A D Kannamwar, G L Maske, I V Ingole
During routine dissection classes we observed bilateral anatomical variations of the brachial and ante brachial arterial pattern and along with variant superficial palmar arch formation. We will be reporting this case with its embryological correlation and clinical implications.
1. Hollinshed Henry. (1962) Anatomy for Surgeons-Back and limbs Vol 3 In: Arm,elbow & forearm And The Wrist & hand. 2nd edition. Harper & Row publishers:pp 368-373, 411-417, 490-498. 2. Moore K.L. & Persaud T.V.N. (2004) The developing human-Clinically oriented embryology; Limbs: Blood supply of limbs. 7th edition. Saunders An imprint of Elsevier. Pp:412-425 3. Patten B.M. (1953) Human embryology : Development of circulatory system: Arteries of extremities. 2nd edition. McGraw-Hill Book Company INC. pp 632-637. 4. R. A. Fadel and H. S. Amonoo-Kuofi (1996) The superficial Ulnar artery: Development and surgical significance. Clinical Anatomy 9:128-132 5. A. Rodriguez-Baeza, J. Nebot, B.Ferreira, F.Reina, J. Perez, J.R. Sanudo And M.Roig (1995) An anatomical study and ontogenic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. J.Anat 187, pp. 473-479. 6. Patnaik, V.V.G;Kalsey, G.Singla Rajan K. (2002) Branching Pattern of Brachial artery-A Morphological Study. J.Anat. Soc. India 51(2) 176-186.
Vembu Radha, Narayanan Palaniappan
Introduction: Sertoli Leydig Cell Tumour of the ovary is an extremely rare tumour that belongs to a group of Sex Cord Stromal tumours of the ovary. It accounts for less than 0.5% of all primary ovarian neoplasms. Very few cases are documented in the literature so far. Hence we report a case of Sertoli Leydig Cell Tumour of intermediate grade differentiation involving the left ovary in a 26 years old nulliparous woman who presented with menstrual irregularity and virilizing features.
1. R.H. Young and R. E. Scully, “Ovarian Sertoli-Leydig cell tumors. A clinicopathological analysis of 207 cases,” American Journal of Surgical Pathology, vol. 9, no. 8, pp. 543–569, 1985. 2. V. W. Chen, B. Ruiz, J. L. Killeen, T. R. Coté, X. C. Wu, and C. N. Correa, “Pathology and classification of ovarian tumors,” Cancer, vol. 97, supplement 10, pp. 2631–2642, 2003. 3. V. W. Chen, B. Ruiz, J. L. Killeen, T. R. Coté, X. C. Wu, and C. N. Correa, “Pathology and classification of ovarian tumors,” Cancer, vol. 97, supplement 10, pp. 2631–2642, 2003. 4. L. M. Roth, M. C. Anderson, and A. D. T. Govan, “Sertoli-Leydig cell tumors: a clinicopathologic study of 34 cases,” Cancer, vol. 48, no. 1, pp. 187–197, 1981. 5. R. H. Young and R. E. Scully, “Sex cord-stromal, steroid cell, and other ovarian tumors,” in Blaustein's Pathology of Female Genital Tract, R. J. Kurman, Ed., p. 929, Springer, New York, NY, USA, 5th edition, 2002. 6. Ahmed Abu-Zaid, Ayman Azzam, Lama Abdulhamid Alghuneim, Mona Tarek Metawee, Tarek Amin, and Turki Omar Al-Hussain. Poorly Differentiated Ovarian Sertoli-Leydig Cell Tumor in a 16-Year-Old Single Woman: A Case Report and Literature Review, Case Reports in Obstetrics and Gynecology Volume 2013 (2013), Article ID 858501, 6 pages 7. C. Sigismondi, A. Gadducci, D. Lorusso et al., “Ovarian Sertoli-Leydig cell tumors. A retrospective MITO study,” Gynecologic Oncology, vol. 125, no. 3, pp. 673–676, 2012
Jayanth Leo, Parimuthukumar, Vishwanath Pai, A. Rekha, Bhuvana
Introduction: Evisceration is an uncommon surgical emergency. A vaginal evisceration is a rare occurrence following hysterectomy. The risk factors of having an evisceration are obesity, sudden increase in intra abdominal pressure, vaginal surgeries and post menopausal age group. This is a case report of a 58 year old lady who presented to the emergency room with evisceration through the vaginal vault. This mandates an early diagnosis of the condition, start the patient on broad spectrum antibiotics on admission and plan emergent surgical intervention. In our case we did a combined vaginal and laparoscopic approach. The use of minimally invasive surgery had saved the patient the morbidity of a laparotomy especially when done as an emergency procedure. The outcome of having managed this patient this way was rewarding.
1. Beth Cronin, MD; Vivian W. Sung, MD, MPH; Kristen A. Matteson, MD, MPH; Vaginal cuff dehiscence: risk factors and management; American Journal of Obstetrics and Gynecology APRIL 2012 2. Kowalski CD, Seski JC, Timmins PF, Kanbour Al, Kunschner AJ, Kanbour-Shakir A. Vaginal Evisceration: presentation and management in postmenopausal women. J Am Coll Surg. 1996; 183:225-9. 3. Joy SD, Phelan M, McNeill HW. Postcoital vaginal cuff rupture 10 months after a total vaginal hysterectomy. A case report. J Reprod med. 2002: 47: 238-40. 4. Ramirez PT, Klemer DP. Vaginal evisceration after hysterectomy: a literature review. Ob- stet Gynecol Surv 2002; 57:462-7. 5. Cardosi RJ, Hoffman MS, Roberts WS, Spellacy WN. Vaginal evisceration after hyster- ectomy in premenopausal women. Obstet Gy- necol 1999; 94:859. 6. Moen MD, Desai M, Sulkowski R. Vaginal evisceration managed by transvaginal bowel resection and vaginal repair. Int Urogynecol J Pelvic Floor Dysfunct 2003; 14:218-20. 7. Wilson A, Longhi J, Goldman C, McNatt S; Intra-abdominal pressure and the morbidly obese patients: the effect of body mass index; J Trauma. 2010 Jul; 69(1):78-83. doi: 10.1097/TA.0b013e3181e05a79 8. Anthony Gyang, Antonio J. Ramirez, Spontaneous Vaginal Evisceration with Small Bowel Infarction; International Journal of Gynecology, Obstetrics and Neonatal Care, 2014, 1, 6-8 9. Yaakovian MD, Hamad GG, Guido RS. Laparoscopic management of vaginal evisceration: case report and review of the literature. J Minim Invasive Gynecol. 2008 Jan-Feb; 15(1):119-21. doi: 10.1016/j.jmig.2007.08.618. 10. Ioannis Nikolopoulos, Hasan Khan, Gnananandan Janakan, Rajab Kerwat; Laparoscopically assisted repair of vaginal evisceration after hysterectomy; BMJ Case Reports 2013; doi:10.1136/bcr-2013-009897
A D Kannamwar, G L Maske, I V Ingole
During routine undergraduate dissection in Anatomy department, bilateral variations were found in the anterior compartment of the arm in male cadaver of approximately 58 years age. The musculocutaneous nerve was absent on both sides. The muscles in the anterior compartment of the arm except coracobrachialis, which are normally supplied by musculocutaneous nerve, were receiving fibers from lateral side of median nerve. Coracobrachialis was supplied by thin nerve arising directly from lateral chord. We will be reporting this case with its clinical significance.
1. Renata Pacholczak, Wiesiawa Klimek-Piotrowska, Jerzy A. Walocha. Absence of the musculocutaneous nerve associated with a supernumerary head of biceps brachii: a case report. Surg Radiol Anat.DOI 10.1007/s00276-010-0771-9. 2. Sinnatamby C. S. Introduction to regional Anatomy. In: Last’s anatomy: Regional and applied. 11th edition (Elsevier- Churchill Livingstone Publ.). 2006: p14. 3. Gupta Shalini, Mittal Anupama, Gautam Prateek. An Unusual Formation of Median Nerve with Absence of Musculocutaneous Nerve. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) Volume 10, Issue 2 (Sep.- Oct. 2013), PP 43-45. 4. Moore K. L. & Persaud T. V. N.The developing Human Clinically oriented Embryology. 7th Edition (Elsevier Science USA) 2003:410-424. 5. Sud M and Sharma A. Absence of musculocutaneous nerve and the innervations of coracobrachialis, biceps brachii and brachialis from the median nerve. The Journal of A natomical Society of India 2000, 49(ii): 176-177. 6. Satheesha NAYAK. Absence of musculocutaneous nerve associated with clinically important variations in the formation, course and distribution of the median nerve – a case report. Neuroanatomy (2007) 6: 49–50. 7. José Humberto Tavares Guerreiro Fregnani, Maria Inez Marcondes Macéa, Celina Siqueira Barbosa Pereira, Mirna Duarte Barros, José Rafael Macéa. Absence of the musculocutaneous nerve: a rare anatomical variation with possible clinical-surgical implications. Sao Paulo Med J. 2008; 126(5):288-90. 8. Le Minor JM. A rare variant of the median & musculocutaneous nerve in man. Archieves of Anatomy, Histology and Embryoogy 1992; 73: 33-42. 9. Rajendrakumar D. Virupaxi, Veereshkumar S. Shirol, Suresh P. Desai, Mathad V. Ravishankar. Absence of musculocutaneous nerve in the left axilla. International journal of anatomical variations (2009) 2:140-142.
Chikkaraddi Manjunath L, Manjunath Shetty
BPH is one the common conditions found in an ageing man, presenting with LUTS. This study focused on comparison of IPSS score with prostrate size and uroflowmetry. We found the age group of 61-70 years were most commonly affected. Symptom score collected, co-related well with uroflowmetry than prostrate size obtained from ultrasound. The average flow rates co-relates well with IPSS score and also co-relates weakly with post void residual urine. Based on this study, the severity of BPH has nothing to do with prostratic size. IPSS score and uroflowmetry should be used to predict the severity of BPH.
1. Malik MA, Khan JH, Gondal WS, BajwaIA.Role of Uroflowmetry in Lower Urinary Tract Symptoms Evaluation due to Benign Prostatic Hyperplasia (BPH). Special Edition Annals. 2010;16(1):34-8. 2. Guler C, Tuzel E, Dogantekin E, Kiziltepe G. Does sildenafil affect uroflowmetry values in men with lower urinary tract symptoms suggestive of benign prostatic enlargement? Urol Int. 2008;80(2):181-5. 3. Agrawal CS, Chalise PR, Bhandari BB. Correlation of prostate volume with international prostate symptom score and quality of life in men with benign prostatic hyperplasia.Nepal Med Coll J. 2008;10(2):104-7. 4. Von GB. Analysis of micturition; a new method of recording the voiding of the bladder.ActaChir Scand. 1957;112(3-4):326-40. 5. De La Rosette JJ, Witjes WP, Debruyne FM, Kersten PL, Wijkstra H. Improved reliability of uroflowmetry investigations: results of a portable home-based uroflowmetry study. Br J Urol. 1996;78(3):385-90 6. Neveus T, von Gontard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176(1):314-24. 7. Djavan B, Margreiter M, Dianat SS. An algorithm for medical management in male lower urinary tract symptoms.CurrOpin Urol. 2011;21(1):5-12. 8. Jensen KM. Uroflowmetry in elderly men. World J Urol. 1995;13(1):21-3. 9. Mebust WK, Holtgrewe HL, Cockett ATK, Peters PC and Writing Committee. Transurethral prostatectomy: Immediate and postoperative complications. A cooperative study of 13 participating institutions evaluating 3885 patients.J. Urol. 1989; 141: 243- 47. 10. Vesely S, Knutson T, Damber JE, et al. Relationship between age, prostate volume, prostate-specific antigen, symptom score and uroflowmetry in men with lower urinary tract symptoms. J UrolNephrol.2003; 37: 322-8. 11. Dicuio M, Pomara G, Vesely S, et al. The use of prostatic intravesical protrusion correlated with uroflowmetry: a new method to measure obstruction in patients with LUTS due to BOO without using P/F studies. Arch ItalUrolAndrol. 2005; 77: 50-3. 12. Ezz el Din K, Kiemeney LA, de Wildt MJ, Debruyne FM, de la Rosette JJ. Correlation between uroflowmetry, prostate volume, postvoid residue, and lower urinary tract symptoms as measured by the International Prostate Symptom Score.Urology. 1996;48(3):393-7. 13. Kolman C, Girman CJ, Jacobsen SJ, Lieber MM. Distribution of post-void residual urine volume in randomly selected men. J Urol. 1999;161:122-7. 14. Barry MJ, Girman CJ, et al. Using repeated measures of symptom score, uroflowmetry and prostate specific antigen in the clinical management of prostate disease. Benign Prostatic Hyperplasia Treatment Outcomes Study Group.J Urol. 153 (1): 99-10 15. Bosch JLHR, Hop WCJ, Kirkels WJ, Schrosber FH. The International Prostate Symptom Score in a community based sample of men between 55 and 74 years of age; prevalence and correlation of symptoms with age, prostatevolume, flow rate and residual urine volume. Br. J. Urol. 1995; 75: 622–30. 16. Din KEE, Kiemeney LAAM, Wildt MJAM, Debruyne FMJ, Rosette JJMC. Correlation between uroflowmetry, prostate volume, postvoid residual, and lower urinary tract symptoms measured by the International Prostate Symptom Score. Urology.1996; 48: 393–7. 17. Wadie BS, Ibrahim E-HI, de la Rosette JJ, Gomha MA, Ghoneim MA. The relationship of the International Prostate Symptom Score and objective parameters for diagnosing bladder outlet obstruction. Part 1: when statistics fail. J. Urol. 2001; 165: 32–4 3 1995.
Vishwanath G Kumbar, Vijayalakshmi N, Vinod Xavier Joseph, Richard Thomas, Tessa N Kaneria, Sandeep M B, Gouri B Kaveriappa
Background and Objectives: Objective of our study was to evaluate the usefulness of middle cerebral artery (MCA) and umbilical artery (UA) Doppler in the diagnosis of intrauterine growth restriction (IUGR) and its prediction of adverse perinatal outcome in clinically suspected IUGR pregnancies and to establish the role of Doppler ultrasound in the management of IUGR pregnancy. Materials and Methods: Data were analysed from 40 cases with clinical suspicion of IUGR between 31 to 40 weeks of gestation from June 2011 to June 2013. Pulsatility index (PI) was used as the Doppler index. The UA and MCA PI was considered abnormal if the value was >95th percentile and <5th percentile of previously published values for gestational age, respectively. Cut-off value of 1.08 was used for MCA/UA PI ratio; velocimetry above 1.08 was considered normal and if below abnormal. The fetus was considered IUGR if the estimated fetal weight (EFW) was <10th percentile of previously published values for gestational age. Pregnancies with documented major congenital abnormality and multiple gestations were excluded from the study. Findings of Doppler studies were correlated with the EFW and the following adverse perinatal outcomes: perinatal death, emergency caesarian section for fetal distress, low Apgar score (5min Apgar <7), and admission to neonatal intensive care unit for complications of IUGR, pregnancy outcome was considered favourable when these were absent. Results: Cerebroplacental ratio (MCA/UA PI) was the most sensitive parameter (95.8%) to predict adverse outcome. It was more sensitive than UA PI (91%) and MCA PI (87.5%). Diagnostic accuracy of cerebroplacental ratio (90%) was better than UA PI (88%) and MCA PI (66%) in predicting adverse outcomes. MCA/UA PI had less diagnostic accuracy (65%) in diagnosing IUGR than predicting its adverse outcome (90%). Conclusion: Cerebroplacental Ratio (MCA/UA PI) is a better predictor of adverse perinatal outcome than an abnormal MCA PI or UA PI, however has less diagnostic accuracy in the diagnosis of IUGR compared to prediction of adverse perinatal outcome.
1. Ozyüncü O, Saygan-Karamürsel B, Armangil D, Onderoğlu LS, Yiğit S, Velipaşaoğlu M, Deren O. Fetal arterial and venous Doppler in growth restricted fetuses for the prediction of perinatal complications. Turk J Pediatr. 2010 Jul-Aug;52(4):384-92. 2. Turan OM, Turan S, Gungor S, Berg C, Moyano D, Gembruch U, Nicolaides KH,Harman CR, Baschat AA. Progression of Doppler abnormalities in intrauterinegrowth restriction. Ultrasound Obstet Gynecol. 2008 Aug;32(2):160-7. 3. Ghosh GS, Gudmundsson S. Uterine and umbilical artery Doppler are comparable in predicting perinatal outcome of growth-restricted fetuses. BJOG. 2009 Feb;116(3):424-30. 4. Figueroa-Diesel H, Hernandez-Andrade E, Acosta-Rojas R, Cabero L, Gratacos E. Doppler changes in the main fetal brain arteries at different stages of hemodynamic adaptation in severe intrauterine growth restriction. Ultrasound Obstet Gynecol.2007 Sep;30(3):297-302. 5. Bano S, Chaudhary V, Pande S, Mehta V, Sharma A. Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome.Indian J Radiol Imaging. 2010 Feb;20(1):20-5. 6. Rozeta Shahinaj, Nikita Manoku, Enriketa Kroi, and Ilir Tasha .The value of the middle cerebral to umbilical artery Doppler ratio in the prediction of neonatal outcome in patient with preeclampsia and gestational hypertension. J Prenat Med. 2010 Apr-Jun; 4(2): 17–21. 7. Gramellini D, Folli MC, Raboni S, Vadora E, Merialdi A. Cerebral-umbilical Doppler ratio as a predictor of adverse perinatal outcome. Obstet Gynecol 1992; 79:416-20. 8. Arias F. Accuracy of the middle-cerebral-to-umbilical-artery resistance index ratio in the prediction of neonatal outcome in patients at high risk for fetal and neonatal complications. Am J Obstet Gynecol 1994; 171:1541-5. 9. Giles WB, Trudinger BJ, Cook CM: Fetal umbilical artery flow velocity-time waveforms in twin pregnancies. Br J Obstet Gynaecol 1985; 92:490. 10. Wang Y, Zhao S. Vascular Biology of the Placenta. San Rafael (CA): Morgan and Claypool Life Sciences; 2010.
Midhun Krishnan, Cherian Jacob
The aim of the study was to compare the functional outcome, patient satisfaction and cost of two methods of treatment, namely plaster of Paris cast and a removable splint, for Torus or buckling fractures of the distal forearm in a rural teaching hospital setting. Methods: The study was done on71 consecutive patients with torus fracture presenting to the emergency department. The functional outcome was assessed using Mayo’s wrist score and patient satisfaction with Verhaar scale. Results: Functional results were satisfactory in 95% of the splint group and in 89% of the plaster group. Patient satisfaction was good to excellent in 97% of the splint group and 91% of the plaster group. The splint group had approximately 61% reduction in overall costs in monetary terms. Conclusion: Removable splinting as opposed to plaster casting has an overall better functional outcome, patient satisfaction and lower cost and may be the preferable treatment option for these simple fractures.
1. Rockwood CA, Wilkins KE. Fractures in children. 7th ed. Lippincott: Williams &Wilkins; 2010. p. 317–20. 2. Solan MC, Rees R, Daly K. Current management of torus fractures of the distalradius. Injury 2002;33(6):503–5. 3. Davidson JS, Brown DJ, Barnes SN, Bruce CE. Simple treatment for torus fracturesof the distal radius. J Bone Joint Surg Br 2001;83(8):1173–5. 4. Abraham A, Handoll HH, Khan T. Interventions for treating wrist fractures inchildren. Cochrane Database Syst Rev 2008;16(2):CD004576. 5. West S, Andrews J, Bebbington A, Ennis O, Alderman P. Buckle fractures of thedistal radius are safely treated in a soft bandage. A randomized prospective trialof bandage versus plaster cast. J PediatrOrthop2005;25(3):322–5. 6. Plint AC, Clifford T, Perry J, Bulloch B, Pusic M, Lalani A, et al. Wrist bucklefractures: a survey of current practice patterns and attitudes towards immobilization. Can J Emerg Med 2003;5:95–100. 7. Firmin F, Crouch R. Splinting versus casting of ‘‘torus’’ fractures to the distalradius in the paediatric patient presenting at the emergency department (ED): aliterature review. IntEmergNurs2009;17(3):173–8. 8. Bochang C, Katz K, Weigl D, Jie Y, Zhigang W, Bar-On E. Are frequent radiographsnecessary in the management of closed forearm fractures in children? J ChildOrthop2008;2(3):217–20. 9. Farbman KS, Vinci RJ, Cranley WR, Creevy WR, Bauchner H. The role of serialradiographies in the management of pediatric torus fracture.Arch PediatrAdolesc Med 1999;153:923–5. 10. Symons S, Roswell M, Bhowal B, Dias JJ. Hospital versus home management ofchildren with buckle fractures of the distal radius. J Bone Joint Surg Br2001;83(4):556–60. 11. Willet KM. Noise-induced hearing loss in orthopaedic staff. J Bone Joint Surg Br1991;73(1):133–5. 12. Wytch R, Ritchie IK, Clayton R. Potential hazards of modern splinting materials.Occup Health 1988;40(3):492–4. 13. Plint AC, Perry JJ, Correll R, Gaboury I, Lawton L. A randomized, controlled trialof removable splinting versus casting for wrist buckle fractures in children.Pediatrics2006;117(3):691–7. 14. Okeley E A, Ooi K S, Barnett P L. A randomized controlled trial of 2 methods of immobilizingtorus fractures of the distal forearm. PediatrEmerg Care 2008;24(2):65–70. 15. Pountos I, Clegg J, Siddiqui A. Diagnosis and treatment of greenstick and torusfractures of the distal radius in children: a prospective randomised single blindstudy. J Child Orthop2010;4(4):321–6. 16. Vernooij CM, Vreeburg ME, Segers MJ, Hammacher ER. Treatment of torusfractures in the forearm in children using bandage therapy. J Trauma Acute Care Surg2012;72(4):1093–7. 17. Kropman RHJ, Bemelman M, Segers MJM, Hammacher ER. Treatmentof impacted greenstick forearm fractures in children using bandage orcast therapy: a prospective randomized trial. J Trauma 2010;68:425–8. 18. Khan KS, Grufferty A, Gallagher O, Moore DP, Fogarty E, Dowling F. A randomizedtrial of soft cast for distal radius buckle fractures in children. ActaOrthopBelg2007;73(5):594–7. 19. Mbubaegbu CE, Munshi NI, Currie L. Audit of patient satisfaction with selfremovablesoft cast for greenstick fractures of the distal radius. J Clin Effect1997;2:14–5. 20. Taranu R, Webb J, Forth M, Brown G, Bowler C, Bayliss N. Using semi-rigidcasts in the management of buckle fractures. PediatrNurs2011;23(2):25–8. 21. Plint A, Perry J, Tsang J. Pediatric wrist buckle fractures: management andoutcomes. Can J Emerg Med 2004;6:397–401.
Lumbeni Kithan, Thomas S Kuruvilla, Tina Damodar
Introduction: The incidence of Extended Spectrum β Lactamase (ESBL) producing strains is increasing over the years. ESBL producing organisms pose problem for treatment. ESBL producers are also higher in uropathogens and baseline knowledge of ESBL organisms is mandatory for formulating control measures hence an attempt was therefore made to study ESBL production from urinary samples at a tertiary care hospital at Mangalore. Aim: To detect the number of ESBL producers among uropathogens in our centre and to compare two methods of ESBL detection. Materials and Methods: 1121 urinary samples were processed, of this 319 were Multi-drug resistant and were tested for ESBL production by Double Disc approximation and CLSI Confirmatory Test. Results: Out of 319 MDR samples, 153 were Enterobacteriaceae 93 were positive for ESBL i.e., 60.78% .Inpatients were more than outpatients and the two methods of ESBL detection were comparable. In this study ESBL was 60.78% among MDR enterobacteriacea and enterobacteriacea being the commonest organism in UTI, an attempt to contain ESBL organism may have some impact on decreasing the load of MDR organism. Conclusion: The burden of ESBL's among Enterobacteriacea uropathogens continues to pose a challenge in treatment. Carbapenems were a mainstay in treating these cases and either methods of ESBL detection may be conviently used. However attempts to minimize ESBL spread through hygiene, contact precautions, suitable antibiotic policy to include cheaper and more effective antimicrobials are the need of the hour.
1. Manoharan A,Premalatha K,Chatterjee S,Mathai D. Correlation of TEM,SHV &CTX-M extended-spectrum beta lactamases among Enterobacteriacea with their in vitro antimicrobial susceptibilities. Indian journal of medical microbiology 2011;29(2):161-4. 2. Taneja and Sharma . ESBLs detection in clinical microbiology: why & how ? Indian J Med Res 127 2008;April: 297-300. 3. Bhattacharya S.Is Screening patients for antibiotic resistant bacteria justified in the Indian context ?.Indian journal of medical microbiology 2011;29(3):213-17. 4. Fouquet M,Morange V,Bruyere F. Five years follow-up of infections with extended-spectrum beta-lactamase producing enterobacteriaceae].Prog Urol 2012;22(1):17-21. 5. Maya AS Prabhakar K and Sarayu YL.A Study on Prevalance & Evaluation of Clinical Isolates from Community Acquired Infections using Different Media in Semiurban areas. World J. Med. Sci 2010;5(2):49-53. 6. Fircanis S,McKay M.Recognition and Management of Extended Spectrum Beta Lactamase Producing Organisms (ESBL).Geriatrics for Practicing Physician 2010;93:161-2. 7. Nahum KC,Odes LS,Riesenberg K,Schlaeffer F and Borer A. Urinary Tract Infections Caused by Multi-Drug Resistant Proteus mirabilis: Risk Factors and Clinical Outcomes.Springer Link 2010;38:41-46. 8. Tankhiwale SS,Jalgaonkar SV,Ahamad S,Hassani U.Evaluation of extended spectrum beta lactamase in urinary isolates. Indian J Med Res 120 2004;Dec: 553-56. 9. Briongos-Figuero LS,Gomez-Traveso T,Bachiller Luque P,Dominguez-Gil GonzalezM,Gomez-Nieto A,Palacios MartinT et al. Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 2012;66(9):891-96. 10. Ferraro MJ,Swenson JM. Clinical and Laboratory Standard Institute, 2009. Performance standards for antimicrobial susceptibility testing: nineteenth informational supplement. CLSI document M100-S19.Vol 29(3). 11. Shiju M P, Yashavanth R, Narendra N. Detection Of Extended Spectrum Beta-Lactamase Production And Multidrug Resistance In Clinical Isolates Of E.Coli And K.Pneumoniae In Mangalore 2010; June (4): 2442 – 2445. 12. .Rao SPN ,Rama P S ,Gurushanthappa V ,Manipura R ,Srinivasan Extended-spectrum beta lactamases producing Escherichia coli and Klebsiella pneumonia : A Multi-centric Study Across Karnataka K. 2014 ; 6 (1): 7-13. 13. .Nair TB,Bhat GK,Pai V,Shantharam M . Extended spectrum β lactamase (esbl)in uropathogenic escherichia coli ,prevalence and susceptibility pattern in south indian city.IJRAP 2011;2(6):1756-57. 14. T Menon, D Bindu, CPG Kumar, S Nalini, MA Thirunarayan.Comparison of double disc and three dimensional methods. Indian Journal of Medical Microbiology 2006;24 (2):117-120. 15. Babypadmini S,Appalaraju B.Extended Spectrum β Lactamases in Urinary isolates of Escherichia Coli and Klebsiella Pneumoniae-Prevalence and susceptibility Pattern in Tertiary Care Hospital.Indian Journal of Medical Microbiology 2004;22(3):172-74. 16. Tantry BA,Rahiman S. TO SCREEN FOR ESBL PRODUCERS IN A TERTIARY CARE HOSPITAL.Antibacterial resistance and trend of urinary tract pathogens to commonly used antibiotics in Kashmir Valley. West Indian med. J; 61 (7 ): Print version ISSN 0043-3144. 17. Kumar MS, Lakshmi V, Rajagopalan R. Related articles, occurrence of extended spectrum beta-lactamases among Enterobacteriaceae spp. isolated at a tertiary care institute. Indian J Med Microbiol 2006; 24: 208–11. 18. Hecker MT, Fox CJ, Son AH, Cydulka RK, Siff JE, Emerman CL, Sethi AK, et al.Effect of a Stewardship Intervention on Adherence to Uncomplicated Cystitis and Pyelonephritis Guidelines in an Emergency Department Setting. PLoS ONE 2014 ; 9 (2): e87899.
Mohammad G Kahrazeh, Hamidoddin Yousefi, Kulkarni U D
Shurchah area is located 60 kilometers to the southeast of Zahedan. Zahedan granitoides and dioritic dykes have intruded in flysch sediments of Eocene age. After collating of factors such as stratigraphy, lithology, tectonics and topological gravity of drainage patterns, 82 stream sediment samples have been taken from streams. Samples were analyzed using ICP-MS and AAS analytical methods. For eight elements Au, Ag, Cu, Pb, Zn, As, Sb and Hg factors such as error, frequency distribution, amount of sensored, background, threshold, anomaly, mean, mode and standard deviation, calculated individually. Among these elements, Sb with an average value of 10 ppm has been considered as anomaly regarding the spatial situation of the anomaly; it was determined to be in the central part of the study area. In addition, strong positive correlation was observed between gold- arsenic and gold- antimony.
1. A.Hasani Pak, 1380, exploration dada analysis, Tehran university publication, Islamic Republic of Iran, p. 987. 2. A.Hasani Pak, 1377, Geostatics, Tehran University Publication, Islamic Republic of Iran, p. 3143 3. A.Sadeghiyan and M.Valizadeh, 1386, replacement of north part zahedan massive granitoide mechanism, twenty sixth earth science association. 4. M.Yazdi, 1381, Conventional methods in Geochemical exploration, Shahid Beheshti university Publication, Islamic Republic of Iran, p.180 5. Camp, V. E. and Griffis, R. J., 1981, "Character, genesis and tectonic setting of igneous in the Sistan suture zone, eastern Iran", Lithos, Vol. 15(3): 221-239. 6. Carranza, E.J.M., 2008, "Geochemical anomaly and mineral prospectively mapping in GIS, 11". Hardbound, 368 pages. 7. Davis, John C., 2002. "Statistics and data analysis in geology", 3therd, john Wiley and Sons Inc, New York. 8. Goncalves, M.A., Vairinho, M., Oliveira, V., 1998, "Study of geochemical anomalies in Mombeja area using a multifractal methodology and geostatistics", In: Buccianti, A., Nardi, G., Potenza, R. (Eds.), IV IAMG 98. De Fred, Ischia Island, Italy, PP. 590-595. 9. Reimam, c., Filzmoser, P., and Garrent, R.G., 2005, "Background and threshold: critical comparison of methods of determination".Science of Total Evironment, 346, 1-16. 10. Stoecklin, J., Eftekharnezhad, J. and Hushmand Zadeh, A., 1972, "Central lut reconnaissance east Iran", Geol. Surv. Iran, Rept. pp. 22-62. 11. Wellmer, F.W., 1998, "Statistical evaluations in exploration for mineral deposits", Article, Springer New York, pp. 350-379
P S Gawali, Sudhir Tungikar
Introduction: To study a) Prevalence of Diabetes Mellitus in Pulmonary tuberculosis. b) Radiological picture in Pulmonary Tuberculosis when it is associated with diabetes Mellitus. c) Co-relation between extent of Pulmonary Tuberculosis and severity of Diabetes Mellitus. Material and Methods: sputum positive pulmonary tuberculosis patients admitted in medical college hospital for about one year irrespective of age and sex constituted material for this study. All 100 sputum positive tuberculosis patients were screened for diabetes mellitus. Extent of tuberculosis was decided by national tuberculosis association of USA criteria which were also adopted by national tuberculosis association of India. Severity of diabetes was decided by criteria used by Deshmukh et al (1966) and Nanda and Tripathi (1984). Results: out of 100 tuberculous patient studied 17 patients were found to have diabetes mellitus. However 5 patients were already known to have diabetes mellitus Thus, Prevalence of diabetes mellitus in pulmonary tuberculosis was 12.6 % (12 out of 95). Prevalence in Male was 13.7% and in Females was 10 %. Prevalence below age of 40 was 9.3 % and it was 15.1% above the age of 40 years of T.B. patients. Amongst 17 diabetes patients 47% had far advanced tuberculous lesions. Of those 35.53% had cavitatory lesions. Bilateral involvement of lungs was found in 70.6%. Of these patients 29.7% had far advanced tuberculosis and severe diabetes. Conclusions: The prevalence of diabetes mellitus is significantly high i.e. 12.6% in this study. Radiological lesions in patients of pulmonary tuberculosis complicated diabetes mellitus are bilateral, cavitatory, confluent and far advanced. The association of advanced pulmonary tuberculosis and severe diabetes millitus is far more common then association of minimal lesion pulmonary tuberculosis and mild diabetes mellitus.
1. Bhatia J.L.: Pulmonary Tuberculosis with Diabetes Mellitus, proceedings of XVIII Pulmonary workers conference p. 326, 1962. 2. Deshmukh M.D.: Tuberculosis in Diabetes J. Asso. Phys. Ind. 1960, 8:311-13. 3. Deshmukh M.D.(1984) : Tuberculosis and Diabetes. Ind. J. Tuber. 31, 104-8. 4. Indian Council of Medical Research (1958): Tuberculosis in Indian sample survey. Quoted by Pamara S.P. in text book of Tuberculosis edited by Rao K.N. Second edition (1981), 50-51. 5. Joslin E.P. (1934): Quoted by Younger D. And Hadley W.B., in Joslins Diabetes Mellitus edited by Marble A., White P., Brandley R.F. Krall L.P., Eleventh edition (Indian Edition). Published by Lea and Febiger (1973): 621-636 6. Khanna K.K. and Khanna B.K. (1963): The problems of Tuberculosis complicated by Diabetes Indian J. Chest. Dis. 1963, 5: 125-127 7. Nanda C.N. and Tripathy S.M. (1968): Association of Diabetes Mellitus with Pulmonary Tuberculosis. J. Asso. Phys. India, 16: 741-746 8. Nicholas G.P. (1957): Diabetes among Young Tuberculosis Patients, Review o the Association of Two Diseases. Amer. Re. Tuber.Pul.Dis. 76: 1016-20 9. Patel J.C,. De Souza, Cherul and Jigjini S.S. (1977): Diabetes and Tuberculosis Ind. J. Tuber. 24: 155-158 10. Patel J.C. and Talwalker N.G. (1966): In Diabetes in the Tropics P. 497-507
Richard Thomas, Ravi Hoisala
Introduction: Diffusion weighted imaging is an essential sequence to be included in any ptotocol for magnetic resonance imaging of the brain and therefore it is essential to study the signal intensity features of intracranial lesions in this sequence. Aims: To describe the signal intensities of intracranial lesions on diffusion weighted imaging and to compare this with apparent diffusion coefficient maps. Methods and Materials: Images of 115 patients who underwent magnetic resonance imaging at our hospital from March 2010 to March 2011 were prospectively studied. The signal intensities of various lesions on diffusion weighted images, apparent diffusion coefficient maps were studied. Statistical analysis used: Percentages of individual intra and extra cranial lesions that showed diffusion restriction, increased diffusivity or isointense signal relative to gray matter were calculated. Results: All cases of acute infarcts, hypoxic ischemic injury, abscesses and extradural empyemas showed diffusion restriction. 50% of subacute infarcts, 33% of tuberculomas, 40% of GBM, 75% of medulloblastomas, 33% of meningiomas, single case of epidermoid cyst and 50% of lymphomas showed true restriction of diffusion. The remaining cases showed increased diffusivity or intermediate signal intensity. Conclusion: Intracranial lesions show a varied appearance on diffusion weighted imaging and this sequence is an important tool in establishing an accurate diagnosis.
1. Sugahara T, Korogi Y, Kochi M, et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging 1999; 9:53-60 2. Gauvain KM, McKinstry RC, Mukherjee P, et al. Evaluating pediatric brain tumor cellularity with diffusion-tensor imaging. AJR Am J Roentgenol 2001; 177:449-454 3. Kono K, Inoue y, Nakayama k, et al. The role of diffusion-weighted imaging in patients with brain tumors. AJNR Am J Neuroradiol 2001; 22:1081-1088 4. Gass A, Gaa J, Schreiber W, et al. Echo planar diffusion weighted magnetic resonance imaging in patients with active multiple sclerosis. Proceedings of the International Society of Magnetic Resonance in Medicine Berkeley, Calif: International Society of Magnetic Resonance in Medicine, 1997; 658 5. Roychowdhury S, Maldjian JA, Grossman RI. Multiple sclerosis: comparison of trace apparent diffusion coefficients with MR enhancement pattern of lesions. AJNR Am J Neuroradiol 2000; 21:869-874 6. Lansberg MG, Thijs VN, O'Brien MW, et al. Evolution of apparent diffusion coefficient, diffusion weighted, and T2-weighted signal intensity of acute stroke. AJNR Am J Neuroradiol 2001; 22:637-644 7. Schaefer PW, Grant PE, Gonzalez RG. Diffusion weighted MR imaging of the brain. Radiology 2000 november;217:331-345 8. Desprechins B, Stadnik T, Koerts G, Shabana W, Breucq C, Osteaux M. Use of diffusion-weighted MR imaging in differential diagnosis between intracerebral necrotic tumors and cerebral abscesses. AJNR Am J Neuroradiol 1999; 20:1252-1257 9. Filippi CG, Edgar MA, Ulu AM, et al. Appearance of meningiomas on diffusion-weighted images: correlating diffusion constants with histopathologic findings. AJNR Am J Neuroradiol 2001; 22:65-72 10. Tsuruda JS, Chew WM, Moseley ME, Norman D. Diffusion-weighted MR imaging of the brain: value of differentiating between extraaxial cysts and epidermoid tumors. AJNR Am J Neuroradiol 1990; 11:925-931. 11. Schwartz R, Mulkern R, Gudbjartsson H, Jolesz F. Diffusion-weighted MR imaging in hypertensive encephalopathy: clues to pathogenesis. Am J Neuroradiol 1998;19:859-862
Bhavana Tiwari, Sushil Kumar
Background: Accidental poisoning of mosquito repellent liquid vaporizer. Case Characteristics: A 3 yrs old male child accidently ingested liquid of mosquito repellent vaporizer. Observation: Child was immediately brought to emergency department of our hospital with urticarial rash all over the body. Outcome: Child was managed conservatively with antihistaminic injection and kept under observation for any respiratory or other complications. Message: Potentially poisonous things should be kept away from the children.
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Asharani S K, Vasantha Kuberappa, Divyalatha
The lateral circumflex femoral artery arises from the lateral side of the profundafemoris artery, passes horizontally between the divisions of the femoral nerve and behind the Sartorius and rectus femoris, and divides into ascending, transverse and descending branches. During routine dissection of cadavers allotted for first MBBS students, variation in the origin of lateral circumflex femoral artery was observed unilaterally in an old aged female cadaver. In the present study, the lateral circumflex femoral artery was taking origin directly from the lateral side of femoral artery. The branches of lateral circumflex femoral artery are used in making anterolateral thigh flap for reconstruction of defects in face, aorto-popliteal bypass, coronary artery bypass grafting. As the femoral artery is the main artery of the lower limb and is frequently visualized by various radiological imaging techniques, anatomical variations of itself as well as its branches have significant clinical importance.
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Madhur M Gupta, Suresh N Chari, Abhay P Kolte
Common risk factors such as smoking, diabetes, hyperlipidemia, aging and male gender place an individual at risk for both periodontitis as well as cardiovascular disease. A Case control study was carried out in 50 subjects with chronic periodontitis aged 30-65 years (group II) and age matched with 50 control subjects (group I) .Group III (n=30) patients included patients of periodontitis with cardiovascular disease (CVD) and group IV(n=40) included patients with cardiovascular disease. Blood samples collected was assessed for lipid profile and homocysteine levels. Total cholesterol, LDL-cholesterol, triglycerides and homocysteine are significantly increased (p<0.001) in periodontitis patients with and without CVD and patients with CVD when compared with normal healthy controls. Significant positive correlation was found when total cholesterol and triglycerides are compared with homocysteine in periodontitis with and without CVD and patients with CVD alone. Hence, homocysteine assessment is useful in predicting the future risk of cardiovascular disease in chronic periodontitis patients
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Bindu C B, Suresh R M, Venkatesh
Reporting a case of snake bite. Viper bites are important venomous snakes in srilanka and south India. We report a 55 year old male bitten by viper on right dorsum of foot later he developed severe pain and swelling at the site of bite and he was shifted to our hospital 6 hours after the bite. His leg was swollen, having severe pain and tenderness at bitten site, anxious with tachycardia tachypnea with normal neurological examination and other systems being normal. Blood investigation showed deranged coagulation which was corrected after giving 40 vials of antisnake venom. He developed right sided hemiperesis36 hours of bite even after giving antivenom treatment and his CT brain showed acute infarct in left frontal lobe (anterior division of MCA). His wound started healing by seventh day and his hemiparesis completely recovered by 6 weeks.
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