Journal of clinical and diagnostic research

Meckel’s Diverticulum and Patent Vitello-Intestinal Duct in Children: A Review of 11 Years of Experience with 46 Cases

Rajendra K Ghritlaharey, K S Budhwani, Dhirendra K Shrivastava, Jyoti Srivastava

Aim: The aim of this study was to review the management of symptomatic Meckel’s diverticulum and patent vitello-intestinal duct (PVID) in children. Patients and Methods: This retrospective study included 46 children (39 boys and 7 girls) who underwent exploratory laparotomy for the management of symptomatic Meckel’s diverticulum and PVID between Jan 1, 2000 to Dec 31, 2010. Results: During last 11 years, 46 (39 boys and 7 girls) children were treated for symptomatic Meckel’s diverticulum and PVID under 12 years: 23 (50%) were infants, 5 (10.86%) were 1 to 5 years and 18 (39.13%) were 6 to 12 years of age. Majority n=28 (60.86%) presented with intestinal obstruction (including 5 cases of intussusception and 6 cases of PVID), followed by n=6 (13.04%) as perforation peritonitis, n=4 (8.69%) as lower gastrointestinal bleeding / melena, n=4 (8.69%) as umbilical discharge (PVID) and n=4 (8.69%) as incidental findings duringlaparotomy for others. Findings at laparotomy in order of frequency were: Meckel’s diverticulum with gangrenous bowel (n = 13), PVID (n=10) 4 had prolapsed ileum and 3 of them were gangrenous, Meckel’s diverticulum with bands (n=9), perforated Meckel’s diverticulum (n=6), diverticulitis / bleeding (n=4) and normal Meckel’s diverticulum / incidental findings (n=4). The surgical procedures done in order of frequency were: segmental resection of ileum containing Meckel’s diverticulum and ileo-ileal anastomosis n=25 (54.34%), diverticulectomy / wedge resection n=19 (41.30%), segmental resection and ileo-ascending anastomosis n=1 (2.17%) and segmental resection with an ileostomy n=1 (2.17%). The mortality following laparotomy done for Meckel’s and PVID was n= 4 (8.69%). Conclusions: Symptomatic Meckel’s diverticulum and PVID is also an important cause of acute abdomen / intestinal obstruction in infants and children and delay in seeking treatment is not only associated with morbidity but prone to mortality as well.

The Utilization of Library Services by Students in a Medical College

Objectives: To find out the extent of use and to identify the utilization of facilities other than books in the library, to discover the problems which are faced by the students and to suggest ways to improve the resources in the library. Methods: All the students studying for the 5th semester in the Department of Pharmacology were administered a pre-tested, structured questionnaire and the responses were obtained. Results: This study did not show any statistically significant gender difference, either in the mean number of visits per week [p = 0.968] or in the number of hours spent per visit [p = 0.77] As majority of the students stayed in hostels, restrictions in the hostel timings, particularly among the female students could have been a deterrent for studying late in the library.The observation that a large number of students either carried their own books to the library or supplemented the study with their own books and the indication by about 53% of the respondents that they did not always get the current editions of the books, suggests that there is a need to increase the availability of the commonly read text books. Conclusion: Though most of the students in this semester did utilize the library services, most of them seemed to be using the standard text books only, without making use of the other available facilities like medical journals and electronic media databases. There is also a need to improve the stock of commonly read books and to pay some more attention to the conveniences and the comforts in the library.

The Reactivation of the Cytomegalovirus (CMV) Infection in HIV Infected Patients

Basawaraju Anuradha, Mane Pratibha M., S. Vijayadurga

Background: CMV is a virus of paradoxes and can be a potential killer or a silent companion lifelong. The CMV infection in immunocompromised patients carries high morbidity and mortality. In most people with a fully functional immune system, an initial infection with CMV may cause a mild flu like illness and later the virus remains dormant. A damaged immune system permits CMV reactivation. The magnitude of this problem in India has not been adequately investigated and it is still a major health problem, warranting strong preventive measures. Aims: We planned to study the prevalence of the CMV infection, re infection and the reactivation of the CMV infection in persons who were infected with HIV and AIDS and to correlate the reactivation of this disease with the CD 4 cell count in these patients. Settings And Design: This study was planned on patients who attended the ICTC center and it was conducted over a period of six months. Methods And Material: This study was conducted on 94 patients who were reactive for the HIV1 and/or HIV2 antibodies. The serum samples were tested for the IgG and IgM antibodies which were directed against CMV by ELISA. Results: Among the 94 cases, IgG antibodies were detected in 84 (89.4%) and IgM in 10(10.6%) cases. Among the 84 IgG cases, 42 were males and 42 were females. The IgM antibodies were positive in 4 (9.52%) out the 42 cases of AIDS and in 6 (11.5%) out of the 52 seropositive healthy individuals. Statistics: Percentage and Chi square tests were applied. Conclusion: As there is a high seroprevalence of the CMV infection in HIV positive patients and as there is a reactivation of CMV in healthy and immuno suppressed HIV positive patients, the early diagnosis of the CMV IgM antibodies help in the early detection of the reactivation of the virus before the development of the clinical manifestations. They improve the survival and protect the patients from the development of end organ disease.

Antibiotic Prophylaxis during Extracorporeal Shock Wave Lithotripsy (ESWL) in the Prevention of Urinary Tract Infections in Patients with Sterile Urine before the Procedure

Behrouz Ghazimoghaddam, Hamidreza Tajari, Mahnaz Gholipoor, Morteza Balmehd

Introduction: There are controversies in the literature regarding the need and the duration of antibiotic prophylaxis in patients with extracorporeal shock wave lithotripsy (ESWL), who had a negative urine culture before the operation. This study was performed to evaluate the efficacy of the antibiotic prophylaxis in patients with proven sterile urine before they underwent ESWL. Materials and Methods: In this clinical trial, 150 patients with renal or urethral stones and sterile urine were examined for bacteriuria (positive urine culture) following ESWL. These patients were classified into 3 groups which received either asingle dose of oral co-trimoxazole (Tab, 400/80 mg)- group A, a single dose of nitrofurantoin (Tab:100mg) -group B and no treatment- group C. Patients were followed with urine analysis and urine culture after two weeks. Results: The occurrence of post-ESWL urinary infections (positive urine culture) was 14% in group A, 10% in group B and 14% in group C. The complications among the groups were not statistically significant. Conclusion: The incidence of urinary tract infections after ESWL is extremely low, provided that in patients who had sterile urine before ESWL, prophylaxis antibiotics do not seem to be necessary.

The Status of Trace Elements after Menopause: A Comparative Study

Naveenta Gupta, Khushdeep Singh Arora

Aim: The aim of this study was to determine the status of trace elements in postmenopausal females as compared to that in premenopausal females. Methods: 100 female subjects were studied, of which 50 were premenopausal (aged 30-40 years) and 50 were postmenopausal (aged 45-55 years, with a permanent cessation of menstruation for more than 1 year). The estimation of the serum levels of zinc (Zn), iron (Fe), copper (Cu), magnesium (Mg) and calcium (Ca) were done in both the groups. Results: On comparative evaluation, the serum Fe (p <0.05) and the serum Ca (p <0.001) levels were found to be significantly increased,while the serum Cu (p <0.05) and the serum Mg (p <0.05) levels were found to be significantly decreased in the postmenopausal females as compared to the levels in the premenopausal females. However, there was no significant difference in the levels of serum Zn in both the groups (p >0.05). Conclusion: Postmenopausal females are exposed to greater risk of serum biochemical changes as compared to the premenopausal females, thus leading to an increased risk of osteoporosis and cardiovascular diseases after menopause.

A Study of Cardiovascular Autonomic Functions in Congenitally Deaf Children with a Long QTC Interval

Surekharani Chinagudi, Shiddanna M. Patted, Anita Herur

Background: Congenitally deaf children are at a risk of cardiac abnormalities in the form of the Long QT syndrome. It can be because of an intracardiac abnormality or autonomic dysfunction. Aim: To study the cardiovascular autonomic functions in congenitally deaf children with a prolonged QTc interval. Material and Methods: Congenitally deaf children who were aged between 6-18 years and having a prolonged QTc interval on ECG were selected as the cases and were compared with matched controls. Children with conductive deafness or those having any cardiovascular disorder were excluded. The tests which were done were Heart rate variation during deep breathingHeart rate response to standing, blood pressure response to standing and blood pressure response to a sustained hand grip. Statistical analysis was done by using the unpaired t test. Results: No abnormal response was recorded in the cases or in the controls with respect to the above tests. The autonomic functions were normal. Conclusion: Since there are no abnormalities in the cardiovascular autonomic functions in the congenitally deaf children, the autonomic imbalance theory for the Long QT syndrome stands invalid. The aetiology goes more in favour of intracardiac abnormality which predisposes to the Long QT syndrome.

Evaluation of the Quality of Prescriptions with Antibiotics in the Government Hospitals of Yemen

Abdulkareem M. Al-Shami, Mohamed Izham M.I., Ahmed Abdo-Rabbo

Introduction: Irrational prescribing is a habit which is difficult to counteract and this may lead to ineffective treatment, health risks, patient non-compliance, drug wastage, wasting resources and needless expenditure. Objective: The aims of this study were to investigate the prescribing of antibiotics in Yemen and provide a baseline picture of prescribing habits. It presented an overview on the quality of prescribing and the resulting patterns coming from the prescriptions. Methods: The scope of the study was limited to four public quaternary health care facilities in Sana’a, Yemen. A prospective drug utilization review method was used in this study. Results: Results showed that the total number of brand name antibiotics prescribed was 76.8%, and 27.5% of the antibioticswere not on the Yemen Essential Drug List (YEDL). Out of all prescriptions, it was found that 51.0% contained antibiotics. Antibiotic prescriptions were lacking in many areas of important information: the diagnosis, patient’s name, gender and age as well as for the prescribed antibiotics information (strength, dosage form, dose, frequency and duration). The average number of antibiotics per each patient received was 1.2 ± 0.4 (median = 1) and the percentage of antibiotics prescribed as injections was 27.8%. Conclusion: The patterns which emerged in prescribing showed that there were various potential problems in antibiotic usage in the government quaternary hospitals in Yemen. Advocacy, education and awareness initiatives are required to alleviate these problems.

Cardiovascular Autonomic Function in Microalbuminuria

Sudhanva .S, Dhananjaya.J.R, Yathish.T.R, Mamatha.C.N

Background: Microalbuminuria (MA) has emerged as a risk factor for left ventricular hypertrophy, myocardial infarction, peripheral vascular diseases and retinopathy which is independent of blood pressure. Aim: The present study was designed to investigate the relationship between cardiovascular autonomic function and microalbuminuria. Methods: The study comprised of 200 male subjects of age group >50 years, who were classified into 2 groups of 100 subjects each. 1) Subjects with MA and 2) Age matched healthy controls without MA. The tests which were performed were 1) Heart rate response to deep breathing, Valsalva maneuover and standing. 2) Blood pressure response to standing and to asustained handgrip. Individual tests were given a score of 0, 1, or 2 and an overall autonomic test score of 0-10 was obtained. Results: The mean autonomic score in the controls and in subjects with MA were 5.73 ± 1.26 and 7.00 ± 1.80 respectively. The coefficient of variation (CV%) of the controls and the subjects with MA was 21.9 and 25.7 respectively. A significant difference in the autonomic score was observed in the subjects with MA (p<0.01) as compared to the controls. Conclusion: The impairment of the autonomic function leads to an increased renal blood flow, glomerular hyperfiltration, and sodium excretion, which accelerates its progression to microalbuminuria. In conclusion, individuals with microalbuminuria should be diagnosed early to minimize cardiovascular complications.

A Study Evaluating Lid Reconstructive Surgeries

SOMASHEKAR P. BIRADAR, SHILPA S. BIRADAR, Manjunath Kamath, Gurudutt Kamath

Background: Eyes are the most important aesthetic units in the human body. The increase in the number of patients who require reconstructive surgeries of the lid makes it imperative for the general ophthalmologists who have a limited experience in this field to acquire at least some knowledge about the basic principles of reconstructive surgeries. Aim of the Study: To study and evaluate the basic principles of lid reconstructive surgeries. Material and Methods: The study included 25 patients who attended the Department of Ophthalmology at KMC hospital, Mangalore. The study was conducted prospectively for a periodof 2 years. The patients who were included were those who were diagnosed to have Entropion, Ectropion, Ptosis and Lid tumours, in the age group of 10-69 yrs. After taking a brief history and after the clinical examination, the patients were operated. The pre-op, intra-op and post-op photographs were taken. Histopathological examination was done for concerned cases. The patients were followed up for 2 months. Results: Our study included a total of 25 patients who underwent lid surgeries. The commonest was ectropion with 8 (32%) cases, followed by entropion, lid tumours and ptosis. Conclusion: An attempt has been made to find out the effective surgeries for the various lid disorders.

Tortuous Vertebral Arteries-Incidence and Clinical Implications

POONAM, RAJAN K. SINGLA, M.S. RATHORE, NARESH JYOTI

Aim: The present study was aimed at investigating the incidence of the tortuosity of the vertebral artery in adult cadavers in order to offer useful data to anatomists, radiologists, endovascular interventionalists and surgeons. In addition, the literature was reviewed so as to enable a comparison of our results with those of previous studies and an analysis of the clinical implications which are related to these variations. Methods: Seventy cadavers were dissected to study the pathway which was carried by the prevertebral segment of 140 vertebral arteries. Result: A total of 31 vertebral arteries (22.1%) were showing the tortuous pathway in 25 cadavers (bilateral in six and unilateral in 19 cadavers single coil tortuosity in 26 and double coil in five vertebral arteries). Conclusions: The described variations in the pathway of the V1 segment of the vertebral artery have clinical implications in a wide field of pathologies in that region. Careful preoperative planning is essential in cases with tortuous vertebral arteries to avoid potentially life threatening complications.

Branching Pattern of the Posterior Cord of the Brachial Plexus: A Cadaveric Study

Priti Chaudhary, Rajan Singla, Gurdeep Kalsey, Kamal Arora

Anatomical variations in different parts of the brachial plexus have been described in humans by many authors, although these have not been extensively catalogued. These variations are of clinical significance for the surgeons, radiologists and the anatomists. In a study of 60 brachial plexuses which belonged to 30 cadavers (male:female ratio = 28:02 ) obtained from the Department of Anatomy, Govt. Medical College, Amritsar, the brachial plexuses were exposed as per the standard guidelines. The formation and the branching pattern of the posterior cord have been reported here. The upper subscapular, lower subscapular, thoracodorsal and the axillary nerves usually arise from the posterior cord of the brachial plexus. This normal branching pattern of the posterior cord was encountered in 52 (86.67%) limbs, the remaining 8 (13.33%) being variants in one form or the other. The upper subscapular nerve, the thoracodorsal nerve and the axillary nerve were seen to arise normally in 91.66%, 96.66% and 98.33% of the limbs respectively. The posterior division of the upper trunk being the parent of the variants of all these. The lower subscapular nerve had a normal origin in 96.66% of the limbs, with the axillary nerve being the parent in its variants, while the radial nerve had a normal origin in all of the limbs. Almost all the branches of the posterior cord emanated distally on the left side as compared to the right side. The present study on adult human cadavers was an essential prerequisite for the initial built up of the data base at the grass root level.

Serum Thyroxin Level during the First-Trimester of Pregnancy

Azad Reza Mansourian, Akhtar Saifi and Hady Reza Mansourian

Objective: The aim of this study was to assess the requirement of serum thyroxin levels during the early stage of the first trimester of pregnancy. Methodology: Serum thyroxin levels of 120 apparently healthy women were evaluated in Gorgan in northern Iran during 2007-08 by the enzyme linked immunosorbant assay (ELISA). Results: According to the reference intervals of our standard kit, 48% of the pregnant women in this study had elevated thyroxin levels. Conclusion: The findings of this study can be misleading, because it was based on the laboratory standard kit, women normal range, as general. Pregnant women require higher levels of thyroxin and therefore, a specific normal range for the first trimester of pregnancy should be established in each particular region.

A Rare Case of Takayasu’s Arteritis with Hyperthyroidism

Mohammed Ashraf, Sayyid M.K., R. Arunachalam, Anitha Sequeira, Veerendra H.K.

Both Takayasu’s arteritis and hyperthyroidism are of uncertain aetiologies. An autoimmune mechanism has been implicated in both these diseases. We had a patient who presented with both the diseases simultaneously. A 23 year old female patient was admitted with a history of generalised weakness and exertional breathlessness since 15 days. On physical examination, she was found to have pallor and absent pulses in the upper limbs. An early diastolic murmur with S3 was heard on cardiac examination. The diagnosis of aortic regurgitation (AR) with congestive cardiac failure (CCF) due to Takayasu’s arteritis was made. The blood investigations showed elevated ESR and C-reactive protein (CRP). 2DEcho showed global hypokinesia ultrasonography (USG) of the neck showed diffuse goiter. The thought field therapy (TFT) showed that thyroid stimulating hormone (TSH) was 0.01 ug/ml, T4 was 19.18 ug/ml and that TPO was normal but the thyroglobulin antibody levels were elevated (761 U). MDCT showed diffuse stenosis in the bilateral subclavian artery, an aberrant right subclavian artery, the narrowing of the left vertebral, celiac and superior mesenteric arteries and multiple chest wall and intra-abdominal collaterals. She was put on steroids, antithyroid drugs and antiplatelets. One and a half year later, she presented with renovascular hypertension (HTN), and her aortogram showed bilateral renal lesions also. She then underwent angioplasty of the right subclavian and both the renal arteries. She is presently under regular follow up and is doing well.

The Effect of Chemotherapy on the Pulmonary Function Tests in Cancer Patients with Healthy Lungs

avjot k. miglani, rajiv arora

Aim: The present study was aimed at determining the effect of chemotherapy on lung function tests. Material and Methods: This study was conducted on 35 cancer patients with healthy lungs, who undertook cancer chemotherapy. The pulmonary function test parameters, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1)and the FEV1/FVC ratio was recorded by using a computerized spirometer, Medspiror (Med Systems (P) Ltd.Chandigarh). Results: All parameters showed a significant decline in the patients after the 1st and 2nd cycles of chemotherapy, as compared to those prior to the chemotherapy. Conclusion: The present study confirms the fact that chemotherapeutic drugs have a toxic effect on lungs.

Is Small Group Teaching among the Under Graduate Dental Students Really Effective?

Background: Lecturing to a large group is the usual mode of teaching in most of the dental colleges in India. Only little research has been done to examine the effectiveness of the different teaching styles. Effective teaching is required to produce more efficient dentists and hence an effort was made to compare two different teaching styles among the dental students. Objective: To compare the effectiveness of large group lectures with small group teaching among the undergraduate students of pharmacology. Setting and Design: Department of Pharmacology, Kasturba Medical College, Mangalore. Randomized cross over design to cover two topics in pharmacology. Methods: Ninety seven students studying for the second year dental course were randomized into one large group and four small groups. Each group was taught two topics in pharmacologyeither by lectures to a large group or by the small group teaching method, with each group crossing over after the first session with the other topic. At the end of each class, the students were tested by using objective questions. Statistical Analysis: The mean marks of each group were compared by using the Student’s t test. Results: The mean marks of all the students in the four sub groups of group B, who were taught in small groups [BS = 43], 12.12 ± 2.2, P = 0.02, were found to be higher than the mean marks of the students in the large group A [AL]. The mean score of the four small groups of group A [AS = 44students], 12.30 ± 1.7, P = 0.01 was higher than that of group B in the large lecture group [BL]. Conclusion: The results of this study provide evidence that small group teaching is more effective and that it facilitates a better recollection of the topics than the large group lecture technique.

Comparison of the Use of Single and Combined Antibiotics for Head and Neck Onco-Surgeries: A Cost effective Analysis

SAPNA PATIL, KUMAR T.N., AZEEM MOHIYUDDIN

Back ground and Objectives:The use of prophylactic antibiotics in surgical treatment is well-established. However, the duration and the dosage of the prophylaxis vary substantially among the surgeons. Therefore, we intended to explore the differences in the cost efficiency in single and combined antibiotics as the prophylaxis for the surgical treatment of major head and neck onco-surgeries. Methods:50 patients of either gender with head and neck cancer, who were to undergo major surgeries were chosen. The perioperative antibiotic prophylaxis and the antibiotics which were used to treat the post operative wound infections were noted. The data on the drug costs were obtained and the cost analysis was performed by comparing the costs which were incurred on using a single antibiotic and combined antibiotics as the prophylaxis. The wound infection controlled days, the time taken for wound healing and the duration of the hospital stay were followed up. Results:22 subjects were on single antibiotic therapy and 28 were on combination therapy. Among those who were on singleantibiotic therapy and combined therapy, 11 (50%) and 7 (25%) had post operative wound infections respectively. The Mean ± SD of the cost which was incurred on using a single antibiotic as the prophylaxis was lesser than (803.15 ± 1104.56 rupees) that which was incurred on using combined antibiotics, i.e 1524.29 ±1468.28 rupees. But, the total cost (for the prophylaxis and the post operatively used antibiotics) had no significant difference between the groups, which used a single antibiotic and combined antibiotic prophylaxis. Among the patients who developed post op infections either with the single antibiotic or with combined antibiotic use, the prophylaxis did not show a significant difference in the total cost which was incurred. Also, it did not make a significant difference in the means of the time which was taken for wound healing. erpretation and Conclusion:There is no significant difference in the total cost which was incurred on using either a single antibiotic or combined antibiotics as the prophylaxis, due to the increased post operative infections in patients who used a single antibiotic as the prophylaxis.

Influence of Associated Factors in the Prevalence of Asthma: A Community Based Study in Mysore

Shivani Rao, Shalinee Rao, N.C. Ashok, Timsi Jain, Anuradha R., Murali Dhar

Background: Asthma, with an upward surge world-wide has become a chronic disease that needs more attention. Although a uniform increase has been depicted, statistics show regional differences with respect to its prevalence in India and in different parts of the world. Aim and Objectives: This study was conducted to estimate the prevalence of known asthmatics in the rural versus urban population of Mysore, India and to identify the factors associated with its prevalence. Material and Methods: This was a community based, crosssectional study conducted over a period of 6 months in the rural and urban practice area of JSS Medical College, Mysore, India, to include the total population around two primary health centres ( Hadinaru and Suttur) and one urban health centre. The data was collected by trained interns from each household by using a pretested proforma with a questionnaire. The results were subjected to statistical analysis by using the SPSS 12 and Epi info softwares. Results: A total of 23280 rural subjects were studied, of which 273 were known cases of asthma. Out of 6218 urban subjects, 76 were diagnosed as asthmatics, thus showing a prevalence rate of 1.2% in both the groups. There was a significant association between the occurrence of asthma and age in the rural and urban areas. A statistical association was seen among the asthma cases in the male gender (p < 0.5). A high prevalence of asthma was seen among cigarette smokers in both the rural (4.0%) and urban (3.5%) areas. A significant association was observed between asthma and tobacco usage. Conclusion: In order to attain a better quality of life in a chronic disease condition like asthma, one needs to be aware of its aggravating factors. The identification of the preventable exacerbating factors of asthma would help in designing control programmes to invoke the awareness on such aspects. Such a study would help in understanding the disease burden, in order to initiate health measures at a community level.

The Significance of the Secretory Immunoglogulin A to Gardnerella vaginalis in the Pathogenesis and Diagnosis of Bacterial Vaginosis

Udayalaxmi, Gopalkrishna Bhat, Subannayya Kotigadde

Background: Although bacterial vaginosis is prevalent, not much progress has occurred in identifying the factors which are responsible and are associated with bacterial vaginosis and its pathophysiology. Studies on the development of better methods for the diagnosis of bacterial vaginosis are still on. Objective: To estimate the levels of secretory immunoglobulin A (sIgA) antibodies against G.vaginalis in vaginal discharge and its correlation with the clinical condition. Materials and Methods: We developed an indirect ELISA by using whole cell antigen to detect sIgA antibodies against G.vaginalis in vaginal washings which were collected from 170 women who attended two hospitals in south India for antenatal care or any other complaint. The women were categorised into bacterial vaginosis, intermediate and normal by using Nugent’s criteria. Statistical analysis was done by using the Chi- Square test, analysis of variance and Scheffe’s multiple range tests, as appropriate. Results: Of the 170 women under study, 42 were cases of bacterial vaginosis, 30 had intermediate flora and 98 were normal women. Of the 42 women with bacterial vaginosis, 16 (38%) showed a significantly high titre and 26 (62%) had low titre. Of the 30 women with intermediate flora, 10 (33.3%) showed a significantly high titre and 20 (66.7%) had low titres of the 98 women with normal flora, 84 (85.7%) showed low titres and 14 (14.3%) showed high titres of sIgA antibodies against G.vaginalis. The results of the ELISA test correlated statistically with the cases of bacterial vaginosis when analysed by Chi-Square test (p < 0.05). Analysis of variance showed that there was significant variation (p < 0.05) between the titers of sIgA antibodies detected in the women categorised by Nugent’s criteria. Conclusion: All the women with bacterial vaginosis or with intermediate flora do not show significant titres of sIgA antibodies to G.vaginalis. So, the detection of sIgA to G.vaginalis in the vaginal discharge cannot be used as a means for the diagnosis of bacterial vaginosis.

Hepatitis B or Hepatitis C: The Bigger Threat in Multiple Infected HIV Positive Blood Donors

Neha Agarwal, Usha Dubey, Asha Agarwal, Riddhi Jaiswal

Aim: To study the prevalence of hepatobiliary co-infections – Hepatitis B (HBV) and Hepatitis C (HCV) in Human Immunodeficiency Virus (HIV) positive voluntary and replacement blood donors in the blood bank of a tertiary health care centre. Methods: 2,48,387 donors were screened for HIV, HBV and HCV co-infections from 1999 to 2010 by using commercially available ELISA kits. Results: The results were as follows: • The total number of donors who were studied from 1999 to 2010 – 2,48,387 • HIV positive cases – 273 (0.11%)The HCV co-infection was detected in 30/273 (10.99%) HIV positive donors, while the HBV co-infection was found in 6/273 (2.19%) donors. 5/273 (1.83%) HIV positive donors tested positive for both HBV and HCV. Conclusion: The implication of HCV and/or HBV co-infection in apparently healthy HIV positive blood donors is of utmost importance as they mostly lie within the reproductive age group of 21-40 years. The knowledge of the co-infection in such cases is vital due to the increased risk of the sexual and perinatal transmission of the hepatitis virus along with increased hepatotoxicity with antiretroviral therapy and rapid progression to cirrhosis and hepatocellular carcinoma.

Fine Needle Aspiration Cytology of Intra-Abdominal Lesions

SIDHALINGREDDY, SAINATH K. ANDOLA

Background: Intra-abdominal masses always remain as an enigma in surgical practice. A documentary evidence of the nature of the pathology before the institution of therapy and for the prognosis is mandatory. FNAC is a substitute for surgical procedures like diagnostic laparotomy. Aims: To assess the utility of FNAC in the diagnosis of intraabdominal lesions. Objectives: To study the cytomorphological features, age and sex distribution of intra-abdominal lesions and to categorize them organwise and as inflammatory, benign and malignant lesions. To classify the malignant lesions according to their cell type. To evaluate the sensitivity, specificity and diagnostic accuracy. Materials and Methods: The study included 245 intra-abdominal lesions which were detected clinically or radiologically. The lesions were divided clinically into palpable and non-palpablelumps. USG or CT were used for all the non-palpable lesions and for a few palpable lesions and direct in selected palpable lesions. Giemsa’s and Papanicolaou’s stains were used. Results: The mean age was 45.16 years, with M:F of 1:1.3. The diagnostic yield was 92.1% in USG guided, 100% in CT guided and 95% in direct aspiration. There were 148 (60.3%) malignant, 55 (22.4%) benign, 25 (10.2%) inflammatory and one (0.6%) suspicious lesions and 16 (6.5%) unsatisfactory smears. The liver and the ovary were the most common sites . Adenocarcinomas and hepatocellular carcinomas were the most common malignant lesions. This study showed 94.1% sensitivity, 100% specificity, 100% positive predictive value, 92.3% negative predictive value and 96.5% diagnostic accuracy . Conclusion: Intra-abdominal FNA is a simple, economical and a safe procedure with high sensitivity, specificity and diagnostic accuracy and it can be utilized as a pre-operative procedure for the management of intra-abdominal lesions.

Comparison between the QCT and the DEXA Scanners in the Evaluation of BMD in the Lumbar Spine

Introduction: Both QCT and DEXA scanners are being used for determination of BMD in lumbar spine in the diagnosis of osteoporosis. But till now, no consensus has been reached that out of QCT or DEXA scanner which modality is most efficacious in the diagnosis of osteoporosis. Objectives: To evaluate BMD in lumbar spine of the same subjects under similar conditions both by QCT and DEXA scanners on the same day and to compare their findings in evaluating these subjects as osteoporotic, osteopenic or normal. Materials and Methods: In this cross sectional study a population of 165 subjects both male and female which included 37 young healthy volunteers, 46 post menopausal females, 32 elderly patients above 65 years of age, 15 patients between 40- 65 years of age and 35 patients on steroid therapy for more than 6 months period underwent bone densitometry both by QCT and DEXA scanners. Light Speed Plus CT scanner of GE and DEXA scanner Norland XR 46 were used for measurement of BMD and accordingly, these subjects were diagnosed as osteoporotic, osteopenic and normal on the basis of WHO defined criteria of T score. Results: In the present study QCT has diagnosed more cases of osteoporosis (both osteopenic and osteoporotic) as compared to DEXA lateral and DEXA AP in the total population as well as in females and males separately. In the total population, 67.3% (111) cases were diagnosed for osteoporosis by QCT as compared to 46.7% (77) and 49.7% (82) cases by DEXA lateral and DEXA AP respectively. In females, 75.8% (97) cases were diagnosed for osteoporosis by QCT as compared to 52.3% (67) each by DEXA lateral & DEXA AP. Similarly in males 37.8% (14) cases were diagnosed for osteoporosis by QCT as compared to 27% (10 ) cases by DEXA lateral and 40.6% (15 ) cases by DEXA AP. Conclusion: Both the modalities confirm the direct correlation between age and osteoporosis, as with increasing age the risk of prevalence of osteoporosis increased across all age groups. But QCT has been found to be more efficacious than DEXA scan in the diagnosis of osteoporosis i.e. QCT helps discriminate between normal subjects and those with osteoporosis better than DEXA-lateral and DEXA-AP.

Patients’ Satisfaction with Medical Services in the Qassim Area

Yousef Hamoud Aldebasi, Mohamed Issa Ahmed

Background: The important goals of hospitals are to deliver high quality health services and to respond to the needs of the patients. Patient satisfaction is one of the most sensitive indicators of the quality of their services as it measures the gap between what is expected and ideal from one side and what actually exists in reality. Objective: To determine the level of the patient’s satisfaction with the medical services and the delivery of those services. Methodology: Overall, 500 patients were selected from five different superspeciality hospitals of the Qassim region and they were analyzed by using a predesigned, prestructured and a self explained questionnaire during September 2009 to February 2010. The results were analyzed by using the SPSS software. Results: A majority of the patients (50%) were satisfied with the skills of the doctors in the form of the provision of medical servicesand almost most of them agreed with the good infrastructure of the medical clinics. 41% of the total patients felt that the medical services which were provided at the hospitals were quick and 46% found that the overall standard of the medical services was good. 42% of the patients were satisfied with the medical services in general, while 14% were strongly satisfied. 27% of the patients felt that the doctors ignored them at some point of time and 36% believed that the doctors did not provide enough time to the patients. Conclusion: In general, the provision of the medical services at various hospitals are satisfactory, but still, improvement in the form of the provision of laboratory services in time and providing enough time to the patients by solving their queries and at the same time, maintaining a satisfactory rapport between the physician and the patient is needed.

Human Calcaneal Facets for the Talus: Patterns and Clinical Implications

Muthukumaravel N., Ravichandran D., Melani Rajendran S.

Background and Objectives: Calcanei with certain talar facet patterns predispose to subtalar arthritis. Knowledge about variations in the talar facets of the calcanei is essential for orthopaedic surgeons while correcting foot deformities like pes planus. This study was undertaken after finding a scarcity of such data in the South Indian population. The objective was to identify the patterns of the talar facets of calcanei and their clinical implications. Methods: Calcanei (n = 237) from the southern part of India were utilized. The literature describes five patterns of calcaneal facets for the talus. Pattern III (absent anterior facet) was not found in the present study. Only four patterns were described as follows: Pattern I: Fusion of the middle and the anterior facets, Pattern II:The middle and the anterior facets separate, Pattern IV: Fusion of all the three facets, Pattern V: Fusion of the middle and the posterior facets. Results: Pattern I was predominant (65.82%), followed by Pattern II in 33.33% of the bones. In the Pattern II, the subtype A with less than 5mm separation was the commonest. Rare cases of pattern IV and pattern V were found in 0.42% of the cases in each type. Interpretation and Conclusion: There is a dominance of pattern I calcanei in Indians as compared to the Europeans who present pattern II commonly. This fact necessitates the orthopaedic surgeons in India to modify the surgical techniques when they perform calcaneal osteotomy. South Indians may be at a greater risk of developing subtalar arthritis due to the dominance of Pattern I calcanei.

Compliance and Adverse drug Effects of Antihypertensives in Rural India

sunil kale, ameeta patil, r.h. mandlecha

Background: Hypertension is the most prevalent health problem among adult primary care patients, but its recognition and treatment are suboptimal. Adherence and persistence have been studied in patients of hypertension in this study. Material and Methods: 491 patients suffering from hypertension and coming to the OPD of a rural medical hospital in Loni were examined in a prospective study over a year after giving the prescribed antihypertensive medication from Oct 2004 to May 2006. Results: A decrease in blood pressure was observed in patients treated with one pill per day as compared to patients being treated with two and three pills per day. Compliance was significantly better in patients in combination therapy as compared to monotherapy. Cost is an important determinant in deciding compliance. Conclusion: Low dose combination therapy is more effective and is well tolerated than high dose monotherapy. Moreover, the incidence of ADR was observed to be significantly lower with low dose combination therapy in addition to better compliance.

The Prevalence of the Gastro Oesophageal Reflux Disease in Asthmatics

Background: Asthma and Gastro Oesophageal Reflux Disease (GERD) often coexist. The prevalence of GERD is estimated to be around 30-80% among asthmatics. GERD may worsen during an episode of airway obstruction and could also serve as a trigger for such an attack. The proposed mechanisms of GERD induced asthma include a vagally mediated reflex, micro aspiration and altered immune activity. As only limited information is available regarding its prevalence in asthmatics in developing countries such as India, this study was undertaken. Aim of the Study: To estimate the prevalence of GERD in adult asthmatics Settings and Design: This cross sectional study was conducted among asthmatics who were recruited from a tertiary centre in Chennai. Methods and Material: This study was conducted among 86 asthmatics which included both males and females in the age group of 20-65 years. Known asthmatics who were diagnosed to be asthmatics at least a year ago, were included in the study. Smokers, subjects with a history of chronic obstructive pulmonary disease, tuberculosis, gastro intestinal malignancies and pregnantwomen were excluded from the study. A structured questionnaire was administered and GERD was determined if they had the typical clinical symptoms such as postprandial chest pain, heart burn, nausea and sour regurgitation. Statistical Analysis Used: The data was analyzed by using the SPSS software. The prevalence rate was expressed in terms of percentage. Results: The overall prevalence of GERD in asthmatics was 51.1%. The prevalence of GERD was higher in female asthmatics as compared to that in men. (56% vs 46%) The prevalence of GERD was higher in younger individuals as compared to that in the elderly. Conclusion: This study has quantified the prevalence of GERD in individuals with asthma, and it has contributed to our understanding about the association between these two diseases. This study can be used to estimate the burden of GERD among asthmatics. Whether it is asthma that precedes GERD or whether it is GERD that precedes asthma has to be explored. This study stresses the need for patients with asthma to be evaluated for gastroesophageal reflux and to be treated with aggressive antireflux therapy to reduce the morbidity.

Radiological Changes in the Hands and Feet of Leprosy Patients with Deformitie

Ankad Balachandra S., Hombal A., Rao Sudhakar, Naidu Varna M.

Context: Leprosy is a social disease and it is perceived in the society due to deformities. Bone changes are common in leprosy. Aim: To study the radiological changes in the hands and feet in leprosy patients with deformities. Settings and Design: This was an observational study done in the Department of Dermatology. Methods and Material: This study was carried out for 24 months and it included 50 leprosy patients who were associated with deformities. The radiological changes were studied by taking roentgenograms (X-rays) of the hands and feet. Statistical Analysis Used: The statistical analysis of the descriptive data, that included the number and percentages, was done for all the categories. Results: Among 50 patients (34 males and 16 females) overall, the radiological changes were seen in 48 patients. The radiological changes found were specific, nonspecific and osteoporotic in 31, 48 and 27 patients respectively. Only 2 patients did not show any bone changes. Male patients, especially manual labourers, showed more bone changes. There was no significant difference in the bone changes among the various types of leprosy. Conclusions: Though leprosy is an ancient disease, it still continues to be the most feared, due to deformities. The bone changes with deformities are preventable, since all these are not due to the disease itself. The study of the radiological changes may help the clinician in formulating methods for the management of the disease and in preventing the permanent loss of function and the occurrence of deformities and disabilities.

Regression Equation for Estimation of Length of Humerus from its Segments: A South Indian Population Study

K. Udhaya, K.V. Sarala Devi, J. Sridhar

Introduction: The aim of the present study was to estimate the length of the humerus from the measurements of proximal and distal segments of humerus in South Indian population using regression equation. This becomes essential for archaeologists, anthropologists and forensic investigators, even when a fragment of bone is available. The current study was therefore focussed on proximal and distal segments of humerus and using their measurements, the length of the humerus was estimated. Methods: A total of 170 humeri, 82 right and 88 left were used for our analysis. Maximum length of humerus, vertical and transverse diameter of proximal segment, transverse diameter and biepicondylar width of distal segment were measured using anthropometric techniques. Results: With the measurements obtained descriptive statistics, linear regressions and regression equations for both sides were derived to estimate the length of the humerus in South Indian population. In the right humeri, multiple linear regression of vertical diameter of superior articular surface alone showed significant changes in maximum humeral length contributing up to 78%. In the left humeri, multiple linear regressions of vertical diameter of superior articular surface as well as transverse diameter of inferior articular surface showed significant changes in maximum humeral length ( P<0.01). Conclusion: The result of our study concludes that the length of the humerus can be estimated from the measures of proximal and distal segments of humerus of both sides.

A Study on Genital Fixed Drug Eruption in a Tertiary Care Hospital

Sanjay Kumar Kanodia, Amoolya K. Seth, Shailja Ratan Shukla

Background: Genital fixed drug eruption (FDE) present as single oval lesion, most commonly over glans penis and are many times wrongly diagnosed and treated as sexually transmitted diseases. Objectives: The aim of this study was to present a series of cases of genital lesions with fixed drug eruptions, diagnose the suspected drug and identify the change in pattern of drugs causing them. Methods and Material: Patients with the genital FDE were interviewed for onset and duration the disease with history of all drugs taken and a list of suspected drugs was made for each patient. Rechallenge test (oral provocation test) was done for the suspected drug with a quarter of a single therapeutic dose, followed if necessary, by a step-wise increase to one half, one full and double of a dose for subsequent days. A definiteerythema at or around the existing lesion was considered as positive provocation test. Results: Thirty eight cases (35 males and 3 females) were enrolled in the study with clinical diagnosis of FDE. The lesions were most commonly present on the glans penis (68.42%) as hyperpigmented macule (47.36%) accompanied with pruritus (71.05%), burning (55.26%) and pain sensation (28.94%). Oral rechallenge test showed positive result in 29 cases with nimesulide (35.29%) as the most common offending drug followed by fluconazole (25.52%) and tetracycline (14.70%). Conclusion: The study emphasizes the changing trend of genital FDE and the importance of oral provocation test for diagnosing genital fixed drug eruptions. The findings in this study is in contrast to the previous studies which showed antimicrobials (tetracyclines) as the commonest cause of genital FDE’s.

The Perceptions Regarding Refractive Errors and Their Psychosocial Impact on Youth in Dakshina Kannada

Sheetal Savur

The prevalence of refractive errors especially amongst children has been commonly studied. The psychosocial impact of spectacle use in youth has seldom been studied. Our purpose was to study the perceptions of refractive errors and to investigate their psychosocial effect on youth. A descriptive questionnaire based study was conducted on unmarried youth in the age group of 18-25 years over a period of two months. The questionnaire elicited details like demography, various other modalities which were used by the respondents for the correction of the refractive errors, their perception about wearing spectacles and the psychosocial problems which they faced. Despite a high level of education, the perceptions regarding the refractive errors varied, with a large number of people having wrong perceptions and attitudes towards refractive errors especially towards spectacle use, which resulted in psychological distress. The dissemination of information about the refractive errors through the right medium will help in dispelling the misconceptions and distorted facts.

The APACHE II Score and Mortality in Relation to Hypocalcaemia in Critically Ill Patients

Background: Electrolyte imbalance is commonly seen in the intensive care unit (ICU) patients. Hypocalcaemia is one of the most common electrolyte deficiencies found in these patients. Methods: This study was conducted on 110 critically ill patients who were admitted to the ICU (71 males and 39 females). The patients were classified into two groups, group I (patients expired) and group II (patients completely recovered). We further subclassified the patients, based on the APACHE II score into three groups as group A (APACHE II score <15), group B (APACHE II score 15-25) and group C (APACHE II score >25). The serum calcium, magnesium and albumin levels were determined byusing a clinical chemistry auto analyzer. Corrected calcium was calculated by using formula. Type of study: Prospective/Retrospective. Results: There was a significant decrease in the calcium and the corrected calcium levels in the group I patients as compared to those in group II (p<0.05). There was significant hypocalcaemia in the group C patients as compared to the group A and group B patients (p<0.01). The calcium levels correlated negatively with the APACHE II score. Conclusions: There is a direct correlation between hypocalcaemia and mortality in the critically ill patients. Hypocalcaemia and the APACHE II score were negatively correlated.

A Comparative Study of Pseudocholinesterase and Liver Function Test in Cirrhosis of Liver, Infective Hepatitis and Obstructive Jaundice: A Case Control Study

S. Venkata Rao, V.S. Ravi Kiran, S. Indira

ectives:docholinesterase is a non-specific cholinesterase found in the blood plasma and may be reduced in patients with advanced liver disease. A comparative study of Pseudocholinesterase along with other liver function test parameters were undertaken in different liver disorders. The aim of the present was to investigate Pseudocholinesterase as a probable diagnostic marker in different liver disorders. MethodsA Totle25 age and sex matched healthy controls and 25 patients each from cirrhosis of liver, infective hepatitis and obstructive jaundice were included in the study. Plasma Pseudocholinesterase and other liver function test parameters were estimated in all the subjects. ANOVA statistics was used. Results: Pseudocholinesterase level was significantly decreased in the order of control (mean ± SD = 7.34400 ± 2.29875) > obstructive jaundice (mean ± SD = 3.23600 ± 0.61161) > infective hepatitis (mean ± SD = 2.27600 ± 0.63527) > cirrhosis of liver (mean ± SD = 1.85200 ± 0.27226) respectively. The difference in the means was statistically significant as p = 0.0000001. Conclusions: Our study showed a significant decrease in Pseudocholinesterase level in cirrhosis of liver than infective hepatitis and obstructive jaundice. The results indicated that with more severe liver cell destruction, reduction and disease, there was corresponding significant decrease in the level of Pseudocholinesterase and could be used as diagnostic marker of liver disease.

Prevalence and Risk Factors of Hepatitis C among Maintenance Hemodialysis Patients at a Tertiary-Care Hospital in Coimbatore, India

ABSTRACT Background: Haemodialysis (HD) patients are at an increased risk of Hepatitis C virus (HCV) infection, which is significantly associated with increased morbidity and mortality. This study was conducted to determine the prevalence of HCV infection among patients who were put on maintenance HD and its associated risk factors. Methods: A total of 145 patients (102 males and 43 females) were included in the study. The medical records were reviewed for details regarding history, age, sex, duration of dialysis, dialyzer reuse, blood transfusions, number of dialysis centers and other biochemical data. Results: Out of 145 patients 18 (12.4%) patients were found to be anti-HCV positive. The mean age of the HCV positive patients was 45.8 ± 13.9 years. There were 13 (72.2%) males in the HCVpositive group and 89 (70.1%) males in the HCV negative group. The mean duration of the dialysis among HCV positive group was 36.6 ± 31.6 months, while it was 18.5 ± 21.2 months for HCV negative ones. The duration of dialysis was significantly longer in HCV positive patients (p = 0.002). Similarly, patients who had dialysis at more than one centre had a higher (55.56%) positivity, which was statistically significant (p = 0.001). Binary logistic regression analysis showed that the duration of dialysis and dialysis at more than one centre were the significant variables for increased positivity. Conclusion: The patients on HD had 12.4% positivity for anti- HCV in our dialysis unit. Further, the present study demonstrated that the duration of haemodialysis and getting the dialysis done at more than one centre were the important risk factors for acquiring HCV infection in these patients.

The Value of the Indian Diabetes Risk Score as a Tool for Reducing the Risk of Diabetes among Indian Medical Students

Introduction: Diabetes Prevention Programme (DPP), LOOK AHEAD trial, Indian Diabetes Prevention Programme have clearly established the benefits of lifestyle interventions coupled with education in reducing diabetes and CVD risk We conducted a study on the effect MDRF-Indian Diabetes Risk Score as a motivational tool for lifestyle change with special reference to physical activity and caloric intake among medical students. Materials and Methods: The study was conducted on 150 medical students who were given their IDRS scores and laboratory values of Fasting plasm glucose and fasting lipid profile. IDRS was recalculated after 6 months. Change in total caloric intake, duration of exercise, pedometer counts and waist circumferencewere recorded before and after giving them their lab reports and risk score. Results: After conveying the IDRS and lab reports, there was a significant decline in IDRS (from 36+ 10 to 31.2 + 11), waist circumference (85.4 + 7.4 cm to 84.1 + 7.2), caloric intake (from 1994 + 154 calories to 1817 + 152 ), physical inactivity score in IDRS (from 26 + 4.7 to 21 + 3.6) with increase in pedometer counts from 4628 + 432 to 9410 + 264. Conclusion: Calculating diabetes risk by using MDRF-IDRS improved physical activity, decreased caloric intake and waist circumference significantly among medical students and is a useful motivational tool for lifestyle change.

Correlation between Clinico-pathological and Ultrasonographical Findings in Hysterectomy

Thamilselvi Ramachandran, Pammy Sinha, Subramanium

Introduction: Hysterectomy is the most commonly performed gynaecological surgery throughout the world. Total abdominal hysterectomy is the procedure of choice in conditions other than uterovaginal prolapse. Menorrhagia is the most common clinical symptom which is seen in the pre and the perimenopausal age group. All perimenopausal women with persistent abnormal uterine bleeding should be evaluated for the presence of endometrial hyperplasia or carcinoma by ultrasound or biopsy. Objectives: To identify the most common pathology in hysterectomy specimens To correlate the clinical diagnosis and ultrasonographical findings with histopathological diagnosis. Materials and Methods: Ours was a retrospective study analysis of hysterectomy cases, over a period of one year from Jan 2010 to Dec 2010 in the Department of Pathology, Vinayaka Mission’s Kirubananda Variyar Medical College. The patients also underwent pelvic and transvaginal ultrasonography. Ninety eight percent of the hysterectomies were done for benign indications. Results: The total number of hysterectomy specimens received were 234. The peak age of the patients was 31–40 years. A high incidence of the disease was seen in multiparous. In our study, 171 patients underwent pelvic ultrasound and transvaginal ultrasound, especially those who were in the peri and postmenopausal age group. Ultrasound detected 100% malignancy, 95% fibroids and 80% in adenomyosis. The commonest indication for transabdominal hysterectomy was fibroids in 30.7% of the cases. The most common pathology which was identified was leiomyoma followed by adenomyosis. Conclusion: This study confirmed that benign diseases were more common in hysterectomy specimens than in their malignant counterparts. Out of the clinical diagnosis, ultrasonographical findings and histopathological diagnosis, histopathological diagnosis was found to be the gold standard to ensure the final diagnosis as the management of the malignant disease varied in the benign and malignant diseases.

Clinical and Radiological Co-relation of Posterior Circulation Stroke in a Tertiary Care Centre in Southern India

Kora S.A, Pramila Devi, Sangamesh Malgi, Biradar Satish, Mahesh Ugale

Aim & Introduction: The present study has been undertaken at a tertiary care centre in rural India to know about the Clinical and Radiological (CT Scan) co-relation of Posterior Circulation Stroke as CT Scan is cheaper, easily available and faster compared to MRI. Material And Methods: A total number of 25 cases were studied during the period from Jan 2010 to Dec 2010, from among those who were admitted to department of Medicine and Neurology in S.Nijalingappa Medical College and HSK Hospital & Research Center. Detailed clinical history was taken in all patients with general physical examination, CBC, urine analysis, random blood sugar,blood urea, serum electrolytes, lipid profile, ECG, CXR, and CT scan were done. In some selected cases CSF analysis, EEG and ECHO were done. Results & Conclusion: Infra tentorial infarcts (83.3%) were seen more frequently than supra tentorial infarcts (16.6%) in this study. CT scan was 100% positive in supra tentorial ischemic strokes and in both infra & supra tentorial hemorrhage. CT scan was only 43% positive in cases of infra tentorial ischemic infarct especially in brain stem infarct. To summarize we recommend CT scan is the first option in critically ill, poor rural Indian population.

Candida Speciation Using Chrom Agar

Vijaya D., Harsha T.R., Nagaratnamma T.

Introduction: CHROM agar for speciation of Candida is a differential culture medium which facilitates the isolation and identification of some clinically important species. Materials and Methods: A total of 102 Candida species were isolated from various clinical specimens (100) including stool, sputum, nasal, oral, ear swabs, diabetic foot, skin and nail scrapings. Speciation of Candida was done using CHROM agar and conventional method simultaneously. Observations: Non albicans candida (NAC) predominated (54.1%) over Candida albicans (45.9%). Non albicans candida spp isolated were C.tropicalis (35.29%), C.krusei (10.78%), C.parapsilosis (7.84%), and C. dubliniensis (0.9%). Antifungal susceptibility testing was done using antimycotic sensitivity testing by disc diffusion method. Isolates were 100% sensitive toketoconazole, clotrimazole, nystatin and amphotericin B. 87.5% of C.krusei, 36% C.tropicalis, 6.25% ,C. albicans were resistant to itraconazole. 25% C.krusei and 8% C.tropicalis were resistant of fluconazole. C.dubliniensis was resistant to itraconozole only. Conclusion:The advantage of using CHROM agar is that it facilitates the isolation and identification of Candida to species level. The performance of CHROM agar exactly paralleled that of conventional methods. Use of this medium is rapid, technically simple and cost effective compared to time consuming technically demanding expensive conventional method. CHRO Magar serves as a primary isolation and differentiation medium for clinical specimens that could allow mycology laboratories to rapidly identify Candida spp, enabling clinicians to choose appropriate antifungal agents,thus decreasing patients morbidity and mortality.

Endometrioid Carcinoma of the Ovary and Uterus: Synchronous Primaries or Metastasis: A Case Report

Synchronous endometrioid carcinoma of the uterine corpus and ovary is an uncommon but well known phenomenon. Such cases may represent either two primary tumours or a single primary and associated metastasis. There are significant clinical implications with either diagnosis. We present a case of a 48 year old unmarried women who came to our hospital with Right ovarian mass measuring 13cm. Total abdominal hysterectomy with bilateral salphingoopherectomy was done. Histological examination showed well differentiated endometrioid ovarian cancer and well differentiated endometrioid endometrial cancer with squamous differentiation and metastasis of the endometrial cancer to the cervix. Patients with synchronous endometroid tumours of the endometrium and ovary are generally younger,tend to be of low grade and the prognosis of endometrioid type carcinoma is better than other histological types of carcinoma. Immunohistochemistry plays an important role to differentiate single primary with metastasis and dual primaries especially at places with limited resources.

Traumatic Perforation of Meckel’s Diverticulum Following a Bull Gore Injury

S.R. Telkar, B.V. Goudar, Y.P. Lamani, R. Koppal, U. Ambi

In abdominal trauma following a penetrating and blunt injury, diagnostic laparoscopy can improve the accuracy of the diagnosis and the management. A case has been reported here, of a 55 year old man admitted following a penetrating injury in the abdomen by bull goring, over the left groin. Following diagnostic laparoscopy, a perforation in the Meckel’s diverticulum was found incidentally and it was resected following an open procedure, due to peritoneal contamination and the late presentation of the patient to the hospital. Feeding jejunostomy was done following resection of the Meckel’s diverticulum for proximal drainage and later, for feeding purposes. Diagnostic laparoscopy plays a major role in the diagnosis and the further management of any abdominal injury.

Handlebar Hernias: Case Reports of Rare Traumatic Abdominal Wall Hernias

Ramesh B. Hatti, Suresh I. Basarkod, Vishwanath G., Vrushab Patil

Abdominal wall hernias caused by direct trauma from handlebar-like objects,are therefore called handlebar hernias, are a rare occurrence. There have been few reports in the literature of traumatic trans-rectus herniation (1). The presentation can vary substantially and the diagnosis is difficult.

Symmetric Diffuse Lipomatosis of the Thyroid Gland

Vijay D. Dombale, Anita P. Javalgi, Kalburgi

Diffuse lipomatosis is a benign lesion of the thyroid gland with very few cases being documented in the literature. We present a case of a 62 yr old male who presented with a midline neck swelling of 6 months duration and respiratory stridor since few days. After the clinical examination, a provisional diagnosis of nodular goitre was made and the patient was sent for cytological study. Fine needle aspiration cytology studies reported it as a benign follicular epithelial lesion. A near total thyroidectomy was done and the specimen was sent for histopathological studies. Multiple sections from both the lobes revealed the diffuse infiltration of the adipose tissue into the thyroid stroma. There was no evidence of amyloid deposits. Other causes of the fat deposits were ruled out. The case was reported as diffuse lipomatosis of the thyroid, a rare finding with only few cases being reported in the literature.

A Rare, Variant Overlapping of the Brachioradial and the Deep Brachial Artery in the Arm: A Potential Hazard for Angiography

Ivan James Prithishkumar, Madhavi Chathu

We report a hitherto unobserved variant of high division of the brachial artery, 7.8 cm distal to the tendon of the teres major and 13.0 cm proximal to the intercondylar line of the elbow into an unusual, medially placed brachioradial artery and a laterally placed deep brachial artery in a 68-year-old male cadaver. These branches again overlap each other, 3.5 cm proximal to the elbow and are very closely related to the median nerve. This variation may pose extreme difficultly and a potential hazard during cardiac catheterization, angioplasty, arterial cannulation, blood pressure monitoring, creation of arteriovenous fistulas and vascular repairs.

Molar Tooth Sign in Joubert’s Syndrome: A Case Report

Rudresh Hiremath, Manswini Pol, Ramesh Pattar, Ramesh Pol, K. Rudrappa

Joubert’s syndrome is a rare cause of hypotonia and developmental delay in infancy and childhood1. Radiologically, the syndrome is characterized by malformations of the hind brain in the form of ‘Molar tooth sign’ and enlargement of the fourth ventricle with a bat wing configuration.

GIST – A Mimicker: A Case Report

Udasimath Shivakumarswamy, Sinhasan Sankappa, Purushotham R, Nagesha K.R.

Mesenchymal tumours in the gastrointestinal tract have long been problematic in terms of diagnosis, prognosis and therapy. But recent advances in Immunohistochemistry (IHC) and related therapies have allowed more specific diagnoses. Histopathological examination and the IHC study can correctly identify gastrointestinal stromal tumours (GIST) that are positive for c-KIT. The Imatinib drug which blocks the c-KIT receptor shows remarkable efficacy in the treatment of GIST. We hereby report a case of GIST in a very young male patient who was admitted with a history of pain in the abdomen and recurrent vomiting since 6 months. The clinical examination revealed gastric outlet obstruction. This case report highlights the difficulties which were encountered in the pre-operative diagnosis, where the barium meal and ultrasound (USG) examination findings reported it as a pseudocyst/pancreatic abscess and the CT findings reported it as leiomyoma/lymphoma of the stomach. The histopathological examination of the partial gastrectomy specimen with the tumour tissue showed features which were suggestive of GIST. The IHC study for c-KIT was positive, thus confirming the diagnosis of GIST.

Jejunal Diverticulae: Presenting as Acute Intestinal Obstruction

B.V. GOUDAR, Y.P. LAMANI, KALBURGI E.B.

Jejunal diverticulosis (JD) is a rare disease of elderly people. A majority of the diagnosed individuals are asymptomatic and are found incidentally on laparotomy. The disease is clinically significant because of the associated potential risk of serious complications. Due to the variable presentation and the rarity of this clinical entity, its diagnosis is often difficult and delayed, resulting in unnecessary morbidity and mortality. In our institute, we came across a case of jejunal diverticulae – which presented as acute intestinal obstruction.

Thoraco-abdominal Anomalies in a Dicephalic Parapagus Twin

L.C. Prasanna, K.M. Nataraj, M.N. Adibatti, H. Mamatha

Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. ‘Parapagus’ is a fairly new term, in which the twins lie side to side, with ventrolateral fusion but there is some confusion in the literature. Parapagus twins arise from streaks that lie adjacent to one another, potentially allowing cross-signaling to occur, with the development of laterality defects. In this article, we demonstrate the various anomalies of the thoracic and the abdominal cavity, with an embryological reason behind their development. An accurate antenatal assessment allows the parents to be counseled in depth as to the likely outcome of the pregnancy and the chances of postnatal separation and survival..

Neglected Peritalar Dislocation: A Case Report with Review of Literature

Yasir Salam Siddiqui, Mohd. Zahid, Aamir Bin Sabir, Hatif Qamar Siddiqui

Peritalar dislocation of the foot is an uncommon injury in which the talocalcaneal and talonavicular joints are dislocated simultaneously, without a fracture at the neck of the talus. This has also been referred to as peritalar or subastragalar dislocation. It is considered to be a severe injury, as it involves the weight bearing articular surfaces of the subtalar joints. Peritalar dislocation is a potentially devastating injury in which the complications range from chronic pain to subtalar arthritis to talar avascular necrosis. Here, a case of neglected medial peritalar dislocation has been presented. Open reduction, followed by early physiotherapy lead to an excellent outcome for this potentially devastating injury. A review of the literature on this rare injury has also been presented.

Partial Duplication of External Jugular Vein Forming a Venous Ring Around Supraclavicular Nerve: A Case Report

Rajan Kumar Singla, Sanju Singla, Kanika Sachdeva

External Jugular Vein (EJV) is an important superficial vein draining head & neck region. It usually lies singly on both sides of neck and drains to subclavian vein. Rarely it may be double on either side. In the present case, there was seen partial duplication of the right EJV in the form of a venous ring enclosing supraclavicular nerve. The vein bifurcated 1 cm below the nerve point and the branches rejoined with each other to form a venous ring. The ontogenic basis and clinical implications of the entity are discussed.

Chromoblastomycosis: A Case Report

Shanthala G.B., Rudresh S.M., Nagarathnamma T.

Chromoblastomycosis is a chronic fungal infection which is caused by the phaeoid fungi which are commonly seen in the tropical and subtropical climates. This infection is thought to be secondary to trauma or autoinoculation. The aetiological agent is a small group of dermatiaceous (pigmented) fungi. At least five species of fungi have been recognized to cause chromoblastomycosis: Cladosporium carrionii, Fonsecaea compacta, Fonsecaea pedrosoi, Phialophora verrucosa, and Rhinocladiella aquaspersa. Here, we report a case of chromoblastomycosis from Karnataka, India. A 72 years old male patient presented with a history of a vegetating ulcer with crusting. The diagnosis of chromoblastomycosis was made by a demonstration of sclerotic bodies on KOH and the isolation of Cladophialophora carionii on culture. The unique feature in this case is that it responded to the medical line of treatment with fluconazole.

Psychosis in a Child Infected with Vivax Malaria: A Case Report

Bhuvaneshwari C. Yelamali, Maruti Talawar, Ramesh Pol

Several neurological complications are associated with complicated and severe falciparum malaria. However association of these neurological manifestations with malaria remains doubtful (3). We report a case of acute malaria in a seven year old girl presenting with seizures with features of psychosis. Her blood film showed Plasmodium Vivax trophozoites which is unusual. The case is being is being discussed.

Synovial Chondromatosis Presenting as a Locking Sensation of the Knee in a 65 Year Old Female Patient

The knee joint is the most common site of synovial chondromatosis with a high prevalence in middle aged males. The following is the description of a 65 year old female who presented with a locking sensation during the motion of her right knee joint every time during movement, which was a less common occurrence at her age. The loose bodies in the right knee joint were excised as much as possible by using arthroscopy. The patient was asymptomatic when she moved her knee after the arthroscopic synovectomy and the removal of the loose bodies. In spite of less chances of the malignant transformation of the synovial chondromatosis, a long term follow up has still been recommended in this female due to the supposed genetic abnormality.

Diaphragmatic Hernia Presenting as a Gastric Volvulus

Prathvi Shetty, Leo F. Tauro, Rajeevkumar Chaudhary, Uday Kumar

Gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach and it presents with the features of gastric outlet obstruction. The precipitating factors are usually idiopathic or due to abnormal laxity of the gastrosplenic, gastroduodenal, gastrophrenic and gastrohepatic ligaments or in cases of paraesophageal hernias. In adults, the most common causes of gastric volvulus are the diaphragmatic defects. We present a case of a 65 yrs old lady, who came with the symptoms of gastric outlet obstruction, which on initial investigation pointed towards the diagnosis of a gastric volvulus. On laprotomy, the stomach was found to be incarcerated in a right-sided Morgagni hernia with surrounding adhesions. The hernia through the foramen of the Morgagni is uncommon in adults, accounting for only 3% of all the treated diaphragmatic hernias. The treatment for these hernias primarily is surgical repair or sometimes, repair by the use of prosthetic material. We report a rare case of a Morgagni hernia presenting as gastric volvulus.

Dyke-Davidoff-Masson Syndrome: An Uncommon Cause of Refractory Epilepsy Identifyied by Neuro-Imaging

GEORGE PETER , SHENOY BASTI RAM

Refractory epilepsy is common in practice of neurology. Dyke-Davidoff-Masson Syndrome (DDMS) is one among the syndromes associated with refractory epilepsy. We have come across a case of Dyke-Davidoff-Masson syndrome while investigating a case of refractory epilepsy. When cerebral hemi atrophy is associated with the radiological features of osseous hypertrophy of calvarium, hyper-pneumatisation of sinuses dilatation, DDMS is to be considered.

Rhinolithiasis: A Case Report

Sonia Seth, Harvinder Kumar

Rhinolith is an uncommon nasal mass in children and adults. A case of a 40 yr old female having a 7 years history of right nasal obstruction and a foul smelling right nasal discharge, which was clinically and radiologically diagnosed to be rhinolith, is being reported here. Epistaxis and nasal obstruction are its most marked symptoms. The complete resolution of the symptoms is easily achieved by the surgical removal of the rhinolith. This case highlights the importance of examining the nasal cavities in any patient with unilateral nasal obstruction symptoms.

Anaesthetic Considerations in Macroglossia Due to Haemangioma of the Tongue: A Case Report

Chhaya Joshi, Uday Ambi, Prakashappa D S, Pramod Mirji

A difficult airway in emergency settings poses a challenge to the attending anaesthesiologist. Fibre optic intubation can be a valuable option in such a scenario. There are very few reports in the literature about airway management in adults who are complicated by haemangioma of the tongue. We are describing here, our experience of a 64 year old man who presented with acute intestinal obstruction with macroglossia which was secondary to haemangioma of the tongue with cervical spondylosis. We emphasize the importance of attention to a difficult intubation and airway management by using the fibre optic technique.

Lepromatous Lymphadenitis Mimicking Non- Hodgkins Lymphoma: A Case Diagnosed by Fine Needle Aspiration Cytology

Prem Singh, Deeba Mushtaq, Jyoti Bala, Kalyani Kapur, Akshay Rana

Objectives: To report a case of generalized lymphadenopathy in a man, clinically suspected as non-Hodgkin’s lymphoma and to present the usefulness of FNAC as a diagnostic tool for leprosy in patients presenting with lymphadenopathy. Methods: A 46 year old man from Uttar Pradesh (India) with generalized lymphadenopathy. Initially diagnosed as tubercular lymphadenitis, he was prescribed a course of antitubercular treatment to which he did not respond. He was hence referred to our institute, where he clinically suspectedto be a case of non-Hodgkin’s lymphoma and was taken for further investigations. Results: Fine needle aspiration was performed on the lymph node which established lepromatous leprosy as the cause of lymphadenopathy.This was further confirmed by lymph node biopsy and its histopathological examination. Conclusion: The standard tools for diagnosis of leprosy are mainly skin slit smears or skin biopsy of the affected area of skin. When the presentation is with lymphadenopathy, then FNAC of the lymph node provides for an infallible tool for diagnosis.

Rapid Maxillary Expansion: A Unique Treatment Modality in Dentistry

S. Arvind Kumar, Deepa Gurunathan, Muruganandham, Shivangi Sharma

Background: Rapid Maxillary expansion or palatal expansion as it is sometimes called, occupies unique niche in dentofacial therapy. Rapid Maxillary expansion is a skeletal type of expansion that involves the separation of the mid-palatal suture and movement of the maxillary shelves away from each other. Materials and Methods: An objective approach to the design of a suitable appliance should be made by preparing a list of criteria based on the biomechanical requirements of RME. Results: RME effects the maxillary complex, palatal vaults, maxillary anterior and posterior teeth, adjacent periodontal structures to bring about an expansion in the maxillary arch. Conclusion: The majority of dental transverse measurements changed significantly as a result of RME.

Cryopreservation of Teeth: Freeze them Now to Use Later

Sarada Penmetcha, Veena Arali

Cryopreservation refers to the storage of a living organism at an ultra-low-temperature in such a way that it can be revived and restored to the same living state as it was before it was stored. Recent studies have shown that mesenchymal stem cells (MSC) with the potential for cell-mediated therapies and tissue engineering applications can be isolated from extracted dental tissues. This article provides a complete review on the cryopreservation of teeth, its effects on the dental tissues and its use in dentistry. The application of this technology for the preservation of stem cells to be used for the regeneration of dental tissues has also been discussed.

Stress as an Aggravating Factor for Periodontal Diseases

LITTLE MAHENDRA, JAIDEEP MAHENDRA, RAVI DAVID AUSTIN, S. RAJASEKHAR, R. MYTHILI

Background and Objective: The aim of the research was to evaluate the association between stress, serum cortisol levels and chronic periodontitis in the police personnel of the Cuddalore District of the State of Tamil Nadu, India. Study design: In this case-control study, 110 police personnel were grouped into the test (group 1 and group 2) and the control groups, depending on their probing pocket depth. The various groups were the control group (PPD ≤ 3 mm, n = 30), the test group 1 (at least four sites with PPD > 4mm and ≤6 mm, n = 40) and the test group 2 (at least four sites with PPD > 6 mm, n = 40). Methodology: The clinical parameters such as the Silness Löe plaque index (PI), the sulcus bleeding index (SBI) and the clinical attachment levels were recorded. Stress was measured by using the occupational stress index (OSI). Blood sampleswere collected and the serum cortisol levels were determined by using ELISA. Results: The mean plaque score and the sulcus bleeding index score were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). The mean clinical attachment level, the occupational stress index score and the serum cortisol levels were found to be significantly higher in the test groups as compared to those in the control group (< 0.001). Pearson’s Correlation showed a positive correlation between the clinical attachment level, the occupational stress index score and the serum cortisol levels only in the test groups. Conclusion: These results suggest that stress can be an occupational risk factor for periodontal diseases because stress accompanied by altered oral hygiene habits causes the accumulation of plaque and obstructs the immunity of the person through the endocrinal connections.

A Review of Laser Doppler Flowmetry and Pulse Oximetry in Dental Pulp Vitality

Baiju Gopalan Nair, Amarendhar Reddy K., Gopikrishna Reddy M., NagaLekshmi Reddy

An early determination of pulp vitality is crucial with respect to the correct differential diagnosis of revascularization or necrosis and its treatment. The use of a sensibility test is no more a precise conclusion, for diagnosing the state of the pulp, as it is based on the neural response, which may not be reliable. The pulpal circulation is of utmost importance as it gives more value in diagnosing the state of the pulp, which aids the clinician to come to a decisive diagnosis and treatment plan. This article describes two non invasive methods for measuring vascular health by evaluating the blood flow in Laser Doppler Flowmetry (LDF) and by measuring the oxygen saturation in the circulation in Pulse Oxiometry.

Management of Impacted Teeth in the Orthodontic Practice- [ Article Retracted on 16.10.2013 as found to be Plagiarized.]

Pankaj Akhare, Akshay Daga

Article Retracted on 16.10.2013 as found to be copied / Plagiarized from an article published in The Orthodontic CYBERjournal 2009. Chief Editor

The Response of Oral Submucous Fibrosis to Lycopene – A Carotenoid Antioxidant: A Clinicopathological Study

Introduction: The oral submucous fibrosis (OSMF) is a precancerous condition of the oral cavity. Untreated and neglected cases of OSMF might end up as invasive squamous cell carcinoma. Some pernicious habits like smoking, pan chewing and tobacco addiction for which human being has succumbed to are causing various dreaded diseases, the important among them being oral submucous fibrosis, leukoplakia and erythroplakia. Free radicals have more recently emerged as mediators of other phenotypic and genotypic changes that lead from mutation to neoplasia. The role of free radicals in the various oxidation processes in the body has lead to the identification of antioxidants in inhibiting and reversing the disease process. Lycopene is a safe antioxidant of utmost importance. Lycopene is a bright red carotene and carotenoid pigment and phytochemical found in tomatoes andother red fruits and vegetables, such as red carrots, watermelons and papayas. Objectives: The main aim and objective of this study is to evaluate the clinical and histopathological response of oral submucous fibrosis to Lycopene-a carotenoid antioxidant. Methods and Materials: The material for this study constitutes 12 adult patients picked from the regular outpatient attending the Department of Dentistry, Hassan institute of Medical Sciences, Hassan, Karnataka, India. Clinically, they are diagnosed as having oral submucous fibrosis. Conclusions: Responses are assessed clinically and histopathologically. We observed clinical and histological improvement in various parameters used in our study. No significant toxicity attributable to Lycopene is encountered in this study.

Medical Education: Are We Ready for a Transition?

Amrita Shriyan, Devan P. P.

Purpose: To analyze whether the current reforms are the right answer to the shortcomings of traditional medical training. To study the preferences of the teaching aids and the methods used by the postgraduate students. Methods: A study was conducted at the A.J. Institute of Medical Sciences, Mangalore, Karnataka. The participants were postgraduates from various medical colleges in and around Mangalore. A questionnaire was distributed among 100 randomly selected postgraduate students who came to attend the Postgraduate CME Program on scientific writing, publication and presentation skills. The students were asked to tick appropriately the teaching aids and the methods which were preferred. Results: The postgraduate students were of the opinion that problem based learning and group discussions were preferred over other teaching methods and that Powerpoint presentations were preferred by 82% of the postgraduates as their teaching visual aid, over 14% who preferred blackboard teaching and 2% the overhead projector. 60%-70%of the postgraduates preferred problem based learning. Only 36% of the students felt that it was necessary to have interactions with other departments to treat a patient. Conclusion: Definitely newer teaching methods would be more helpful than the traditional curriculum with didactic lectures. Visual aids like Power-point presentations will motivate the students to learn their subjects, thus making the learning process an enjoyable experience.