Journal of clinical and diagnostic research

Use of Humour in Orthopaedic Teaching

Narula Ramesh, Agarwal Ashok, Chaudhary Varsha, Narayan Ram

Background: The attention span of a lecture is roughly 15 minutes. After this time, it has been observed that the number of students who pay attention begins to drop dramatically, leading to loss in the retention of lecture material. Aims: The present study was undertaken with the aim of examining the effectiveness of humour when it was used as an intervention to prolong the attention span. Methods and Material: This interventional, randomized, control trial was undertaken among a total of 90 medical students who were in their 4th semester. Based on the roll number, the students of the whole class were equally divided into group A and group B by using a lottery method. Group A was the control group and group B was the experimental group. For both the groups, four lectures were delivered on the same topic, with the difference that in the group A classes, no intervention was used, while in group B, humour was used as an intervention. The outcome of this study was measured by using ‘Class response’ and ‘Observations’. For the class response, a pretested, 5 point ‘Likert’ scale questionnaire was used. For the ‘observations’, two clinical psychologists were involved. Data was collected from both the groups A and B in the first and last lectures. Statistical analysis used: SPSS for Windows (version 10.0) by the Chi-Square test. Results: The students agreed that they could better understand the concept of the lecture (68.17%), feel more comfortable in class (74.99%), have increased attention power (74.99%) and have the perception that the teacher was friendlier to them (74.99%). In the lecture four, it was observed that behaviour that implied negative attitudes such as turning up late and yawning were frequent in group A, whereas behaviour which indicated positive attitudes such as writing notes and eye contact were noted more frequently in group B. Conclusion: Humour, when used as a teaching aid, has a positive impact on the students’ perceptions and behaviour towards teaching.

A Case for Bleeding: Structures at the Risk of Injury during Invasive Procedures of the Cricothyroid Membrane

Ivan James Prithishkumar, Christilda Felicia

Background: Transcutaneous puncture of the cricothyroid membrane is a component of several important invasive clinical procedures, including surgical cricothyroidotomy. One of its most feared complications is endolaryngeal haemorrhage that has been fatal at times. Aim: Our aim was to determine the structures at the risk of injury during procedures which involved puncture of the cricothyroid membrane. Methods: Anterior neck dissection was done on sixty three cadavers in a tertiary care, university teaching hospital. Results: Several structures were noted to be anterior to the membrane, such as the paired and the median anterior jugular veins, the transverse cricothyroid artery, the median descending artery, the sternohyoid muscle, the pyramidal lobe of the thyroid gland, the thyroidea ima artery and the jugular venous arch. The transverse cricothyroid artery was seen anterior to the upper 1/4th of the membrane in 98% of the cadavers. In most of the cadavers, the right and left transverse cricothyroid arteries joined to form a median descending artery. Both the transverse cricothyroid artery and the median descending artery gave multiple branches that perforated the cricothyroid membrane. Conclusion: All invasive procedures require a firm grounding in anatomy. Regarding surgical cricothyroidotomy, the authors recommend an initial vertical incision of the skin and the investing layer of the deep cervical fascia, followed by a horizontal incision of the cricothyroid membrane, just above the arch of the cricoids, to avoid the transverse cricothyroid artery. For needle procedures, the authors suggest an anterior midline approach, immediately above the arch of the cricoid.

Knowledge of Nurses Towards Cardiopulmonary Resuscitation in a Tertiary Care Teaching Hospital in Nepal

Sita Parajulee, Valarmathi Selvaraj

Background: Nurses are knowledgeable in handling patients with life threatening conditions and hence are expected to be knowledgeable in performing cardio-pulmonary resuscitation (CPR) techniques. Aims: To assess the knowledge of nurses towards CPR and to study the association between the nurses knowledge scores and selected demographic variables. Settings and Design: A questionnaire-based, cross sectional study was performed at the College of Medical Sciences-Teaching Hospital, Bharatpur, Nepal, among the nurses who were working in the hospital during October, 2010. Methods and Materials: A self-developed questionnaire containing 21 questions was distributed to the nurses and the filled questionnaires were analyzed as per the study objectives. A correct response was given a score of ‘1’ and the wrong responses were given a score of ‘0’. Statistical Analysis Used: Descriptive statistics was used to calculate the mean and the standard deviation and the Kurskal- Wallis test was used to compare the mean scores of the respondents with their demographic variables. Results: Among the total 175 nurses, 70 of them responded with a response rate of 40%. The mean ± SD age of the respondents was 22.07 ± 2.30 years and their mean ± SD duration of experience was 11.45 ± 2.67 months. The worksites of the respondents varied and there were more than 15 different sites. A relatively high number (n = 8; 11.43%) of the respondents were from the Department of Medicine. The mean± SD of the overall total knowledge scores was 11.45 ± 2.67 (the maximum possible score was 21). There was no significant association between the total scores and age (p = 0.823) and the duration of experience (p = 0.239). However, there was an association between the worksites and the total scores (p = 0.013). Conclusions: In general, the knowledge of the nurses was found to be low, thus suggesting a need for educational interventions.

The Effects of Vasectomy on the Testes of Albino rats: A Histological Study

Golghate Tarkeshwar D, Naidu Sunetra S, Sathe Vivek M, Fulpatil Milind P

Context: Population explosion has become one of the most challenging problems which are being faced by the entire world. Vasectomy is a simple, safe, quick and effective but vital method for male sterilization. In the recent years, a large number of vasectomies are being performed in India, since the inception of the National Family Planning Program in 1956. Thus, the number of requests for the restoration of fertility is also being increased. Aim: The present study was carried out to know whether the histology of the testes and spermatogenesis remains normal after vasectomy. Method and Material: The histology of the testes of 50 male albino rats was studied one, two, three and four months after vasectomy in 10 male albino rats of each group and 10 male albino rats served as the controls. Results: After vasectomy, the seminiferous tubules were cut in various planes, which were covered externally by connective tissue stroma with a normal histological picture. The spermatogonia, spermatids, Sertoli cells, spermatozoa and Leydig cells showed a normal histological picture, with normal sized blood vessels in the interstitial connective tissue in the vasectomised and the control rats. In some seminiferous tubules, granular cytoplasmic vesicle like structures were found to fill the lumen and the spermatids which were metamorphosing to spermatozoa. Many round or elongated heads of the spermatozoa were present at the apical portion of the Sertoli cells. In some seminiferous tubules, disorganization of the seminiferous epithelium was found after the second month of the vasectomy. Conclusions: On critical analysis, it was concluded that the histology of the testes and the spermatogenesis remained normal at four months after the vasectomy.

Microbiological Profile of Vaginosis among Women of the Reproductive Age Group, Who Attended a Tertiary Care Hospital

Renu Mathew, Sudhakshina R, M Kalyani, S Jayakumar, Binesh Lal, Shameem Banu

Background: An abnormal vaginal discharge is a common complaint in women and it can be due to vaginal infections like bacterial vaginosis, candidiasis and trichomoniasis . Aim: A descriptive cross sectional study was done to find out the common pathogens which caused vaginosis in patients of the reproductive age group, who attended the Obstetrics and Gynaecology Department at the Saveetha Medical College Hospital, Thandalam, Kanchipuram District, from 1st April to 30th September, 2010. Materials and Methods: All the 140 vaginal discharge samples were subjected to gram staining to view the morphological nature of the bacteria which caused bacterial vaginosis and gram positive, budding yeast cells, wet film for the motility of Trichomonas and Chlamydial antigen detection by ELISA. Results: The overall positivity was 44%, which included bacterial vaginosis (36.4%). The positivity of candidiasis was 4.2%, that of trichomoniasis was 2.1% and that of chlamydiasis was 1.4%. Conclusion: Bacterial vaginosis was found to be the commonest cause of the abnormal vaginal discharge in women of the reproductive age group.

The Prevalence of the Leading Causes of Certification for Blindness and Partial Sight in the Hassan District of Karnataka, India

Dadapeer Kareemsab, Niranjan Mambally Rachaiah, Balasubramanya

Context: The prevention of visual impairment is an international priority which was agreed upon at the World Health Assembly of 2002. Yet, countries like India lack contemporary data on the prevalence and the causes from which the priorities for its prevention, treatment and management can be identified. Aims: To identify the leading causes of visual disability among certified, visually disabled individuals in the Hassan District in Karnataka, India. Settings and Design: A prospective cross-sectional study. Methods and Material: The cases were selected on the basis of a simple random sampling method. Statistical analysis: Descriptive analysis was done and the results were expressed in terms of mean, median and proportions. Results: In our study, the leading causes of certification for blindness and partial sight were congenital anomalies, refractive errors and retinitis pigmentosa. Conclusion: There will be a variation in the prevalence of leading causes of certification for blindness and partial sight, from one geographical area to another. If the accurate cause is identified, the necessary preventive measures can be taken.

A Clinical and Histopathological Study on the Oral Mucosal Lesions in Common Dermatological Disorders

Vippan Goyal, Ritesh Singla

Aims: To study the clinico-histopathological correlation of mucosal involvement in various dermatological disorders. Background: The mucosa of the oral cavity is very important from the dermatologist’s point of view as it originates from the ectoderm. The structure and the lining of the oral cavity has importance in the diagnosis of oral as well as systemic diseases, as it is the site of various isolated mucosal lesions as well as mucosal lesions of systemic diseases. The physical examination is completed by doing a histo-pathological examination in order to establish a final diagnosis. Material and Methods: 110 patients who had oral lesions, who were diagnosed clinically were included in the study. A 4-5 mm punch biopsy specimen of the oral lesion was taken under local anaesthesia and sent for histopathology. Results: Of the 110 cases, Lichen planus and Pemphigus vulgaris formed a majority of the cases and the lips and the buccal mucosa were the most common sites which were reported. Conclusion: From the ongoing discussion and observations, it can be concluded that for any disease which presents with oral manifestations or for diseases in which oral manifestations precede the systemic onset, especially of longer duration, the histopathology of the oral lesions should always be performed as it is an essential diagnostic tool.

Serum Neopterin Estimation as an Indicator for Safe Blood Transfusion

Shameem Banu A.S., Latha.P., Kaveri K., Jayakumar S.

Background and Objective: Neopterin is regarded as an early biomarker of the cellular immune response. Neopterin concentrations in body fluids are raised with high sensitivity infections. The determination of neopterin is an innovative tool for monitoring diseases which are associated with the activation of cell-mediated immunity. There is not much data of India available on serum neopterin estimation among voluntary blood donors attending the blood bank for assessing various transfusion transmitted diseases which are necessary for this study. Materials and Methods: Blood samples were collected from Government General Hospital blood bank by venipuncture and serum was obtained by centrifugation. Serum antibodies against Human Immunodeficiency Virus (HIV-1&2), Hepatitis C Virus (HCV), Treponema pallidum, Cytomegalovirus (CMV-IgM) and Hepatitis B Virus surface antigen (HBsAg) were determined in all donor samples by routine ELISA method. Screening was done for malaria and filarial parasite by making smears. Serum neopterin was measured by a commercially neopterin enzyme immunoassay kit. Results: A total of 304 donors were screened out of which 58 had elevated neopterin levels contributing to 19.07%. A total of 43 samples were positive for any one or more of the screening tests. All the 43 samples well correlated with neopterin elevation. Conclusion: We conclude that the risk of transmitting new pathogens may be reduced using neopterin assay as a routine in blood banks.

Cadaveric Tissue Histology: A Viable Alternative

Tulika Gupta, Krishan Gauba

Background: Histological slides are routinely prepared by using tissues from surgically removed specimens which are an unreliable source for a normal histology, with associated with ethical issues. An alternative tissue source is animal tissue which is easily available, but it has different histological details as compared to the human tissue. Aim: Therefore, this study was conducted to standardize the histology of different tissue types of the human body, which were obtained from the embalmed cadavers which were available in anatomy departments. Methods: Histology slides were made the following standard protocol, with haematoxylin and eosin staining. The study material was selected to include all the tissue types. Results: Histologically, all the tissues showed excellent tissue organization. The nuclei, the cell membranes and the cytoplasmic details were clear and well preserved. Conclusions: This study showed that cadaveric tissue is suitable for histological studies. A cadaver is an ideal source of tissue for the purpose of teaching and research.

Comparison of Autonomic Neuropathic Changes in Type 1 and Type 2 Diabetes Mellitus

Kaur Nimarpreet, Singh H.J., Sidhu R.S., Sharma R.S.

Introduction: Diabetes is the most common endocrine metabolic disorder. Duration of Diabetes affects the quality and longevity. Autonomic neuropathy is postulated to be an indicator of impending demise. Aims & Objectives: The aim of the present study was to compare the autonomic nervous system activity between Type 1 and Type 2 diabetes mellitus and with normal control subjects and to evaluate the effect of duration of disease. Materials and Methods: The present study was conducted on 100 Diabetics attending the diabetic clinic of Guru Nanak Dev hospital Amritsar and 25 healthy attendants served as controls. The patients were divided into two major groups i.e. Type 1 and Type 2 diabetes and two subgroups (< 5 years of duration, >5 years of duration). Autonomic nervous system activity was assessed in the physiology department. Sympathetic activity was measured by cold presser test, hand grip test, and blood pressure response to standing. Parasympathetic activity was measured by S/L ratio, 30/15 ratio, valsalva ratio and I/E ratio. The results were statistically analyzed. Results: Changes in sympathetic activity as observed by changes in SBP, CPT & HGT were significantly (p< 0.001) affected by type of diabetes (Type 1 DM vs Type 2 DM) and by the duration of disease (<5 yrs vs >5yrs)as compared to normal. Significant changes in parasympathetic activity (30:15 ratio, DBT, S/L ratio) were observed in diabetics as compared to normal which progressed with duration of disease (<5 yrs vs >5yrs, p<0.05) but were similar in both types of diabetes. Conclusion: With early detection of Autonomic neuropathy, use of aggressive approach in management of Diabetes Mellitus would reduce mortality and morbidity in these patients.

Correlates of Overweight and Obesity Among Urban School Going Children of Nagpur City

Introduction: Overweight and obesity during childhood are a matter of growing concern in India. Most individuals develop their eating and activity patterns during childhood. Obesity in children and adolescents is gradually becoming a major public health problem in many developing countries, including India. The objective of the present study is to estimate the prevalence of overweight and obesity among school children and to identify the factors which influenced childhood overweight and obesity. Materials and Methods: A cross-sectional study was carried out from July 2009 to January 2011 on school children who were aged between 5 and 16 years. Results: The prevalence of overweight and obesity among children was 9.00% and 5.5% respectively. Overall, the prevalence of overweight/obesity was 14.52%. The risk of overweight/obesity was significantly (p<0.0120) higher among children who belonged to the upper SES and to the age group of ≥ 10 years, who viewed television for ≥ 1 hour, who slept for only ≥ 7 hours (OR=1.87; 95% CI=1.87-2.53) and who used vehicles to go to school (OR=1.59 ;95%CI =1.14-2.24). The prevalence of overweight and obesity was significantly (p<0.0032) lower among children who swam, danced regularly (p<0.0353) and played outdoor games (p<0.0323) than their counterparts. Its association was found to be protective against overweight/ obesity. The risk of overweight /obesity was significantly higher among children who were non-vegetarians (OR=1.88; 95% CI=1.39-2.55, p<0.0001), who regularly consumed junk food (OR=2.54; 95% CI=1.82-3.53, p<0.0001), and in whom the calorie intake was more than the recommended daily allowances (OR=1.88; 95% CI=1.39-2.55, p<0.0001). Conclusion: This study confirmed the findings of earlier studies which were carried out in the other parts of the country and it emphasized that regular physical exercise, regulated television viewing, and a healthy eating behaviour could contribute to control overweight and obesity.

Laparoscopic versus Open Appendectomy: A Comparison of Primary Outcome Studies from Southern India

B V Goudar, Sunil Telkar , Y.P. Lamani, S.N. SHIRBUR, SHAILESH M.E.

Introduction Currently, laparoscopic appendectomy is widely practiced for the management of acute appendicitis. It is not clear whether open or laparoscopic appendectomy is more appropriate. Our aim was to compare the safety and the advantages of laparoscopic versus open appendectomy in a prospective randomized study. Methods: Two hundred and forty patients were randomly divided into two groups. The group A patients were subjected to laparoscopic appendectomy [LA], whereas the group B patients were subjected to open appendectomy [OA]. The demography and the primary outcome measures of the patients such as operative duration, hospital stay, post-operative pain and post operative complications were recorded and analyzed. Results: There were 120 patients in group A and group B each. Of the 120 patients in group A, 6 patients were selected for open appendectomy. The operative time for LA and OA were 18-80 (49)minutes and 30-120 (72) minutes respectively. Although LA was associated with a shorter hospital stay [LA-2.5 days versus OA-4.25 days]; the postoperative complication rates were comparable between the two groups. Conclusion: LA is safe and superior to OA with respect to an early discharge, lesser postoperative pain, decreased wound infection, early return to work and a better cosmetic scar.

Expression of Her-2/neu in Colon Carcinoma and Its Correlation with the Histological Grades and the Lymph Nodes Status

Manmeet Kaur Gill, Kalpana Jain, Mridu Manjari, Tanveer Kaur

Background and Objective: This study was done to check the expression of Her-2/neu in colon carcinoma and its correlation with the histological grades and lymph node metastasis. Colon cancer is the third prevalent cancer in men and women and it is a leading cause of morbidity and mortality in both. Her-2/neu is a useful antigenic marker in immunological studies of colon carcinoma and it can be used for predicting the prognosis and the treatment. Materials and Methods: The present study was conducted on 40 cases of histopathologically proven colon carcinoma cases to check for Her-2/neu expression by using the novocastra kit.Both cytoplasmic as well as membranous staining were considered as positive for colon cancer. Results: Her-2/neu was positive in 65% of the cases. It was seen in 68.75% cases of well differentiated, 53.84% cases of moderately differentiated and 100% cases of poorly differentiated conventional adenocarcinomas. Mucinous carcinomas showed more positivity (71.4%)for Her-2/neu as compared to conventional adenocarcinomas (64.5%). The positivity was more in the grade III tumours as compared to that in the other grades. All the colorectal carcinoma cases with metastatic nodes were positive for Her-2/neu staining. Conclusion: Thus, it was concluded that colorectal carcinomas, especially those with lymph node metastasis, should be subjected to Her-2/neu expression studies, as the tumours which expressed Her-2/neu could carry a poor prognosis and therefore would require a different therapeutic approach, as these cases could respond to Trastuzumab (Herceptin) therapy.

Optical Spectroscopy: A Promising Diagnostic Tool for Breast Lesions

Sanjay Kala, Chayanika Pantola, Asha Agarwal, Asima Pradhan, Sudeep Thakur

Background: With the rising trend of breast cancer, there is a need to develop a diagnostic procedure which can solve the problem of differentiating the benign and malignant lumps and of detecting breast cancer at an early stage. Intrinsic fluorescence is an important step in this regards. Auto-fluorescence from biological tissues involves evaluating the biomolecular environment through optical spectroscopy. Aim of study: To study the role of optical spectroscopy in differentiating the benign from the malignant breast lesions by detecting the change in the intrinsic fluorescence, especially of Flavin adenine dinucleotide (FAD) and porphyrins. Method: A study of 37 patients with breast lumps was done, out of which 14 had benign and 23 had malignant lesions. After excision for the intrinsic fluorescence study, fresh samples were taken and excited by using an optical spectrophotometer. Results: This study showed that intrinsic fluorescence is a good method of investigation with a sensitivity of 68% and a specificity of 73%. Conclusion: Optical spectroscopy has a bright future in differentiating the benign and malignant lesions of the breast. Furthermore, it can detect cancer at an early stage.

Adolescent Menorrhagia: Study of the Coagulation Profile in a Tertiary Centre in South India

Background: Abnormal uterine bleeding accounts for approximately 50% of the visits of adolescent girls to gynaecologists. These complaints encompass disorders which range from minimal spotting to profuse bleeding. These affect the quality of life in a majority of women who are affected. The prevalence of menorrhagia in the adolescent population with bleeding disorders varies between 14 to 48%. The common conditions which are associated with adolescent menorrhagia include the von Willebrand disease (vWD), platelet functional disorders, and coagulation factor deficiencies. This prospective study was conducted to identify the frequency of the bleeding disorders in women who presented with menorrhagia from the Indian subcontinent. Material and Methods: 688 adolescent girls were evaluated, amongst which 40 cases were included in our study. Each case was analyzed for the demographic profile, the duration of menorrhagia, the severity of the symptoms, the degree of anaemia, and laboratory investigations. Results: Amongst the 40 cases, 14 (35%) cases were found to be suffering from haemostatic disorders. The haemostatic disorders were divided into platelet related abnormality i.e., primary (9 cases) and clotting factor abnormality i.e., secondary disorders (5 cases). The leading cause of menorrhagia was found to be vWD and quantitative platelet disorders. A majority of the girls had anaemia (97.5%). The commonest blood group which was found in the girls was O, followed by the A group, with all the cases of vWD having the O group. Conclusion: Menorrhagia may be an important clinical manifestation in an inherited bleeding disorder and it has been suggested that these patients need to be investigated for these disorders, especially for vWD. Early diagnosis and treatment with individualization of each case is the keystone in the management of adolescent menorrhagia.

Thyroid Stimulating Hormone (TSH) Level as a Possible Indicator of Pre-eclampsia

Dhananjaya BS, Sendil Kumaran D, Venkatesh G, Murthy Niranjan, Shashiraj HK

Background: Pre-Eclampsia is characterized by hypertension and proteinuria. There is a high incidence of thyroid dysfunction during pregnancy resulting in adverse maternal and fetal effects. Therefore, we intended to evaluate the influence of pre-eclampsia on thyroid hormone levels. Methods: Twenty five (25) pregnant women who developed preeclamplsia and an equal number of age matched, parity matched and gestation age matched normal pregnant women were taken for the study. Blood samples collected were estimated for T3, T4 and TSH which was measured using CLIA system Results: 64% offspring of the pre-eclampsia subjects had birth weight <2.5kg and the values were highly significant. T3 and T4 levels were within the normal limits and there was significant increase in TSH levels in pre eclampsia subjects. Conclusion: In the present study the pre-eclampsia showed elevated TSH levels with a risk of low birth weight babies. Increase TSH levels could be used as a predictor of Pre-eclampsia.

Surgical Implant Generation Network (SIGN) Solid Intramedullary Interlocking Nail in the Lower Extremity: An Observational Study from Western Nepal

Manoj Kumar Chakraborty, Pabin Thapa, Brijesh Sathian

Background: Intramedullary nail fixation has become the standard of treatment for both femoral and tibial shaft fractures. It functions as internal splints that allow secondary fracture healing. The axial and rotational stability of the conventional hollow interlocking nails depends primarily on the locking screws. Surgical Implant Generation Network (SIGN) was formed in 1999, with the vision of creating an equality of fracture care throughout the world. This system has been utilized at a variety of facilities in low income countries throughout the world. Objective: To evaluate the efficacy of SIGN nailing in the long bones of the lower extremity. Method and Materials: This was a hospital based, retrospective study which was conducted in the Orthopedics Department of the Manipal College of Medical Sciences, Pokhara, Nepal between May, 2010 and August, 2011. A total of 24 cases with fractures of the femur and the tibia were studied. Both closed and open types of fractures were included and the fracture fixation was done by using SIGN interlocking solid nails and instrumentation. The analysis was done by using descriptive statistics and the testing of the hypothesis. The data was analyzed by using Excel 2003, the Statistical Package for the Social Sciences (SPSS) for Windows Version 16.0 (SPSS Inc; Chicago, IL, USA) and the EPI Info 3.5.1 Windows Version. Results: Out of the 24 patients, 16 (66.7%) were males and 8 (33.3%) were females. The average age of the patients was 29.58, with a range of 13-60 years. An intramedullary interlocking SIGN nail was performed in 18 (75%) tibial and 6 (25 %) femoral fractures, with 41.7 % being right sided and 58.3% being left sided. The types of fractures which were included were closed= 66.67 % and open fractures= 33.33%. According to the Gustilo- Anderson classification, 4.17 % were Gustilo I, 25 % were Gustilo II and 4.17 % were Gustilo III a. Open reduction was done in 58.3 % and closed reduction was done in 41.7 % of the cases. Reaming was done in all the cases and no post-operative infections were noted. There was a significant relationship between the type of fracture and factors like the affected side, the method of the fracture reduction and the location of the fracture. Conclusion: The SIGN solid intramedullary interlocking nail shows promising results in comparison to the hollow nail because of its better strength, better accuracy in distal locking and surprisingly better results in infection and non-union

Evaluation of the Auditory Effects of Hyperlipidaemia and Diabetes Mellitus by Using Audiometry

Anandhalakshmi Swaminathan, Rajendran Sambandam, Mythili Bhaskaran

Background: Hyperlipidaemia is a common disease of lipid metabolism, whereas diabetes mellitus (DM) is a chronic disease which is caused due to the relative or absolute lack of insulin, which results in elevated blood glucose levels. Hearing loss is the total or partial inability in hearing sound in one or both the ears. Although the relationship between hearing loss and hyperlipidaemia or diabetes mellitus has been shown in many clinical investigations, this concept is still controversial. Objective: The aim of the study was to evaluate the auditory effects of hyperlipidaemia and diabetes mellitus by using audiometry. Materials and Methods: The study group consisted of 30 normal subjects (group I), 30 subjects with hyperlipidaemia (group II), 30 Type II diabetic patients (group III) and 30 subjects with both diabetes and hyperlipidaemia (group IV) of the age group of 40- 50 years, who attended the Diabetology Outpatients Department and the Master Health Check Up Scheme at the Stanley Medical College and Hospital, Chennai. The subjects underwent blood pressure examination and the laboratory evaluation of the serum lipid profile, fasting and post prandial blood glucose levels, serum urea levels and creatinine levels. Pure tone audiometry was done for both the ears of all the subjects. Results: The prevalence of hearing loss in group IV was 63.3%, in group III, it was 56.7%, in group II, it was 40% and in group I, it was 6.7%. There was also an increased association of hearing loss in people with high total cholesterol, high triglycerides and high LDL levels. The audiogram analysis showed a high frequency of hearing loss. Conclusion: Our study reports that the prevalence of sensorineural deafness was increased in the subjects with diabetes and in subjects with hyperlipidaemia and the subjects having both diabetes and hyperlipidaemia had the highest risk of developing sensorineural deafness. The hearing loss was a progressive, bilateral, sensorineural deafness of gradual onset, which affected mainly the higher frequencies.

Mental Stress Induced Changes in Autonomic Nervous Activity in Normotensive ffsprings of Hypertensive Parents

Back ground: The genetic component is a major contributor in the pathogenesis of essential hypertension. Consequently the likelihood of acquiring hypertension in offspring of hypertensive parents has been estimated to be higher when compared to that of normotensive individuals. The current study is an attempt to identify the early markers for the development of hypertension in these individuals by assessing the autonomic nervous activity when subjected to mental stress. Methodology: Two groups of thirty normotensive subjects matched for age, body mass index, and physical activity were recruited .The only differentiating factor between the two groups being the genetic predisposition to hypertension of one group. Blood pressure & electrocardiogram was recorded in both groups at rest and during mental stress. Power spectral analysis of heart rate variability was done.Statistical analyses were conducted by paired & unpaired t-test. A p value of < 0.05 was considered as statistically significant. Results: A significant decrease in high frequency normalized (HFnu) in the offspring of hypertensive parents was observed at rest. During mental stress, an increase in heart rate, systolic and diastolic blood pressure was observed in both groups. Increase in low frequency normalized and decrease in HFnu in offsprings of normotensive parents and increase in LF/HF ratio in individual with hypertensive parents were observed. Difference in basal and mental stress value of heart rate and systolic pressure was significantly more and HFnu was less in offspring of hypertensives. Conclusion: Impairment in parasympathetic activity at rest and sympathovagal imbalance during mental stress is observed in individuals with hypertensive parents. This implies high chances of developing hypertension in their later life. So an evaluation of autonomic nervous activity by simple procedures like heart rate variability analysis to all individuals with a family history of hypertension in early stages of their life would prove to be invaluable. Life style modification such as regular exercises, yoga etc. can be suggested to those individuals who are found to be at the risk of developing hypertension.

Study of Lipid Profile and C Reactive Protein in Pre- and Post-menopausal Women

Background and Objectives: Menopause is the transition period in women’s life when her normal ovarian function of ovulation ceases.There is less estrogen and progesterone secretion. Since cardiovascular disease (CVD) is the leading cause of death among post-menopausal women, the present study was undertaken to evaluate lipid profile status and C reactive protein (CRP) level in post-menopausal women and compare with premenopausal women. Materials and Methods: 100 cases (post-menopausal women) were included in the study and 100 regularly menstruating women in the reproductive age group were taken as control. In both the study groups we have measured lipid profile which includes (Serum total cholesterol(TC), TG, HDL-C, LDL-C, VLDL-C), C-reactive protein(CRP) and Body mass index(BMI) as cardiovascular risk factors. Statistical analysis was done by students ‘t’-test. Results: The results of this study shows significant increased level of serum total cholesterol, TG, LDL-C and VLDL-C in postmenopausal women compared to pre-menopausal women (p<0.001). While serum HDL-C level is significantly lower in cases compared to control(p<0.001). Present study also show elevated mean LDL-C to HDL-C ratio (4.8 + 0.73) in post-menopausal women compared to control(p<0.001). There was also increased level of CRP and BMI in cases compared to control(p<0.001). Conclusion: The results of our study provide information that cardiovascular risk factors are elevated in post-menopausal women compared to pre-menopausal women so these women are at an increased risk of developing cardiovascular disease.

Effect of Rajyoga Meditation on the Heart Rate, Blood Pressure and ECG

Seema Maini, Harleen Kaur, Navneet Maini

Introduction: Meditation is a technique of achieving harmony between the physical, mental, intellectual and spiritual personalities of man. Rajyoga is one of the techniques of meditation where a flow of thoughts is encouraged thus using mind in a natural way. Meditation has a number of positive effects on the physiology of human body. It has shown to reduce diastolic blood pressure , systolic blood pressure, heart rate and serum cholesterol levels thus reducing the risk of coronary artery disease. Aims and Objectives: This study aims to highlight haemodynamic effects of meditation by studying its impact on blood pressure, heart rate and ECG. Materials and Methods: The study was conducted on 100 healthy subjects (50 meditators and 50 non-meditators) from Brahma Kumari Ashram. They were further subgrouped on the basis of their sex, age and duration for which they had been practicing yoga. A detailed history was taken and detailed general physical examination was conducted on all of them. Anthropometric measurements were taken. Systolic and diastolic blood pressures, heart rate and ECG was recorded in all of them. Data was collected and statistically analyzed to achieve the results. Results: The mean heart rate, systolic blood pressure, diastolic blood pressure, heart rate were significantly lower in subjects who practised meditation regularly than in subjects who did not. ECG did not show any significant change except for decreased heart rate in meditators. Conclusions: Coronary Heart Disease remains one of the most important causes of morbidity and mortality in Indian population. Yoga and Meditation, given its positive effects on physiology of human body,if practised regularly, can emerge as one of the important non-pharmacological method of prevention of heart disease.

Tubercular Mastitis is Common in Garhwal Region of Uttarakhand: Clinico athological Features of 14 Cases

Hatwal Deepa, Suri Vijay, Mishra Jai P., Joshi Chitra

The incidence of breast tuberculosis is not uncommon but there is gross under reporting of such an important disease. It presents with mimics of breast abscess, fibrocystic disease and breast cancer. Breast tuberculosis has been rarely reported from Garhwal region of Uttrakhand. Breast tuberculosis has no well defined clinical features and apart from breast lump, vague complain of generalized weakness,maliase and low grade fever is non-specific presentation. Radiological imaging is not diagnostic. Diagnosis is based on the identification of cytological and histopathological findings of tubercular granuloma and identification of tubercle bacilli either under microscope or by culture. Anti-tubercular therapy for 6 months with minimal surgical intervention is the mainstay of treatment today. The risk factors include multiparity,malnutrition, lactation, trauma, past history of suppurative mastitis, immunocompromised state, drug abuse and emergence of AIDS. In this study we detected 14 cases of breast tuberculosis in 1 year duration that shows tuberculosis of breast is common in Garhwal region of Uttarakhand.

A Prospective Randomized Controlled Trial Complains Open Pyeloplasty and Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction (UPJO): Subjective Outcome

Srinivas K.K., Uppin I.V., Nerle R.B.

Background: A study was conducted at the KLES hospital and MRC, Belgaum, for a period of 1 year from April 2004 to March 2005. Objectives: To compare the efficacy of open pyeloplasty and laparoscopic pyeloplasty in the treatment of primary ureteropelvic junction obstruction with regards to the subjective outcome. Materials and Methods: A total of 30 patients of congenital UPJO was evaluated and operated. All the 30 patients were randomized into two groups of 15 each. One group formed the open pyeloplasty group and the other formed the laparoscopic pyeloplasty group. All the patients were assessed for the subjective outcome post-operatively and all the patients were followed up for a minimum of 3 months. The results were analyzed by using the Student’s paired and unpaired tests. Results: The mean age group, the laterality of involvement of the kidney and the sex ratio were almost similar between the two groups. The pre-operative pain and the activity levels were almost similar and comparable between the 2 groups. But, there was a significant post-operative improvement in the pain and the activity level in each group. In our study, we found that the improvement in the pain and the activity level post-operatively was much better in the laparoscopic pyeloplasty group patients as compared to those in the open pyeloplasty group patients. The time period when oral feeds were started and the drain was removed, was slightly more in the laparoscopic group, owing to the transperitoneal approach. There was no conversion to open procedure done in any of laparoscopic cases. The postoperative cosmesis was better inthe laparoscopic pyeloplasty patients as compared to the open pyeloplasty patients. Conclusion: Our study was done on a small number of patients and the post-operative follow up was only for 3 months. It is difficult to draw conclusions from such a study. Hence, a large randomised controlled trial with a long period of follow up studies are needed to establish the role of laparoscopic pyeloplasty in the treatment of UPJ obstruction. The potential advantages of laparoscopic pyeloplasty over open pyeloplasty are decreased post-operative pain, a shorter period of hospitalisation, a short convalescence and improved cosmesis. Laparoscopic pyeloplasty is a technically challenging procedure and it is still in its infancy. It is being practised at only few medical centres around the world. With the recent technological advances, laparoscopic pyeloplasty has become a valid alternative to endoscopic pyelotomy and open pyeloplasty.

A Research Study of Santorini Duct

Introduction: The accessory pancreatic duct also called as dorsal pancreatic duct or Santorini duct as it is formed from the portion of dorsal bud and was first described by Santorini in 1775. It is the main drainage duct of the dorsal pancreatic bud in the embryo and enters the duodenum at the minor duodenal papilla. Methods: The study was conducted on 30 pancreas and duodenum enblock obtained from adult cadavers in the Forensic medicine Department of Govt. Medical College, Amritsar. Length and width of accessory pancreatic duct were measured and the results were compared according to the sex and were also analysed statistically. The shape of terminal part of the accessory pancreatic duct has also been discussed with reference to patency of the duct. Results: Length of accessory pancreatic duct ranged between 2.0-6.2cm with a mean of 3.89+ 0.85cm. Width of accessory pancreatic duct ranged between 1.33-2.01cm with a mean of 1.67+ 0.48cm.The most common terminal shape of accessory pancreatic duct observed was stick type in 63.33% and the least common was saccular type i.e. 3.33%. In decade wise division into group I (<40 yrs) and group II (>40 yrs), length of the accessory pancreatic duct did not show any alteration with age but width was significantly greater in group II as compared with group I in male and in female subjects. Conclusion: The anatomical aberrations in the duct system of pancreas have clinical importance because they can predispose to various clinical disorders including pancreatitis and carcinogenesis. Aging also results in increase in the diameter of the pancreatic duct. Pancreas divisum is a common anatomical variation, in which the dorsal and ventral pancreatic ducts do not unite leading to inadequate pancreatic juice drainage resulting in dorsal pancreatitis.

Autonomic Nervous System Changes in Chronic Obstructive Pulmonary Disease (Copd) Patients

Aggarwal S., Arora Meena, Kaur N., Bachhal R., Sidhu R.S.

Introduction: In the patho-physiology of chronic obstructive pulmonary disease (COPD), changes in the autonomic control of the cardiopulmonary functions are important. The quantification of the para-sympathetic and the sympathetic activity may be useful in treating COPD patients. Aims And Objectives: To observe the changes in the autonomic activity in COPD patients. Material And Methods: The present study was conducted on 90 (male) COPD patients and 30 controls. The para-sympathetic activity tests i.e. the heart rate variation with deep respiration, the valsalva manoeuver, the standing to lying ratio and postural changes (30:15) and the sympathetic activity tests i.e. orthostasis, the cold pressor test (CPT) and the blood pressure response to a sustained hand grip were conducted. An FEV1 which was >80% was the criteria for the healthy control subjects. Results: The heart rate variation to the para-sympathetic stimuli was less in the COPD patients as compared to that in the healthy subjects. The fall in systolic blood pressure (SBP) in response to standing was lesser while the rise in diastolic blood pressure in response to a sustained hand grip was higher in the COPD patients. A significant rise in the SBP in response to CPT was observed. Conclusion: The cardiac para-sympathetic activity was significantly reduced in COPD, while there was sympathoexcitation.

The Survival of Elderly Patients on Haemo- Dialysis: A Single Center Study from Rural North Karnataka

Introduction: Dialysis and transplantation prolong the survival and the quality of life in patients with chronic kidney disease (CKD). There are no published data on the survival of elderly patients of over 65 years of age, who are on dialysis. Because of several social, economical and practical reasons (mentioned below), not many elderly chronic kidney disease patients opt for dialysis. It is worthwhile to look into the data of the survival of elderly CKD patients on dialysis to justify the treatment. Materials and Methods: All adult patients who were aged 60 years and above, who continued dialysis for more than one month were included in the study which was conducted in Department of Medicine in the S.Nijalingappa Medical College and HSK Hospital and Research Center between 1st May 2005 and 31st March 2011 The patients with ESRD were prospectively followed up and a survival analysis was done. Results and Conclusions: The total number of patients who were undergoing dialysis during this period, who were aged 60 years and above after the above mentioned criteria, were 23. All were ambulant, not opting for renal transplant and willing for maintenance HD regularly, at least twice weekly and they were taking regular medications and erythropoietin. Very few had co morbid factors. The mean age of the elderly patients was 63+2.7 years. Elderly males constituted 82.6 % (19/23) of the patients and in them 68.2% were diabetics. 17.4% (4/23) of the patients were elderly females and in them, 50% were diabetics. The mean period for which they were on dialysis was 14.7 months. As expected, their haemoglobin and calcium levels were lower and these were corrected accordingly. A 1 year survival was seen in 34.75% (8/23) patients and a 2 year survival was seen in 26 % ( 6/23) patients. Our study showed reasonably good 1 year survival rates which were in par with the rates of other Indian studies. The survival in our set up can be improved by proper patient selection, by creating awareness among the patients and their family members for an early initiation of the ESRD patients on haemodialysis before the complications occur, and by giving a maintenance haemodialysis weekly twice, even though they are asymptomatic. In addition, proper management of the co morbid factors, maintaining adequate haemoglobin levels by using erythropoietin and providing good nutrition and concessional rates for MHD for the elderly in accordance with the state government norms are the other modalities for the improvement of their survival in rural conditions.

Invitro Activity of Tigecycline Against Gram Positive and Gram Negative Isolates in a Tertiary Care Hospital

Shanthi M., Uma Sekar

Background: Resistance to multiple anti-microbial agents among gram positive and gram negative pathogens is high worldwide. Tigecycline, a glycylcycline antibiotic is a promising advancement in the treatment of infections caused by multidrug resistant organisms. Objectives: To evaluate the invitro activity of tigecycline against a spectrum of Gram positive and Gram negative pathogens Materials and Methods: A total of 195 non -repetitive, clinically significant isolates obtained from various clinical specimens from hospitalised patients were included in the study. The organisms isolated include methicillin resistant Staphylococcus aureus (MRSA) (n=40), Enterococcus fecalis (n=15), Streptococcus pneumoniae (n=10), Extended Spectrum Beta Lactamase (ESBL) producing Escherichia coli(n=40), ESBL producing Klebsiella pneumoniae (n=40), ESBL producing Enterobacter spp (n=15), Serratia marcesens (n=5), Acinetobacter baumannii (n=25) and Haemophilus influenzae (n=5). Minimum inhibitory concentrations (MIC) were determined for various classes of anti-microbial agents including tigecycline using broth microdilution methodology as defined by the Clinical laboratory Standards Institute (CLSI) using Microscan panels. Interpretation of the anti-microbial susceptibility testing was done as per CLSI criteria. For tigecycline, interpretative criteria was as per the United States Food and Drug Administration breakpoints. MRSA and ESBL screening were performed in accordance with CLSI guidelines. Results: Tigecycline exhibited good activity against all the isolates tested in the study. The three most active agents in vitro against MRSA and Enterococcus fecalis isolates in this study were tigecycline, vancomycin and linezolid with 100 % susceptibility. In the case of ESBL producing Enterobacteriaceae, meropenem and tigecycline were the most active agents. Tigecycline was the most effective anti-microbial agent against the multidrug resistant Acinetobacter baumannii including the meropenem resistant isolates. Conclusion: Tigecycline is an alternative option for the treatment of multi-drug resistant pathogens causing complicated skin and soft tissue and intra-abdominal infections.

Prevalence of Clinical Vitamin A Deficiency Among Primary School Children in Urban Slums of Ahmedabad: A Cross Sectional Study

Naresh T. Chauhan, Trivedi Atul V., Khan Iqbal M., Talsania Niti J.

Background: Although there is a substantial documentation of prevalence, severity and health consequences of vitamin A deficiency (VAD) in preschool-aged children, very few studies have been done to find out the extent of VAD in primary school children. Present study was carried out in school children (5-15 years age) from slum areas of Ahmedabad city to see the prevalence of xerophthalmia. Aims: To clinically asses the prevalence of xerophthalmia among school going children in urban slums of Ahmedabad. To study the socio-demographic factors associated with VAD in urban slums. Settings and Design: The present study was designed as a cross sectional study conducted in primary schools of urban slums in Ahmedabad from October 2007 to July 2008. Methods and Materials: 1000 children were randomly selected from 10 schools and examined with predesigned and pretested Performa. From each school 100 children were randomly selected from standard I-VII. Xerophthalmia was diagnosed if there was a history of night blindness, or on examination, there were signs of conjunctival xerosis, Bitot’s spots, corneal xerosis or keratomalacia. Statistical Analysis: The collected information was analysed by using the Microsoft Excel and the Epi info 3.4 software. Chisquare test was used for analysis. Results: In this study prevalence of VAD was found to be 2.9%. Prevalence of VAD among girls (4.1%) was significantly high than boys (1.9%). In present study 0.5% cases of night blindness, 1.4% cases of conjunctival xerosis and 2.1% cases of Bitot’s spot were found. Types of family, lower social class (class IV & V) and poor intakes of green vegetables were significantly associated with the vitamin A deficiency. Conclusion: The observation of this study underlines the magnitude and severity of vitamin A deficiency in an age group that policy makers do not usually consider to be at risk in this respect.

A Cadaveric Study of Sciatic Nerve and It’s Level of Bifurcation

Muthu Kumar T., Srimathi, Ananda Rani, Sumathi Latha

Sciatic nerve, the thickest nerve in the body, formed in the pelvis, emerges through greater sciatic foramen to enter the gluteal region, then the nerve passes on the back of thigh to reach the superior angle of popliteal fossa and bifurcates into tibial and common peroneal nerves. But the level of bifurcation varies. The assessment of level of bifurcartion of sciatic nerve were available minimal in the Indian literature. So this study was taken and it focus on the frequency of the level of bifurcation of sciatic nerve. For this 50 free lower limbs were dissected. The results were compared with previous reports.

A Clinical Study on Warts

Sudhakar Rao K.M., Ankad B.S., Varna Naidu, Sampaghavi V.V., Vinod, Aruna M.S.

Context: Verruca vulgaris is the commonest skin disease in the dermatology practice. The clinical management of Verruca vulgaris is often challenging. Multiple modalities of treatment currently exist, but none of them is singularly effective. Aim: To study the case of warts clinically. Settings and Design: This was an observational study which was done in the Department of Dermatology. Methods and Materials: The study was carried out for 12 months and it included 90 patients. Patients with genital warts, immunocompromised patients and pregnant females were excluded from the study. Statistical Analysis : The statistical analysis of the descriptive data, that included the number and percentages, was done for all the categories. Results: There were 90 cases of warts and a majority of the patients (30) belonged to the age group of 11-20 yrs. 67 patients were males and 23 were females. A majority of the warts were seen in students (45). The most commonly involved site was the hand (34). The most common type of wart was the common wart (60). Conclusions: Viral warts were common in the younger age groups. Males outnumbered the females. The hand was the commonest site which was involved. Common warts was the commonest type of warts.

ESBL and MBL Mediated Resistance in Pseudomonas aeruginosa: An Emerging Threat to Clinical Therapeutics

Prashant Durwas Peshattiwar, Basavaraj Virupaksappa Peerapur

Purpose: The present study was undertaken to detect the extended spectrum β lactamases (ESBL) and metallo β lactamases (MBL) in isolates of Pseudomonas aeruginosa which were isolated from wound infections and to evaluate their susceptibility patterns. Materials and Methods: One hundred and twenty six isolates of P.aeruginosa were analyzed to study their sensitivity patterns. The presence of the ESBL enzyme was detected by the Phenotypic confirmatory test and the MBL enzyme was detected by the Imipenem – EDTA Double Disk Synergy test. Result: Out of 126 isolates of P.aeruginosa, 28 (22.22%) were ESBL producers and 10 (7.8%) were MBL producers. None of the isolates showed the coexistence of ESBL and MBL in the same isolate. All the ESBL producing isolates were sensitive to Imipenem, while the MBL producing isolates showed widespread resistance to aminoglycosides, ciprofloxacin and the piperacillin with tazobactum combination. Conclusion: The present study underlines the unique problem that the presence of ESBL has led to the widespread use of Imipenem, but that the emergence of MBLs and their broad spectrums and unrivalled drug resistance is creating a therapeutic challenge for clinicians and microbiologists. Hence, we suggest that the detection of ESBL and MBL in Pseudomonas aeruginosa should be a routine practice. We recommend a routine surveillance on antibiotic resistance in the hospital.

Comparison of Alkalinized and Non-Alkalinized Lignocaine in the Brachial Plexus Block

Ramesh Koppal, Adarsh E.S., Prakashappa D.S., Anilkumar G.

Introduction: Interruption of pain is central to the anaesthetic practice. Regional anaesthesia is one of the widely practiced ways for mitigating surgical pain. Many long acting local anaesthetics have been tried, viz.. bupivacaine, ropivacaine … but they are limited by the drawbacks of delayed onset, the varying quality of the blockades and their unpredictable duration of action. The alkalinization of lignocaine has been shown to fasten the onset, potency and the duration of the block. Type of study: Randomized single blind clinical trial. Materials and Methods: After obtaining the institutional ethical committee clearance and their written informed consent, fifty patients who were aged between 25-50 yrs, of either sex, who belonged to ASA grade 1 and 2, who were posted for elective/ emergency surgery of the upper limb were enrolled for the study. Group 1 received 30ml of 1.5% lignocaine with adrenaline and Group 2 received 30 ml of 1.5% alkalinized lignocaine with adrenaline. A supra-clavicular block by a classical approach was made and the degree of the blockade was graded. The results were tabulated and analyzed by using appropriate statistical tests. Conclusion: Alkalinization of lignocaine offers an earlier onset and it provides a good intensity and adequate depth and a satisfactory distribution of the regional block.

Multiple Anomalies in the Morphology and the Blood Supply of the Thyroid Gland: A Case Report

Rimpi Gupta, Rajan Kumar Singla

During the routine undergraduate dissection of the thyroid gland of a 50 year old male cadaver, multiple anomalies in the morphology and the blood supply of the thyroid gland were encountered. These were in the form of the absence of the thyroid isthmus, the presence of the pyramidal lobe and levator glandulae thyroidae on the right side and the bilateral absence of the superior thyroid artery, the gland being supplied solely by the inferior thyroid arteries which came out as the branches of the thyrocervical trunk. Agenesis of the isthmus can be associated with other types of dysorganogenesis, such as the absence of a lobe or the presence of ectopic thyroid tissue and hence, in clinical practice, when such a condition is diagnosed, it is necessary to perform a differential diagnosis against other pathologies such as autonomous thyroid nodule, thyroiditis, etc. The knowledge of various developmental anomalies of the gland and the variations in the neurovascular relations helps the surgeon in the better planning of a safe and effective surgery.

Tubercular osteomyelitis– rare presentation of MDR–TB in a child –a case report

Hemavathi, Leela Rani, Sandhya Belwadi

Abstract: Tuberculosis is a major public health problem in the world. As such, the scenario is quite alarming and it has further been complicated by the spread of the Human Immunodeficiency virus (HIV), as well as by the increased drug resistance. We report here about a child who was previously treated for pulmonary tuberculosis and later on developed skeletal tuberculosis, who did not respond to the first line anti tubercular drugs. Later on, genotyping was done and the diagnosis was found to be Multi Drug Resistant Tuberculosis (MDR-TB). She was started on the 2nd line of anti tubercular drugs since 6 months and is doing well.

Recurrent Dermatofibrosarcoma Protuberans: A Case Report

S.R. Telkar, S.B. Kuntoji, V.D. Dombale, H.B. Kotabagi, B.A. Kolhar

Dermatofibrosarcoma protuberans is an uncommon, locally aggressive, cutaneous, soft tissue sarcoma. It is most commonly seen on the trunk and it frequently recurs locally after an incomplete excision, but distant metastasis is rare. Patients need postoperative local irradiation even with histopathological clear margins, following wide excision, owing to its high affinity for local recurrence. Here, we are reporting a case of recurrent dermatofibrosarcoma protuberans which was seen over the lower part of the abdomen.

Apareunia Due to Labial Adhesions: A Rare Postpartum Complication

Katageri Geetanjali M., Pujari Linganand L., Vishwanath G., Usha Doddamani

Severe degree of vaginal or labial adhesions is due to the healed intrapartum lacerations which requires surgical correction that are rarely reported. A woman presented three months after home delivery with apparent obliteration of the vagina by adhesions resembling a thick membrane. This was divided surgically with successful restoration of the anatomy. Prolonged immobilization with tight apposition of the thighs most likely led to the adhesions in this case.

Bilateral Non-Formation of Upper Trunk of the Brachial Plexus with a Unilateral Communication Between the Musculocutaneous Nerve and the Median Nerve: A Case Report

Rajan Kumar Singla, Ritika Mahajan, Rajan Sharma, Tripta Sharma

Variations in the brachial plexus are common and they have been reported in relation to the origin of the roots, trunks, cords, divisions and the branches. They may prove to be valuable to the orthopaedic surgeon, the radiologist, the anaesthesist, the neurosurgeon, the neurologist, and the vascular surgeons while they perform their respective procedures. In this report, a rare, bilateral non-formation of the upper trunk of the brachial plexus with a unilateral communication between the musculocutaneous nerve and the median nerve has been reported. C5 and C6 on both the sides did not join to form the upper trunk. On the right side, it separately divided into the anterior and the posterior divisions. On the left side, C5 did not give any anterior division and continued as the posterior cord after receiving the posterior division of C6. A communicating branch from the musculocutaneous nerve to the median nerve was also seen on the left side. An earlier unilateral non-formation of the brachial plexus has been reported, with an incidence of 1%, but a bilateral variation is extremely rare. Further, its ontogeny and clinical implications have been discussed in detail.

Parietal Meningioma Excision Under Hypotensive Anaesthesia in a Patient with a Prosthetic Mitral Valve

Mohan Koyee, Mohana Rupa K., Bhavana U., Greeshma, Ganesh M.V.

Non-cardiac surgeries in cardiac patients and post-valve replacement are increasing these days. The prevention of thromboembolic sequelae in these patients is a major challenge. We report here, a case of parietal lobe meningioma excision in a 70-year-old post mitral valve replacement patient who was on irregular anti-coagulant treatment. Low molecular weight Heparin was given preoperatively in the immediate post-operative period and Warfarin was started with later. INR was maintained within normal limits and patient had uneventful recovery following surgery.

Anomalous Right Testicular Artery and Vein: Embryologic Explanation and Clinical Implications

Punita Sharma, Surinder Kumar Salwan

The invasive interventions such as renal transplantation, interventional radiologic procedures and urologic operations increase awareness of the possible variations of the renal and gonadal arteries which is necessary for adequate surgical management in the aforementioned specialties. We have come across an anomalous origin of right testicular artery from right renal artery which is though not a rarity warrant attention because of the origin and course of the anomalous vessel. The origin of right testicular artery from right renal artery was obscured by inferior vena cava. This vascular variation shows a major significance in renal surgery, in partial or total nephrectomy and in renal transplant. The presence of such variations may become a major risk when this type of gonadal artery represents the single blood supply of the gonad, without a second supply from the aorta or other arterial sources. Thus it becomes imperative to report this case and discuss its embryologic and clinical aspects.

Primary Splenic Lymphoma: A Rare Clinical Case Report

Primary Splenic Lymphoma (PSL) is a rare neoplasm of the spleen, probably comprising less than 2% of all the lymphomas (1), (7) and 1% of all the non-Hodgkin’s lymphomas (NHL) (3). The true incidence of the disease is difficult to estimate because of the variable definitions of the disease. Das Gupta et al. proposed that the diagnosis of PSL could be made when the disease was confined to the spleen or the hilar lymph nodes and that no recurrence of the disease was evident for at least 6 months after splenectomy (7). The case which is reported here met these strict criteria. The patient is in complete remission one year after the diagnosis. Splenectomy is considered as the most effective therapy for PSL (2), (3), (6), (7). In this article, we present a rare case of PSL in a 65 years old male. The histopathological evaluation of the splenectomy specimen revealed low grade NHL. The purpose of writing this article was to report this rare occurrence of PSL.

The diagnosis of Morquio disease correlating the clinical, radiological and biochemical findings – a case series

Kamlesh Palandurkar, Sumit Thakur, Udit Agrawal, Madhur M Goyal, Anjan Basak

Background: Mucopolysaccharidoses (MPS) are a group of genetic diseases and its diagnosis is a challenging task due to multiple differential diagnosis. Materials and methods: We had conglomerated clinical findings, radiological and Ophthalmological features. Biochemical test for urine glycosaminoglycans (GAG) was done for confirmation of diagnosis in two pediatric patients. Case summary: Both the cases of Morquio disease were characterized by short-trunk, dwarfism, fine corneal deposits, a skeletal dysplasia that was distinct from other MPS and their intelligence were normal. Radiological features were suggestive of Morquio syndrome and urine GAG test for MPS was positive in both the cases. Discussion and Conclusion: With the clinical features we had multiple differential diagnoses. The radiological investigations minimized the list and the biochemical test confirmed GAG in urine. Combination of clinical, radiological and biochemical findings confirmed the diagnosis of Morquio syndrome in these two cases.

The Cytology of the Benign Extra- Gastrointestinal Stromal Tumour in the Pouch of Douglas: A Case Report

B. Devanand, Vadiraj P.

Extra-gastrointestinal stromal tumours are rare, non-epithelial, mesenchymal tumours which arise from the soft tissues of the abdomen- mesentry, the omentum and the retroperitoneum. These tumours are histologically and cytologically similar to the stromal tumours of the gastrointestinal tract, they are composed of purely rounded epithelioid cells or short fusiform cells or a mixture of both and are set in a fine fibrillary myxiod background. The cytological features of the imprint smears in a case of benign extra-gastrointestinal stromal tumour of the mesentry, projecting into the pouch of douglas in a 42-year old female, have been described here. The recognition of these tumours is important because of their aggressive biological behaviour. The metastatic potential and the high rate of recurrence of these tumours necessitate the frequent follow up of the patients after a surgical resection.

Rehabilitation of Phthisis Bulbi: A Case Report

Patil Brajesh A., Mankani Nivedita H., Chowdhary Ramesh, E. Nagaraj

Maxillofacial prosthetics refers to all artificial prosthesis that restores missing parts of the face due to trauma, a congenital anomaly or surgically removed, the reason being either malignant or benign neoplasia. The objective of this article is to reveal the final rehabilitation of uniocular phthisis bulbi, a clinical case treated with a scleral cover shell in a male patient whose cause of defect was trauma. These prosthesis are the most difficult to perform, with good results, because they try to reconstruct a mobile organ with a non-mobile prosthesis. Maxillofacial prosthesis increases the patient’s quality of life and helps enhance their confidence. Patients who have been rehabilitated in such a way are ready to be integrated again in society.

Urinary Tract Infection by Corynebacterium Urealyticum – Look Twice

Sushma Krishna, Rajani K., Indira Bairy, Shobha K.L.

Corynebacterium urealyticum though rare, is known to cause alkaline-encrusted urinary tract infections and struvite calculi. Identification of the bacilli and administration of the right antibiotic therapy is important in preventing persisting infections and complications. This report describes one of the rare cases which was encountered on routine urine culture of a long term catheterized patient following a road traffic accident. This case highlights the importance of the proper identification of gram positive bacilli and suggests that they may not be disregarded as urinary contaminants.

An Unusual Clinical and Morphological Features of Uterine Leiomyosarcoma: Immunohistochemistry Solves the Diagnostic Pitfalls of Uterine Sarcomas

P.M. Subramaniam, P.R. Rekha, R. Thamil Selvi.

Introduction: Leiomyosarcoma (LMS) arises from smooth muscle of the uterus and is a rare tumour that accounts for 2% to 5% of all uterine malignancies. Very few cases are reported in the literature. Our patient presented with a pelvic mass and did not have any history of genital bleeding, which is the usual presentation in uterine sarcoma. We report here an original case report of an unusual presentation of this rare tumour in the endometrial cavity with combined features of epithelioid differentiation and haemangiopericytoma (HPC) like areas in a single tumour which is not yet reported in the published literature. Case Report: A 55- years multiparous woman presented with a pelvic mass for 8 months duration with a rapid increase in size over the last three months. Ultrasonography showed a mass arising from the uterus. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine sarcoma combined with epithelioid differentiation and haemangiopericytoma like areas and hence a panel of immunohistochemical (IHC) workup was done which confirmed leiomyosarcoma. Conclusion: Our report highlights how a good index of suspicion, detailed histopathological diagnosis which when complemented with immunohistochemical work up could prevent the pitfalls of misdiagnosis and mismanagement of uterine sarcomas.

Cytology of Pleuropulmonary Blastoma: A Case Report

Cervical Aplasia

Annie Rajaratnam, Prema D’cunha, Nancy Paul, Amitha Ray

The incidence of genital malformations in the general population is 3-5%. Ours was a case of cervical aplasia. Our objective was to confirm the diagnosis and to manage the same surgically. It is essential that these patients receive psychological support as it has implications on their reproductive life. This case was referred to our tertiary care teaching hospital. After investigations and examination under anaesthesia, the patient underwent hysterectomy. Obstructive anomalies of the genital tract are the commonest among the mullerian duct malformations.

Desmoid Tumor of the Abdominal Wall: Report of a Case

Salman Yousuf Guraya, Khalid Rida Murshid

Desmoids tumours of the abdomen are uncommon benign tumours with varied presentations. The diagnosis is frequently established by histological examination. These tumours are known to recur even after surgical excision. A case report of a 41-year-old female with a painless abdominal mass has been presented. She was found to have a firm, non-tender, immobile, and regular mass in the left lumbar region of the abdominal wall. Her CT scan and FNAC revealed a benign-natured lesion. The patient’s mass was completely excised and the histology confirmed desmoids tumour of the abdominal wall. The rarity of such lesions warrants that the treating physicians should have a high degree of suspicion while managing abdominal masses of a questionable nature.

Klippel –Trenaunay Syndrome : A Rare Cause of Recurrent Lower GI Bleeding.

Klippel-Trenaunay syndrome is a non-hereditary congenital abnormality characterized by a clinical triad of soft tissue hypertrophy of an extremity, varicosities and cutaneous hemangiomas or Lymhangiomas. Hematochezia is an uncommon but potentially serious complication of Klippel-Trenaunay syndrome. We report here a case of a young female who presented to us with intermittent bleeding per rectum and iron deficiency anemia. The patient gave history of excision of hemangioma in the right leg 12years ago. Her upper GI endoscopy revealed grade-I esophageal varices and colonoscopy showed vascular malformation from rectum to sigmoid. CT Angio revealed splenic haemangiomas with multiple vascular malformations in GI tract.

Malignant mixed epithelial tumour ovarypapillary serous adenocarcinoma and malignant Brenner’s tumour. An exceedingly rare Neoplasm

Nalini Gupta, Aparna Ahuja

Mixed ovarian epithelial carcinoma with an unusual histological pattern can be very difficult to diagnose and a thorough sampling of the specimen is needed to rule out the presence of a dual neoplasm. This case reports a very unusual case of mixed epithelial tumour, moderately differentiated serous papillary adenocarcinoma and malignant Brenner’s tumour, in a 65 year old female. She presented with a three month history of abdominal pain. Ultrasound of the abdomen revealed an ovarian mass, for which pan-hysterectomy was performed. Extensive sampling of the tissue revealed a dual neoplasm, serous papillary adenocarcinoma (80%) and malignant Brenner’s tumour (20%), with multiple deposits of the former (dominant tumour) on the uterus, the contralateral ovary and on both the fallopian tubes.

Treatment of Black Triangle by using a Subepithelial Connective Tissue Graft

Plato Palathingal, Jaideep Mahendra

One of the most difficult and elusive goals of periodontics in the field of reconstruction, regeneration and esthetic aspect of periodontal therapy is the surgical reconstruction of the lost interdental papilla. Loss of interdental papilla could result in patient complaints such as phonetic problems, food impaction, functional problems and esthetic concern. It is clinically represented by open embrasures and is often referred to as the “black triangle”. Periodontal plastic surgery offers both surgical and non surgical approaches in the treatment of “Black triangle”. This case report demonstrates complete reconstruction of the lost interdental papilla following a semilunar coronally repositioned papilla technique with 6 months follow-up.

Dental Prosthesis: An Evaluation on Mechanical Properties of Recast Base Metal Alloys

Prabhu R., Geetha Prabhu K.R., T. Ilango

Introduction: Dental casting alloys have found widespread usage in restorative dentistry owing to their physical, biological and economical properties. Recent technologies have been applied to these alloys to improve their utility, longevity and efficiency. Purpose of the Study: The current study aimed at evaluation of recast base metal nickel-chromium alloy with or without addition of new alloy based on their mechanical properties. Materials and Methods: The study evaluated 10 samples each of fresh alloy, recast alloy with addition of 50% of wt. of new alloy and recast alloy without addition of new alloy. Samples were subjected to computerized Universal Testing Machine and mechanical properties viz. tensile strength, yield strength, percentage of elongation, modulus of elasticity and microhardness was tabulated. Data was subjected to multiple posthoc test of significance. Results: Significant changes were observed in recast alloy with and without addition of new alloy in contrast to fresh alloy. Conclusion: Recast alloys used in fixed dental prostheses without addition of new alloy show degenerative changes when compared to unused alloys after casting.

Prosthodontic Management of Undercut Tuberosities: A Clinical Report

Chakravarthy Ramasamy, Abby Abraham

The buccal undercut of the maxillary tuberosity, together with the reduced width of the buccal vestibule can complicate denture fabrication. This clinical report describes the treatment options which are available for this situation, the rationale for the design, the use of soft resilient denture flanges in the maxillary posterior buccal vestibule, and the chair-side permanent reline procedure for the incorporation of resilient denture flanges in the undercut area.

Customized Sectional Stock Tray for a Patient with a Restricted Oral Opening: A Case Report

Shivasakthy M., Syed Asharaf Ali

The branch of Prosthodontics is not only a science but also an art of handling patients who present with limitations in continuing with normal procedures. One such limitation is the difficulty in mouth opening of the patient due to various reasons like fracture due to trauma, oral sub mucous fibrosis, TMJ ankylosis, etc. Impressions can be made for patients with restricted mouth opening, with a sectional impression tray that can be assembled and disassembled in the mouth and reassembled outside the mouth. This article describes a sectional stock tray system for making preliminary impressions. It may be used not only for individual dental arches, but also for patients with microstomia or constricted oral openings. This system allows many combinations of the right and left tray sizes and the forms to be assembled into a well-fitted anatomically-conforming tray in spite of the individual anatomic discrepancies.

Clinical Crown Lengthening by Surgical Extrusion: A Case Report

S.C. Chandrasekaran , Jumshad B. Mohamed , MD Nazish Alam, Parthiban Saket

Aesthetic considerations have influenced the management of dental maladies in varying degrees for many years. The patient awareness and expectations have increased recently to the point that less than optimal aesthetics are no longer an acceptable outcome. An essential goal of the treatment is the longterm stability of the result; for this to be achieved, the integrity of the dentogingival junction must be respected, and the dental restorations and the periodontium must be in harmony. This case report deals with root canal treatment of the fractured tooth, followed by atraumatic extrusion of the tooth by using a periotome and stabilization of the tooth to a required level by temporary splinting, followed by its final restoration. The outcome of the treatment within a short duration has very good aesthetic results.

Diabetic Patient with Involuntary Movements

Senthil Kumar Aiyappan, Upasana Ranga, Saveetha Veeraiyan

Sputum Gram Stain Assessment in Relation to Sputum Culture for Respiratory Tract Infections in a Tertiary Care Hospital

Mariraj J., Surekha Y. Asangi, Krishna S., Suresh B. Sonth, Ramesh, Shanmugum