Journal of clinical and diagnostic research

Ringxiety and the Mobile Phone Usage Pattern among the Students of a Medical College in South India

Aims: Technologies like mobile phones may not always work positively but they may have unforeseen adverse effects. This study was conducted to find the proportion of students who experienced ringxiety (phantom ringing) and other perceived effects, as well as the pattern of the mobile phone usage among college students. Method: A cross-sectional study was carried out at Kasturba Medical College, Mangalore, south India, among 336 medical students by using a pre-tested, semi-structured questionnaire. Results: Among the total number of students, 335 students possessed mobile phones. Mostly, the persons whom they talked to on their phones were parents for 220 (51%) of the students. 48% (150) talked for less than half hour in a day and 41% (137) were high volume message users. “Ringxiety” was experienced by 34.5% (116) of the students and they were more likely to use their phones at restricted places like classrooms (99%) and libraries (60.3%). A significantly larger proportion of ringxiety sufferers also complained of hampered studies. Conclusion: The pattern of mobile phone use among the medical students appeared to be problematic, as a fairly large proportion suffered from ringxiety, they reported getting very upset and they used their phones at restricted times and places. This problem needs to be recognized, all stakeholders must be made aware of the symptoms and measures must be taken to reduce it.

The Effect of Smoking on the Hearing Status -A Hospital Based Study

Adesh kumar, Rajiv Gulati, Sangeeta Singhal, Abrar Hasan, Asif Khan

Introduction: Fatty Liver (FL) disease is commonly encountered in clinical practice and is frequently seen in patients with Acute Pancreatitis (AP) due to common risk factors such as obesity, alcohol abuse, and insulin resistance among others. Aim: To evaluate the effect of FL on the severity of AP radiologically using Computed Tomography (CT). Materials and Methods: This was a retrospective study, conducted from June 2021 to July 2021 in which plain CT images of patients with AP were reviewed to measure the mean attenuation values of the liver and spleen. A ratio of mean hepatic/splenic Hounsfield Units (HU) <1 was considered as FL. The severity of AP was assessed using the Modified CT Severity Index (CTSI) on Contrast Enhanced Computed Tomography (CECT) scan. Data collected was entered into Microsoft Excel datasheet and frequency (n) and percentages were calculated. Chi-square test was used to calculate the level of significance. Results: A total of 50 patients (44 males and 6 females; mean age 35.58±13.792 years) with AP were included in this study amongst whom FL was found in 23 patients (46%) and non FL in 27 patients (54%). The severity of pancreatitis was significantly greater in patients with FL than patients without FL. AP patients with FL had higher rates of local complications like acute Peripancreatic Fluid Collections (PPFC) (56.5% vs 22.2% p<0.001) and Acute Necrotic Collections (ANC) (26.1% vs 3.7% p<0.001) than those without FL. Conclusion: Fatty liver plays a significant role in the severity acute pancreatitis and can be used as an indicator for the same. Combined plain and contrast CT scans can be used to assess FL and diagnose and predict the severity of AP.

Use of Triplex PCR for Rapid Detection of PVL and Differentiation of MRSA from Methicillin Resistant Coagulase Negative Staphylococci

Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA) has become a major public health problem in both hospitals and communities. Panton – Valentine Leucocidin (PVL) has been reported to be an important marker for the highly pathogenic community acquired S. aureus infections. A rapid detection of these MRSA is very important for its treatment. The specific detection of MRSA is always a problem due to the prevalence of methicillin resistance among the coagulase negative Staphylococci. Hence, this study was done to develop a rapid triplex PCR for the detection of PVL positive MRSA and for the simultaneous differentiation of MRSA from Coagulase Negative Staphylococci (CoNS). Materials and Methods: We developed a triplex PCR for the specific detection of PVL positive Community Acquired (CA) – MRSA and for its simultaneous differentiation from the coagulase negative Staphylococci. We used PCR for targeting the fem A gene which is specific for S. aureus, mecA which is specific for methicillin-resistance and luk - PV which is specific for the PVL toxin. The method was evaluated with a total of 100 clinical isolates of Staphylococcus spp. Results: The triplex PCR was successfully standardized by using the reference strains and it was evaluated by using clinical strains. The method was found to be rapid, highly sensitive (100%), specific (99%) and cost effective. Conclusion: Triplex PCR can be used as a diagnostic tool for the detection of the highly pathogenic strains of CA-MRSA.

The Microbiological Profiles of Infected Prosthetic Implants with an Emphasis on the Organisms which Form Biofilms

Anisha Fernandes, Meena Dias

Background:In spite of the decreasing incidence of orthopaedic device related infections to 1%, nowadays, device-related infections still remain a diagnostic, therapeutic and cost -related problem. Aims and Objective:To record the common causative organisms and the contributing risk factors for orthopaedic device-related infections in a tertiary care teaching hospital. Methods:In a prospective study, fifty patients who underwent orthopaedic device implantation from Jan 2009 – June 2010 were enrolled; among them, 42 patients were complicated with infections. The demography, microbiological data, treatment and the outcome of each patient were recorded. Statistical Analysis: The data was analyzed in terms of frequency and percentage. Results:Of the 50 samples, 42(84%) were culture positive, while 8(16%) were cultures negative. The femur was the most commonly affected bone in both males (median age–37.1yrs) and females (median age–41.3 yrs). Staphylococcus aureus was the organism which was most commonly isolated and which caused biofilms, followed by non-fermenting, gram negative bacilli and Klebsiella spp. We reported the first case till date in the literature of Candida kruseiPJI, to the best of our knowledge. No anaerobes were isolated. Tissue trauma, open fractures, post-operative surgical site infections and Diabetes mellitus were found to be the important risk factors. The biofilm forming organisms were commonly associated with polymicrobial infections and even an aggressive antibiotic therapy was often inadequate to eliminate the infections. A conservative surgical treatment was associated with treatment failures. Implant removal or replacement was required in most of the cases to eradicate the infection. Conclusion:The most common bacteria which were isolated included Staphylococcusaureus ,followedbyPseudomonas aeruginosa and Klebsiella. A majority of them are resistant to the commonlyusedantibiotics, leading to treatment failures which necessitated an implant removal.

Comparative Evaluation of the in-vitro Activity of Six ß-lactam/ß-lactamase Inhibitor Combinations against Gram Negative Bacilli

Smita Sood

Introduction: Procedural skill learning is fundamental part of medical education. Simulation based learning helps students acquire the competencies without putting patients at risk. Manikins and cadavers are available resources of medical simulation. Which one is more effective in learning the skills with acceptable confidence, competence and satisfaction is to be elucidated. Establishing a cadaver based Procedural Skill Lab (PSL) may play a role in early exposure of procedural skills to medical students. Aim: To study the intern’s perceptions of effectiveness of procedural skill learning on cadaver and manikins and to record their opinion on need for establishing PSL in Anatomy Department. Materials and Methods: An observational study conducted at S. Nijalingappa Medical College, Bagalkot, Karnataka, India. Twenty five (n=25) interns who volunteered to participate in the study were included. After collecting the baseline data about exposure to said skills, students were divided into two groups. Students learnt six procedural skills on manikins (M group) and on cadavers (C group). Post-test data was collected. Then crossover was done and survey about the satisfaction, preferred mode of learning and need of the PSL in anatomy was collected. Non parametric test were applied: Wilcoxon signed rank test for paired data Mann-Whitney U test for unpaired data, using Medcalc and Statistical Package for the Social Sciences (SPSS) software. Results: Perceived confidence and competence of students after training in both the groups (M and C) increased for all the six skills which was statistically significant (M group p<0.0005 and C group p<0.0002). Satisfaction score was more for cadaver group (p<0.0001). Students chose cadaver based learning as the preferred method of learning and wanted PSL. Conclusion: Soft embalmed cadaver can be an effective tool to learn procedural skills at all level. Establishing a cadaver based PSL in anatomy can provide undergraduates with early exposure of skills develop the requisite knowledge, postgraduates can learn the speciality concerned procedural skills and faculty can venture upon innovative procedures and prevent de-skilling.

Modified Double Disc Synergy Test to Detect ESBL Production in Urinary Isolates of Escherichia coli and Klebsiella pneumoniae

Jaspal Kaur, Shashi Chopra, Sheevani, Gomty Mahajan

Background and Objectives: Various phenotypic methods are recommended in the routine practice to detect the ESBL production in gram negative bacilli. Among them, the Double Disc Synergy Test (DDST) which uses the third generation cephalosporins (3GC), is a simple and a reliable method. But the coexistence of AmpC may give false negative results. In such cases, the ESBL detection can be improved by using cefepime along with the third generation cephalosporins in DDST. Methods: A total of 350 urinary isolates (224 Escherichia coli and 126 Klebsiella pneumoniae) were studied for ESBL production by the modified double disc test (MDDST) i.e. by using cefotaxime, ceftriaxone, cefpopdoxime (third generation cephalosporins) and cefepime ( fourth generation cephalosporin) along with a amoxicillin-clavulanate disc. Results and Interpretation: ESBL production was seen in 63.4% (142/224) Escherichia coli and in 60.3% (76/126) Klebsiella pneumoniae isolates by MDDST. Among these, in twelve E.coli and five K.pneumoniae strains, only cefepime but none of the third generation cephalosporins showed synergism with amoxicillin-clavulanate. All these seventeen strains showed a clear extension of the edge of inhibition which was produced by cefepime towards the amoxicillin-clavulanate disc. These strains were further tested for AmpC co-production by the AmpC disc test and all these strains were found to be AmpC positive, thus revealing the superior activity of cefepime in detecting ESBLs in the bacteria which co-produced AmpC. A high degree of co-resistance was found in the ESBL producers. Conclusion: The ESBL detection can be improved by MDDST by using cefepime along with the third generation cephalosporins.

A Study on the HBV and the HCV Infections in Female Sex Workers and their Co-Infection with HIV

Desai Praseeda S., Dutta Anuradha, Shastri Jayanthi S.

Background: Sexually Transmitted Infections (STIs) have been shown to enhance the transmission of the Human Immunodeficiency Virus (HIV). The Hepatitis B and the Hepatitis C viral infections are highly prevalent among the HIV-infected persons as a result of shared transmission routes. Aim: To determine the seroprevalence of the HIV, Syphilis, HBV and HCV infections and their co-infection rates among Female Sex Workers (FSWs). Settings and Design: 250 blood samples were collected from FSWs from a red light area of Mumbai by using an outreach strategy. Materials and Methods: Their sera were tested for the HIV antibodies as per the strategy II of the NACO guidelines, for syphilis by RPR, for the HCV antibodies and for HBsAg by ELISA. Results: The study group showed (105/250) 42% HIV reactivity, (15/250) 6% RPR reactivity, (20/250) 8% HBsAg positivity, (7/250) 2.8% HCV reactivity, (11/250) 4.4% HIV-RPR reactivity, (7/250) 2.8% HIV-HBV co-infection and (3/250)1.2% HIV-HCV co-infection. Statistical test which was used: The Chi square test. Conclusion: A high HIV sero-prevalence was found among the FSWs. A high HIV prevalence was found among the RPR reactive FSWs. The relationship between the HIV reactivity and the RPR reactivity was statistically significant. Co-infections with HBV and HCV were detected among the HIV reactive FSWs, but they were not statistically significant.

Prevalence of High and Low Level Mupirocin Resistance among Staphylococcal Isolates from Skin Infection in a Tertiary Care Hospital

Background:Mupirocin has been used for the treatment ofskin infections and for the eradication of the nasal carriage of Methicillin -resistant Staphylococcus aureus(MRSA). The increased use of this antibiotic has been accompanied by its resistance, resulting in treatment failures. Objective:This study was aimed at determining the prevalences of low and high level Mupirocin resistance among the clinical isolates of Staphylococcus species which were obtained from pyogenic infections. Material and Method:Clinical samples such as wound swabs,tissues and pus which were submitted to the microbiology laboratory during a period of six months were screened for the growth of Staphylococcus species, which were identified as Staphylococcus aureus and Coagulase negative Staphylococcus species by the routine microbiological procedures. All the isolates were tested for their Mupirocin susceptibilities by using 5 and 200 µg discs and their resistance was confirmed from their Minimum Inhibitory Concentrations (MICs). Result:Out of 400 samples, 150 samples grew Staphylococcus species,of which 113 wereStaphylococcus aureus and 37 were Coagulase negative Staphylococcus(CoNS). Only 5(3.3%)mupirocin resistant Staphylococcus species: three high level and two low level strains were detected. The MICs for the two low level and three high level Mupirocin resistant strains were 256mg/L and= 512mg/L each respectively. Conclusion:We conclude that the screening for mupirocin resistance, in terms of high-level and low-level resistance among theStaphylococcus species from patients with skin and soft tissue infections is warranted and that it is important for the clinicians in selecting the appropriate, empirical, topical,antimicrobial therapy. It also provides useful information about the prevalence of these resistant pathogens.

Serratia Marcescens- A Rare Opportunistic Nosocomial Pathogen and Measures to Limit its Spread in Hospitalized Patients

Ashish Khanna, Menka Khanna, Aruna Aggarwal

Background: In November 2011, 6 patients who were in the ICU of the Sri Guru Ram Dass Institute of Medical Sciences and Research acquired an infection which was caused by Serratia marcescens. We investigated the cause of the increase in frequency of the isolation of Serratia marcesens from hospitalized patients. Methods: Various samples from patients and environmental sources, which were collected from the ICU of Sri Guru Ram Das Institute of Medical Sciences and Research during the 6 month period from November 2011 to April 2011, were included in the study. The isolates from the patients and the surrounding environmental sources were examined by using standard techniques. Further, the isolates of Serratia marcescens were identified, depending upon their biochemical and morphological characteristics. Results: Seven isolates of Serratia marcescens were identified (six from the patients in the ICU and one from the soap dispenser in the ICU) among a total of 327 isolates from the clinical samples and 84 isolates were identified from the environmental sources in the ICU. Discussion and Conclusion: An outbreak of the Serratia marcescens infection in the ICU was traced to the extrinsic contamination of the soap dispenser in the ICU, as after the removal of the dispenser, no further case occurred.

Increasing Antimicrobial Resistance of Campylobacter Jejuni Isolated from Paediatric Diarrhea Cases in A Tertiary Care Hospital of New Delhi, India

Roumi Ghosh, Beena Uppal, Prabhav Aggarwal, Anita Chakravarti, Arun Kumar Jha

Introduction:The resistance to the clinically important antimicrobial agents, particularly the fluoroquinolones and the macrolides, is increasing among the Campylobacter isolates. Only limited data is available regarding the changing antimicrobial resistance pattern in the Indian scenario. Methodology:Three hundred fifty cases (ages< 12years) of acute diarrhoea, who were admitted to a tertiary-care hospital, were investigated for Campylobacter spp. The antimicrobial susceptibilities of all the C. jejuniisolates were assessed by the disk diffusion method according to the CLSI guidelines. Results:A total of 36 isolates of C. jejuni were tested for their antimicrobial susceptibilities. A high degree of resistance to the fluoroquinolones (100% to Nalidixic acid and 86.66% to Ciprofloxacin) was detected in the Campylobacter isolates. The frequency of resistance against Tetracycline was 33.33% and that against Erythromycin was 22.2%. Fifteen (41.66%) isolates were multiresistant, being resistant to 3 or more antimicrobial agents. Conclusions:An increased resistance to the quinolones and the macrolides and multidrug resistance warrant a reconsideration of their use as the drugs of choice in patients with severe gastroenteritis when Campylobacter is the presumed cause.

The Prevalence of Fungi in Fingernail Onychomycosis

Prakash Gelotar, Swati Vachhani, Bhargav Patel, Naresh Makwana

Introduction: Corpus callosum is the collection of white fibres situated in the longitudinal fissure of brain connecting the two halves of the brain. Different methodologies may yield different results in the measurement of diameters of corpus callosum. Aim: To find out any difference in corpus callosum diameters when these diameters were measured in formalin fixed brain specimens and in Magnetic Resonance Imaging (MRI) scans. Materials and Methods: This was a cross-sectional study carried out in the Department of Anatomy, Silchar Medical College and Hospital, Silchar, Assam, India from April 2014 to March 2019. A total of 107 formalin fixed cadaveric brain specimens were used to measure length, height and thickness of corpus callosum and MRI scans of 43 patients were used to measure the same diameters. The mean value of all the diameters of corpus callosum measured in formalin fixed brain specimens and in MRI scans were compared. Statistical significance was calculated with student’s t-test and p-value <0.05 was considered significant. Results: Total data collected from 107 brain specimens (66 were males and 41 were females) and MRI scans of 43 subjects (30 were males and 13 were females), all in age range of 10- 70 years, were analysed. Mean values of length, height, midbody, rostrum and splenium thickness of corpus callosum in cadaveric brain specimens were recorded 70.85 mm, 23.37 mm, 5.46 mm, 5.91 mm and 8.40 mm, respectively and same diameters in MRI scans were 74.61 mm, 25.85 mm, 5.84 mm, 6.68mm, 10.46 mm, respectively. Difference of these diameters of corpus callosum measured in cadaveric brain specimens and in MRI scans was statistically significant with p-value=0.0001 for length, 0.0006 for height and 0.0001 for thickness. Conclusion: Significant difference was observed when the same diameters of corpus callosum were measured in MRI and in formalin fixed cadaveric brain specimens.

Lower Respiratory Tract Infections (LTRIs): An Insight into the Prevalence and the Antibiogram of the Gram Negative, Respiratory, Bacterial Agents

Background: Community acquired respiratory tract infections are one of the commonest health issues globally, which de mand frequent visits to the family practitioners. The emergence of antibiotic resistance in the frequently isolated pathogens has complicated the use of the empiric therapy with traditional agents. Aim:This study was focused on obtaining a comprehensive insight into the microbial profile, its prevalence and the susceptibility patterns of the gram negative bacilli isolates in lower respiratory tract infections. Methods and Materials:Respiratory samples which were received from the patients at a Medical College Hospital in North Kerala, India were processed according to the standard protocol over a period of one year, from April 2011 to March 2012. The antimicrobial susceptibility was tested by the Kirby-Bauer disc diffusion method as per the CLSI guidelines. The data was interpreted by using the WHO Net antibiotic susceptibility surveillance software. Results:Out of 1750 respiratory samples, 298(17.03%) were culture positive for gram negative bacilli. The highest isolation rate was observed in the 61-80 years age group with a male pre-ponderance and Klebsiella pneumoniae(41.95%) was found tobe the predominant organism. The resistance pattern varied for different organisms. Among the different groups of antibacterial agents which were ested, levofloxacin was found to be an effective oral antibacterial against the pathogens which wereisolated. The carbapenems (imipenem and meropenem), the betalactum/betalactamase inhibitors (piperacillin/tazobactum)and the aminoglycosides (amikacin) were effective among the parenteral antibacterials. The selection of the appropriate anti-bacterial therapy should be based on the organisms which are isolated and on the emerging resistance to the conventionaltherapies. Conclusion:Owing to the increased concern which surrounds anti bioticresistance and the changing patterns of the bacterial pathogens, the ongoing surveillance of disease and a regularreview of the management guidelines are critical.

The Prevalence of Nasal Carriage of Staphylococcus Aureus Among Healthcare Workers at a Tertiary Care Hospital in Assam with Special Reference to MRSA

Sharon Rainy Rongpharpi, Naba Kumar Hazarika, Hitesh Kalita

Background: The recent years have witnessed the increasing resistance of Staphylococcus aureus to many antimicrobial agents. The most notable example is the emergence of Methicillin- resistant Staphylococcus aureus (MRSA), which was reported just one year after the launch of methicillin. The ecological niches of the S. aureus strains are the anterior nares. The identification of Staphylococcus aureus by using a proper antibiogram and the detection of methicillin resistant Staphylococcus aureus greatly contribute towards the effective treatment of the patients. Aims and objectives: To isolate Staphylococcus aureus from the nasal swabs of healthcare workers (HCWs) and to study their antimicrobial susceptibility patterns, which include methicillin resistance. Materials and Methods: Nasal swabs were collected from the healthcare workers of various clinical departments of the hospital over a period of one year. The isolation of Staphylococcus aureus and their antimicrobial susceptibility patterns were carried out by standard bacteriological procedures. Results: Staphylococcus aureus was isolated in 70 cases (22.22%). The prevalence of the S.aureus nasal carriage was higher among the male HCWs (54.28%) than among the female HCWs (45.71%). The carriage rate was the highest in the orthopaedics department, followed by those in the surgery and the gynaecology departments. All the Staphylococcus aureus isolates were sensitive to vancomycin and linezolid (100%). Penicillin and ampicillin were the most resistant, (90% and 88.6%) respectively. Methicillin resistance was seen in11.43% of the S.aureus isolates, both by the disc diffusion test and by the Oxacillin Resistance Screen Agar (ORSA) test. Conclusions: The compliance with the sanitary and the antibacterial guidelines of the health professionals is the single most important factor in preventing nosocomial infections. Simple preventive measures like hand washing before and after the patient examination, the use of sterile aprons and masks in the postoperative wards, awareness during the examination of the immunocompromised patients, and avoiding touching one’s nose during work, can reduce the disease transmission rate considerably.

The Evaluation of Carotid Atherosclerosis in Patients with the HIV-1 Infection: The Role of the Antiretroviral Therapy

Retroperitoneal liposarcoma is a malignant mesenchymal tumour. The incidence is rare and early diagnosis is difficult as they present with non specific symptoms. A 55-year-old male patient, presented to General Surgery Department with complaints of abdominal swelling since two months and discomfort for three to four months. Abdominal examination revealed a mass, soft to firm in consistency with restricted mobility, was palpated in right quadrants. A clinical diagnosis of soft tissue tumour was made. Abdominopelvic computed tomography (CT) scan was performed showing a well-defined circumscribed, low-attenuated mass of retroperitoneal origin crossing midline and significantly displacing the intestinal loops, right grade 2 hydronephrosis and was compressing on inferior vena cava posteriorly. The patient underwent a resection surgery of the lesion and the histopathological examination showed a well-differentiated liposarcoma and Castleman’s disease. These tumours are generally resistant to radiotherapy and/or chemotherapy. Thus the major prognostic factor related to survival is resection with tumour-free margins that includes the tumour as well as adjacent structures showing infiltration.

Sonoelastography and Dynamic Magnetic Resonance Mammogram in the Evaluation of BIRADS III and above Breast Lesions Categories- A Prospective Cohort Study

Introduction: Breast cancer has become a major health hazard in society. Early diagnosis of breast cancers plays a vital role in its management and control. Sonoelastography and Magnetic Resonance (MR) mammography are non invasive imaging methods in the diagnosis of breast lesions. Aim: To determine the accuracy of sonoelastography and dynamic MR mammogram in the evaluation of breast masses of Breast Imaging Reporting and Database System score (BIRADS)- III and above (BIRADS-IV, V and VI ) lesion categories. Materials and Methods: The present prospective cohort study conducted in the Department of Radiodiagnosis at Bowring and Lady Curzon Medical College and Research Institute and Prestige Medical Health Sciences, Bangalore, India from June 2019 to March 2020. A total of 60 female cases clinically and histopathologically diagnosed with breast cancers above 28 years of age were recruited. All the subjects underwent conventional B mode ultrasonogram. Cases with BIRADS-III and above lesion category were assessed through sonoelastography and dynamic contrast enhances MR mammogram. MR mammogram was performed by using 1.5 tesla GE Magnetic Resonance Imaging (MRI). The sequences like axial and sagittal Time (T)1 Weighted (W)1 and T2 WI, Diffusion Weighted Imaging (DWI), axial Short Inversion Time Inversion Recovery (STIR) were performed. The Chi-square test was used to compare the difference between study variables. Results: A total of 60 female cases, clinically and histopathologically diagnosed with breast cancers above 28 years of age were included in the study with maximum in age range of 41-50 years. The dynamic MRI curve category sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy as 91.8%, 95.3%, 96.3%, 92% and 94.8%, respectively. The study showed sonoelastography sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy as 79.8%, 93%, 88.6%, 82.2% and 84%, respectively. Conclusion: The MR mammogram and sonoelastography are effective methods in the diagnosis of breast lesions; however, MR mammography has higher sensitivity, specificity and diagnostic accuracy

Fetal Haemoglobin and B-globin Gene Cluster Haplotypes among Sickle Cell Patients in Chhattisgarh

Sanjana Bhagat, Pradeep Kumar Patra, Amar Singh Thakur

Background: Foetal Haemoglobin (HbF) is the best-known genetic modulator of sickle cell anaemia, which varies dramatically in concentration in the blood of these patients. The patients with SCA display a remarkable variability in the disease severity. High HbF levels and the B-globin gene cluster haplotypes influence the clinical presentation of sickle cell disease. To identify the genetic modifiers which influence the disease severity, we conducted a B-globin haplotype analysis in the sickle cell disease patients of Chhattisgarh. Aim: The foetal haemoglobin and the B-globin gene haplotypes of the sickle cell trait and the sickle cell disease patients from Chhattisgarh were investigated. Materials and Method: A total of 100 sickle cell patients (SS), 50 sickle cell trait patients (AS) and 50 healthy control individuals were included in the present study. The distribution of the B-globin gene haplotype was done by the PCR-RFLP method. Result: PCR-RFLP showed that the homozygous Arab-Indian haplotype (65%) was the most frequent one, followed by the heterozygous Arab-Indian haplotype (11%) in the sickle cell patients (SS), while the AS patients had a higher frequency of the heterozygous Arab-Indian haplotype (38%) in comparison to homozygous one (32%). Four atypical haplotypes, 3 Benin and 1 Cameroon were also observed, although they were in lower frequencies. In the present study, the HbF levels were higher in the AS and the SS patients, with one or two Arab-Indian haplotypes as compared to the other haplotypes. Conclusion: The presence of the Arab-Indian haplotype as the predominant haplotype might be suggestive of a gene flow to/from Saudi-Arabia or India and it was associated with higher HbF levels and a milder disease severity.

Fluoroscopic Detection of Ventral Wall Violation during C2 Intralaminar Screw Insertion: A Descriptive Study

Hemalatha A.L, Sumana.Sindhuram.V, Sushma.S, Suma.J.K, Varna.I, Anubha Aditya

Introduction: The C2 (second cervical) laminar screws were considered for rigid fixation of the axis because the use of pars or pedicle screws posed a risk to the vertebral artery with C2. Though considered to be a relatively safe method, ventral spinal canal violations have been reported in laminar screws fixations. Fluoroscopy-based image guidance may increase the accuracy and safety of the technique. Aim: To report the use of fluoroscopy technique in the detection of ventral wall violation during C2 intralaminar screw insertion. Materials and Methods: This descriptive study reports seven dry axis vertebrae from the adult south Indian population for which fluoroscopic analysis was done from January 2013 to December 2013. True lateral views were taken before and after applying a vertical line of barium paint on the ventral surface of the lamina at two points: at the centre of the lamina and close to the facet joints at the face to-laminar junction. Results: In the total seven dry axis vertebrae analysed, the mean ratio of the distance from the spinolaminar junction to the barium line (drawn on the ventral surface of the lamina just next to face to laminar junction) to the distance between the spinolaminar junction and uppermost part of inferior articular facet of C2 vertebrae was 0.465±0.0389 mm. Conclusion: Even though considered a relatively safer technique, laminar cortical violations have been reported in C2 translaminar screw fixations. Fluoroscopy-based imaging guidance can improve the accuracy of C2 translaminar screw insertion, as this technology provides real-time imaging during the process of screw insertion and helps in accurate screw sizing.

Subclavian Vein Cannulation and its Common Technical Errors, Failure Rates and Complications: A Cross-sectional Study

Introduction: Central Venous Catheter (CVC) is indicated when peripheral vein administration is not possible which can be inserted via different routes. CVC play a significant role in the therapeutic armamentarium of the surgeon and intensivist. The subclavian vein is the most frequently used access site but is associated with certain risks and failures. Aim: To study common technical errors, failure rate and complications associated with subclavian cannulation. Materials and Methods: This was a cross-sectional observational study carried out on 100 patients admitted from October 2017 to October 2020 for various surgical diseases in a Swami Ramanand Teerth Rural Government Medical College, Ambajogai, Maharashtra, India, requiring CVC placement. Subclavian vein cannulation (SVC) technique was done as standard method. Surgeon or anaesthetist who was performing the procedure noted the number of insertion attempts, failures and complications. Data was collected and analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 and paired t-test. Level of significance was set at p-value <0.05. Results: Total of 100 patients included in the study, 57 (57%) were male with mean age of 61±14.2 years and 43 (43%) were female with mean age of 58±11.7 years. SVC was successfully done in all 100 cases but in 236 attempts. Thus, 136 attempts were failure and the overall failure rate was 57.62%. On an average there are 2.4 failed attempts per line. The most common technical error observed was improper site for needle insertion relative to the clavicle 27.94% followed by insertion of the needle through the clavicular periosteum 25.74%. The overall complication rate was 9% and most common complications was haematoma in 6%, catheter site infection 2% and pneumothorax in 1%. Conclusion: Subclavian vein catheterisation is an important invasive procedure often performed to administer drugs, haemodynamic monitoring and total parenteral nutrition. It is associated with high failure rate and complications due to technical errors of judgement leading to multiple attempts of needle insertion. They can be minimised with knowledge of anatomical landmarks, ultrasound guidance and Subclavian Vein Cannulation (SVC) personnel experience.

The Diagnostic Role of the Marginal Vacuoles in FNAC of Solitary Thyroid Nodules

Anomalous blood vessels are important from the clinical aspects such as hydronephrosis, Varicocele leading to risk of infarction of kidney during renal transplant surgeries. Here, we report a case series of 30 cadavers of male and female aged between 40-80 years in the Department of Anatomy of a tertiary care institute in Bangalore, India. In three male cadavers, there was a variation in right testicular artery arising from abdominal aorta above the right renal artery later coursing downward, giving a branch to right kidney (10%). In another two male cadavers, right testicular artery (6.6%) was arising as branch of abdominal aorta above the right renal artery later coursing downward giving branch to right suprarenal gland and also observed right accessory renal artery branch of abdominal aorta arising below superior mesenteric artery and coursing upward to lower pole of right kidney. Observed in two male cadaver, inferior phrenic artery was arising as a common trunk from abdominal aorta above the main renal vessels and coursing laterally upward to diaphragm (6.6%). All the other branches of abdominal aorta and venous drainage were normal in the dissection of cadavers. The knowledge of these variations of arteries are essential before performing any transplantation surgeries, thus one can avoid the complications during uroradiological interventions.

Evaluation of the Factors which Contribute to the Ocular Complaints in Computer Users

Smita Agarwal, Dishanter Goel, Anshu Sharma

Context: Use of information technology hardware given new heights to professional success rate and saves time but on the other hand its harmful effect has introduced an array of health related complaints causing hazards for our human health. Increased use of computers has led to an increase in the number of patients with ocular complaints which are being grouped together as computer vision syndrome (CVS). In view of that, this study was undertaken to find out the ocular complaints and the factors contributing to occurrence of such problems in computer users. Aims: To evaluate the factors contributing to Ocular complaints in computer users in Teerthanker Mahaveer University, Moradabad, U.P. India. Settings and Design: Community-based cross-sectional study of 150 subjects who work on computer for varying period of time in Teerthanker Mahaveer University, Moradabad, Uttar Pradesh. Materials and Methods: Two hundred computer operators working in different institutes offices and bank of were selected randomly in Teerthanker Mahaveer University, Moradabad, and Uttar Pradesh. 16 were non responders 18 did not come for assessment and 16 were excluded due to complaints prior to computer use making no response rate Twenty-one did not participate in the study, making the no response rate 25%. Rest of the subjects (n = 150) were asked to fill a pre-tested questionnaire, after obtaining their verbal consent Depending on the average hours of usage in a day, they were categorized into three categories viz. <2 hrs, 2-6 hrs, >6 hrs of usage. All the responders were asked to come to the Ophthalmic OPD for further interview and assessment. Statistical Analysis Used: Simple proportions and Chi-square test. Results: Among the 150 subjects studied major ocular complaint reported in descending order were eyestrain. (53%). Occurrence of eye strain, ( 53.8%), itching ( 47.6%) and burning (66.7%) in subjects using computer for more than 6 hours. distance from computer screen with respect to eyes, use of antiglare screen, taking frequent breaks, use of LCD monitor and adjustment of brightness of monitor screen bear a significant association with these ocular complaints in computer users. Conclusions: Eye strain is the most common ocular complaints among computer users working for more than 6 hours a day. We also found that maintaining ideal distance from screen, keeping level of eyes above the top of screen, taking frequent breaks, using LCD monitors and using antiglare screen and adjusting brightness levels according to workplace reduced these ocular complaints to a significant level.

Vitamin D Deficiency Among Postmenopausal Women with Osteoporosis

Background: Hypovitaminosis D is widely prevalent in India and is a formidable issue especially in postmenopausal women. The study intends to estimate the prevalence of vitamin D deficiency among postmenopausal women with osteoporosis. Methods: The study was performed at a referral teaching institute in north India between 2007 and 2009. One hundred and ninety postmenopausal osteoporotic women were enrolled and the clinical information was collected along with the assessment of biochemical parameters. Results & Conclusion: Serum vitamin D was found to be deficient in two third of patients. A significant correlation was observed between body mass index and bone mineral density at lumbar spine. Prevention and early detection of hypovitaminosis D is the key to reduce the incidence of osteoporosis among postmenopausal women.

Cancellous Screw with Tension Band Wiring for Fractures of the Olecranon

Raju S M, Rashmi A Gaddagi

Background: Olecranon fractures are one of the most commonly seen orthopaedic injuries in the emergency room. The K-wire which is used in the AO Tension Band Wiring (TBW) technique resists the shear better than the figure of eight wire alone, but, it does not add compression to the fixation strength. But, the cancellous screw plus the tension band wire, in combination, provides the strength of fixation i.e., by converting the tensile force to a compressive force at the fracture site, with additional resistance to the displacement due to the lag screw compression. Objective: • To clinically evaluate the result of the cancellous screw with tension band wiring for fractures of the olecranon. • To assess the elbow joint motion and stability after the procedure. Material and Methods: 25 cases of fractures of the olecranon which were treated by using 6.5mm AO cancellous screws with a screw length of 80-105mm with a 16 gauge TBW, were evaluated . All the cases were followed up and the results were analyzed by using a 19 point scale. Results: The results which were obtained in our series were excellent in 15(60%) patients, good in 3(12%) patients and fair in 7(28%) patients and there were no poor results. Conclusion: The technique of open reduction and internal fixation with a 6.5mm AO cancellous screw and TBW, is a simple and effective means of treating fractures of the olecranon and it is based on the biomechanical principle of sound.

Popular Misconceptions Regarding the Diabetes Management: Where Should We Focus Our Attention?

Introduction: Foramen Ovale (FO) is an important aperture present in the middle cranial fossa which transmits delicate neurovascular structures, especially the mandibular nerve. Morphological and morphometrical variations of this foramen are seen in literature and this knowledge is important as it is used for cannulation in rhizotomy for trigeminal neuralgia. Aim: To analyse the foramina of the middle cranial fossa by emphasising on morphometry and morphology of FO as mandibular nerve passes through it. Materials and Methods: This observational study was conducted in the Department of Anatomy, Vydehi Institute of Medical Sciences and Research,Banglore, Karnataka,India from January 2020 to June 2020. Fifty-one fully ossified adult skulls were utilised for this observational study. Antero-Posterior (AP) diameter, transverse diameter, area, and different shapes of the FO, distance between FO and other foramina, presence of foramen of Vesalius and accessory bony structures were studied. Independent sample t-test was done to compare the mean values of all the diameters. Results: The AP and transverse diameter of FO on the right and left side was found to be almost symmetrical. AP diameter on the right and left side was found to be 6.79±1.4 mm and 6.78±1.3 mm, respectively and transverse diameter was 3.58±0.90 mm on the right and 3.45±0.99 on left side. Distance between FO and Foramen Spinosum (FS), foramen lacerum and Meckel’s cave were similar on both the sides. The distance between FO and rotundum was greater on the right side i.e., 11.09±1.9 mm than left side which showed a diameter of 10.68±1.6 mm. The different shapes of the FO observed were oval, almond, D-shaped, elongated, round, slit and irregular. Oval shape (22 skulls on the left side and 27 skulls on the right) was the most common type. Foramen of Vesalius was observed in four skulls and accessory bony structures like bony septum, plate and spurs were also seen in the current study. Conclusion: The knowledge regarding the shape and distance between the FO and various foramina might benefit the neurosurgeons and radiologists during surgical procedures.

Comparing the Daily Versus the Intermittent Regimens of the Anti-Tubercular Chemotherapy in the Initial Intensive Phase in Non-HIV, Sputum Positive, Pulmonary Tuberculosis Patients

Pranab Kumar Mandal, Abhijit Mandal, Sujit Kumar Bhattacharyya

Background: Tuberculosis (TB) is a major health problem in the universe and India is no longer exempted from this crisis .The emergence of HIV and MDRTB (Multi Drug Resistant Tuberculosis) have further made the situation critical. Aims: Our aim was to compare the efficacy of the daily and the intermittent doses of the Anti Tubercular Drug (ATD) therapy which is under the Revised National Tuberculosis Control Programme, amongst the sputum positive pulmonary tuberculosis in terms of the sputum conversion rate at the end of the initial phase, the default rate and the adverse drug reactions. Methods: This was an observational prospective study. Material: Eighty three patients were selected from the out patient and the inpatient departments of a tertiary medical centre in India. Results: Forty three cases received an intermittent regimen, where the major age group belonged to the under 40 years age group, the default rate to the therapy was 9.3%, the sputum conversion rate was 94.87% and adverse drug reactions were found in 25.58% of the patients. In the daily regimen, there was an equal proportion of the age group of the patients, both above and below 40 yrs, the sputum conversion rate was 94.74%, a default rate was found in 5% cases and adverse reactions were found in 35% of the cases. Conclusion: Both the intermittent and the daily regimens showed equal sputum conversion rates and the drug default cases were found more in the intermittent group. However, the adverse reactions were found more in the daily regimen category.

Peripheral Insensate Neuropathy- Is Height a Risk Factor?

G S Sharath Kote, Ajay N Bhat, Thajuddeen K, Mohammed H Ismail, Abhishek Gupta

Introduction: Peripheral insensate neuropathy is one of the most commonest and the earliest forms of peripheral neuropathy. It is one of the leading causes of the disability in working population who are at risk. Methods: A study was conducted in Kasturba medical college (Manipal university) in the year 2009-12, which included examination of 818 people of more than 30yrs of age by random sampling method who were attending the outpatient clinic. A monofilament was used to determine the peripheral insensate neuropathy, which was defined by the presence of one or more insensate areas. Results: In our study , the prevalence of peripheral insensate neuropathy was 16.2 % ( p-0.0001), among which 9.7% were males and 7.5% were females. The males were 1.27 times significantly at a higher risk than the females , even after a height adjustment to the gender difference in height. As the height increased, the prevalence of peripheral insensate neuropathy increased, irrespective of the diabetic and hypertensive statuses. The risk of the peripheral insensate neuropathy increases at a height of >167 cm in males and at a height of >159 cm in females. Conclusion: The authors conclude that body height is an important and an independent risk factor for peripheral insensate neuropathy, irrespective of co morbidities. Height as a marker, helps the health care professionals in identifying the people who are at risk for peripheral insensate neuropathy.

The HLA Class II Associations with Rheumatic Heart Disease in South Indian Patients: A Preliminary Study

Divya Bajoria, Thangam Menon

Introduction: Rheumatic heart disease (RHD) occurs in 30-45% of the patients with rheumatic fever (RF) and it leads to chronic valvular lesions. The human leukocyte antigen (HLA) might confer a susceptibility to RHD. The aim of the present study was to determine the prevalent HLA class II DR/DQ allelic types which were associated with rheumatic heart disease (RHD) in a small group of south Indian patients and to compare them with those in the control subjects. Methods: A total of 23 patients who were diagnosed with RHD and 6 control samples were included in this study. A low resolution HLA Class II DR/DQ typing was performed on the blood samples by the PCR-SSP method. Results and Conclusion: The DRB3*01:01:02:01 allele showed a positive association with RHD, whereas the DQB1 loci alleles did not show any significant association.

The Use of Procalcitonin as a Marker of Sepsis in Children

Bin Mathew, Dinesh Roy D, T Vijaya kumar

Objective: Sepsis is a life-threatening disease which is associated with high rates of morbidity and mortality. The critically ill patients often manifest a Systemic Inflammatory Response Syndrome (SIRS) which is independent of an infection. The early diagnosis of different severities of sepsis is important for an early implementation of the specific therapies. Our objective was to evaluate the diagnostic and the prognostic values of blood Procalcitonin (PCT) in cases of bacterial septicaemia in children. Methods: The total sample comprised of 150 subjects who were admitted to the ICU with septicaemia and 50 normal, healthy, age and sex matched children. The first sample was collected at the time of admission, before the start of the antibiotic therapy (T0). A second sample was collected at 24 hours (T24) and a final sample was collected at 96 hours (T96). A PCT value of > 0.5ng/ml was accepted as positive. Results: 63% of the children who were diagnosed with a bacterial aetiology showed detectable blood PCT levels with higher concentrations, while in the children who were diagnosed with a viral aetiology, only 22.2 % had detectable PCT levels, but in lower concentrations. The mean percentage reduction in the PCT value among the bacterial infection subjects was 44.39 ± 41.82 as compared to that in the viral infection subjects (5.71 ± 26.68) and in the subjects where the aetiology was not established (5.71 ± 26.68). Conclusion: The results which were obtained in our study confirmed that the PCT levels were a better marker for the bacterial infections. The PCT measurements may be used as a guide to the antibiotic therapy in critically ill children with suspected sepsis.

A Study on the Correlation between Cord Blood Glucose Level and the Apgar Score

Kalyan Khan, Ashis Ranjan Saha

Introduction: The study of the biochemical parameters of cord blood acts as a mirror, which usually reflects the neonatal status. The widely used system for the evaluation of a neonate is the Apgar score. There is no comprehensive published data which has established the association between the cord blood glucose level and the Apgar score. Similarly, there is also no well accepted reference range of the cord blood glucose level. Objectives: The main objectives of the present study was to ascertain any adverse effects of an abnormal cord blood glucose level on the neonatal status and to find out a standard reference level of glucose in cord blood. Methods: The cord blood glucose estimation was done by using the glucose oxidase peroxidase method and the statistical analysis was performed by using the SPSS, version 16 software. Results and Conclusions: In the present study, the cord blood glucose level was found to have no correlation with the Apgar scores which were calculated at both one minute and five minutes after birth. It was also found that for the foetus to be free from any obvious complication, the cord blood glucose level had to be around 87 mg/dl. The fluctuations in the maternal glucose levels are weakly associated with the level in the cord blood.glucose .

A Clinico-Pathological Study of Lichenoid Tissue Reactions-A Tertiary Care experience

Introduction: The aim of this article was to study the spectrum of clinico-histopathological lesions with an age and sex distribution in various lichenoid reactions of the skin. The spectrum of clinical diseases which is related to the lichenoid tissue reaction is wider. There is a recent increase in the relatively new subgroups of the lichenoid clinical picture. Material And Methods: This was a one and a half year prospective study which was conducted in the Dermatopathology Section of the Department of Pathology, from January 2011 to June 2012. All the patients who visited the Dermatology Outpatients/Inpatients Department and presented with lichenoid tissue reactions were included in the study. The selected patients’ clinical findings were noted and their informed consents and an institutional ethical clearance were taken. Light microscopy was used for the histopathological diagnosis. The SPSS, version 14 software was used to analyze the data. Frequencies and percentages were used to describe the data. Results: During the study period, 107 cases were clinically diagnosed as lichenoid reactions, of which 84 cases were concordant on histopathology and 6 cases were diagnosed, solely based on the histology. So, a total of 90 cases were diagnosed histologically, of which 42 were of the Lichen planus type and 48 were lichenoid eruptions. Females were affected more commonly than the males. Conclussion: In our study, the lichenoid reactions were more common in children and the most common prototype was Lichen planus. So, we conclude that histopathology is a dependable tool for identifying the underlying cause in lichenoid reactions.

Acanthosis Nigricansin PCOS Patients and Its Relation with Type 2 Diabetes Mellitus and Body Mass at a Tertiary Care Hospital in Southern India

Background: Acanthosis nigricansis was viewed recently as a possible marker of an increased risk for diabetes. Acanthosis Nigricans (AN) can help in identifying the patients with an increased risk for Type 2 Diabetes Mellitus (T2DM) among Polycystic Ovary Syndrome (PCOS) cases. Hence, this study was carried to know the prevalence of AN in PCOS and its correlation with diabetes mellitus and the body mass. Methods: A prospective, longitudinal study in the patients with PCOS, who attended the Department of Medicine, Kasturba Medical College [KMC] Hospital, Attavar, Mangalore, Karnatka, India between December 2008 to April 2010, was carried out. A total of 119 patients with PCOS were included in the study. A complete history, along with the demographic data of the patients who were aged between 15-35 years, were considered for the analysis. Results: AN was observed in 56% of the PCOS patients. The Body Mass Index (BMI) and the waist circumference were significantly higher in the PCOS patients with AN, as compared to those without AN. Among the 119 PCOS patients,77% were found to have BMI values which were above the normal. Among the obese PCOS patients, 58% had BMI values of more than 30kg/m2 as compared to 19% of the patients who did not have AN. Type 2 DM was observed in 77% of the PCOS patients with AN, while none of the PCOS patients were found to be diabetic among those without AN. A family history of DM in the first degree relatives was present in all the patients with AN. The results were analyzed by the Mann Whitney U test for the continuous data and by the Chi square test for the categorical data. Conclusion: The PCOS patients who had a family history of diabetes and obesity with a body mass index of more than 30 kg/m2and a waist circumference of =90 cm were more likely to develop AN, which is a marker of hyperinsulinaemia and insulin resistance. Identifying such PCOS patients will stimulate the discussions of the lifestyle modifications in the primary care setting.

The Corpus Callosum Wallerian Degeneration in the Unilateral Brain Tumors: Evaluation with Diffusion Tensor Imaging (DTI)

Purpose: The purpose of this study was to evaluate whether DTI could demonstrate the water diffusivity changes in the corpus callosum (CC), which were not visible on the morphologic imaging in patients with glioblastoma multiforme (GBM) and brain metastases with no midline CC infiltration. Materials and Methods: Twenty-seven patients with treatment naïve unilateral GBM and eleven patients with a solitary brain metastasis with no midline CC infiltration underwent DTI. Ten controls with normal brain MRI were also included. Based on the tensors, the principal diffusion directions, the anisotropy values, and the prior information about the diffusivity pattern in CC, a similarity measure was proposed. Subsequently, the CC was automatically divided into the Witelson subdivisions. Results: We observed significantly decreased fractional anisotropy values in all the regions of CC in the patients with GBM and metastases as compared to those in the controls. The mean diffusivity values showed a significant increase in all the regions of CC, except the splenium in patients with GBM and the isthmus in the patients with metastases, as compared to that in the controls respectively. Conclusion: In conclusion, DTI is more sensitive than the morphologic MR imaging in the evaluation of changes within the CC, in brain tumours which do not infiltrate the CC. However, these changes of the DTI metrics in the CC are due to a Wallerian degeneration rather than a tumour infiltration, as was shown by our results, as similar changes were seen in the GBM as well as the non-infiltrating metastases patients.

A Prospective Randomized Comparative Study of Vicryl Rapide Versus Chromic Catgut for Episiotomy Repair

A. Bharathi, D.B. Dharma Reddy, G.S. Sharath Kote

Background and Objectives: A significant number of women experience perineal trauma following vaginal deliveries and they require stitches. This may result in perineal pain, dyspareunia and faulty healing. The type of suture material which is used, will influence these factors. This study was conducted to compare the impact of two absorbable suture materials which were used for episiotomy repair, namely vicryl rapide and chromic catgut in relation to a short term maternal morbidity, in terms of the perineal pain and the wound healing. Methods: This was a prospective, randomized study which was conducted in the hospitals which were attached to JJMMC, Davangere. Four hundred women with episiotomies were randomly allocated to repair with either vicrylrapide or chromic catgut (200 each). The outcome measures which were assessed were perineal pain and wound healing at 24-48 hours, 3-5 days and 6 weeks postpartum. Results: The two groups were similar at the trial entry. As compared to the chromic catgut group, the vicryl rapide group was associated with less pain (32.5% vs 57%) and a less need for analgesia (15.5% vs 0.5) at 3-5 days. There was also a significant reduction in the wound indurations, uncomfortable stitches and wound dehiscence (4% vs 13.5%) and a better wound healing (p<0.05 significant) in the vicrylrapide group. No significant difference was noted in the perineal pain at 6 weeks postpartum. Wound infections (3.5%) and wound resuturing (2%) were seen in the chromic catgut group and they were absent in the vicrylrapide group. Interpretation and conclusion: So, this study concluded that vicrylrapide was the ideal suture material for episiotomy repair, which resulted in less perineal pain and a better wound healing.

A Study on the Morphology of the Suprascapular Notch and Its Distance from the Glenoid Cavity

Introduction: A suprascapular nerve entrapment can occur at the suprascapular notch or at the spinoglenoid notch. So, the size and shape of the suprascapular notch are associated with suprascapular entrapment neuropathy as well as with an injury to the suprascapular nerve in arthroscopic procedures. The knowledge on the variations along the course of the nerve is important in understanding the source of the entrapment syndrome. Material and Methods: The present study was carried out on 104 scapulae which were obtained from the Department of Anatomy, NRI Medical College and from other nearby medical colleges. The suprascapular notches in the scapulae were classified, based on the descriptions of Rengachary et al and Ticker et al. The distance between the suprascapular notch and the supraglenoid tubercle, and the distance between the posterior rim of the glenoid cavity and the medial wall of the spinoglenoid notch at the base of the scapular spine, were determined. The data were analyzed statistically. Results: Based on the Rengachary classification, the type III notch was more common. The suprascapular foramen was observed in 2 scapulae. In 56.73% scapulae, the superior transverse diameter was greater than the maximum depth. The U shaped notch (69.23%) was more common. 2.88% and 8.65% scapulae fell short of the mentioned respective safe zone distances from the margin of the glenoid cavity. Conclusion: Such studies may be useful in understanding the role of the notch in causing nerve entrapment and to prevent iatrogenic nerve injuries while posterior approaches are made to the shoulder joint.

A Prevalence of Thyroid Disorder in Western Part of Nepal

Raj Kumar Yadav, Namrata Thapa Magar, Bibek Poudel, Naval Kishor Yadav, Binod Yadav, A Prevalence of Thyroid Disorder in Western Part of Nepal (Published in Journal of Cilinical and Diagnostic Research. 2013 Feb: 7(2):). 193-196 It was brought to the editorial notice, that this article has contents which are plagiarized from an earlier published article. This was confirmed and Authors were communicated, they acknowledged and agreed that this has been done by mistake. To avoid misleading the scientific community the article has been retracted. Date of Retraction: 13.7.15

Serum Carbohydrate Deficient Transferrin as A Sensitive Marker in Diagnosing Alcohol Abuse: A Case – Control Study

V. Madhubala, A.R.Subhashree, B.Shanthi

Background:Alcoholism is a major problem in India thereby causing a heavy toll on the health related expenditure of the country. Detection of alcohol abuse rely mainly on clinical details which is sometimes inaccurate or unreliable and hence using a specific diagnostic parameter might be of immense use not only for early diagnosis but also during follow up of the cases. Aims and Objectives:This case control study aimed at evaluating the usefulness of Carbohydrate Deficient Transferrin (CDT) as a sensitive marker to diagnose alcohol abuse. Materials and Methods:The study was approved by Institutional research and ethical committee. Twenty five known male alcoholics who attended to the OPD (Out Patient Department) of Alcohol deaddiction centre of a tertiary care hospital were elected as cases. All of them were diagnosed to have a strong likely hood of hazardous alcohol consumption based on ‘Alcohol Use Disorders Identification test” (AUDIT) questionnaire. Twenty five age matched, gender matched healthy individuals who were teetotalers were elected as controls. They scored zero in AUDIT questionnaire. Informed consent was obtained from all the cases and controls.The following tests were done: Liver function tests including Serum Bilirubin, Total Proteins, Aspartate Amino Transferase (AST), Alanine Amino Transferase (ALT), Alkaline Phosphatase (ALP), Gamma Glutamyl Transferase (GGT) and Blood glucose levels were estimated using a fully automated biochemistry analyser, XL – 300 (Trans Asia Biomedical systems) and Mean Corpuscular Volume (MCV) was done using an automated hematology analyser sysmex KX-21. Percentage of Serum Carbohydrate Deficient Transferrin (%CDT) was assessed u sing immuno Turbidimetric assay, ELISA method (iMark, Bio-Rad Laboratories,). Statistical analysis of the data obtained was done sing SPSS 16.0. Results:There was a statistically significant difference in values of AST, ALT, ALP, MCV, GGT and % CDT in cases as compared to controls. ROC curves drawn to assess the sensitivity and specificity of each parameter showed that %CDT has the highest sensitivity and specificity (84% and 92% respectively) and MCV (48% and 52% respectively) had the least. GGT when compared to % CDT had a lower sensitivity and specificity (64% and 72% respectively). Conclusion: % CDT is a sensitive biomarker which can be used to diagnose alcohol abuse and is superior to GGT in terms of sensitivity as well as specificity.

Nerve Conduction Studies in the Upper Limb in the Malwa Region-Normative Data

Ruchika Garg, Nitin Bansal, Harpreet Kaur, Khushdeep Singh Arora

Introduction: Though volumetric High Resolution Computed Tomography (HRCT) has increased the sensitivity of diagnosing diffuse lung diseases, there are some drawbacks related with lesion detection. Post processing techniques like Maximum Intensity Projection (MIP) can help in increasing the sensitivity of HRCT further. Aim: To study various possible utilities of MIP in HRCT lung. Materials and Methods: A retrospective cross-sectional study was done in a tertiary care hospital, including all Computed Tomography (CT) scans performed in July 2020 to August 2020, with multiple lung findings and diffuse involvement of lungs. Two radiologists reviewed the base mean axial images of 1 mm and MIP images in sliding scale from 2 to 10 mm in lung window. They recorded the findings in every scan based on widely accepted basic pattern of interpretation of HRCT thorax. The slice/slab thickness that best depicted each finding was noted. Inter reader agreement was calculated for each finding. Results: Fifty nine CT cases, which included scans of 34 males and 25 female patients with a mean age of 37.4±12.5 years were reviewed. There was near perfect to substantial agreement between the two radiologists on various findings (kappa > 0.75). MIP images of 6-10 mm slab thickness were best suited to detect smaller nodules, assess vessel size in areas of mosaic attenuation and detect dense lesions in images with poor breath hold. The MIP images of 2-5 mm thickness were useful in detecting the location in relation to secondary pulmonary lobule, reticular densities and crazy-paving densities. Conclusion: The MIP being an easy to use and readily available post processing technique, when used with volumetric HRCT dataset of thorax enhanced the value of HRCT in detecting various lesions.

Multiple Musculovascular Anomalies in the Superior Extremities of a Cadaver: A Case Report

Rajan Kumar Singla, Rimpi Gupta, Kanika Sachdeva

During the evolution from the lower animals to man, the upper limbs have acquired a great mobility, but at the cost of their stability. The reverse is true for the lower limbs. The muscular anomalies which are common in the upper limbs are largely explainable on a phylogenetic basis. The same is true for the vascular anomalies. However, such anomalies are usually seen singly and they are never together in the same limb or in two limbs of the same body. The upper limbs which are being reported here had multiple musculovascular anomalies and some of these were bilateral. These include the superficial brachial artery, the accessory head of the biceps brachii, the accessory muscular slips which arose from the common flexor origin and went to the tendons of the flexor digitorum profundus and the flexor pollicis longus separately, bifurcation of the tendon of insertion of the brachioradialis and bifurcated (split) insertion of the third lumbrical on the adjacent fingers. Though all these variations have been described in the standard text books of Anatomy, their occurrence, together in one limb and the bilateral presentations of some of these, have never been encountered. Almost all these variations have been explained phylogenically, thus supporting the dictum, “The ontogeny repeats the phylogeny.” Furthermore, their clinical significance has also been discussed.

A Rare Case of the Lenz Syndrome

Sohil T, Ketki K, Rukmini M S, Nutan K, Poornima M

We are reporting here, a case of the Lenz syndrome in a neonate who was brought to the Paediatric OPD, Kasturba Medical College Hospital, Attavar, Mangalore India, with the complaints of poor suckling since birth and abnormal facial features. Altogether, the characteristic congenital abnormal findings in Lenz syndrome, which comprise of microophthalmia, ear anomalies, microcephaly, skeletal and digital deformities, and urogenital malformations were observed, with an exception of a dental anomaly. Dental abnormalities were not pertinent, as the patient was a neonate.

Factitious Biochemical Reports which are Caused Due to Paraproteinaemia in Multiple Myeloma – A Case Report

Sunil Kumar Nanda, Rajlaxmi Sarangi, Lopamudra Ray, Anil Kumar, Somanath Padhi

Factitious biochemical reports result in the misguiding of clinicians, unnecessary retesting, wrong diagnoses and incorrect treatments. A vigilant biochemist identifies these factitious biochemical reports and alerts the clinician regarding the proper interpretation of the biochemical reports, thus preventing a misdiagnosis and an incorrect treatment. We are presenting a case report of a multiple myeloma patient who presented with factitious biochemical reports which were caused due to paraproteinaemia. In the present case, the patient presented with an underestimation of urea and creatinine, an underestimation of sodium, low albumin levels and high phosphate levels. On repeating the same tests after dilutions and deproteinizing, the effects of the paraproteins on the above mentioned tests were reduced. Thus, from the observations of our study, we suggest that the interference by paraproteinaemia can be reduced by analyzing the biochemical parameters after dilution and deproteinization.

Iatrogenic Cushing’s Syndrome in an Infant

Rajendra Prasad Namburu, Karthik T.S., Amaresh Reddy P.

A high potency, long acting and/or the extended use of oral corticosteroids, particularly in children, may cause suppression of the hypothalamo-pituitary-adrenal axis. However, the iatrogenic Cushing’s syndrome in the infantile age group is rare and only few patients have been reported to date in the literature. Here, we are reporting a case of iatrogenic Cushing’s syndrome in a 5-month-old male child, whose parents brought him to the hospital for puffiness of the face and overweight.

A Consanguinity Related Autosomal Translocation which Leads to Premature Ovarian Failure

Mot Yee Yik, Murizah Mohd Zain, Zubaidah Zakaria, Narazah Mohd Yusoff

The premature ovarian failures with underlying chromosomal abnormalities are normally X-linked, although their associations with the autosomal and the Robertsonian translocations are also possible. Here, we are reporting a case of premature ovarian failure which was associated with a translocation between the long arm of chromosome 7 at q11.23 and the short arm of chromosome 5 at p15.3. The proband was a 26-year-old Malay woman who presented with premature ovarian failure, who was referred for cytogenetic testing due to the suspicion of a chromosomal anomaly. Her physical examination revealed that she had no abdominal or pelvic masses and that she had normal secondary sexual characteristics. Her medical history as well, revealed no points for concern. However, a consanguineous relationship existed, as the patient’s paternal grandmother and maternal grandfather were biological cousins. Our present case indicated that region p15.3 of chromosome 5 and region q11.23 of chromosome 7 possibly carried essential genes for the ovarian function and that they postulated a link between the consanguinity and the chromosomal abnormalities.

A Hairy Cell Leukaemia Variant – A Rare Case Report

Pankaj Pande, Balasaheb Ramling Yelikar, Mahesh Kumar U

The aim of the article is to present a rare case of Hairy cell leukaemia variant (HCl-V) which is a distinct clinico-pathological entity with intermediate features between classical HCl (HCl-C) and B-cell prolymphocytic leukaemia. It is an uncommon disorder accounting for approximately 0.4% of chronic lymphoid malignancies and 10% of all HCl cases. A 58 year old woman presented with pain abdomen and loss of weight. On examination she had massive splenomegaly. Peripheral smear was reported as chronic lymphoproliferative disorder (? Hairy cell leukemia or splenic lymphoma with villous lymphocytes). On Bone marrow examination, differential diagnosis was given as splenic lymphoma with villous lymphocytes (SLVL) and prolymphocytic variant of Hairy cell leukemia. On flow cytometric analysis, these cells were positive for CD11c, CD19, CD20, and CD22. Based on the clinical, peripheral smear, bone marrow and flow cytometry findings, a diagnosis of hairy cell leukaemia variant was confirmed. The differential diagnosis should always include SLVL, HCL-C and Japanese variant HCL because they have different clinical and biological features, particularly regarding their response to purine analogue-based treatment or splenectomy.

Pulmonary Tuberculoma and Miliary Tuberculosis in Silicosis

Sanjeev Kumar Verma, Saurabh Karmakar

Tuberculosis is a disease with protean manifestations. We present a case which was initially suspected as bronchogenic carcinoma with lymphangitic carcinomatosis, based on radiological appearance but later diagnosed as pulmonary tuberculoma with military tuberculosis and silicosis after thoracotomy and open lung biopsy. The patient was treated successfully with Antituberculosis Therapy (ATT). Rarity of presentation in form of pulmonary tuberculoma co-existing with histological features of miliary tuberculosis and silicosis, led us to report this case.

An Interesting Case of a Subcutaneous Nodule

Basavaprabhu Achappa, Deepak Madi, Soundarya Mahalingam

Human dirofilariasis is a zoonotic disease which is caused by the filarial nematodes, Dirofilaria repens and Dirofilaria immitis. Dirofilariae are transmitted to humans via mosquito bites. Human Dirofilariasis presents commonly as subcutaneous nodules, pulmonary nodules or nodules in the eyes. They are considered as emerging pathogens. We are presenting a case of human Dirofilariasis from Karnataka, which was caused by Dirofilaria repens.

“Toxic Pancreatitis with an Intra-Abdominal Abscess which was Caused by Organophosphate Poisoning (OP)”

Venugopal L, Dharma Rao V, Srinivas Rao M, Mallikarjuna Y

Organophosphate insecticides are the potent inhibitors of the acetylcholinesterase enzyme which lead to an increased acetylcholine activity, which are responsible for symptoms such as abdominal pain, diarrhoea, vomiting and hypersalivation. We are reporting on a young male with acute organophosphate poisoning, who presented with unusual complications like toxic pancreatitis with an intraabdominal abscess.

Neonatal Meningoventriculitis Due to Proteus Mirabilis – A Case Report

Deepak Juyal, Vyas Kumar Rathaur, Neelam Sharma

A five day old full term born baby was admitted to our Neonatal Intensive Care Unit with seizures, opisthotonous posture and was icteric upto thigh. Baby had a three day history of poor feeding, lethargy and abnormal body movements. Mother was a 29 years old primigravida and had a normal vaginal delivery at home. Sepsis profile of the patient was requested, lumbar puncture and ventricular tap was performed. Patient was put on third generation cephalosporins, aminoglycosides and phenobarbitone. Culture and sensitivity report of blood, Cerebro spinal fluid and ventricular fluid showed Proteus mirabilis. Computerized Tomography scan showed a large parenchymal lesion in the right frontal lobe and diffuse ependymal enhancement along both the lateral ventricles suggestive of meningoventriculitis. We hereby present a fatal case of neonatal meningoventriculitis due to Proteus mirabilis.

Anterior Dislocation of the Shoulder Due to an Idiopathic Deltoid Contracture-the Report of a Rare Presentation

Satyadev Vadapalli

Post injection fibrosis leading to muscle contracture is a known complication. Deltoid fibrosis is known to occur following trauma or an intramuscular injection. Idiopathic Deltoid fibrosis leading to abduction contracture and anterior dislocation of the shoulder is a rare entity. Prompt diagnosis and surgery by distal release of fibrosed Deltoid muscle will lead to good functional recovery.

The Pathology of Lithium Induced Nephropathy: A Case Report and Review, with Emphasis on the Demonstration of Mast Cells

Kumarguru B.N., Natarajan M., A.H. Nagarajappa

Lithium is a psychotropic agent which is widely employed in the psychiatric practice throughout the world. The therapeutic index of lithium is low and an acute intoxication may appear, which may lead to death or a permanent disability. A frequent side effect of lithium is renal toxicity. The collecting tubules have been identified as the site of action of lithium, due to the down regulation of Acquaporin-2. The mast cells have been associated with a wide range of human renal diseases.They have been documented to be associated with interstitial fibrosis and an impaired renal function.We are reporting a case of a 42 year old male who was admitted with a history of an ltered sensorium of short duration.He had bipolar disorder and was on lithium. Investigations revealed a severely compromised renal function. The patient’s condition worsened and he expired. A necropsy was performed. The kidneys and the lungs were subjected to a histopathological examination. The kidneys showed a significant Chronic Tubulointerstitial Nephropathy [CTIN] and a considerable glomerular pathology. Toludine blue [1%] staining demonstrated mast cells in the interstitium and the connective tissue of the renal pelvis. This appears to be the first time that mast cells were demonstrated in a case of lithium induced nephropathy in humans. It may be hypothesized that mast cells may possibly play a role in lithium induced nephropathy as a concurrent mechanism.

Stromal Endometriosis of the Intestine: An Elusive Presentation with A Review of the Literature: A Case Report

Shashi Upreti, Rani Bansal, Sanjay Upreti, Shiva Mathur

Although endometriosis involves the small intestine only rarely, when present, this condition may simulate a variety of inflammatory and sometimes neoplastic conditions because of its nonspecific symptoms. We are reporting here, a case of ileal, caecal and appendiceal endometriosis which presented in the emergency as a case of an acute intestinal obstruction with a long history of symptoms which were referable to the GI tract. The patient had the diffuse involvement of a segment of the ileum with mural thickening and luminal narrowing, which led to obstruction. The literature on small bowel endometriosis has been reviewed and the clinical and pathological features have been discussed.

An Epidermal Cyst in the Floor of the Mouth: A Rare Presentation

Suraj Mammen, Anu Korulla, Paul M.J.

Epidermal cysts rarely occur in the head and neck region as compared to the dermoid cysts and when they do occur in this region, they present in the floor of the mouth. We are reporting a rare case of an epidermal cyst in the floor of the mouth, with a brief review of the literature.

Askin’s Tumour in an Adult, with a Varied Clinical Presentation

We are reporting a case of Askin’s tumour in a 28 year old male, on the right side of the chest wall, with no symptoms and signs of a pulmonary involvement or a distant metastasis. A wide excision of the tumour mass was done. Immunohistochemistry strongly expressed MIC-2. The prognosis of Askin’s tumour is poor. An early diagnosis and treatment are important to improve the chances of a survival.

Anomalous Origin of the Hepatic Artery from the Hepatomesenteric Trunk

During the routine dissection of the abdominal cavity of a 75 years old, embalmed, male cadaver in the Department of Anatomy, an anomalous origin of the common hepatic artery from the hepatomesenteric trunk was observed. The Hepatomesenteric trunk originated from the ventral surface of the aorta at the L1 level. After coursing anteriorly, the trunk divided into the common hepatic artery and the superior mesenteric artery. The common hepatic artery is normally a branch of the coeliac trunk, but in the present case, the coeliac trunk gave two branches i.e. the left gastric and the splenic arteries. The length and the external diameter of the variant arteries were measured by using a Vernier calliper. The type V of Adachi’s classification resembled closely with the variation which was observed. A knowledge on such a variation is important to avoid upheavals during surgical procedures. It is also helpful for the radiologists in interventional processes such as embolization of the hepatic artery and chemotherapy.

Comparative Evaluation of Gingival Depigmentation using Tetrafluoroethane Cryosurgery and Gingival Abrasion Technique: Two Years Follow Up

Santhosh Kumar, G. Subraya Bhat, K. Mahalinga Bhat

Objective:A comparative evaluation of the gingival depigmentation by using Tetrafluoroethane cryosurgery and the gingival abrasion technique – 2 years of follow up. Material and Methods:Ten systemically healthy patients who were aged 18 to 36 years were selected for the study. Tetrafluoroethane was used for the cryosurgical depigmentation andthe gingival abrasion technique used a coarse flame shaped bur. The presence or absence of pigmentation was tabulated, based on the GPI (Gingival Pigmentation Index). For the statistical analysis, Freidman’s test was used. Results:The keratinization was completed within a week after the application of the cryogen and about 10 days after the gingival abrasion technique was done. The statistical analysis which was done after 90th, 180th days and 2 years. The p-value which was obtained (p<.001) showed the superiority of cryosurgery over the gingival abrasion. During the follow up period, no side effects were seen for both the techniques and the improved aesthetics was maintained upto 2 years. Conclusion: The use of cryogen Tetrafluoroethane is easy, practical and inexpensive as compared to gingival abrasion, due to its high rate of recurrence. Hence, it is more acceptable to the patients and the operator. Further studies are needed to assess the long term effectiveness of the cryosurgical method of depigmentation.

Orthodontic Camouflage Treatment in an Adult Patient with a Class II, Division 1 Malocclusion – A Case Report

Appasaheb Naragond, Smitha Kenganal, Roshan Sagarkar, Sugaradday

Since so many decades, various treatment modalities have been presented for the treatment for the class II, div 1 malocclusions. In recent times, we have seen enormously increasing numbers of young adults who desire the shortest, cost effective and a non surgical correction of Class II malocclusions and they accept dental camouflage as a treatment option to mask the skeletal discrepancy. This case report presents one such case of a 22 year old non-growing female who had a skeletal Class II, division 1 malocclusion with an orthognathic maxilla, a retrognathic mandible, a negative VTO and an overjet of 12mm, who did not want a surgical treatment. We considered the camouflage treatment by extracting the upper first premolars. Following the treatment, a satisfactory result was achieved with an ideal, static and a functional occlusion, facial profile, smile and lip competence and stability of the treatment results.

Multiple Splenic Artery Aneurysms Secondary to Extra Hepatic Portal Vein Obstruction

Y.C. Manjunatha, K.N.v. prasad, Y.C. Beeregowda, Bhaskaran A.

Ochronotic Spondyloarthropathy

Upasana Ranga, Senthil Kumar Aiyappan, Natarajan Shanmugam, Saveetha Veeraiyan

The Respiratory Health of Rural Indian Women: Does the Domestic Cooking Fuel Really Matter?

Neelam D. Sukhsohale, Uday W. Narlawar, Suresh N Ughade

The Peak Expiratory Flow Rate (PEFR): the Effect of Stress in a Geriatric Population of Chennai- A Pilot Study

Sitalakshmi R, Poornima K N, Karthick N

Hyponatraemia in Head Injuries Caused by Road Traffic Accidents

Vijayalakshmi Udipi Badikillaya, Muralikrishna Tummi, Srinivasa rao pernenkil

Nosocomial Candida Infection in a Rural Tertiary Care Hospital

Sheevani, Poonam Sharma, Aruna Aggarwal