, who had never worked as welders. This study was conducted during the period from March 2012 to May 2012. Methods and Material: The demographic data, smoking habits, work history and the respiratory symptoms were gathered by using a standard self -administered questionnaire. A complete haemogram study was done and pulmonary function tests were performed for both the cases and the controls. All the cases and the controls were examined in the hospital outpatients room and subsequently, their blood samples were collected. The pulmonary function tests were conducted in the spirometry room in the hospital. The statistical analysis was done using the SPSS, version 15.0. Results: A statistically significant inverse correlation was found between the RDW% and the FEV1/FVC ratio% in the cases. Conclusions: RDW can be used as a biomarker to identify the pulmonary compromise in automobile welders.

Influence of Anabolic Steroid on Tibial Fracture Healing in Rabbits – A Study on Experimental Model

Farida Ahmad, Syed Mobashir Yunus, Adil Asghar, N.A.Faruqi

Introduction: Anabolic steroid is an established drug for treating catabolic states. The said drug has been shown to restore the lean body mass, to prevent osteoporosis and to correct the impaired immune response, but only few studies have evaluated the effect of the same on fracture healing. Methods: Fracture was produced by an impact device in 24 rabbits which were divided into experimental (I) and control (II) groups of 12 animals each. The experimental groups were further divided into the subgroups IA and IB of equal animals, which received Nandrolone Decanoate 10 mg/kg intramuscularly, biweekly for 2 weeks and 4 weeks respectively. Results and Conclusion: Radiographs taken on the post fracture day15 and 40 showed better healing in the Nandrolone Decanoate administrated groups as a dense periosteal bone formation and prevention of the local osteoporosis. Histochemical examination of the callus and high serum alkaline phosphatase levels on day 15 and 40 confirmed better mineralization in experimental animals.

A Survey on the Knowledge, Attitude and the Practice of Pharmacovigilance Among the Health Care Professionals in a Teaching Hospital in Northern India

Hardeep, Jagminder Kaur Bajaj, Rakesh Kumar

Objective: To assess the pharmacovigilance awareness among the healthcare professionals in a teaching hospital in Northern India. Material and Methods: A questionnaire which was suitable for assessing the basic Knowledge, Attitude and the Practice (KAP) of pharmacovigilance was designed and distributed among 100 doctors of the Punjab Institute of Medical Sciences (PIMS) Hospital, Jalandhar, Punjab, India. Results: Among the 100 doctors, 61 responded. The data was analyzed by using the SPSS statistical software. Although 77% of the subjects knew the term ‘pharmacovigilance’, only 59% were aware of the existence of the National Pharmacovigilance Program. 23% volunteered to reports Adverse Drug Reactions (ADRs), but more than 60% doctors did not know how and where to report the ADRs. Conclusion: There is a need for a regular training and the re-enforcement for the ADR reporting among the health care personnel. The perception of the reporting process being tedious, the lack of time, a poor knowledge on the reporting mechanism and inadequate expertise seemed to be the main reasons for not reporting the ADRs. A majority of the respondents suggested regular training sessions on a priority basis for the success of the pharmacovigilance program and for the better clinical management of the patients in general.

A Comparative Clinical Evaluation of Once Daily Versus Alternate Day Application of Topical Clobetasol Propionate Cream in Psoriasis

Afroz Abidi, Farida Ahmad, Satyendra K. Singh

Background: Corticosteroids are extremely useful in the treatment of inflammatory skin disorders. Topical steroid applications are the most effective treatment for all types of psoriasis. Aims: To compare the efficacy of once daily versus alternate day application of topical steroid clobetasol propionate 0.05% (Tenovate cream®) in patients who have mild to moderate plaque psoriasis. Settings and Design: This study was conducted on 89 patients of plaque psoriasis, who attended the skin OPD in our hospital. Methods and Material: The patients who had a mild to moderate severity of plaque psoriasis were selected. Those patients who required systemic corticosteroids, those who were already undergoing any psoriasis treatment, those who had any other debilitating illness and pregnant and lactating women were excluded from the study. Eighty nine patients were enrolled for the study after taking written informed consent from them and they were randomly allocated into two groups. Two patients dropped out, one in each group and 1 of group 2 was prescribed systemic corticosteroids. Group 1- once daily application (n= 44) Group 2- alternate day application (n= 42) An objective scoring was done on the basis of the PSI (Psoriasis Severity Index) score, which was graded from 0-4. Follow ups were done in the 2nd, 4th and 6th weeks. Statistical Analysis: It was done by the Student’s ‘t’ test and ANOVA. Results and Conclusions: The results showed that there was equal improvement in both the groups in the 2nd week, since the p-value was not significant (P> 0.05), but in the 4th and 6th weeks, there was less improvement in the alternate day group (P< 0.05). An intra group comparison indicated that clobetasol was effective both in the once daily and the alternate day groups, but clinical and symptomatic improvement occurred more quickly in the once daily group after 6 weeks of assessment. Thus, it can be concluded that the alternate day application of the topical steroid clobetasol propionate cream is as effective as the once daily application in the initial 2 weeks, but by 6 weeks, its efficacy decreases. Therefore, initially, we can advocate a less frequent application of potent topical steroids but for the complete remission of the disease, the application frequency should be once daily.

Comparison of Fentanyl and Clonidine for Attenuation of the Haemodynamic Response to Laryngocopy and Endotracheal Intubation

sameenakousar, Mahesh, K.V. Srinivasan

The Socio-Demographic Characteristics of the Clients of Female Sex Workers and their Perspectives, Behaviours and Attitude on HIV and AIDS: A Questionnaire Based Survey from Pokhara, Nepal

Background: The clients of Female Sex Workers (FSWs) have been represented from different socio-demographic backgrounds and their risk behaviour depends upon their learning skills and attitudes and its impacts on practice. Objective: The general objective of this study was to find the socio-demographic characteristics, background, knowledge, behaviour, and the attitude on STIs, HIV and AIDS of the clients of female sex workers. Material and Methods: This questionnaire based, cross sectional study was conducted on 109 clients of FSWs during the time period from January 2010 to July 2010 in Pokhara (sub-metropolitan city of the Kaski district), Nepal. The locations were the Baglung Bus Park, Lakeside and Mahendrapool. Result: Among the 109 respondents, the mininum and the maximum age were 18 and 50 years. According to the religion-wise distribution, 77.1% of the respondents were Hindus, 10.1% were Buddhists, 8.3% were Christians, 1% were Muslims and 3.7% were from other religions. 67.9% of the respondents were tested for HIV at least once, whereas nearly one third (32.1%) of the respondents were never tested for HIV. 49.5% of the respondents answered that there was no difference between HIV and AIDS. Among the respondents, 89.9% respondents knew how to be safe from STIs and the HIV infections and 99.1% knew about HIV and AIDS. Conclusion: HIV and AIDS is a cross cutting issue in the present situation rather than a health issue. One of the most at risk groups is the clients of female workers who frequently have risk behaviours like having sex with female sex workers. The sexual behaviour among these clients depends upon their attitude, knowledge and perception, which also influence several internal and external factors. In our study, the clients of the female sex workers had some extent of knowledge about the condom, sexually transmitted infections and HIV/AIDS. They were made aware on these by different organizations who were working in the field of HIV and AIDS, but still they intended to practice unsafe sex with the female sex workers.

NT-proBNP in Myocarditis after a Scorpion Sting Envenomation

Objective: This study was to evaluate the levels of NT-proBNP in patients with myocarditis which occurred after a scorpion sting envenomation. Material and Methods: A total of 30 patients with scorpion sting envenomation and 21 patients with heart failure which was caused by cardiomyopathy, were prospectively studied. The data included the patient demographics, clinical features, echocardiography and the NT-proBNP levels. Results: An echocardiographic evidence of myocarditis with a left ventricular ejection fraction of less than 50%, was found in 22 patients. In all the 22 patients, NT-proBNP was significantly elevated. The NT-proBNP levels were very high in the patients with severe LV dysfunction. However, it was in the normal range in the patients without an evidence of myocarditis. The elevated NT-proBNP levels were correlated with the LV dysfunction and myocarditis. When they were compared with the patients with heart failure which was caused by cardiomyopathy, the NT-proBNP levels were found to be significantly more elevated in scorpion sting myocarditis. Conclusions: The NT-proBNP levels were significantly elevated in myocarditis which occurred after a scorpion sting envenomation.

A Study on the Clinico-Epidemiological Profile and the Outcome of Snake Bite Victims in a Tertiary Care Centre in Southern India

Halesha B.R., Harshavardhan L., Lokesh A J., Channaveerappa P.K. Venkatesh K.B

Background: Snake bite is a common medical emergency and an occupational hazard, more so in tropical India, where farming is a major source of employment. The available data on the epidemiology of snake bite from the Indian subcontinent are sparse. Snake bite is a neglected disease that afflicts the most impoverished inhabitants of the rural areas in the tropical developing countries. Aims: This study was carried out to describe the epidemiology, arrival delays, clinical features, complications, and the outcome of snakebites which were seen in a tertiary care hospital of southern India. Setting: Sri Chamarajendra District Hospital which is attached to the Hassan Institute of Medical Sciences, Hassan, Karnataka, India. Study Design: A record–based, retrospective, descriptive study. Materials and Methods: One hundred eighty patients of snake bite were studied from January 2010 to December 2011. The data on the demographic factors, clinical features and complications, details of the treatment which was received and the outcome of the snake bite victims were recorded and analyzed. Results: Among a total 180 cases of snake bite, there were 108 cases of viper bite which presented with haematotoxic manifestations and 74 elapid bites had neuroparalytic manifestations. The victims were predominantly males (60.5%) and they were aged 20-40 years. A majority of the victims are from the rural areas (81.1%) and most of the bites occurred during the day time (70.5%), mainly on the lower limbs (67.2%). The highest number of cases occurred during July- September. Most of the victims were farmers (54.4%) and plantation workers (30.5%), which suggested that snake bite was an occupational hazard. A reaction to the ASV was noted in 12.7% of the patients and the mortality rate in our study was 3.8%. Conclusion: In the tropics, snake bite is a rural and an occupational hazard among farmers, plantation workers, herders and hunters. Regular public health programmes regarding the prevention, pre –hospital management (first aid) and the importance of the early transfer to the hospital should be emphasized.

An Analysis of the Risk Factors and the Outcomes of Cerebrovascular Diseases in Northern India

Malini Kulshrestha, Vidyanand

Introduction: Stroke is a growing epidemic in the developing countries. The risk factors of stroke are the same as those of atherosclerosis, but the relative incidences of the various risk factors keep changing with time and cultural and environmental factors. So, a periodic analysis should be done. Aims and Objective: The generation of the data which pertained to the clinical profile of stroke in our institution by using the WHO Steps Stroke Manual, version 2 and to make note of the risk factors and the correlation of the outcome with the Glasgow’s Coma Scale (GCS) at admission and with the Modified Rankin Scale (MRS) on the 28th day. Material and Methods: A prospective study was conducted on 157 cases of stroke patients who were admitted to the Medicine Department of a tertiary care institute during June 2011 through June 2012. Observations: Amongst the 157 cases (92 males and 65 females), 86 % were above 40 years of age and this was the most prevalent age group in the age range of 51-60 years. The risk factor analysis showed hypertension as the most prevalent risk factor, followed by diabetes cum hypertension. Hemiplegia/hemi paresis was the most common presentation, followed by aphasia. Radiological studies showed that ischaemic strokes were the most frequent ones, followed by haemorrhagic strokes (71 vs. 29 %). Amongst the ischaemic infarcts, the anterior circulation infarct was the most frequent one. The outcome was poor with haemorrhagic strokes and in those who were presented with a GCS of less than 3. The overall mortality was 22.29 %. A significant residual deficit (MRS >3) was seen in 49.7 % of the patients. Conclusions: There is a need for prospective representative population based surveys viz. the WHO Stroke Steps 2 and 3.Public health measures are essential to enhance the awareness about the importance of knowing the risk factors. Hence, the message which has to be percolated to the masses is - stroke is a ‘brain attack’ that is preventable.

The Role of Sevista in the Management of Dysfunctional Uterine Bleeding

Dhananjay BS, Sunil Kumar Nanda

Objective: The complaints of excessive menstrual bleeding (menorrhagia) have a substantial impact on the gynaecological services and in most of the cases, no organic pathology is identified. Nonsteroidal anti-inflammatory drugs and tranexamic acid offer a simple therapy which has to be taken during menses, with reductions of 25-35% and 50% respectively in the Menstrual Blood Loss (MBL). Danazol and the gonadatrophin-releasing hormone analogues are highly effective, but their side-effects make them suitable only for a short-term use. In the present study, the role of ormeloxifene was studied in patients of DUB. Materials & Methods: The subjects were diagnosed cases of DUB. After ruling out the possible causes of the abnormal uterine bleeding, a diagnosis of DUB was made and the treatment with ormiloxifene was started. The number of cases were 35 cases. The treatment with ormeloxifene was evaluated by measuring the Hb g/dl and the endometrial thickness before and after 3 months of treatment with sevista. Ormeloxifene was given in the dosage of a 60 mg tablet twice a week for 3 months, followed by once a week for another 3 months. Observation & Results: There was a statistically significant increase in the Hb g/dl (p < 0.001) and a statistically significant decrease in the endometrial thickness (p< 0.001) after the treatment with ormeloxifene. Conclusion: Ormeloxifene can be used asa effective drug in the treatment of Dysfunctional uterine bleeding.

The Quality of Life During and After Menopause Among Rural Women

POOMALAR G K, BUPATHY AROUNASSALAME

Introduction: The overall health and well-being of middle-aged women has become a major public health concern around the world. More than 80% of the women experience physical or psychological symptoms in the years when they approach menopause, with various distresses and disturbances in their lives, leading to a decrease in the quality of life. The aim of our study was to assess the quality of life and the impact of hormonal changes in perimenopausal and postmenopausal women and to correlate the prevalence of the symptoms with their duration since menopause. Material and Methods: A cross- sectional study was done at Sri Manakula Vinayagar Medical College and Hospital, Puducherry, from January 2012 to April 2012. Five hundred women who were in the age group of 40-65 years, who came from rural areas to our hospital, were included in the study. The women who were receiving hormonal treatment and those who refused to participate in the study were excluded. The data such as the socio-demographic information and the menstruation status, which were based on the reported length of time since the last menstrual period and the experience of the symptoms, as were tested in the Menopause Specific Quality of Life (MENQOL) questionnaire, were collected from each patient. The women who were included in the study were divided into three groups as the menopause transition, early postmenopausal and the late postmenopausal groups. All the data which were gathered were analyzed by using SAS 9.2. The Chi square test and the relative risk and the confidence interval calculations were applied to compare the frequencies of the symptoms among the women with different menopausal statuses. A p-value of less than 0.05 was considered to be statistically significant. Results: Mean menopausal age in the study group was 45 years. The most common symptom within study subjects were low back ache (79%) and muscle-joint pain (77.2%). The least frequent symptoms were increase in facial hair (15%) and feeling of dryness during intimacy (10.8%). Scores of vasomotor domain were significantly more in menopause transition group. Scores of physical domain were significantly more in late postmenopausal group. Conclusion: The menopause related symptoms had a negative effect on the quality of life of the perimenopausal and the postmenopausal women. Such regional studies can help in creating awareness and in educating women on the early identification of the common menopausal symptoms.

The Transcervical Foley Catheter Versus the Vaginal Prostaglandin E2 Gel in the Induction of Labour in a Previous One Caesarean Section – A Clinical Study

Farah Ziyauddin, Seema Hakim, Sridevi Beriwal

Objective: To compare the effectiveness and the safety of the transcervical Foley catheter and the prostaglandin E2 (PGE2) gel for the induction of labour in women with a previous one caesarean section with an unfavourable cervix at term. Method: This study was conducted in the Department of Obstetrics and Gynaecology, J.N. Medical College, Aligarh, (U.P),India. Seventy women with singleton pregnancies at term, with previous one lower segment caesarean sections with a cephalic presentation and a Bishop’s score of ≤ 6, who required induction at term were included in the study. Group A had 35 women in whom the transcervical Foley catheter was inserted and Group B included 35 women in whom the PGE2 gel was inserted vaginally for the induction of labour. The Bishop’s score after 12 hours of induction, the oxytocin requirement, the induction to delivery interval, the mode of delivery, the maternal complications and the neonatal outcome were compared. Results: The Foley catheter and the PGE2 gel had a comparable effect on the Bishop’s score after 12 hours and the induction to the delivery interval was slightly shorter with the Foley catheter (18.15 hours) as compared to 21.06 hours with the PGE2 gel. There was no case of uterine rupture or scar dehiscence. Conclusion: In this study, both the modes of induction in women with previous one caesarean sections were safe, simple and effective. The main advantages of the cervical ripening with the Foley catheter over the Prostaglandin E2 gel are the low cost, reversibility and the lower risk of systemic and serious side effects like uterine hyperstimulation and rupture, as well as it induces a significant ripening and dilatation of the cervix and a shorter induction to the delivery interval. So, the cervical ripening effect of the Foley catheter is as good as that of the Prostaglandin E2 gel in women with previous one caesarean sections.

A Clinical Study on the Management of Inguinal Hernias in Children on the General Surgical Practice

V. Ravikumar, Rajshankar S, Hareesh R. S. Kumar, Nagendra Gowda M.R

Background: Inguinal and scrotal swellings are frequently encountered in the surgical practice, especially in children. It is also important to study the factors which are associated with inguinal hernia, especially in children, for its effective management. Objective: To study the factors which are associated with inguinal hernia in children. Setting and Design: A prospective hospital based study was undertaken in the Department of Surgery for a period of one year between 2001 to 2002. Children who were aged one day to 12 years were selected for the study. Out of 960 children who were admitted to the surgical ward, 50 children had inguinal hernia and they constituted the sample. Methodology: The details regarding the clinical history and the examination details were collected by using a predesigned proforma. The data which was thus collected was analyzed by using the appropriate statistical tests. Results: The inguinal hernia in the study group was common in the 1-5 years age group. 90% of the study group was males; a swelling in the inguinal region was the commonest symptom. 70% of the study group was term deliveries; the swelling of the inguinal hernia was elastic in consistency in 35 cases. The swelling of the inguinal hernia was irreducible in two cases. The testis was palpable in 48 cases; a cough impulse was seen and felt in 48 cases. Tenderness of the swelling was present in 2 cases. Conclusions: Inguinal hernia is a common congenital condition in children. Difficulties are commonly encountered by the surgeons to identify and to confirm the presence of inguinal hernia. This study will help in a better management of hernia in the paediatric age group by understanding the features of inguinal hernia.

Anaesthetic Management of a Geriatric Patient with Parkinson’s Disease, who was Posted for Emergency Laparotomy- A Case Report

Renuka T Holyachi, Santosh Karajagi, Siddanagouda M Biradar

Parkinson’s Disease (PD) is a relatively common neuro degenerative disorder in the geriatric age group. The pathophysiological changes in these patients predispose to major systemic complications like aspiration pneumonitis, respiratory depression, myocardial depression and postural hypotension. Anaesthetic agents interact with the anti-Parkinsonian medication and this may lead to adverse effects. Here, we are presenting a case report of the anaesthetic management of a patient with a history of Parkinson’s disease, who was posted for emergency laparotomy.

A Right Ectopic Kidney with Bilateral Multiple Anomalies of the Renal Vasculature – A Case Report

Krishnaveni C, Roopa Kulkarni

The renal anatomy and its development is complex. This complexity is associated with numerous variations. Each renal variation has its own clinical and surgical importance. There is a good correlation between the ascent of the kidney, the level of its origin and number of the renal arteries. Any anomaly in the renal artery development may be due to a delay in the kidney ascension and it can lead to an ectopic kidney. Ectopic kidneys are more frequent in males and they are observed commonly on the left side. In the present study, we came across a rare case of a unilateral right renal ectopia and bilateral multiple renal arteries, with 5 renal arteries on the right side and 2 on the left side. The renal veins were 3 on the right side and two on the left side, with the retro aortic left renal vein, which were observed during the routine dissection of a male cadaver. This observation would be of immense importance for surgeons, interventional radiologists, nephrologists and vascular surgeons.

Giant Congenital Melanocytic Nevi: A Case Report

Sudhanshu ku. Das, M. Amarendra, Monalisa Subudhi

Congenital melanocytic naevi which are formed by the overgrowth of melanocytes, are present at birth, which are called as bathing trunk, coat¬sleeve or stocking naevi, which are commonly found over the back and the thigh areas . The giant congenital naevi of sizes which are greater than 20 cm are pigmented and are often hairy. The risk of malignant melanoma for the giant naevi is approximately 6% and 50% of the melanomas that develop by the age of two years, and 80% of those that develop by the age of seven years. So, an early removal is recommended The objective of this paper is to present a unique case of giant naevi along with a review of the literature.

Sarcoptic Mange: A Zoonotic Ectoparasitic Skin Disease

Kiran Madhusudhan Bandi, Chitralekha Saikumar

A 56-year old man attended the Dermatology Outpatients Department with the complaint of a localized, extremely itchy, erythematous papular lesion of acute onset on the ventral aspect of the right thigh. The patient was referred to the Microbiology Lab for the microscopic detection of the fungal elements. The KOH mount from the skin scrapings showed no fungal elements, but it showed the mites of Sarcopetes scabiei mange. The Sarcoptic Mange is noteworthy because of the fact that it is a zoonotic disease which can easily be passed on to humans. A close contact with infested pet dogs was considered as the main predisposing factor in this case. The response to the antiscabietic treatment was dramatic.

Bull Gore Injury of the Vagina

Maitri Raghavendra Kulkarni, Mahendra Gangadharaiah, Sunanda R. Kulkarni

Although an obstetrically related trauma is the most common cause of the injuries to the female genital tract, non obstetric causes also lead to a significant number of vaginal and vulval injuries. We present 2 cases of vaginal injury, due to bull goring, one of which was associated with massive vulval haematoma. The 2 cases presented in a span of 2 months, in a rural medical college in South India. Both of them were managed surgically, following an initial haemodynamic resuscitation. They also required blood transfusions and an antibiotic prophylaxis. The postoperative period was uneventful.

An Ectopic Pregnancy in the Tubal Interstitium: Beware!

Nidhi Sharma, Rohini, Upasana

An interstitial ectopic pregnancy is a rare and a dangerous form of an ectopic pregnancy .It presents late clinically and it is difficult to be imaged radiographically . We are presenting a case of an interstitial pregnancy which was a surprise intra operative finding. As Assisted Reproductive Technology (ART) procedures are becoming popular, the incidence of ectopic pregnancies is likely to increase .The clinicians should be well equipped to diagnose and to treat this unusual form of ectopic pregnancies at the earliest.

Squamous Cell Carcinoma Arising in Warthin’s Tumour: A Case Report

P J Yaranal, Umashankar T

Warthin’s tumour (adenolymphoma) is a well defined salivary gland tumour which consists of epithelial and lymphoid components. However, the malignant transformation of adenolymphoma is extremely rare. We are reporting a case of squamous cell carcinoma which arose in a Warthin’s tumour of the right parotid gland, to highlight its varied cytolomorphological features which can cause diagnostic problems on cytological examination. The review of the literature has been discussed.

Steatocystoma Multiplex -A Rare Genetic Disorder:A Case Report and Review of Literature

Hemlata T. Kamra, Pradeep A. Gadgil, Ajay G. Ovhal, Rahul R. Narkhede

A 17 years old female presented with multiple asymptomatic cutaneous cysts all over body, sparing the head and neck region. The microscopic examination of the cysts showed the features of steatocystoma multiplex. This disorder, although it is asymptomatic, is a cosmetic threat to the patient . Only a few cases of the patients with an autosomal dominant mutation, who had keratin 17, have been reported. We are reporting here, a case of steatocystoma multiplex in a 17 years old female, along with its review of literature.

Intrapericardial Hemangioma:A Case Report

Nalini Gupta

Hemangiomas of the pericardium are very rare primary pericardial tumours. Very few cases of pericardial hemangioma have been reported in the literature till date. We are reporting a case of a 40 years old male who presented with the complaints of chest discomfort and palpitation on exertion, of 3 months duration. ECHO and Colour Doppler ECHO which were done, revealed a large heterogeneous mass which measured 7.6 × 7.1cms, which was possibly attached to the roof and the anterior surface of the left atria, which was possibly a myxoma. Based on the radiological findings, a diagnosis of left atrial myxoma was considered. However, intra operatively, an encapsulated mass was seen within the pericardium, which was successfully excised and sent for histopathology. The histopathological examination revealed an intrapericardial hemangioma. This case has been reported on account of its extreme rarity.

Multiple Apocrine Hidrocystomas: A Case Report

Hidrocystomas are rare cystic lesions that form benign tumours of the sweat glands. In this report, a clinical case of multiple apocrine hidrocystomas on both the upper and lower eyelids, and on both the malar regions has been discussed. These lesions are less likely than the eccrine lesions to occur at the periorbital region.

Probiotics and their Effects on Metabolic Diseases: An Update

Juhi Aggarwal, Gaurav Swami, Mayur Kumar

Probiotics are lactic acid bacteria which are used extensively in therapeutic preparations and added to foods.There are many studies which have demonstrated the effects of probiotics on metabolic diseases. One study has shown the effect of fermented dairy products on the serum cholesterol, especially with selected strains of lactic acid bacteria.It has been found that a minute quantity of the dry culture of Lactobacillus fermentum KC4b, for example, can remove 14.8 mg of cholesterol from the culture medium. Lactobacilli also play an important role in deconjugating the bile salts in the intestine to form bile acids and thereby inhibiting the micelle formation. Probiotics reduce the lipid peroxidation and improve the lipid metabolism in vivo.The addition of probiotics to the diet for weeks improved the immune response without the release of inflammatory cytokines, thereby reducing the onset of sysmatic inflammatory induced diabetes.There are evidences that the differences in the composition of the gut microbiota may precede the development of obesity in children. This review has illustrated the potential of probiotics in mediating metabolic diseases via the positive modulation of several different physiological systems, apart from its conventional benefits for the gastrointestinal health.

Malnutrition and its Oral Outcome – A Review

Malnutrition affects the oral health and a poor oral health in turn, may lead to malnutrition. This interdependent relationship sees good nutritional health, thus promoting good oral health and vice versa. Malnutrition may alter the homeostasis, which can lead to disease progression of the oral cavity, reduce the resistance to the microbial biofilm and reduce the capacity of tissue healing. It may even affect the development of the oral cavity. Protein-energy malnutrition occurs when there is a deficiency of protein, energy foods or both, which are relative to a body’s need. Studies have suggested that enamel hypoplasia, salivary gland hypofunction and saliva compositional changes may be the mechanisms through which the malnutrition is associated with caries, while an altered eruption timing may create a challenge in the analysis of the age specific caries rates. This paper gives an insight on the relationship of the malnutrition and the protein-energy malnutrition with the oral health status.

How to Help the Oral Pathologist in Making an Accurate Diagnosis

K.M.K. Masthan, S. Leena Sankari, N.Aravindha Babu, Jagadish P. Rajguru

A biopsy is a valuable diagnostic tool in clinics. In this procedure, the sample tissue is obtained in order to study its structure both macro and microscopically , thus making it possible to establish a final diagnosis.Some clinicians are surprised and disappointed when the report from the oral pathologist comes as “not from the representative area and “inadequate specimen size”, instead of a final diagnosis. To avoid such disappointments and to make the best utilization of the of the oral pathologist,certain ideas have been suggested. Right from the history taking to the clinical examination to the operative findings, the clinician can pave the way to a conclusive histopathological diagnosis.

The Application of Vizilite in Oral Cancer

Thirugnana Sambandham, K. M. K. Masthan, M.Sathish Kumar, Abhinav Jha

This article depicts the various applications of Vizilite plus in oral cancer. The oral cavity demonstrates a variety of red and white, pigmented and vesiculo- bullous lesions. Oral cancer still happens to carry the highest mortality worldwide, especially in India. In India, the prime focus is on the downstreaming of oral cancer from an advanced stage to an early diseased state. The techniques that are promoted to facilitate an earlier detection and diagnosis of an oral malignancy include Toluidine blue, ViziLite Plus with TBlue, ViziLite, Microlux DL, Orascoptic DK, VEL scope, Oral CDx and brush biopsy.

Acute Myeloid Leukaemia(AML) Presenting as a Bilateral Pleural Effusion

Ranjan Agrawal