Tungikar Sudhir, Kulkarni Pratima, Kawle Deepak
Situs inversus is rare congenital anomaly, in which there is general transposition of viscera due to reverse rotation including heart which rotates to right side and all abdominal - thoracic viscera are laterally transposed i.e. all viscera normally on right are seen on left and vice versa. The heart is structurally normal in 90-95% of cases. Incidence of cardiac anomalies in dextrocardia with SI is low (3%), while in isolated dextrocardia it is high. Dextrocardia with situs inversus occurs in 2 per 10,000 live births. Establishment of body axis antero-posterior, dorso-ventral and right-left axis is during embryogenesis at the time of gastrulation.Gene expression patterns are responsible for establishing right-left axis, mainly hox code that specify segmental position. Recent research on mice suggests that situs inversus is caused by the absence of a single protein due to particular mutation on chromosome 12. We came across a 30 year old lady having this rare anomaly of situs inversus with dextrocardia associated with complex congenital heart disease.
1. Gaio U, Schweickert A, Fischer A, et all: A role of cryptic gene in the correct establishment of the left right axis. Max-Delbruck-Centrum for Molecular Medicine, Berlin, 13125, Germany. 2. Wink K, Dragert W.; Case of dextrocardia with inversion of the ventricles,corrected transposition of great vessels and pulmonary valve stenosis with hyperplasia of the infundibulum: PMID : 853997 (PubMed) 3. Wink K, Dragert W.et al, Case of dextroversion without ventricular inversion with corrected transposition of great vessels and pulmonary valve stenosis with hemodynamically small VSD; PMID:958138 (Pub Med) 4. Adeyekun AA, Onunu AN, Mazeli FO; Dextrocardia with situs inversus: A case report: Dept. of Radiology, University of Benin Teaching Hospital, P.M.B.1111, Benin City. 5. Distefano G, Romeo MG, et al; Dextrocardia with and without situs viscerum inversus in two sibs. Dept of Paediatrics, University of Catania, Italy. 6. A.K.Dutta, Essentials of Human Embryology, 4ed, 181. 7. Langman’s Medical Embryology, T.W.Sadler, 9ed, Lippincott Williams and Wilkins, 72-76, 229-31, 251-52. 8. Inoue T, Matsuda M, Kuroda K, Takeuchi A.: Proceedings: A case of single ventricle associated with dextrocardia, TGV, PS and persistent right superior vena cava.
Shubhatara Swamy, Pratibha Nadig, Bhanuprakash, Muralimohan, Manjula Shetty
Purpose: The present study was carried out to analyse the profile of suspect adverse drug reactions (ADRs) reported to the Pharmacovigilance unit. The primary objective was to identify the common drugs implicated and the pattern of the reactions, which would ensure a judicious prescription and further prevention. Methods: An awareness building lecture on voluntary reporting of ADRs was conducted after which ADR forms were distributed to various departments. They were assessed for the type of reaction based on Rawlins and Thomson criteria; severity based on Hartwig’s scale; seriousness as per Centre for Drugs Standards Control Organisation; expectedness as defined by International Conference on Harmonisation and causality based on Naranjo’s algorhythm. The common group of offending class of drugs were also identified. The results were analysed using descriptive statistics. Results: Out of 75 reactions 74 (98.67%) were type B and 1 reaction (1.33%) was type A. There were 5 unexpected reactions. Sixty four reactions (85.3%) were mild, 4 (5.33%) moderate and 7 (9.33%) were severe in nature. Seven (9.33%) out of 75 were considered serious as they required hospitalisation. The causality assessment for 154 drugs from 75 forms showed 118 (51%) to be possibly related, 36 (49%) as probably related and none were definitely related. The major group of drugs implicated were Antimicrobials followed by Non-steroidal anti-inflammatory drugs. Conclusion: ADRs were mostly due to antimicrobials and Non-steroidal anti-inflammatory drugs. It is necessary to create more awareness to curb irrational polypharmacy which helps in prevention and an accurate diagnosis of the reactions.
1. Mandavi, D’Cruz S, Sachdev A, et al. Adverse drug reactions & their risk factors among Indian ambulatory elderly patients. Indian J Med Res. 2012 September; 136(3): 404–410 2. Lazarou J. Pomeranz BH, Corey PN. Incidence of adverse drug reactions. A meta-analysis of prospective studies. JAMA. 1998; 279: 1200-1205 3. Ramesh M, Pandit J, Parthasarthy G. Adverse drug reactions in a south Indian hospital – their severity and cost involved. Pharmacoepidemiol drug Saf 2003, 12: 687-92 4. Arulmani R, Rajendran SD, Suresh B. Adverse drug monitoring in a secondary care hospital in South India. British Journal of Clinical Pharmacology, 2008, 65: 210-216 5. WHO technical report 2002 downloaded from http://apps.who.int/medicinedocs/en/d/Js4893e/ (accessed on 11/05/2013). 6. Santosh KC, Tragulpiankit P. Pharmacovigilance: an overview. Mahidol University Journal of Pharmaceutical Science 2011; 38 (1-2), 1-7 7. Harmark L, van Grootheest AC. Pharmacovigilance: methods, recent developments and future perspectives. Eur J Pharmacol 2008 Aug; 64(8); 743-52. doi: 10.1007/s00228-008-0475-9. 8. www.cdsco.nic.in/ (accessed on 11/05/2013) 9. Rawlins MD, Thomson JW. Pathogenesis of adverse drug reactions. In Textbook of Adverse Reactions. Davies DM (ed). Oxford University Press: Oxford, 1977: 10 10. Glossary of terms used in Pharmacovigilance http://who-umc.org/Graphics/24729.pdf (accessed on 11/05/2013) 11. Hartwig SC, Siegel J, Schneider PJ. Preventability and severity assessment in reporting adverse drug reactions. Am J Hosp Pharm. 1992 Sep; 49(9): 2229-32. doi: 10.1111/j.1365-2125.2007.02993.x. 12. Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30: 239–45 13. International conference on harmonisation of technical requirements for registration of pharmaceuticals for human use ich harmonised tripartite guideline;post-approval safety data management: definitions and standards for expedited reporting;e2d -Current Step 4 version;dated 12 November 2003 downloaded from-www.ich.org/fileadmin/Public_Web_Site/ICH.../E2D_Guideline.pdf(accessed on 11/05/2013) 14. Kamtane AR, Jayawardhani V. Knowledge, attitude and perception of physicians towards adverse drug reaction (adr) reporting: a pharmacoepidemiological study. Asian Journal of Pharmaceutical and Clinical Research. Vol 5, Suppl 3, 2012 210-214 15. Gupta P, Udupa A. Adverse drug reaction reporting and pharmacovigilance: knowledge, attitudes and perceptions amongst resident doctors. J. Pharm. Sci. & Res. Vol.3 (2), 2011, 1064-1069 16. Johansson ML, Hägg S, Wallerstedt SM. Impact of information letters on the reporting rate of adverse drug reactions and the quality of the reports: a randomized controlled study. BMC Clin Pharmacol. 2011 Sep 7; 11:14. doi:10.1186/1472-6904-11-14. 17. Jose J, Rao PG. Pattern of adverse drug reactions notified by spontaneous reporting in an Indian tertiary care teaching hospital. Pharmacol Res. 2006; 54:226–33 18. Ding WY, Lee CK, Choon SE. Cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia. Int J Dermatol. 2010 Jul; 49(7):834-41. doi: 10.1111/j.1365-4632.2010.04481.x. 19. Padmaja U, Adhikari P, Pereira P. A prospective analysis of adverse drug reactions in a south indian hospital. Online J Health Allied Scs. 2009; 8(3):12.
Brahadeesh M., Suresha R. N., Satish A. M
Objective: To study the anti-inflammatory activity of sumatriptan in acute and sub acute experimental animal model. Methods: Adult albino rats of either sex weighing 150-200 grams were randomly divided into 3 groups of 6 each. The control, standard and test group received Gum acacia 2g%, indomethacin 10 mg/kg and sumatriptan 1.28 mg /kg respectively .Acute inflammatory activity was assessed by carageenan induced paw oedema, Turpentine induced arthritis model and sub acute activity was assessed by cotton pellet induced granuloma model. Results: The anti-inflammatory activity was expressed as percentage of inhibition. In carageenan induced paw oedema, percentage of inhibition of paw oedema by indomethacin and sumatriptan respect to control were 51%and25% respectively. Hence the anti-edema effect of the test group was good and comparable with standard.The percentage of inhibition of paw oedema by the test group considering the percentage of inhibition of standard as 100 % was 65.5%.Thus sumatriptan showed good anti-inflammatory activity compared with the standard drug indomethacin in carageenan induced rat paw oedema model. The percentage of inhibition of knee arthritis with respect to control by standard and sumatriptan were 60% and 23%respectively.Hence the test group showed moderate antiarthritic effect in comparision to indomethacin .The percentage of inhibition of knee arthritis by the test group considering the percentage of inhibition of standard as 100% was 52.3%.Thus sumatriptan showed anti-inflammatory activity of moderate degree compared with the standard drug indomethacin in Turpentine induced arthritis animal model. The percentage of inhibition of granuloma. by standard and sumatriptan were49% and 13%respectively.The antigranuloma effect of test group was good as compared with standard.The percentage of inhibition of dry granulation tissue of the test group considering the percentage inhibition of standard as 100% was 58.2%.Thus sumatriptan shows moderate anti-inflammatory effect compared with the standard drug indomethacin in cotton pellet induced granuloma animal model. Conclusion: As sumatriptan showed considerably good antiinflammatory effect in acute models and in sub acute model ,it can be used as a promising antiinflammatory agent .
1. Anderson WAD. Inflammation and Healing. Pathology, 9th Edition, C.V. Mosby co 1990; 1: 67. 2. Tripathi KD. Anti-rheumatoid and anti-gout drugs, Chapter 15. Essentials of Medical Pharmacology, 7th edition. Jaypee brother publishers 2013: 210-212 3. Kuzell WC, Schaffarmic RW, Bowmann B and Manke EA. Phenyl butazone (Butazolidin) in Rheumatoid arthritis and Gout. JAMA 1952; 149:729. 4. Rang HP, Dale MM, Ritter JM and Flower RJ. Anti-inflammatory and immunosuppressant drugs, Chapter 26. Rang and Dale’s Pharmacology, 7th edition. Elseveir publications 2008: 318-334. 5. Rang HP, Dale MM, Ritter JM and Flower RJ. Local hormones, inflammation and immune reactions, chapter 13.Rang and Dale’s Pharmacology, 6th edition. Philadelphia: Elseiver publications;2007:202-223. 6. Laurence L Brunton, John S Lazo,Keith L parker Analgesic Antipyretic and Anti- Inflammatory Agents: pharmacotherapy of gout.Goodman and Gillman’s “The Pharmacological Basis of therapeutics”,Mc Graw Hill;2006.11:1889. 7. Buzzi MG Moskowitz M .The Trigemino vasculo system and migraine.Pathol Biol ;(Paris) 1992 April 40(4):313. 8. David William J,Sara shepherd, Raymond Hill G The Novel anti-migraine agent Rizatriptan inhibits neurogenic dural vasodilatation and extravasation. European Journal of pharmacology .1997 sep;32(10):61-64. 9. Winter CA, Risley EA et.al Carrageenan induced edema in hind paw of the rat as an assay for anti inflammatory drugs. Proc soc Expt Biol(NY),1962;111:544. 10. Teotino UM, Polofrig L, Gandini A et.al Antipyretic activity of thio derivative of 2,3 dihydro 4H-1,3Benzoxacin-4-1 synthesis and pharmacological property J.Med.chem.1963;6:2489. 11. Penn GB, Ashford A The inflammatory response to implantation of cotton pellets in the rat. Journal of Pharmacy and Pharmacology. 1963;15:798–803.
P. Saravanan, G. Chandramohan, J. Maria Jancy Rani, P. Shanmuga Sundaram
Natural dyes can be anything that comes from natural sources such as barks, flowers, leaves, roots, insects, shells, and mineral substances. They are used for food coloring, painting and textile dyeing. Using natural dyes in textile processing have been shown a greater interest because they are more eco-friendly than synthetic dye and show a variety of colors from one natural dye depending on dyeing process and types of mordants. In present study, the cotton fabric was treated with chitosan at different concentrations to finda suitable concentration on dye ability with natural dye from barks of Ficus Religiosa Linn. The influence of dyeing methods with mordants, i.e. pre-mordanting, post-mordanting and simultaneous mordanting was determined. The light and wash fastness of chitosan treated samples were measured compared with untreated samples. Chitosan-treated cotton fabric improved both dyeability and fastness compared with untreated cotton fabric. The cotton fabrics treated with chitosan not only provided better depth of shade but also provided better wash fastness and light fastness than those of the untreated fabrics. The use of different mordants and mordanting methods affected the dye shade and depth of shade differently on the dyed fabrics both with and without chitosan. The range of colour developed on dyed materials were evaluated in terms of (L*a*b*) CIELAB coordinates and the dye absorption on the cotton was studied by using K/S values.
1. Zin Mar Win and Moe MoeSwe, World Academy of Science, Engineering and Technology, 2008;pp 536-540 2. Gupta, V.K. Sachan, R.A., Singh V.P. and Shasma, S.K., Indian Textile Journal,1998; PP. 16-18 3. Kumar V. and Bharti, B.V. , Indian Textile Journal, 1998; PP. 18-20 4. . M Alam, M. L. Rahman and M. Z. Haque, Bangladesh J. Sci. Ind. Res. 2007; 42(2), 217-222, 5. Mathur NK, Narang CK., J. Chem. Educ., 1990; 67, 938–42 6. Pradip Kumar Dutta, Joydeep Dutta and V S Tripathi, J. Sc. Ind. Res.,2004; 63, 20-31 7. Md. MonarulIslama,, Shah Md. Masumb, M. Mahbubur Rahmana, Md. Ashraful Islam Mollab, A. A. Shaikhc and S.K. Roya, International Journal of Basic & Applied Sciences,2011; 11 No: 01 8. Gu R., Sun W., Zhou H., Wu Z., Meng Z., Zhu X., Tang Q., Dong J. and Dou Q., Biomaterials,2010; 31(6): 1270-1277 9. Prasad, P.V., Subhaktha, P.K., Narayana, A. and Rao, M.M., Bull. Indian Inst. Hist. Med., Hyderabad, 2006; 36, 1-20 10. Makhija, Sharma, Khamar, Scholars Research Library Annals of Biological Research, 2010; Vol.1, Iss 4, pp 171-180 11. Piyaporn Kampeerapappun, Trongsu Phattararittigul, Sutida Jittrong and Dararat Kullachod, Chiang Mai J. Sci.,2010; 38(1), 95-104 12. P. Saravanan, G. Chandramohan and S. Saivaraj, Asian Journal of Research in Chemistry, 2012;5(3) 13. Shanker R. and Vankar P. S, Dyes and Pigments, 2007; Vol. 74, No.2, pp. 464-469 14. S. Habibzadeh, H. Tayebi, E. Ekrami, A. Shams Nateri, M. Allahinia and M. Bahmani, World Journal of Applied sciences,2010; Vol 9(3), pp 295-299 15. Rakhi Shanker and Padma S Vangar, Dyes and Pigments,2006; pp-1-6.
Pramod V. Bhale, Medha Kulkarni, Radhika Ruhatiya, Selva Kumaran
Hypertrophic Cardiomyopathy is most common genetic cardiovascular disease with a prevalence of 1:500 and is transmitted as autosomal dominant condition with variable penetrance (1, 2). It can affect patients of all ages. The disease is characterised by LV hypertrophy most commonly septal and anterolateral free wall hypertrophy. Surgery poses a very high risk for these patients because of several complications (1, 2) that can occur in the perioperative and post operative period. We present a case of 67yr old male a diagnosed case of HOCM posted for #Rt. IT Femur(DHS plating) under Epidural anaesthesia.
1. Maron BJ. Hypertrophic cardiomyopathy. Circulation 2002;106:2419. 2. Poliac LC, Barron ME, Maron BJ. Hypertrophic cardiomyopathy. Anesthesiology 2006; 104:183‑92. 3. Sunny Rupal, Adarsh C Swami, Swati Jindal, Sneh Lata. Perioperative management of an elderly patient of hypertrophic obstructive cardiomyopathy for knee arthroplasty and the role of peripheral nerve blocks. Indian Journal of Anaesthesia | Vol. 57 | Issue 4 | Jul-Aug 2013 ; 394-396. 4. Autore A, Brauneis S, Apponi F, Commisso C, Pinto G, Fedele F. Epidural anesthesia for cesarean section in patients with Hypertrophic Cardiomyopathy: a report of three cases. Anesthesiology 1999; 90: 1205–7. 5. Renato Mestriner Stocche, Luis Vicente Garcia, Jyrson Guilherme Klamt, Anesthesia for Cesarean Section in a Patient with Familiar Hypertrophic Cardiomyopathy. Case Report. Rev Bras Anestesiol 2007; 57: 6: 665-671 6. P. Chavda, H.Gadani, R.K. Choudhary. Case report – Anaesthetic management of a case of Iatrogenically complicated thyroid disorder with HOCM under Cervical epidural. 7. Michael J Tessler, Robert Hudson, Marry Anne Naugler – Colville, Diane R Biehl. Clinical reports – Pulmonary oedema in two parturients with HOCM. Canadian journal of Anaesthesia 1990/ 37:4/ pp :469-73. 8. Jackson JM, Thomas SJ — Valvular Heart Disease, em: Kaplan JA — Cardiac Anesthesia. 3a Ed, Philadelphia, WB Saunders, 1993;644–650.
Dhananjay Vasantrao Bhale
Prostate specific antigen (PSA), neutral serine protease secreted exclusively by prostatic epithelial cells, has a number of applications in the management of men with prostatic carcinoma. While it is widely recognized that elevated PSA correlates with the presence of carcinoma, little data exist regarding the use of PSA as the initial test in the early detection of prostatic cancer Prostate-specific antigen (PSA) is a protein produced by the prostate and this protein may be elevated for several reasons, including prostatitis, benign prostatic hypertrophy and cancer. The value of the PSA test varies when used for screening, diagnosis, prognosis and as indicator of recurrence of prostate cancer. AIMS and Objectives: To study levels of Serum PSA in patients of Benign prostatic hypertrophy and prostatic carcinoma and comparing them with normal healthy individuals above 55 years of age. Material and Methods: The study was performed on 100 consecutive male patients (mean age 68 ± 10.8 years SD) comprising of 80 patients with benign disease (80%) and 20 prostate carcinoma patients (20%), who had histologically proven prostate cancer. Patients with total PSA between 2-25 ng/ml were included in the study. 30 normal healthy males with age 55 ± 10 years, served as control. Serum total PSA were analyzed using CLIA method.The mean total PSA in normal healthy control subjects was 1.72 ± 1.06 ng/ml. It was increased significantly in diseased condition. Its mean concentration in carcinoma patients was 12.6 ± 5.3 ng/ml and in benign patients it was 6.3 ± 4.6 ng/ml. Conclusions: Markedly increased PSA levels in serum suggests a cancer. This information may aid patients and clinicians in management of prostate cancer, such as selecting patients for watchful waiting. However, more research is needed to determine the performance characteristics of PSA in clinical practice. It is recommended that the use of PSA and Digital Rectal Examination in combination is important as a diagnostic procedure for the early detection of prostate cancer.
1. Fournier G, Valeri A, Mangin P, Cussenot O., Prostate cancer: Diagnosis and staging. Prostate Cancer Prostatic Dis. 2006;9(1):6-13. 2. Brawer MK, Chetner MP, Beatie J, Buchner DM, Vessella RL, Lange PH., Screening for prostatic carcinoma with prostate specific antigen. [J Urol. 1992] Screening for prostatic carcinoma with prostate specific antigen. 3. Hammerer P, Huland H. Urologe A., Value of determining prostate-specific antigen for early detection or prostatic carcinoma. 1995 Jul;34(4):283-9. 4. Hammerer P, Huland H., Status of PSA determination for early detection of prostate carcinoma S Afr Med J. 2001 Aug;91(8):679-84. 5. Candas B, Cusan L, Gomez JL, Diamond P, Suburu RE, Lévesque J, Brousseau G, Bélanger A, Labrie F., Evaluation of prostatic specific antigen and digital rectal examination as screening tests for prostate cancer. PMID: Ann Urol (Paris). 2004 Oct;38(5):207-24. 6. Lee CT, Oesterling JE, Diagnostic markers of prostate cancer: utility of prostate-specific antigen in diagnosis and staging. Semin Surg Oncol. 1995 Jan-Feb;11(1):23-35. S Afr Med J. 2001 Aug;91(8):679-84. 7. Heyns CF, Naudé AM, Visser AJ, Marais DC, Stopforth HB, Nyarko JK, Stellmacher GA, Early diagnosis of prostate cancer in the Western Cape. Pathologe. 2005 Nov;26(6):469-72. 8. Significance of the PSA-concentration for the detection of prostate cancer. 9. Changgeng Yi Xue Za Zhi., Diagnosis of prostate cancer: comparison of serum prostate specific antigen, digital rectal examination and transrectal ultrasonography. 1997 Mar;20(1):23-8. 10. Saito Y. Nihon Rinsho. The usefulness of prostate-specific antigen assay for the early detection and follow up of the prostate cancer, 1998 Aug;56(8):1989-93.
Dhananjay V. Bhale
Background: Diabetes has emerged as a major public health problem in our country Insulin has important effects on key steps in metabolism of lipids and lipoproteins and altered lipid metabolism is common in diabetic population. As far as diabetes in India is concerned, the vast majority are found to be nonobese. More peculiarly prevalence is rising in lean and underweight persons. Very little data is available on Nonobese type 2 diabetes and especially on those who have low body weight BMI< 18.5 Kg/m2. Materials and Methods: Present study was carried out in MGM Medical College, Aurangabad. Total 90 known cases of type 2 diabetes mellitus were taken from OPD, Medicine wards of above institute and were divided into three groups as follows: Lean (B.M.I.< 18.5) Nonobese (B.M.I.= 18.5-25) and obese( B.M.I.>25). B.M.I.(Body mass index): Weight in kg/height in m2. Following biochemical parameters were done 1. Fasting and Postprandial Blood glucose measured by glucose oxidase method on RA 1000 fully automated Biochemistry Analyser 2. Glycosylated Hemoglobin was estimated by Flukinger and Winterbalter’s colorimetric method. Conclusion: The increase in glycosylated haemoglobin in lean i.e. Group I diabetics as compared to nonobese and obese is statistically significant (P<0.05). This shows that low body weight type 2 diabetics had a poor glycemic control as compared to nonobese and obese type 2 diabetics.
1. Baliarishna AK, Das S.Experience from cuttack. Low Body weight Type 2 D.M.1999:5-16 2. Banergee Samar, Uttam k. Paul. Experience from Colkata. Low Body weight Type 2 D.M.1999:17-24. 3. Das S, Kamal KC, Tripathi BB. Metabolic and hormonal status in underweight (lean)NIDDM.Diabetes1991;40(Suppl I):34A. 4. Das S, Kamal KC, Baliarishna AK. Tripathi BB, Lean NIDDM-Pecularities and differences in metabolic and hormonal status-A pilot study.JAPI 1995;43(5):339-42. 5. Das S. Introduction to Low body weight type 2 Diabetes mellitus,1999:1-4. 6. Das S, Tripathi BB , Kamal KC.Factors influencing plasma lipids and lipoprotein cholesterol in Indian NIDDM Journal of diabetes Asso of India 1992;32(2):27-34. 7. Diabetes epidemiology as a tool to trigger diabetes research and care.Diabetologia 1999;42:499-518. 8. Kenneth H, Gabby H, Fluckinger R et al. Glycosylated hemoglobin, increased glycosylastion of hemoglobin A in diabetic patients. Diabetes 1979;28:337-40. 9. Nigam Anant. Experience from Jaipur Low body weight type 2 Diabetes mellitus, 1999:25-31. 10. Sahay BK. Experience from Hyderabad. Low body weight type 2 Diabetes mellitus, 1999:25-31. 11. Tripathi BB, Kar BC. Observations and clinical patterns of diabetes mellitus in India. Diabetes 1965;14:404-12. 12. Patnaik Alok, Das S., Patnaik B.K..Hepatic glucose handling and glucokinase. Low body weight type 2 Diabetes mellitus,1999:48-53
G. K. Frimpong, V. Appiah, J. Nketsia-Tabiri, W.Torgby-Tetteh
Consumption of fresh and fresh-cut fruits and vegetables has increased every year in the past decade because of their convenience and nutritional benefits. Unfortunately, the increasing consumption of fresh produce has been accompanied by an increase in the number of outbreaks and recalls due to contamination with human pathogens. Irradiation of this kind of ready-to-eat product is a feasible alternative treatment to be considered in order to improve the microbiological quality and to extend the shelf life. The objective of this study was to explore the effect of medium-dose gamma irradiation on the microbial quality of cut-cabbage. Cut-cabbage was irradiated and its microbial quality determined. The initial total viable count (TVC) for unirradiated or control cut cabbage samples was 9.11 log10 cfu/g and that of irradiated samples (1-3kGy) at 0 day ranged from 7.39 to 8.95 log10 cfu/g. However, total coliform count for cut-cabbage irradiated at 2kGy was not significantly different from the rest of irradiated samples. The effective irradiation dose of 2kGy was able to reduce the bioburden of by up to 4 log cycles in fresh pre-cut cabbage.
1. Bender D. A. and Bender A.E. (2005). A Dictionary of Food and Nutrition. New York: Oxford University Press.607 ISBN 0198609612. 2. Diehl, J.F. (1995) Safety of Irradiated Foods, Second Edition, Marcel Dekker, Inc., New York. pp 160-165. 3. Dris, R. and Jain, S.M. (2004). Production Practices and Quality Assessment of Food Crops Volume 4: Postharvest Treatment and Technology.12: 289-301. 4. Hawke R. and Edmonds C. (2004). Microbiological and metal contamination of watercress in the Wellington region, New Zealand – 2000 survey. Australian and New Zealand Journal of Public Health, 28(1): 20–26. 5. Fan X. Niemira A. B. and Prakash A. (2008). Irradiation of Fresh Fruits and Vegetables. Food Technology Journal 03.08 pp 37. 6. Farkas J. (1997) Effects of low-dose gamma radiation on shelf-life and microbiological safety of pre-cut/prepared vegetables, Adv. Food Sci. (CMTL) 19(3/4) 111-119. 7. Ghana Standard Board (GSB) 2009 legislations for food. Microbiological quality of fruits and vegetables. (GS 995: 2009). 8. López V.,Avendaño V., Romero R., Garrido S, Espinoza J. and Vargas M., (2008) Effect of gamma irradiation on the microbiological quality of minimally processed vegetables. WHO/FAO Coordinated Research Program. L.pp5. 9. Mukherjee, A., Speh, D., Dyck, E. & Diez-Gonzalez, F. (2004). Pre-harvest evaluation of coliforms, Escherichia coli, Salmonella, and Escherichia coli O157:H7 in organic and conventional produce grown by Minnesota farmers. Journal of Food Protection, 67(5): 894–900. 10. Narvaiz P, Giménez P., Horak C, AdeilPietranera M, Kairiyama E,Gronostajski D, A.M. Ribetto A.M (2001). Feasibility of obtaining safe, shelf-stable, nutritive and more varied whole rations for immuno-suppressed patients by gamma irradiation. Journal of Food Science 83: 790-800 11. Nguyen – The C, Carlin F. 1994. The microbiology of minimally processed fresh fruit and vegetables. Crit Rev food Sci Nutr 34(4): 371 – 401. 12. Prakash A., Inthajak P., Huibregtse F., Caporaso F. and Foley D.M. (2000) Effects of low-dose gamma irradiation and conventional treatments on shelf life and quality characteristics of diced celery. J Food Sci 65 (6):1070-1075. 13. Sanusi, R. A., Ogunro Y.and Nwozoh S. (2008) Effect of Storage Time on Ascorbic Acid Content of Some Selected “Made in Nigeria” Fruit Preserves Pakistan Journal of Nutrition 7 (6): 730-732. 14. Solomon, E.B., S. Yaron and K.R. Mathews (2002). Transmission of Escherichia coli 0157: H7 from contaminated manure and irrigation water to lettuce plant tissue and its subsequent internalization. Applied Environ. Microbiol.,68: 397-400. 15. Mead P.S, Slutsker L, Dietz V, McCaig L. F, Bresee J. S, Shapiro C, Griffin M.P, and R. V. Tauxe (1999). Food-related Illness and Death in the United States. Centers for Disease control and Prevention, Atlanta, Georgia. Emerg Infect Dis 5:607 -25. Synopses Volume 5, p.5.
Pramod Bhale, Narender Bhandari, Selva Kumaran P., Rashmee Joshi
Background: In the present day practice, muscle relaxation is used for facilitation of endotracheal intubation and to provide muscle relaxation throughout the surgery. Rocuronium bromide is a nondepolarizing aminosteroidal, vecuronium derivative drug with intermediate duration Side effects of suxamethonium are not observed with rocuronium bromide. Present study is aimed at determining the efficacy of rocuronium for routine endotracheal intubation within 60 seconds in general population. Objective: To compare the intubating conditions of rocuronium bromide with suxamethonium chloride. Methods: Patients were premedicated with inj. midazolam 0.05mg kg-1, inj. Pentazocine 0.5mg kg-1 and inj. glycopyrolate 0.005 mg kg-1, after which patients were preoxygenated for 03min with 100% oxygen. Induction was done with inj.thiopentone at the dose of 5mg kg-1. After loss of eye lash reflexes, muscle relaxant (rocuronium bromide/ suxamethonium chloride) was given as iv bolus. Intubating conditions were assesed at 60 seconds after injection of muscle relaxant, if intubating conditions were unsatisfactory, then repeat scopy was attempted after every 30sec interval (90, 120, 150 and 180 sec). Bag mask ventilation with 100% oxygen was continued till the repeat scopy was attempted. Monitoring of pulse rate, oxygen saturation, systolic and diastolic blood pressures, electrocardiogram were recorded immediately after laryngoscopy, at 5 and 10min after intubation. Results: Suxamethonium showed acceptable intubating conditions in 100% of cases at 60 Sec. out of which 93.24% were excellent. In rocuronium Group 100% of cases had acceptable intubating conditions at 60 sec. out of which 77.7% excellent and 22.2% good intubating conditions were observed. Conclusion: Rocuronium bromide at 0.9 mg kg-1 is a safe and good alternative for suxamethonium 1.5mg kg-1 for endotracheal intubation at 60 seconds. We advice rocuronium bromide 0.9 mg kg can be used for Rapid Sequence induction and Intubation, if there is no prediction of difficult intubation.
1. Mohamed Nagib, Cynthia A.Lien,chapter 29, Pharmocology of muscle relaxants and their agonists,Miller’sanaesthesia,7th edition,Vol.1;p. 859-894. 2. Dr.mishra M.N, Dr.Agarwal.M, Dr.Pandey R.P, Dr.gupta.A, A comparative study of rocuronium, vecuronium and succinylcholine for rapid sequence induction of anaesthesia, Indian j.Anaesth.2005 dec;49(6): P.469-473. 3. Dr.Aparnashukla, Dr.K.PDubay, Dr.M.S.N.Sharma. Comparative evaluation of heamodynamic effects and intubating conditions after the administration of ORG 9426 and succinylcholine. Indian j.Anaesth.2004;48(6): P.476-479. 4. Robert k. Stoelting,MD ,Simon C. Hillier, MB, Ch.B., FRCA. Pharmacology and physiology in Anaesthetic practice, Stoelting 4th ed,2006; P.228-241. 5. Kanveer K Bhati , VandanaParmar S. Comparative study of intubating conditions after Rocuronium and suxamethonium,The internet j Anaesth. 2009; 20( 1):P.1-14. 6. Jamshid Ali, Showkat Ahmad Gurckoo, AsafShora, ShaguftaQazi. Intubating conditions of Rocuronium Bromide and Succinylcholine During Rapid Sequence Induction of Anaesthesia in Unpremedicated Adult Patients. J AnaesthClinPharmocol 2008;24(3):P.337-42. 7. Shizan Hamid Feroz, Faisal Wahid, Waqas Ahmed Kazi, FahimAkhtar, BurianEldin Al Masalmah. Comparitive study of intubating conditions after rocuronium and suxamethonium.Pakistan armed forces medical Journal. 2011 Mar;1 8. R.K.Verma, R. Goordayal, S. Jaiswal, G. Sinha. Acomparative study of the intubating conditions and cardiovascular effects following succinylcholine and rocuronium in adult elective surgical patients. The internet J Anaesth.2007;14(1).DOI:10.5580/1030 9. M.Rose, M.Fisher. Rocuronium:high risk for anaphylaxix?.Br J Anaesth 2001;86(5):P.678-82. 10. AditiPonkshe, Anil Dhole, Vinaya R, Kulkarni, M.A. Jamkar, Salunke. Comparison of rocuronium with vecuronium for intubation in Cervical Spine Surgery under General Anaesthesia. J AnaesthclinPharmacol 2010; 26(1):P.23-26. 11. R.Scott: Lee’s Synopsis of Anaesthesia.13thEdition,section 2.5;2010: P175-196.
B. Darfour, S. Annan, E. A. Ayeh
Abstract: Retrogradation of starch occurs when the amylose in starch-containing products returns to a less soluble, crystalline state over time. Irradiation has been shown to be a useful method for producing modified starch since it generates free radicals that can alter the structure of starch molecules. The aim of this work was to enhanced cereal flour composite using gamma irradiation to be used as breakfast meal. Cereal flour composites were prepared from three local cereals wheat, sorghum and rice in a certain ratio and gamma irradiated for subsequent analysis. Pasting properties and moisture were analyzed. The irradiated flour composite showed decreases in maximum viscosity temperature, maximum viscosity, cooling and final holding viscosities, setback viscosity, breakdown viscosity and retrogradation. The irradiation and the composite ratio had significant effect on all the pasting parameters studied except the beginning gelatinization torque. Cereal breakfast meal could be preferably prepared from irradiated wheat, sorghum and rice flours in the ratios of 25 % wheat: 25 % sorghum: 50 % rice or 100 % each of wheat, sorghum and rice or 25 % wheat: 50 % sorghum: 25 % rice.
1. Adebowale KO, Olu-Owolabi BI, Olawumi Ek, Lawal OS. Functional properties of native, physically and chemically modified breadfruit (Artocarpusartillis) starch. Industrial Crops and Products 2005; 21, 343-351. 2. A/Azim AMN, Shireen EAH, Gammaa AMO. Effect of Gamma Irradiation on the Physico-chemical Characteristics of Groundnut (Arachis hypogaea). Aust. J. Basic and Appl. Sci. 2009; 3, 2856-2860. 3. Ayernor GS. The Yam (Dioscorea) Starches. In: Advances in Yam research. 1st Ed. Godson Osuji. Anambra State University of Technology Publishers. Nigeria. 1985; pp.79-88. 4. Barimah J, Amankwah EA, Oldham JH, Pecku S. Effect of acetylation and varietal differences on the pasting properties of some corn starches. Journal of Ghana Science Association. 2009; 11, 106-107. 5. Cuevas R, Figueira E, Racca E. The technology for industrial production of precooked corn flour in Venezuela. Cereal Foods World. 1985; 30, 707-712. 6. Darfour B, Wilson DD, Ofosu DO, Ocloo FCK. Physical, proximate, functional and pasting properties of flour produced from gamma irradiated cowpea (Vigna unguiculata, L. Walp). Radiation Physics and Chemistry. 2012; 81, 450–457. 7. Eliasson AC. Differential scanning calorimetry studies on wheat starchgluten mixtures. Effect of gluten on the gelatinization of wheat starch. Journal of Cereal Science. 1983; 1, 199-205. 8. Longton J, LeGrys GA. Differential scanning calorimetry studies on the crystallinity of ageing wheat starch gels. Starch/Sta¨rke. 1981; 33, 410–414. 9. MacArthur LA, D‟Appolonia BL. Gamma radiation of wheat. II. Effects of low dosage irradiation on starch properties. Cereal Chemistry. 1984; 61, 321-326. 10. Marathe SA, Machaiah JP, Rao BYK, Pednekar MD, Rao VS. Extension of shelf-life of whole-wheat flour by gamma radiation. International Journal of Food Science & Technology. 2002; 37, 163-168. 11. Mohd AN, Mat HD, Muhammad K, Rahman AR, Ghazali Z, Hashim K. Pasting and leaching properties of irradiated starches from various botanical sources. International Food Research Journal. 2009; 16, 415-429. 12. Nelles EM, Dewar J, Bason ML, Taylor JRN. Maize Starch Biphasic Pasting Curves. Journal of Cereal Science. 2000; 31, 287-294. 13. Nunoo AP. Pasting of G-irradiated proteins from Vigna subterranea in native starch models and the surface functional properties of the proteins. MSc. Thesis. Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. (2009). 14. Nakazawa F, Noguchi S, Takahashi J, Takada M. Retrogradation of gelatinized potato starch studied by differential scanning calorimetry. Agricultural and Biological Chemistry. 1985; 49, 953-957. 15. Pomeranz Y. Functional properties of food components. 2nd edition, Academic Press. Inc. New York. 1991; pp. 24-78. 16. Rao VS, Vakil UK, Sreenivasan A. Studies on rheological and baking properties of irradiated Indian wheat. Acta Alimentaria. 1978; 7, 91-101. 17. Rao VS, Vakil UK. Effects of gamma-irradiation on cooking quality and sensory attributes of four legumes. J. Food Sci. 1985; 50, 372-375. 18. Sanni LO, Ikuomola DP, Sanni SA. Effect of length of fermentation and varieties on the qualities of sweet potato gari. Proc. 8th triennial Symposium of the International Society for Tropical Root Crops – Africa Branch (ISTRC-AB), Ed. M.O. Akoroda, IITA, Ibadan., Nigeria, 12-16 November. 2001; pp 208-211. 19. Shelton DR, Lee WJ. Cereal Carbohydrate.In: Handbook of Cereal Science and technology.2nd edition, revised and expanded. Edited by Kulp, K. and Ponte, J.G. Mercel Dekker, Inc.USA: 2000; pp. 385-415. 20. Sokhey AS, Hanna MA. Properties of irradiated starches. Food Str. 1993; 12, 397-410. 21. Tomasik P, Zaranyika MF. Nonconventional methods of modification of starch. Adv. Carbohydr. Chem. Biochem. 1995; 51, 243–320. 22. Urbain W. Radiation chemistry of food components. In: W. Urbain, Food Irradiation (1986); pp. 38-41. London: Academic Press, Inc. 23. Zobel HF. Gelatinization of starch and mechanical properties of starch pastes. Whistler, R.L., Bemiller, J.N. and Paschall, E.F. (Ed.) In: Starch Chemistry and Technology. Academic Press, New York. 1984; pp. 300-302.
Dhananjay Vasantrao Bhale, Pramod Vasantrao Bhale, Shubhangi Arun Mande, Sanjay Guddetwar
Abstract: Anemia in pregnancy is a global problem and is associated with increased maternal morbidity and mortality (WHO, 1992). Iron deficiency anemia is defined as anemia accompanied by depleted iron stores and signs of a compromised supply of iron to the tissues. The objectives of this study were to determine the serum ferritin in anemic pregnant women and to compare them to that of normal healthy non-pregnant women. Materials and Methods: Present Cross sectional study was carried out in the Department of Biochemistry MGM Medical College, Aurangabad during March 2011 to March 2013. A total of 50 pregnant women of 15-35 yrs age with hemoglobin level < 10.5 g% were compared with 50 non-pregnant healthy women. Serum ferritin levels were done by Chemiluminescence assay (Immulite 1000).Mean and standard deviation were calculated for Hb%, Serum Ferritin. Statistical analysis was done using SPSS. In the present study mean hemoglobin level and serum ferritin level was low in test group as compared to control group. Low level of hemoglobin and serum ferritin was noted in 2nd trimester as compared to 1st and 3rd trimester of pregnancy which was statistically significant.
1. World Health Organization. The prevalence of anaemia in women: a tabulation of available information. W. H. O., Geneva, 1992 2. Gambling L, Andersen HS, McArdle HJ. Iron and copper, and their interactions during development. Biochemical Society Transactions 2008;36:1258-61. 3. Seshadri S. Nutritional anaemia in South Asia. In Malnutrition in South Asia- A regional Profile, 1997 pg 75-124. 4. Agarwal KN. Indicators for assessment of anemia and iron deficiency in the community. Health Care & Research Association for adolescents. Available on [email protected]. 5. World Health Organization, Iron Deficiency Anemia Assessment Prevention and Control: A Guide for Program Managers, World Health Organization, Geneva, Switzerland, 2001. 6. L. Reveiz, G. M. Gyte, and L. G. Cuervo, “Treatments for iron-deficiency anaemia in pregnancy,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD003094, 2007. View at Scopus 7. World Health Organization, The Prevalence of Anaemia in Women: A Tabulation of Available Information (WHO/MCH/MSM/92), WHO, Maternal Health and Safe Motherhood Programme, Division of Family Health, Geneva, Switzerland, 1992. 8. World Health Organization. Prevention and management of severe anemia in pregnancy. Report of a Technical Working Group, Geneva, 20–22 May 1991. Maternal Health and Safe Motherhood Programme, Geneva: WHO; 1993. 9. J, Janne O, Vihko R. Serum ferritin in the diagnosis of anemia during pregnancy. Acta Obstet Gynecol Scand 1980;95(suppl):57–63. 10. Van den Broek NR, Letsky EA. Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr 2000;72:247S–56S. 11. Letsky EA Blood Volume, Haematinics, Anaemia. In: deSwietM, editor. Medical Disorders in Obstetric Practice. Oxford : Blackwell Science, 1995: 33–70. 12. Van den Broek NR, Letsky EA. Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr2000;72:247S– 13. Wells MS, Awad WM. Iron and heme metabolism. In: Textbook of biochemistry with clinical correlations (ed. by TM Devlin), 1986; pp. 855-874. A Wily Medical, USA. 14. Chancy SG. Principles of nutrition: Micronutrients. In: Textbook of biochemistry with clinical correlations (ed. by TM Devlin), 1986; pp. 961-992. A Wily Medical, USA. 15. Barnes CG, Medical Disorders in pregnancy. 1978 (4) 184-87 16. Firkin F, Chesterman C, Penington D, Rush B. Clinical Hematology in medical practice. 1997 ( 5th Edition 17. Nutritional in pregnancy and lactation – Report of a WHO Expert Committee1965). Wild Hlth Org Techn Rep Ser 1965;302:5–30 18. Van den Broek NR, Letsky EA. Etiology of anemia in pregnancy in south Malawi. Am J Clin Nutr 2000;72:247S–56S. 19. Raza N, Sarwar I, Munazza B, Ayub M, Suleman M. Assessment of iron deficiency in pregnant women By determining iron status. J Ayub Med Coll Abbottabad 2011;23(2). Available on 20. Frenkel EP, Yardley DA. Clinical and laboratory features and sequelae of deficiency of folic acid (folate) and vitamin B12 (cobalamin) in pregnancy and gynecology. Hematol Oncol Clin North Am 2000;14(5):1079–100, viii.
R. Vijayalakshmi, R. Venkatachalam, T. Periyathambi, P. Saravanan
Abstract: Morinda tinctoria seed used for the removal of reactive red 198 from an Aqueous solution was studied by batch biosorption system process The equilibrium dye uptake capacity of Morinda tinctoria was determined with the influence of various environmental parameters such as sorbent dosage (0.02–0.1 g 100mL-1), initial pH (1–6), and initial dye concentration (10-50 mg L-1). Batch experiments were carried out for biosorption kinetics and isotherm studies. The results showed that dye uptake capacity was found to increase with decreases in biosorbent dosage. Equilibrium uptake capacity was found to be more at pH2, when compared with all other pH values studied. The equilibrium data was analyzed with the use of Freundlich and Langmuir adsorption isotherm models. The equilibrium data was found to be fitted very well with the Freundlich isotherm model when compared with the Langmuir isotherm model. Adsorption kinetics data modeled with the application of pseudo-first order and pseudo-second order models revealed that the pseudo-second order model was the best fitting model. The biosorbent characteristics were observed by SEM and FTIR analysis.
1. Ong S.T, Lee C.K. and Zainal Z, Removal of basic and reactive dyes using ethylene diamine modified rice hull, Bioresource Technol.,2007; 98(15),2792-2799. 2. Churchley, J.H., Removal of dye waste color from the sewageeffluent – the use of a full scale ozone plant. Water Sci. Technol.1994; 30,176–182. 3. Demirbas A, Agricultural based activated carbons for the removal of dyes from aqueous solutions: a review, J. Hazard. Mater.,2009; 167(1-3), 1-9. 4. G. McKay, J.F. Porter, G.R. Prasad, Water Air Soil Pollut., 114, 423–438. 5. Z. Aksu, S. Tezer,(2005), Process Biochem.,1999; 40, 1347–1361. 6. G. Crini, (2006), Bioresour. Technol., 97, 1061–1085. 7. A.K. Nadkarni ,(1998), Indian MatriaMedica. Bombay: Popular Prakashan, 138 8. Renganathan, S., J. Kalpana, M. Dharmendirakumar, and M. Velan,, ‘‘Equilibrium and Kinetic Studies on the Removal of Reactive Red 2 Dye from Aqueous Solution Using Positively Charged Functional Group of Nymphaearubra Biosorbent,’’ Clean-Soil AirWater, 2009; 37, 901 9. N.Parveena, Asia-pac.J.chem.Eng.,20127;761-768. 10. N.Naveen,journal of the Taivaninstitute of chemical engineer, 2011;42, 463-469. 11. E. Elisa, P.C. Vandeerlei, D. Nelson,Biotechnol. Lett.,1991;13, 571–576. 12. I.M. Banat, P. Nigam, R. Marchant, Bioresour. Technol., 1992; 58, 217–227 13. J.H. Lora, W.G. Glasser, J. Polymer and Enivironmental, 2000; 10, 39–48 14. Z. Aksu, S. Tezer, Process Biochem.,2000; 36, 431–439 15. O. Mahony, T.E. Guibal, J.M. Tobin., Enzym. Microb. Tech., 2002; 31, 456–46). 16. L.Khezami,R.Capart,J.HAZARD.MATER.,2005; B123, 223-24 17. Y.S. Ho, G. Mc Kay, Conserv. Recyc., 1999; 25, 171–193 18. A. Acharya, K.K. Sahu, J. Hazard. Mater., 2006; B137,915–924). 19. Lee, C. K., K. S. Low, and P. Y. Gan, ‘‘Removal of some Organic Dyes by Acid-Treated Spent Bleaching Earth,’’ Process Biochem.,1999; 34, 451 20. K.S. Low, C.K. Lee, K.K. Tan, Bioresour. Technol., 1995; 52, 79–83. 21. Lagergren.,S., ”About the theory of so-called Adsorption of soluble substance,”KungSven.Veten.Hand.,1898; 24,1 22. R.Naveen Prasad, S. Viswanathan, J. Renuka Devi, J. Rajkumar, N. Parthasarathy, Amer.-Eurasian J. Sci. Res., 2008; 3(2), 123–127 23. K. Chowdhury, A.D. Sarkar, A. Bandyopadhyay, Clean: Soil, Air, Water, 2009; 37, 581–591.
Arun M., Reddy A., Kagne R. N., Sowmya S., Balaraman R
Abstract: Multicentric hepatocellular carcinoma is relatively a rare malignant condition usually presenting without symptoms. It is commonly seen in hepatitic or cirrhotic liver as an incidental finding at autopsy. In non hepatitic liver multicentricity is associated with secondary metastasis rather than primary hepatocellular carcinoma. Medicolegal autopsy was conducted on a 56 year old male who died due to septicemic complications of burns. On gross examination of the liver secondary metastasis was suspected because of the presence of multiple nodules seen on the surface of both the lobes. After histopathological examination of the lesion the diagnosis of primary multicentric hepatocellular carcinoma was established. Thus a case of multicentric hepatocellular carcinoma was detected as an incidental finding on medicolegal autopsy.
1. Li S-L, Su M, Peng T, Xiao K-Y, Shang L-M, Xu B-H, et al. Clinicopathologic characteristics and prognoses for multicentric occurrence and intrahepatic metastasis in synchronous multinodular hepatocellular carcinoma patients. Asian Pac J Cancer Prev APJCP. 2013;14(1):217–23. 2. World digestive health day- Special 2013 WDHD publication. [Internet]. World Gastroenterology Organisation; 2013. Available from: http://www.wgofoundation.org/assets/export/userfiles/wdhd13-supplement-FINAL.pdf 3. Farazi PA, DePinho RA. Hepatocellular carcinoma pathogenesis from genes to environment. Nat Rev Cancer 2006;6:674–87. 4. Rosai J, Ackerman. Surgical Pathology. 10th ed. Newyork: Elsevier Inc; 2012. 946. 5. Mohan H. Textbook of pathology. 6th ed. New Delhi: Jaypee brothers medical publications (p) Ltd; 2010. 633-4. 6. Nomoto S, Kinoshita T, Kato K, Otani S, Kasuya H, Takeda S, Kanazumi N, Sugimoto Z, Nakao A. Hypermethylation of multiple genes as clonal markers in multicentric HCC. British Journal of Cancer 2007;97:1260-5. 7. Ibrahim AS, Zaghloul H, Badria FA. Case Report Evidence of Relationships between HCC and Ochratoxicosis. PloS One. 2013;8(8):1-8. 8. Kubo S, Nishiguchi S, Hirohashi K, Shuto T, Kuroki T, Minamitani S, et al. Clinicopathological criteria for multicentricity of hepatocellular carcinoma and risk factors for such carcinogenesis. Japan J Cancer Res Gann. 1998 Apr;89(4):419-26. 9. Feitelson MA, Sun B, Satiroglu Tufan NL, Liu J, Pan J, Lian Z. Genetic mechanisms of hepatocarcinogenesis. Oncogene 2002;21:2593-604. 10. Parikh CK. Parikh’s textbook of medical jurisprudence, Forensic medicine and toxicology. 6th ed. New Delhi: CBS publishers and distributors; 2005. 4.89-90.
Bashir Khan, Bipin Khade, Gajanan Patil
Abstract: Present study is a case observed in the department of anatomy at Shri Bhausaheb Hire Government Medical College, Dhule. During routine cadaveric dissection of first M,B.B.S students in department of anatomy, a case of unilateral ectopic kidney with non rotation and vascular anomaly was found in an adult male cadaver. An accessory artery to inferior pole may obstruct the ureter leading to hydronephrosis. During operative procedures, a surgeon should be careful about accessory renal arteries because these are end arteries, consequently, if an accessory artery is damaged or ligated, the part of kidney supplied by it will become ischemic.
1. Hamilton WJ and Mossman HW, Hamilton, Boyd and Mossman’s Human embryology, 4th ed. London, The Macmillan Press Ltd.,1976, Urogenital system; 391-2 2. Moore KL and Persaud TVN, The Developing Human, Clinically Oriented Embyology, 8th ed. (south asia), Saunders Elsevier Publisher;249-54 3. Sadler TW. Langman’s medical embryology. In: Urogenital system. 10th ed; Philadelphia Lippincott Williams & Wilkins 2006; 236.) 4. Benjamin JA, Tobin CE. Abnormalities of kidneys, ureters and perinephric fascia-anatomic and clinical study. J Urol 1951; 65: 715-33.) 5. W.H Hllinshead, C. Rosse, Text book of Anatomy, 4th ed. Harper & Row publisher, Philadelphia.;710-11) 6. Bauer SB. Anomalies of the kidney and ureteropelvic junction. In: Walsh PC, Retik AB, Vaughan ED Jr, Wein AJ, editors. Campbell’s urology. 7th ed. Philadelphia: WB Saunders; 1998. p. 1708-55.) 7. Claudinei Leôncio Beraldo, Eugênio Fernandes De Magalhães, Demétrius Tierno Martins,.; Thoracic ectopic kidney; J Bras Pneumol 2005; 31(2): 181-3. 8. Kemper MJ, Müller-Wiefel DE. Renal function in congenital anomalies of the kidney and urinary tract. Curr Opin Urol 2001;11:571-5. 9. Cambell MF. Renal ectopy. J Urol 1930; 24:187- 98. 10. Thompson GJ, Pace JM. Ectopic kidney: a review of 97 cases. Surg Gynecol Obstet 1937; 64:935-43. 11. Magak P, King CH, Ireri E et al. High prevalence of ectopic kidney in Cost Province, Kenya. Trop Med Int Health 2004;9(5): 595-600). 12. Muhammad Asghar and Fidaullah Wazir; PREVALENCE OF RENAL ECTOPIA BY DIAGNOSTIC IMAGING; Gomal Journal of Medical Sciences July-December 2008, Vol. 6, No. 2) 13. Campbell MF, Wein AJ, Kavoussi LR. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders Elsevier, 2007:3279.) 14. Datta AK. Essentials of human embryology. In: Urogenital system. 4th ed; calcutta, India 2000; 219 15. Rascher W, Rosch WH. Congenital abnormalities of the urinary tract. Oxford Textbook of Clinical Nephrology. Oxford: Oxford University Press, Inc, 2005:1402-12. 16. Malek RS, Kelalis PP, Burke EC. Ectopic kidney in children and frequency of association with other malformations. Mayo Clin Proc 1971;46:461-7.) 17. Kang IJ, Lee SH, Lee SM, Lim CH, Yoon JH, Kim TW, Seo SM, Kim BS, Chang YS. A case of congenital single ectopic kidney in pelvis of patients with proteinuria. Korean J Nephrol 2005;24:137-40.) 18. Sashi Kumar, MD; Srinivasa Rao Bolla1, MSc; Venkata Ramana Vollala2, PhD; Unilateral Ectopic Kidney in the Pelvis – A Case Report; Chang Gung Med J 2011;34(6 Suppl):10-2 19. Abbas Fadaii, Somaye Rezaian, Farshad Tojari; Intrathoracic Kidney Presented With Chest Pain; IJKD 2008;2:160-2 20. Belsare SM, Chimmalgi, Vaidy SA. Ectopic Kidney and associated anomalies: A case Report. J Anat Soc India 2002; 51: 236-8. 21. Russell RCG, Williams NS, Bulstrade CJK. Bailey and Love’s short practice of surgery. In: The kidneys and ureters. 23rd ed; Arnold, London 2000; 1174. 22. Aysel Türkvatan, Tülay Ölçer, Turhan Cumhur; Multidetector CT urography of renal fusion Anomalies;Diagn Interv Radiol 2009; 15:127–134 23. CK Reddy,1NA Syed,1 N Satyanarayana,2 MJ Phukon,1 R Dutta,1 P Sunitha3 and PS Devi;Left ectopic kidney with non rotation: a case report; Nepal Med Coll J 2010; 12(2): 123-124 24. Bauer SB. Anomalies of the upper urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell’s urology. 8th ed. Philadelphia: WB Saunders, 2002; 1898– 1906. 25. Bailey SH, Mone MC, Nelson EW. Transplantation of crossed fused ectopic kidneys into a single recipient. J Am Coll Surg 2002; 194:147–50 26. Gray SE, Skandalakis JE. Embryology for surgeons. The embryological basis for the treatment of congenital defects, W.B.Saudners co. Philadelphia, London, Toronto 1972; 472-4. 27. Satyapal KS, Haffejee AA, Singh B, Ramsaroop L, Robbs JV, Kalideen JM: Additional renal arteries: incidence and morphometry. Surg Radiol Anat 2001, 23(1):33-38. 28. Dhar P. An additional renal vein. Clin Anat. 2002; 15: 64–66. 29. Roopa Kulkarni, Ashwini C Appaji, R N Kulkarni; Crossed Renal Ectopia Associated With Malrotation Of Intestine- A Rare Case Report; Int J Anat Res 2013, Vol 1(2):53-56. 30. K. Thyagaraju1 and V. Subhadra Devi; Crossed Fused Left Renal Ectopia (Cre) In A Fetus With Left Sided Polydactyly - A Case Report International Journal of Basic and Applied Medical Sciences; 2013 Vol. 3 (1) January-March, pp.161-164 31. Gokhan Gokalp, Bahattin Hakyemez and Cuneyt Erdogan; Vascular anomaly in bilateral ectopic kidney: a case report; Cases Journal 2010, 3:5.
Archana Rokade, R. P. Patange, D. P. Javadekar
Objective: To determine risk factors and explore the socio-behavioral context of pregnancyin the unmarried adolescent girls. Methods: This is cross-sectional observational study over period of one year from August 2012 to July 2013. Total 90 unmarried pregnant girls were included in study. All unmarried adolescent girls seeking abortion were given questionnaire and data that collected was analyzed. This study was conducted in Obstetrics and Gynecology Department of Krishna University of medical sciences karad. Study variables: age, relation with partner, age of partner, literacy and education, socioeconomic class, parenting, type of family and parenting, family problems, awareness of sexual and reproductive health, involvement in productive activities, awareness regarding STD and AIDS, knowledge of contraception, gestational age, methods used for MTP. Results: 90 unmarried adolescent girls undergoing abortions included in the study.60% were from rural area and 44.4% were in age group of 17-18 years. More than 57.7% of unmarried girls had a friend or fiancée as their sex partner who were also in adolescent age. 42% sought abortion in the second trimester of pregnancy. Single parenting with irrational strictness or negligence and family disputes are independent risk factor for adolescent unmarried pregnancy. Contraceptive awareness was low, awareness regarding AIDS (though low at 47%), was higher than that for STDs in general (31%).lack of awareness regarding sexual and reproductive health and noninvolvement in productive activities are important risk factors.
1. World Health Organization. Programme for Adolescent Health & Development. WHO Technical Report Series No. 886; 1999: 2. 2. Jejeebhoy SJ. Adolescent Sexual and Reproductive Behaviour. ICRW Working paper 1999: 8-20. 3. Population Reference Bureau and Centre for Population Option: facts at glance. New York: 1994. 4. Babu NP, Nidhi, Verma RK. Abortions in India: What does the National Family Health Survey tell us? The Journal of Family Planning 1998; 44(4): 49-52. 5. UNAIDS. Force for change: World AIDS Campaign with youth people. World AIDS Campaign Briefing Paper; 1988. 6. De Vore ER, Ginsburg KR. The protective effect of good parenting on adolescent. CurrOpinPedaitr .2005:17(4);460-5 7. Miller BC. Family influence on adolescent sexual and contraceptive behavior. J Sex Res .2002;39(1):22-6 8. Kirby D Antecedents of adolescent initiation of sex, contraceptive use, and pregnancy .Am J Health Behav . 2002;26(6):473-85 9. Berglund S, Liljestrand J. Marin FM, et al. The background of adolescent pregnancies in NICARAGUA: A qualitative approach Soc Sci Med 1997;44(1):1-12 10. Ellis BJ, Bates JE, Dodge KA et al Does father,s absence place daughters at special risk for early sexual activity and teenage pregnancy? Child Dev. 2003;74(3):801-21 11. Huebner AJ, Howell LW. Examining the relation between adolescent sexual risk taking and perception of monitoring, communication and parenting style. J Adolesc Health. 2003;33(2):71-8 12. Slap GB,LotL,Haung B et al. Sexual behavior of adolescent in Nigeria: Cross sectional survey of secondary school students. BMJ. 2003;326(7379):15 13. Guijarro S, Naranjo J, Padilla M, et al. Family risk factors associated with adolescent pregnancy: study of a group of adolescent girls and their families in Ecaudor. J Adolesc Health. 1999; 25(2): 166-72 14. Kasen S, KohenP,Brook JS. Adolescent school expiriences and dropout, adolescent pregnancy and young aduld deviant behavior. J Adoles Res. 1998;13(1):49-72 15. Chhabra S. A step towards helping mothers with unmarried pregnancies. Indian Journal of Maternal and Child Health 1992; 3(2): 41-2.
Sudhir, Deepa.K., Ashok N.C., Murali Dhar
Background: Introduction of ART has initially improved the quality of life (QoL) of HIV positive patients, however body fat redistribution and metabolic disorders associated with long-term ART use may attenuate this improvement. As access to treatment improves in India, the disfiguring nature of lipodystrophy (peripheral atrophy and/or central adiposity) may deter treatment adherence and decrease QoL. Objective: To study the relation between lipodystrophy and QoL in ART-treated HIV+ patients. Methodology: The study was conducted in January 2012 to August 2012. This cross sectional study was done in 1000 HIV/AIDS patients out of which 255 had lipodystrophy at ART centre K.R Hospital, Mysore. WHO-QOL-Brief a summarized quality of life questionnaire was used to assess the Quality of life. Physical examination was done to assess lipodystrophy. Statistical analysis was done using SYSTAT 13 software. To test the significance, t test was applied. Results: Out of 255 patients, who had lipodystrophy, 163 of them were male and 92 of them were females. Facial atrophy was more common among males and abdominal enlargement was found more commonly associated with females. The Quality of life score was found significantly less among HIV patients with lipodystrophy than those without. However CD4 count was found to be significantly higher in patients with lipodystrophy than those without. Conclusion: Body fat alterations negatively affect quality of life. These symptoms may result in stigmatization and marginalization and adversely affect ART adherence and treatment initiatives. Efforts to evaluate self-perceived body fat changes may improve patient’s wellbeing, ART adherence and treatment outcomes can contribute towards stability in quality of life continuum.
1. Carr A, Samaras K, Burton S, Law M, Freund J, Chisholm DJ et al. A syndrome of peripheral lipodystrophy, hyperlipidaemia and insulin resistance in patients receiving HIV protease inhibitors. AIDS 1998;12:F51-8. 2. Carr A, Miller J, Law M, Cooper DA. A syndrome of lipoatrophy, lactic acidaemia and liver dysfunction associated with HIV nucleoside analogue therapy: Contribution to protease inhibitor-related lipodystrophy syndrome. AIDS 2000;14:F25-32. 3. Amassari A, Antinori A, Cozzi-Lepri A, Trotta MP, Nasti G,Ridolfo AL et al. Relationship between HAART adherence and adipose tissue alterations. Journal of Acquired Immune Deficiency Syndromes 2002;31:140-4. 4. Carr A, Samaras K, Chisholm DJ, Cooper DA. Abnormal fat distribution and use of protease inhibitors. Lancet 1998;351:1736. 5. Collins E, Wagner C, Walmsley S. Psychosocial impact of the lipodystrophy syndrome in HIV infection. AIDS Read 2000; 10: 546-50. 6. Eriksson LE, Bratt GA, Sandstrom E, Nordstrom G. The two-year impact of first generation protease inhibitor based antiretroviral therapy (PI-ART) on health-related quality of life. Health Qual Life Outcomes 2005, 4:3:32. 7. Santos CP, Felipe YX, Braga PE, Ramos D, Lima RO, Sequrado AC. Self-perception of body changes in persons living with HIV/AIDS: prevalence and associated factors. AIDS 2005, 19(suppl 4):S14-S21. 8. Burgoyne R, Collins E, Wagner C, Abbey S, Halman M, Nur M, Walmsley S. The relationship between lipodystrophy-associated body changes and measures of quality of life and mental health for HIV-positive adults. Quality of life Research 2005,14:981-990. 9. Paton N, Earnest A, Ng Y, Karim F, Aboulhab J. Lipodystrophy in a cohort of human immunodeficiency virus-infected Asian patients: Prevalence, associated factors and psychological impact. Clin Infect Dis 2002, 35:1244-1249. 10. Miller J, Carr A, Emery S, Law M, Mallal S, Baker D, Smith D, Kaldor J, Cooper DA. HIV lipodystrophy: prevalence, severity and correlates of risk in Australia. HIV Med 2003, 4:293-301. 11. Blanch J, Rousaud A, Martinez E, De Lazzari E, Milinkovic A, Peri JM et al. Factors Associated with Severe Impact of Lipodystrophy on Quality of Life of Patients Infected with HIV-1. Clin Infect Dis 2004,38:1464-1470. 12. Power R, Tate HL, McGill SM, Taylor C. A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals. Sex Transm Infect 2003, 79:137-141. 13. Letamo G. Prevalence and factors associated with HIV/AIDS-related stigma and discriminatory attitudes in Botswana. J Health Popul Nutr 2003, 21:347-357.
Sunil B. V., Sahana K. S., Jajee P. R
Background: Intrathecal adjuvants has gained popularity with the aim of prolonging the duration of block, quality of block and decreased resource utilization compared with general anaesthesia. The purpose of this study was to evaluate the onset and duration of sensory and motor block as well as adverse effects of adding exmedetomidine, fentanyl or magnesium to hyperbaric bupivacaine for spinal anesthesia. Design: randomized double blind trail. Setting: hospital based study during the period, march-june 2013. Method: 90 Patients were randomly allocated to three groups of 30 each to receive intrathecally either 15 mg hyperbaric bupivacaine plus 10 µg dexmedetomidine ( group D) or 15 mg hyperbaric bupivacaine plus 25 µg fentanyl (group F) or 15 mg hyperbaric bupivacaine plus 50 mg magnesium (group M). The onset time to reach T10 sensory and Bromage 3 motor level, the regression time for L1 sensory and Bromage 0 motor block, Sedation scores, hemodynamic changes and side effects were recorded. Statistical analysis: Performed using computer statistical software system SPSS version 16. Data were expressed as either mean and standard deviation or numbers and percentages. Continuous covariates (age, height, weight and duration of surgery) were compared using analysis of variance (ANOVA). For categorical covariates (gender, ASA class, blood transfusion, nausea/vomiting, hypotension, bradycardia, use of ephedrine, additive analgesia, atropine and type of surgery) a Chi-square test was used, with the p value reported at the 95% confidence interval. For the time to reach T10 dermatome, Bromage 3 scale, and the regression of the sensory block to L1 dermatome and Bromage scale 0, ANOVA test was used to compare the means. The level of significance used was p<0.05. The total sample size was calculated to be 90 (30 patients in each group). Results: Onset of bromage 3 motor block and time to reach T10 sensory dermatome level was statistically significant between group D, group M and group F .onset time for sensory and motor block was significantly earlier in group D but delayed in group M .(P<0.001, DvsM. P<0.05, DvsF and FvsM). The time for regression of sensory block to L1 dermatome and bromage 0 motor block was significantly prolonged in group D compared to group M, which was greater then group F . (p <0.001, F vs D,M and DvsM). Conclusion: addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine for spinal anesthesia. Onset of both sensory and motor block was earlier and significant in Dexmedetomidine group. In magnesium sulfate group although onset of sensory and motor block was delayed, the regression was significantly prolonged then fentanyl group, good haemodynamic stability was observed and there was no significant side effects in three groups during study period.
1. Hunt CO, Naulty JS, Bader AM, Hauch MA, Vartikar JV, Datta S, et al. Perioperative analgesia with subarachnoid fentanyl-bupivacaine for Cesarean delivery. Anesthesiology. 1989;71:535–40. 2. Wang C, Chakrabarthy MK, Whitwam JG. Specific enhancement by fentanyl of the effect of intrathecal bupivacaine on nociceptive afferent but not on sympathetic efferent pathways in dogs. Anaesthesiology 1993; 79(4)766-73. 3. Singh H, Yang J, Thornton K, Giesecke AH. Intrathecal fentanyl prolongs sensory bupivacaine spinal block.Can J Anaesth.1995;42(11)987-91. 4. Tramer MR, Schneider J, Marti RA, Rifat K. Role of magnesium in postoperative analgesia. .Anaesthesialogy 1996;84;340-7. 5. Woolf CJ, Thompson WN .The induction and maintainance of central sensitization is dependent on N –Methyl- aspartate acid receptor activation:implication for treatment of post injury pain hypersensitivity states .Pain .1991:44;293-9. 6. Fawcell VY, Haxby EJ, Male DA. Magnesium:physiology and pharmacology Br J Anaesth.1999;83:302-20. 7. Arcioni R, Palmisani S, Santorsola C, Sauli V, Romano S, Mercieri M et al.combined intrathecal and epidural magnesium sulfate supplementation of spinal anaesthesia to reduce post-operative analgesia requirements: a prospective, randomized,double blind controlled trail in patients undergoing major orthopedic surgery. Acta Anaesthesiol Scand.2007;51:482-89. 8. Ozalevli M,Cetin TO,Unlugence H,Guler T, Isik G.The effect of adding intrathecal magnesium sulfate to bupivacaine fentanyl spinal anaesthesia. Acta Anaesthesiol Scand.2005;49;1514-9. 9. Martin E, Ramsay G, Mantz J, Sum-Ping ST. The role of alpha2 – Adrenoreceptor agonist dexmedetomidine in post surgical sedation in intensive care unit . J Intensive Care Med.2003 ;18:(29-41). 10. Scheinin B, Lindgren L, Randell T, Scheinin H, Scheinin M. Dexmedetomidine attenuates sympathoadrenal responses to tracheal intubation and reduces the need for thiopentone and perioperative fentanyl. Br J Anaesth 1992; 68:126-131. 11. Gertler R, Brown HC, Mitchell DH, Silivious UN. Dexmedetamidine : a novel sedative analgesic agent. Proc (Bayl univ med cent)2001 ;14(1):13-21. 12. Venn RM, Ground RM. Comparison between dexmedetomidine and propofol for sedation in intensive care unit: patient and clinician perception. Br J Anaesth. 2001;87:684-90. 13. Shimode N, Fukuoka T, Tanimoto M, Tashiro C, Tokunaga A, Noquichi K. The effect of dexmedetomidine and halothane on fos expression in the spinaldorsal horn using a rat post operative pain module. Neurosci Let 2003; 29:343(1)45-8. 14. O O, Smith LJ. A comparision of epidural analgesia provided by bupiaicaine alone ,bupivacaine + morphine or bupivicaine+dexmedetomidine for pelvic orthopaedic surgery in dogs. Vet Anaesth Analg 2013; 40(5):527-36. 15. Eisenach JC, Shafer SL, Buuckler BA, Jackson C, Kallio A. Pharmacokinetics and pharmacodynamics of intraspinal dexmedetomidine in sheep. Anaesthesiology 1994 ;80(6):1349-59. 16. Kalso EA, Poyhia R, Rosenberg P. Spinal antinociception by dexmedetomidine, a highly selective α2-adrenergic agonist. Pharmacol Toxicol 1991;68:140-143. 17. Asano T, Dohi S, Ohta S, Shimonaka H, Iida H. Antinociception by epidural and systemic alpha 2 adrenoreceptor agonists and their binding affinity in rat spinal cord and brain. Anesth Analg 2000; 90:400-407. 18. Werdehausen R, Fazeli S, Hollmann MW, Bauer I, Stevens MF. Apoptosis induction by different local anaesthetics in a neuroblastoma cell line. Br j anaesth 2009 ;103(5):711-8. 19. Sanders RD, Sun P, Patel S, Li M, Maze M, Ma D. Dexmedetomidine provides cortical neuroprotection impact on anaesthetic induced neuroapoptosis in rat developing brain. Acta Anaesthesiol Scand 2010;54:710-716. 20. Celik F, Gocmez C,Kamasak K,Tufek A,Guzel A, Tokqoz O et al. The comparison of neuroprotective effect of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury. Int J Surg2013;11(5)414-8. 21. Elia N, Culebras X, Mazza C ,Schiffer E, Tramer MR. Clonidine as an adjuvant to intrathecal local anaesthetics for surgery:systematic review of randamised trails. Req Anesth Pain Med 2008 ;33(2):159-67. 22. Bischoff P, Kochs E. Alpha 2 agonists in anesthesia and intensive medicine. Anasthesiol Intensivmed Notfallmed Schmerzther13.1993;28(1):2-12. 23. Fairbanks CA, Wilcox GL. Spinal antinociceptive synergism between morphine and clonidine persist in mice made acutly or chronically tolerant to morphine. J Pharmacol Exp Ther 1999;288:1107-1116. 24. Li X, Eisenach JC. Alpha 2A adrenoceptor stimulation reduces capsaicin induced glutamate release from spinal card synaptosomes. J Pharmacol Exp Ther 2001;299(3):939-44. 25. Kim JE, Kim NY, Lee HS, Kil HK. Effect of intrsthecal dexmedetamidine on low dose bupivacaine spinal anaesthesia in elderly patient undergoing transurethral prostatectomy. Biol Pharm Bull 2013;36(6):959-65. 26. Kanazi GE, Aouad MT, Jabbour-Khoury SI, Al-Jazzar MD, Alameddine MM, Al-Yaman R. Effect of low-dose dexmedetomidine or clonidine on the characteristics of bupivacaine spinal block. Acta Anaesthesiol Scand 2006;50:222-227. 27. Al-Mustafa MM, Abu –Halaweh SA, Aloweidi AS, Mushidi MM, Amman BA, Awwad ZM, Al-Edwan GM, Ramsay MA. Effect of dexmedetomidine added to spinal bupivacaine for urological procedures. Soudi Med j.2009 ;30(3):365-70. 28. Gupta R, Varma R, Bogra J, Kohli M, Raman R, Kushwaha JK. A comparative study of intrathecal dexmedetomidine and fentanyl as adjuvants to bupivacaine. J Anaesthesiol Clin Pharmacol 2011 ;27(3):339-343. 29. Al-Ghanem SM, Massad IM, Al-Mustafa MM, AL- Zaben KR, Qudaisat IY,Qatawneh AM et al.effect of adding dexmedetomidine verses fentanyl to intrathecal bupivacaine on spinal block characteristics in gynecological procedures :a double blind controlled study. Am J Appl Sci 2009;6:882-7. 30. Shukla D, Verma A ,Agarwal A, Pandey HD, Tyagi C. Comparitive study of intrathecal dexmedetomidine with intrathecal magnesium sulfate used as adjuvants to bupivacaine. Anesthesiol clin pharmacol.2011;27(4):495-99. 31. Malleeswaran S, Ponda N, Malhew P,Bagga R. Magnesium as an intrathecal adjuvant in mild pre eclampsia . .Int J Obstet Anesth.2010;19:161-6. 32. Talke P, Tayefeh F, Sessler DI, Jeffrey R, Noursalehi M, Richerdson C. Dexmedetomidine does not alter the sweating threshold, but comparably and linearly decreases the vasoconstriction and shivering threshold. Anaesthesiology.1997;87:835-41.
Latheesh Latheef, Mrinal B Shetty, Vivian D’ Almeida, Rajesh Wilson, Tinu Joseph
Abstract: Knowledge of the vertebral morphology has been seen to be crucial for the safe placement of screws in pedicle screw fixation of the spine .An analysis of the morphometric parameters of the thoracic vertebrae was done in 229 patients using computed tomography scans in south Indian population .The results show significant variation in the morphology of the vertebral body and the pedicle in Indian population when compared to other races. The measurements were seen to be greater in males than in females with the exception of the transverse angle of the pedicle. The vertebral body height was found to be progressively increasing from T1 to T12 levels and ranged from 5.8mm(cumulative) at T1 to 22.3mm (cumulative) at T12.The vertebral body width was found to decrease from T1 to T5 and again increase from T6 to T12.The cephalo-caudal height of the pedicle ranged from 7.8mm at T1 to 13mm at T12.The medio-lateral width of the pedicle was found to decrease from T1 to T5 and increase from T6 to T12; the smallest cumulative value being 4.4 mm at T4 and the largest being 6mm at T12.The cord length ranged from 30.8mm at T1 to 40.4mm at T12.The mean transverse angle of the pedicle was observed to reduce from 26.80 at T1 to 1.80 at T12.The pedicle sagittal angulation was seen to be lowest at T12 with a cumulative value of 11.570 and highest at T3 with a cumulative value of 17.580. The study shows that medio-lateral width of the pedicle is smaller from T4 to T7 levels for the use of standard pedicle screws, thus making their use difficult and risky. The cord length measurements according to the study allow the use of standard screws ranging from 25mm to 35mm.A wide variation in the dimensions is also observed between different individuals, demonstrating the need for computed tomography as a preoperative evaluation tool in each patient for choosing the appropriate implant and also to prevent complications.
1. Fayyazi AH, Hugate RR, Pennypacker J, Gelb DE, Ludwig SC: Accuracy of computed tomography in assessing thoracic pedicle screw malposition. J Spinal Disord Tech 2004;17: 367-71. 2. Yue JJ, Sossan A, Selgrath C, Deutsch L, Wilkens K, Testaiuti M, et. al..: The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3-year consecutive series. Spine 2002; 27: 2782-87. 3. Datir SP, Mitra SR: Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine 2004; 29: 1174-81. 4. Scoles PV, Linton AE, Latimer B, Levy ME, Digiovanni BF: Vertebral body and posterior element morphology: The normal spine in middle life.Spine 1988; 13:1082-86. 5. Nottmeier EW, Seemer W, Young PM: Placement of thoracolumbar pedicle screws using three-dimensional image guidance: experience in a large patient cohort. J Neurosurg Spine, 2009; 10: 33-39. 6. Gray’s Anatomy. 35th edition. Edited by R Worwick, PL Williams. London, Longman, 1973. 7. Vaccaro AR, Rizzolo SJ, Allardyce TJ, et. al.. Placement of pedicle screws in the thoracic spine: I. Morphometric analysis of the thoracic vertebrae. J Bone Joint Surg Am 1995; 77:1193-99. 8. Liljenqvist UR, Halm HF, Link TM: Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine 1997; 22: 2239-45. 9. Kim NH, Lee HM, Chung IH, Kim HJ, Kim SJ: Morphometric Study of the pedicles of thoracic and lumbar vertebrae in Koreans.Spine 1994; 19: 1390-94. 10. Berry JL, Moran JM, Berg WS, Steffee AD: a morphometric study of the human lumbar and selected thoracic vertebrae. Spine 1987; 12: 362-67. 11. Zindrick MR, Wiltse LL, Doornik A, et. al.. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 1987;12(2):160-67. 12. Yong Soo Choi, M.D., Young Jin Kim, M.D., Ph.D., Hyeong-Joong Yi, M.D., Ph.D., Young Joon Kim, M.D., Ph.D. Pedicle morphometry for thoracic screw fixation in ethnic Koreans: Radiological Assessment using computed tomographic myelography. J Korean Neurosurg Soc 2009;46:317-21. 13. Hou S, Hu R, Shi Y. Pedicle morphology of the lower thoracic and lumbar spine in a Chinese population. Spine. 1993; 18: 1850-55. 14. Manish Chadha, MS(Ortho), Birender Balain, MS(Ortho), Lalit Maini, MS(Ortho), and B.K.Dhaon, MS(Ortho). Pedicle morphology of the lower thoracic, lumbar and S1 vertebrae: An Indian prespective.Spine. 2003; 28(8): 744-49.
Chetana I. Wahane, Vanita A. Kulkarni
Staphylococci act as major aerobic pathogens in the causation of chronic suppurative otitis media (CSOM). Clindamycin is one of the alternative agents used to treat CSOM and accurate identification of clindamycin resistance is important to prevent therapeutic failure. Inducible clindamycin resistance cannot be detected by standard susceptibility tests. This study aimed to detect macrolide-lincosamide-streptogramin B (MLSB) resistance in staphylococcal isolates causing CSOM in order to assist clinicians in treatment of CSOM by thesegroup of antibiotics. MLSB resistance in the present study was detected in 59 staphylococcal isolates (41 S. aureus and 18 CONS) isolated by standard procedure from ear discharge in CSOM. D-test was performed on these isolates to detect MLSB resistance. Inducible clindamycin was detected in 5% Methicillin susceptible staphylococcus aureus (MSSA), 0% Methicillin resistant staphylococcus aureus (MRSA) and 5.5% Coagulase negative Staphylococci (CONS). Constitutive resistance (8.4%) was found more common than inducible clindamycin resistance (5%) in the present study. Detection of inducible clindamycin resistance can help in using clindamycin safely and effectively in patients with true clindamycin susceptible isolates and thus helps to avoid treatment failure while high prevalence of constitutive resistance makes D-test essential when clindamycin is an option for therapy of staphylococci in CSOM.
1. Srivastava VK, Agarwal SK, Malik GK. Chronic suppurative otitis media in children. Indian J paediatrics;46:363-67,1979. 2. Nikakhlagh S, Khosravi AD, Fazlipour A, Safarzadeh M, Rashidi N. Microbiological findings in patients with CSOM. J Med Sci;8(5):503-06,2008. 3. Maji PK, Chatterjee TK, Chatterjee S, Chakrabarty J, Mukhopadhyay BB. The investigation of chronic suppurative otitis media in patients attending a tertiary care hospital with special emphasis on seasonal variation. IJO & HNS;59:128-31,2007. 4. Rama Rao MV, Jayakar PA. Bacteriological study of Chronic suppurative otitis media. J Indian M A ,75(2):30-34,1980. 5. Klein J. Strategies for decreasing multidrug antibiotic resistance: role of ototopical agents for treatment of middle ear infections. The American J managed care ,8(14):345-52,2002. 6. Jha A.K.. Bacteriology and treatment of chronic otitis media. Journal of Nepal medical association,41:518-521,2002. 7. Saderi H, Owlia P, Eslami M. Prevalence of Macrolide-Lincosamide-Streptogramin B (MLSB) resistance in S. aureus isolated from patients in Tehran, Iran. Iranian journal of pathology,4(4);161-166,2009. 8. Mackie & McCartney. Laboratory strategy in the diagnosis of infective syndrome. In. Collee JC, Fraser AG, Marmion BP, Simmons A. Practical medical microbiology. 14th edn. New Delhi: Elsevier;. pp 53-94,2006. 9. Forbes BA, Sahm DF, Weissfeld AS. Specimen management. Bailey & Scott’s diagnostic microbiology. 12th edn. Philadelphia: Elsevier;.pp 65,2007. 10. Clinical laboratory standard institute guidelines 2010. 11. Kasten MJ. Clindamycin, metronidazole and Chloramphenicol. Mayo Clin Proc,74:825-33,1999. 12. Martinez-Angular G, Hammerman WA, Mason EO,Jr, Kaplon SL. Clindamycin treatment of invasive infections caused by community-aquired, methicillin resistant and methicillin susceptible S. aureus in children. Paediatr Infect Dis J,22:593-8,2003. 13. Roberts S, Chambers S. Diagnosis and management of staphylococcus aureus infections of the skin and soft tissue. Intern Med J,35(2):S97-105,2005. 14. Lewis JS, Jorgensen TH. Inducible clindamycin resistance in staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis,40:280-5,2005. 15. Rao GG. Should clindamycin be used in treatment of patients with infections caused by Erythromycin-resistant staphylococci? J Antimicrob Chemother,45:715,2000. 16. Chelae S, Laohaprertthisarn V, Phengmak M, Kongmuang U, Kalnauwakul S. Detection of inducible Clindamycin resistance in staphylococci by disk diffusion induction test. J Med Assoc Thai,92;7:947-951,2009. 17. Schmitz FJ, Verhoef J, Fluit AC. Prevalence of resistance to MLS antibiotics in 20 European university hospitals participating in the European SENTRY surveillance programme. Sentry participants group. J Antimicrob Chemother,43(6):783-92,1999. 18. Gupta V, Datta P, Rani H, Chander J. Inducible clindamycin resistance in staphylococcus aureus: A study from north India. J Postgrad Med,55:176-9,2009, 19. Gadepalli R, Dhawan B, Mohanty, Kapil A, Das BK, Chaudhary R. Inducible clindamycin resistance in clinical isolates of S. aureus. Indian J Med Res,123:571-3,2006. 20. Delialiaglu N, Aslan G, Ozturk L, Baki V, Sen S, Emekdas G. Inducible inducible resistance in staphylococcal isolates from clinical samples. Jpn J Infect Dis.,58:104-6,2005. 21. Frank AL, Marcinak JF, Mangat PD, Tjhio JT, Kelkar S, Schreckenberger PC, et al. Clindamycin treatment of methicillin resistant S. aureus infections in children. Paediatr Infect Dis J,21(6):530-4,2002. 22. Shantala GB, Shetty AS, Rao RK, Vasudeva, Nagarathnamma T. Detection of inducible clindamycin resistance in clinical of S. aureus by disk diffusion induction test. Journal of Clinical and Diagnostic Research,5(1):35-37,2011.
Sunil B. V., Sahana K. S., Jajee P. R
We are presenting a case of central venous catheter (CVC) malposition which was introduced under ultrasound (USG) guidance and its tip position was evaluated by transesophageal echocardiography (TEE), in a patient with severe scoliosis posted for cardiac surgery. CVC insertion is difficult and complications are more common in such cases due to distorted anatomy. Our aim was to avoid major complications related to central venous catheter insertion. We recommend USG guided insertion of central line in scoliosis which decreases complications during insertion, number of attempt, and failure rate.
1. Pikwer A, Baath L, Davidson B, Perstift I, Akeson J. The incidence and risk central venous catheter malpositioning :a prospective cohart study in1619 patients. Anaesth Intensive Care 2008;36(1):30-7. 2. Ghafoor AV, Mayhew JF, Gentry WB, Schmitz ML.Transpleural subclavian central venous catheter placement in a child with scoliosis discovered during thoracotomy. J Clin Anesth. 2003;15(2):142-4 3. Bross P, Volco O,Leben J,Schregel W.Central venous cannulation – always with ultrasound support?. Anaesthesiol Intensivmed Notfallmed Schmerzther.2002;36(10):619-27 4. Milone M,Di minno MN, Di minno MN, Salvatore G, Lacovazzo C, Policastro C, Milone F.The real effectiveness of ultrasound guidence in subclavian venous access. Ann Ital chir.2010;81(5):331-4 5. Leung S, Malhotra AD, Eisen LA. Vascularaccess challenge on a patient with cerebral palsy and severe kyphoscoliosis. J Vasc Access.2010;11(1):66-8. 6. Andropoulos DB, Stayer SA, Bent ST, Compos CJ, Bezold LI, Alvarez M, Fraser CD. a controlled study of transesophageal echocordiography to guide central venous catheter placement in congenital heart surgery patients.Anesth Analg.1999;89(1):65-70. 7. Rondolph AG, Cook DJ, Pribble CG.Ultrasound guidence for placement of central venous catheter :A meta- analysis of the literatures. Crit Care Med.1996 ;24(12):2053-8 8. Fraqou M, Gravanis A ,Dimitriou V, Papalois A, Kouraklis G, Karabinis A , Saranteas T et al. Crit care med.2011 ;39(7)1607-12.
Suresh Lankeshwar, Usha Ramachandra, Prabhu N. B
Background: Tuberculosis is one of the common communicable infections in our country. The present study reveals the status of Tubercular infection and Cervical Tuberculosis lymphadenitis in rural school children of Nagamangala Taluka of Karnataka State in the year 2004-2005. Objectives: Assessment of prevalence of Tubercular infection and Tubercular Cervical lymphadenitis in school children of Nagamangala district of Karnataka state. Materials and methods: data was collected from sample size of 693 school children using simple random technique. Tuberculin test to assess prevalence of Tubercular infection and FNAC test to confirm tubercular cervical lymphadenitis. Results: Tubercular infection was found to be 3.17% and Tubercular Cervical lymphadenitis o.58%. Conclusion: Tuberculosis infection is still common in school children and so is tubercular cervical lymphadenitis (extra pulmonary tuberculosis). Tuberculin test in children and FNAC test are cost effective in assessing status of TB infection and Tubercular cervical lymphadenitis.
1. Park K, editor. Park’s textbook of preventive and social medicine: 17th ed. Jabalpur: Banarasidas Bhanot; 2002: 138-153 2. Government of India.TB India 2003 RNTCP status report. Government of India DGHS publication, New Delhi: Governament of India; 2004; 1-20 3. Bhagyalakshmi A, Khadri AM, Lala MK, Jivarajani P, Patel T, Patel M. Prevalence of tuberculosis infection among children in slums of Ahmadabad. Indian Pediatr. 2003; 40(3); 239-43. 4. Chadha VK, Vaidyanathan PS, Jagannatha PS. Annual risk tuberculosis infection in rural areas of Junagadh district. J Commun Dis. 2001; 33(4); 231-40. 5. Suryanarayana L, Suryanarayana HV, Jagannatha PS. Prevalence of pulmonary tuberculosis among children in a south Indian community. Ind. J. Tub.1999; 46; 171.