Journal of clinical and diagnostic research

Comparison of Traneximic Acid with a Combination of Traneximic Acid and Mefenamic Acid in Reducing Menstrual Blood Loss in Ovulatory Dysfunctional Uterine Bleeding (DUB)

Najam R *, Agarwal D **, Tyagi R ***, Singh S ****

Objective: To compare the efficacy of traneximic acid (Txa), with a combination of traneximic acid (Txa) and mefenamic acid (Mfa) in reducing menstrual blood loss in patients of ovulatory DUB. Design: Prospective, randomised trial performed in 110 patients of ovulatory dysfunctional uterine bleeding. Intervention: Patients diagnosed with ovuatory DUB based on the history of regular heavy cyclical bleeding, with normal transvaginal sonography (n= 110 patients), were included in the study. The patients were grouped into two, group T receiving tablets of 500mg Txa, three times a day from day 1 to 5 of the menstrual cycle, and group TM receiving tablets of 500mg Txa +250mg Mfa, three times a day from day 1 to 5 of the menstrual cycle, for 3 cycles i.e. 3 months. The efficacy of the treatment in both the groups was evaluated by recording the reduction in menstrual blood loss (measured by calculating pictorial blood assessment chart scores) and the improvement in post-treatment haemoglobin concentrations at 3 and 6 months follow up. Results: Of the 110 patients who were followed up for a period of 6 months, 38.1% (n=42) were in the age group of 30-39 years. 54.5% of the patients (n=60) presented with moderate anaemia at the first outpatient visit. In the T group, the mean pre-treatment haemoglobin concentration was 9.5 g/dl and the mean PBAC score was 250. At 6 months of follow up, the mean haemoglobin concentration was 12.0 g/dl, which showed an improvement by 26.3% and the mean PBAC score was 125, which showed an improvement by 50%. In group TM, the mean pre-treatment haemoglobin concentration and the PBAC score were 8.6 g/dl and 246, respectively, while at 6 months of follow up, the mean haemoglobin concentration was 12.3g/dl, which showed an improvement of 38.9% and the PBAC score was 100, with a decline of 59.3%. Conclusion: Both traneximic acid and a combination of traneximic acid and mefenamic acid are effective in decreasing PBAC scores and reducing menstrual blood loss in DUB, though a combination of traneximic acid and mefenamic acid showed better long term results.

Gender Variation Of Somatic Symptoms Of Depression As Possible Indicators Of Its Diagnosis And Severity

Depression is a common mental health problem around the world and is responsible for a wide range of problems in all the aspects of a person’s functioning. It is the 4th in the list of the most urgent health problems worldwide, as per the World Health Organization (WHO) and its lifetime prevalence is around 10-25% for women and 5-12% for men. Several studies estimate the prevalence for major depression as around 5%, making it one of the most common clinical problems. Among them, only around 10% are referred to psychiatric services and get treated, but many others suffer in silence and solitude. The present study was carried out in 131 patients who were diagnosed as having depression according to the Structured Clinical Interview for ICD. The Beck Depression Inventory (BDI) was routinely administered as part of the standard intake assessment battery. When patients scored >1 on each of the four somatic BDI items, they were considered as having moderate to severe somatic depression. Descriptive statistical methods and confidence intervals were used to find out the severity of the symptoms among males and females. There were 65 (98.5%) females and 56 (94.9%) men who could be classified as having somatic depression and 1 (1.5%) female and 3 (5.1%) men who were classified as having non-somatic depression. The somatic symptoms of depression are always associated with the pathophysiological changes in the brain. There are evidences that changes in the cortisol, nor adrenalin (NE) and serotonin activities cause abnormal physiological activity of the brain, which is responsible for the somatic symptoms in depression. In the present study, a significant difference was found in appetite and fatigue in moderate to severely depressed female patients than in the males. Therefore, the somatic symptoms can be considered as indices while diagnosing depressive disorders.

The Re-Emergence Of Chloramphenicol Sensitivity Among Enteric Fever Pathogens In Mangalore

YASHAVANTH R*, VIDYALAKSHMI K**

Background: Enteric fever is a global health problem, especially in the developing countries of the tropics. Drug resistance among enteric fever pathogens is a major challenge for the clinicians. Since its introduction in 1948, chloramphenicol (C) remained as the drug of choice for enteric fever. Later, ciprofloxacin (Cf) replaced C, when C-resisitant enteric fever emerged and caused outbreaks in different parts of the world. Fluoroquinlones are replaced by third generation cephalosporins like ceftriaxone (Ci) and cefotaxime (Ce) as the first line therapy nowadays. C-sensitive Salmonella serotypes emerged again due to the withdrawal of antibiotic pressure. Therefore, an attempt was made to study the incidence of blood stream Salmonella infections and their antimicrobial susceptibility pattern. Method: Strains isolated from 188 blood culture positive cases of enteric fever over a period of 1 year and 11 months were studied and their sensitivity pattern to chloramphenicol(C), ampicillin(A), cotrimoxazole(Co), nalidixic acid(Na), ciprofloxacin(Cf), ofloxacin(Of) and ceftriaxone(Ci) were analysed by the disk diffusion method according to the Clinical Laboratory Standard Institute(CLSI) guidelines. The Minimum Inhibitory Concentration (MIC) was determined for chloramphenicol by the agar dilution method according to the CLSI guidelines. Results: A total of 188(2.99%) Salmonella isolates were obtained from blood culture during the period of 1 year and 11 months. Of these, 77 were S.typhi and 111 were S.paratyphi A. The present study showed higher chloramphenicol sensitivity for S.typhi (97.4%) and S.paratyphi A (100%). The MIC for Chloramphenicol was ≤ 4 µg/ml for 187 Salmonella isolates. One Salmonella isolate showed C - MIC of 64 µg/ml. Conclusion: This study has shown the reemergence of chloramphenicol sensitivity among enteric fever pathogens. The results suggest the necessity for the reevaluation of chloramphenicol therapy in enteric fever.

Microbiological Profile Of Nosocomial Infection In The Intensive Care Unit

SHALINI S, KRANTHI K, GOPALKRISHNA BHAT K*

Introduction: Nosocomial infections (NI) are those acquired in hospital settings. Each nosocomial infection adds 5-10 days to the affected patients’ stay in the hospital and leads to extra expenditure, thus overburdening the already strained health economy. The rate of nosocomial infections ranges from 2.8% to 34.6% in various studies. Materials and Methods: We conducted this study to estimate the rate of nosocomial infections in the Intensive care unit (ICU) of a tertiary care hospital from coastal Karnataka, South India. The patients who developed infections after 48 hours of admission to the ICU were included in the study. The specific site related investigations included blood cultures and cultures of CVP or intravenous catheter tips, urine and indwelling catheter tips, endotracheal tube tips, suction catheter tips and endotracheal secretions. 97 suspected cases of nosocomial infections were studied prospectively, which were identified as per the guidelines laid down by CDC. Observations: The rate of nosocomial infections was 27. 4%. The rates of the urinary, respiratory and the intravascular catheter related infections were 55.52%, 35.78% and 11.52%, respectively. Klebsiellapneumoniae and Staphylococcus aureus were the most common isolates with maximum susceptibility to imipenem and vancomycin respectively. Environmental sampling and healthcare personnel screening showed the presence of these organisms as the local flora in our hospitals. Conclusion: Infections in the ICU patients are important problems. Adherence to infection prevention protocols and the proper monitoring and the judicious use of antibiotics are important in preventing such infections.

The Effect Of Hyperglycaemia On Some Biochemical Parameters In Diabetes Mellitus

GITANJALI G,* SUDEEP G**, NEERJA***, MILI G****, DEEPAK A*****, PRIYANKA S******

Diabetes Mellitus (DM) is the most common endocrinological disorder which is characterized by metabolic abnormalities and long term complications. The purpose of this study was to investigate the role of hyperglycaemia on various parameters like 1) Malondialdehyde (MDA), a parameter to study increased oxidative stress, as hyperglycaemia leads to increased lipid peroxidation 2) Adenosine Deaminase (ADA) activity which is suggested to be an important enzyme for modulating the bioactivity of insulin and 3) Free Fatty acids (FFA) to study dyslipidaemias which are associated with diabetes. Design and Methods: MDA, ADA and FFA levels in serum were measured spectrophotometrically in 50 patients of type 2 Diabetes Mellitus (DM) and also in 25 healthy controls. The patients were divided into three groups according to the levels of Glycosylated haemoglobin (HbA1c); Group I (with HbA1c 6-10%), Group II (with HbA1c 10-13%) and Group III (with HbA1c >13%). The results were also compared with the control group which had HbA1c of 4-6%. Results: All the three parameters, ADA, MDA and FFA levels were found to be significantly higher in the case subjects as compared to the controls (p<0.001). In addition to this correlation, the study revealed that MDA levels are positively associated with FBS and PPBS and also, that ADA is positively correlated with MDA (r = +0.57, p <0.001). Conclusion: These findings suggest that hyperglycaemia is associated with increased levels of ADA and that it is one of the factors which lead to the increased production of oxidative stress and also the derangements of lipid metabolism which are associated with DM. Also, ADA has got a role in increasing lipid peroxidation by reactive oxygen species (ROS) generation, as reflected by increasing MDA levels.

Evaluation of Troponin I in Patients with Acute Myocardial Infarction in the Emergency Department

TAMIMI W., ALOTHAIM A., ALHODAB A., DAFTERDAR R.

Objectives: To evaluate and validate the cut-off values for troponin I (Trop I) in diagnosing acute myocardial infarction (AMI) in the emergency department (ED) and to establish the local healthy reference value. Methods: 86 patients with chest pain and/or shortness of breath were admitted to the ED. Blood samples were collected at 0-3 hours, 6-9 hours and 12-24 hours post-admission and were assayed for (Trop I) and creatine kinase MB (CK-MB). The sensitivity, specificity and the area under the curve (AUC) were determined. Blood samples were also collected from 140 healthy volunteers. Results: The AUC values for (Trop I) were found to be 0.830, 0.863 and 0.912 for the cut-off values of 0.33, 1.0, and 1.5 ng/ml, respectively. The AUC for CK-MB at admission time was found to be 0.736. The reference value based on the 99th percentile was found to be 0.12 ng/ml. Conclusion: Trop I levels were identified in 81-88% of the patients with AMI, with higher sensitivity and specificity than the CK-MB levels.

Health Of Males In Jamaica

PAUL A. BOURNE

Background: Studies on males in the Caribbean have been on marginalization; fatherhood; masculinity and none on the changing pattern of diseases. Aims: This study aims to 1) provide a detailed epidemiological profile of the health conditions; 2) indicate the changing pattern of the health conditions; 3) calculate the mean age of having reported illness or not; 4) compute the mean age of particular health conditions; 5) state whether the mean age of having a particular illness is changing; 6) determine whether there is a significant statistical correlation between health status and self-reported illness; 7) identify factors that correlate with health status; and 8) ascertain the magnitude of each determinant of the health status. Methods and materials: The current study used secondary cross-sectional data taken from two nationally representative surveys. A subsample of 12,332 males out of 25,018 respondents and 3,303 males from 6,783 respondents were extracted from the surveys of the years 2002 and 2007 respectively. Statistical analysis used: The Statistical Package for the Social Sciences for Windows, Version 16.0 was used for the analysis. Multiple logistic regressions were used to explain the variables of the models. Results: There is a possibility of a diabetes mellitus epidemic among Jamaican males, as the yearly average increase was found to be 156% for the studied period. Predictors of poor self-reported illness of males in Jamaica for the year 2002 were age (Odds ratio, OR = 1.044; 95% CI = 1.038, 1.049; P < 0.05); urban area (OR = 1.547, 95% CI = 1.172, 2.043; P < 0.05); and consumption (OR = 1.183; 95% CI = 1.056, 1.327; P < 0.05). Non self-reported illness of males in Jamaica for the year 2007 can be predicted by good health status (OR = 17.801; 95% CI = 10.761, 29.446; P < 0.05); fair health status (OR = 2.403; 95% CI = 1.461, 3.951; P < 0.05); age (OR = 0.967; 95% CI = 0.957, 0.977; P < 0.05); urban area (OR = 1.579, 95% CI = 1.067, 2.336; P < 0.05); and consumption (OR = 0.551; 95% CI = 0.352, 0.861; P < 0.05). Conclusion: The findings are far reaching and can be used to guide health policy formulation and intervention programmes in the future.

Correlation Between Inverse Age And Serum Thyroxin Levels Among Children And Adolescents

Azad R Mansourian*, Ali R Ahmadi**

The aim of this research was to investigate whether serum thyroxin concentration, within the normal reference intervals were age-related among children and adolescents. This investigation was carried out on 243 subjects who were chosen randomly from all those patients who were referred during the one-year period from to the Danesh Medical Diagnostic Laboratory in Gorgan, northern Iran. The thyroxin concentrations of the subjects were obtained from the outpatient records of the patients who were referred to the Laboratory during 2007-08. The thyroxin concentrations were determined by the Radio Immunoassay method by using standard laboratory kits. The sample population were divided into 4 age groups of 1-5 years, 6-10 years, 11-15 years and 16-21years. The results of this study showed that there is an inverse age correlation between thyroxin concentrations among children and adolescents in this region.

The Incidence Of Deep Vein Thrombosis In Post Operative Patients In A Large South Indian Tertiary Care Centre

TAURO L F*, GEORGE C**, RAO BSS SHENOY D H***, AITHALA P S****, HEGDE B R*****

Objective: To determine the incidence of deep vein thrombosis (DVT) in postoperative patients after major abdominal, orthopaedic and neurosurgical procedures, which require long term postoperative hospital stay and to identify the risk factors for DVT in these patients. Materials and Methods: This is a prospective study done in our medical college’s hospital from July 2004 - June 2006. The patients were chosen from all the major branches of surgery, provided they were selected to undergo major surgical procedures requiring prolonged hospital stay after surgery. They were all over the age of 30 years and were routinely assessed for deep vein thrombosis by duplex scan pre and post operatively. Results: A total number of one hundred patients were studied. Out of them, 60 were males and 40 were females. The patients were between the age groups of 30 – 91 years (the mean age was 53 years). Out of 100 postoperative patients, deep vein thrombosis was observed in 14 patients; out of these, 7 were from general surgery, 4 were from neurosurgery and 3 were from orthopaedics. In this study, out of 76 patients who underwent surgery under general anaesthesia, 9 patients developed DVT and out of 24 patients who underwent surgery under spinal anaesthesia, 5 developed DVT. Conclusion: In this study, the incidence of deep vein thrombosis in postoperative patients was found to be 14 % (as compared to 34-63% in the Western population). The incidence of DVT in our study (14%) is significant enough to advocate prophylactic anticoagulant therapy to those who have to undergo major surgical procedures and those who have risk factors.

A Qualitative Study Exploring the Impact Of The Pharmaceutical Price War Among Community Pharmacies In The State Of Penang, Malaysia

BACKGROUND: Competition among community pharmacists in developing countries can be very intense due to the unregulated pricing mechanism for pharmaceuticals. Within this context, it is relatively unknown as to what extent the current pricing strategies for pharmaceuticals can improve the professional practice of community pharmacy in these countries. OBJECTIVE: To determine the factors contributing to the occurrence of the price war and to explore its potential impact on the current pharmacy practice in community pharmacies. DESIGN: Qualitative research by using individual interviews. PARTICIPANTS:Ten community pharmacists throughout the state of Penang who were recruited by using the ‘snowball sampling’ technique participated in this study. DATA ANALYSIS: All the interviews were transcribed in verbatim and were thematically analyzed. RESULTS: Four main themes emerged when the factors associated with the price war phenomenon among community pharmacies in the State of Penang were analyzed. These were (1) The distribution of the community pharmacy premises; (2) The role of pharmaceutical companies; (3) The lack of the development of price control mechanisms by the government and (4) The role of the community pharmacists. The participants also highlighted the negative impact which was imposed by the pharmaceutical price war. These included the shrinkage of the profit margins, the lower survival rate of the pharmacy in the current market and the negligence of pharmacy professionalism. Finally, several suggestions were put forward to resolve this phenomenon, including the role of government agencies in developing policies to control the price war by limiting the number of pharmacies in an area, as well as enforcing the recommended retail price policy. CONCULSION The pharmaceutical price war was commonly reported and due to its’ impact on the survival of the community pharmacies and also the professionalism of the pharmacists, prompt action needs to be taken to address this phenomenon.

A Clinimetric Approach To The Detection And Management Of Vitamin B12 Deficiency Among A Vegan Group In Rural Coimbatore In Tamilnadu

BHARATWAJ R S*, MUTHUKUMAR K**

Introduction: Unfortified plant based foods do not contain Vit B12. The deficiency of the vitamin is markedly under-diagnosed and is widespread in the developing countries. Low B12 levels can have profound effects on the patient’s well-being and if this condition is not detected and treated, it can lead to serious irreversible sequelae. There is no gold standard test for diagnosing the B12 deficiency. Materials and Methods: 121 vegans living as a group were assessed for the deficiency of Vit B12 by using a clinimetric tool. Those who were found positive were given parenteral B12 supplementation and were followed up for a three month period. The results were tabulated and analyzed by tests for the significance of the difference in the proportions. Results and Discussion:91(75.2%) of participants were found to be positive for Vit B12 deficiency. The most common (90.1%) presentations were loss of appetite, excess fatigue, mood swings and irritability. The deficiency was significantly higher among the participants who were vegans for more than 5 years. The treatment with parenteral B12 brought about a dramatic improvement in 85.7% of the deficient participants. 93.5% of the participants who were found to be deficient did show a perceptible improvement in well being by the end of three months. Conclusion:Clinimetric approaches to detect Vit B12 deficiency, a majority of which is sub-clinical, as a primary care tool at least for the high risk groups, would definitely help in alleviating a big magnitude of suffering people in the general population.

The Effect of Integrated Teaching with Case Based Learning (CBL) In the Biochemistry of Undergraduate Medical Curriculum

SURAPANENI K M *

Context: To compare the academic performance of the undergraduate medical students on the traditional curriculum with didactic lectures with that of the students who followed an innovative curriculum with case-based learning in biochemistry. . Methods: The study was conducted in Saveetha Medical College and Hospital, Saveetha University, Chennai, Tamil Nadu, India. The participants (n = 150) were Ist year MBBS students studying in the Saveetha Medical College, Saveetha University, during the academic year from 2008-2009. All the 150 students were divided into two groups as the control group and the study group. A total of 75 students on the traditional curriculum as the control group and 75 students on the innovative curriculum as a study group were studied. Outcomes: The educational outcomes which were assessed were the marks in the written examination (i.e. based on the student’s performance) on the traditional Curriculum with didactic lectures and those on the innovative curriculum with Case Based Learning (CBL). The students were asked to evaluate the relevance for the learning process of the use of Case Based Learning with regard to 13 items on a 5 point Likert scale. Results: A total of 75 students on the traditional curriculum and 75 students on the innovative curriculum were studied. The performance of the students on the innovative curriculum with Case Based Learning was found to be significantly improved (P < 0.001) when compared to the performance of the students on the traditional curriculum, in terms of clinical knowledge. A 5 point Likert scale questionnaire containing 13 questions was administered to the students to know their perception on the usefulness of the CBL and this was completed by all the 150 students of Ist year MBBS. 98% of the students reported that in CBL sessions, a valuable exchange of ideas took place in group discussions. 97% of the students thought that by virtue of the CBL sessions, understanding of the subject / topic was better and all the students reported that it was helpful in terms of the future application of knowledge. Conclusion: The introduction of the innovative curriculum with case based learning coincided with improved academic performance. The students opined that this innovative method to learn bio-chemistry trained them in self learning skills and improved their attitude towards the newer trends in medical education. The students perceived the CBL method to be a valuable learning tool in biochemistry which improved their reasoning skills and motivated them to learn.

Awareness regarding puberty changes in secondary school children of Bagalkot, Karnataka”- A cross sectional study

DORLE A S, HIREMATH L D, MANNAPUR B S, GHATTARGI C H

Research Question was whether the students are aware regarding secondary sex characters during puberty and also regarding STI and RTI and to know what the sources of their information are. Objectives were to evaluate the awareness regarding puberty changes in both boys and girls also to find out the necessity of the subject of sex education in the curriculum and to find out the source of information of the respondents. It was a cross sectional study conducted in Basaveshwar High school, Bagalkot, the Participants were 8th, 9th and 10th Standard students. The data was collected by using pre- tested and pre- designed proforma. The results obtained were as follows: 1) Out of 502 students, 394 (78.49%) were boys and 108 (21.51%) were girls. 2) Only 19.80% of the boys and 9.25% of the girls had correct knowledge regarding secondary sex characters. 3) About 45.18% of boys discussed sex matters with their friends and unlike the boys, 55.56% of the girls discussed it with their parents. 4) Nearly ¾th of the (74.07%) girls did not have prior knowledge about menstruation and 66.7% of the girls used unhygienic pads during menstruation. 5) 41.23% of the students mentioned the inclusion of sex education from higher secondary school. Half of the students did not specify regarding the inclusion of sex education in the curriculum. 6) Only ¼th of the boys and girls had correct knowledge about Sexually Transmitted Diseases. 7) About 58.62% of the boys and 60.18% of the girls had either correct or some knowledge about HIV transmission. 8) 52.28 % of the boys and 46.26% of the girls had either correct or some knowledge regarding the prevention of HIV/AIDS. 9) 51.52% of the boys got the information through television, while only 40.74% of girls got the information through television.

A Prospective Study Of Surgical Site Infections In A Teaching Hospital

MAHESH C B*, SHIVAKUMAR S**, SURESH B S***, CHIDANAND S P****, VISHWANATH Y*****

Context: Surgical site infections (SSI) remain a significant problem following an operation and the third most frequently reported nosocomial infections. Aim: The current study was undertaken to identify aerobic pathogenic bacteria in SSI, to determine their antibiotic resistance pattern and to study the factors influencing SSI. Material and Methods: The prospective study was carried out on 418 surgeries. Samples from patients were collected by following all aseptic precautions and were processed without delay by the standard microbiological techniques. Chi square test was used for statistical analysis. Results and Conclusions: The overall infection rate was 20.09%. The SSI rate was 11.53% in clean surgeries, 23.33% in clean contaminated ones, 38.10% in contaminated ones and 57.14% in dirty surgeries. Male patients were affected more (21%) than the female patients (18.88%). The SSI rate increased with increasing age and it also increased significantly with the increasing duration of pre-operative hospitalization. The SSI rate was significantly less in patients who received pre-operative antibiotic prophylaxis. The SSI rate was significantly higher in emergency surgeries as compared to the elective surgeries. The infection rate was significantly higher as the order and the duration of the surgery increased. The most commonly isolated organism from surgical site infections was Staphylococcus aureus (34.44%), followed by Pseudomonas aerogenosa (26.22%) and other bacteria. Most of the organisms which were isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that could promote a more rational use of antibiotics.

Variations In Social Determinants Of Self-Rated Health And Self-Reported Illness

PAUL A. BOURNE*

Background There are extensive empirical studies which have examined the social and/or medical determinants of the health status, but none have evaluated whether those determinants vary by the definitions of health.Aims: This research seeks to elucidate the social determinants of health, based on the definition of health and the dichotomization of health, in order to establish whether variations exist in the social determinants, based on the definition and the measurement of health, as well as the correlation between the determinants.Design and setting: By using a representative probability sampling dataset, 2007 Jamaica Survey of Living Conditions, of some 6,782 respondents, and logistic regression analyses, the determinants of health were examined in these subjects.Methods and measure: Self-rated health was a five-point ordinal scale (very poor; poor; moderate; good; very good health) measure. It was dichotomized as good-to-very good health status, and moderate-to-very good health, and not reporting an illness, to measure health to explore the effect and the determinants of each definition of health.Results: When health was measured and the cut-off was good-to-very good, eight variables emerged as statistically significant factors of the self-rated health status of Jamaicans (Model, χ2 = 1187.67, P < 0.0001; -2 Log likelihood = 3374.2, R2 = 0.367). By using a cut-off of moderate-to-very good health, six variables emerged as statistically significant factors of the self-rated health status of Jamaicans. The health status was dichotomized as moderate-to-very good self-rated health and very poor-to-poor health (Model, χ2 = 498.41, P < 0.0001; -2 Log likelihood = 1491.30, R2 = 0.295). However, when self-reported illness was used to measure health, six factors emerged from a listing of social variables as explanations of self-rated health (using not reporting an illness) (Model, χ2 = 2012.57, P < 0.0001; -2 Log likelihood = 1726.05, R2 = 0.641).Conclusion: With the importance of correct information in policy making, health assessment and health modifications, the current findings provide pertinent materials that can be used by researchers and other health professionals to make correct conclusions, the choice of the dichotomization of health and the fact that the social determinants of health vary across the different subgroups of measure and the definitions of health. Key words: Social determinants, self-rated health status, self-reported illness, dichotomization of self-rated health status

Awareness Of Clinical Trials Among University Pharmacy Students – A Questionnaire Survey

Background There is an increasing trend to undertake clinical trials in India from the past one decade, but its awareness has not reached to the maximum among the health care professionals and pharmacists in particular. The present study was aimed to evaluate the general awareness of the clinical trials among pharmacy undergraduates and postgraduates. To ascertain their interest to be involved in clinical trials and research studies in the present and future scenarios and to evaluate the various barriers in the way of conducting clinical trials from their perspective. Materials and methods This was a questionnaire based study which was conducted among the University Pharmacy students. The respondents were enrolled after explaining to them the aims and objectives of the study and their willingness was checked before their participation in the study. The basic demographic information and qualitative statements were noted. Results A total of 102 students participated in the study. A majority of the students had a very poor concept regarding the designing of the study, the sponsors, the role of DCGI, protocol writing/ IRB /ethics committee (60- 80%), etc. However, they scored on an average scale in knowing the basic concepts of clinical trials, preclinical testing, adverse events (30-40%), etc. Conclusion Increasing boom in clinical research opens a door for more job opportunities and advanced research; hence, it is mandatory to educate the students at the grass root level about this advanced branch in itself. From this study, we conclude that the awareness about clinical trials and research in pharmacy students stands at an average. These major pitfalls could be improved by conducting many workshops, CMEs, panel discussions and symposiums at the college level itself.

Seroepidemiology Of Hepatitis B Virus Infection Diagnosed At A Teaching Hospital In Western Nepal: A Prospective Study

EASOW J M*, SHANKAR P R**, TULADHAR R***, SINGH Y I****

Background Hepatitis B virus (HBV) infection is a major problem in developing countries and a major cause of jaundice in Nepal. Hepatitis B surface antigen (HBsAg) is the first serological hallmark of HBV infection. In a study of the Nepalese male population, inhabiting various districts, HBsAg was found to be positive in 4% of the population. The prevalence of HBV infection among patients attending the Manipal Teaching Hospital, a major healthcare provider in the western region of Nepal, has not been studied. Hence, the present study was carried out to determine the prevalence of HBV infection in patients attending the hospital and to assess the associated risk factors. Method The study was carried out during the period from 15th March 2004 to 15th September 2005. Serum samples requisitioned for the investigation of HBsAg from the wards and the Out Patient Departments to the Department of Microbiology were included. The demographic and clinical details of the patients who tested positive for HBsAg, was obtained through a semi structured questionnaire, as well as from their medical records. The results were analyzed according to their demographic characteristics. Results 288 serum samples were included; 215 samples (74.6%) were from males. Inpatients accounted for 195 specimens (67.7%). Thirty-six (12.5%) samples were positive. The seroprevalence of HBsAg was higher among males, individuals from Kaski district where the hospital is located and ex-army and businessmen respondents. A majority of the positive individuals were males from Kaski district, students, ex-army men, agriculturists or housewives belonging to the 21 to 30, 41-50 or the 31-40 year age groups. High risk sexual behaviour was elicited in two individuals, intravenous drug abuse in two and a history of blood transfusion and dental manipulation in one each, while one person had shared razors with an infected person. Conclusion The frequency of seropositivity among individuals who were referred for HBsAg testing was high. Various factors could have influenced the results. Further studies are required to assess the seroprevalence among all the patients attending the hospital OPD and admitted in the wards.

The Efficacy And The Safety Of A Fixed Dose Combination Of Amlodipine And Atorvastatin In Hypertensives With Dyslipidaemia

MUKTA N C*, PRABHA A**, ASHOK S K***, NITHYANANDA C K****

Introduction:It was claimed that the amlodipine/atorvastatin combination improved the patient’s achievement of national-guideline-recommended blood pressure and lipid target levels and exhibited a safety profile consistent with its parent compounds. The present study has been undertaken to evaluate the efficacy and the safety of a fixed dose combination of amlodipine with atorvastatin in the Indian population. Methods: The study was designed as a prospective, open labeled, noncomparative trial in 35 adult patients of mild to moderate essential hypertension with dyslipidaemia. The blood pressure criteria for inclusion was >140/90mmHg and less than 180/110mmHg. The dyslipidaemia criteria was LDL cholesterol>130mg/dl and triglycerides more than 150mg/dl. The patients were screened at baseline visit (Day 0) and at visit 2 (Day 4). The supine blood pressure was recorded by taking the mean of three readings. The blood pressure was measured again after a week during the placebo period (visit 3, day 10, week 1). The active medication (Combination of 5mg of amlodipine and 10mg of atorvastatin) started at visit 4 (day 17, week 2). The blood pressure was measured again during visit 5 (day 31, week 4), visit 6 (day 45, week 6) and visit 7 (day 60, week 8) by using the same instrument at all visits. Results: A total of 35 patients were included in the study, out of which 27 were males and eight were females. The average decrease of supine blood pressure from the baseline recording was 10.3+ 3.62mmHg at the end of treatment, which was statistically highly significant (p=0.005). The average decrease of diastolic blood pressure was 9.51+2.13mmHg at the end of the treatment, which was also statistically highly significant (p=0.0002). A statistically significant decrease in the levels of total cholesterol and LDL cholesterol were observed during the treatment. The most common adverse events were hyponatraemia (25.93%), head ache (22.22%) and hypoglycaemia (22.22%). Conclusion: To conclude, the concomitant administration of amlodipine and atorvastatin is well tolerated and effective in reducing both blood pressure and lipid levels and in helping patients achieve their goals in cases of hypertension and dyslipidaemia. Key words: Amlodipine, atorvastatin, hypertension, dyslipidaemia.

Glycosylated Haemoglobin In Non- Diabetic End-Stage Renal Disease Patients Undergoing Haemodialysis

SANGEETA K*, LAL A K**, GULSHAN M***

Background: Glycosylated haemoglobin is widely used as a measure for glycaemic control in patients with diabetes mellitus. The significance of the increased levels of glycosylated haemoglobin in non-diabetic patients with end-stage renal disease, receiving maintenance haemodialysis remains unclear at the present time. It is known that the attainment of glycaemic control is important in these patients. Objectives: In this study, an attempt has been made to study glycosylated haemoglobin levels, which may serve as a reliable indicator of integrated glycaemia in these patients. Material and Methods: We enrolled 65 non-diabetic end-stage renal disease patients who received haemodialysis and 30 non-diabetic patients without end-stage renal disease for this study. Glycosylated haemoglobin was analysed by a turbidimetric immunoassay by using a Synchron CX system in order to avoid assay interference from uraemia and anaemia in end-stage renal disease patients. Results: We found that the average glycosylated haemoglobin levels in non-diabetic end - stage renal disease patients on haemodialysis was 5.23% +1.16 and that in the control group was 4.56% + 0.52 (p < 0.001). There was no significant difference in the random blood glucose levels between the two groups. Our data indicated that glycosylated haemoglobin levels are elevated in non - diabetic end-stage renal disease patients undergoing haemodialysis. Conclusions: We conclude that the elevation in glycosylated haemoglobin level cannot be solely explained by glucose reabsorption from the dialysates and that it reflects true glucose intolerance, which is consistent with increased cardiovascular risk in such patients. Moreover, correlations between glycosylated haemoglobin and the duration of dialysis and the lipid profile of the patient were made, thus indicating the cumulative effect of these factors in regulating the glycaemic status of such patients. Cardiac risk ratio (TC / HDLc) and Freidwald’s ratio (LDLc / HDLc ), the indicators of coronary heart disease ( CHD), were also computed . It was found that these ratios varied significantly with the increase in HbA1c levels in ESRD patients.

The prevalence of HIV–2 seropositivity in blood donors

SONTH S B, SOLABANNAVAR S S, BARAGUNDI M C, PATIL C S

Blood transfusion has been the transmission mechanism in 15% of all the HIV infections. The HIV pandemic brought into focus the importance of a safe blood donor pool. In India, the HIV-2 epidemic occurs along with HIV-1. The analysis of HIV-2 screening was carried out in a tertiary care hospital among all the blood donors (2005-2009). Among 43130 blood donors, 350 (0.81%) were positive for HIV infection from which 304 (0.704%) were positive for HIV-1 and 46 (0.106%) were positive for the HIV-2 infection. We are showing here, the infection rate of HIV-2 among blood donors and the importance of promoting voluntary blood donations to ensure that the donors are free from transfusion transmissible infections like HBV, HCV, HIV-1 and 2 and Syphilis.

Branching Pattern Of External Carotid Artery In Human Cadavers

SANJEEV I K*, ANITA H**, ASHWINI M*, MAHESH U*, RAIRAM G B*

Background: The rich vascularity of most parts of the head and neck is mainly maintained by the external carotid artery through its branches. Like other great vessels of the neck, the external carotid artery and its branches have numerous variations. These variations pose a dangerous situation during various neck surgeries. Aim: To study the branching pattern of external carotid artery in human cadavers. Methods: The present cross-sectional study was undertaken to assess the branching pattern of the external carotid artery in 37 formalin-preserved head and neck specimens by detailed dissection method. Results: The level of termination of the common carotid and the origin of the branches of the external carotid arteries were found to be variable significantly. The anterior branches of the external carotid arose separately only in 56.76% of the cases and in the remaining, they shared common trunks between themselves. In 35.14% of the cases, the superior thyroid artery was found to arise from the common carotid. The posterior branches were found to share common trunks between themselves in 27% of the cases. The point of origin of the branches from the external carotid artery was also found to be variable. The trunk between the occipital and the ascending pharyngeal arteries was the commonest, the next common to it was the linguofacial trunk and the least common was the thyrolingual trunk. Conclusion: It can be concluded that these vessels show great variability and hence, a better anatomical knowledge about the vessels and their variations is essential in head and neck surgeries and also during the interpretation of angiograms by the radiologist.

Aortic Arch And Variations In Its Branching Pattern

INDUMATHI S*, SUDHA S**, HANNAH SUGIRTHABAI RAJILA R**

Background: The relationship of the arch of the aorta and its branches are embryologically determined and are found to be highly variable. This makes the arch of the aorta more vulnerable to injury during the surgical manipulation of the heart, lungs and the great vessels. The arch anomalies produce tracheo-oesophageal constriction, which accounts for 1%-2% of all congenital heart defects. The present study was undertaken to study the variations in the branching pattern of the arch of the aorta in the South Indian population and their surgical applications. Aim: An extensive analysis of the arch of the aorta, which is surgically important, was done under the following headings such as origin, whether it is a left or right-sided aortic arch, the normal branching pattern of the aortic arch and variations in the branching pattern of the aortic arch. Methods: The study material included 75 specimens consisting of 16 dissection room cadavers, 34 post - mortem en - bloc specimens and 25 patients who underwent angiograms. The study was carried out by using the conventional dissection method and angiograms. The radio graphical imaging of the arch of the aorta and its branches were obtained by the Angiogram, which combines the use of cineangiocardiography and aortography. Results: The left aortic arch was found in 73 specimens (97.3%) and the right aortic arch in 2 specimens (2.67%). The normal branching pattern was present in 41 male specimens (89.1%) and in 24 female specimens (88.8%). The common origin for both the brachiocephalic and the left common carotid artery was present in 4 specimens (5.48%). 6.52% male specimens and 3.7% female specimens showed this variation. For the left vertebral artery arising from the aortic arch between the left common carotid and the left subclavian artery, 2.17% out of 46 male specimens and 7.4% out of 27 female specimens showed this variation. This type of variation was present in 4.1%. 73 specimens that had left aortic arch werevtaken and studied for right vertebral artery arising as fourth branch from the aortic arch. 1.36% showed this type of variation. Conclusion:From the results of our present study, we conclude that no specific south Indian variation beyond the limits of average fluctuation was noted and also, the variations are not only clinically important, but are also clinically important to both the patient as well as the operating surgeons.

Plasma Protein Thiols, Malondialdehyde, Phosphodiesterase and RBC Acetylcholinesterase in Patients with Intrauterine Growth Restriction

*PRABHU K, #KUMAR P, °BHAT P, *RAO A, *MOHAN S, *SHARMA S

Introduction: Intrauterine growth restriction (IUGR) is a term which is used to describe a condition in which the foetus is smaller than expected, for the number of weeks of pregnancy. One of the main reasons for this condition is that the foetus is not receiving the necessary nutrients, blood and oxygen which are needed for the growth and development of its organs and tissues. Nitric oxide (NO) which acts through cyclic GMP (cGMP), plays an important role in the pathophysiology of the vascular system. So, phosphodiesterase (PDE) activity may play a role in pre-eclampsia and endothelial dysfunction. Another compound that maintains the vascular tone is acetylcholine (Ach). It exerts its effect at neuromuscular junctions and is involved with muscle contraction. The oxidant status of the cell modulates angiogenesis, which is critical for embryonic growth. Aim: To estimate plasma phosphodiesterase, protein thiols, malondialdehyde (MDA) and RBC acetylcholinesterase (AchE) in normal pregnant women who were in their 28-36th weeks of gestation and to compare their respective levels of these parameters in pregnant women who were diagnosed with IUGR in the same time period of their gestation. Results and Discussion: We found a significant decrease in PDE (p < 0.05) and a marginal decrease in AchE activities in patients with IUGR as compared to the controls. Both protein thiols and MDA were found to be marginally elevated in IUGR patients, thus indicating an increased turnover of Reactive Oxygen Species (ROS). Our study shows that the pathophysiology of IUGR is multifactorial and a large scale study in this matter is required to further substantiate our findings. Key Messages:The foetoplacental circulation plays a key role in the growth and the development of the foetus. Both acetylcholinesterase and phosphodiesterase may play key roles in the growth and development of a foetus. If a definitive marker can be found in this regard, it will be of immense help to mankind. Any attempt to find such markers is worth rewarding.

Perception Of Academic Pharmacists Regarding Their Career Growth: A Qualitative Case Study From Pakistan

Background and Objective Academic pharmacists are involved in the teaching and training of future pharmacy practitioners and occupy key positions in research related to drug discovery, pharmacy practice and as well as therapeutic outcome in patients. This study is tried to explore the prominent factors that influences the choice to be an academic among pharmacists as well as their career growth in academia. Method A semi-structured interview guide was used as an instrument raising questions to join academics, possible opportunities and hindrances in career growth and job turnover intentions. Results Mixed factors like second career choice, passion, and challenging nature of the profession were stated as reasons to join academic pharmacy. Research and salary structure were cited as opportunities for career growth by junior academic pharmacists although they joined academics simply to earn postgraduate qualifications. Irrespective of professional experience all the academic pharmacists stated lack of authority and power in taking decisions. Conversely, senior academic pharmacists showed no job turnover intentions but cited salary as major obstacle in their career growth Conclusion Factors like second career choice due to personal reasons and challenging nature of the profession were cited as main reasons to join academia. Although junior faculty joined academics for short-term but they viewed salary and research as opportunities for career growth. A revision of salary structure with additional perks and freedom to work will benefit the institute in terms of more productivity and stimulate faculty retention.

Does The Pharmacological Management Of Unstable Angina Vary With Age And Gender – A Descriptive Study

BANERJEE S*, KUMAR V*, RAMACHANDRAN P#, KAMATH A*

Purpose Observational registries have shown the underutilization of evidence based therapies in women and elderly patients. While the burden of unstable angina is high in India, there is minimal data on the drug utilization patterns. Also, gender and age differences in the treatment have not been assessed. This study intends to present the data on drug utilization in the management of unstable angina in a tertiary care hospital and to detect the presence of significant gender or age related differences in the treatment. Method The case record files of all patients who were admitted with unstable angina during January 2006 to December 2008 were studied. The demographical details, comorbidities, the duration of the hospital stay, outcomes and the drugsadministered within 24 hours of admission and at discharge for each case was obtained. Results Of the 318 patients, 63.2% were males and 55.7% were less than 65 years of age. The mean (± SD) age of the males was 60.64 (± 11.71) years as compared to the mean age of 64.21 (± 9.98) years in females (p=0.006). The overall mortality was 1.89 %. There was an underutilization of aspirin and betablockers in the elderly, while antiplatelet agents and anigotensin converting enzyme inhibitors were used to a lesser extent in females. The prescription rate of statins was high. Conclusion There was an underutilization of drugs in the elderly and in female patients. The results are similar to the data reported from previous studies. The diagnosis and management of unstable angina poses a difficult challenge because these subgroups quite often present with atypical symptoms and have less extensive coronary artery disease.

Persistent Hyperinsulinemic Hypoglycemia Of Infancy: A Case Report

BHAKHRI B K, ARYA S, DEBATA P K, CHELLANI H

Hypoglycaemia in newborns is usually a transient metabolic event. Hyperinsulinaemic hypoglycaemia is an important cause of nonketotic hypoglycaemia and it is characterized by macrosomia and hypoglycaemia with potential short and long term complications, if not properly managed with available medical and surgical options. We are presenting a neonate with this condition, who was managed in our unit and who underwent pancreactomy to control hypoglycaemia.

An Uncommon Occurrence Of Acute Myeloid Leukemia In Tabriz

Seifi S*, Asvadi Kermani A**, Asvadi Kermani I***, Dolatkhah R****

Acute Myeloid Leukemia accounts about 80% of adult acute leukemias, that presents as de novo or following MDS. It shows typical clinical and cytological pattern of presentation, Hepatosplenomegaly presents in one third of the cases and Lymphadenopathy, extramedullary involvement are rarely seen. We tried to report an uncommon occurrence of AML in a 21 y/o female who admitted in Rheumatology service as a spondylitis. She experienced low back pain , anorexia , sever weight loss , fever, tenderness of lumbar spines and head of left humorous accumpanied with limited left shoulder girdle movements, and hematocytologic and pathologic challenges were not clear enough for specific diagnosis. The clinical and paraclinical findings of the case looked uncommon for de novo leukemia or MDS-AML. Even thought there were so many questions left without clear answer but the diagnosis of Acute Myeloid Leukemia confirmed histopathologically.

Clinical, Imaging And Pathological Features Of Infected Atypical Rathke’s Cleft Cyst With Secondary Pituitary Abscess Formation

AZAD R*, AZAD S**, AHMAD A***, ARORA P****

Infected atypical Rathke’s cleft cyst (RCC) is a rare cause of secondary pituitary abscess. A thirty year old afebrile female presented with a two year history of diabetes insipidus with loss of vision in the left eye over a period of one month. Brain imaging showed a large heterogenous sellar and suprasellar mass with left parasellar extension. The lesion demonstrated a thick, partially calcified wall and a central cystic component with an intracystic nodule. Craniopharyngioma was considered as a likely possibility due to lack of awareness of the imaging features of atypical RCC. However, the typical pattern of calcification and the MR signal intensity of the intracystic nodules can provide valuable clues to differentiate this uncommon lesion from craniopharyngioma and can guide the further clinical and operative management.

Inflammatory fibroid polyp of small intestine: Report of two cases with review of literature

Singhal M,* Singh P,** Misra V,*** Dhingra V,**** Bhatia R*****

Inflammatory fibroid polyps (IFPs) can occur throughout the gastrointestinal tract. Previous reports indicate that the stomach is the site of predilection, followed by the small intestine. IFPs usually are solitary lesions and affect all age groups, though adults are mainly affected. The presenting signs and symptoms vary according to the anatomical site. They appear grossly as localized submucosal sessile polypoidal masses. Microscopy reveals spindle-shaped cells, prominent capillaries and an inflammatory cell infiltrate. The lesions are benign, with unknown pathogenesis. We report here, two cases of inflammatory fibroid polyps leading to intussusceptions.

Cytological Diagnosis In A Case Of Histoid Leprosy

CHUFAL S S*, MANNAN R**, SINGH M***, YADAV S****

Histoid leprosy, a variant of lepromatous Leprosy, usually develops due to resistance to dapsone monotherapy. It also can arise denovo. The clinical presentation of Histoid leprosy can mimic other inflammatory and some neoplastic conditions, especially if it arises denovo. FNA cytology can be performed as an outdoor procedure and can provide a quick and reliable diagnosis in such cases. A 35 year old male presented with multiple nodules all over the body. There was no previous history of Leprosy or antileprotic treatment. The clinical differential diagnoses were Post Kala azar dermal Lehishmaniasis (PKDL), Histoid Hansen’s leprosy and Cutaneous metastasis. FNA with a 23G needle showed numerous histiocytes which were filled with intracellular and extracellular negative bacillary images. These bacilli were arranged parallel to each other rather than in a random manner, which differentiated it from Atypical mycobacterial cutaneous infection, although a rare condition, without the aid of special stains and other ancillary investigations. Ziehl Neelsen’s staining for acid fast bacilli was positive. The arrangement of the negative bacillary images was important in distinguishing it from Atypical Mycobacterial infection, as FNA smears can be similar in both the cases and the treatment for both the entities is different. Subsequent histopathology confirmed the diagnosis and the patient responded to the treatment.

Primary Fibrosarcoma Of Kidney- A Rare Case

SOUMIT D*, ROHINI B**, SANJAY M***, VATSALA M****

Primary Fibrosarcoma of the kidney is a very rare tumour.[1,2] We report here, a case of a 55 year old man, presenting with a gradually progressive left loin swelling and weakness.

Subhyaloid Haemorrhage In Severe Dimorphic Anaemia And Thrombocytopaenia – A Case Report

VIDYA H*, NEELAM P**, ANUPAMA B***, SOWMYA P D****

We report here, a case of a 15 year old girl who presented with the complaint of reddish discolouration of vision in the left eye. This was ascertained to be due to a subhyaloid haemorrhage in the macular area. Haematological investigations and confirmatory bone marrow biopsy revealed severe dimorphic anaemia with thrombocytopaenia. Following blood transfusion under the physician’s supervision, the subhyaloid haemorrhage showed signs of resolution and there was improvement in the vision. This case report highlights the role of routine fundoscopy in all cases of anaemia, especially as retinal findings may be present with or without visual impairment.

Epidermolysis Bullosa Simplex

RAMESH B Y*

Epidermolysis bullosa (EB) is a rare group of inherited skin disorders that manifests as blistering of the skin in the varying degrees of severity. The severity can range from a mild, localized disease to a generalized, devastating process. The three major types of EB include simplex, junctional and dystrophic epidermolysis bullosa. EB simplex (EBS) is the most common and dominantly inherited disease. In EBS, the blisters are usually present at birth or appear during the neonatal period (1),(2). Secondary infection is the primary complication. A newborn with extensive blistering of the skin, minimal oral lesions and secondary infection with a staphylococcus is described.

Case Report: Dieulafoy Lesion

CHIDAMBARANATH R*,

Introduction: Dieulafoy lesion (DL) is one of the rare causes of upper GI bleeding, less often diagnosed. We had an elderly female patient with haematemesis which turned out to be unusual, the case details are presented here. There were very few female patients in this hospital with haematemesis in the over 40 age group, out of which most were duodenal ulcer bleed or those from carcinoma stomach. This is only the second case in the author’s experience. Case history: This is a 55 yr old female patient who presented with progressive haematemesis, initially controlled by adrenaline injection, but later, due to continued bleeding was subjected to surgery, and made a full recovery. Conclusion: Dieulafoy lesion is less often suspected. Adrenaline injection or other Endoscopic modes of sclerotherapy are usually useful in control of bleeding. It also needs to be differentiated by endoscopy or by biopsy, from other forms of benign non-epithelial vascular lesions of the stomach, primarily, angiodysplasis.

Chronic Thromboembolic Pulmonary Artery Hypertension With Deep Vein Thrombosis Due To Protein S Deficiency

CHOWTA NITHYANANDA K*, ARUN S**, BIPIN P***, FAZIL A****

A 30 year old male presented with the complaint of progressive dyspnoea. Cardiovascular examination showed tachycardia and loud second sound in the pulmonary area. ECG showed T wave inversion in lead III and chest X-ray showed dilatation of the pulmonary artery. Echocardiography showed mildly dilated right atrium/right ventricle, mild tricuspid regurgitation and moderate pulmonary arterial hypertension. Venous Doppler of the bilateral lower limbs showed deep vein thrombosis of both the lower limbs. HRCT (high resolution CT) showed pleural thickening in the apical segment of the left upper lobe and scattered ground glass attenuation in the apical basal segment of both the lower lobes, which were suggestive of thromboembolism. CECT (contrast enhanced CT) of chest showed pulmonary artery thrombosis of the left lower lobe segmental and interlobar artery. Protein S activity was 25 %( normal range: 77-143%), protein C activity was 82 %( normal range: 70-130%) and antithrombin III was 119(normal range: 80-120).

Primary Bilateral Ovarian Non-Hodgkin’s Lymphoma: A Case Report

DEEPTI A*, SANGEETA S**, RANI B***, SHIKHA S****

Malignant lymphoma has been known to involve the ovaries secondarily, in later stages of disseminated nodal disease. Lymphoma presenting with ovarian mass as an initial manifestation is a rare entity, accounting for 0.5% of Non Hodgkin’s lymphomas and 1.5% of all ovarian tumors. We report here, a case of primary bilateral ovarian B-cell type non Hodgkin´s lymphoma with ascitis in a 30 year old female, without any obvious lymphadenopathy. The post-surgery patient refused further work-up and treatment and expired after 4 months.

Inverted Papilloma Of The Nose -A Case Report

VEERESH M*, MAHESH K B**, NANDAKUMAR H***, MANSI P****

Inverted papilloma is a lesion of the mucosal membrane of the nasal cavity and the paranasal sinuses. It is a rare tumour occurring in approximately 0.5% of all the nasal tumours and represents 4% of all the nasal polyps. Here, we are reporting a case of inverted papilloma of the right nasal cavity. The aetiology and clinical and histological features and the treatment with the review are discussed.

Choroidal detachment in an elderly patient treated post operatively with topical dorzolamide and timolol combination

ANUPAMA B,PUTHRAN N,HEGDE V

We report here, a case of choroidal detachment in a 76 year old man who underwent right eye cataract surgery. He was being treated for bilateral Primary open angle glaucoma in the postoperative period with a combination of timolol and dorzolamide, as the intraocular pressure remained poorly controlled with timolol. He developed choroidal detachment with the use of the Dorzolamide and timolol combination. This case highlights the fact that antiglaucoma medication in a previously operated eye causes higher risk for the development of choroidal detachment, especially in elderly patients.

Fixed Dose Combination Antimicrobials Practices In Nepal – Review Of Literature

Kadir Alam1,2,3, Arjun Poudel1,4, Subish Palaian 1,2,4

Antibacterial drugs are one used commonly as fixed dose combination. The use of fixed dose combination antimicrobials is more common in developing countries. There are several studies which suggest extensive use of fixed dose combination antimicrobials drugs in Nepal. Although thousands of fixed dose combination are available in world market, WHO has approved only 25 fixed dose combination in 15th edition of WHO essential drug list. Even if some of the fixed dose antimicrobial offer some benefit in treatment of disease like Tuberculosis, Leprosy etc., majority of irrational fixed dose antimicrobials has major contribution in resistance development, decrease the flexibility of prescriber and increase the misuse by self-medication. To minimize the extensive use of fixed dose combination of antimicrobials certain measure like developing guideline for preparing of combination product, evaluation of product before registration, banning of irrational IFDC antimicrobials, strict monitoring, strict antibiotic policy, hospital antibiotic policy etc., will be helpful. In the developing world where resistance to antimicrobials is increasing, minimizing the use of irrational fixed dose combination antimicrobials can be better tool to combat with the resistance.

Problem-based learning: A Review

SHANKAR P R*

Problem-based learning (PBL) uses patient problems as a context for students to learn problem-solving skills and acquire knowledge about basic and clinical sciences. PBL is based on the principles of adult learning. PBL takes place in small groups and learning depends on the effectiveness of the small group process. There is lack of agreement on what constitutes PBL. PBL is active, adult-oriented, problem-centred, student centred, collaborative, integrated and interdisciplinary and it operates in a clinical context. There are a number of advantages of PBL. However, PBL is demanding in terms of time, teaching materials and physical resources. A PBL facilitator should be comfortable with relinquishing authority and exerting indirect control. According to some authors, Asian cultures have an authoritarian student-teacher relationship. There is a high degree of acceptance of authority and knowledge is seen as something which is transmitted by the teacher. However, most Asian schools and students seem to be positive about adapting to PBL. The effectiveness of PBL is being seriously studied. Newer learning approaches are also under development.

Mandibular Guide Flange Prosthesis Following Mandibular Resection: A Clinical Report

SHAILENDRA KUMAR SAHU*

Loss of the continuity of the mandible destroys the balance and the symmetry of mandibular function, leading to altered mandibular movements and deviation of the residual fragment towards the surgical side. This clinical report gives a brief review of resection guidance prosthesis and describes the fabrication of an acrylic guidance flange prosthesis. Successful intercuspal position was accomplished through the use of the guidance appliance, combined with physiotherapy in a patient who underwent a hemisection of the mandible, subsequent to treatment for an ameloblastoma.

A Holistic Approach To The Management Of A Fractured Tooth Fragment- A Case Report

MUNISH S*

Anterior crown fractures are a common form of traumatic dental injuries that mainly affect the maxillary central incisors in children and teenagers.(1) Traumatic injuries of the teeth involve varying degrees of damage to the supporting soft tissues, or the teeth itself. In the pre-adhesive era, fractured teeth needed to be restored either with pin retained inlays or cast restorations that sacrificed the healthy tooth structure and were a challenge for clinicians to match with the adjacent teeth.(3) With the advent of adhesive dentistry, the process of fragment reattachment has become simplified and more reliable. This study reports a case of fragment reattachment of the maxillary right central incisor.

Maxillary Osteomyelitis Secondary To Osteopetrosis – A Rare Case Report

AMBIKA G*,SHIKHA K**, PREMDEEP G***, VIRENDRA S****

Osteomyelitis of the mandible at a young age may occur as a complication of immunocompromised status or bone disorders. Osteomyelitis rarely occurs in the maxilla due to thin bone and collateral blood supply of the maxillary bone. We report here, a rare case of maxillary osteomyelitis that led to the diagnosis of the underlying condition of osteopetrosis. The clinical and radiographical features are being discussed here, along with the relevant review of literature.

Multiple Impacted Permanent and Supernumerary Teeth: A Case Report

AJAY PARIHAR*, RAM KISHORE R**, VILAS N***, MADHU R****

Supernumerary teeth are an important cause of dental retention. Multiple supernumerary teeth without a syndrome are rare. Most of such cases are found in association with syndromes such as Gardner's syndrome, cleidocranial dysostosis and cleft lip and palate. It has been reported that the prevalence for non-syndrome multiple supernumerary teeth is less than 1%.We describe here, a case of a 24 year old patient presenting with thirty four impacted permanent and supernumerary teeth, which is a unique presentation in the absence of any syndrome.

“Tissue Engineering” – Future Concepts In Endodontics – A Short Overview

ANILKUMAR K*, GEETHA A**

Dental caries result in the loss of the tooth structure. Therefore, the regeneration of enamel, cementum and the dentin-pulp complex is the long term goal of restorative and endodontic treatment. There is a high rate of success in the retention of teeth by endodontic therapy. The current treatment modalities consist of regenerative based approaches by the application of tissue engineering in which the diseased or necrotic pulp tissues are removed and replaced with healthy pulp tissue to revitalize the teeth. The purpose of this article is to review the components and the biological principles of tissue engineering, it is an overview of regenerative endodontics and its goals and it describes the possible techniques that will allow regenerative endodontics to become a reality.

Intentional Replantation: A Measure to Save the Natural Tooth

RAJIV B*, SUNANDAN M**, RAMTA B***, DILPREET K****

Context:- Intentional replantation is the intentional removal (extraction) and replantation of the same tooth. This technique can be useful for teeth that cannot be treated with conventional endodontic therapy or surgery. Aim:- To save the natural tooth with intentional replantation Material and methods:- A female patient reported of pain with 46. A failed root canal attempt # 46 had been made, with the calcified root canals being assessed radiographically. The tooth was carefully extracted with no intra-operative complications. The root end cavities were prepared with the inverted cone bur and were filled with MTA. The tooth was rinsed in sterile saline and was replanted back into its socket. Result:- Intentional replantation can be particularly helpful in the lower first and the second molars where the proximity to the mandibular nerve and the thickness of the buccal bone make endodontic surgery difficult.

Retrieval of an Unusual Foreign Object with the Help of a Magnet: A Case Report

MITTAL S*, BANSAL R**, KUMAR T***, KAUR D****

The patient may accidentally leave certain metallic objects (pins, nails, stapler pins) into the root canal. Retrieval of these intracanal obstructions may be difficult but is essential for non-surgical treatment.Aim: to retrieve the foreign object in the canal by non- surgical approach. Material and methods: 18 year male patient reported of pain with #36 tooth. The radiograph revealed a metallic pin in the distal canal. Access was gained and canal orifices were located. Pin removal was attempted with H file but to no avail. Pin was loose in the canal, so a magnet was placed over the orifice of the distal canal and due to the magnetic pull, the instrument was retrieved.

Evaluation Of The Antidiarrhoeal Activity Of The Leaves Of Ixora Coccinea Linn. In Rats

YASMEEN M*, PRABHU B**, AGASHIKAR N V***

Purpose:Ixora coccinea Linn (Rubiaceae), a small shrub which is cultivated throughout India, has been reported to possess a number of medicinal properties. The purpose of the present study was to evaluate the antidiarrhoeal activity of the aqueous extract of the leaves of Ixora coccinea linn which is used traditionally as folk medicine by using a castor oil induced diarrhoea model. Methods: The aqueous extract of the leaves of Ixora coccinea were studied against a castor oil induced diarrhoea model in rats. The gastrointestinal transit rate was expressed as the percentage of the longest distance which was traversed by the charcoal, divided by the total length of the small intestine. The weight and the volume of the intestinal content induced by castor oil were studied by the enteropooling method. Loperamide was used as a positive control. Result: The plant-extract showed significant (P<0.001) inhibitor activity against castor oil induced diarrhoea and castor oil induced enteropooling in rats at the dose of 400 mg/kg. There was significant reduction in gastrointestinal motility by the charcoal meal test in rats. Conclusion: The results obtained by this study substantiate the antidiarrhoeal effects of the aqueous extract and its use by the traditional practitioners in the treatment of diarrhoea.

Auto Fluorescence And Fourier Transform – Infra Red (FTIR) Spectral Investigation On Di Ethyl Nitrosamine (DEN) Induced Hepatocellular Carcinoma, Treated With Pericarp Extract Of Garcinia Mangostana Linn In Rats

The aim of the present study was to analyze the tumour activity of diethyl nitrosamine (DEN); a chemical carcinogen which induced hepatocellular carcinoma in the liver tissue samples of male albino rats. The analysis has been carried out in the following conditions; normal, tumour induced and tumour treated liver tissue samples. In all these cases, the action of the diethyl nitrosamine drug in inducing tumours in the liver has been investigated. Garcinia mangostana pericarp extract was the Ayurvedic drug which was chosen for the treatment of hepatocellular carcinoma. The control liver tissues, those in which tumour formation was induced by using diethyl nitrosamine and those in which the tumour was treated with the Garcinia mangostana pericarp extract after inducing tumor formation were analyzed by using auto fluorescence spectroscopy and fourier transform infra red (FTIR) spectroscopy. The qualitative spectral analysis was done by using auto fluorescence spectroscopy and the quantitative study was carried out by using FTIR spectroscopy. The tissue samples were experimented with auto fluorescence spectroscopy at the excitation wavelengths of 280nm, 325nm and 405nm, which exhibits emission due to tryptophan, collagen and porphyrin, respectively. It was observed that in all the tissue samples, the effect of diethylnitrosamine in inducing tumours was predominant. However, on treating the tumours with the pericarp extract of Garcinia mangostana, they responded positively. FTIR spectra have been recorded in the mid frequency region of 4000 – 450 cm-1 for all the liver tissue samples. The samples were analyzed quantitatively by using intensity ratio calculation among the selected absorption peaks to study the biochemical changes in the tissue samples. From this study, it was found that the total protein content was decreased in the liver tissues after inducing them with diethyl nitrosamine, thus causing the hepato cellular carcinoma. During the recovery phase, the decreased levels of the bio-chemical constituents were restored to near normal levels.

Beneficial Effects Of Inhaled Nitric Oxide On Lung Pathology And Energy Metabolism In A Canine Model Of Smoke Inhalation Injury

Nitric oxide (NO) exhibits positive effects in the treatment of acute lung injury (ALI); angiotensin converting enzyme (ACE) has been indicated as a marker of pulmonary endothelium damage in ALI. We examined the effects of inhaled NO on ACE activity, pulmonary pathology and energy metabolism in a canine model of smoke inhalation injury. Following smoke exposure, 17 dogs were randomly assigned to receive a mixture of NO (45 ppm) and O2 (FiO2=45%) (Treatment group, n=9) or O2 alone (FiO2=45%) (Control group, n=8) for 12 hours. As compared to O2 alone, NO therapy effectively limited the increase in ACE activity and preserved lung ATP level and energy charge. Moreover, NO exerted a protective effect on the extensivemorpho-structural changes which were observed in the dogs who received O2 alone. The present study demonstrates that inhaled NO after smoke inhalation injury may exert beneficial effects that are likely to be due in part to a protective effect on pulmonary endothelium and pulmonary haemodynamics.

Practical Assessment In Pharmacology At A New Nepalese Medical School

SHANKAR PR, GURUNG SB, JHA N, BAJRACHARYA O, ANSARI SR, THAPA HS

Intramedullary Spinal Cord Abscess as a complication of the Dermal Sinus

VIKRAM D*, BALDEEP S**, SUNIL S***, ANJAY P****

Intramedullary Spinal Cord Abscesses secondary to congenital dermal sinus are infrequently seen in paediatric age group. The thoracic spinal cord is most often involved. Although rare, yet treatable, it is imperative that we have knowledge of its existence because misjudgement and delay in necessary treatment may lead to complete paralysis below the lesion. We present a similar case of a 5 year old girl.