Journal of clinical and diagnostic research

Ultrasonography Is Still A Useful Diagnostic Tool In Acute Appendicitis

Aim: The aim of the study was to evaluate the role of ultrasonography in the diagnosis of acute appendicitis and to study the correlation between clinical signs, laboratory investigations and ultrasonographic findings in the evaluation of the diagnosis of acute appendicitis. Methods: A total number of 100 patients (52 men and 48 women) over a period of 2 years, with the clinical suspicion of appendicitis, were subjected to abdominal ultrasonographic examination. Ultrasound positive cases were subjected to surgery. The accuracy of ultrasonography in the diagnosis of appendicitis was compared with clinical diagnosis, laparotomy findings and histopathological examination reports. Results: Out of 100 cases that underwent ultrasonography, 58 cases were sonographically positive for appendicitis and 3 cases were appendicular masses. Right iliac fossa tenderness, rebound tenderness and Rovsing’s sign were the cardinal signs. The Murphy’s triad of symptoms holds good in the diagnosis of appendicitis in the present study. The overall specificity of ultrasound was 88.09% and the sensitivity was 91.37% in the diagnosis of acute appendicitis. Conclusion:Acute appendicitis is a common indication for emergency abdominal surgery. Ultrasonography is still a useful tool in the diagnosis of acute appendicitis in spite of sophisticated investigations like CT abdomen and laparoscopy; thus, reducing the cost of treatment and preventing negative laparotomies.

Impact Of Ethnicity Upon Body Composition Assessment In Iranian Northern Children

VEGHARI G*, ASADI J**, ESHGHINIA S***

Objective: This study was designed to determine secular growth among rural children between two ethnic groups (Sisstanish and Non-Sisstanish ) in north of Iran. Methods: We chose 20 villages from 118 by cluster and simple sampling. All of 25-60 months old children in this area were considered in this study. Sample size was 1569 cases (632=Sisstanish and 937=Non- Sisstanish). Height, weight and personal identification were recorded by questioner. BMI percentile and under -1sd, -2sd and -3sd from NCHS were used for comparison. X2 test and T.test were used to analyze by software SPSS. Results: Sisstanish children were 900 g lighter and 4.39 cm taller than non-Sisstanish among all of age groups. T.test is significant between two groups based on weight and height (P<0.05). Stunting and underweight were observed in Sisstanish group 23% and 5.9% respectively more than in non-Sisstanish by –2sd criterion. There is a significant difference between two groups by stunting (P<0.05). Overweight (1.52%) and obesity (12.4%) were shown in Sisstanish group more than in non-Sisstanish group and Statistical differences is significant between them based on obesity (P<0.05). Conclusion: Secular growth in two groups is disproportionate and in Non-Sisstanish group is better than Sisstanish group. Sisstanish children suffer from severe height deficit and BMI high. Thereby, malnutrition is the most health problem in rural area in the north of Iran and nutritional intervention is necessary for solving these problems.

Public Opinion On Dispensing Doctors In Malaysia

HASSALI M A*, SHAFIE A A**, PALAIAN S***, AWAISU A****

Health Problems Amongst Adolescent Girls In Rural Areas Of Ratnagiri District Of Maharashtra India.

PATIL S N*, WASNIK V**, WADKE R***

Adolescent constitute over 21.4 % of the population in India. This period needs special attention because of turmoil of adolescence faces due to different stages of development, different circumstances, different needs and diverse problems. The psychosocial and emotional problems are of considerable magnitude and they may exert significant influence on their nutritional status. Unfortunately assessment of nutritional status of adolescent girls has been the least explored area of research particularly in rural India Objective •To assess the Nutritional problems amongst the adolescent girls. •To find out the reproductive problems amongst the adolescent girls. •To suggest the recommendation based on Study findings. Methods:The approach adopted for this community based study was cross sectional one. One Community Development Block (i.e. Chiplun) was selected from nine CD Block of the Ratnagiri District by simple random sampling. Anganwadi centre of Chiplun were stratified into 3 strata according to distance Viz. < 15 Km, 15-30 Km and > 30 Km) from Institute and from each stratum three bit were selected by simple random sampling. In the selected Anganwadi centre three adolescent girls were selected. This served as the sampling frame. The information on age, Weight, Height, BMI, Socioeconomic status, menstrual problems, and reproductive problems were assessed. The hemoglobin concentration as well as MCHC was measured. The data was collected and analyzed using SPSS version 16.0. Results: The mean age of the study subjects was calculated to be 16.9 years. Most (77.6) of the subjects were students followed by school dropout (22.4). As per Proposed Asian and WHO criteria, 67.8% & 69.3% adolescent girls were under weight (BMI < 18.5). Adolescent girls who were categorized as overweight by Proposed Asian (23 to 24.9 kg/m2) and Previous WHO (25-29.9 kg/m 2) criteria’s were 2 % and 2.4% respectively. As much as 41.9% study subjects were anaemic (Hb < 12 gm %) as per WHO guidelines. It was found that 68.9% (MCHC < 34 %) of the study subjects were showed hypochromic red cells suggesting Iron deficiency anaemia. The mean age of the menarche was found to be 13.7 years. As far as problems related to menstruation cycle were concerned Dysmenorrhea (44.2%) was the commonest problems faced by adolescent girls. Irregular menses 16.9%, Irritation-21.7%, Malaise – 9.5% , Headchae-14.2, chest pain- 8.2% , abdominal bloating 20.3% , constipation- 11.3%, tightness in chest 10.6%. White discharge-38.3 %. Conclusion: The study concludes that majority of the girls had clinically obvious nutritional deficiency diseases. Two third of study subjects were undernourished (BMI <18.5 kg/m 2). The prevalence of anaemia among the adolescent girls was found to be 41%.There was a significant association of anaemia with educational status of adolescent girls. Majority more than three fourth of the adolescent girls were suffering from menstrual related problems which leads to reproductive morbidities. Adolescents are expected to enjoy a good health but this does not seem to be in rural areas of developing country like India, where poverty, malnutrition and repeated infection are rampant. To achieve the optimum health and development of the adolescent segment of the population. There is a need to introduce a comprehensive Adolescent Health Initiative (AHI) at block level.

The Clinical Profile Of HIV Infected Patients Of Teaching Hospital In Punjab And The Relation With Absolute CD4 And CD8 Counts

SINGH R*, ARORA D **, KAUR M ***, KUMAR R****

The most common cause of HIV disease throughout the world is HIV-I which was first identified in West Africa. Worldwide , the World Health Organization (WHO) estimated that there were 1 million HIV-1 infected people in South America, 0.5 million in Europe, 5 to 6 million in sub-Sahara Africa, and 30,000 in Oceania. Inspite of it being highly prevalent in the world there have not been many studies to study its clinicopathological behavior in this part of the world. Hence the present study was planned to study the clinical profile of HIV positive patients presenting to a tertiary care hospital, absolute CD4 and CD8 cell count in HIV positive patients at the time of presentation and the association of CD4 and CD8 cell counts with the predominant clinical infection at the time of presentation.

The Role Of Fine Needle Aspiration Cytology In Palpable Head And Neck Masses.

FERNANDES H *, D’SOUZA C R S**, THEJASWINI B N ***

Background And Objective: This study is done to evaluate the role of FNAC in palpable head and neck masses and also to study their distribution. A correlation was done between cytology and histopathology whenever surgical specimens were available and to assess the accuracy, sensitivity, specificity, positive predictive value and negative predictive value in various head and neck lesions. Materials And Methods: From 620 cases, FNA smears were taken and stained with PAP, MGG and special stains whenever required. FNA results were interpreted and analysed according to the anatomical sites and the lesions were categorized into inflammatory and neoplastic conditions. The cytological findings were compared with those of histopathology wherever available. With the help of K value, the agreement between the methods was de-termined. Results: Among 620 cases, histopathological correlations were available only in 129 cases. The sensitivity, specificity, predictive value of the positive test, predictive value of the negative test and false negatives of the thyroid lesions which were being detected were 83.33%, 100%, 100%, 97% and 16.66%, respectively. There were no false positives. The diag-nostic accuracy of the salivary gland, lymph node and soft tissue lesions were 100%. Interpretation And Conclusion: There was perfect agreement in a majority of the lesions. The technique is simple, safe, convenient and an accurate method for tissue di-agnosis. Hence, FNAC is an effective diagnostic tool in the diagnosis of head and neck masses.

Metallo-β-lactamase production among Pseudomonas species and Acinetobacter species in costal Karnataka

SHOBHA KL* ,LENKA PR **,SHARMA MK***, RAMACHANDRA L****, BAIRY I *****

Background and objectives: The emergence of multidrug resistance among Pseudomonas species and Acinetobacter species is a notable threat. Acquisition of the metallo-β-lactamase (MBL) gene is an important mechanism of broad-spectrum-β-lactam resistance. The aim of the study is to detect the prevalence of MBL among Pseudomonas spp. and Acinetobacter spp. isolated from various clinical samples collected from different age groups. Materials and Methods: A total of 54 meropenem resistant Pseudomonas spp. and Acinetobacter spp., tested by the disc diffusion method, were included in the study .The strains were isolates obtained from burn wounds, ulcers, sputum and urine collected from the patients aged from one year to 90 years. The strains were identified up to the species level and the EDTA disk synergy test was used, with simultaneous testing of different β-lactams (meropenem and aztreonam). Results: Of the 54 meropenem resistant strains, 16(30%) were MBLs producing isolates, of which 13(81%) were isolates of samples from male patients and 3(19%) were those from female patients. More strains of MBLs [13(81%)] were seen in the age group of 40-75 years and only few strains of MBLs [3(19%)] were isolated from samples in the age group below 40 years and above 75 years. MBLs were more prevalent in respiratory specimens 4(45%) and less prevalent in urine specimens 3(21%) when compared to other specimens. Pseudomonas putida 7(64%) had more number of MBLs producing organisms as compared to other species of Pseudomonas. The isolates producing MBLs were more resistant to Tobramycin [16(100%)] and Gentamicin [15 (94%)] and were less resistant to Piperacillin [10(63%)] than meropenem -non susceptible isolates which did not produce MBLs. Conclusion: The rapid discrimination of MBL producers is worrisome and necessitates the implementation of not just surveillance studies, but also the proper and judicious selection of antibiotics, especially carbapenems.

Role of Homocysteine, Vitamins B6, B12 and Folic Acid in Acute Myocardial Infarction Patients

Background: Homocysteine is a risk factor for cardiovascular disease. We evaluated the efficacy of homocysteine-lowering treatment with B vitamins for secondary prevention in patients who had had an acute myocardial infarction. Methods: We investigated the possible correlation between deficiency of vitamins B6, B12 or folic acid and homocysteine in patients with acute myocardial infarction (AMI). A case control study was carried out involving 50 AMI patients and age matched 50 normal healthy subjects. Results: Mean serum B12 concentration in AMI patients was found to be significantly lower than the mean for controls. Mean serum folate and PLP level in patients was also found to be lower than controls; however, the differences were not statistically significant. Mean plasma homocysteine level in AMI cases was higher than the mean level in controls. Compared to controls, there was significantly greater deficiency of folate, B12 and PLP in AMI patients. Conclusion Substantial nutritional deficiencies of these three vitamins along with mild hyperhomocysteinemia, perhaps through interplay with the classical cardiovascular risk factors (highly prevalent in this population), could be further aggravating the risk of CAD in the population.

The Changing Scenario Of The Salmonella Serotype And Its Drug Resistance Pattern

ARORA D *, SEETHA K S **, KUMAR R ***

Enteric fever continues to be a global health problem because of its high morbidity and mortality and presently, due to the increased incidence of multi drug resistant salmonella. So, the present study was planned to evaluate the change in frequency of the isolated salmonella serotype and to know its drug resistance pattern.

(Article Retracted) Evaluating The Effectiveness Of Telephone Triage For Priority Emergency Ambulance Dispatch

PANDEY A*, KHANDEKAR R**

This article has been retracted on 10th Oct 2012 due to irrefutable evidence of Plagiarized data.

Transient Non Immune Hydrops Foetalis

BHAT P R B* ,SHARMA L**,KARKADA D L***

Nonimmune hydrops which is secondary to parvovirus B-19 can manifest itself in various forms. It can manifest as severely as foetal death to as mild as spontaneous resolution without any sequelae. We present here, a rare case of nonimmune hydrops which resolved spontaneously in a span of 5-6 weeks.

Malignant Melanoma Of Maxillary Sinus: A Rare Entity

GUPTA S *, SINGH P A **, MISRA V ***, JAIN S ****

Malignant melanoma of the nose and paranasal sinuses is an aggressive disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. Melanomas are tumours arising from melanocytes which are neuroectodermally derived cells located in the basal layers of the skin, adnexa and some of the mucosal membranes. Malignant melanomas developing from maxillary sinuses are extremely rare. Their diagnosis can be confirmed by immunohistochemistry by using anti-S100 and HMB-45 antibodies.

Split Notochord Syndrome With Dorsal Enteric Fistula In A Male Neonate: A Case Report

GHRITLAHAREY R K*, MALIK R**

Split notochord syndrome (SNS) is an extremely rare congenital anomaly and 33 such cases have been reported in literature, till date. Of these 33 cases of SNS; 20 presented with associated dorsal enteric fistula. We are reporting here a 2.5 kg male neonate, born normally at hospital, to a 24 yrs old Gravida II Para I mother. Clinical examination and investigations revealed SNS associated with hydrocephalus (Arnold Chiari malformation), thoracic meningomyelocele and dorsal enteric fistula just below meningomyelocele. He also had associated imperforate anus, reducible right inguinal hernia and penoscrotal transposition. Staged correction of the disease was planned. Right inguinal herniotomy and sigmoid loop colostomy was done on 14th day of age as a first stage of the operation. His father was reluctant for further operation at present therefore he was discharged on request after a week of operation. The reason for reporting the case is its rarity.

Neonatal Teratoma

BHAT RY*, KUMAR V**

Teratomas are neoplasms originating in pluripotent cells. They are composed of a wide diversity of tissues representing all three germ cell layers. The sacrococcygeal area is the most common extragonadal site. A sacrococcygeal teratoma is the commonest teratoma presenting in the neonatal period. We present a term neonate who had a large teratoma in the sacrococcygeal region. The tumour was associated with polyhydramnios and elevated alpha-fetoprotein at birth. Enbloc resection of the tumour resulted in rapid decline in the alpha-fetoprotein. Histopathological examination of the mass confirmed the tissues of all the three germ cell layers.

Recent Advances In Antiretroviral Therapy

KAMAT T S*,RATABOLI P V**, PHIRKE V R***, MANGRULE S A****

Despite significant progress in the study of human immunodeficiency virus (HIV) infection over the past few years, it still remains a leading cause of death throughout the world. The field of antiretrovirals is dramatically growing. 25 antiretroviral drugs have been approved by the US-FDA till date. The development of newer antiretrovirals has dramatically altered the progression of the disease and has improved the quality of life in many HIV-infected patients. Over the last two years, three novel antiretroviral drugs, maraviroc (CCR5 antagonist), raltegravir (integrase inhibitor) and etravirine (a second generation non nucleoside reverse transcriptase inhibitor) have been approved by the FDA and several others are in the pipeline. This review discusses the pharmacology of the three novel antiretroviral agents. Drugs which are currently in the pipeline and the latest HIV treatment guidelines have also been addressed.

Herb-Drug Interaction, the Fall Out Of Poor Communication Between Doctors And Patients

GHOSH R*, MONDAL S**, DATTA S***

Improving Efficiency In Quality Assurance Documentation Cell With Lean Thinking

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

The pharmaceutical industry is regulated by regulatory agencies like the U.S. Food and Drug Administration (FDA), the European Union (EMEA), WHO and the Ministries of Health of various countries and guidelines such as the Good Practice (GxP) guidelines. The GxP guidelines are primarily Good Laboratory Practice (GLP), Good Clinical Practice (GCP) and Good Manufacturing Practice (GMP), ensuring the quality of the processes leading to the final product. The pharmaceutical industry has to comply with regulations from the law and health authorities. This article provides an insight into how lean thinking concepts like 5S can help the Quality Assurance Documentation cell of a Pharmaceutical company and can increase its efficiency of document upkeep, storage, archival, distribution, presentation and retrieval.

The Essentials of Contraceptive Technology

SHANKAR PR*