Journal of clinical and diagnostic research

Laboratory Assessment of the Diabetes Scenario with Respect to HbA1c and Microalbuminuria

MANJREKAR POORNIMA A , SHENOY R , HEGDE A

Background: Glycated haemoglobin (HbA1c) has proved to be a good indicator of long term glycaemic control and reflects the mean glucose value (MGV). A linear relationship with HbA1c, microalbuminuria and the incidence of diabetic nephropathy is known to exist. Aim: To analyze the prescribing patterns of clinicians, the correlation of the plasma glucose values to HbA1c and the prevalence of microalbuminuria in a laboratory set up. Settings and Design: Retrospective, data collection of one year from Medical records, conducted at KMC hospital, Ambdekar circle, Mangalore. Materials and Methods: A data survey was conducted for a period of 12 months at the clinical biochemistry lab of our institution to note the number of requisitions for Fasting Plasma Glucose (FPG), Post Prandial Plasma Glucose (PPPG), Random Plasma Glucose (RPG), Glycated Haemoglobin (HbA1c) and Urinary microalbumin (UmA). Mean Glucose Value (MGV) was calculated from the HbA1c values. Statistical analysis: All findings were expressed as summations and percentiles. The SPSS package was used for descriptive statistics. Pearson’s correlation coefficient was employed for correlational analysis. Results: There were about 15,000 requests each for FPG and PPPG, 7,058 for RPG, 2,884 for HbA1c and only 515 for microalbuminuria. RPG showed a better correlation than FPG with HbA1c (r = 0.472 vs 0.699). The patients with HbA1c and UmA requisitions were categorized, based on their MGV values. The prevalence of UmA was found to be around 32% in all the groups, except in the group with MGV between 251-300 mg/dL, in which it was 62.06 %. Conclusion: The number of requests for FPG and PPPG were to the same. The HbA1c requests comprised of 7.8% of the plasma glucose requests, thus indicating a probable underutilization of the same. In patients with infrequent HbA1c estimations, RPG was a better predictor of HbA1c levels. MGV resulted in a meaningful translation of the HbA1c values to the patients. Considering the high prevalence of UmA and the relatively lesser number of requisitions for the same, it would be desirable to screen the diabetes patients more rigorously.

Education Sessions For Pharmacy Students On Pharmacovigilance: A Preliminary Study

SUBISH P,,, MOHAMED IZHAM MI, MISHRA P*,**, SHANKAR PR, ALAM K ,

Introduction: In Nepal, there are no mandatory clinical trials for new products. Drugs are approved based on the data from developed countries. Manipal Teaching Hospital is one of the pioneers in establishing the Pharmacovigilance program in Nepal. For the past three years, the students of Pokhara University visit the Pharmacovigilance center, Drug information center and the Hospital Pharmacy of MTH for a 15 days training program. In the year 2007, the students were also trained in pharmacovigilance. Objectives: To study the demographical details of the students who participated in the pharmacovigilance training and to obtain student feedback regarding the sessions. Methodology: The session module was activity based and emphasized the following four areas: sketching out the current National Pharmacovigilance programme, designing an adverse drug reaction reporting form, carrying out the causality assessment and severity assessment. The feedback of the students on the training module was evaluated using the specially designed feedback form. Results: Altogether, thirty students [males 18 (60%) and females 12 (40%)] were present and all of them participated in the study. The Mean ± SD overall feedback score was 81.5 ± 4.4 (maximum possible score was 100). In general, male students had a higher score (82.29 ± 4.88) than females (80.33 ± 3.75). Conclusion: Overall, the students liked the session and were interested in having similar sessions in the future. This module can be taken as a model for other researchers who would like to carry out educational sessions in pharmacovigilance for pharmacy students.

Forecasting Breast Cancer Cases requiring Radiotherapy at a Teaching Hospital in Nepal.

SATHIAN B, SREEDHARAN J , SHARAN K*, SURESH B N , NINAN J , JOY T, ABHILASH E S

Objective: The aim of this study was to determine the trends and to estimate the future load of patients with breast cancer requiring radiotherapy at Manipal Teaching Hospital, Pokhara, Nepal. Materials and Methods: A retrospective study was carried out on the data collected from the treatment records of patients who were treated with radiotherapy at the department of Radiation Oncology at Manipal Teaching Hospital (MTH), Pokhara, between September 2000 and December 2008. Descriptive statistics and statistical modelling were used for the analysis and the forecasting of data. Results: Seventy patients were found to have been treated with radiotherapy for breast cancer during the study period. The patients’ mean age was 49.9 years (95% CI: 47.6, 52.3). Curative treatment was given to 80% and palliative treatment to the remaining 20% of the patients. Patients from the age group of 45-64 years were more likely to receive curative 76.2% radiotherapy. The compliance to treatment was 100% among the age group of 25-44 years and 90.5% among the group of 45-64 years, as compared to only 66% among patients older than 65 years. (p = 0.03). The number of patients receiving radiotherapy for breast cancer showed a pattern of increasing trend. Excluding the constant term from the equation, the cubic model was the best fitted with R2 = 0.95, p = 0.001 for the forecasting of breast cancer cases. Using this model, the number of breast cancer cases treated with radiotherapy at the hospital by the year 2015 was estimated to be 194. Conclusion: Breast cancer cases in Nepal show an increasing trend and treatment facilities are bound to be hard pressed in providing the necessary health care to the public. Nepal should adopt better strategies for the early detection of the disease and improvise on the resources required for the treatment of this malady.

A Comparative Study Of Oral Analgesics: Etoricoxib With Tramadol In Acute Postoperative Pain: A Randomised Double Blind Study

KUMARAVELU P, KALIAPPAN V, VISWANATHAN G, DAVID D C, VENKATESAN H

Background: Etoricoxib is known to be a selective inhibitor of the cox-2 enzyme. It is an effective analgesic, associated with a reduced risk of bleeding due to platelet dysfunction, gastrointestinal bleeds and ulcers. Studies on etoricoxib in the dental extraction pain model have proved the superior efficacy of etoricoxib with fewer adverse effects as compared to oxycodone/acetaminophen. Aims: The aim of this study was to compare the efficacy and tolerability of oral etoricoxib 120mg with oral tramadol 100 mg in postoperative pain. This comparison will help to determine the rapidity and sustained efficacy of these agents in pain relief and the possible side effects attributable to the medications. Settings and Design: The study was conducted among 60 patients with one or more impacted third molar teeth, posted for extraction at the oral surgery department of the Vinayaka Missions Kirupananda Variyar Medical College and Hospitals, Salem, Tamil Nadu. Patients selected for the study were randomized by a computer generated list using random allocation software and were given a sequentially-numbered sealed opaque envelope containing the study drugs by the blinded investigator. Methods and Material: Pain assessment was done by assessing the following: mean pain scores using a 10 point VAS scale, investigator assessment of ancillary clinical outcomes, inflammation, opening of the mouth, global assessment of study medications and the incidence of adverse effects. Statistical Analysis used: The statistical analysis was done by using the paired preference test. Unpaired t test was used to compare the mean VAS score values from day 0 to day 5. Results and Conclusions: The frequency of the inflamed condition at day 0 to the uninflammed condition at day 5 was 86.67% and 70% respectively for etoricoxib and tramadol. Statistically, etoricoxib was preferred to tramadol by a T score of 0.667 (50% confidence). The frequency of lack of pain was found to be predominant in etoricoxib as compared to tramadol (93.34% versus 60%). Preferential analysis showed a clear preference for etoricoxib, with a T score of 1.219, significant at a 77% confidence level. Etoricoxib had a superior effect over tramadol in terms of anti-inflammatory and analgesic properties. Patients receiving cox-2 inhibitors had a lower incidence of gastritis and drowsiness as compared to patients receiving tramadol.

A Comparison Of Nifedipine With Methyldopa For Control Of Blood Pressure In Mild To Moderate Pregnancy Induced Hypertension.

BHARATHI K N , PRASAD KVSRG ,JAGANNATH P, NALINI KS
Objectives: To compare efficacy of nifedipine and methyldopa for control of blood pressure in mild to moderate pregnancy induced hypertension (PIH). Methods: A comparative study of efficacy of nifedipine and methyl dopa was carried out in 50 pregnant women with pregnancy induced hypertension. Patients were randomly selected who were on either oral nifedipine or oral methyl dopa on a standard dose and blood pressure was measured at 0, 6, 24, 48 and 72 hours of initiation of therapy. Adverse and side effects of drugs were also recorded during this treatment period. Control of blood pressure was assessed in each treatment group by statistical analysis using one way ANOVA followed by Dunnett’s test. P values <0.05 were considered as significant. Results: The result showed both nifedipine and methyl dopa were equally effective in control of blood pressure. Both treatments were well tolerated with minimal side effects. Conclusion: Data analysis of the study shows both nifedipine and methyl dopa are equally effective in reducing the blood pressure in pregnancy induced hypertension, nifedipine may be preferred in view of low cost and easy availability.

Study of Tissue and the Plasma Concentrations of Cefotaxime to Assess Its Suitability for Prophylaxis in Cholecystectomy

SHANMUGAM S *, ACHARYA L D **, MALLAYASAMY S R , RAO A , KHAN SA ,RAJAKANNAN T
Background: Cholecystectomy is one of the frequent causes for abdominal surgery. It is generally thought that the antibiotic concentration used should be four to six times than the minimum inhibitory concentration (MIC) to be effective, when it is used as prophylaxis. Cefotaxime is a commonly prescribed agent for surgical prophylaxis. Aim: The aim of this study was to measure the gall bladder tissue and the plasma concentrations of cefotaxime in cholecystectomy and to assess its suitability as a prophylactic agent. Methodology: 24 patients who were undergoing Cholecystectomy were enrolled to collect plasma and gall bladder tissue samples. Cefotaxime levels in the Gall bladder tissue and plasma samples were estimated. These concentrations were compared against the Minimum Inhibitory Concentrations (MICs) of commonly isolated organisms from surgical wound samples. Results and Discussion: Plasma concentrations to MIC ratios were calculated which were in the range of 10 to 21 times higher than MIC. Tissue drug concentrations to MICs ratios were also calculated and were found to be smaller. This indicated that the concentration of the drug in the tissues was less than the MIC during the sampling time. This situation of lesser tissue concentration of the drug might result in drug failure and subsequent infection if contamination occurs during surgery. Conclusion: This study showed that even though cefotaxime remained at a microbicidal concentration in plasma, it was present in the tissues at ineffective concentrations with respect to MIC. These results showed that the practice of using cefotaxime as a prophylactic agent in cholecystectomy may be reconsidered.

Assessment Of Satisfaction Among Patients Attending Surgical Outpatient

SIDHU T K , KAUSHAL R , KUMAR R
Objective: To find out patient satisfaction with the Surgical Outpatient Department in Adesh Institute of Medical Sciences and Research, Bathinda which is a tertiary care teaching hospital using Concise OPD User Satisfaction Scale. Methodology: From August 2009 to January 2010, only new patients attending the surgical OPD of Adesh Institute of Medical Sciences and Research, Bathinda were included in this observational study after taking informed consent. The Concise Outpatient Department User Satisfaction Scale was used to measure patient satisfaction. The items in this score were (i) physical environment, (ii) equipment and facilities, (iii) appointment arrangement, (iv) waiting time, (v) service of the dispensary, (vi) support staff (vii) physician’s professionalism, (viii) explanation given by the case physician, (ix) consultation time. Results: A total of 510 patients, 308 (60.39%) males and 202 (39.61%) females attending the Surgical Outpatient Department were included in this cross-sectional study from August 2009 to January 2010. Physician’s professionalism scored maximum with a mean ± SD score of 7.71 ± 1.68 and service of dispensary scored minimum with a mean ± SD of 3.67 ± 1.57. Significant difference was found between gender, with males satisfied more in terms of support staff, physician’s professionalism , explanation and consultation time given by physicians. Conclusion: Patient satisfaction level was overall good with the Surgical Outpatient Department. The patients were most satisfied with physician’s professionalism and least satisfied with service of dispensary.

Prescribing Pattern For Osteoarthritis In A Tertiary Care Hospital

ULLAL S D , NARENDRANATH S , KAMATH R K, PAI MRSM, KAMATH S U, SAVUR AMARNATH D
Background: Treatment of osteoarthritis aims at reducing pain and improving mobility. NSAIDs are widely prescribed for symptomatic relief despite well-known adverse effects. Paracetamol with its better safety profile is recommended as the initial analgesic of choice. SYSADOA is a generic term used for symptomatic slow acting drugs for osteoarthitis, and includes glucosamine sulphate and related compounds, chondroitin sulphate, and diacerein. SYSADOA when compared to NSAIDs, are safer, comparable in symptomatic efficacy and better in structure modifying efficacy in osteoarthritis. A drug utilization study is considered to be one of the most effective methods to assess and evaluate the prescribing attitude of physicians. Despite the considerable socio-economic impact of OA, not many studies have established the drug-prescribing trend in India. Hence we decided to study the prescribing pattern of SYSADOA, paracetamol and NSAIDs in OA vis-à-vis the standard recommendations and in the process provide constructive feedback to prescribing clinicians. Methods: Prescriptions for osteoarthritic patients collected cross-sectionally for six months from an orthopaedic outpatient unit in a tertiary care hospital, were analysed. Results: Out of 154 prescriptions analysed, 7% were prescribed glucosamine and chondroitin, while 4% received diacerein. Paracetamol was prescribed in 17% cases. NSAIDs were prescribed in 84%, with 27% receiving two or more NSAIDs simultaneously. Conclusion: SYSADOA and paracetamol were under-prescribed while NSAIDs were probably over-prescribed.

The prevalence of Staphylococcus aureus colonization among Healthcare Workers at a Specialist Hospital in Saudi Arabia

AHMAD S
Objectives: The aim of this study was to determine the prevalence of the nasal carriage of Staphylococcus aureus among healthcare workers (HCWs) at a Specialist Hospital and to detect the antibiotic susceptibility of S. aureus. Material and Methods: This cross-sectional study was conducted from January to April, 2007. Nasal swabs were taken from 352 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. The sensitivity of the isolates was carried out by the modified Kirby Bauer method. Results: A total of 352 subjects comprising medical doctors, nurses, cleaners and the administrative staff of a Specialist Hospital, who worked in or frequently visited the nursery, maternity, paediatric, medical, surgery and intensive care wards during January to April 2007 were tested for the carriage of Staphylococci. 204 of them (58.0%) were males and 148(42%) were females. 313 (89%) subjects were doctors, nurses and cleaners and 39 (11%) were administrative personnel. Of the total 352 samples, S. aureus was isolated from 112 (31.8%) specimens. Of these 112 S. aureus isolates, 103 (92%) were found to be methicillin sensitive S. aureus (MSSA) and 9 (8%) were found to be methicillin resistant S. aureus (MRSA).The rate of S. aureus in males and females were 23.0% and 46.0%, respectively. The rate of S. aureus in the medical staff, nurses, cleaners and administrative personnel were 35.5% and 2.6%, respectively. The prevalence of the carriage was higher (30.1-33.4%) in young persons, i.e. less than 35 years than (6.8-15.7%) those aged 35-55 years or above. Most of the MSSA strains were susceptible to tested agents except penicillin, ampicillin, gentamicin and erythromycin. A majority of the MRSA isolates showed multiple drug resistance. All MSSA and MRSA isolates were fully sensitive to Vancomycin. Conclusion: A high rate of the carriage of S.aureus in this hospital, with a large proportion of strains being resistant to penicillin and the isolation of MRSA strains from these carriers calls for periodic surveillance of nosocomial infections due to S.aureus and other important bacterial pathogens.

Detection Of Extended Spectrum Beta-Lactamase Production And Multidrug Resistance In Clinical Isolates Of E.Coli And K.Pneumoniae In Mangalore.

SHIJU M P , YASHAVANTH R , NARENDRA N
Purpose:The incidence of Extended Spectrum β –Lactamase (ESBL) producing strains among clinical Klebsiella species and Escherichia coli isolates has been steadily increasing over the past years. ESBL producing organisms pose a major problem for clinical therapeutics. Identifying organisms that are ESBL producers are a major challenge for the clinical microbiology laboratory. An attempt was therefore made to study ESBL production and multidrug resistance in clinical isolates of K.pneumoniae and E.coli at a hospital in Mangalore. MethodESBL production and multidrug resistance was studied in a total of 228 isolates of K.pneumoniae and E.coli which were obtained from various clinical samples during one year period from January to December 2008. Identification of the isolates was done based on cultural characteristics and reactions in standard biochemical tests. All the isolates were tested for antimicrobial susceptibility by the disk diffusion technique according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The screening for ESBL production was done by the phenotypic confirmatory test using ceftazidime discs in the presence and absence of clavulanic acid. Result:All the isolates showed resistance or decreased susceptibility to at least one of the third generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone) which were used for the study. ESBL production was noted in 59.65% of the isolates tested. ESBL production was detected in 51.47% strains of E.coli and 48.53% strains of K.pneumoniae (70% of E.coli isolated from urine samples and 75% of K.pneumoniae isolated from exudates samples were ESBL producers). All the isolates were found to be sensitive to the antibiotic, imipenem. Sensitivity of E.coli to piperacillin-tazobactum (Pt) and cefaperazone-sulbactum (Cfs) was 100%, whereas K.pneumoniae showed 98% sensitive to Pt and 88% sensitive to Cfs. Conclusion:The study has shown an increase in the incidence of ESBL producing E.coli and K.pneumoniae strains in Mangalore. The prevalence of ESBL and multidrug resistant strains constitute a serious threat to the current β -lactam therapy. Tests for the detection of ESBL producing bacteria should be carried out at all diagnostic centers routinely and the use of third generation cephalosporins should be restricted. This can reduce the prevalence of ESBL producing organisms.

A Clinicopathological Study Of 22 Cases Of Pemphigus

LEENA , VIJAYA B, MANJUNATH G V , SUNILA
Background : The term pemphigus refers to a group of autoimmune blistering diseases of the skin and the mucous membranes . Pemphigus affects 0.1- 0.5 patients per 1,00,000 population per year . Aim: To evaluate the clinical findings in association with histopathological findings, to study the histopathological findings in various vesiculobullous lesions of skin and to confirm with immunofluorescence wherever possible. Materials And Methods: Histopathological evaluation of biopsies received from the department of Dermatology was done in the Department of Pathology, JSS hospital, Mysore, from August 2006 to July 2008. Results: A total number of 648 skin biopsies were received, out of which 22 cases were of the pemphigus group of diseases. Pemphigus vulgaris accounted for 81 %( 18) of cases and pemphigus vegetans accounted for 9.01 %( 2) of cases. The less common types were pemphigus erythematosus and IgA pemphigus constituting 4.1 %( 1) of the cases. Pemphigus vulgaris formed the most common variant. The male to female ratio was 1.35:1. The age incidence was between 21-70 years .The trunk and extremities were the frequently involved sites and had classical flaccid bullae in 90.9% of cases. Oral mucosa was involved in 66% of the cases of pemphigus vulgaris. Apart from the common histopathological changes in pemphigus vulgaris, we also observed: 1.Spongiosis of adjacent epidermis (11 cases) 2. Acantholysis in adnexa (4cases) 3. Hair shaft and sebaceous gland inside bulla (biopsy artifact)(3cases). Both the cases of pemphigus vegetans showed hyperkeratosis, papillomatosis and acanthosis, along with suprabasal bulla containing inflammatory infiltrate. Conclusion; Histopathological features were conclusive in most of the cases of primary vesiculobullous lesions of the skin. The study also revealed additional histopathological findings which are not encountered normally. Analysis of the subtle light microscopic features apart from the classical diagnostic features assisted in the diagnosis of difficult cases. The immunofluorescence study done, helped in confirming the diagnosis where histopathology and clinical features alone were inconclusive.

Evaluation Of Deritis In Alcoholic And Non-Alcoholic Liver Diseases - A Case Control Study

PUJAR S , KASHINAKUNTI S V , KALLAGANAD G S , DAMBAL A , DODDAMANI G B
Background: Oxidative stress and the influence of free radicals and their metabolites decrease the serum antioxidant status. They play a very important role in the pathogenesis of liver disease. The aim of the present study is to assess the Deritis in alcoholic and non-alcoholic liver disease patients in comparison to healthy controls and to evaluate its significance as a prognostic marker of liver disease. Methods: 100 cases were studied, of which 50 were normal healthy controls,10 were alcoholic hepatitis patients, 10 were non-alcoholic hepatitis patients, 10 were alcoholic cirrhosis patients and 20 were non-alcoholic cirrhosis patients. Serum AST and ALT levels were estimated in all subjects by using commercial kits from CPC diagnostics (Raichem USA). The readings were taken on a semiautoanalyser (STATFAX 3300). Statistical analysis was done by using the Student’s ‘t’ test. Results: The Deritis was significantly increased in patients with alcoholic hepatitis and cirrhosis as compared to non-alcoholic hepatitis and cirrhosis patients, respectively (P<0.05). Further, significantly elevated Deritis was observed in non-alcoholic hepatitis and cirrhosis patients as compared to healthy controls (P<0.001). Conclusion: The findings of the present study are consistent with previous studies, suggesting that hepatocyte damage causes leak of these enzymes into the circulation. This study concludes that Deritis is a dependable marker of alcoholic liver disease.

Type IV Collagen: A Non Invasive Bio Marker To Detect Non - Alcoholic Steato Hepatitis (NASH), Among Non - Alcoholic Fatty Liver Disease (NAFLD) Patients

SURAPANENI K M, SARASWATHI P, SHYAMA S, SUBRAMANIAM S
Introduction: Non-Alcoholic Fatty Liver Disease (NAFLD) encompasses a disease spectrum ranging from simple hepatic steatosis to steatohepatitis (NASH), fibrosis and cirrhosis. It is becoming the leading cause for referral to liver clinics in most areas. The prevalence of NAFLD is most likely to continue to rise. Obesity, hyperglycaemia, type 2 diabetes mellitus and hypertriglyceridaemia are the most important risk factors. Genetic factors undoubtedly predispose to NAFLD. NAFLD has the potential to progress to hepatocellular carcinoma or liver failure, both being events that ultimately lead to early death. Aim: To evaluate the Type-IV collagen – NASH test, a new bio marker for Non- Alcoholic Steato Hepatitis in patients with Non Alcoholic Fatty Liver Disease. Materials and Methods: 69 patients with Non-Alcoholic Fatty Liver Disease (NAFLD) who were diagnosed by ultrasound scanning and age and sex matched 69 normal healthy individuals as controls, were selected for this study. The levels of serum Type-IV collagen, lipid profile and liver function test parameters were estimated in patients and were compared to controls. Results: Type – IV collagen levels were significantly increased in patients with NASH among the NAFLD patients as compared to the controls. When compared to the liver function test parameters and the lipid profile levels, NASH was found to have a positive negative predictive value among the NAFLD patients. Conclusion: In patients with NAFLD, the Type – IV collagen test was found to be a simple, non – invasive and reliable test to predict the presence or absence of NASH.

Comparative Assessment In Pharmacology Multiple Choice Questions Versus Essay With Focus On Gender Differences

PAI M R S M *, SANJI N**, PAI P G ***, KOTIAN S ****
Background: Assessment is a driver of innovation and changes in education. In this study, medical student performances in pharmacology short essay questions (SEQ) and multiple choice questions (MCQ) were assessed and compared and gender differences were also explored. Methods: A total of 712 second year students with records of scores in SEQ and MCQ papers were analyzed. The performances of students who scored > 60% marks in theory papers were compared with those who scored > 60% marks in MCQ and vice versa. Gender differences in performances were also studied. Statistical analysis was done using McNemar, Chi-Square and Pearson’s co-efficient of correlation. P values < 0.05 were considered to be significant. Results: The analysis showed that the probability of students scoring > 60% marks in SEQ papers was higher when they had scored > 60% marks in MCQ papers (P < 0.001). Their SEQ performance positively correlated with their MCQ performance (r= 0.768, r= 0.599 and r=0.767 for the first, second and third tests respectively). Females scored higher than males in all tests. Conclusion: Literature indicates that MCQ as an assessment tool is debatable. This study indicates: performance in MCQ is an effective tool to predict SEQ paper performance; and correlates with global data on better performances by female counterparts.

Intestinal Parasitic Infections In HIV Seropositive Patients –A Study

BASAK S *, BOSE S**, MALLICK S K ***, GHOSH AK ****
Opportunistic infections are the hallmark of the Human Immuno Deficiency Virus (HIV) infection. In recent years, intestinal infections such as Cryptosporidium, Cyclospora and Isospora are becoming more prevalent in Acquired immunodeficiency syndrome (AIDS) patients. Strongyloides stercoralis infections can lead to the hyperinfection syndrome and even to lethal disease in immunosuppressed patients. The present study was undertaken to study the prevalence of parasitic infections in HIV seropositive patients. Out of 268 stool samples, 148, stool samples were collected from HIV seropositive patients with diarrhoea and 120 stool samples were collected from HIV seronegative patients with diarrhoea. All the 268 stool samples were examined by wet mount preparation (saline, Lugol’s iodine) and staining (modified Ziehl Neelsen staining) for the detection of the parasitic infection. The total number of intestinal coccidian parasite was 52 (35.1%)(in HIV seropositive patients. No intestinal coccidian parasite was found in HIV seronegative patients. Co-infection with Cryptosporidium, Isospora and Cyclospora was observed in three (2%) of the HIV seropositive cases. However, the larva of Strongyloides stercoralis was found in two (1.4%) of the HIV positive patients and both the patients had chronic diarrhoea.

Expression Of P53, Ck7, Ck20 And Rb Proteins in Oesophageal Squamous Cell Carcinoma In Iran

MOHSENI MEHRAN S M , MANSOUR-GHANAEI F
Background Cancer of the oesophagous is one of the most malignant tumours and has a poor prognosis. The p53 and retinoblastoma (Rb) genes are involved in the regulation of the cell population by the suppression of cell proliferation. Our aim was to show whether the expression of the p53, Ck7, Ck20 and Rb genes could be used as a prognostic indicator in oesophageal squamous cell carcinoma. Methods Samples obtained from 49 patients undergoing subtotal or total oesophagectomy were mmunohistochemically stained for studying the expression of the p53, Ck7, Ck20 and Rb genes and then the clinicopathological characteristics of those patients were investigated. Results P53 was positive in 40.4% of the patients (more than 20% of the tumour cells were stained), 12.8% were partially positive and in others, it was negative. Immunohistochemical staining for the expression of the Ck7, Ck20 and Rb genes in our samples was negative. P53 seemed to have significance in the prognosis of the cancer but Ck7, Ck20 and Rb expression did not have prognostic significance in the surgical treatment of oesophageal cancer.

A Cross-Sectional And Observational Study To Assess The Health Status Of People Engaged In The Tailoring Occupation In An Urban Slum Of Mumbai, India

CHAVADA V K

Maternal Thyroid Stimulating Hormone Levels During The First Trimester Of Pregnancy At The South-East Of The Caspian Sea In Iran
This study was designed to explore the status of the thyroid stimulating hormone [TSH] in the first trimester of pregnancy. In this analytical research, ‘Project 120’, apparently healthy pregnant women in their first trimester of pregnancy were selected randomly from pregnant women who visited the Danesh Medical Diagnostic Laboratory in Gorgan, which is located in northern Iran, during 2007-08. Serum TSH was measured by the Enzyme linked Immunosorbant Assay [ELISA]. The findings of this study indicated that 10% of pregnant women who also were apparently healthy subjects showed abnormal TSH serum concentration on the bases of the reference range of the laboratory kit used in this study, which seems to be incorrect. It is concluded here, that for the accurate measurement and the interpretation of thyroid hormones, the proper reference intervals in each region should be established to avoid confusion about the diagnosis of the thyroid function tests.

Fine Needle Aspiration Cytology (FNAC) As A Diagnostic Tool In Pediatric Lymphadenopathy

DHINGRA V *, MISRA V **, MISHRA R***, BHATIA R****, SINGHAL M*****
ntroduction: Lymphadenopathy is one of the commonest clinical presentations among paediatric patients, having several aetiologies and can pose as a diagnostic dilemma to a paediatrician. Therefore, it is necessary to arrive at a definitive diagnosis in order to administer proper treatment. The objective of this study was to evaluate the diagnostic role of fine needle aspiration cytology in lymphadenopathy in the paediatric age group. Material and Methods: This study was carried out in patients up to 14 years of age, who had palpable lymph node masses. The duration of this study was 3 years. A total number of 270 cases were included in the study for cytological examination. Histopathological examination was performed in 90 patients. Both dry and wet fixed smears were prepared in all cases and were stained by MGG and Papanicolaou stains. Results: Overall, inflammatory lymphadenopathy comprised 88.5% of the total lesions of the lymph nodes; it included 56% cases of reactive hyperplasia, 28.1% cases of granulomatous lymphadenitis and 4.4% cases of acute nonspecific lymphadenitis. Malignant lesions were seen in 11.5% patients. Overall, the diagnostic accuracy of the cytological examination was 98.89% and the overall sensitivity and specificity were 91.3% and 99.1%, respectively. Conclusions: Fine needle aspiration cytology is a reliable, easy and economical technique in the diagnosis of paediatric lymphadenopathy.

Evaluation Of Biochemical Parameters To Differentiate Transudates From Exudates In Certain Diseases

KALE A B *, MODI M**, THORAT A P ***, CHALAK S S****, PATIL A B *****

Background: Pleural effusion is a common occurrence in medicine wards/OPD. To determine the cause of the pleural effusion is not always easy. The distinction between an exudate and a transudate is the first and the most important step in the differential diagnosis of a pleural effusion. Several biochemical markers are used to classify the type of pleural effusion. The oldest and the most conventional way of classifying the pleural effusion is by the Light’s criteria. There are multiple other biochemical markers which are available, the diagnostic accuracy of which is not well established and is a subject of debate. Aim: To evaluate the diagnostic performance of the pleural fluid protein, LDH, cholesterol, bilirubin and their ratio with serum values, as well as the albumin gradient in differentiating the pleural fluid into transudate and exudate . Materials And Methods: A total of 50 cases of pleural effusion due to different diseases were analysed using certain biochemical parameters like pleural fluid cholesterol, protein and LDH. Their ratio with serum values and the albumin gradient were also analysed. Statistical Analysis: ROC curves were drawn for individual markers and the areas under the curve were computed and compared using the SPSS version 17. The optimal cut off with a combination of highest sensitivity and specificity was defined. Result: The pleural fluid protein, its ratio to serum protein and pleural fluid LDH had excellent diagnostic accuracy in differentiating exudative pleural effusions from transudative effusions. Pleural fluid LDH levels were not influenced by serum LDH levels. The optimal threshold for pleural fluid LDH was 175 IU/L. Conclusion: The pleural fluid to serum protein ratio and pleural fluid LDH had excellent diagnostic accuracy in classifying the pleural fluid type. A single test pleural fluid LDH had diagnostic performance higher than or comparable to most of the other biochemical parameters.

A Pilot Study Evaluating Health Literacy Towards Breast Cancer Among Multi-ethnic Students

KHAN T M *, AFZAL HA** KHAN A ***, TAHIR H **** , EJAZ M *****

The main aim of this study was to evaluate and compare the knowledge, attitudes and perception about breast cancer among students from different ethnic groups. A qualitative study was conducted among the multiethnic students at a Malaysian public university in Penang Island. The ethnic groups which were approached were Malay, Indians, Chinese, Arabs and Thais. On an average, fifteen students from every group was a part of the study. A questionnaire was used to evaluate the respondents’ knowledge about the symptoms, causes and the treatment of breast cancer. A self designed 15 items questionnaire was used to achieve the objective of the study. A total of N=125 students were approached for their participation in the study. However, only n=102 showed a willingness to be a part of the study. The mean age of the respondents was 24±4.46. Overall, the findings demonstrated that the Thai students had comparatively better knowledge than the other groups. In terms of diagnosis, mammography and physical examination were recommended by a majority of the students. Surgery and radiation therapy were the preferred options to treat breast cancer. Thai students had good knowledge about the symptoms of breast cancer. However, the knowledge level towards the diagnosis of breast cancer was best among the Malays and the Arabs. Overall, the findings highlighted the need of further educational sessions among all the groups for the substitution of negative perceptions with positive and evident beliefs about the symptoms, causes, prevention, diagnosis and the treatment of breast cancer.

Assessing The Need And Effect Of Updating The Knowledge About Cardio-Pulmonary Resuscitation In Experts

BAKHSHA F*

Cardiopulmonary resuscitation [CPR] is an emergency medical procedure for the victims of cardiac arrest, which should be performed by skillful individuals. This study was done to assess the level of knowledge in 35 CPR staff of a hospital which was affiliated to the Golestan University of Medical Sciences. Materials and Method: Simple Sampling with a before-after method was applied. Data Collection was done by a questionnaire of 43 questions about knowledge which was completed by the participants before and after teaching and after a two-month duration. Educational lectures were held by expert professors. The data were analyzed by the Wilcoxon test. P-values less than 0.01 were considered to be significant. Results: The mean age was 37.16 ± 6.21 years. The results showed that the level of knowledge had improved to 85% after training and to 87% after two months [P-value<0.01]. Conclusion: It is suggested that a periodic training of practical skills should be scheduled for these staff.

Cost Benefit Analysis Of The Diabetes Self Management Program At A University Health Centre In Malaysia

Al-HADDAD M, IBRAHIM M M I , SULAIMAN S A S, SHAFIE A A, MAARUP N

Objectives: This study aims to conduct the Cost Benefit Analysis for the diabetes self management program using the payment card contingent valuation technique at the Health Center of Universiti Sains, Malaysia. Setting: Health centre of Universiti Sains, Malaysia. Methods And Materials: A cross sectional study design was used to elicit the patients' maximum willingness to pay money for the diabetes self management program. All costs and benefits of the program were measured for the cost benefit analysis evaluation. Statistical Analysis: All data were analyzed by using the SPSS software package 12 at a significance level of less than 0.05. Results: The net benefit of the diabetes self management program was RM7374.50, while the benefit to the cost ratio was equal to 1.2:1. On the other hand, the diabetes self management program would result in a net benefit of RM211418.67, if it resulted in the prevention of the development of one case of end stage renal disease. This study showed that patients with diabetes for more than 2 years had significant higher WTP amounts than those with lower diabetes length. In addition, more educated patients and those with higher incomes showed significant higher WTP amounts than less educated and lower income patients. Conclusion: WTP has been approved to be a suitable tool for measuring the benefits of the intervention of the diabetes self management program. The diabetes self management program was found to be an effective intervention which would result in net benefits and large savings.

Gender Differences In Self-Assessed Health Of Young Adults In An English-Speaking Caribbean Nation

BOURNE P A

Background: Gender differences in self-assessed health in young adults (i.e. ages 15 – 44 years) are under-studied in the English-speaking Caribbean. Aims: The aims of the current research were to (1) provide the demographical characteristics of young adults; (2) examine the self-assessed health of young adults; (3) identify social determinants that explained the good health status for young adults; (4) determine the magnitude of each social determinant, and (5) determine gender differences in self-assessed health. Materials and methods: The current study extracted a sub-sample of 3,024 respondents from a larger nationally cross-sectional survey of 6,782 Jamaicans. Statistical analyses were performed using the Statistical Packages for the Social Sciences v 16.0. Descriptive statistics were used to provide demographic information on the samples. Chi-square was used to examine the association between non-metric variables and an Analysis of Variance was used to test the relationships between metric and non-dichotomous categorical variables. Logistic regression examined the relationship between the dependent variable and some predisposed independent variables. Results: One percent of the sample reported injury and 8% reported illness. Self-reported diagnosed illnesses were influenza (12.7%); diarrhoea (2.9%); respiratory disease (14.1%); diabetes mellitus (7.8%); hypertension (7.8%); arthritis (2.9%) and unspecified conditions (41.2%). The mean length of illness was 26.0 days (SD = 98.9. Nine social determinants and biological conditions explained 19.2% of the variability of self-assessed health. The biological conditions accounted for 78.1% of the explanatory model. Conclusion: Injury accounts for a miniscule percentage of illness and so using it to formulate intervention policies would lack depth to effectively address the health of this cohort.

Conservative Management Of Congenital Dacrocystocele

BAPPAL A, SUDHIR S, RATHNAKAR U P, UDUPA A L, PRAKASH S

Congenital dacryocystoceles are variants of nasolacrimal duct obstruction. Even though they are considered to be a benign condition, intranasal extensions can bring about serious respiratory distress syndrome in neonates. Controversy still exists regarding conventional and invasive treatment options. There was total resolution with simple massaging of the cyst in this case.

Massive Ovarian Oedema

SINGH P A*, SRIVASTAVA R N** , MISRA V*** , DEY S**** , MISHRA S*****

Massive ovarian oedema is a rare pseudotumour. It is often mistaken for a malignant tumour. Our article describes a case of in a 36-year-old nulligravid patient, who presented with an acute abdomen which was suspected to be due to ovarian torsion. Ultrasonography revealed an enlargement of the left ovary, measuring 10 x5 x 2.5 cm. A left sided salpingo-oopherectomy was performed and the diagnosis of massive ovarian oedema was made after histological examination. Torsion was found in our case.

Isolated Cysticercosis Of Inferior Rectus Muscle Presenting With Eccentric Proptosis – Case Report And Treatment Review

SHADANGI P, SAGGAR V, MITTAL S R, SINGLA R, KUMAR R

Intraocular infections by Cysticercus Cellulosae larvae are often found as part of a generalized systemic infestation. Reports of orbital adnexal cysticercosis are uncommon, despite the high incidence of brain and ocular involvement, with isolated infestation of extraocular muscle being exceedingly rare. We at our institute report a rare case of isolated right inferior rectus muscle cysticercosis which presented with unilateral eccentric proptosis and restriction of upward gaze.

An Atypical Presentation of Rocky Mountain spotted fever (RMSF)- A Case Report

AMRITA SHRIYAN, ASHVIJ S

Tick-borne illness has a highest incidence in South Central and South East U.S. The presence of Rickettsial diseases in India have been documented in Jammu and Kashmir, Himachal Pradesh, Uttaranchal, Rajasthan, Assam, West Bengal, Maharashtra, Kerala and Tamil Nadu (1),(2),(3),(4),(5),(6),(7),(8). We report here, a case of a 70 year old man admitted with high grade fever and hypotensive and hypovolemic needed emergency intervention. Later, a Weil Felix test was done, followed by a demonstration of rise in titre. IgM ELISA and PCR confirmed the diagnosis of Rickettsiae. The patient was treated with Doxycycline and within 48 hours of treatment with Doxycycline, the patient was off ionotropes and was extubated.With gangrene of the extremities and superadded bacterial infection, the patient’s WBC count had increased and the patient succumbed to death due to sepsis.

Conjoined Twins with Omphalocele and Unilateral Club Foot: A Case Report

SHARMA P , GHIMIRE A

Conjoined twins are a rare clinical entity. Various congenital defects like anencephaly, gastrointestinal anomaly, urogenital anomaly, cleft lip, cleft palate and lumbosacral meningomyelocele may be associated with conjoined twins. Here, we report a case of thoracoomphalopagus associated with omphalocele and club foot.

Convergence E-Health Services Under A Unified National Health Grid For India

DESHPANDE G S, DESHPANDE S R, NALINI G K

Though the budgeting for health has increased in recent times and we see a robust network of quality public and private health centres across the nation, the budgeting for e-Health technologies have not received the Indian health planner’s adequate attention. The heart of e-Health efforts should be an efficient mobile based short messaging network which is very much available at a common man’s price. A back up network of call centres like Project M of Africa will not be difficult for a nation that provides call centre back –up and technologies to the world. Convergence E-Health Services under a Unified National Health Grid hold good prospects for a big overpopulated country like India, with a poor and inefficient health infrastructure.

Nitric Oxide And Cancer

DHANKHAR R, DAHIYA K, SINGH V, SANGWAN L, KAUSHAL V

Nitric oxide (NO) is a pleiotropic biological mediator which plays a key role in various physiological and pathological processes. It is synthesized with the help of the enzyme nitric oxide synthase (NOS), which has three isoforms. All these isoforms of NOS have been reported to be involved in promoting or inhibiting the aetiology of cancer. High levels of NOS expression in tumour cells may be cytostatic or cytotoxic, while low levels can have the opposite effect and may promote tumour growth. NO also has diverse effects in cancer treatment. It can enhance the cytotoxic efficacy of some chemotherapeutic agents as well as radiation. The modification of NOS activity in tumours can be considered to be a promising mean for selective tumour blood flow modification, thus providing a novel approach for reducing tumour oxygenation which is aimed at enhancing the efficiency of hypoxia- mediated, bioreductively activated modalities for cancer treatment.

Detection of Porphyromonas Gingivalis (Fima) In Coronary Plaque

MAHENDRA J , MAHENDRA L , KURIAN V M, JAISHANKAR K

Background: Recent studies indicate that chronic bacterial infections are an important risk factor for coronary artery disease. The inflammation initiated by bacteria and their components might be the common causal factor in the progression of atherosclerosis. The ability of oral pathogens to colonize in the coronary atherosclerotic plaque is well known. Aims: The aim of this study was to detect the presence of the periodontal oral pathogens; namely, Porphyromonas gingivalis (fimA) gene, Porphyromonas gingivalis, Tannerella forsythia and Prevotella nigrescens in the atherosclerotic plaque samples of the patients undergoing Coronary Artery Bypass Grafting. Settings and Design : The study population consisted of 51 patients with chronic periodontal infection in the age group of 40 to 80 years and were recruited consecutively from the institute of Cardiovascular disease, Madras Medical Mission, Chennai. These patients were suffering from Coronary Artery Disease and were undergoing Coronary Artery Bypass Grafting. Methods and Materials: DNA was extracted from the subgingival plaque and from the coronary atherosclerotic plaque samples from the same patients. Polymerase chain reaction was used to amplify the part of the 16S rRNA gene to detect the presence of the above microorganisms. Statistical Analysis: Kappa Measures of Agreement, Percentage Prevalence Results: Bacterial DNA was detected in all the samples of subgingival and atherosclerotic plaques. Tannerella forsythia, Porphyromonas gingivalis, Porphyromonas gingivalis (fimA) gene and Prevotella nigrescens were detected in 31.4%, 45.1%, 39.2% and 21.6% of atherosclerotic plaque samples. In both subgingival plaque and coronary atherosclerotic plaque samples, T. forsythia was detected in 19.6%, P.gingivalis in 39.2%, P.gingivalis (fimA) gene in 33.3% and P. nigrescens in 15.7% of the samples. 11.8 % of T.forsythia, 5.9% of P.gingivalis, 5.9% of the P.gingivalis (fimA) gene and 5.9 % of P.nigrescens were found only in coronary plaques without the presence of these microorganisms in subgingival plaques. Conclusion: Our study confirmed the detection of the DNA of the above microorganisms in coronary plaque samples. This may explain that the inflammation in the oral cavity triggers and influences the atherosclerotic process.

Management Of Acute Dental Trauma-Avulsion And Extrusive Luxation: A Case Report

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

This report presents a case of extrusive luxation and the avulsion of the maxillary left incisors with concomitant uncomplicated crown fractures in a 20 year old boy.The slightly extruded and avulsed teeth were repositioned in the sockets and were splinted for 2 weeks. Endodontic therapy was performed. After a follow up of 3 years, no root resorption and ankylosis was seen .The present case report showed that under the limited time of 30 minutes, ankylosis and root resorption like affects can be avoided for luxated and avulsed teeth.

Magnet Retained Sectional Lip Plumper Prosthesis for A Patient With Hemi-Mandibulectomy: A Clinical Report

CHAKRAVARTHY R

An intraoral sectional prosthesis was fabricated to restore more normal contour to a patient’s lower lip that was compromised following a marginal mandibulectomy which was performed to eradicate a malignant neoplasm. The surgical resection compromised the lower lip on the affected side, because the marginal mandibular branch of the facial nerve was damaged during the surgical resection. The prosthesis successfully restored the lost lip support, reduced the incidence of lip biting and improved the patient’s oral competency. This clinical report describes the procedure for making an intraoral magnet retained lip plumper prosthesis to improve patient aesthetics and oral function.

Prosthetic Rehabilitation Of A Maxillary Defect With Hollow Bulb Obturator Retained By A Combination Of A Cast Clasp And Zest Anchor Type Radicular Ball Attachment- A Case Report

RAMARAJU A V, SAJJAN S, REDDY N

Prosthetic rehabilitation of patients with acquired defects of the maxilla present a challenging task and these goals are met by means of an obturator prosthesis. Palatal defects that are treated prosthodontically, present biomechanical problems. An obturator prosthesis fabricated for a unilateral maxillary resection, has intrinsic leverages that act as dislodging factors. Many methods have been recommended to accomplish the retention of maxillary obturator prostheses. The placement of radicular attachments and the process of making the prosthesis hollow can have a significant effect on the stability and retention of the obturator prosthesis in partially edentulous maxillectomy patients. This case report describes a clinical case of sub-total maxillectomy due to osteomyelitis, which was successfully rehabilitated with a hollow bulb obturator, retained in a unique combination of a cast clasp and zest anchor type of radicular ball attachment.

The effect of Four Fruit Juices on the Ph of Dental Plaque - A Four Period Cross-Over Study

PREETHI B P, MAITREYEE D S, DODAWAD R

Background: The concept of health has prevailed for centuries and dietary habits are changing with modernization. “Healthy eating” is perceived to be important and fruit juices are marketed and promoted aggressively as a “Health drink”. Objectives: 1. To estimate the endogenous pH and titratable acidity of four fruit juices. [Freshly prepared- Apple and Sweet lime, Ready to drink- Frooti and Pulpy orange] 2. To assess the effect of these test drinks on the pH of the plaque in two groups. [DMFT, Decayed Missing Filled Teeth=0 and DMFT, Decayed Missing Filled Teeth >3] 3. To compare between the juices for the two groups. Methodology: 24 volunteers aged 20–30 years from the College of Dental Sciences, Davangere, were included and divided into 2 groups, based on the caries experience. The groups were randomly allocated for fruit juices and a four period cross-over study was designed. The endogenous pH of the fruit juices and plaque samples were collected at the baseline and after consumption of the fruit juices at 1, 5, 10, 15 and 30 minutes and was assessed by a digital pH meter. Statistical analysis was done by using the Student’s t-test, ANOVA and Tukey’s post hoc. Result: Four fruit juices were acidic and reduced the pH of the plaque. The maximum pH drop was observed in the ready to drink juices as compared to the fresh fruit juices in both the groups, but in group B, it dropped below the critical pH. Conclusion: The ready to drink juices have more cariogenic potential as compared to fresh fruit juices, especially for the caries active group.

Dentigerous Cyst Associated With Supernumerary Teeth: A Report Of Three Cases

JOHN T , GUNA SHEKHAR M , KOSHY M

Dentigerous cyst originates by the separation of the follicle from the crown of an unerupted tooth or a developing tooth bud. These cysts seldom associate with supernumerary teeth. The resorption of roots which are adjacent to a supernumerary tooth (mesiodens) or its cyst is a rare complication. The purpose of this article is to describe three rare cases of dentigerous cyst associated with supernumerary teeth and their complications and management.

Multiple Variations in the Paired Arteries of Abdominal Aorta – Clinical Implications

SONI S , WADHWA A

Introduction - The knowledge of the commonest pattern of the arterial supply of the abdomen and the deviants thereof is mandatory in various diagnostic, interventional and surgical procedures. Methods - Multiple variations in the origin of the lateral branches of the abdominal aorta were observed during the routine dissection of the abdominal cavity in an adult male cadaver in the Department of Anatomy, Govt. Medical College, Amritsar. Results – The variations encountered during the dissection were- 1) Double renal arteries were seen on the left side. 2) Double testicular arteries were seen on the left side, with the superior testicular artery arising from the inferior renal artery and the inferior testicular artery arising directly from the abdominal aorta. 3) Triple renal arteries were seen on the right side. 4) The right inferior phrenic artery was found to originate from the celiac trunk and the left inferior phrenic artery was found to arise directly from the abdominal aorta. Conclusions - Accessory renal arteries may constitute a danger in nephrotomy and in the partial resection of the kidney. The presence of triple renal arteries is infrequent, with a reported incidence of 1-2%. A gonadal artery originating from an inferior renal artery may be injured during the percutaneous treatment of the syndrome of pelvi-ureteral junction and so it may become a major contraindication. Also, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum.

Effect Of The Insulin Plant ( Costus Igneus ) Leaves On Blood Glucose Levels In Diabetic Patients: A Cross Sectional Study.

SHETTY AJ, PARAMPALLI S.M, BHANDARKAR R, KOTIAN S

Background: The complications of Diabetes mellitus are related to glycaemic control. Normoglycaemia or near normoglycaemia is the desired, but often elusive, goal for most patients. Regardless of the level of hyperglycaemia, improvement in glycaemic control will lower the risk of diabetes complications. Consumption of the leaves of the insulin plant has been claimed to achieve glycaemic control and hence, we have planned the present cross sectional study in diabetic patients. Aim Of The Study: Analysis of glycaemic control in diabetic patients who have been consuming the leaves of the insulin plant and to know the adverse effects/ benefits of insulin plant leaf consumption. Materials And Methods/ Statistical Analysis: A cross sectional study was conducted after taking informed consent from the patients. Retrospective data was collected from diabetic patients who consumed the leaves of the insulin plant. Wilcoxson’s paired test was the statistical method which was used for analysis of the data. Results And Conclusion: Statistically significant reduction in the fasting and postprandial blood sugar levels in all the patients who consumed the leaves.

Incidence Of The Anomalous Origins Of The Vertebral Artery – Anatomical Study And Clinical Significance

POONAM, SINGLA R K , SHARMA T

Context: The anatomical and the morphological variations of the vertebral artery are significant for diagnostic and surgical procedures in the head and neck region, where an incompatible knowledge can lead to serious implications Aims: This study was conducted to know the variations in the origins of vertebral arteries and to discuss their clinical implications while performing diagnostic and interventional angiography, both to identify them correctly and to know where to look when vertebral arteries are not seen in the normal position. Material And Methods: Eighty vertebral arteries belonging to 40 cadavers were dissected in the head and neck region. Their source and mode of origin were studied. Out of the total cadavers, four were found to have abnormal origins of vertebral arteries, which were studied in detail along with their clinical implications. Results: An extremely rare and interesting case of the origin of the left vertebral artery from the external carotid artery was encountered in one of these specimens. The direct origin of the left vertebral artery from the aortic arch was also found in three cadavers, out of which one was found to be bifurcating after taking origin. No abnormality in the origin was encountered on the right sided vertebral arteries. Conclusion: The described morphological variations have clinical applications in the wide field of surgery, in the head and neck region. To know about these findings seems to be very important before undertaking any surgery or endovascular treatment in that region. Cerebral angiography must be included in the evaluation of patients with unexplained neurological findings.

Influence of Food Intake on BMI of Indian and Nepalese Medico Sportsmen

SATHIAN B, RAMESH MG, BEDANTA R, JAYADEVAN S, BABOO NS

Pharmacovigilance: Where do we stand?

PEETHAMBARAN K , KHANWELKAR C C

Knowledge of Selected Medicine Related Issues among Inpatients in a Nepalese Teaching Hospital: A Preliminary Study

SHAKYA SR, SHANKAR PR

Primary Pancreatic Lymphoma - A Diagnostic Dilemma

AGARWAL D, SAXENA V, BANSAL P, PANDEY A

Primary pancreatic lymphoma (PPL) is a rare form of extranodal lymphoma, mimicking the carcinoma of the head of pancreas clinically (1). Most PPLs are non-Hodgkin's lymphomas (NHLs), predominantly the diffuse large B-cell type (2). We present here, a case of primary pancreatic non-Hodgkin's lymphoma, presenting with abdominal pain and jaundice and CT scan features suggestive of cholangiocarcinoma. The patient underwent surgical resection of the tumour and the histopathology revealed the primary involvement of the pancreas by the lymphoma cells. Immunohistochemistry confirmed the diagnosis as diffuse large B-celltype of lymphoma. The patient refused chemotherapy postoperatively and expired after 6 months of follow up.

To Study the Clinico-Epidemiological Factors of Tetanus Cases Admitted In a Tertiary Care Hospital for the past 10 Years

CHAVADA V K

Aim:To study the epidemiological factors of tetanus cases admitted in a tertiary care hospital Objectives: 1. To Study the Sociodemographical factors of Tetanus. 2. To study the clinical types of tetanus and the mortality associated with tetanus Study Design: Retrospective cross sectional study. Participants: Cases of tetanus admitted for a period of last 10 years at GOVT MEDICAL COLLEGE Hospital Dhule, MAHARASTRA, INDIA. Results: There were 440 cases of Tetanus admitted in the hospital for treatment, out of which 262 were males and 178 were females. 344 (78%) cases were from rural areas and 96 (22%) cases were from urban areas. It was also observed that Traumatic tetanus is the most common type of tetanus. Out of the 440 cases of tetanus, 151 died. Out of these deaths, 134 (89%) were reported from rural areas and 17 (11%) were reported from urban areas. The case fatality rate of neonatal tetanus was the highest (60%) amongst all types of tetanus.

The Status Of NIDDM Patients After Yoga Asanas: Assessment Of Important Parameters

Fifty six patients of Type 2 Diabetes Mellitus (NIDDM), with a history of diabetes of 0 – 10 years, in the age group of 30 – 60 years, were selected. The diagnoses of Type 2 Diabetes Mellitus (NIDDM) patients were done according to the WHO criteria Technical Report Series. Subjects suffering from cardiac, renal and proliferative retinal complications were excluded from the study. The yoga asanas regime included the Suryanamskar Tadasan, Konasan, Padmasan Pranayam, Paschimottansan Ardhmatsyendrasan, Shavasan, Pavanmukthasan, Sarpasan and Shavasan. The subjects were called to the cardio-respiratory laboratory in the morning and were given training by the Yoga expert. The Yoga exercises were performed for 30-40 minutes every day for 40 days. The subjects were on a recommended diet and oral hypoglycaemic drugs. Basal blood glucose, serum insulin, lipid profile, body mass index, malondialdehyde levels (MDA) as an index of lipid peroxidation, cardiac function, p300 and the nerve conduction velocity of the median nerve was measured and repeated after 40 days of the Yogic regime. Another group of 50 Type 2 diabetes subjects of comparable age and severity, called as the control group, were kept on prescribed medication and light physical exercises like walking. Their basal and post 40 daysparameters were recorded for comparison. There was a reduction in the weight and even in the distribution of fat in the body space, as shown by a significant decrease in the waist to hip ratio in NIDDM patients on Yoga asanas. There was a significant fall in the fasting blood glucose levels. The one hour postprandial blood glucose level also decreased after 40 days of Yoga asanas), the subjects developed a sense of wellbeing within 10 days and there was a lowering of the dosage of the oral anti-diabetic drug (s). There was a significant reduction in total cholesterol also. There was a noticeable decrease in triglyceride levels, LDL and VLDL cholesterol, MDA levels and GHb. Improvement of nerve conduction velocity and pulmonary and cardiovascular function occurred, thus indicating a shift to the parasympathetic dominance. The subjects were also more aware and restful. Yoga asanas in mild to moderate NIDDM cases, which were used in addition to normal medical therapy, would give benefit to the patient and improve the status of diabetics in terms of the use of less medicine, improvement of physical well being, improvement of mental alertness and activity and and leading a complication free life. Consequently, it is suggested that Yoga asanas and pranayama may be used as an adjunct to reduce Diabetes Mellitus.

Fine Needle Aspiration Cytology diagnosis of the Eccrine Variant of Chondroid Syringoma- Case Report of a Rare Entity with Review of Literature

BHASIN T S *** , MANNAN R ***, BHATIA P K ****, SHARMA M ***, BHALLA A ***

Chondroid syringomas (CS) are rare mixed tumours of sweat-gland origin which were first described by Billroth in 1859, that have both benign and malignant forms. They are also known as mixed tumours of the skin and are composed of both epithelial and mesenchymal components. A 40-year-old female presented to the surgical outpatient department with a gradually increasing swelling over the side of the nose, of 1 year duration. FNAC was done and the aspirate was thick and mucoid. Microscopic examination revealed clusters of epithelial and myoepithelial cells, embedded in a metachromatic, chondromyxoid ground substance. Based on these features, a diagnosis of chondroid syringoma was made and histopathological examination was advised. On histopathological examination, it was found that there were numerous nests of polygonal cells and interconnecting tubuloalveolar structures whicha were lined by a single layer of cuboidal epithelial cells. The stroma consisted of cells in a bluish chondroid matrix. Based on these findings, a diagnosis of the eccrine variant of CS was given. The patient was well after excision and no recurrence was reported. CS is a rare primary skin tumour; the incidence is < 0.098% and affects middle aged and older men. The most common sites are the head and neck region, the hand, foot, the axillary region, the abdomen, penis, vulva and the scrotum. Fine needle aspiration cytology has been used for diagnostic purposes and may prove to be useful to determine the pathology before excision of the tumour. However, examination of excised tissue is most reliable in establishing a definitive diagnosis.

National Workshop on Molecular Cytogenetics

National Workshop on Molecular Cytogenetics: Cancer Cytogenetics (hematological malignancy) by FISH, New Delhi, India November 29th to December 4th, 2010 For more information: Ashutosh Halder, Department of Reproductive Biology, All India Institute of Medical Sciences, New Delhi 110029, India www.aiims.ac.in (visit conference/workshop link) ashutoshhalder@gmail.com, ahalder@aiims.ac.in