Biofilm formation has become a major factor in enhancing the antibiotic resistance of staphylococci. In the present study, we observed methicillin resistance and further biofilm production by two methods – Congo red agar method and Christenson’s test tube method and compared the antibiotic resistance pattern between biofilm producers and non biofilm producers. 102 S. aureus and 168 S. epidermidis were isolated from various clinical samples with 70.5% and 79.7% methicillin resistance resp.51.4% MRSA and 61.2% MRSE were biofilm producers. Antibiotic sensitivity was observed in biofilm producing S. epidermidis and S aureus for Vancomycin (63%/85%), Doxycycline (48%/61%), Tetracycline (41%/52%), Cephalexin (19%/15%), Cefotaxime (41%/43%), Ceftrioxone (31%/37%), Cotrimoxazole (10%/11%), Ciprofloxacin (45%/52%), Amoxicillin (34%/35%), Ampicillin (4%/2%), Amoxyclave (26%/17%), Erythromycin (6%/14%), Amikacin (71%/76%), Gentamycin (66%/65%) and for urinary isolates Norfloxacin (9%/11%) and Nitrofuranoin (57%/78%) which was significantly less as compared to non biofilm producers.
1. Atshan SS, Shamsudin MN, Lung LT, Sekawi Z, Ghaznavi-Rad E, Pei CP. Comparative characterisation of genotypically different clones of MRSA in the production of biofilms. J Biomed Biotechnol. 2012; 2012:417247
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7. Gowrishankar S, Duncun Mosioma N, Karutha Pandian S. Coral- Associated Bacteria as a Promising Antibiofilm Agent against Methicillin-Resistant and Susceptible Staphylococcus aureus Biofilms. Evid Based Complement Alternat Med. 2012; 2012: 862374
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10. P. Ponnusamy,R. Nagappan. Extended Spectrum Beta -Lactamase, Biofilm-producing Uropathogenic Pathogens and Their Antibiotic Susceptibility Patterns from Urinary Tract Infection- An Overview. Int J Microbiol Res.2013;4 (2): 101-118.
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An unusual case of uterine inversion: A case report
Uterine inversion is a rare obstetric emergency. The incidence varies considerably and can range from 1 case in 2000 to 1 case in every 50,000 births. This postpartum complication has an academic importance due to its rarity and severity. When not immediately identified, the massive and often underestimated blood loss can lead to hypovolemic shock and maternal death that can reach 15% in some series. The best management options for this condition are not fully known, given the worldwide scarce experience of each obstetrical team managing this type of situation. There are several therapeutic strategies described in the literature, including drugs, manual maneuvers and surgical interventions. The aim of this article is to describe a case of complete acute uterine inversion after a normal delivery, and provide a literature review of uterine inversion, its definition, etiology, predictive and risk factors, diagnosis and treatment.
1. Dwivedi S, Gupta N, Mishra A, Pande S, Lal P: Uterine inversion: a shocking aftermath of mismanaged third stage of labour. Int J ReprodContraceptObstetGynecol 2013, 2(3):292–295. 

2. Hostetler D, Bosworth M: Uterine inversion, a life-threatening obstetric emergency. J Am Board Fam Med 2000, 13(2):120–123. 

3. Dali M, Rajbhandari S, Shrestha S: Puerperal inversion of the uterus in Nepal: case reports and review of literature. J ObstetGynaecol Res 1997, 23:319. 

4. Fofie C, Baffoe P: Non-puerperal uterine inversion: a case report. Ghana Med J 2010, 44(2):79–81. 

5. Pauleta R, Rodrigues R, Melo A, Graça L: Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound ObstetGynecol 2010, 36:260. 

6. Repke J, Ramin S, Barss V: Puerperal uterine inversion – March 2013. http:// www.UpToDate.com. 

7. Livingston S, Booker C, Kramer P, Dodson W: Chronic uterine inversion at 14 weeks postpartum. ObstetGynecol 2007, 109:555. 

8. Witteveen T, Van Stralen G, Zwart J, Van Roosmalen J: Puerperal uterine inversion in the Netherlands: a nationwide cohort study. ActaObstetGynecolScand 2013, 92:334. 

9. Hsieh T, Lee J: Sonographic findings in acute puerperal uterine inversion. J Clin Ultrasound 1991, 19:306. 

10. Momani A, Hassan A: Treatment of puerperal uterine inversion by the hydrostatic method; reports of five cases. Eur J ObstetGynecolReprodBiol 1989, 32:281. 

11. Neves J, Cardoso E, Araujo C, Santo S, Gonçalves P, Melo A, Rodrigues R, Pereira A: Inversão Uterina. Acta Med Port 2006, 19:181–184. 16. 

12. Antonelli E, Irion O, Tolck P, Morales M: Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006, 113:846. 

13. Shepherd L, Shenassa H, Singh S: Laparoscopic management of uterine inversion. J Minim Invasive Gynecol 2010, 17:255. 

14. You W, Zahn C: Postpartum hemorrhage: abnormally adherent placenta, uterine inversion, and puerperal hematomas. ClinObstet Gynecol 2006, 49:184. 

15. Adesiyun A: Septic postpartum uterine inversion. Singapore Med J 2007, 48:943.
16. VanVugt PJH, Baudoin P, Blom MV, van Deursen STBM. Inveriso uteri puerperalis. Acta Obstet GynaecolScand1981; 60:353-62.
17. Rajagopalan V, Sujatha Y. Acute postpartum uterine inversion with hemorrhagic shock with laparoscopic reduction: a new method of management. BJOG 2006; 113:1100-1102.
18. Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113:846-847.
19. Robson S, Adair S, Bland P. A new surgical technique for dealing with uterine inversion.Australian and New Zealand Journal of Obstetrics and Gynaecology2005; 45:248-258.
Role of early laparoscopic cholecystectomy in acute cholecystitis – A retrospective analysis
Background: Various studies have proposed conflicting opinion about first-line management of patients with Acute Cholecystitis. Results from these studies have evidences for and against the early Laparoscopic Cholecystectomy. The aim of this study is to retrospectively analyse the results of our practise in managing acute Cholecystitis with early Laparoscopic Cholecystectomy. Methods: Data collection from the case records of patients who underwent initial Laparoscopic approach for Acute Cholecystitis. Various parameters assessed are conversion rate, operating time, length of hospital stay, bile duct injury and port site infection as predictors of efficiency of early laparoscopic approach. Results: The analysis included 95 patients, 57 females and 38 males, average age was 52 years. Mean duration of symptoms before intervention was 64 hours. Mean operating time was 96 minutes. Over all conversion rate was 16.8%, which decreased substantially from year 1 through till the end of study period. Length of hospital stay was 3-7 days (Mean =4.6 days). Postoperative complication occurred in 7 patients (2 cases of cystic duct leak and 5 cases of port site infection). Conclusion: Early laparoscopic approach has yielded comparable results in terms of operating time, conversion rate, and complication rates, while the total length of hospital stay was substantially reduced when compared with total hospital stay in delayed approach from other studies
1. Kolla, S.B., et al., Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc, 2004. 18(9): p. 1323-7.
2. Cuschieri, A., Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy, 1993. 25(6): p. 397-8.
3. Macafee, D.A., et al., Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg, 2009. 96(9): p. 1031-40.
4. Gurusamy, K., et al., Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg, 2010. 97(2): p. 141-50.
5. Johansson, M., et al., Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg, 2003. 7(5): p. 642-5.
6. Lai, P.B., et al., Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg, 1998. 85(6): p. 764-7.
7. Lo, C.M., et al., Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg, 1998. 227(4): p. 461-7.
8. Miura, F., et al., TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci, 2013. 20(1): p. 47-54.
9. Suter, M. and A. Meyer, A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc, 2001. 15(10): p. 1187-92.
10. Wong, H.P., et al., Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis. J Hepatobiliary Pancreat Sci, 2012. 19(4): p. 458-64.
11. Chandler, C.F., et al., Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg, 2000. 66(9): p. 896-900.
12. Cox, M.R., et al., Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg, 1993. 218(5): p. 630-4.
13. Miller, R.E. and F.M. Kimmelstiel, Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc, 1993. 7(4): p. 296-9.
14. Rattner, D.W., C. Ferguson, and A.L. Warshaw, Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg, 1993. 217(3): p. 233-6.
15. Wiesen, S.M., et al., Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol, 1993. 88(3): p. 334-7.
16. Zucker, K.A., et al., Laparoscopic management of acute cholecystitis. Am J Surg, 1993. 165(4): p. 508-14.
17. Minutolo, V., et al., Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci, 2014. 18(2 Suppl): p. 40-6.
A cadaveric study of variations in branching pattern of brachial plexus
Aims and Objectives: The aims of present study are 1) to study the variations in branching pattern of the brachial plexus 2) to study the communication of median nerve with other nerves of upper limb. Materials and Methods: In present study 30 brachial plexuses from 15 well embalmed human cadavers were studied in anatomy department. In depth study was done on the communications of median with the musculocutaneous nerve and the different types were classified. Communication between ulnar nerve and median nerve was studied. Results: Out of 30 upper limbs, we found communication between musculocutaneous nerve and median nerve in 6 cases. In such cases, the communicating branch run from musculocutaneus nerve towards median nerve. Four upper limb shows communication between ulnar nerve and medial root of median nerve. Conclusion: It is concluded that knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to upper limb. Knowledge of these variations is important to anatomists, radiologists, anesthesiologists and surgeons.
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4. Choi D, Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Sanudo JR. (2002): Patterns of Connections between the Musculocutaneous and Median Nerves in the Axilla and Arm. Clinical Anatomy: 2002; 15:11–17.
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7. Loukas M, Aqueelah H. (2005): Musculocutaneous and Median Nerve Connections Within, Proximal and Distal To the Coracobrachialis Muscle. Folia Morphologica 2005; 64: 101-108.
8. Yoganandham Janani, HannahSugirthabai RajilaRajendran, Thotakura Balaji , Rajendran SharmilaSaran , Batmanabane Mounissamy (2014) : A Study On The Communications Of Median Nerve With Musculocutaneous And Ulnar Nerves. International Journal of Research in Health Science 2014; 2 (2):480-487.
9. Saeed M,Rufai, A. (2003) : Anastomotic Branch From The Median Nerve To The Musculocutaneous Nerve: a case report. Clinical Anatomy 2003; 16: 453-457.
10. Le Minor, J.M. (1990): A Rare Variant of the Median and Musculocutaneous Nerve in Man. Archieves Anatomy Histology Embryology 1990; 73: 33 – 42.
11. Beheiry EE (2004): Anatomical Variations Of The Median Nerve Distribution And Communication In Arm. Folia Morphologica 2004; 63(3): 313-318.
12. Gupta M, Goyal N, Harjeet (2005): Anomalous Communications in the Branches of Brachial Plexus. Journal of the Anatomical Society of India 2005; 54 (1): 1-3.
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15. Chauhan R, Roy TS (2002): Communication between the Median and Musculocutaneous Nerve- A Case Report. Journal of Anatomical Society of India: 2002; 51(1): 72-75.
Evaluation of lipid profile in patients with liver cirrhosis and their association with severity of the disease
The study was conducted to determine the Lipid profiles in Patients with Liver Cirrhosis and to assess their association with severity of the disease. In an analytical cross sectional study, 150 Cirrhotic subjects of either sex ranging in age from 25-65 years were included in the study and the results were compared with 50, age and sex matched healthy control subjects. All Cirrhotic subjects were assessed for severity of disease as Mild (Child A), Moderate (Child B) and Severe (Child C) as per Child Pugh classification. Total Cholesterol, HDL, LDL and triglycerides were measured. The results of this study showed that all the serum lipid profile parameters (Total Cholesterol, LDL and HDL) were significantly (p <0.05)decreased in cirrhotics as compared to control group and the concentration of these study variables decreased with Severity of liver disease and the mean level difference was statistically significantly (p <0.01) with the exception of serum triglyceride levels. Triglyceride levels rather showed a decline in Cirrhotic patients but it was not statistically significant. Dyslipidemia exists in patients with liver cirrhosis. Serum Lipid profile is routinely measured parameters, which may have independent prognostic value in patients with liver cirrhosis thus assessment of the serum lipid profile is important for an effective treatment and prognostic evaluation of patients with chronic liver disease.
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6. .Schiff ER, Sorrell MF, Maddrey EC et al. Schiff’s Diseases of the Liver. 9th Edition Lippincott, Williams and Wilkins. Lancet. 2008; 371(9615):838–851.
7. Cheruvattath R, Vijayan Balan et al. Infections in Patients With End-stage Liver Disease. J Clin Gastroenterol. 2007; 41:403–411.
8. Sanjay Kumar Mandal1, Koelina Sil, Sumanta Chatterjee, Jacky Ganguly. A Study On Lipid Profiles In Chronic Liver Diseases. National Journal Of Medical Research. 2013; Volume 3:Issue 1: Page 70.
9. Jing-ting Jiang, Ning Xu, Xiao-ying Zhang, and Chang-ping Wu. Lipids changes in liver cancer. J Zhejiang Univ Sci B. 2007; 8(6): 398–409. doi: 10.1631/jzus.2007.B0398
10. Libo Luo, Xiangke Pu, Yongzhong Wang, and Ning Xu. Impaired plasma lipid profiles in acute hepatitis. Lipids Health Dis. 2010; 9: 5. doi: 10.1186/1476-511X-9-5.
11. Valerio. Nobili V,Alkhouri N, Bartuli A, Manco M, Lopez R, Alisi A, Feldstein AE.Severity of Liver Injury and Atherogenic Lipid Profile in Children With Nonalcoholic Fatty Liver Disease.Pediatric Research .2010; 67: 665–670.
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Study of gram negative septicemia in cases of neonates admitted in neonatal intensive care unit at tertiary care hospital
Background: Septicemia in neonates is one of the four leading causes of neonatal mortality in India. The pattern of causative agents has been constantly changing and there has been a frequent emergence of resistant bacteria. The antibiotic misuse has resulted in emergence of drug resistant bacterial strains in the neonatal units with grave sequelae. Objectives: to describe the spectrum of aerobic gram negative bacterial isolates and study the sensitivity pattern in cases of neonatal septicemia. Methods: Blood samples were collected aseptically from 200 clinically suspected cases and inoculated into BHI broth and incubated at 370 C for 7 days. Repeated subcultures were made on 1st, 3rd and 5th days onto Blood agar and Mac Conkey agar. Any growth was identified by colony characteristics and appropriate biochemical tests. Antibiotic susceptibility was done by disc diffusion method as per CLSI guidelines. Results: Of the 200 cases, 31.5% were found to be culture positive. Gram negative isolates were predominant 73% and Gram positive isolates were obtained in 27% of the cases. Out of the Gram negative, Klebsiellaspp was the commonest (44.4%) followed by Pseudomonas aeruginosa (17.5%), Escherichia coli (9.5%), Proteus vulgaris (1.6%). Gram negative isolates were most sensitive to Imipenem and Meropenem (98%), followed by Cefoperazone /Sulbactum (75-80%), Amikacin and Gentamycin (70-75%) and least sensitive to third generation cephalosporins. Conclusion: Therefore uncertainty regarding the choice of antibiotics can be minimized by regular survey of etiological agents and their antimicrobial susceptibility pattern.
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3. AtulGarg, S Anuprabha, Jaya Garg, RK Goyal, MR Sen. Bacteriological profile and antimicrobial resistance of blood culture isolates from a university hospital. Journal, Indian Academy of Clinical Medicine2007; 8(2): 139-143.
4. Roy I, Jain A, Kumar M, Agarwal SK. “Bacteriology of Neonatal Septicemia in Tertiary care Hospital of Northern Indiaâ€. Indian Journal of Medical Microbiology July 2002; 20(3): 156-159.
5. Kumhar GD, Ramachandran VG and Gupta P. Bacteriological analysis of blood culture isolates from neonates in a Tertiary Care Hospital in India. J Health Popul Nutr, Dec 2002; 20(4):343-347.
6. AH Movahedian, R Moniri, Z Mosayebi. “Bacterial Culture of Neonatal Sepsisâ€. Iranian J Public Health 2006; 3 5(4): 84-89.
7. S Bhattacharya. “Blood Culture in India: A Proposal For A National Programme For Early Detection of Sepsisâ€. Indian Journal of Medical Microbiology 2005; 23 (4):220-226.
8. Rajlakshmi Viswanathan et al. “etiology and Antimicrobial resistance of neonatal Sepsis at a Tertiary Care Centre in Eastern India: A 3 year Studyâ€. Indian JPediatr 201 l April; 78(4):40-42.
9. Tsering DC, Chanchal L, Pal R, Kar S. Bacteriological Profile of septicemia and the risk factors in neonates and infants in Sikkim. J Glob Infect Dis. Jan-Mar2011; 3(1):42-45.
10. PrabhuK,Bhat S and Rao S. Bacteriological profile and antibiogram of blood culture isolates in a pediatric care unit. J of Lab Physicians. 2010 Jul-Dec; 2(2):85-88.
11. Shashikala S. Tallur, Kasturi AV, Shobha D. Nadgir, Krishna BVS. “Clinico bacteriological Study of Neonatal Septicemia in Hubliâ€. Indian J Pediatr 2000; 67(3): 169-174.
12. Bambala Puthattayil Zakariya, Vishnu Bhat, Belgode Narasimha Harish, Thirunavukkarasu Arun Babu, Noyal Mariya Joseph. “Neonatal Sepsis in a Tertiary Care Hospital In South India: Bacteriological Profile and Antibiotic Sensitivity Patternâ€. Indian J Pediatr April2011; 78(4): 413-417.
13. Madhu Sharma, Nidhi Goel, Uma Chaudhary, Ritu Aggarwal, Arora OR. “Bacteremia in Childrenâ€. Indian J Pediatr Dec 2002; 69 (12): 1029-1032.
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Effect of modulation of environment of learning by ‘Mantra-Meditation’ in MBBS students
Introduction: Learning is a multidimensional and dynamic process requiring a stress free and relaxed environment. There is some evidence in literature that meditation could positively influence memory and help medical students in reducing stress. Chanting of mantra is basically mind oriented with minimum body activity involvement, passive method of meditation Aims: At the end of ‘Mantra-Meditation’ technique, for three lectures, to assess the effect of ‘Mantra Meditation’, just prior to a learning session, on the students’ concentration towards lecture, academic performance, relaxation of mind and pulse rate. Material and Methods: Institutional Ethical Committee approval was taken. 69 students were included in the study, after taking their written informed consent. Test group- 34 Students were asked to chant mantra (Mantra-Meditation) for 8 min. at the start of the lecture, then lecture was delivered. Control group- Without Mantra-Meditation, same lecture was delivered to 35 students. Evaluation was done after three lectures by i) Students’ feedback questionnaire- ii) Multiple choice question test- was carried out before and after third lecture in both groups . iii) Discussion with students iv) ‘Pulse rate per minute’ of each student was recorded, before and after entire session. Statistical analysis used: Analysis of the difference in the performance in MCQ tests between two groups was done using independent samples t test. The change in pulse rate was analysed using paired t test. Results: In MCQ tests, difference in students' post MCQ test scores between control and test group was not statistically significant. But pre MCQ test score of meditation group was significantly better than control group. Significant number of students of mantra meditation group reported to be more attentive, relaxed, increase in concentration towards lecture, reduction in thoughts and in wandering of mind. There was significant reduction in mean pulse rate in mantra meditation group. Conclusions: This simple and easy mantra meditation could be adopted to enhance student learning.
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25. Perlman DM, Salomons TV, Davidson RJ, Lutz A.Differential effects on pain intensity and unpleasantness of two meditation practices. Emotion.2010; 10(1):65-71.
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28. Rangan R, Nagendra H, Bhat GR. Effect of yogic education system and modern education system on memory. Int J Yoga. 2009; 2(2):55-61.
29. Lutz A, Slagter HA, Rawlings NB, Francis AD, Greischar LL, Davidson RJ. Mental training enhances attentional stability: neural and behavioral evidence. J Neurosci. 2009; 21; 29(42):13418-27.
30. Tang YY, Ma Y, Wang J, Fan Y, Feng S, Lu Q, Yu Q, Sui D, Rothbart MK, Fan M,Posner MI. Short-term meditation training improves attention and self-regulation. Proc NatlAcadSci U S A. 2007; 23; 104(43):17152-6. Epub 2007 Oct 11.
A comparative study of symptomatic and radiologic findings in cases of gall bladder disease undergoing cholecystectomy
A prospective clinical study of 100 selected cases admitted in the Department. Of General Surgery, M.G.M Medical College and L.S.K. Hospital, Kishanganj during the period of July, 2012 – September, 2014 was undertaken to assess the mode of clinical presentation, laboratory and radiological impressions and finally their management. A brief review of available literature was also made. Majority cases (35%) belonged to age group of 31-40yrs with a female preponderance (F:M- 3:1) with most of the women in their child bearing age. Pain abdomen over the right hypochondrium with referred pain to the inferior angle of scapula and positive Murphy’s sign were the commonest clinical presentation followed with nausea, vomiting, flatulence and dyspepsia. Only 1 case had jaundice during the first clinical presentation. Ultrasonography of abdomen not only revealed evidence of gall stones with impressions of acute or chronic cholecystitis in 95% cases but also revealed some changes in common bile duct, liver, pancreas etc. Total WBC count was found to be elevated (mild to moderate) in 100% cases. Liver function test results- 16% cases was with elevated serum bilirubin, 24% cases with elevated alkaline phosphatase and 6% with elevated liver enzymes was observed. All cases were managed conservatively in acute phase of which 20% cases needed early operation being refractory to conservative means. Rest underwent interval cholecystectomy after 4-6 weeks. Open Cholecystectomy through right subcostal Kocher’s incision were carried out in all cases out of which Choledocholithotomy and Choledochoduodenostomy were done in 5% cases. 80% cases revealed multiple stones, 14% solitary stone and 3% sludge only. Macroscopically 60% cases showed mixed stones, 22% pigment stones and 6% cholesterol stones. Macroscopically 72% revealed gross thickening with fibrosis, 28% with congestion. Microscopically chroniccholecystitis was found in 100% cases. Bacteriological examination of gall bladder contents showed 56% to be sterile, Klebsiella sp. And Staphylococcus aureus predominant in infected cases (42%). E. coli, Enterococcus, Enterobacter were also detected. The post operative period of all cases were uneventful except pain abdomen and wound sepsis in few. There was no mortality and significant morbidity.
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2. Anil kumar Sakalecha, D.B. Udoshi. To evaluate the role of real time, gray scale B-mode ultrasonography in patients of acute cholecystitis. A cross sectional study. Jawaharlal Nehru Medical College, Belgaum, 2001
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A comparative study of phosphate binders in patients of end stage kidney disease undergoing haemodialysis
Introduction: Hyperphosphatemia is one of the complication in patients with chronic kidney disease on long term haemodialysis which will add on to the morbidity and mortality of the patient. This study was conducted in an attempt to compare the efficacy of phosphate binders prescribed to the patients of end stage kidney disease undergoing haemodialysis. It was a retrospective study in which medical records of patients with ESKD who received phosphate binders over past 2 years (2013 and 2014) were included in the study and divided into groups receiving sevelemer, calcium carbonate and calcium acetate and their baseline serum phosphate levels were compared with serum phosphate levels after 8weeks of treatment and found that at the end of 8th week the difference in control of phosphate levels in sevelemer group compared with control group was highly significant with a p value of 0.003. The difference in control of phosphate levels in the calcium carbonate group compared with control group also had a significant result with p value 0.039. There were no significant differences in calcium acetate and control group with respect to serum phosphate level difference at the end of 8th week. There were no statistically significant differences between individual groups. Conclusion: Our study confirms that phosphate binders significantly control the serum phosphate levels over a period of eight weeks treatment in ESKD patients on haemodialysis. However sevelemer was found to be more effective in controlling the serum phosphate levels but its high costs limits its use for the poor socioeconomic population.
1. Block GA, Hulbert-Shearon TE, Levin NW, Por FK. Association of serum phosphate and calcium × phosphate product with mortality risk in chronic hemodialysis patients: A national study. Am J Kidney Dis 1998; 31:607-17.
2. Burke SK, Amin NS, Incerti C, Plone MA, Lee JW. Sevelamer hydrochloride (Renagel), a phosphate-binding polymer, does not alter the pharmacokinetics of two commonly used antihypertensives in healthy volunteers. J ClinPharmacol. 2001;41(2):199–205
3. Chertow GM, Burke SK, Raggi P, Treat to Goal Working Group Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62(1):245–252
4. Amiri FS. Contemporary management of phosphorus retention in chronic kidney disease: a review. ClinExpNephrol. 2015 Jun 2. [Epub ahead of print] PubMed PMID: 26032778.
5. Tonelli M. Serum phosphorus in people with chronic kidney disease: you are what you eat. Kidney Int 2013; 84:871.
6. Stevens LA, Djurdjev O, Cardew S, et al. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am SocNephrol 2004; 15:770.
7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney IntSuppl 2009; :S1.
8. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42:S1.
9. Fournier A, Morinière P, Ben Hamida F, et al. Use of alkaline calcium salts as phosphate binder in uremic patients. Kidney IntSuppl 1992; 38:S50.
10. Delmez J, Block G, Robertson J, et al. A randomized, double-blind, crossover design study of sevelamer hydrochloride and sevelamer carbonate in patients on hemodialysis. ClinNephrol 2007; 68:386.
11. Agarwal N. Phosphate binders in CKD – Past, Present, and Future. J Indian AcadClin Med 2009; 10:43-5.
12. Caravaca F, Santos I, Cubero JJ, et al. Calcium acetate versus calcium carbonate as phosphate binders in hemodialysis patients. Nephron 1992; 60:423-7.
13. Schaefer K, Scheer J, Asmus G, Umlauf E, Hagemann J, von Herrath D. The treatment of uraemichyperphosphataemia with calcium acetate and calcium carbonate: A comparative study. Nephrol Dial Transplant 1991; 6:170-5.
14. Ben Hamida F, el Esper I, Compagnon M, Moriniere P, Fournier A. Long-term (6 months) cross-over comparison of calcium acetate with calcium carbonate as phosphate binder. Nephron 1993; 63:258-62.
15. Delmez JA, Tindira CA, Windus DW, et al. Calcium acetate as a phosphorus binder in hemo- Phosphate binders in patients with ESRD undergoing hemodialysis 537 dialysis patients. J Am SocNephrol 1992; 3:96- 102.
16. Chertow GM, Burke SK, Raggi P. Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62:245- 52.
17. Panichi V, Rosati A, Di Giorgio A, Scatena A, Bigazzi R, Grazi G, Migliori M, Paoletti S, MancaRizza G, Casani A, Sgambato A, Ruggeri M. A pharmacoeconomic analysis of phosphate binders cost-effectiveness in the RISCAVID study. Blood Purif. 2015; 39(1-3):174-80.
18. Meinero S, Alloatti S, Triolo G, et al. Withdrawing or discontinuing chronic dialysis in adult patients. G ItalNefrol. 2007; 24:43–50.
19. Johnson CA, Levey AS, Coresh J, et al. Clinical practice guidelines for chronic kidney disease in adults, Part I: definition, disease stages, evaluation, treatment and risk factors. American Family Physician. 2004; 70:869–76.
20. Fitzgerald JT, Schanzer A, Chin AI, et al. Outcomes of upper arm arteriovenousfistulas for maintenance hemodialysis access. Archives of Surgery. 2004; 139:201–8.
21. Vazquez I, Valderrabano F, Jofre R, et al. Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. Journal of Nephrology.
Potential drug interactions in chronic kidney disease patients - A cross sectional study
Chronic kidney disease (CKD) is a major systemic condition whose prevalence is rising in India. Presence of comorbid conditions like hypertension, diabetes mellitus, metabolic bone disease and electrolyte disturbances along with the deteriorating renal function makes the management of CKD complex .The aim of this study was to assess the pattern of drug drug interactions in CKD patients. This was a prospective cross sectional study conducted in a tertiary care medical hospital in India. A total of 120 patients were enrolled and the list of drug interactions in them was analysed using drug interaction software. The mean age of the study group was 58.53±8.38 years. Hyperphosphataemia, hypertension and diabetes mellitus were among the frequently associated comorbid illnesses.146 potential drug drug interactions (PDDI) were found with an average of 2.39 interactions per patient. Of these 38.14% were mild, 45.36% were moderate and 16.41% were severe. Hypotension, hypertension, hyperkalemia, hypokalemia, anemia, hyperphosphatemia, hyperuricemia were among the commonest outcomes of interactions. Sodium bicarbonate, ferrous sulfate, calcium carbonate, aspirin, pantoprazole, allopurinol were the drugs commonly involved in PDDI. There was a positive correlation between the age and number of interactions (Karl Pearson correlation coefficient: 0.607; p value<0.001) and the number of tablets and number of interactions (karl pearson coefficient: 0.876; p value<0.001). The prevalence of PDDI among CKD patients in this study was high (80.83%). Hence, rational prescription, early detection of harmful drug combinations and careful monitoring of these patients can prevent the occurrence of drug interactions.
1. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013; 382:260–72.
2. Modi GK, Jha V. Incidence of End stage renal disease in India: a population based study. Kidney Int. 2006 Dec; 70(12):2131-3.
3. KDIGO. Chapter 1: Definition and classification of CKD. Kidney Int Suppl 2013; 3:19. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf (last accessed on July 25, 2015).
4. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008; 35:329–344.
5. Olyaei AJ, Bennett WM. Drug dosing in the elderly patients with chronic kidney disease. Clin Geriatr Med. 2009 Aug; 25(3):459-527. doi:10.1016/j.cger.2009.04.004. Review.
6. Mahmood M, Malone DC, Skrepnek GH, Abarka J, Armstrong EP, Murphy JE, et al. Potential drug-drug interactions within veterans affairs medical centers. Am J Health Syst Pharm. 2007; 64:1500–5.
7. Doubova Dubova SV, Reyes-Morales H, Torres-Arreola Ldel P, Suárez-Ortega M. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007 Sep 19; 7:147.
8. Marquito AB, Fernandes NM, Colugnati FA, de Paula RB. [Identifying potential drug interactions in chronic kidney disease patients]. J Bras Nefrol. 2014 Jan-Mar; 36(1):26-34.
9. Chavda NB, Solanky PP, Baria H, Naik R, Bharti K. Study of potential drug–drug interaction between prescribed drugs in patients attending outpatient department of medicine at tertiary-care hospital in south Gujarat region. Natl J Physiol Pharm Pharmacol. 2015; 5(3): 236-242. doi:10.5455/njppp.2015.5.0508201428.
10. Rama M, Viswanathan G, Acharya LD, Attur RP, Reddy PN, Raghavan SV. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital. Indian J Pharm Sci. 2012 Jan; 74(1):63-8.doi: 10.4103/0250-474X.102545.
11. Vyas A, Pan X, Sambamoorthi U. Chronic Condition Clusters and Polypharmacy among Adults. Int J Family Med 2012; 2012:193168.
12. Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, et al. Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (São Paulo) 2011; 66: 1867-72.
13. Weir MR, Fink JC. Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens. 2014 May; 23(3):306-13. doi: 10.1097/01.mnh.0000444912.40418.45. Review.
14. Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis 2005; 46:669-80.
Urinary tract infection in children in Chennai- Mangadu area
Urinary tract infections are the most frequent bacterial infections. They occur most frequently in female children and uncircumcised male children.10% of female getting an infection yearly and 60% get infection in some point of their life. Recurrences are common. Infection occurs four times more frequently in female than male sex. Urinary tract infection affects 10% of people during childhood. It is necessary to have the spectrum of infecting bacteria and antibiotic sensitivity pattern in the particular area, so that the treating physician is capable of treating the disease easily. That is the reason the author has taken this topic. Introduction in United States of America, urinary tract infection accounts for nearly seven million office visits, and one million emergency department visits. One hundred thousand hospitalisation every year. The cost of these infections is significant in terms of lost time at work and cost of medical care. In united states, the direct cost of treatment is estimated at 1.6 billion U.S. Dollars yearly. Urinary tract infections have been described since ancient times with first documented description in the ebers papyrus to 1550 b. c., it was described by egyptians as: sending forth heat from the bladderâ€. Effective urinary tract infection treatment did not develop until the discovery of antibiotics in 1930. Before which time herbs, bloodletting and rest were re commended.
1. Dai,B; liu, Jia, J;mei;c(20010) long term antibiotics for prevention of urinary tract infections in children . A. systemic review and meta analysis::Archives of disease in childhood 95(7)499-508.doi:10.1136/adc.2009.173112(http://www.ncbi.nlm.nih.gov/pubmed/20457696)
2. Jaganath, VA; Fedorowicz, Z; Sud,V; Verma, AK; Hajebrahimi, S.(november14, 2012) routine neonatal circumscision for prevension of urinary tract infection in infancy. cochrane database of systematic reviews(online)11:cd009129.doi:10.1002/14651858cd009129.pub(http:wwwncbi.nlm.nih.gov/pubmed/23152269)
3. Ambedekar, S. Singh, D D (November 2011) diagnosis and management of urinary tract infection. Current microbioglogy63(5):484-90.doi:10.7861/clinmedicine.11-1-80(http:dx.doi/.org./10.1007/2fs00284-011-006-2). (http:www.ncbi.nlm.nih.gov(pub med//21901556)
4. Bhat, RG: Katy, Taplace, (august2001).pediatric urinary tract infection.-emergency medicine clinics of north america 29(3); 637-53.doi:10.1016/j.emc.2011.04.004 (http://doi.org/10.1016%2fj.emc.2011.04.004).
5. Karmwr, ED. By a. Barry belman; Stephen a. (Clinical pediatricurology (2002). (http://books.gooble.ca/books?id=pa338)(4.ed.ed.)London:dunitz.p.338.isbn3781901865639.
6. Engleberg, N C; Dirita, V; Dermody, T S (2007) Schachters mechanism of microbial Disease. Baltimore: lippincott Williams and wilkins. ISBN 978-0 7817-5342-5.
7. Cubeddu, Richard Finkel, Michelle A. Clark, luigix (2009) pharmacology (http://books. Google. ca/books?id=q4hg2rhy7ocandpg=pa397)(4thed.ed.)Philadelphia: lippin cot Williams and wilkins.p.397 isbn 9780781771559.
Single incision two ports and two slings technique of laparoscopic cholecystectomy – A retrospective analysis of our practise
Background: Since the advent of Single incision laparoscopic surgery, there has been genuine effort from the Laparoscopic fraternity to improvise the technique and make it safe, lesser discomfort and cost effective for the patients. One such effort is the use of standard laparoscopic trocars and instruments in accomplishing Single incision laparoscopic surgery. Various modifications have been introduced by various surgeons all over the world. Our modification is the first instance in literature, where cholecystectomy using standard laparoscopic instruments in single incision, has been done with only two ports. Here we analyse the expediency, safety, benefits, and drawbacks of our practice. Methods: For a duration of 2 years, 65 patients with cholelithiasis without any complications were operated upon by our modified single incision laparoscopic technique. Results were analysed. Results: All 65 patients were successfully operated upon by SITPS (Single incision two ports and two slings) technique. VAS score <4 in 64 patients and >5 in one patient. There was no significant postoperative complications. Seven patient had port site edema. No patient had port site infection. There was no incidence of port site hernia after one year follow up. Conclusion: SITPS technique of laparoscopic cholecystectomy is a technically feasible and safe alternative to standard laparoscopic approach, with reduced postoperative pain, with no visible scar and hence cosmetically superior.
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2. Chow, A., et al., Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surg Endosc, 2010. 24(3): p. 709-14.
3. Hodgett, S.E., et al., Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg, 2009. 13(2): p. 188-92.
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5. Romanelli, J.R., et al., Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc, 2010. 24(6): p. 1374-9.
6. Sinha, R. and A.S. Yadav, Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study. J Minim Access Surg, 2014. 10(4): p. 175-9.
7. Majeed, A.W., et al., Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet, 1996. 347(9007): p. 989-94.
Does hypovitaminosis D have a role in lipid profile alteration among non-obese diabetics?
Objective: The prevalence of hypovitaminosis D among diabetics is very high with it being an adjuvant causative factor. It has been shown in few studies that hypovitaminosis D has an impact on lipid profile of diabetic patients but most of the studies haven’t excluded the confounding factor viz. obesity. It is a known fact that obesity has a major role in development of hypovitaminosis D. So in our study, we try to find out whether the association between hypovitaminosis D and lipid profile exists even after excluding obesity in diabetics. Materials and Methods: It is a cross section study conducted in 55 Non-obese diabetics. We had measured serum FBS, vitamin-D, urea, creatinine, lipid profile and urinary microalbumin. Results: We found a negative correlation between vitamin-D with that of TGL (r: -0.337; p<0.012) and VLDL (r: -0.190; p<0.011). There was no association found between hypovitaminosis D with that of cholesterol, HDL and LDL. Conclusion: From our study it’s clear that hypovitaminosis D is associated with TGL and VLDL even after excluding obesity.
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2. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdiaDIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec; 54(12):3022–7.
3. Bender DA. Micronutrients: Vitamins and Minerals. Harper’s illustrated biochemistry. 30th ed. McGraw Hill Education; p. 551–3.
4. Forouhi NG, Ye Z, Rickard AP, Khaw KT, Luben R, Langenberg C, et al. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updated meta-analysis of prospective studies. Diabetologia. 2012 Aug; 55(8):2173–82.
5. Hurskainen A-R, Virtanen JK, Tuomainen T-P, Nurmi T, Voutilainen S. Association of serum 25-hydroxyvitamin D with type 2 diabetes and markers of insulin resistance in a general older population in Finland. Diabetes Metab Res Rev. 2012 Jul; 28(5):418–23.
6. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J ClinEndocrinolMetab. 2007 Jun; 92(6):2017–29.
7. Department of paramedical Sciences, School of Applied Medical Sciences, Lovely Professional University (Punjab) India, Maaji SU, Prabhakar PK. Hypovitaminosis d in type-2 diabetes melitus patients; variation with age, sex AND SEASON. Indian Journal of Applied Research. 2011 Oct 1; 4(6):422–5.
8. Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007 Jun 11; 167(11):1159–65.
9. Botella-Carretero JI, Alvarez-Blasco F, Villafruela JJ, Balsa JA, Vázquez C, Escobar-Morreale HF. Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity. ClinNutr. 2007 Oct; 26(5):573–80.
10. Jorde R, Figenschau Y, Hutchinson M, Emaus N, Grimnes G. High serum 25-hydroxyvitamin D concentrations are associated with a favorable serum lipid profile. Eur J ClinNutr. 2010 Dec; 64(12):1457–64.
11. Gonzalez Molero I, Rojo G, Morcillo S, Gutierrez-Repiso C, Rubio E, Soriguer F, et al. Vitamin D deficiency and obesity. Atherosclerosis. 2014 Aug 1; 235(2):e212.
12. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J ClinNutr. 2000 Sep 1; 72(3):690–3.
13. Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007 Jun 11; 167(11):1159–65.
14. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes MetabSyndrObes. 2013 Sep 17; 6:327–38.
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16. Saedisomeolia A, Taheri E, Djalali M, Moghadam AM, Qorbani M. Association between serum level of vitamin D and lipid profiles in type 2 diabetic patients in Iran. J Diabetes MetabDisord. 2014; 13(1):7.
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19. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J ClinEndocrinolMetab. 2007 Jun; 92(6):2017–29.
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A rare case of kimura’s disease presenting as posterior auricular swelling
S Deivanayagam, Vinod Balaji, Jawahar, Yeshwanth Kumar
Kimura's Disease is a chronic inflammatory disorder of unknown etiology commonly seen among people who live in the Middle and Far East countries; characterised lymphatic follicles, vascular proliferation, and marked eosinophilic infiltration by histologically. It is mainly seen on the head and neck region. The lesion is benign but might be confused with malignant lesions. Kimura's Disease is often seen in the second and third decades of life. This disease is characterised by a blood and tissue eosinophilia, markedly elevated serum IgE levels, painless subcutaneous mass and regional lymphadenopathy on the head and neck region. In this report, we present a 14 yr old boy who was admitted to our hospital with bilateral post auricular swelling for 4 yr duration. Bilateral postauricular masses were excised under general anaesthesia and Kimura's disease was diagnosed by histopathological examination of these lesions.
Maxillary central incisors usually have one root canal. The cases with two root canals with type IV vertucci canal configuration are extremely rare. Internal morphology of the root canals is variable and often complex. Better understanding of root canal complex is very essential for a clinician to ensure proper treatment. Computed tomography plays an excellent role in diagnosing such anatomical variations.
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Comparative study of RR, PR and JT intervals during the different phases of menstrual cycle
Aim: Cardiac functions are influenced by gender and gonadal steroids. Ventricular arrhythmias are more common in women and seem to exhibit during the menstrual cycle. JT interval is major component of QT interval. It measures ventricular repolarization. According to literature, estrogen lengthens the JT interval. Hormonal changes during menstrual cycle may cause changes in ECG intervals. Objective: The objective of the present study is to evaluate the effect of different phases of menstrual cycle on the RR, PR and JT intervals of ECG. Methods: This is a prospective study among a cohort of 30 healthy female students, who were aged 18-22 years and had regular menstrual cycles over past six months. Subjects were monitored on three separate occasions during two consecutive menstrual cycles. ECG was recorded for 5 minutes in Lead –II using Power lab multichannel polygraph instrument, once during every phase. The computerized recordings of RR, PR and JT intervals thus obtained were analyzed statistically using pooled t test, probability < 0.05 to assess if any significant difference existed in these parameters during the different phases of menstrual cycle. Results: This study did not show any statistically significant variation in RR, PR and JT intervals between the menstrual, follicular and luteal phases of the menstrual cycle. Conclusion: It may be concluded that there was no statistically significant variation in RR, PR and JT intervals during different phases of the menstrual cycle which may be due to the small sample size.
1. Sex and gender differences in Pharmacology by Vera Regitz, Zagrosek. Handbook of experimental pharmacology.2012.(e book)
2. Richard S. Crow, Peter J. Hannan et al. “ Prognostic Significance of Corrected QT and Corrected JT Interval for Incident Coronary Heart Disease in a General Population Sample Stratified by Presence or Absence of Wide QRS Complexâ€.Circulation.Sep2003;108
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5. Banker J, Dizon J, Reiffel J. Effects of the ventricular activation sequence on the JT interval. Am J Cardiol. 1997; 79: 816–819.
6. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. 1987. Menopause and the risk of coronary heart disease in women. N Engl J Med 316: 1105-1110.
7. Minson CT, Halliwill JR, Young TM, Joyner MJ. 29 Feb 2000. Influence of International Journal of Health Sciences and Research (www.ijhsr.org) 40 Vol.3; Issue: 6; June 2013 the menstrual cycle on Sympathetic activity, baroreflex Sensitivity, and vascular transduction in young women. 1: Circulation. 101(8): 862-868.
8. Tada H, Sticherling C, Chough S P et al, “Gender and age differences in induced atrial fibrillationâ€. American J cardiology: 2001Aug: 88(4):436-8.
9. Rosano G.M, Leonardo F, Sarrel P.M et al. “Cyclical variation in paroxysmal supraventricular tachycardia in women.†Lancet 1996 347:786-8.
10. Pham TV, Robinson R B,Danilo P Jr, Rosen MR, Effects of gonadal steroids on gender related differences in transmural dispersion of Ltype of calcium current. Cardiovasular research 2002;53:752-63
11. ShanmugalKarthic,Kandanbalmurugeshan,StalinVishwanathan,Vishnokumarsivaji et al, “Role of gender and menstrual cycle on Heart rate variability, QTc and JT intervals†International Journal Of Scientific Study ǀMarch 2015ǀ volume 2ǀissue 12.
12. Rajeshwari L, C P Ganashree, Anithu C and A R Gorkal. “Comparative study of heart rate, QT and QTc intervals during the different phases of the menstrual cycle. International journal of Health and Allied Sciences, July-sep 2014:3(3):154-158.
A study of effect of injection drotaverine hydrochloride in agumentation of labour
Maya Narayan Arvikar, Prashant C Patil, Shubhangi Choudhari
Background: The common cause of prolonged first stage of labour is cervical dystocia. Many a times inspite of good utrine contractions cervix fails to dilate or dilates very slowly. In modern obstetrics the passive concept of watchful expectancy has long been abandoned and replaced by intensive care. Objectives: To study the effect of injection drotaverine hydrochloride in augmentation of first stage of labour. Material and Methods: Study was conducted in Dr. Ulhas Patil Medical College and Hospital Jalgaon, Kh, Maharashtra. Total uncomplicated 140 full term patients were studied, 70 patients with injection drotaverine hydrochloride and 70 controls. In both the groups 35 primigravidas and 35 multigravidas each. Results and Conclusion: Injection Drotaverine Hydrochloride during active phase of labour increases rate of cervical dilatation and decreases duration significantly.
1. IAN Donald practical obstetrics problems 6th edition
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8. Poomima R Ranka, Varsh A Hishikar. Effect of drotaverine hydrochloride on normal labour A randomized study. J of Obstet gynec India 2002; 52(6):28-30.
A study of knowledge on osteoporosis among peri –menopausal women in an urban slum area of Berhampur
Background: Osteoporosis, a condition characterized by decreased bone strength, is prevalent among perimenopausal women as a major risk factors. world wide it causes more than 8.9 million fractures annually. Aims and Objectives: aimed to assess the knowledge on osteoporosis among peri menopausal women in urban slum area of southern Odisha Material and Methods: It was a cross-sectional study carried out in slum area of Berhampur, Odisha between September 2013 to February 2014. The study population include all the peri-menopausal women in the slum area. Sample size taken as 369. data was collected from a structured pre tested and pre designed questionnaire. The data was analysed SPSS version 16.0. p value less than 0.05 was taken to be statistically significant. Results and Conclusion: majority of the women (75%) were in the age group 51-60yr and (42%) of women had no formal education. By occupation 32% were daily labourer. As per average family income, 24% belonged to the income group of more than Rs.5000/- per month. regarding source 36% had known about osteoporosis from health personnel. About 48% opined that osteoporosis is a disease of bone. 72% women agreed old age to be a risk factor for it. 44% knew that back pain as a major symptom of the disease. Only 28% knew that calcium rich foods can prevent osteoporosis. The study shows limited knowledge on understanding of osteoporosis and it’s preventive measures suggested this as a evidence to be used for future correspondence. In the community : knowledge on osteoporosis among peri-menopausal women is very low and it is significantly associated with factors like age, occupation. The symptoms of osteoporosis submerged in the population like a tip of ice berg which is expressed only in the form of fracture or serious complications. Also the literacy does not make any difference as per our observation
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11. Mohamed SG, Tayel DI. Dietary behaviour toward osteoporosis among women in a slum area influenced by nutritional knowledge and stages of precaution adoption model. J American Sci 2012; 8(8):222-227.
12. Ungan M, Tumer M. Turkish women’s knowledge of osteoporosis. Family practice 2001; 18:199-203.
13. Ford Allison M, Bass M, Zhao Y, Jin-Bing Bai, Yue Zhao. Osteoporosis knowledge, self-efï¬cacy, and beliefs among college students in the USA and China. SAGE-Hindawi Access to Research Journal of Osteoporosis 2011; Article ID 729219, 1-8.
14. Ellen Townsend Edmonds. Osteoporosis - knowledge, beliefs, and behaviors of college students: utilization of the health belief model. A dissertation 2009; Department of Health Sciences in the Graduate School of The University of Alabama Tuscaloosa, Alabama
15. Abushaikha L, Omran S Barrouq L. Osteoporosis knowledge among female school students in Jordan. Eastern Mediterranean Health Journal 2009;Vol. 15, No. 4:906-11
16. Puttapitakpong P, Chaikittisilpa S, Panyakhamlerd K, Nimnuan C, Jaisamrarn U, Taechakraichana N. Inter-correlation of knowledge, attitude, and osteoporosis preventive behaviors in women around the age of peak bone mass. BMC Women's Health 2014; 14:35:1-4.
Intrathecal block for breast augmentation surgery in poland’s syndrome: A case report
Breast augmentation is an increasing popular day case procedure. Local infiltration anaesthesia with sedation is routinely used for it’s ease of application as compared to more complex and potentially riskier intrathecal block. We hypothesized that intrathecal isobaric ropivacaine by experienced anaesthetist was more effective than local anaesthesia with sedation, in view of adequate sensory blockade. Intrathecal Isobaric ropivacaine which is less cardiotoxic produces more sensory blockade over motor blockade as compare to intrathecal hyperbaric bupivacaine which is most popular anaesthetic drug for spinal anaesthesia. Moreover ropivacaine needs less dose and does not require head low position to achieve higher level of blockade as compare to bupivacaine since it is isobaric in nature. we present a case of unilateral breast augmentation of a women, successfully performed by the application of intrathecal block without any complication.
1. Singh S, Singh VP, Jain M, Gupta K, Rastogi B, Abrol S. Intrathecal 0.75% isobaric ropivacaine versus 0.5% heavy bupivacaine for elective caesarean section delivery: A randomized controlled trial. J Pak Med stud 2012, 2(2):75-80.
2. McClellan KJ, Faulds D. Ropivacaine- An update of its use in regional anaesthesia. Drugs 2000; 60(5): 1065-93.
3. Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anaesthesia: Comparision of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiol Belg. 2008;59(2): 65-71.
4. Lirk P, Kleber N, Mitterschiffthaler G, Keller C, Benzer A, Putz G. Pulmonary effects if bupivacaine, ropivacaine and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery :A randomized controlled study. Int J Obstet Anesth 2009; 19: 287-92.
Cytodiagnosis of Gouty Tophi – Case report
A D Jungare, S A Jungare, U D Suryawanshi, B B Sonawane
Gout is a clinical syndrome which is characterized by hyperuricemia and recurrent acute arthritis. Accumulation of tophi in joints triggers the inflammatory response of gouty arthritis. We report here a case of gouty tophi diagnosed by fine needle aspiration, along with review of literature. A 53 year old male presented with multiple subcutaneous nodules on both feet. The nodules were firm and nontender. Fine needle aspiration was diagnostic as it revealed granular amorphous material and scattered stacks and sheaves of slender needle shaped crystals few histocytes and chronic inflammatory cells. Radiographs of both feet showed extensive soft tissue swellings with underline bone erosion. The serum uric acid levels were found to be raised confirmed diagnosis. Fine needle aspiration is an effective tool in the diagnosis of gouty tophi. Difficulties in management can be avoided by using the fine needle aspiration technique.
1. Koley S, Salodkar A, Choudhary S, Bhake A, Singhania K, Choudhary M. Tophi as first manifestation of gout. Indian J Dermatol Venereol Leprol 2010;76:393-6
2. Agrawal K, Pahuja S, Agrawal C, Harbhajanka A. Fine needle aspiration cytology of gouty tophi with review of literature. J Cytol 2007;24:142-5
3. McCarty DJ. Gout without hyperuricemia. JAMA 1994;271:302-3
4. Porkodi R, Parthiban M, Rukmangatharajan S, Kanakarani P, Rajendra CP. Clinical spectrum of gout in South India. J Indian Rheumatol Assoc. 2002;10:61-3.
5. Thissen C A, Frank J, Lucker GP. Tophi as first clinical sign of gout. Int J Dermatol 2008; 47:49-51a.
6. Schlesinger N, Norquist JM, Waqtson DJ. Serum urate during acute gout. J Rhematol 2009;36:1287-9
7. Rege J, Shet T, Naik L. Fine needle aspiration of tophy for crystal identification in problematic cases of gout. A report of two cases. Acta Cytol 2000;44:433-6.
Breakage of the tip of a flipcutter during ACL reconstruction: A rare complication of the knee arthroscopy
We report a case of broken tip of the reprocessed flipcutter guide pin (arthrex, Naples, FL ) while drilling the tibial socket for the ACL reconstruction. The complication was identified immediately and the broken instrument removed piece meal. We have not come across such a case in the literature and it is the first report of its kind to our knowledge. Repeated use of flip cutter is to be avoided to prevent such hazards. Also care should be taken to lock the blades properly before starting to drill the sockets. Although instrument breakage is a rare complication during knee arthroscopy, orthopaedic surgeon should be aware of this complication and methods to deal with it.
1. Öztekin HH. An unusual complication of knee arthroscopy: an extra-articular migrated asymptomatic broken probe from the knee joint. Arch Orthop Trauma Surg. 2005 May 1;125(4):285–7.
2. Lynch JL, Anderson K. Anterior Cruciate Ligament Reconstruction: All-Inside Reconstruction. Oper Tech Sports Med. 2013 Mar;21(1):40–6.
3. Lubowitz JH, Amhad CH, Anderson K. All-Inside Anterior Cruciate Ligament Graft-Link Technique: Second-Generation, No-Incision Anterior Cruciate Ligament Reconstruction. Arthrosc J Arthrosc Relat Surg. 2011 May;27(5):717–27.
4. Allum R. Complications of arthroscopy of the knee. J Bone Joint Surg Br. 2002 Sep;84(7):937–4
Screening of Glucose-6-Phosphate Dehydrogenase deficiency in Neonates
Introduction: Glucose – 6 – phosphate dehydrogenase (G-6-PD) is an enzyme that participates in the first step of Hexose monophosphate pathway of glucose metabolism. Deficiency of this enzyme is most common genetic disorder in India. Its deficiency causes hemolysis which eventually lead to acute haemolytic anemia and neonatal jaundice. The hemolysis in these deficient patients are triggered by bacterial, viral infections, drugs like aspirin and chloroquine, foods like fava beans Period from after birth to first 4 weeks is the neonatal period and the child is called a neonate. There is no cure for G-6-PD.Early detection and prevention of hemolytic episodes by avoiding the triggers is the only cure for this deficiency. Aim: To screen the neonates for glucose -6-Phosphate dehydrogenase deficiency so as to prevent the morbidity and mortality occurring due to this deficiency. Material and Methods: One Thousand neonatal blood sample were obtained from the Labour room, of the civil Hospital of vasai. The samples were analysed by Dye Decolourization method. Results: Of the 1000 samples, 10 was found to be G-6- PD deficient and 20 were found to be G-6-PD deficiency carriers. Conclusion: G-6-PD deficiency is common in Adivasi Population.G-6-PD deficiency testing should be done as a screening procedure at least in Adivasi residing areas as early diagnosis and prevention is the only way of treating this deficiency disorder and avoiding its complications.
Introduction: Glucose – 6 – phosphate dehydrogenase (G-6-PD) is an enzyme that participates in the first step of Hexose monophosphate pathway of glucose metabolism. Deficiency of this enzyme is most common genetic disorder in India. Its deficiency causes hemolysis which eventually lead to acute haemolytic anemia and neonatal jaundice. The hemolysis in these deficient patients are triggered by bacterial, viral infections, drugs like aspirin and chloroquine, foods like fava beans Period from after birth to first 4 weeks is the neonatal period and the child is called a neonate. There is no cure for G-6-PD.Early detection and prevention of hemolytic episodes by avoiding the triggers is the only cure for this deficiency. Aim: To screen the neonates for glucose -6-Phosphate dehydrogenase deficiency so as to prevent the morbidity and mortality occurring due to this deficiency. Material and Methods: One Thousand neonatal blood sample were obtained from the Labour room, of the civil Hospital of vasai. The samples were analysed by Dye Decolourization method. Results: Of the 1000 samples, 10 was found to be G-6- PD deficient and 20 were found to be G-6-PD deficiency carriers. Conclusion: G-6-PD deficiency is common in Adivasi Population.G-6-PD deficiency testing should be done as a screening procedure at least in Adivasi residing areas as early diagnosis and prevention is the only way of treating this deficiency disorder and avoiding its complications.
Serum cortisol levels in critically Ill versus non-critically Ill patients
This case control study was undertaken to compare the early morning venous serum cortisol levels between 40 cases of critically ill (group A) vs non critically ill (group B) patients admitted to a tertiary teaching hospital for a duration of one year. It was found that there was significant increase in the serum cortisol levels among critically ill (mean 33.68 μg/dl ±15.93) as compared to non critically ill (mean 15.93 μg/dl ± 5.93) patients.
Studies have shown that biochemical, clinical and ultrasonographic parameters alone or together have good predictive power for non-invasively assessing the presence of esophageal varices. Here we studied the correlation of right liver lobe diameter to albumin ratio as a predictor of esophageal varices in 50 patients of cirrhosis admitted to medicine wards of tertiary teaching hospital. Considering the right liver lobe/albumin ratio cut-of value of 4.425 as suggested by Tamara Alempijevic et al., our study yielded a sensitivity of 83.3% and specificity of 29.5%
1. Y. Iwakiri “Vascular endothelial dysfunction in cirrhosis,†Journal of Hepatology. 2007; 46 (5): 927-934.
2. R.J. Groszmann, G, “Beta-blockers to prevent gastroesophageal varices in patients with cirrhosis,†The New England Journal of Medicine. 2005; 353 (21): 2254-2261.
3. De Francis Natural history of portal hypertension in patients with cirrhosis. Clin. Liver Disease 2001; 5: 645-63.
4. M. Merli “Incidence and natural history of small esophageal varices in cirrhotic patients,†Journal of Hepatology. 2003; 38(3): 266-272.
5. G. D’Amico “Pharmacological treatment of portal hypertension: an evidence-based approach,†Seminars in Liver Disease. 1999; 19 (4): 475-505.
6. J.G. Abraldes “Hepatic venous pressure gradient and prognosis in patients with acute variceal bleeding treated with pharmacologic and endoscopic theray,†Journal of Hepatology. 2008; 48 (2): 229-236.
7. J. Bosch “Recombinant factor VIIa for variceal bleeding in patients with advanced cirrhosis: a randomized, controlled trial,†Hepatology. 2008; 47 (5): 1604-1614.
8. C. Villanuev “A randomized controlled trial comparing ligation and sclerotherapy as emergency endoscopic treatment added to somatostatin in acute variceal bleeding,†Journal of Hepatology. 2006; 45(4): 560-567.
9. J. Bosch “Prevention of variceal rebleeding,†The Lancet. 2003; 361: 9361: 952-954.
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12. Alempijevi, Right liver lobe/albumin ratio: Contribution to non-invasive assessment of portal hypertension. World J Gastroenterol. 2007 Oct 28;13(40):5331-5.
13. Esmat S, Can we consider the right hepatic lobe size/albumin ratio a noninvasive predictor of oesophageal varices in hepatitis C virus-related liver cirrhotic Egyptian patients . Eur J Intern Med. 2012 Apr;23(3):267-72.
14. Kara R, Towards noninvasive detection of oesophageal varices.International Journal of Hepatology Volume 2012, Article ID 343591, 9 pages doi:10.1155/2012/343591.
15. Alepijevic T Right liver lobe diameter albumin ratio: a new nonâ€invasive parameter for prediction of oesophageal varices in patients with liver cirrhosis (preliminary report).Gut. 2007 August; 56(8): 1166–1167.
Study of Glutathione S-Transferase in gastrointestinal cancer
Glutathione S-Transferase(GST) distributed widely in tissues such as liver, lung, skin, brain, intestine and placenta. Levels of enzyme detection in serum are useful for diagnosis and prognosis of human disease. Recently GST may be useful in monitoring pathogenesis of liver disease. In the present study of serum GST was significantly higher in patients with esophagus and stomach cancer as compared to those obtained from normal healthy group. Our results showed a significant increased activity of GST in stage III patients than stage II patients of both cancers; which may trigger the progression of cancer.
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8. StefaniaBoccia.et.al.GST T1 status and gastric cancer risk: a meta analysis of the literature, Mutagenesis 2006, 21 (2), 115-23.
9. Prabhu K. et. al.Serum total GST level in oral cancer J. Cancer Res 2007 3, (3), 167-168.
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Introduction of project as a learning tool in forensic medicine
Project Based Learning is a teaching method in which student gains knowledge and skills by working for an extended period of time to investigate and respond to a complex question, problem, or challenge. The aim of our study was to improve learning of Forensic Medicine in under graduate students. A batch of 100 under graduate students were given didactic lecture on injuries. After that 50 were divided into 5 batches of 10 each and allotted projects on injuries. Pretest and post test were conducted for all 100 students. The pre and post test were evaluated by student ‘t’ test. Learning gain of the project subjected group was more as compared to traditional teaching (p = 0.000). The absolute learning gain was much higher (228.80%).
1. What is project based learning (PBL)? (cited 2014 December 22). Available from: URL: http://bie.org/about/what_pbl
2. Project-based learning and telecollaboration enhances teachers confidence in Bangladesh. (cited 2014 December 22). Available from: URL: http://www.unescobkk.org/education/ict/online-resources/databases/ict-in-education-database/item/article/project-based-learning-and-telecollaboration-enhances-teachers-confidence-in-bangladesh-1/
3. Johnston JM, Schooling CM, Leung GM. A randomised-controlled trial of two educational modes for undergraduate evidence-based medicine learning in Asia. BMC Medical Education 2009;9(63):1-8.
4. Gurpinar E, Musal B, Aksakoglu G, Ucku R. Comparison of knowledge scores of medical students in problem-based learning and traditional curriculum on public health topics. BMC Medical Education 2005; 5(7):1-8.
Sympathetic cardiovascular function integrity in children with parental history of diabetes mellitus
Introduction: Type 2 DM has a strong genetic component. Individuals having parents with type 2 DM have an increased risk of diabetes; if both parents have type 2 DM, the risk approaches 40%. The autonomic nervous system regulates the electrical and contractile activity of myocardium via interplay of sympathetic and parasympathetic activity. Sympathetic nerves of heart are derived from the upper thoracic 5 segments of the spinal cord. In general, sympathetic stimulation increases the overall activity of the heart. This is accomplished by increasing both the rate and force of heart contraction. Amis and Objectives: To study Sympathetic cardiovascular Function Integrity in children with parental history of diabetes mellitus. Materials and Method: The study procedure was carried out on healthy volunteer medical students of age group 18 to 25 years. They were first categorized into two groups, control (without parental history of diabetes mellitus) and subject (with parental history of diabetes mellitus). The sample size was 70 in the control group and 70 in the subject group. All participants were examined after explaining the study procedure. The cardiovascular tests to measure cardiovascular autonomic response were performed. These tests were explained and demonstrated to the participants before performing on them. Tests Done For Assessing Sympathetic Activity were Blood pressure response to standing (Orthostasis) test, Hand grip test and QTc interval test. The mean and standard deviation (S D) was calculated for all the parameters. The data was entered using Microsoft Excel (2007). Statistical analysis was done using SPSS version 10.The statistical test used were (as per the requirement of the data). Results: The age distribution and sex distribution was nearly same in the study and control group. Mean resting pulse, mean SBP and DBP was slightly more in study group as compared to control group and the difference was not significant statistically. While assessing sympathetic activity Orthostasis and Mean QTc interval test showed no statistically significant difference in study and control group whereas sustained handgrip test showed statistically significant difference in study and control group. Conclusion: Early subclinical sympathetic autonomic neuropathy may develop in children of type 2 diabetic parents without the presence of long term hyperglycemia. It could be due to inherited susceptibility genes for sympathetic autonomic neuropathy which could be expressed before or even without development of diabetes mellitus.
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3. Ganong WF. Review of Medical Physiology. 21nd ed. New York, NY: McGraw-Hill Companies, Inc.; 2005.p. 607-608.
4. Freeman R. Cardiovascular autonomic neuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic Neuropathy. 2nd ed. Philadelphia: W B Saunders; 1999. P 541-554.
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Issue details
MRSA and MRSE: Its prevalence, antibiotic sensitivity and correlation with biofilm formation observed in various clinical isolates
Deepika Atray, Anshu Sharma, Meena Atray
Biofilm formation has become a major factor in enhancing the antibiotic resistance of staphylococci. In the present study, we observed methicillin resistance and further biofilm production by two methods – Congo red agar method and Christenson’s test tube method and compared the antibiotic resistance pattern between biofilm producers and non biofilm producers. 102 S. aureus and 168 S. epidermidis were isolated from various clinical samples with 70.5% and 79.7% methicillin resistance resp.51.4% MRSA and 61.2% MRSE were biofilm producers. Antibiotic sensitivity was observed in biofilm producing S. epidermidis and S aureus for Vancomycin (63%/85%), Doxycycline (48%/61%), Tetracycline (41%/52%), Cephalexin (19%/15%), Cefotaxime (41%/43%), Ceftrioxone (31%/37%), Cotrimoxazole (10%/11%), Ciprofloxacin (45%/52%), Amoxicillin (34%/35%), Ampicillin (4%/2%), Amoxyclave (26%/17%), Erythromycin (6%/14%), Amikacin (71%/76%), Gentamycin (66%/65%) and for urinary isolates Norfloxacin (9%/11%) and Nitrofuranoin (57%/78%) which was significantly less as compared to non biofilm producers.
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An unusual case of uterine inversion: A case report
Shreyaa A Shriram, U T Bhosale
Uterine inversion is a rare obstetric emergency. The incidence varies considerably and can range from 1 case in 2000 to 1 case in every 50,000 births. This postpartum complication has an academic importance due to its rarity and severity. When not immediately identified, the massive and often underestimated blood loss can lead to hypovolemic shock and maternal death that can reach 15% in some series. The best management options for this condition are not fully known, given the worldwide scarce experience of each obstetrical team managing this type of situation. There are several therapeutic strategies described in the literature, including drugs, manual maneuvers and surgical interventions. The aim of this article is to describe a case of complete acute uterine inversion after a normal delivery, and provide a literature review of uterine inversion, its definition, etiology, predictive and risk factors, diagnosis and treatment.
1. Dwivedi S, Gupta N, Mishra A, Pande S, Lal P: Uterine inversion: a shocking aftermath of mismanaged third stage of labour. Int J ReprodContraceptObstetGynecol 2013, 2(3):292–295. 
 2. Hostetler D, Bosworth M: Uterine inversion, a life-threatening obstetric emergency. J Am Board Fam Med 2000, 13(2):120–123. 
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 5. Pauleta R, Rodrigues R, Melo A, Graça L: Ultrasonographic diagnosis of incomplete uterine inversion. Ultrasound ObstetGynecol 2010, 36:260. 
 6. Repke J, Ramin S, Barss V: Puerperal uterine inversion – March 2013. http:// www.UpToDate.com. 
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 8. Witteveen T, Van Stralen G, Zwart J, Van Roosmalen J: Puerperal uterine inversion in the Netherlands: a nationwide cohort study. ActaObstetGynecolScand 2013, 92:334. 
 9. Hsieh T, Lee J: Sonographic findings in acute puerperal uterine inversion. J Clin Ultrasound 1991, 19:306. 
 10. Momani A, Hassan A: Treatment of puerperal uterine inversion by the hydrostatic method; reports of five cases. Eur J ObstetGynecolReprodBiol 1989, 32:281. 
 11. Neves J, Cardoso E, Araujo C, Santo S, Gonçalves P, Melo A, Rodrigues R, Pereira A: Inversão Uterina. Acta Med Port 2006, 19:181–184. 16. 
 12. Antonelli E, Irion O, Tolck P, Morales M: Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006, 113:846. 
 13. Shepherd L, Shenassa H, Singh S: Laparoscopic management of uterine inversion. J Minim Invasive Gynecol 2010, 17:255. 
 14. You W, Zahn C: Postpartum hemorrhage: abnormally adherent placenta, uterine inversion, and puerperal hematomas. ClinObstet Gynecol 2006, 49:184. 
 15. Adesiyun A: Septic postpartum uterine inversion. Singapore Med J 2007, 48:943. 16. VanVugt PJH, Baudoin P, Blom MV, van Deursen STBM. Inveriso uteri puerperalis. Acta Obstet GynaecolScand1981; 60:353-62. 17. Rajagopalan V, Sujatha Y. Acute postpartum uterine inversion with hemorrhagic shock with laparoscopic reduction: a new method of management. BJOG 2006; 113:1100-1102. 18. Antonelli E, Irion O, Tolck P, Morales M. Subacute uterine inversion: description of a novel replacement technique using the obstetric ventouse. BJOG 2006; 113:846-847. 19. Robson S, Adair S, Bland P. A new surgical technique for dealing with uterine inversion.Australian and New Zealand Journal of Obstetrics and Gynaecology2005; 45:248-258.
Role of early laparoscopic cholecystectomy in acute cholecystitis – A retrospective analysis
Loganathan Mannu, Habeeb Mohammed Shajahan, Balakrishnan Varadharajan, Karunanithi Ramaiah, Natarajan Ramalingam
Background: Various studies have proposed conflicting opinion about first-line management of patients with Acute Cholecystitis. Results from these studies have evidences for and against the early Laparoscopic Cholecystectomy. The aim of this study is to retrospectively analyse the results of our practise in managing acute Cholecystitis with early Laparoscopic Cholecystectomy. Methods: Data collection from the case records of patients who underwent initial Laparoscopic approach for Acute Cholecystitis. Various parameters assessed are conversion rate, operating time, length of hospital stay, bile duct injury and port site infection as predictors of efficiency of early laparoscopic approach. Results: The analysis included 95 patients, 57 females and 38 males, average age was 52 years. Mean duration of symptoms before intervention was 64 hours. Mean operating time was 96 minutes. Over all conversion rate was 16.8%, which decreased substantially from year 1 through till the end of study period. Length of hospital stay was 3-7 days (Mean =4.6 days). Postoperative complication occurred in 7 patients (2 cases of cystic duct leak and 5 cases of port site infection). Conclusion: Early laparoscopic approach has yielded comparable results in terms of operating time, conversion rate, and complication rates, while the total length of hospital stay was substantially reduced when compared with total hospital stay in delayed approach from other studies
1. Kolla, S.B., et al., Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial. Surg Endosc, 2004. 18(9): p. 1323-7. 2. Cuschieri, A., Approach to the treatment of acute cholecystitis: open surgical, laparoscopic or endoscopic? Endoscopy, 1993. 25(6): p. 397-8. 3. Macafee, D.A., et al., Prospective randomized trial using cost-utility analysis of early versus delayed laparoscopic cholecystectomy for acute gallbladder disease. Br J Surg, 2009. 96(9): p. 1031-40. 4. Gurusamy, K., et al., Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg, 2010. 97(2): p. 141-50. 5. Johansson, M., et al., Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial. J Gastrointest Surg, 2003. 7(5): p. 642-5. 6. Lai, P.B., et al., Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg, 1998. 85(6): p. 764-7. 7. Lo, C.M., et al., Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg, 1998. 227(4): p. 461-7. 8. Miura, F., et al., TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci, 2013. 20(1): p. 47-54. 9. Suter, M. and A. Meyer, A 10-year experience with the use of laparoscopic cholecystectomy for acute cholecystitis: is it safe? Surg Endosc, 2001. 15(10): p. 1187-92. 10. Wong, H.P., et al., Preoperative MRCP to detect choledocholithiasis in acute calculous cholecystitis. J Hepatobiliary Pancreat Sci, 2012. 19(4): p. 458-64. 11. Chandler, C.F., et al., Prospective evaluation of early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg, 2000. 66(9): p. 896-900. 12. Cox, M.R., et al., Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg, 1993. 218(5): p. 630-4. 13. Miller, R.E. and F.M. Kimmelstiel, Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc, 1993. 7(4): p. 296-9. 14. Rattner, D.W., C. Ferguson, and A.L. Warshaw, Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg, 1993. 217(3): p. 233-6. 15. Wiesen, S.M., et al., Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol, 1993. 88(3): p. 334-7. 16. Zucker, K.A., et al., Laparoscopic management of acute cholecystitis. Am J Surg, 1993. 165(4): p. 508-14. 17. Minutolo, V., et al., Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of outcomes and costs between early and delayed cholecystectomy. Eur Rev Med Pharmacol Sci, 2014. 18(2 Suppl): p. 40-6.
A cadaveric study of variations in branching pattern of brachial plexus
Smita K Balsurkar, Surwase Ramdas G, Ferozkhan J Pathan, Ugale Mahesh, Reddy Anand
Aims and Objectives: The aims of present study are 1) to study the variations in branching pattern of the brachial plexus 2) to study the communication of median nerve with other nerves of upper limb. Materials and Methods: In present study 30 brachial plexuses from 15 well embalmed human cadavers were studied in anatomy department. In depth study was done on the communications of median with the musculocutaneous nerve and the different types were classified. Communication between ulnar nerve and median nerve was studied. Results: Out of 30 upper limbs, we found communication between musculocutaneous nerve and median nerve in 6 cases. In such cases, the communicating branch run from musculocutaneus nerve towards median nerve. Four upper limb shows communication between ulnar nerve and medial root of median nerve. Conclusion: It is concluded that knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to upper limb. Knowledge of these variations is important to anatomists, radiologists, anesthesiologists and surgeons.
1. Harris W. (1904): The True Form of the Brachial Plexus. Journal of Anatomy and Physiology 1904; 38 (4): 399-422. 2. Streib EW. (1979): Ulnar-To-Median Nerve Anastomosis In The Forearm: Electromyographic Studies. Neurology 1979; 29: 1534-1537. 3. Kerr AT (1918): The Brachial Plexus of Nerve in Man the Variation in Its Formation and Branches. American Journal of Anatomy 1918; 23: 285 – 295. 4. Choi D, Rodriguez-Niedenfuhr M, Vazquez T, Parkin I, Sanudo JR. (2002): Patterns of Connections between the Musculocutaneous and Median Nerves in the Axilla and Arm. Clinical Anatomy: 2002; 15:11–17. 5. Eglseder WA Jr, Goldman M. (1997): Anatomic Variations of the Musculocutaneous Nerve In The Arm. American Journal Orthopedics 1997; 26 (11):777-80. 6. Venieratos D, Anagnostopoulou S. (1998): Classification of Communications between the Musculocutaneous and Median Nerves. Clinical Anatomy 1998; 11 (5): 327-331. 7. Loukas M, Aqueelah H. (2005): Musculocutaneous and Median Nerve Connections Within, Proximal and Distal To the Coracobrachialis Muscle. Folia Morphologica 2005; 64: 101-108. 8. Yoganandham Janani, HannahSugirthabai RajilaRajendran, Thotakura Balaji , Rajendran SharmilaSaran , Batmanabane Mounissamy (2014) : A Study On The Communications Of Median Nerve With Musculocutaneous And Ulnar Nerves. International Journal of Research in Health Science 2014; 2 (2):480-487. 9. Saeed M,Rufai, A. (2003) : Anastomotic Branch From The Median Nerve To The Musculocutaneous Nerve: a case report. Clinical Anatomy 2003; 16: 453-457. 10. Le Minor, J.M. (1990): A Rare Variant of the Median and Musculocutaneous Nerve in Man. Archieves Anatomy Histology Embryology 1990; 73: 33 – 42. 11. Beheiry EE (2004): Anatomical Variations Of The Median Nerve Distribution And Communication In Arm. Folia Morphologica 2004; 63(3): 313-318. 12. Gupta M, Goyal N, Harjeet (2005): Anomalous Communications in the Branches of Brachial Plexus. Journal of the Anatomical Society of India 2005; 54 (1): 1-3. 13. Hollinshed, W. H. (1979): Textbook of Anatomy In: upper limb. 3rd edition. Oxford and IBH publishing co. Calcutta, India, p. 225:245. 14. Konstantin J. KAZAKOS, Anastasios SMYRNIS, Konstantin C. XARCHAS, Alexandra DIMITRAKOPOULOU, Dionysios-Alexandros VERETTAS (2005): Anastomosis Between The Median And Ulnar Nerve In The Forearm, An Anatomic Study And Literature Review. Acta Orthopedica Belgica, 2005; 71:29-35. 15. Chauhan R, Roy TS (2002): Communication between the Median and Musculocutaneous Nerve- A Case Report. Journal of Anatomical Society of India: 2002; 51(1): 72-75.
Evaluation of lipid profile in patients with liver cirrhosis and their association with severity of the disease
Vijay laxmi Nangliya
The study was conducted to determine the Lipid profiles in Patients with Liver Cirrhosis and to assess their association with severity of the disease. In an analytical cross sectional study, 150 Cirrhotic subjects of either sex ranging in age from 25-65 years were included in the study and the results were compared with 50, age and sex matched healthy control subjects. All Cirrhotic subjects were assessed for severity of disease as Mild (Child A), Moderate (Child B) and Severe (Child C) as per Child Pugh classification. Total Cholesterol, HDL, LDL and triglycerides were measured. The results of this study showed that all the serum lipid profile parameters (Total Cholesterol, LDL and HDL) were significantly (p <0.05)decreased in cirrhotics as compared to control group and the concentration of these study variables decreased with Severity of liver disease and the mean level difference was statistically significantly (p <0.01) with the exception of serum triglyceride levels. Triglyceride levels rather showed a decline in Cirrhotic patients but it was not statistically significant. Dyslipidemia exists in patients with liver cirrhosis. Serum Lipid profile is routinely measured parameters, which may have independent prognostic value in patients with liver cirrhosis thus assessment of the serum lipid profile is important for an effective treatment and prognostic evaluation of patients with chronic liver disease.
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Study of gram negative septicemia in cases of neonates admitted in neonatal intensive care unit at tertiary care hospital
Preeti M Huggi, Sanjeev B Navadagi
Background: Septicemia in neonates is one of the four leading causes of neonatal mortality in India. The pattern of causative agents has been constantly changing and there has been a frequent emergence of resistant bacteria. The antibiotic misuse has resulted in emergence of drug resistant bacterial strains in the neonatal units with grave sequelae. Objectives: to describe the spectrum of aerobic gram negative bacterial isolates and study the sensitivity pattern in cases of neonatal septicemia. Methods: Blood samples were collected aseptically from 200 clinically suspected cases and inoculated into BHI broth and incubated at 370 C for 7 days. Repeated subcultures were made on 1st, 3rd and 5th days onto Blood agar and Mac Conkey agar. Any growth was identified by colony characteristics and appropriate biochemical tests. Antibiotic susceptibility was done by disc diffusion method as per CLSI guidelines. Results: Of the 200 cases, 31.5% were found to be culture positive. Gram negative isolates were predominant 73% and Gram positive isolates were obtained in 27% of the cases. Out of the Gram negative, Klebsiellaspp was the commonest (44.4%) followed by Pseudomonas aeruginosa (17.5%), Escherichia coli (9.5%), Proteus vulgaris (1.6%). Gram negative isolates were most sensitive to Imipenem and Meropenem (98%), followed by Cefoperazone /Sulbactum (75-80%), Amikacin and Gentamycin (70-75%) and least sensitive to third generation cephalosporins. Conclusion: Therefore uncertainty regarding the choice of antibiotics can be minimized by regular survey of etiological agents and their antimicrobial susceptibility pattern.
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Effect of modulation of environment of learning by ‘Mantra-Meditation’ in MBBS students
Santosh C Gursale, Mohankrishna Ghanta
Introduction: Learning is a multidimensional and dynamic process requiring a stress free and relaxed environment. There is some evidence in literature that meditation could positively influence memory and help medical students in reducing stress. Chanting of mantra is basically mind oriented with minimum body activity involvement, passive method of meditation Aims: At the end of ‘Mantra-Meditation’ technique, for three lectures, to assess the effect of ‘Mantra Meditation’, just prior to a learning session, on the students’ concentration towards lecture, academic performance, relaxation of mind and pulse rate. Material and Methods: Institutional Ethical Committee approval was taken. 69 students were included in the study, after taking their written informed consent. Test group- 34 Students were asked to chant mantra (Mantra-Meditation) for 8 min. at the start of the lecture, then lecture was delivered. Control group- Without Mantra-Meditation, same lecture was delivered to 35 students. Evaluation was done after three lectures by i) Students’ feedback questionnaire- ii) Multiple choice question test- was carried out before and after third lecture in both groups . iii) Discussion with students iv) ‘Pulse rate per minute’ of each student was recorded, before and after entire session. Statistical analysis used: Analysis of the difference in the performance in MCQ tests between two groups was done using independent samples t test. The change in pulse rate was analysed using paired t test. Results: In MCQ tests, difference in students' post MCQ test scores between control and test group was not statistically significant. But pre MCQ test score of meditation group was significantly better than control group. Significant number of students of mantra meditation group reported to be more attentive, relaxed, increase in concentration towards lecture, reduction in thoughts and in wandering of mind. There was significant reduction in mean pulse rate in mantra meditation group. Conclusions: This simple and easy mantra meditation could be adopted to enhance student learning.
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A comparative study of symptomatic and radiologic findings in cases of gall bladder disease undergoing cholecystectomy
Sushant Kumar, Pranaya Kunal, Deepak Kumar Yadav
A prospective clinical study of 100 selected cases admitted in the Department. Of General Surgery, M.G.M Medical College and L.S.K. Hospital, Kishanganj during the period of July, 2012 – September, 2014 was undertaken to assess the mode of clinical presentation, laboratory and radiological impressions and finally their management. A brief review of available literature was also made. Majority cases (35%) belonged to age group of 31-40yrs with a female preponderance (F:M- 3:1) with most of the women in their child bearing age. Pain abdomen over the right hypochondrium with referred pain to the inferior angle of scapula and positive Murphy’s sign were the commonest clinical presentation followed with nausea, vomiting, flatulence and dyspepsia. Only 1 case had jaundice during the first clinical presentation. Ultrasonography of abdomen not only revealed evidence of gall stones with impressions of acute or chronic cholecystitis in 95% cases but also revealed some changes in common bile duct, liver, pancreas etc. Total WBC count was found to be elevated (mild to moderate) in 100% cases. Liver function test results- 16% cases was with elevated serum bilirubin, 24% cases with elevated alkaline phosphatase and 6% with elevated liver enzymes was observed. All cases were managed conservatively in acute phase of which 20% cases needed early operation being refractory to conservative means. Rest underwent interval cholecystectomy after 4-6 weeks. Open Cholecystectomy through right subcostal Kocher’s incision were carried out in all cases out of which Choledocholithotomy and Choledochoduodenostomy were done in 5% cases. 80% cases revealed multiple stones, 14% solitary stone and 3% sludge only. Macroscopically 60% cases showed mixed stones, 22% pigment stones and 6% cholesterol stones. Macroscopically 72% revealed gross thickening with fibrosis, 28% with congestion. Microscopically chroniccholecystitis was found in 100% cases. Bacteriological examination of gall bladder contents showed 56% to be sterile, Klebsiella sp. And Staphylococcus aureus predominant in infected cases (42%). E. coli, Enterococcus, Enterobacter were also detected. The post operative period of all cases were uneventful except pain abdomen and wound sepsis in few. There was no mortality and significant morbidity.
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A comparative study of phosphate binders in patients of end stage kidney disease undergoing haemodialysis
Manjuprasad M S, Padmaja Udaykumar, Shreya Hegde
Introduction: Hyperphosphatemia is one of the complication in patients with chronic kidney disease on long term haemodialysis which will add on to the morbidity and mortality of the patient. This study was conducted in an attempt to compare the efficacy of phosphate binders prescribed to the patients of end stage kidney disease undergoing haemodialysis. It was a retrospective study in which medical records of patients with ESKD who received phosphate binders over past 2 years (2013 and 2014) were included in the study and divided into groups receiving sevelemer, calcium carbonate and calcium acetate and their baseline serum phosphate levels were compared with serum phosphate levels after 8weeks of treatment and found that at the end of 8th week the difference in control of phosphate levels in sevelemer group compared with control group was highly significant with a p value of 0.003. The difference in control of phosphate levels in the calcium carbonate group compared with control group also had a significant result with p value 0.039. There were no significant differences in calcium acetate and control group with respect to serum phosphate level difference at the end of 8th week. There were no statistically significant differences between individual groups. Conclusion: Our study confirms that phosphate binders significantly control the serum phosphate levels over a period of eight weeks treatment in ESKD patients on haemodialysis. However sevelemer was found to be more effective in controlling the serum phosphate levels but its high costs limits its use for the poor socioeconomic population.
1. Block GA, Hulbert-Shearon TE, Levin NW, Por FK. Association of serum phosphate and calcium × phosphate product with mortality risk in chronic hemodialysis patients: A national study. Am J Kidney Dis 1998; 31:607-17. 2. Burke SK, Amin NS, Incerti C, Plone MA, Lee JW. Sevelamer hydrochloride (Renagel), a phosphate-binding polymer, does not alter the pharmacokinetics of two commonly used antihypertensives in healthy volunteers. J ClinPharmacol. 2001;41(2):199–205 3. Chertow GM, Burke SK, Raggi P, Treat to Goal Working Group Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int. 2002;62(1):245–252 4. Amiri FS. Contemporary management of phosphorus retention in chronic kidney disease: a review. ClinExpNephrol. 2015 Jun 2. [Epub ahead of print] PubMed PMID: 26032778. 5. Tonelli M. Serum phosphorus in people with chronic kidney disease: you are what you eat. Kidney Int 2013; 84:871. 6. Stevens LA, Djurdjev O, Cardew S, et al. Calcium, phosphate, and parathyroid hormone levels in combination and as a function of dialysis duration predict mortality: evidence for the complexity of the association between mineral metabolism and outcomes. J Am SocNephrol 2004; 15:770. 7. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney IntSuppl 2009; :S1. 8. National Kidney Foundation. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 2003; 42:S1. 9. Fournier A, Morinière P, Ben Hamida F, et al. Use of alkaline calcium salts as phosphate binder in uremic patients. Kidney IntSuppl 1992; 38:S50. 10. Delmez J, Block G, Robertson J, et al. A randomized, double-blind, crossover design study of sevelamer hydrochloride and sevelamer carbonate in patients on hemodialysis. ClinNephrol 2007; 68:386. 11. Agarwal N. Phosphate binders in CKD – Past, Present, and Future. J Indian AcadClin Med 2009; 10:43-5. 12. Caravaca F, Santos I, Cubero JJ, et al. Calcium acetate versus calcium carbonate as phosphate binders in hemodialysis patients. Nephron 1992; 60:423-7. 13. Schaefer K, Scheer J, Asmus G, Umlauf E, Hagemann J, von Herrath D. The treatment of uraemichyperphosphataemia with calcium acetate and calcium carbonate: A comparative study. Nephrol Dial Transplant 1991; 6:170-5. 14. Ben Hamida F, el Esper I, Compagnon M, Moriniere P, Fournier A. Long-term (6 months) cross-over comparison of calcium acetate with calcium carbonate as phosphate binder. Nephron 1993; 63:258-62. 15. Delmez JA, Tindira CA, Windus DW, et al. Calcium acetate as a phosphorus binder in hemo- Phosphate binders in patients with ESRD undergoing hemodialysis 537 dialysis patients. J Am SocNephrol 1992; 3:96- 102. 16. Chertow GM, Burke SK, Raggi P. Treat to Goal Working Group. Sevelamer attenuates the progression of coronary and aortic calcification in hemodialysis patients. Kidney Int 2002; 62:245- 52. 17. Panichi V, Rosati A, Di Giorgio A, Scatena A, Bigazzi R, Grazi G, Migliori M, Paoletti S, MancaRizza G, Casani A, Sgambato A, Ruggeri M. A pharmacoeconomic analysis of phosphate binders cost-effectiveness in the RISCAVID study. Blood Purif. 2015; 39(1-3):174-80. 18. Meinero S, Alloatti S, Triolo G, et al. Withdrawing or discontinuing chronic dialysis in adult patients. G ItalNefrol. 2007; 24:43–50. 19. Johnson CA, Levey AS, Coresh J, et al. Clinical practice guidelines for chronic kidney disease in adults, Part I: definition, disease stages, evaluation, treatment and risk factors. American Family Physician. 2004; 70:869–76. 20. Fitzgerald JT, Schanzer A, Chin AI, et al. Outcomes of upper arm arteriovenousfistulas for maintenance hemodialysis access. Archives of Surgery. 2004; 139:201–8. 21. Vazquez I, Valderrabano F, Jofre R, et al. Psychosocial factors and quality of life in young hemodialysis patients with low comorbidity. Journal of Nephrology.
Potential drug interactions in chronic kidney disease patients - A cross sectional study
S Hegde, P Udaykumar, M S Manjuprasad
Chronic kidney disease (CKD) is a major systemic condition whose prevalence is rising in India. Presence of comorbid conditions like hypertension, diabetes mellitus, metabolic bone disease and electrolyte disturbances along with the deteriorating renal function makes the management of CKD complex .The aim of this study was to assess the pattern of drug drug interactions in CKD patients. This was a prospective cross sectional study conducted in a tertiary care medical hospital in India. A total of 120 patients were enrolled and the list of drug interactions in them was analysed using drug interaction software. The mean age of the study group was 58.53±8.38 years. Hyperphosphataemia, hypertension and diabetes mellitus were among the frequently associated comorbid illnesses.146 potential drug drug interactions (PDDI) were found with an average of 2.39 interactions per patient. Of these 38.14% were mild, 45.36% were moderate and 16.41% were severe. Hypotension, hypertension, hyperkalemia, hypokalemia, anemia, hyperphosphatemia, hyperuricemia were among the commonest outcomes of interactions. Sodium bicarbonate, ferrous sulfate, calcium carbonate, aspirin, pantoprazole, allopurinol were the drugs commonly involved in PDDI. There was a positive correlation between the age and number of interactions (Karl Pearson correlation coefficient: 0.607; p value<0.001) and the number of tablets and number of interactions (karl pearson coefficient: 0.876; p value<0.001). The prevalence of PDDI among CKD patients in this study was high (80.83%). Hence, rational prescription, early detection of harmful drug combinations and careful monitoring of these patients can prevent the occurrence of drug interactions.
1. Jha V, Garcia-Garcia G, Iseki K, Li Z, Naicker S, Plattner B, et al. Chronic kidney disease: Global dimension and perspectives. Lancet. 2013; 382:260–72. 2. Modi GK, Jha V. Incidence of End stage renal disease in India: a population based study. Kidney Int. 2006 Dec; 70(12):2131-3. 3. KDIGO. Chapter 1: Definition and classification of CKD. Kidney Int Suppl 2013; 3:19. http://www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf (last accessed on July 25, 2015). 4. Thomas R, Kanso A, Sedor JR. Chronic kidney disease and its complications. Prim Care. 2008; 35:329–344. 5. Olyaei AJ, Bennett WM. Drug dosing in the elderly patients with chronic kidney disease. Clin Geriatr Med. 2009 Aug; 25(3):459-527. doi:10.1016/j.cger.2009.04.004. Review. 6. Mahmood M, Malone DC, Skrepnek GH, Abarka J, Armstrong EP, Murphy JE, et al. Potential drug-drug interactions within veterans affairs medical centers. Am J Health Syst Pharm. 2007; 64:1500–5. 7. Doubova Dubova SV, Reyes-Morales H, Torres-Arreola Ldel P, Suárez-Ortega M. Potential drug-drug and drug-disease interactions in prescriptions for ambulatory patients over 50 years of age in family medicine clinics in Mexico City. BMC Health Serv Res. 2007 Sep 19; 7:147. 8. Marquito AB, Fernandes NM, Colugnati FA, de Paula RB. [Identifying potential drug interactions in chronic kidney disease patients]. J Bras Nefrol. 2014 Jan-Mar; 36(1):26-34. 9. Chavda NB, Solanky PP, Baria H, Naik R, Bharti K. Study of potential drug–drug interaction between prescribed drugs in patients attending outpatient department of medicine at tertiary-care hospital in south Gujarat region. Natl J Physiol Pharm Pharmacol. 2015; 5(3): 236-242. doi:10.5455/njppp.2015.5.0508201428. 10. Rama M, Viswanathan G, Acharya LD, Attur RP, Reddy PN, Raghavan SV. Assessment of Drug-Drug Interactions among Renal Failure Patients of Nephrology Ward in a South Indian Tertiary Care Hospital. Indian J Pharm Sci. 2012 Jan; 74(1):63-8.doi: 10.4103/0250-474X.102545. 11. Vyas A, Pan X, Sambamoorthi U. Chronic Condition Clusters and Polypharmacy among Adults. Int J Family Med 2012; 2012:193168. 12. Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, et al. Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics (São Paulo) 2011; 66: 1867-72. 13. Weir MR, Fink JC. Safety of medical therapy in patients with chronic kidney disease and end-stage renal disease. Curr Opin Nephrol Hypertens. 2014 May; 23(3):306-13. doi: 10.1097/01.mnh.0000444912.40418.45. Review. 14. Manley HJ, Cannella CA, Bailie GR, St Peter WL. Medication-related problems in ambulatory hemodialysis patients: a pooled analysis. Am J Kidney Dis 2005; 46:669-80.
Urinary tract infection in children in Chennai- Mangadu area
Inayath Ali Badusha, Sumathi
Urinary tract infections are the most frequent bacterial infections. They occur most frequently in female children and uncircumcised male children.10% of female getting an infection yearly and 60% get infection in some point of their life. Recurrences are common. Infection occurs four times more frequently in female than male sex. Urinary tract infection affects 10% of people during childhood. It is necessary to have the spectrum of infecting bacteria and antibiotic sensitivity pattern in the particular area, so that the treating physician is capable of treating the disease easily. That is the reason the author has taken this topic. Introduction in United States of America, urinary tract infection accounts for nearly seven million office visits, and one million emergency department visits. One hundred thousand hospitalisation every year. The cost of these infections is significant in terms of lost time at work and cost of medical care. In united states, the direct cost of treatment is estimated at 1.6 billion U.S. Dollars yearly. Urinary tract infections have been described since ancient times with first documented description in the ebers papyrus to 1550 b. c., it was described by egyptians as: sending forth heat from the bladderâ€. Effective urinary tract infection treatment did not develop until the discovery of antibiotics in 1930. Before which time herbs, bloodletting and rest were re commended.
1. Dai,B; liu, Jia, J;mei;c(20010) long term antibiotics for prevention of urinary tract infections in children . A. systemic review and meta analysis::Archives of disease in childhood 95(7)499-508.doi:10.1136/adc.2009.173112(http://www.ncbi.nlm.nih.gov/pubmed/20457696) 2. Jaganath, VA; Fedorowicz, Z; Sud,V; Verma, AK; Hajebrahimi, S.(november14, 2012) routine neonatal circumscision for prevension of urinary tract infection in infancy. cochrane database of systematic reviews(online)11:cd009129.doi:10.1002/14651858cd009129.pub(http:wwwncbi.nlm.nih.gov/pubmed/23152269) 3. Ambedekar, S. Singh, D D (November 2011) diagnosis and management of urinary tract infection. Current microbioglogy63(5):484-90.doi:10.7861/clinmedicine.11-1-80(http:dx.doi/.org./10.1007/2fs00284-011-006-2). (http:www.ncbi.nlm.nih.gov(pub med//21901556) 4. Bhat, RG: Katy, Taplace, (august2001).pediatric urinary tract infection.-emergency medicine clinics of north america 29(3); 637-53.doi:10.1016/j.emc.2011.04.004 (http://doi.org/10.1016%2fj.emc.2011.04.004). 5. Karmwr, ED. By a. Barry belman; Stephen a. (Clinical pediatricurology (2002). (http://books.gooble.ca/books?id=pa338)(4.ed.ed.)London:dunitz.p.338.isbn3781901865639. 6. Engleberg, N C; Dirita, V; Dermody, T S (2007) Schachters mechanism of microbial Disease. Baltimore: lippincott Williams and wilkins. ISBN 978-0 7817-5342-5. 7. Cubeddu, Richard Finkel, Michelle A. Clark, luigix (2009) pharmacology (http://books. Google. ca/books?id=q4hg2rhy7ocandpg=pa397)(4thed.ed.)Philadelphia: lippin cot Williams and wilkins.p.397 isbn 9780781771559.
Single incision two ports and two slings technique of laparoscopic cholecystectomy – A retrospective analysis of our practise
Loganathan Mannu, Habeeb Mohammed Shajahan, Balakrishnan V, Karunanithi Ramaiah, Natarajan Ramalingam
Background: Since the advent of Single incision laparoscopic surgery, there has been genuine effort from the Laparoscopic fraternity to improvise the technique and make it safe, lesser discomfort and cost effective for the patients. One such effort is the use of standard laparoscopic trocars and instruments in accomplishing Single incision laparoscopic surgery. Various modifications have been introduced by various surgeons all over the world. Our modification is the first instance in literature, where cholecystectomy using standard laparoscopic instruments in single incision, has been done with only two ports. Here we analyse the expediency, safety, benefits, and drawbacks of our practice. Methods: For a duration of 2 years, 65 patients with cholelithiasis without any complications were operated upon by our modified single incision laparoscopic technique. Results were analysed. Results: All 65 patients were successfully operated upon by SITPS (Single incision two ports and two slings) technique. VAS score <4 in 64 patients and >5 in one patient. There was no significant postoperative complications. Seven patient had port site edema. No patient had port site infection. There was no incidence of port site hernia after one year follow up. Conclusion: SITPS technique of laparoscopic cholecystectomy is a technically feasible and safe alternative to standard laparoscopic approach, with reduced postoperative pain, with no visible scar and hence cosmetically superior.
1. Navarra, G., et al., One-wound laparoscopic cholecystectomy. Br J Surg, 1997. 84(5): p. 695. 2. Chow, A., et al., Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surg Endosc, 2010. 24(3): p. 709-14. 3. Hodgett, S.E., et al., Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg, 2009. 13(2): p. 188-92. 4. Piskun, G. and S. Rajpal, Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A, 1999. 9(4): p. 361-4. 5. Romanelli, J.R., et al., Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc, 2010. 24(6): p. 1374-9. 6. Sinha, R. and A.S. Yadav, Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study. J Minim Access Surg, 2014. 10(4): p. 175-9. 7. Majeed, A.W., et al., Randomised, prospective, single-blind comparison of laparoscopic versus small-incision cholecystectomy. Lancet, 1996. 347(9007): p. 989-94.
Does hypovitaminosis D have a role in lipid profile alteration among non-obese diabetics?
Hariharan A, Asmathulla S, Suresh S
Objective: The prevalence of hypovitaminosis D among diabetics is very high with it being an adjuvant causative factor. It has been shown in few studies that hypovitaminosis D has an impact on lipid profile of diabetic patients but most of the studies haven’t excluded the confounding factor viz. obesity. It is a known fact that obesity has a major role in development of hypovitaminosis D. So in our study, we try to find out whether the association between hypovitaminosis D and lipid profile exists even after excluding obesity in diabetics. Materials and Methods: It is a cross section study conducted in 55 Non-obese diabetics. We had measured serum FBS, vitamin-D, urea, creatinine, lipid profile and urinary microalbumin. Results: We found a negative correlation between vitamin-D with that of TGL (r: -0.337; p<0.012) and VLDL (r: -0.190; p<0.011). There was no association found between hypovitaminosis D with that of cholesterol, HDL and LDL. Conclusion: From our study it’s clear that hypovitaminosis D is associated with TGL and VLDL even after excluding obesity.
1. Key findings 2014 [Internet]. International Diabetes Federation. [cited 2015 Jul 28]. Available from: http://www.idf.org/diabetesatlas/update-2014 2. Anjana RM, Pradeepa R, Deepa M, Datta M, Sudha V, Unnikrishnan R, et al. Prevalence of diabetes and prediabetes (impaired fasting glucose and/or impaired glucose tolerance) in urban and rural India: phase I results of the Indian Council of Medical Research-INdiaDIABetes (ICMR-INDIAB) study. Diabetologia. 2011 Dec; 54(12):3022–7. 3. Bender DA. Micronutrients: Vitamins and Minerals. Harper’s illustrated biochemistry. 30th ed. McGraw Hill Education; p. 551–3. 4. Forouhi NG, Ye Z, Rickard AP, Khaw KT, Luben R, Langenberg C, et al. Circulating 25-hydroxyvitamin D concentration and the risk of type 2 diabetes: results from the European Prospective Investigation into Cancer (EPIC)-Norfolk cohort and updated meta-analysis of prospective studies. Diabetologia. 2012 Aug; 55(8):2173–82. 5. Hurskainen A-R, Virtanen JK, Tuomainen T-P, Nurmi T, Voutilainen S. Association of serum 25-hydroxyvitamin D with type 2 diabetes and markers of insulin resistance in a general older population in Finland. Diabetes Metab Res Rev. 2012 Jul; 28(5):418–23. 6. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J ClinEndocrinolMetab. 2007 Jun; 92(6):2017–29. 7. Department of paramedical Sciences, School of Applied Medical Sciences, Lovely Professional University (Punjab) India, Maaji SU, Prabhakar PK. Hypovitaminosis d in type-2 diabetes melitus patients; variation with age, sex AND SEASON. Indian Journal of Applied Research. 2011 Oct 1; 4(6):422–5. 8. Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007 Jun 11; 167(11):1159–65. 9. Botella-Carretero JI, Alvarez-Blasco F, Villafruela JJ, Balsa JA, Vázquez C, Escobar-Morreale HF. Vitamin D deficiency is associated with the metabolic syndrome in morbid obesity. ClinNutr. 2007 Oct; 26(5):573–80. 10. Jorde R, Figenschau Y, Hutchinson M, Emaus N, Grimnes G. High serum 25-hydroxyvitamin D concentrations are associated with a favorable serum lipid profile. Eur J ClinNutr. 2010 Dec; 64(12):1457–64. 11. Gonzalez Molero I, Rojo G, Morcillo S, Gutierrez-Repiso C, Rubio E, Soriguer F, et al. Vitamin D deficiency and obesity. Atherosclerosis. 2014 Aug 1; 235(2):e212. 12. Wortsman J, Matsuoka LY, Chen TC, Lu Z, Holick MF. Decreased bioavailability of vitamin D in obesity. Am J ClinNutr. 2000 Sep 1; 72(3):690–3. 13. Martins D, Wolf M, Pan D, Zadshir A, Tareen N, Thadhani R, et al. Prevalence of cardiovascular risk factors and the serum levels of 25-hydroxyvitamin D in the United States: data from the Third National Health and Nutrition Examination Survey. Arch Intern Med. 2007 Jun 11; 167(11):1159–65. 14. Colosia AD, Palencia R, Khan S. Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review. Diabetes MetabSyndrObes. 2013 Sep 17; 6:327–38. 15. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001 May 16; 285(19):2486–97. 16. Saedisomeolia A, Taheri E, Djalali M, Moghadam AM, Qorbani M. Association between serum level of vitamin D and lipid profiles in type 2 diabetic patients in Iran. J Diabetes MetabDisord. 2014; 13(1):7. 17. Effect of vitamin D on lipid levels [Internet]. cvgk.nl - CardiovasculaireGeneeskunde. [cited 2015 Jul 8]. Available from: http://www.pace-cme.org/d/322/effect-of-vitamin-d-on-lipid-levels 18. Johnson JA, Grande JP, Roche PC, Kumar R. Immunohistochemical localization of the 1,25(OH)2D3 receptor and calbindin D28k in human and rat pancreas. Am J Physiol. 1994 Sep; 267(3 Pt 1):E356–60. 19. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J ClinEndocrinolMetab. 2007 Jun; 92(6):2017–29. 20. Maestro B, Campión J, Dávila N, Calle C. Stimulation by 1, 25-dihydroxyvitamin D3 of insulin receptor expression and insulin responsiveness for glucose transport in U-937 human promonocytic cells. Endocr J. 2000 Aug; 47(4):383–91. 21. Chaudhuri JR, Mridula KR, Anamika A, Boddu DB, Misra PK, Lingaiah A, et al. Deficiency of 25-hydroxyvitamin d and dyslipidemia in Indian subjects. J Lipids. 2013; 2013:623420. 22. Huang Y, Li X, Wang M, Ning H, A L, Li Y, et al. Lipoprotein lipase links vitamin D, insulin resistance, and type 2 diabetes: a cross-sectional epidemiological study. CardiovascDiabetol. 2013 Jan 16; 12:17.
A rare case of kimura’s disease presenting as posterior auricular swelling
S Deivanayagam, Vinod Balaji, Jawahar, Yeshwanth Kumar
Kimura's Disease is a chronic inflammatory disorder of unknown etiology commonly seen among people who live in the Middle and Far East countries; characterised lymphatic follicles, vascular proliferation, and marked eosinophilic infiltration by histologically. It is mainly seen on the head and neck region. The lesion is benign but might be confused with malignant lesions. Kimura's Disease is often seen in the second and third decades of life. This disease is characterised by a blood and tissue eosinophilia, markedly elevated serum IgE levels, painless subcutaneous mass and regional lymphadenopathy on the head and neck region. In this report, we present a 14 yr old boy who was admitted to our hospital with bilateral post auricular swelling for 4 yr duration. Bilateral postauricular masses were excised under general anaesthesia and Kimura's disease was diagnosed by histopathological examination of these lesions.
1. Kimm HT, Szeto C. Eosinophilic hyperplastic lymphogranuloma, comparison with Mikulicz's disease. Proc Chin Med Soc. 1937. 329. 2. Kimura T, Yoshimura S, Ishikawa E. On the unusual granulation combined with hyperplastic changes of lymphatic tissues. Trans Soc Pathol Jpn. 1948. 37:179-80. 3. Ramchandani PL, Sabesan T, Hussein K. Angiolymphoid hyperplasia with eosinophilia masquerading as Kimura disease. Br J Oral Maxillofac Surg. 2005 Jun. 43(3):249-52. 4. Ohta N, Fukase S, Suzuki Y, Ito T, Yoshitake H, Aoyagi M. Increase of Th2 and Tc1 cells in patients with Kimura's disease. Auris Nasus Larynx. 2011 Feb. 38(1):77-82 5. Katagiri K, Itami S, Hatano Y, Yamaguchi T, Takayasu S. In vivo expression of IL-4, IL-5, IL-13 and IFN-gamma mRNAs in peripheral blood mononuclear cells and effect of cyclosporin A in a patient with Kimura's disease. Br J Dermatol. 1997 Dec. 137(6):972-7. 6. Hosoki K, Hirayama M, Kephart GM, et al. Elevated numbers of cells producing interleukin-5 and interleukin-10 in a boy with Kimura disease. Int Arch Allergy Immunol. 2012. 158 Suppl 1:70-4. 7. Sun QF, Xu DZ, Pan SH, et al. Kimura disease: review of the literature. Intern Med J. 2008 Aug. 38(8):668-72. 8. Kung IT, Gibson JB, Bannatyne PM. Kimura's disease: a clinico-pathological study of 21 cases and its distinction from angiolymphoid hyperplasia with eosinophilia. Pathology. 1984 Jan. 16(1):39-44. 9. Wang DY, Mao JH, Zhang Y, et al. Kimura disease: a case report and review of the Chinese literature. Nephron Clin Pract. 2009. 111(1):c55-61. 10. Thomas J, Jayachandran NV, Chandrasekhara PK, Rajasekhar L, Narsimulu G. Kimura's disease--an unusual cause of lymphadenopathy in children. Clin Rheumatol. 2008 May. 27(5):675-7. 11. Chen H, Thompson LD, Aguilera NS, Abbondanzo SL. Kimura disease: a clinicopathologic study of 21 cases. Am J Surg Pathol. 2004 Apr. 28(4):505-13. [Medline]. 12. Rajpoot DK, Pahl M, Clark J. Nephrotic syndrome associated with Kimura disease. Pediatr Nephrol. 2000 Jun. 14(6):486-8. [Medline]. 13. Jennifer Lee and Yeon-Sik Hong. Kimura Disease complicated with bowel infarction and multiple arterial thromboses in the extremities. J Clin Rheumatol. Jan 2014. 20:38-41. 14. Yoganathan P, Meyer DR, Farber MG. Bilateral lacrimal gland involvement with Kimura disease in an African American male. Arch Ophthalmol. 2004 Jun. 122(6):917-9. 15. Park SW, Kim HJ, Sung KJ, Lee JH, Park IS. Kimura disease: CT and MR imaging findings. AJNR Am J Neuroradiol. 2012 Apr. 33(4):784-8. 16. Bonfils P, Moya-Plana A, Badoual C, Nadéri S, Malinvaud D, Laccourreye O. Intraparotid Kimura disease. Eur Ann Otorhinolaryngol Head Neck Dis. 2013 Apr. 130(2):87-9. 17. Yadla M, Sriramnaveen P, Sivakumar V, Sandeep Reddy Y, Sridhar AV, Krishna Kishore C. Epitrochlear mass in a patient on maintenance hemodialysis-Kimura disease. Hemodial Int. 2012 Jan 26. 18. Li D, Li YJ, Zhan FH, Dang CJ. The false-positive finding of left pulmonary Kimura disease on 18F-FDG PET/CT. Clin Nucl Med. 2013 Jul. 38(7):569-72. 19. Sakamoto M, Komura A, Nishimura S. Hematoserological analysis of Kimura's disease for optimal treatment. Otolaryngol Head Neck Surg. 2005 Jan. 132(1):159-60. 20. Ohta N, Okazaki S, Fukase S, Akatsuka N, Aoyagi M, Yamakawa M. Serum concentrations of eosinophil cationic protein and eosinophils of patients with Kimura's disease. Allergol Int. 2007 Mar. 56(1):45-9.
A rare case of maxillary central incisors with two root canals
Rosamma George, Kavyashree G, Jayalakshmi C
Maxillary central incisors usually have one root canal. The cases with two root canals with type IV vertucci canal configuration are extremely rare. Internal morphology of the root canals is variable and often complex. Better understanding of root canal complex is very essential for a clinician to ensure proper treatment. Computed tomography plays an excellent role in diagnosing such anatomical variations.
1. Burns RC HE. Tooth morphology and access cavity preparation. In: Cohen S BR, editor. Pathways of the pulp 8th Edition: St Louis, Mosby 2002:pp.173-229. 2. Vertucci FJ HJ, Britto LR. Tooth morphology and access cavity preparation. In: Cohen S HK, editor. Pathways of the pulp 9th edition: St Louis, MO: Mosby Elsevier; 2006:pp.148-232. 3. Cleghorn BM GC. Morphology of Teeth and their root canal system. Ingle JIaBLKEtE,editor: Hamilton BC;2008. 4. Anantanarayanan Krishnamurthi, Natanasabapathy Velmurugan, Suresh Nandini. Management of single-rooted maxillary central incisor with two canals: A case report. Iranian Endodontic Journal 2012:7(1):36-39. 5. Sert S, Bayirli GS.Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population.J endod.2004;30(6):391-8. 6. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral surg Oral Med Oral Pathol Oral Radiol Endod. 1984;58(5):589-99. 7. Weng XL, Yu SB, Zhao SL, Wang HG,Mu T, Tang RY,Zhou XD.Root canal morphology of permanent maxillary teeth in the Han nationality in Chinese Guanzhong area: a new modified root canal staining technique. J Endod. 2009;35(5):651-6. 8. Theodore M.Roberson, Harald O.Heymann, Edwars J.Swift. Textbook of Art and science of Operative Dentistry.5th ed, Sturdevant’s; 2006. 9. Andreasen JO, Andreasen FM,Classification, etiology and epidemiology of traumatic dental injuries.IN: Andreasen JO, Andreasen FM, editors. Textbook and color atlas of traumatic injuries to the teeth.3rd ed,Copenhagen:Munksgaard;1993.p.151-77 10. Ellis GE, Davey KW. The classification and treatment of injuries to the teeth of children. 5th ed. Chicago: year book medical; 1970. 11. Olgart L, Brannstrom M,Johnson G. Invasion of bacteria into dentinal tubules. Acta Odontol scand 1974; 32:61. 12. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Traumatic dental injuries-a manual. Copenhagen; Munksgaard; 1999.
Comparative study of RR, PR and JT intervals during the different phases of menstrual cycle
Rajeshwari L, Uma R, A R Gorkal
Aim: Cardiac functions are influenced by gender and gonadal steroids. Ventricular arrhythmias are more common in women and seem to exhibit during the menstrual cycle. JT interval is major component of QT interval. It measures ventricular repolarization. According to literature, estrogen lengthens the JT interval. Hormonal changes during menstrual cycle may cause changes in ECG intervals. Objective: The objective of the present study is to evaluate the effect of different phases of menstrual cycle on the RR, PR and JT intervals of ECG. Methods: This is a prospective study among a cohort of 30 healthy female students, who were aged 18-22 years and had regular menstrual cycles over past six months. Subjects were monitored on three separate occasions during two consecutive menstrual cycles. ECG was recorded for 5 minutes in Lead –II using Power lab multichannel polygraph instrument, once during every phase. The computerized recordings of RR, PR and JT intervals thus obtained were analyzed statistically using pooled t test, probability < 0.05 to assess if any significant difference existed in these parameters during the different phases of menstrual cycle. Results: This study did not show any statistically significant variation in RR, PR and JT intervals between the menstrual, follicular and luteal phases of the menstrual cycle. Conclusion: It may be concluded that there was no statistically significant variation in RR, PR and JT intervals during different phases of the menstrual cycle which may be due to the small sample size.
1. Sex and gender differences in Pharmacology by Vera Regitz, Zagrosek. Handbook of experimental pharmacology.2012.(e book) 2. Richard S. Crow, Peter J. Hannan et al. “ Prognostic Significance of Corrected QT and Corrected JT Interval for Incident Coronary Heart Disease in a General Population Sample Stratified by Presence or Absence of Wide QRS Complexâ€.Circulation.Sep2003;108 3. Spodick DH. Reduction of QT-interval imprecision and variance by measuring the JT interval. AmJCardiol. 1992; 70(1): 628–629. 4. Das G. QT interval and repolarization time in patients with intraventricular conduction delay. J Electrocardiol. 1990; 23: 49–52. 5. Banker J, Dizon J, Reiffel J. Effects of the ventricular activation sequence on the JT interval. Am J Cardiol. 1997; 79: 816–819. 6. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. 1987. Menopause and the risk of coronary heart disease in women. N Engl J Med 316: 1105-1110. 7. Minson CT, Halliwill JR, Young TM, Joyner MJ. 29 Feb 2000. Influence of International Journal of Health Sciences and Research (www.ijhsr.org) 40 Vol.3; Issue: 6; June 2013 the menstrual cycle on Sympathetic activity, baroreflex Sensitivity, and vascular transduction in young women. 1: Circulation. 101(8): 862-868. 8. Tada H, Sticherling C, Chough S P et al, “Gender and age differences in induced atrial fibrillationâ€. American J cardiology: 2001Aug: 88(4):436-8. 9. Rosano G.M, Leonardo F, Sarrel P.M et al. “Cyclical variation in paroxysmal supraventricular tachycardia in women.†Lancet 1996 347:786-8. 10. Pham TV, Robinson R B,Danilo P Jr, Rosen MR, Effects of gonadal steroids on gender related differences in transmural dispersion of Ltype of calcium current. Cardiovasular research 2002;53:752-63 11. ShanmugalKarthic,Kandanbalmurugeshan,StalinVishwanathan,Vishnokumarsivaji et al, “Role of gender and menstrual cycle on Heart rate variability, QTc and JT intervals†International Journal Of Scientific Study Ç€March 2015Ç€ volume 2Ç€issue 12. 12. Rajeshwari L, C P Ganashree, Anithu C and A R Gorkal. “Comparative study of heart rate, QT and QTc intervals during the different phases of the menstrual cycle. International journal of Health and Allied Sciences, July-sep 2014:3(3):154-158.
A study of effect of injection drotaverine hydrochloride in agumentation of labour
Maya Narayan Arvikar, Prashant C Patil, Shubhangi Choudhari
Background: The common cause of prolonged first stage of labour is cervical dystocia. Many a times inspite of good utrine contractions cervix fails to dilate or dilates very slowly. In modern obstetrics the passive concept of watchful expectancy has long been abandoned and replaced by intensive care. Objectives: To study the effect of injection drotaverine hydrochloride in augmentation of first stage of labour. Material and Methods: Study was conducted in Dr. Ulhas Patil Medical College and Hospital Jalgaon, Kh, Maharashtra. Total uncomplicated 140 full term patients were studied, 70 patients with injection drotaverine hydrochloride and 70 controls. In both the groups 35 primigravidas and 35 multigravidas each. Results and Conclusion: Injection Drotaverine Hydrochloride during active phase of labour increases rate of cervical dilatation and decreases duration significantly.
1. IAN Donald practical obstetrics problems 6th edition 2. O,Driscoll et al. Active management of labour BMJ 1973; 3:135-137. 3. Friedman EA. Dysfunctional. In Sciarrea JW, ed Gynecology and obstetrics Vol 2ch 73. Philadelphia Harper and Row, 1985. 4. Philpott RH, Castle WM. Cervicograph in the management of labour inprimigravidae II. ; The action line and treatment of abnormal labour. Br J ObstetGynec 1972; 79; 599. 5. Suranyi S. Use of spasmolytic agent drotaverine for the assistance of labour. Medikins Univ 1972:22; 202-211. 6. Farkas M, Viski S. Relief of pain in child birth by new antispasmodic, TherHung 1967; 15:4. 7. Sharma JB. Drotaverine Vs Valethamate bromidein acceleration of labour. Int JGynecol Obstet, 2001; 74:255-260. 8. Poomima R Ranka, Varsh A Hishikar. Effect of drotaverine hydrochloride on normal labour A randomized study. J of Obstet gynec India 2002; 52(6):28-30.
A study of knowledge on osteoporosis among peri –menopausal women in an urban slum area of Berhampur
Gurukrushna Mohapatra
Background: Osteoporosis, a condition characterized by decreased bone strength, is prevalent among perimenopausal women as a major risk factors. world wide it causes more than 8.9 million fractures annually. Aims and Objectives: aimed to assess the knowledge on osteoporosis among peri menopausal women in urban slum area of southern Odisha Material and Methods: It was a cross-sectional study carried out in slum area of Berhampur, Odisha between September 2013 to February 2014. The study population include all the peri-menopausal women in the slum area. Sample size taken as 369. data was collected from a structured pre tested and pre designed questionnaire. The data was analysed SPSS version 16.0. p value less than 0.05 was taken to be statistically significant. Results and Conclusion: majority of the women (75%) were in the age group 51-60yr and (42%) of women had no formal education. By occupation 32% were daily labourer. As per average family income, 24% belonged to the income group of more than Rs.5000/- per month. regarding source 36% had known about osteoporosis from health personnel. About 48% opined that osteoporosis is a disease of bone. 72% women agreed old age to be a risk factor for it. 44% knew that back pain as a major symptom of the disease. Only 28% knew that calcium rich foods can prevent osteoporosis. The study shows limited knowledge on understanding of osteoporosis and it’s preventive measures suggested this as a evidence to be used for future correspondence. In the community : knowledge on osteoporosis among peri-menopausal women is very low and it is significantly associated with factors like age, occupation. The symptoms of osteoporosis submerged in the population like a tip of ice berg which is expressed only in the form of fracture or serious complications. Also the literacy does not make any difference as per our observation
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Intrathecal block for breast augmentation surgery in poland’s syndrome: A case report
Abhirup Samanta, Shama Shikalgar, Prashant Lomate
Breast augmentation is an increasing popular day case procedure. Local infiltration anaesthesia with sedation is routinely used for it’s ease of application as compared to more complex and potentially riskier intrathecal block. We hypothesized that intrathecal isobaric ropivacaine by experienced anaesthetist was more effective than local anaesthesia with sedation, in view of adequate sensory blockade. Intrathecal Isobaric ropivacaine which is less cardiotoxic produces more sensory blockade over motor blockade as compare to intrathecal hyperbaric bupivacaine which is most popular anaesthetic drug for spinal anaesthesia. Moreover ropivacaine needs less dose and does not require head low position to achieve higher level of blockade as compare to bupivacaine since it is isobaric in nature. we present a case of unilateral breast augmentation of a women, successfully performed by the application of intrathecal block without any complication.
1. Singh S, Singh VP, Jain M, Gupta K, Rastogi B, Abrol S. Intrathecal 0.75% isobaric ropivacaine versus 0.5% heavy bupivacaine for elective caesarean section delivery: A randomized controlled trial. J Pak Med stud 2012, 2(2):75-80. 2. McClellan KJ, Faulds D. Ropivacaine- An update of its use in regional anaesthesia. Drugs 2000; 60(5): 1065-93. 3. Mantouvalou M, Ralli S, Arnaoutoglou H, Tziris G, Papadopoulos G. Spinal anaesthesia: Comparision of plain ropivacaine, bupivacaine and levobupivacaine for lower abdominal surgery. Acta Anaesthesiol Belg. 2008;59(2): 65-71. 4. Lirk P, Kleber N, Mitterschiffthaler G, Keller C, Benzer A, Putz G. Pulmonary effects if bupivacaine, ropivacaine and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery :A randomized controlled study. Int J Obstet Anesth 2009; 19: 287-92.
Cytodiagnosis of Gouty Tophi – Case report
A D Jungare, S A Jungare, U D Suryawanshi, B B Sonawane
Gout is a clinical syndrome which is characterized by hyperuricemia and recurrent acute arthritis. Accumulation of tophi in joints triggers the inflammatory response of gouty arthritis. We report here a case of gouty tophi diagnosed by fine needle aspiration, along with review of literature. A 53 year old male presented with multiple subcutaneous nodules on both feet. The nodules were firm and nontender. Fine needle aspiration was diagnostic as it revealed granular amorphous material and scattered stacks and sheaves of slender needle shaped crystals few histocytes and chronic inflammatory cells. Radiographs of both feet showed extensive soft tissue swellings with underline bone erosion. The serum uric acid levels were found to be raised confirmed diagnosis. Fine needle aspiration is an effective tool in the diagnosis of gouty tophi. Difficulties in management can be avoided by using the fine needle aspiration technique.
1. Koley S, Salodkar A, Choudhary S, Bhake A, Singhania K, Choudhary M. Tophi as first manifestation of gout. Indian J Dermatol Venereol Leprol 2010;76:393-6 2. Agrawal K, Pahuja S, Agrawal C, Harbhajanka A. Fine needle aspiration cytology of gouty tophi with review of literature. J Cytol 2007;24:142-5 3. McCarty DJ. Gout without hyperuricemia. JAMA 1994;271:302-3 4. Porkodi R, Parthiban M, Rukmangatharajan S, Kanakarani P, Rajendra CP. Clinical spectrum of gout in South India. J Indian Rheumatol Assoc. 2002;10:61-3. 5. Thissen C A, Frank J, Lucker GP. Tophi as first clinical sign of gout. Int J Dermatol 2008; 47:49-51a. 6. Schlesinger N, Norquist JM, Waqtson DJ. Serum urate during acute gout. J Rhematol 2009;36:1287-9 7. Rege J, Shet T, Naik L. Fine needle aspiration of tophy for crystal identification in problematic cases of gout. A report of two cases. Acta Cytol 2000;44:433-6.
Breakage of the tip of a flipcutter during ACL reconstruction: A rare complication of the knee arthroscopy
Mozimul haq siddiqui
We report a case of broken tip of the reprocessed flipcutter guide pin (arthrex, Naples, FL ) while drilling the tibial socket for the ACL reconstruction. The complication was identified immediately and the broken instrument removed piece meal. We have not come across such a case in the literature and it is the first report of its kind to our knowledge. Repeated use of flip cutter is to be avoided to prevent such hazards. Also care should be taken to lock the blades properly before starting to drill the sockets. Although instrument breakage is a rare complication during knee arthroscopy, orthopaedic surgeon should be aware of this complication and methods to deal with it.
1. Öztekin HH. An unusual complication of knee arthroscopy: an extra-articular migrated asymptomatic broken probe from the knee joint. Arch Orthop Trauma Surg. 2005 May 1;125(4):285–7. 2. Lynch JL, Anderson K. Anterior Cruciate Ligament Reconstruction: All-Inside Reconstruction. Oper Tech Sports Med. 2013 Mar;21(1):40–6. 3. Lubowitz JH, Amhad CH, Anderson K. All-Inside Anterior Cruciate Ligament Graft-Link Technique: Second-Generation, No-Incision Anterior Cruciate Ligament Reconstruction. Arthrosc J Arthrosc Relat Surg. 2011 May;27(5):717–27. 4. Allum R. Complications of arthroscopy of the knee. J Bone Joint Surg Br. 2002 Sep;84(7):937–4
Screening of Glucose-6-Phosphate Dehydrogenase deficiency in Neonates
Raviraj Naik, Sarita Dakhure, Rittu Chandel, Leela Abichandani
Introduction: Glucose – 6 – phosphate dehydrogenase (G-6-PD) is an enzyme that participates in the first step of Hexose monophosphate pathway of glucose metabolism. Deficiency of this enzyme is most common genetic disorder in India. Its deficiency causes hemolysis which eventually lead to acute haemolytic anemia and neonatal jaundice. The hemolysis in these deficient patients are triggered by bacterial, viral infections, drugs like aspirin and chloroquine, foods like fava beans Period from after birth to first 4 weeks is the neonatal period and the child is called a neonate. There is no cure for G-6-PD.Early detection and prevention of hemolytic episodes by avoiding the triggers is the only cure for this deficiency. Aim: To screen the neonates for glucose -6-Phosphate dehydrogenase deficiency so as to prevent the morbidity and mortality occurring due to this deficiency. Material and Methods: One Thousand neonatal blood sample were obtained from the Labour room, of the civil Hospital of vasai. The samples were analysed by Dye Decolourization method. Results: Of the 1000 samples, 10 was found to be G-6- PD deficient and 20 were found to be G-6-PD deficiency carriers. Conclusion: G-6-PD deficiency is common in Adivasi Population.G-6-PD deficiency testing should be done as a screening procedure at least in Adivasi residing areas as early diagnosis and prevention is the only way of treating this deficiency disorder and avoiding its complications.
Introduction: Glucose – 6 – phosphate dehydrogenase (G-6-PD) is an enzyme that participates in the first step of Hexose monophosphate pathway of glucose metabolism. Deficiency of this enzyme is most common genetic disorder in India. Its deficiency causes hemolysis which eventually lead to acute haemolytic anemia and neonatal jaundice. The hemolysis in these deficient patients are triggered by bacterial, viral infections, drugs like aspirin and chloroquine, foods like fava beans Period from after birth to first 4 weeks is the neonatal period and the child is called a neonate. There is no cure for G-6-PD.Early detection and prevention of hemolytic episodes by avoiding the triggers is the only cure for this deficiency. Aim: To screen the neonates for glucose -6-Phosphate dehydrogenase deficiency so as to prevent the morbidity and mortality occurring due to this deficiency. Material and Methods: One Thousand neonatal blood sample were obtained from the Labour room, of the civil Hospital of vasai. The samples were analysed by Dye Decolourization method. Results: Of the 1000 samples, 10 was found to be G-6- PD deficient and 20 were found to be G-6-PD deficiency carriers. Conclusion: G-6-PD deficiency is common in Adivasi Population.G-6-PD deficiency testing should be done as a screening procedure at least in Adivasi residing areas as early diagnosis and prevention is the only way of treating this deficiency disorder and avoiding its complications.
Serum cortisol levels in critically Ill versus non-critically Ill patients
Chandrashekar M, Shivaraj B M, V P Krishna
This case control study was undertaken to compare the early morning venous serum cortisol levels between 40 cases of critically ill (group A) vs non critically ill (group B) patients admitted to a tertiary teaching hospital for a duration of one year. It was found that there was significant increase in the serum cortisol levels among critically ill (mean 33.68 μg/dl ±15.93) as compared to non critically ill (mean 15.93 μg/dl ± 5.93) patients.
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Non invasive prediction of esophageal varices using right lobe of liver to albumin ratio
Sanjay Raj, Chandrashekar M
Studies have shown that biochemical, clinical and ultrasonographic parameters alone or together have good predictive power for non-invasively assessing the presence of esophageal varices. Here we studied the correlation of right liver lobe diameter to albumin ratio as a predictor of esophageal varices in 50 patients of cirrhosis admitted to medicine wards of tertiary teaching hospital. Considering the right liver lobe/albumin ratio cut-of value of 4.425 as suggested by Tamara Alempijevic et al., our study yielded a sensitivity of 83.3% and specificity of 29.5%
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Study of Glutathione S-Transferase in gastrointestinal cancer
N R Hazari, V S Hatolkar
Glutathione S-Transferase(GST) distributed widely in tissues such as liver, lung, skin, brain, intestine and placenta. Levels of enzyme detection in serum are useful for diagnosis and prognosis of human disease. Recently GST may be useful in monitoring pathogenesis of liver disease. In the present study of serum GST was significantly higher in patients with esophagus and stomach cancer as compared to those obtained from normal healthy group. Our results showed a significant increased activity of GST in stage III patients than stage II patients of both cancers; which may trigger the progression of cancer.
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Introduction of project as a learning tool in forensic medicine
Sachin Janbaji Gadge, Alka Rawekar
Project Based Learning is a teaching method in which student gains knowledge and skills by working for an extended period of time to investigate and respond to a complex question, problem, or challenge. The aim of our study was to improve learning of Forensic Medicine in under graduate students. A batch of 100 under graduate students were given didactic lecture on injuries. After that 50 were divided into 5 batches of 10 each and allotted projects on injuries. Pretest and post test were conducted for all 100 students. The pre and post test were evaluated by student ‘t’ test. Learning gain of the project subjected group was more as compared to traditional teaching (p = 0.000). The absolute learning gain was much higher (228.80%).
1. What is project based learning (PBL)? (cited 2014 December 22). Available from: URL: http://bie.org/about/what_pbl 2. Project-based learning and telecollaboration enhances teachers confidence in Bangladesh. (cited 2014 December 22). Available from: URL: http://www.unescobkk.org/education/ict/online-resources/databases/ict-in-education-database/item/article/project-based-learning-and-telecollaboration-enhances-teachers-confidence-in-bangladesh-1/ 3. Johnston JM, Schooling CM, Leung GM. A randomised-controlled trial of two educational modes for undergraduate evidence-based medicine learning in Asia. BMC Medical Education 2009;9(63):1-8. 4. Gurpinar E, Musal B, Aksakoglu G, Ucku R. Comparison of knowledge scores of medical students in problem-based learning and traditional curriculum on public health topics. BMC Medical Education 2005; 5(7):1-8.
Sympathetic cardiovascular function integrity in children with parental history of diabetes mellitus
Amruta Nitin Kumbhar, Lalit H Nikam
Introduction: Type 2 DM has a strong genetic component. Individuals having parents with type 2 DM have an increased risk of diabetes; if both parents have type 2 DM, the risk approaches 40%. The autonomic nervous system regulates the electrical and contractile activity of myocardium via interplay of sympathetic and parasympathetic activity. Sympathetic nerves of heart are derived from the upper thoracic 5 segments of the spinal cord. In general, sympathetic stimulation increases the overall activity of the heart. This is accomplished by increasing both the rate and force of heart contraction. Amis and Objectives: To study Sympathetic cardiovascular Function Integrity in children with parental history of diabetes mellitus. Materials and Method: The study procedure was carried out on healthy volunteer medical students of age group 18 to 25 years. They were first categorized into two groups, control (without parental history of diabetes mellitus) and subject (with parental history of diabetes mellitus). The sample size was 70 in the control group and 70 in the subject group. All participants were examined after explaining the study procedure. The cardiovascular tests to measure cardiovascular autonomic response were performed. These tests were explained and demonstrated to the participants before performing on them. Tests Done For Assessing Sympathetic Activity were Blood pressure response to standing (Orthostasis) test, Hand grip test and QTc interval test. The mean and standard deviation (S D) was calculated for all the parameters. The data was entered using Microsoft Excel (2007). Statistical analysis was done using SPSS version 10.The statistical test used were (as per the requirement of the data). Results: The age distribution and sex distribution was nearly same in the study and control group. Mean resting pulse, mean SBP and DBP was slightly more in study group as compared to control group and the difference was not significant statistically. While assessing sympathetic activity Orthostasis and Mean QTc interval test showed no statistically significant difference in study and control group whereas sustained handgrip test showed statistically significant difference in study and control group. Conclusion: Early subclinical sympathetic autonomic neuropathy may develop in children of type 2 diabetic parents without the presence of long term hyperglycemia. It could be due to inherited susceptibility genes for sympathetic autonomic neuropathy which could be expressed before or even without development of diabetes mellitus.
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Autonomic neuropathy in nondiabetic offspring of type 2 diabetic subjects is associated with urinary albumin excretion rate and 24-h ambulatory blood pressure. The Fredericia Study. Diabetes. March 2001; 50(3):p630- 636. 25. Frontoni S, Bracaglia D, Baroni A, Pellegrini F, Perna M, Cicconetti E et al. Early autonomic dysfunction in glucose-tolerant but insulin- resistant offspring of type 2diabetic patients. Hypertension 2003; 41: p1223–1227. 26. Tuppad S, Sanganabasappa H, Aithala M. A study of glycaemic status and parasympathetic functions in nondiabetic offsprings of type 2 diabetes mellitus. Int Journal of Biomedical and Advance Research. 2012; 03(12):887-890. 27. Gaede P, Vedel P, Parving HH, Pedersen O. Intensified multifactorial intervention in patients with type 2 diabetes mellitus and microalbuminuria: the Steno type 2 randomized study. Lancet.1999; 353: p617– 622. 28. Toyry JP, Niskanen L, Mantysaari MJ, Lansimies EA, Uusitupa MI. 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