Journal of clinical and diagnostic research

The study of Iran-Iraq war Victim Ear Finding in Golestan Province(Gorgan-IRAN)

TAZIKEI M H *, BEHNAMPOUR N**, MANSOURIAN A R***

Background and aim: Ear as vestibule auditory system can be damaged by many cases. The Army personals whom are exposed to many traumas, ear can also be traumatized. Many of injuries to ears are irreversible, because of eight years of war in Iran and as far as there is not any study in Golestan Province about such an abnormality, this research was done for the determination of common findings in Golestan province about war victims, ear’s problems. Material and Methods: This is a descriptive cross-sectional study on 256 war victims of Golestan province which were choosen on randomized sampling. Hearing loss tinnitus, othorea, vertigo, tympanic membrane perforation audiologic findings and the type of trauma were considered. B.C over than 15dB considered as hearing loss. Hearing loss were divided in few groups and the questionnaire was filled for all of the sample population. Dates were analyzed by SPSS soft ware and exact Fisher test. Findings:In this study the sample population were exclusively male subjects, 21.5% complained from audiologic problems. 94.6% had hearing loss, 83.6% tinnitus without hearing loss, but there was a hearing loss on the audiologic findings. 80% of hearing loss was bilateral, 10.9% on the Wright and 9.1% on the left side. 89% of hearing loss was sensory neural 88% in high frequency. The intensity in 48.5% of sample population was 15-30dB, 6.4% of them had tympanic membrane perforation only in 3.6% of them othorea, was observed none had complained of vertigo. Discussion: Also there are few years passed from the end of the war but still the hearing abnormality is a common problem among the war victims. Therefore it is necessary to look for manufacturing the sound protective instruments, at the same time proper training are required for those army personals in war front. On the condition where the sounds can cause reversible lesions the health care personal should be ready to look after of those victims. Also the risk factor should be omitted and the remaining hearing in the war victims to be preserved.

An investigation of the Bacterial contamination of ultrasound equipments at a university hospital in Saudi Arabia

MATTAR EH , HAMMAD LF , AHMAD S, EL-KERSH T A

Objective: Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, ultrasound has the potential to be a vector of infection in the Radiology setting. The purpose of the present study was to determine the degree of contamination on ultrasound equipment and gel after routine clinical use and to determine the effectiveness of three different methods of ultrasound probe cleaning for the prevention of nosocomial infections. methods: A total of 444 culture swabs from different parts of the three ultrasound machines and from the gels were taken. All samples were tested in a microbiology laboratory at King Khalid University Hospital, Riyadh, Saudi Arabia, using different culture media. The isolates were identified by using standard techniques. All isolates were subjected to antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion technique on Muller-Hinton agar and commercial antibiotic discs were used for antimicrobial testing. In addition to this, MIC was performed for all isolates according to the Clinical and Laboratory Standards Institute (CLSI) interpretative criteria. Results: The majority of organisms which are found in normal skin and environmental flora were isolated from different parts of the ultrasound machines. The gels were heavily contaminated with opportunistic and potentially pathogenic organisms like Staphylococcus aureus and Enterococcus faecalis. No multi-resistant organisms were identified. There was a significant reduction in the bacterial count after applying either of all the three cleaning methods for the ultrasound probe as compared to the count on the probes before cleaning (p<0.001). However, the soap cleaning method was the most effective one in decreasing the bacterial count to the minimum level in comparison to other two methods (p<0.001). The overall reduction in the pathogenic bacterial count after performing each cleaning method was 46%, 75% and 97% for the paper cleaning, the normal saline and the soap cleaning methods, respectively. Conclusion: The non-invasive ultrasound equipment is a potential vector for nosocomial infection in Radiology patients. Cleaning the ultrasound probe after performing each procedure is a cost-effective practice with a potential for reducing nosocomial infections. The soap cleaning technique is the most effective method for reducing the bacterial count which is acquired due to the patients’ body contact with the ultrasound probes. Further research into the possible strategies to reduce the risk of infection from the ultrasound gels is needed.

Community Associated- Methicillin Resistant Staphylococcus aureus in skin and soft tissue infections.

MANDELIA C*, SHENOY S**,

Introduction Methicillin-Resistant Staphylococcus aureus (MRSA) is well recognized as a major cause of nosocomial infections worldwide. Infections due to MRSA have become increasingly common among healthy members of the community with no other known risk factors for acquiring HA-MRSA infection. They are termed CA-MRSA and differ significantly from HA-MRSA in their virulence and epidemiological properties. In this study, we detected the infections caused by CA-MRSA and studied their anti-biotic sensitivity pattern. Settings and Design : A prospective study which included 60 subjects attending the Surgery OPD with ailments like abscesses, carbuncles, osteomyelitis and skin infections in whom MRSA infection was newly identified in the microbiology laboratory and who fulfilled the inclusion & exclusion criteria for CA-MRSA.. Materials and Methods: The specimens were cultured in the laboratory and identified as Staphylococcus aureus and subsequently, as MRSA using standard methods. Anti-biotic sensitivity pattern of these MRSA was studied using the modified Kirby Bauers disc diffusion method. Antibiotics used were Amoxyclav, Gentamicin, Netilmycin, Erythromycin, Trimethoprim + Sulfamethoxazole, Ciprofloxacin, Clindamycin, Linezolid and Vancomycin. Statistical Analysis was done using SPSS Version 11.5 and association was found by using chi square test. Results: A total of 60 CA-MRSA strains were isolated in Skin and Soft Tissue Infections (SSTIs), these strains were highly susceptible to Vancomycin (100%), Clindamycin (93.3%) and Linezolid (96.7%), moderately susceptible to Gentamicin (75%) and Netilmycin (90%) and a low susceptibility was recorded to Ciprofloxacin (18.3%) and Cotrimoxazole (31.7%), indicating the emergence of resistance to these valuable antibiotics. The results indicate that Vancomycin, Linezolid and Clindamycin, are to be used as ‘Reserve Drugs’ for resistant cases. Conclusion: A high proportion of resistance was found among CA-MRSA isolates. Susceptibility to Gentamicin, Ciprofloxacin and Cotrimoxazole was much lower than what was previously reported. This suggests that, the face of CA-MRSA has changed in both, epidemiological and microbiological features and calls for the formulation of specific treatment guidelines to prevent emergence of resistance to currently used drugs.

Existence of Metallo beta lactamases in carbapenem susceptible gram negative bacilli: a cause for concern

G RENU*, T RAJEEV**, S SMITA**

Background: Metallo-ß-lactamases (MBLs) have been increasingly recognized among imipenem resistant isolates, but they also appear to exist in imipenem susceptible isolates. These undetected hidden MBLs in sensitive isolates can spread unnoticed in hospitals if such isolates are reported susceptible to carbepenem without screening for the presence of MBLs. The laboratory detection of such isolates is crucial as they pose a serious therapeutic challenge. Aims: The aim of our study was to detect MBLs in both the imipenem resistant and sensitive isolates by using combination of available phenotypic methods. Settings and design: This was a hospital based prospective study which was carried out in a tertiary neuropsychiatric centre from April 2008 to April 2009. Methods and Material: A total of 130 gram negative isolates (50 imipenem sensitive, 30 imipenem intermediate and 50 imipenem resistant by the Kirby Bauer disc diffusion method) were tested for the presence of MBLs by the double disk synergy test (imipenem, EDTA 750µg/ml), the combined disk test (imipenem, imipenem + EDTA 750µg/ml) and the MBL E test strip. Statistical analysis: Descriptive statistics was used and the percentages of MBLs carrying imipenem resistant and sensitive isolates were calculated. Results: MBLs were detected in 11 (20%) imipenem sensitive isolates. Out of these 11 imipenem sensitive MBL producing strains, 8 were from the imipenem sensitive category and 3 were from the intermediate category. These 3 isolates in the intermediate category had MIC for imipenem in the sensitive range (MIC ≤4 ug/ml) by E test method. All the MBL carrying imipenem sensitive isolates had zone diameters in between 16 to 22 mm by the Kirby Baeur disc diffusion method. Among the imipenem resistant isolates, 38 isolates were MBL producers (32 from the imipenem resistant category and 6 from the intermediate category). Conclusions: This study reports the existence of MBLs in carbapenem susceptible organisms and proposes that gram negative bacterial isolates having an imipenem zone diameter ≤22mm by the disk diffusion method should be routinely screened for presence of MBLs.

Screening For Asymptomatic Bacteriuria In Pregnancy: An Evaluation Of Various Screening Tests In Hassan District Hospital, India

GAYATHREE L *, SHETTY S**, DESHPANDE S R***, VENKATESHA D T****

Objective: To study the prevalence of asymptomatic bacteriuria (ASB) in pregnant women who attended the Hassan District hospital, Hassan. Method/Design: The group A- study group subjects were 900 pregnant women of any gestational age who attended the Obstetrics Department for antenatal care. The Group B (control group) consisted of 50 non pregnant women of the fertile age group. Midstream clean catch urine was used to screen for asymptomatic bacteriuria. Results: Asymptomatic bacteriuria was prevalent in 6.2% of the 900 women who were evaluated in our study. Urine culture was the gold standard for the detection of asymptomatic bacteriuria. Gram’s stain of uncentrifuged urine was found to be the best among the screening tests which were evaluated. There was a higher prevalence of asymptomatic bacteriuria in the IIIrd trimester (61.77%) than in the IInd trimester (32.35%) and the Ist trimester (5.88%). Conclusions: Screening for asymptomatic bacteriuria in all the three trimesters is necessary to prevent the dangerous complications which are associated with asymptomatic bacteriuria in pregnancy.

Incidence of Japanese Encephalitis in a Tertiary care Centre

Shriyan A *

Background: Arbovirus are responsible for a significant number of viral encephalitis cases worldwide. Japanese Encephalitis virus is a mosquito-borne flavivirus that causes a major epidemic of acute encephalitis in humans throughout Asia (5). Scientific literature unequivocally shows the prevalence of Japanese encephalitis in various parts of India (4). In India, cases have been reported from Tamil nadu , Andra Pradesh , Uttar Pradesh , Bihar , Assam , West Bengal , Karnataka , Goa and Maharashtra (6). In recent years, South India has become endemic for the Japanese Encephalitis Virus. While there are reports from other parts of Karnataka which are on the border of Tamil Nadu and Andhra Pradesh, till date, no data is available from South Karnataka. Aim : The present study was conceived to estimate the incidence and clinical profile of Japanese Encephalitis among the patients which were clinically diagnosed with Viral Encephalitis at a tertiary care centre in South India. Material and Methods: One hundred randomly selected cases of clinically diagnosed Encephalitis who were admitted in K.M.C. , Manipal, were included in the study . In - house MAC ELISA was used to detect specific IgM antibodies in the Cerebrospinal fluid (25,26). Results : Anti- JEVirus IgM antibodies were detected in 8 % cases of clinicallydiagnosed encephalitis who were admitted to the K.M.C. Hospital. The mortality rate of the Japanese Encephalitis cases was 12.5 % . No sequalae was recorded in the Japanese Encephalitis cases who survived in our study.

Metallobetalactamase Producing Pseudomonas Aeruginosa: An Emerging Threat To Clinicians

ATTAL RO, BASAK S, MALLICK S K , BOSE S

In recent years, carbapenem resistance due to the production of metallobetalactamase (MBL) in Pseudomonas aeruginosa and other Gram negative bacilli have been reported worldwide. Metallobetalactamase producing P. aeruginosa constitute nearly 20% of all nosocomial isolates. The present study was undertaken to detect the prevalence of metallobetalactamase producing P. aeruginosa in our hospital and to evaluate an easy, but specific test for the detection of metallobetalactamase production so that it would be feasible for our laboratory. A total number of 140 P. aeruginosa strains which were isolated from different clinicalspecimens were studied. An antibiotic susceptibility test with antipseudomonal antibiotics was done as per CLSI guidelines. Imipenem resistant isolates were screened for carbapenem hydrolysis by the Hodge test and the modified Hodge test. Metallobetalactamase production was detected by the double disk synergy test (DDST) and the disk potentiation test. Out of 140 P. aeruginosa strains, 18 (12.9%) were imipenem resistant. Amongst these 18 strains, 16(88.8%) were Hodge test and modified Hodge test positive and all 16 were found to be metallobetalactamase producers by the DDST and the disk potentiation tests. We hereby conclude that the detection of metallobetalactamase producing P. aeruginosa strains by the disk potentiation test should be introduced in any clinical Microbiology laboratory in order to aid infection control.

Antioxidant Vitamins And Enzymes Status In Patients With Alcoholic Liver Disease.

JANANI A V* and SURAPANENI K M**

OBJECTIVES: The exact pro-oxidant and antioxidant status in alcoholic liver disease among the chronic alcoholics is still not clear. Consumption of excess amounts of ethanol causes liver damage by several mechanisms. Chronic alcohol consumption is associated with increased incidence of variety of illnesses including cirrhosis. Studies have shown that ethanol consumption may result in increased oxidative stress with increased formation of lipid peroxides and free radicals. METHODS: To add a new insight to the question, changes in the levels of antioxidant vitamins ascorbic acid and plasma vitamin E (non enzymatic antioxidant parameters) and activities of antioxidant enzymes superoxide dismutase (SOD), glutathione peroxidase (GPx) and catalase in erythrocytes were measured in 30 patients with alcoholic liver disease (study subjects) and compared to 30 age and sex matched healthy subjects (controls). Statistical analysis between controls and patients was performed by the unpaired t-test using the SPSS package RESULTS: It was observed that there was a significant increase in the activities of SOD and GPx and a significant decrease in erythrocyte ascorbic acid, plasma vitamin E levels and catalase activity in patients with alcoholic liver disease, among chronic alcoholics when compared to controls. CONCLUSIONS: The results of our study have shown higher oxygen free radical production, evidenced by the decreased levels of ascorbic acid, vitamin E and catalase activity, supporting the hypothesis that there is increased oxidative stress in patients with alcoholic liver disease. The increased activities of antioxidant enzymes may be a compensatory regulation in response to increased oxidative stress. The decreased concentrations of the antioxidant vitamin status support the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of alcoholic liver disease among chronic alcoholics. These data reveal that antioxidant defense mechanisms might be impaired in these patients. These findings also provide a theoretical basis for the development of novel therapeutic strategies, such as antioxidant supplementation.

Variations Of Lipid Peroxidation And Superoxide Dismutase Activity Due To Haemodialysis In Gorgan

MOUJERLOO M*

Background: Free radicals are formed in all living organisms during normal cell metabolism. Patients with chronic renal failure who are regularly dialyzed are candidates for free radical damage. The aim of this study was to evaluate the variations of lipid peroxidation and erythrocyte superoxide dismutase due to haemodialysis in Gorgan. Method: The sampling procedure was the purposive sampling of22 patients (age 43.54±9.21 years of old ) with chronic renal failure (CRF) disease who were haemodialysed at the 5th Azar hospital of the Gorgan dialysis center (from September 2007 to February 2008) and 22 age and sex matched healthy controls (43.77±9.33 years of old ) were recruited for this study. This study was a clinical trial. Results: Plasma lipid peroxidation levels showed significant differences between the predialysis and the control group (P<0.001). They were found to be increased in the post-dialysis group when compared with the predialysis and the control groups(P<0.001).Erythrocyte superoxide dismutase levels were found to be decreased in the post-dialysis group when compared with the predialysis and the control groups (P<0.001).There was also significant difference between it’s levels in the control and the predialysis groups (P<0.001).Erythrocyte superoxide dismutase levels were lower in the dialysis group than in the control group. (P<0.001). Conclusions: The significant differences of the erythrocyte superoxide dismutase levels between the pre- and post-dialysis groups may be related to the loss of this antioxidant through membranes during the dialysis process and the decreased superoxide dismutase levels may also be related to the increase of lipid peroxidation in haemodialysed patients. This situation may play an important role in the development of atherosclerosis in these groups.

Oxidative Stress And Antioxidants In CRF Patients Before And After Dialysis

Chronic Renal Failure (CRF) is a debilitating condition which is responsible for high morbidity and mortality. Tissue injury due to free radicals is commonly seen in a variety of disease processes. The aim of the present study was to investigate the possible free radical mediated tissue damage in CRF before and after dialysis, by measuring Melondialdehyde (MDA) which is marker of oxidative stress. Antioxidants like Vitamin A, Vitamin E and Vitamin C, which prevent oxidative damage, were also measured. The study included 30 healthy persons as controls and 30 patients of CRF (before dialysis and after dialysis) as the study cases. All parameters were assessed by spectrophotometric methods. Results: MDA levels were found to be significantly increased in pre dialysis CRF patients as compared to the controls (P< 0.001) and the levels further increased in post dialysis CRF patients as compared to that in pre dialysis CRF patients (P <0.001). The levels of antioxidants like Vitamin A, Vitamin E and Vitamin C were significantly decreased in pre dialysis patients as compared to the controls (P=<0.001) and the values further significantly decreased in post dialysis patients as compared to the pre dialysis CRF patients(P<0.001). Conclusion: This study indicates that there is considerable oxidative stress in patients with CRF, which is further exacerbated by hemodialysis, as evidenced by increased lipid peroxidation and low antioxidant levels.

Plasma Malondialdehyde Levels In Age Related Macular Degeneration

SINGH SB *, SINGH B **

Age-related macular degeneration (AMD) is the leading cause of blindness in older adults. Oxidative damage is likely to occur in an environment of extremely high oxygen tension, such as centre of macula, which has continuous and lifelong exposure to radiation. The evaluation of alteration in plasma malondialdehyde (MDA) levels in AMD has been made. Significantly higher MDA levels were detected in patients with AMD when compared with controls (p<0.001).The result supports the role of oxidative damage in the pathogenesis of age related macular degeneration.

Comparative Study Of Oxidative Stress And Antioxidant Activity In Males And Females With Increase In Age

KAUR S*, KUMAR R**, GUPTA K**, MANCHANDA KC****

Aim:The aim of the study was to compare the extent of free radical damage in the form of oxidative stress and the antioxidant activity with increase in age in healthy males and females. Methods: The present study was conducted in 150 normal healthy subjects of both sexes in the age ranging from 15 – 65 years. They were divided in 3 groups. Each group had equal number of male and female subjects. Oxidative stress was by measured by estimating malondialdehyde [MDA], a lipid peroxidation product, and antioxidants in the form of superoxide dismutase [SOD] and glutathione peroxidase [GPX] in both male and female subjects of all age groups. Results: MDA levels increased significantly with increase in age of all subjects and this increase was more in females was more than males of each group. Levels of antioxidant enzymes [SOD and GPX] decreased with increase in age more in males than females of each group. Conclusion: Males are exposed to greater risk of oxidative stress with age compared to females which may be related to lower life expectancy in males.

Should Mucin Histochemistry Be Routinely Done For Carcinoma Cervix

PREETI* , KALHAN S**, ALKA ***, JAIN K****, ARORA K S*****

Aim: The primary objective of our study is to find out prevalence of mucin secretion in cervical carcinoma by mucin histochemistry with special reference to squamous cell carcinoma; diagnosed by Haematoxylin and eosin (H&E) stain and to find the relative incidence of invasive carcinoma on the basis of H&E stain versus mucin stains. Materials & Methods:Biopsies from 223 cases of carcinoma cervix were subjected to H&E stain and mucin stains i.e. Periodic acid schiff with diastase (DPAS) and Alcian blue at pH 2.5. Interpretation of cases on the basis of H&E staining alone and on the basis of mucin stains was done and the results were compared with each other. Results: Morphological assessment on the basis of H&E stain showed 201(90.1%) cases of squamous cell carcinoma, out of these 132(59.2%) cases were moderately differentiated and 62(27.8%) cases were poorly differentiated. On application of mucin stains 29(13.0%) cases and 2(0.9%) cases out of 201 cases of squamous cell carcinoma were re-classified as squamous carcinoma with mucin secretion and adenosquamous carcinoma respectively. Conclusion: Mucin stains should be done routinely on moderately and poorly differentiated squamous cell carcinoma for evidence of mucin secretion which can be missed on H&E stain. Such carcinomas are known to have a more aggressive clinical course associated with a poorer survival when compared to non-mucin secreting squamous cell carcinoma.

Effect of different modalities of chelation in Beta Thalassemia

KUMAR P*, GHALAUT V S**, ABROL P***, SEN J****,SACHDEVA A*****

Beta-thalassemia major is a genetic blood disorder that results in defective production of haemoglobin.In India, almost 25 million people are carriers of beta-Thalassemia gene. Beta Thalassemia affects almost all body organ systemsand the main stay of treatment is regular blood transfusion which has its associated complications, the most important being iron overload.The iron chelators have a major role improving the life expectancy of the patients. Desferrioxamine and Deferiprone are two such chelating agents being used in patients on blood transfusion. Methods: We carried out a study on 45 Thalassemics receiving blood transfusion and divided them into three groups on the basis of iron chelators used. Their cardiac and hepatic status was assessed and correlated with serum ferretin levels that had been on chelation therapy for a minimum of six months. Results: The serum ferretin did not show a significant change in all three groups but the patients on combination therapy showed improvement in cardiac and hepatic functions. Conclusion: Although promising, a longer duration of study on a larger number of patients is required to assess the beneficial effect of combination therapy over individual chelators.

Assessment of Blood Donation Process at Four Major Centers in Jamaica

Background: A major challenge for blood banks is to provide a safe and regular supply of blood to meet the patients’ needs through voluntary donation. In this study, we investigated the process of blood donation at four major donating centres in Jamaica. Materials and Method: The research was carried out at four blood donation centres under the National Blood Bank, during routine blood collection, in a period of five working days in September 2004. It involved the systematic random sampling of 42 blood donors by using a 17-item, self-administered, anonymous questionnaire. Results: Of the 42 donors, (51%) were voluntary and 49% were replacement donors. The motivation drivers of first time donors were as a result of certain personal considerations such as to assist family or relatives in need. Seventy six percent of donors were repeated and 24% were first timers. Four (10%) of 42 applicant donors were rejected and the most frequent reasons for deferral were high/low blood pressure and anaemia. Forty-five percent of the donors were fearful of the process and the greatest fears highlighted by donors were that of the needle size and the stinging sensation experienced upon venipuncture. The majority of the donors (78%) found that the facilities at the blood donation centres were adequate, while 22% found that they were clustered. Conclusion: The results provide useful insights that can be used to make effective plans and to implement strategies to encourage the current donors to donate blood more often and to motivate the persons who are eligible to donate, in order to support Jamaica’s transfusion needs.

Disparities in self-rated health, health care utilization, illness, chronic illness and other socioeconomic characteristics of the Insured and Uninsured

BOURNE P A *

Background: Previous studies which have examined health status as regards the insured and the uninsured have used a piecemeal approach. Aims: This study elucidates information on the self-rated health status, health care utilization, income distribution and health insurance status of Jamaicans. It also models self-rated health status, health care utilization and income distribution and how these differ between the insured and the uninsured. Methods And Material: Cross-sectional data from the 2007 Jamaica Survey of Living Conditions (JSLC) were used to analyze the information for this study. Statistical Analyses Used: The statistics were analyzed by using the Statistical Package for the Social Sciences for Windows, Version 16.0. Analytic models using multiple logistic and linear regressions were used to determine factors which explained self-rated health status, health care utilization and income distribution. Result: The majority of health insurance was owned by those in the upper class, (65%), as compared to 19% for those in the lower socio-economic strata. No significant statistical difference was found between the average medical expenditure of those who had insurance coverage and the non-insured. Insured respondents were 1.5 times (Odds ratio, OR, 95% CI = 1.06 – 2.15) more likely to rate their health as moderate-to-very good as compared to the uninsured, and they were 1.9 times (95% CI = 1.31-2.64) more likely to seek medical care, 1.6 times (95% CI = 1.02-2.42) more likely to report having chronic illness and more likely to have greater income than the uninsured. Illness is a strong predictor of why Jamaicans seek medical care (R2 = 71.2%) and health insurance coverage accounted for less than half a percent of the variance in health care utilization. Health care utilization is a strong predictor of self-reported illness, but it was weaker than illness in explaining health care utilization (61.1% of 66.5%). Public health insurance was mostly acquired by those with chronic illnesses: (76%) as compared to 44% private health coverage and 38% without coverage. Conclusion: The findings highlighted that any reduction in the health care budget in developing nations means that vulnerable groups will seek less care and this will further increase the mortality among those cohorts.

Social and Psychological Evaluations of Diabetic Patients Towards Disease Management: A Cross Sectional-Study at a University Health Center in Malaysia

AL-HADDAD M , MOHAMED IBRAHIM M I , HASSALI M A, SULAIMAN SYED S A, MAARUP N

Objectives: This study aims to explore the social and psychological behaviours among diabetic patients regarding diabetes and its treatment at a University Health Center in Malaysia. Setting: Health Center of Universiti Sains Malaysia Methods: A cross sectional study design was used to explore the patients’ social and psychological domains of diabetes and its treatment by using a Diabetes Care Profile (DCP) questionnaire. All questions used were based on a 5-point Likert scale and appropriate statistical tests were conducted at a significant level of less than 0.05. Results: The patients showed good level of diabetes understanding, care ability, importance of care, positive attitudes, self care adherence and long term benefits. In addition, they showed a low impact of diabetes on their social and personal lives and low negative attitudes. Adherence to a good diet was seen as the most difficult behaviour to change among diabetic patients. Patients with fewer years with diabetes scored significantly better than those with more years with diabetes, in most of the domains of this study. Conclusion: A majority of the patients showed a good level of understanding about diabetes and its treatment. Difficulty in controlling diet was the major problem which was identified by most of the respondents. Therefore, these study findings could be used to develop better counseling and educational programs for diabetic patients based on their needs.

Relationship between Initial Psychological Response To Diagnosis Of Diabetes Mellitus And Its Impact On Subsequent Management.

KAUR H

Introduction: This study is designed to test the hypothesis that a relationship exists between emotional reaction to diagnosis and the subsequent adherence to diet and exercise regimen, and to correlate the responses of subjects with factors like knowledge about diabetes and education status. Material and methods: 100 randomly selected established cases of type 2 diabetes patients attending the diabetes clinic at MMIMS Hospital were interviewed with a questionnaire designed to elicit the reaction to diagnosis and adherence to the diet and exercise regimen among them. Responses were analyzed after content analysis to achieve the objectives. Chi‐square test was applied to determine statistical significance. Results: It was found that the patients with positive feelings at the time of diagnosis were better adherent to exercise regimen than those with negative feelings. The difference in adherence to dietary plan, however, wasn’t found significant. Also, males were adherent to exercise than females. The patients who were fully explained about diabetes by physician showed better adherence to exercise than those who were not. Conclusions: It can be safely concluded that patients with negative feelings and less knowledge about diabetes at the time of diagnosis show poor adherence to self‐management regimen. The physicians need to understand the emotional state of the patients at the time of diagnosis and provide them sufficient information about the condition for better response to the prescribed self management plans.

Report of the Multiple Sclerosis Treatments in Iran (Khorasan Provinces)

Multiple sclerosis (MS) is a chronic disease of the central nerve system. Iran has a medium-high prevalence of MS patients. While much is known about the beneficial and adverse treatments of MS in the world, there is a paucity of documental information about MS treatments in Iran. This study was done to provide the documentary details of MS medications. In a 6-month cross-sectional study, 248 MS patients from the Mashhad MS association in the Khorasan province were surveyed. Data was collected by employing a 32- item self-administered questionnaire in a face to face interview, which consisted of different variables. Nonparametric tests and descriptive statistical analysis were applied to assess the distribution and the effects of medication use in the population. 40% of the patients used interferonβ-1b (Betaferon), 30% used interferonβ-1a (Rebif), 14% used interferonβ-1a (Avonex), 13% used interferon β-1a (CinnoVex) [Immunomodulatory Agents (IMDs)] and 3% used Mitoxantrone (Non-IMDs). The patients’ satisfaction with INF therapy in terms of, the most efficacy, the least side effect, the cost and attacks reduction was 59% for Avonex, 74% for Betaferon, 44% CinnoVex and 77% for Rebif. The most adverse effects reported by Avonex users were flulike symptoms (53%), headache (31%), tiredness and muscle-aches (16%); Betaferon: flulike symptoms (60%), injection site reactions (25%), hair loss(15%) and Rebif: headache and muscle-aches (60%), injection site reactions (30%) and menstrual disorders (10%) . There was no significant association between the side effects of INF with respect to gender, the war attendance, family history of attending in the war, BMI (p value>0.05). The only significant difference was between CinnoVex side effects with respect to gender and BMI, as a high proportion of females reported flu-like symptoms, injection site reaction and hair loss. The common method of MS treatment was the modulation of the immune system with IMDs, low-dose (Avonex-CinnoVex) for low frequency and high -dose (Betaferon-Rebif) for high frequency. The main aim of symptom therapy was to cure depression and spasticity. The least adverse effects were related to Rebif, Betaferon, and Avonex respectively. The only medicine for MS relapses was a course of high dose of Methyl prednisolone. The overall treatment pattern of MS in Iran is like that in the western countries.

The effect of Verapamil in Malaria – A Prospective Randomized Double Blind Control Clinical Study

LATHA K*, RUCKMANI A**

Context: To reduce the drug resistance produced by malarial parasites to chloroquine and Verapamil, a chemosensitiser which has been tried in vivo. Objectives: To find out whether verapamil facilitates the action of chloroquine in malaria and to find out the safety of using verapamil in malaria. Study Design: A double blind randomized control study Description of the Subjects: Sixty patients who were positive for malaria by the QBC test (vivax, falciparum) without any associated illness (hypertension, diabetes, anaemia, cardiac, renal diseases) were included. Informed consent was obtained from each patient. Interventions: After thorough clinical examination, the patients were randomly allocated for two different treatments. Group A received standard chloroquine therapy (600 mg loading dose, 300 mg after 8 hrs, 24 hrs and 48 hrs). Group B received in addition to chloroquine therapy, verapamil 40 mg orally two hours after the administration of chloroquine. All the patients were evaluated, based on the time taken for the temperature to become normal, disappearance of rigor and chills (patients were evaluated at every 4th hour ) and the QBC test to become negative (test done at every 12th hour ) Results: It was observed that patients in group B had earlier relief of symptoms and signs and QBC became negative early as compared to group A. Fever (Mean—18.53 hours for group A and 9.33 hours for group B, SD for group A is 7.68 hours and for group B is 3.53 hours)and rigor and chills (Mean for group A is 18.8 hours and group B is 9.7 hours, SD for group A is 7.94 hours and for group B is 3.53 hours) were reduced to normal within 24 hours in group B, whereas in group A, it became normal only in 36 hours. Parasitaemia was cleared in 36 hours in group B, but in group A, it was cleared only in 48 hours (Mean for group A is 28.4 hours and for group B is 19.7 hours, SD for group A is 7.68 hours and for group B is 6.81 hours). No one had hypotension or any other significant adverse effects. The results were analyzed by the Student’s t test and they was considered to be significant (p<0.001). Conclusion: Verapamil facilitates the action of chloroquine in malaria and it is safe.

Transhiatal Oesophagectomy and Lymph Node Clearance in a Teaching Hospital

CHIDAMBARANATH R*

Introduction: Transhiatal Oesophagectomy for resectable oesophageal carcinoma has been gaining popularity and acceptance as a reasonably safe procedure, given the question over the choice of procedure for these patients who are nutritionally depleted and the limitations of preoperative evaluation methods. The purpose of this study was to find the lymph node retrieval rate and to assess Transhiatal Oesophagectomy (THE) as practiced in this centre as a means of node clearance. Methods: A retrospective audit of patients who were found fit and who underwent THE between 2004 and 2008 was done. Operative notes and histopathology reports of all patients were scrutinized. A total of 16 out of 60 patients underwent the procedure. There were no major complications in these patients and no in-hospital mortality. Results: Out of the 16 patients who were fit to undergo THE, 8 had no nodes found on HPE, 4 had 1-3 nodes and only 2 had greater than 10 nodes which were retrieved during surgery. Post-operative complications were few and there was no in-hospital mortality. Conclusion: The transhiatal approach may not be a reliable means of removing intratoracic nodes during Oesophagectomy for carcinoma. However, a larger study directly comparing this to a transthoracic approach in the Asian population may be necessary.

A Pilot Study Of The Normal Measurements Of The Liver And Spleen By Ultrasonography In The Rajasthani Population

MITTAL R*, CHOWDHARY DS**

Aim :To determine the normal standards of liver and spleen by ultrasonography in the Rajasthani population. Materials And Methods :Two hundred subjects (100 males and 100 females) from Rajasthan were evaluated. The dimensions of the organs were measured 3 times and the mean values were recorded. The subjects were divided into 5 groups according to their ages (11-70 yrs.). Results :The average longitudinal diameter of the right lobe of the liver was 12.99±0.76 cm (males) and 12.66±1.07 cm (females) and of the left lobe was 9.28±0.81 cm (males) and 9.17±1.03 cm (females). The average length of the spleen was 9.40±0.91 cm (males) and 9.34±0.95 cm (females). The average width of the spleen in males as well as in females was 3.45±0.59 cm. Conclusion: The normal values of the dimensions of the liver and spleen are important parameters during a sonographical examination. This study provides valuable data from the Rajasthani population. So, this study will be of importance in the daily practice in radiology clinics.

Spontaneous Bacterial Peritonitis In Ascites: A Prospective Study In A Tertiary Care Hospital

DODDAMANI G B*, PUJAR SUNITA**, KORA S A***

Background: Spontaneous bacterial peritonitis is a common and fatal complication occurring in cirrhotic patients with ascites. It is defined as infected ascites in the absence of any recognisable secondary cause of infection. Objective: To evaluate the relative frequency, clinical presentation and microbial spectrum of spontaneous bacterial peritonitis in ascites patients. Design: A Hospital based prospective study carried out in patients with ascites. Place And Duration Of Study: The study was conducted in the departments of Medicine and Biochemistry from August 2008- July 2009 at S.Nijalingappa Medical College and HSK hospital and Research Center, Bagalkot, Karnataka. Material And Methods: 100 patients admitted to the Department of Medicine with the diagnosis of ascites were selected. They were divided into cirrhotic and non cirrhotic ascites cases. Ascitic fluid from these patients was analysed for cytology, culture/sensitivity and biochemical parameters. Based on these investigations, the cases were further categorized into the SBP (Spontaneous bacterial peritonitis), CNNA (Culture Negative Neutrocytic Ascites) and MNB (Monomicrobial non-Neutrocytic Bacterascites) groups. Statistical analysis was done by using the unpaired “t” test. Results: 81 patients were cirrhotic and the rest of the 19 cases were non cirrhotic. Among the patients of cirrhotic ascites, SBP was diagnosed in 8 cases (9.81%) and CNNA and MNB were diagnosed in 3(3.7%) and 1(1.23%) cases, respectively. In the SBP group, Escherichia.coli was the most frequently cultured organism and it was isolated in 4 cases (50.0%), followed by Klebsiella pnuemoniae in 3(37.5%) cases and Pseudomonas aeruginosa in 1 (12.5%) case. In the CNNA group, the culture was negative, while in MNB one case was E.coli positive. Abdominal pain, hepatic encephalopathy and fever were the common presenting features in 75%, 75% and 62.5% cases in the 3 groups, respectively. The ascitic fluid protein was 0.92 ± 0.25 gms/dl in the SBP group, 1.13 ± 0.49 gms/dl in the CNNA group and 1.4gms/dl in MNB patients. Conclusion: SBP is a fatal complication of cirrhosis with ascites. It has a heterogenous clinical presentation. Ascitic fluid should be analysed routinely in all cases of cirrhosis with ascites for the early detection of SBP.

The Effect Of Music Therapy On Sedative Requirements And Haemodynamic Parameters In Patients Under Spinal Anaesthesia; A Prospective Study

Background: Music therapy is the application of music in the treatment of physiological and psychological aspects of an illness or disability. Music has been shown to modulate the stress response in minor operations, intensive care and other various hospital settings. We designed this study to determine the effects of music therapy on intraoperative sedative requirements in achieving similar degrees of sedation and on Haemodynamic parameters in patients undergoing surgery under spinal anaesthesia. Methods: We prospectively studied 100 cases of ASA Grade I and II between 15-65 years of age from both sexes, undergoing abdominal, urological and lower extremity surgery under spinal anaesthesia. The patients were randomized into Group M (those who listened to music) and Group C (those who didn't listen to music). After the induction of spinal anaesthesia, and after achieving the desired effects and levels, headphones were applied to all the patients and music was started in group M. The intraoperative vital parameters and total sedative requirements were recorded and compared in both the groups. Observations: The total midazolam requirements were significantly lower in patients who listened to music intraoperatively (2.17 ± 0.53 mg versus 3.25 ± 0.77 mg; P =0.02), for achieving similar degree of sedation (Ramsay grade 3). The mean pulse rate was significantly lower in group M as compared to group C (from 68-76 versus 86-98; P<0.05) at 30-90 minutes intervals intraoperatively. Systolic and diastolic blood pressure were comparable in both the groups, with insignificant difference at all times (P > 0.05), though the patients in group M reported a higher sense of satisfaction and well- being postoperatively. Conclusions: Our findings suggest an important role of music in perianesthetic patient care. We conclude that music is a non-pharmacological alternative which is suitable for decreasing intraoperative sedative requirements under spinal anaesthesia.

Lipid Profile In Preeclampsia – A Case Control Study

KASHINAKUNTI S. V. *, SUNITHA H. **, GURUPADAPPA K. ***, MANJULA R.****

Background and Objectives: According to the current knowledge, rise in the serum triglycerides level is a major contributor in the pathogenesis of pre-eclampsia. In this context, this study was undertaken to compare the changes in lipid profile in normal pregnancy and in pre-eclampsia. Method: A Case control study was done consisting of 90 pre-eclamptic (cases) and 90 healthy pregnant women(controls). Fasting venous blood samples were collected during ante partum period and serum levels of Triglycerides (TG), Total cholesterol (TC),low density lipoprotein cholesterol (LDL-C), very low density lipoprotein cholesterol(VLDL-C), high density lipoprotein cholesterol (HDL-C) were measured. Results : In the pre-eclamptic group serum triglyceride (193.37±43.93 mg/dl) was increased significantly (P<0.001) as compared to normal pregnant women. Other parameters TC,LDL-C,VLDL-C and HDL-C were not raised significantly. There is a positive correlation between serum triglycerides and systolic blood pressure and diastolic blood pressure in pre eclampsia cases. Interpretation and Conclusion : The findings of the present study are consistent with previous studies, suggesting high levels of serum triglycerides as an important factor in the pathogenesis of pre -eclampsia.

Carotid Cavernous Fistulae: Various Presentations And Treatment Approaches: Results In 25 Cases

KARANAM L.S.P. *, BADDAM S.R**, DEV B ***, JOSEPH S ****

Aim: To discuss the clinical presentation and the efficacy of endovascular management by various methods as the treatment option for direct carotid cavernous fistulae. Method and materials: In our study, 25 patients were included during the period from 04/02/2006 to 02/12/2008. 16 were male patients and 09 were female patients with a mean age of 37 years.25 patients presented with Type A carotid fistulae, of which 21patients had an aetiology of trauma. A majority of the patients (21) presented with proptosis, the other symptoms being redeye (19), diplopia (9), headache (13) and diminished vision (17). Pre procedural workup with CT, CTA, MR and MRA was done in all the patients. High resolution DSA was done by using Advantax LCN+ (GE Biplane system). Embolisation materials in the form of balloons were used in 15 patients and coils in 5 patients. Both balloons and coils were used in 3 patients. Results: Complete cure in the form of total reversion was achieved in twenty one patients. Improvement with residual pathology was achieved in two patients in whom there was complete clinical cure, but the angiogram demonstrated small residual fistula. The procedure was abandoned because of technical reasons in one patient. Spontaneous closure of the fistula occurred in one patient. Complications in the form of inadvertent balloon detachment occurred in two patients. Thus, complete cure was seen in 84% of our patients which is in par with the worldwide literature of 84-87% success rate. Conclusion: Endovascular therapy is the treatment of choice for Direct carotid cavernous fistulae.

Effect Of Radiofrequency Radiations Emitted From Mobile Phones On Plasma Oxidants And Antioxidants In Mobile Phone Users

AWANTI SM, INGIN JB, JEEVANGI SR, PATIL RB, PATIL GA, AWANTI BS

Introduction: Wide spread concerns have been raised about the possibility that exposure to the radiofrequency (RF) radiations emitted from mobile phones could affect people’s health. The radiofrequency radiations emitted from mobile phones may affect biological systems by increasing free radicals which mainly enhance lipid peroxidation and by changing the antioxidant activities in human blood, thus leading to oxidative stress. The present study was designed to evaluate the effect of the exposure to the radiofrequency radiations emitted from mobile phones on the plasma parameters of oxidants and antioxidants in 50 volunteers using mobile phones. The plasma obtained, was used for the estimation of lipid hydroperoxide, total thiols and the ferric reducing ability of plasma (FRAP). There was a significant increase in lipid hydroperoxide (p<0.05) and a significant decrease in FRAP (p<0.05) and total thiols (p<0.05). FRAP correlated negatively with lipid hydroperoxide and positively with thiols. This decrease in antioxidants like FRAP and total thiols and an increase in oxidants like lipid hydroperoxide prove the existence of oxidative stress in mobile phone users.

Maternal And Neonatal Serum Magnesium Concentrations In Neural Tube Defects Pregnancies In Gorgan (North Of Iran) - A Case Control Study

GOLALIPOUR M J* , MANSOURIAN A R**

Objective: Neural tube defects (NTD) comprise a group of congenital malformations that include spinabifida, anencephaly and encephalocele. Previous studies have reported the embryotoxic and teratogenic effects of Magnesium deficiency in animal models. Therefore, this study was conducted to determine an association between Magnesium deficiency and neural tube defects in Northern Iran, which was reported to have a high prevalence of neural tube defects. Methods: This hospital based case control study was conducted on 13 mothers with newborns having neural tube defects and 35 healthy mothers as controls in Northern Iran during 2005-2006. Serum Magnesium was measured by spectrophotometery. Results: Serum Magnesium levels in mothers with NTD affected newborns and in mothers with healthy newborns were 1.5±0.6 and 1.32±0.3 micromol/litter, respectively. Overall, 46.2% mothers in the case group and 48.6 % mothers in the control group had Magnesium deficiency. Logistic regression analysis showed no association between the presence of NTD and Magnesium deficiency (OR =0.9, 95% Cl: 0.2-3.9, p=0.88). Serum Magnesium levels in newborns with NTD and healthy normal newborns were 1.4±0.6 micromol/litter and 1.3±0.4 micromol/litter, respectively. Overall, 30.8% newborns in the case group and 37.1 % newborns in the control group had Magnesium deficiency. Logistic regression analysis showed no association between the presence of NTD and Magnesium deficiency (OR =0.8, 95% Cl: 0.1-3.4 p=0.68). Conclusion: The present study did not find any association between the occurrence of NTD and Magnesium deficiency.

The efficacy of the epidural depo-methylprednisolone and triamcinolone acetate in relieving the symptoms of lumbar canal stenosis: A comparative study

HUDA N *, BANSAL P**, GUPTA S M ***, RUHELA A****, REHMAN M*****, AFZAL M******

Objective: To compare the efficacy of depo-methylprednisolone and triamcinolone acetate in pain relief and in the improvement in claudication distance after two doses of epidural injections in patients with clinically diagnosed lumbar canal stenosis. Material and Methods: This prospective, randomized trial was performed in seventy patients with the clinical features of lumbar canal stenosis, who received epidural medications for pain relief. The patients were grouped into two; the T group receiving an injection of 80mg triamcinolone acetate with bupivacaine (0.125%) diluted in normal saline and the M group receiving 80 mg methylprednisolone acetate with bupivacaine (0.125%) diluted in normal saline solution (total volume of 20 ml in each group). The pain relief was assessed at 1, 3 and 6 months post-procedurally for improvement in the VAS pain scores and for the increase in the claudication distance. Results: Of the 70 patients who were included in the study, 40% were females (n=28) and 60% were males (n=42). In the M group, 24 patients (68.5%) reported improvement in the VAS pain scores at the end of 6 months, as compared to 14 (40%) patients in the T group. The pre-intervention mean claudication distance was 163 meters in the group M and 170 meters in the group T, which improved to 637 metres and 350 meters in groups M (P < .001) and T (P>0.05) respectively, at the end of a 6 month follow up. In group M, the average VAS scores decreased from 7.34 in the pre-treatment phase, to 3.64 at the end of a 6 month follow up, which was significantly low (P=0.02). Comparatively, in group T the pre-treatment VAS score value decreased from 6.4 to 4.8 after 6 months of treatment (P< 0.05). Conclusion: Both triamcinolone and methylprednisolone are effective epidural medications for symptomatic relief in lumbar canal stenosis, though depo-methylprednisolone showed better long term pain relief and improved walking distance at long term intervals as compared to triamcinolone.

The Self-Evaluated Health And Health Conditions Of Rural Residents In A Developing Country

BOURNE P A*

Background: In Jamaica, in 1989, the national poverty rate was 30.5% and this exponentially fell by 208.1% in 2007, but in the latter year, rural poverty was 4 times more than in the peri-urban areas and 3 times more than the urban poverty rate. Yet, there was no study on health status and health conditions in order to examine the changes among the rural residents. Aims: The present study aimed to (1) examine epidemiological shifts in the typology of the health conditions in rural Jamaicans, (2) determine the correlates and the estimates of the self-evaluated health status of the rural residents, (3) determine the correlates and estimates of the self-evaluated health conditions of the rural residents and (4) assist policy-makers in understanding how intervention programmes can be structured to address some of the identified inequalities among the rural residents in Jamaica. Methods and Material: The current study involved the extraction of the samples of 15,260 and 3,322 rural residents from two national cross-sectional surveys (2002 and 2007 Jamaica Survey of Living Conditions). Setting and Design: The survey was drawn using stratified random sampling. This design was a two-stage stratified random sampling design, where there was a Primary Sampling Unit and a selection of dwellings from the primary units. Statistical Analyses: Statistical analyses were performed by using the Statistical Package for the Social Sciences. Descriptive statistics such as mean, standard deviation, frequency and percentage were used to analyze the socio-demographical characteristics of the sample. The Chi-square test was used to examine the association between the non-metric variables and multiple logistics were used to establish the factors that explained a dichotomous dependent variable. Results: In 2002, 14% of the respondents indicated having an illness in the 4-week period of the survey as compared to 17% in 2007. In 2002, there were 12 determinants of health: 11 social and 1 psychological, whereas in 2007, there were 7 determinants of health: 6 social and 1 biological. The determinants accounted for 22.6% of the explanatory power of the health model for 2002 and 44.7% for 2007. Conclusion: With the exponential increase in diabetes mellitus and the health inequalities that exist today in rural Jamaica, public health authorities and other policy-makers need to use multidimensional intervention strategies to address those inequalities.

Emergency Obstetric Hysterectomy: A Retrospective Study At A Tertiary Care Hospital

NAJAM R *, BANSAL P**, SHARMA R***, AGARWAL D ****

Objectives: To analyze the cases of emergency hysterectomy due to obstetrical causes with a view to know the incidence, indications, maternal profile and complications following this surgery. Methods: Retrospective analysis of 24 obstetric hysterectomies which were performed during caesarean sections (n= 550) which were performed over a period of 32 months. Results: The incidence of emergency hysterectomy in our study was10.05/1000 deliveries, with a maximum numbers of patients (n= 11) in the age group of 26-30yrs. The parity was >5 in patients and ruptured uterus (n=11; 45.8%) was the commonest indication for which this life saving surgery was performed. There was only one case of morbidly adherent placenta. Out of the 24 hysterectomies performed, 19 were subtotal hysterectomy and 5 were total hysterectomy. Post-operatively, fever was commonest complication (n=12; 50%), followed by wound infection (n=4; 16%). There were three maternal deaths and only 4 live births. Conclusion: Proper antenatal care and early referral are the only potential methods which can be used for preventing this catastrophic event. Moreover, timely decision, liberal blood transfusion and speedy surgery by an experienced clinician are the main pillars in the management of this life saving procedure.

A study of Psychological stress in undergraduate Medical students at S N Medical College, Bagalkot, Karnataka

Background: Medical students are known to be the victims of tremendous mental stress. In recent years, mental stress has been on the rise and this may affect their learning and academic performances. They face tremendous competition and fear of failure. Very few studies on this subject have been reported by Indian researchers. Objectives: To study the levels of psychological stress and its relationship with personal/ curricular variables in undergraduate medical students. Materials and Methods: Setting: Descriptive cross sectional study in undergraduate medical students. Sample size: 251 students Scores used in the study: The scores have been given on the basis of the Presumptive Stressful Life Events Scale [PSLES]. Statistical test used: Chi-square test Results: 42.63% of the study subjects had experienced less/moderate stress and 47.01% of them had experienced severe stress. 78.26% of the smokers and 68.97% of the alcoholics had severe stress. The statistical association between the history of alcohol intake, smoking and the PSLES results was found to be significant. The stress was found to be more among repeaters and the association between them was statistically significant. Conclusion: The students with psychological stress were found to be involved in habits like tobacco chewing and smoking, as well as alcohol intake. The repeater students had significantly higher stress as compared to their regular batch counterparts.

The occurrence of clinically evident ischaemic heart disease in patients of type 2 diabetes with resting tachycardia

PRACHETH R, ADHIKARI P M*, SABITHA P**, KAMATH A

Background: Epidemiological studies have reported the association between resting tachycardia (RT) and cardiovascular mortality, both in cardiac and non cardiac subjects. Aims: To investigate the association between RT and clinically evident ischaemic heart disease (IHD) in diabetic patients. Settings and Design: Retrospective analysis of the hospital data. Data collection period - 2008-2009. Material and Methods: Electro cardiogram recordings of diabetic patients (n=100) were used for the calculation of the resting heart rate (RHR). RHR > 90 beats/ minute (bpm) was considered as RT. Presence/ absence of IHD were noted from the patient case records. The association between RHR and the prevalence of IHD was analyzed by applying the x2 test by using the SPSS software 12 version. P values <0.05 were considered to be statistically significant Results: Fifteen percent of the patients had RT and 28 % had clinical evidence suggestive of IHD. More than 50 % of those with RHR >90/bpm had IHD as compared to 23.5% in the group having RHR ≤90/bpm and the comparison between the two showed statistical significance (p=0.028). Conclusions: This retrospective analysis reports a positive association between RT and the pre-existing IHD in diabetic patients. RHR could be considered as a clinical marker for clinically evident IHD. A careful search for coronary artery disease, including the administration of an angiogram need to be considered in all diabetic patients presenting with RT.

Factors affecting adherence to highly active anti retroviral therapy in HIV positive patients - Southern India

Introduction: According to the National AIDS control organization (NACO) guidelines, the percentage of adherence to the HAART regimen should be >95% in order to get the maximum therapeutic effect and to decrease viral resistance. That means that a patient can miss only a single tablet unexpectedly in the course of one month. The motive behind the present study was to analyse the factors which affect the patient’s adherence to Highly Active Antiretroviral Therapy in HIV positive patients in a tertiary care hospital in Southern India. Methods: A prospective study was conducted after obtaining approval from the institutional ethical committee and after obtaining informed consent from patients in a tertiary care hospital in Southern India from July 2006 till November 2007. Relevant data from HIV positive patients on the HAART regimen for a minimum of 1 month was recorded. Children were excluded from the study. Chi Square test was applied for the statistical analysis of data. Results: We obtained data from 313 HIV +ve patients on HAART during the study period. The patients consisted of 226 males and 87 females. High adherence was observed in females 64 (73.6 %) P<0.02, X2 = 5.18 as compared to males and this was due to the greater family support offered to them P<0.008, X2 = 6.9. 135 (59.7%) of males showed high adherence due to the presence of a greater degree of health consciousness in them P<0.008, X2 = 6.9. The reasons for low adherence in 91 (40.3 %) males were the social stigma associated with their visit to ART centres in 74 (81.3 %) , lack of family support in 6 ( 6.5 % ) and financial problems in 11 (12 %). 23( 26.4%) females had low adherence due to depression, the distance from the ART centers was the reason in 17(73.9%), lack of family support was the reason in 1(4.3%) and financial problems were the reason in 5 (21.7%). Financial problems as the causes for nonadherence have been overcome presently, since the medicines are being given free of cost since June 2007. Conclusions: In the present study, females showed a higher degree of adherence due to family support and in males, the reason for a high degree of adherence was health consciousness. Time should be spent by the staff on duty at the drug dispensing centres to explain the benefits of adherence and the results of non adherence to the drug regimen to the patients and their caretakers to improve patient compliance. Dispensing the drugs free of cost has improved patient compliance in a vast majority of patients.

Keratomycosis With Superadded Bacterial Infection Due To Corticosteroid Abuse-A Case Report

KUMAR A*, PANDYA S**, MADAN M***, KAVATHIA G****

We report a case of keratomycosis by Aspergillus flavus with superadded bacterial infection by Pseudomonas aeruginosa. An 83 years old male patient was referred to our institute with pain and copious mucopurulent discharge from the left eye of 15 days duration. Clinically, the case was diagnosed as keratomycosis. Gram stain showed Gram variable fungal elements and Gram negative bacteria, while the potassium hydroxide preparation showed branching septate hyphae.

Acute Leukemia During Pregnancy – A Case Report

Pregnancy complicated with leukemia is rare. Here, we report a case of a 33 year old pregnant lady, who came for a routine ante -natal checkup with symptoms of anemia and fever but later was surprisingly diagnosed to be suffering from acute myeloid leukemia.

Relative Adrenal insufficiency masquerading hypothyroidism

DOSHI S R *

A 35 year old male presented with complaints of generalized weakness, easy fatigability and low grade fever for the past 6 months. His past, personal and family history was unremarkable. On examination, his temperature was found to be normal, his pulse was 108/min regular and his blood pressure was 98/60 mmHg in the supine posture, with a fall of 20 mm Hg on standing. Oral examination revealed brownish-black pigmentation over the palate, the buccal mucosa and the palmer crease. The respiratory and the cardiovascular system examinations were normal. Investigations revealed haemoglobin of 8 gm% with other normal parameters; normal liver and renal function tests; serum HIV was non-reactive; serum electrolytes were normal; electrocardiogram was suggestive of sinus tachycardia; chest x-ray was normal; Abdominal ultrasonography was unremarkable and Computerized Tomogram of the Adrenal glands was normal. Serum thyroid stimulating hormone was 20.9 mcg/ml, S Free T4 was 1.2 ng/dl, anti-thyroid Peroxidase antibody was negative and serum cortisol (fasting 8 AM) was 12.0 mcg/dl. The Insulin Tolerance test failed to stimulate cortisol production and hence, the patient was diagnosed as having relative adrenal insufficiency. On treatment with physiological doses of corticosteroids, the patient improved remarkably and his thyroid function test returned to normal within a month.

Congenital Adrenal Hyperplasia: Presentation In A Male Infant

Bhakhri BK *, Biswas K **

We describe the clinical course of a male infant presenting with recurrent dehydration and salt loosing crises, diagnosed as Congenital Adrenal Hyperplasia. After initial crises management, the child was continued on replacement therapy. During the two year follow up, he was found to be growing appropriately and achieving normal milestones for age.

Idiopathic Granulomatous Mastitis - Report Of A Case With A Brief Review Of Literature

HATWAL D*, PANDA KM**, SURI V***

Idiopathic granulomatous mastitis is a rare inflammatory disorder which is characterized by the presence of non-caseating granulomas within the breast lobules, in which no organisms are found. It is hypothesized that the disease is a hypersensitivity reaction to the lobular epithelium and its contents. Though it is frequently reported from western countries, very few cases have been described from India. It affects only parous women and clinically mimics inflammatory breast carcinoma and tubercular mastitis. FNAC alone is not sufficient for the diagnosis and this can only be confirmed by an open biopsy. We report here, a case of granulomatous lobular mastitis in a 25 year old lactating female patient.

An Unusual Migrated Foreign Body

KAVITHA A K*, PINTO G O**, MORAS K***, LASRADO S****

Besides infections, foreign body incidences are amongst the most frequently encountered pathologies in otorhinolaryngology. Ingested foreign bodies whichmigrate extra-luminally are rare occurrences, which if untreated, result in life threatening complications. We present here, a case of a sharp metallic wire which migrated from the hypopharynx and lodged in the soft tissue of the neck. It was successfully removed via neck exploration and the patient recovered well.

Gorlin – Goltz syndrome–a rare presentation

BHAT K R, VASU C K*, RATHNAKAR U P**, RAVICHANDRA G***, ACHARYA D****

The Golin-Goltz syndrome is a rare, multisystemic and autosomal dominant disease. We are describing here, a case with an unusual presentation of purulent discharge into the mouth from infected cysts in the jaw, in a 22 year old male patient. The case was associated with some of the classical radiological features described in the literature for this syndrome

Normotensive Pheochromocytoma As An Adrenal Incidentaloma: A Case Report

NIAFAR M*, GHOLAMI N**, BOZORGI F***, MONTAZERI V****, NIAFAR F*****

Pheochromocytomas and paragangliomas are catecholamine producing tumours that arise from the sympathetic or the parasympathetic nervous system. If the tumour is confined to the inner part of the adrenal gland, it is called as pheochromocytoma and if it has extra adrenal location, it is called as paraganglioma. Pheochromocytoma is a rare cause of hypertension with about 0.1 % incidence in hypertensive patients. Adrenal masses are found in about 2% of the abdominal CT scans which are performed for other reasons (e.g. incidentalomas) and of these, 5.1% to 23% are considered to be pheochromocytomas. Nonfunctional pheochromocytoma is usually an asymptomatic adrenal tumour, even if it is associated with hypercatecholaminaemia. In this paper, we report a rare case of normotensive pheochromocytoma which was discovered incidentally while assessing abdominal discomfort. Despite the presence of excess catecholamines in the circulation, the patient was normotensive without any other sign of pheochromocytoma. Surgical excision of the adrenal tumour revealed pheochromocytoma.

Importance of Consumer Pharmacovigilance System In Developing Countries: A Case Of Malaysia

AHMED A M*, IZHAM IM**, SUBISH P***

Adverse drug reactions (ADRs) are a major cause for morbidity and mortality. The existing system for monitoring ADRs in Malaysia depends on spontaneous reporting from health professionals as a main source of information. We present here, an overview on the need for consumer reporting in Malaysia and on the advantages, disadvantages and international experiences on consumer reporting. We discuss here, how to start consumer reporting in Malaysia and its significant contribution to the existing system of drug monitoring in Malaysia. We conclude that consumer reporting should be introduced to overcome underreporting, to promote consumer rights and to increase the knowledge about the risks of medications.

Models Of Health Care Development For Disease Free India

NAIK G L* DESHPANDE S R

Providing healthcare and disease prevention to India’s billion plus population has always been challenging in the face of limited resources, the socialistic mindset, pluralistic systems of health, misgovernance and socioeconomic disparities. The Government of India needs to understand its limitations with respect to health entrepreneurship. India needs to repeat its successful privatization saga with respect to medical care, health infrastructure provisioning and maintenance and uplift its masses or else, its ambitious rural and urban health schemes will collapse and national health empowerment agendas will remain unfulfilled.

Pharmacotherapy of Alcohol Dependence

Alcohol is a commonly used psychoactive substance all over the world and responsible for a significant proportion of mortality and morbidity. The treatment of alcohol dependence consists of two phases, detoxification and rehabilitation. Pharmacotherapy is being investigated to enhance abstinence and prevent relapse and complement interventions at a psychosocial level. Alcohol activates dopamine in the nucleus accumbens and mediates positive reinforcement and reward. The US Food and Drug Administration (FDA) have approved three medications, disulfiram, naltrexone and acamprosate for the treatment of alcohol dependence. The selective serotonin reuptake inhibitors (SSRIs) particularly fluoxetine and citalopram have been evaluated. Buspirone and Ondansetron have also been tried for alcohol dependence. Combination of naltrexone and acamprosate has shown promising results. It is essential to develop clinically useful pharmacological treatments, which can be evaluated using large-scale clinical trials. Clinical trial methodologies to evaluate combination treatments and using medications along with psychosocial treatments are required.

Dental Profile Analysis of Young Indian Population

DESHPANDE S*, RADKE U**, KAHAR A***

Purpose of Study: To evaluate the prevalence of canine guidance & group function and various factors contributing to dento-facial aesthetics in young Indian population. Methodology: A questionnaire was designed including all the factors. Subjects were students of VSPM’s Dental College & Research Centre of age group 22-25 yrs. Total sample size was100. Result & conclusion: Most prevalent type of occlusion was found to be Angle’s Type I & most common guidance pattern is bilateral canine guidance. The prevalence of Average smile line was found to be highest. Most prevalent shade was B2.Such studies should be widely conducted in all regions of the country to provide a baseline data for future reference

Ovate Pontic Design: An Aesthetic Solution To Anterior Missing Tooth- A Case Report

BANERJEE R *, BANERJEE S**, USHA RADKE***

Advances in the field of restorative materials allow a lost tooth to be replaced by an artificial tooth structure that is virtually indiscernible from the original. However, in fixed partial dentures, the standards for the pontic area and the adjacent soft tissue in the maxillary anterior region have increased in particular. The pontic design in this region is primarily influenced by aesthetic and phonetic considerations. Local defects of the alveolar ridge often complicate restorative measures. Treatment methods proposed to solve this problem involve modification of the pontic design and pretreatment of the recipient site for the pontic. A valuable solution to provide a natural, aesthetic and immediate restoration is the use an ovate pontic design. The ovate pontic is a design which creates the illusion of the tooth growing out of the gum and thereby, provides with the best aesthetic outcome. The ovate pontic helps to create or maintain the interdental papilla. It is also an effective design for cleansibility and also eliminates ‘black triangle’ spaces.

A combination of platelet rich plasma and hydroxyapatite (osteogen) bone graft in the treatment of intrabony defects – A case report

Sunitha .J *, Manjunath K **

A major goal of periodontal therapy is the regeneration of the attachment structures such as alveolar bone, periodontal ligament and the cementum. Open flap debridement results in the formation of long junctional epithelium, which is more susceptible to microbial invasion and is thought to be a less stable attachment. Regeneration is thought to partially mimic developmental mechanisms, which require a coordinated orchestration of cellular events such as proliferation, migration and differentiation. Polypeptide growth factors are naturally occurring biological modifiers that have the potential to alter the host tissue to stimulate or regulate the wound healing process. They can regulate key cellular events in tissue regeneration, including cell proliferation, chemotaxis, differentiation, and matrix synthesis via binding to specific cell surface receptors. Growth factors (GF), either singly or in combination, have been used and experimental evidence for bone regeneration has been documented in both animal and human trials. Platelets are a rich source of naturally occurring growth factors, which can play an important role in the regeneration of periodontal tissues.

As A Calcifying Cystic Odontogenic Tumour Mimicking Residual Cyst

Manveen J K*, subramanyam RV**, Simmerpreet S V*, Ramandeep NS*

BACKGROUND: Calcifying cystic odontogenic tumour (CCOT), first described by Gorlin in 1962, accounts for less than 2% of all odontogenic tumours. This rare cystic odontogenic lesion, sometimes referred to as the ‘keratinizing and calcifying odontogenic cyst’, is characterized by the presence of ‘ghost’ epithelial cells and by its resemblance to the pilomatrixoma of the skin. CASE: In this report, we present a rare case of calcifying odontogenic cyst mimicking as a residual cyst in the maxillary anterior region, in a 60-year-old female patient. The lesion was surgically removed. After enucleation, no recurrence has been recorded. CONCLUSION: Correlation of clinical and radiological information with histological features is important in the diagnosis of odontogenic tumours and cysts.

Removal Of Provisionally Cemented Ceramic Crown- An Innovative Method

SHARMA A K*, BANSAL P**, BHANOT R***

One of the most frustrating experiences in fixed prosthodontics is the fracture of the ceramic margin during removal of provisionally cemented crown. Although there are many techniques and crown removers available for the removal of crowns, but a technique hereby is described for an easy and atraumatic removal of such crowns.

Preventive Prosthodontics for Head and Neck Radiotherapy

MANTRI S S*, BHASIN A S**

Adverse tissue reactions associated with the use of radiotherapy in the management of patients with head and neck cancer are painful and they diminish the quality of life, often discouraging the patient from taking treatment. Customized intraoral stents can help prevent the unnecessary irradiation of the surrounding normal tissues, thus reducing the severity of reactions. Since the use of these stents is individualized, close collaboration between the radiotherapist and the prosthodontist is essential. However, when properly designed and used, these stents are effective in reducing the treatment morbidit

Endodontic Consideration For The Usage Of Drugs In Pregnant And Lactating Mothers

AGGARWAL R*,SINGLA M**, MITTAL N***

The pregnant or lactating patient presents with a number of unique management problems for oral health care providers. Practitioners with minimal training in gestational medicine may be hesitant to treat their pregnant patients. Because of a fear of injuring either the mother or unborn child, some practitioners may withhold care or medications from their patients, inadvertently causing harm. An understanding of the patient’s physiological changes, the effects of chronic infection or illicit drugs and the risks or benefits of medications are necessary to adequately advise a patient on her options regarding medical/dental care.

Fenestration and dehiscence in a non vital tooth – A case report

AGARWAL V *

Fenestration and dehiscence are usually accompanied with long standing traumaticteeth. If this occurs, the solution is surgical intervention along with endodontic treatment. This surgical procedure consists of raising the flap to expose the dehiscence, followed by curettage, placing the bone graft and repositioning of the flap. A conventional endodontic treatment is carried out before the surgical procedure. A case is described here, that illustrates this clinical situation.

An Aesthetic Alternative- Tooth Fragment Reattachment - A Case Report

MITTAL N* , SINGLA M**, RADHIKA M***

A combination of platelet rich plasma and hydroxyapatite (osteogen) bone graft in the treatment of intrabony defects – A case report

PRAKASH V *, GUPTA R **

The aesthetic corrections of unaesthetic anterior teeth with all ceramic restorations have become more predictable and durable with time. Conventionally, orthodontic therapy was considered to be the most conservative approach for correcting mild to severe malocclusion. However, time and the potential of relapse of orthodontic treatment has inspired clinicians to opt for restorative means to correct malocclusion. Instant orthodontics using all ceramic restorations has become popular among clinicians in recent times. This case report highlights the use of instant orthodontics to correct malocclusion.

Could pranayama and ekapadasana be an alternative modality in the management of Attention Deficit Hyperactivity Disorder in children ?

AKHILA .J.S.*

ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3% to 5% of children globally. The symptoms are frequently comingled with learning problems, oppositional conduct, and depression, which altogether compound the family's emotional burden. Mounting controversy over the widespread use of drugs in the management of AttentionDeficit Hyperactivity Disorder in children. and possible life-threatening effects from its long-term use make it imperative that alternative modalities be implemented for ADHD management. Parents and children express desperation for interventions that will work, but without the adverse effects inflicted by the pharmaceutical management model. Research has proved that an effective alternative modality for treating ADHD in otherwise physically and mentally healthy children would be the regular dedicated practice of the ANULOM – VILOM PRANAYAMA PROCEDURE and the EKA PADASANA by the affected child above age 8-9 yrs and her/his parent, because it has been noted that children practice regularly only if accompanied by their guardians. The benefits are seen immediately, but last only until the procedures are practiced. Hence, to maintain the benefits, daily practice is essential. The results therefore depend on the dedication of the parents towards the child’s improvement.

Adaptogenic Potential Of Herbal Immunomodulators As New Therapeutic Approach To Combat Swine Influenza A/H1N1 Crisis

SINGH S*, GUPTA M**, GAUTAM S***

This short communication makes use of Mashelkar’s “Golden Triangle” of scientific, modern and traditional medicine as a unified approach to combat Swine Influenza A/H1N1 crisis in a safe, cost-effective manner. It considers the theoretical approach that can be effectively utilized when scientific systems take plunge into the unfamiliar waters of Ayurvedic biology. This paper proposes herbal immunomodulators as effective adaptogens along with neuraminidase inhibitors for primary prevention. Finally, in our fight to control H1N1, there is a golden opportunity to bring these different systems together.

Epidermal Inclusion Cyst On The Right Thumb In A 10 Year Old Boy: An Unusual Location

Ghritlaharey R K , Shrivastava J

HbA1C: What is its place in the Indian Scenario?

Shah V *

WHO Medicines Bookshelf Version 5.0: A review

SHANKAR PR, BAJRACHARYA O

Development Of A Micro Glucose Bulb For Plasma Glucose Assay In Two Drops Of Blood

SARKAR GN*, GULKOTWAR SN**, SORTE KG***, BASAK A****

We have devised a Micro-glucose bulb, where two drops of blood are collected by finger prick. After standing for 20 minutes, 10uL plasma can be collected by micropipette from bulb without centrifugation. The amount of plasma is sufficient for glucose estimation in 1000uL of glucose oxidase-peroxidase based reagent and absorbance can be read by a colorimeter. This procedure of blood collection has been compared with that of classical procedure for glucose estimation. Regression analysis gave the equation of y = 1.008 + 0.248 and R value = 0.999. This validates the blood collection in Micro-glucose bulb. We routinely employ this method of blood collection in our hospital when only glucose is to be estimated in a patient. We also use this method during screening of Diabetes mellitus in Community. This method will be useful to developing countries for time saving and economic reasons.