Introduction: Annular pancreas is a very rare congenital problem that can manifest clinically from neonatal age to adulthood. Here we present a rare case of Annular pancreas which presented in neonatal period. The child presented with bilious vomiting and the AXR revealed classical Double bubble appearance. Laparotomy revealed the diagnosis and we did Kimura’s diamond shaped Duodeno-duodenostomy. Postoperatively we gave peripheral TPN for 10 days.
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32. Kiesewetter WB, Koop CE: Annular pancreas in infancy. Surgery. 36:146-159 1954
33. Merrill JR, Raffensperger JG: Pediatric annular pancreas: twenty years’ experience. J Pediatr Surg. 11:921-925 1976
34. De Ugarte DA, Dutson EP, Hiyama DT. Annular pancreas in the adult: management with laparoscopic gastrojejunostomy. Am Surg 2006; 72:71.
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38. Lainakis N, et al.: Annular pancreas in two consecutive siblings: an extremely rarecase. Eur J Pediatr Surg. 15:364-368 2005
39. Montgomery RC, et al.: Report of a case of annular pancreas of the newborn in twoconsecutive siblings. Pediatrics. 48:148-1501971
40. Hebrok M, et al.: Regulation of pancreas development by hedgehogsignaling. Development. 127:4905-4913 2000 11044404
41. Kamisawa T, et al.: A new embryologic hypothesis of annularpancreas. Hepatogastroenterology. 48:277-278 2001
42. Ben-David K, Falcone RA Jr, Matthews JB:Diffuse pancreatic adenocarcinomaidentified in an adult with annular pancreas. J Gastrointest Surg. 8:565-568 2004
43. Benger JR, Thompson MH: Annular pancreas and obstructive jaundice. Am JGastroenterol. 92:713-714 1997
44. Foo FJ, et al.: Ampullary carcinoma associated with an annular pancreas. JOP. 8:50-54 2007
45. Kamisawa T, et al.: Biliary carcinoma risk in patients with pancreaticobiliarymaljunction and the degree of extrahepatic bile ductdilatation. Hepatogastroenterology. 53:816-818 2006
46. Dowsett, J.F., Rode, J. and Russell, R.C.G. (1989) Annular pancreas: A clinical, endoscopic, and immunohisto- chemical study. Gut, 30, 130-135.
Tight tendoachilles as etiological factor in plantar fasciitis
Terence Derryl L. Dsouza, Ronald Menezes, Arun Mathew Cyriac
Introduction: Plantar fasciitis is a commonly encountered problem and could be secondary to a plethora of causes. Among the various causes suggested, tight TA is one of the frequently implicated etiology in many previous studies. Our study was to test this hypothesis of tight tendoachilles in cases with Plantar fasciitis using a foot pressure plate analysis.Among the 33 patients clinically diagnosed as PF only 5 had Point of Maximum Pressure anteriorly suggesting the co existence of tight TA in these cases. However overall results showed no staitsically significant association of tight tendoachilles with plantar fasciitis.
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5. Taunton JE, Ryan M, Clement DB, McKenzie DC, Lloyd-Smith R. Plantar fasciitis: a retrospective analysis of 267cases. Phys Ther Sport. 2002;3:57-65
6. Riddle, D.L., and D.B. Freeman. Management of a patient with a diagnosis of bilateral plantar fasciitis and Achilles tendinitis. Phys. Ther. 1988.68(12):1913-1916.
7. Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int. 2011; 32:5-8.
Trichoblastoma is a rare, benign adnexial tumour arising from follicular germinative cells, presenting as a solitary mass of brown/black nodule usually on head or neck in adult males. It is a dermal, epithelial and stromal neoplasm consisting of proliferation of basaloid cells in a stroma resembling perifollicular fibrous structures. A biopsy is essential for diagnosis as it may closely resemble a basal cell carcinoma or rarely undergo malignant transformation. Complete surgical excision is the treatment of choice. We present herewith a rare case of a giant trichoblastoma on thigh along with a a comprehensive review of the whole subject.
1. Ackerman A. B., de Virag PA, Chong chitnant N.: Neoplasm with follicular differenciation, Philadelphia: Le and Febigner – 1993. P. 357 – 412
2. Ackerman A.B., Reddy V.B., Soyer H.P.: Trichoblastoma. In: Neoplasms with follicular differenciation. 2nd ed. Newyork : Ardor serbendi , 2001 : 405 – 622
3. Girish Kamat, Balasab Yelikar, Savita Shettar et al: Pigmented Trichoblastoma with sebaceous hyperplasia – Indian Jour. Dermatol Venerol Leprol 2009 ; 75 : 506 – 8
4. Headington J.T.: Differenciating neoplasms of hair germ – Jour. Clin. Pathol. 1970 ; 23(6) : 464 – 71
5. Headington J.T.: Tumours of hair follicle – A review – Am. Jour. Of Pathol. 1976 ; 85 : 479 – 514
6. Han Kyoung Cho, Ji-Sun Song, Won Hyoung Kang et. al. : Pigmented Trichoblastoma arising from the nevus sebaceous – A rare case in Korea – Ann. Dermatol vol 21, no. 4, 2009
7. Kristen A. Zellar, Deborah F. Billimire : Trichoblastoma :Management of a rare skin lesion – Jour. Of Paediatric Surgery (2012), 47, 250 -252
8. Kim J.V., Kim Y.C.: Trichoblastoma and Syringocystadenoma papilliferrum arising in nevus sebaceom in 4 yr old boy : Cli. Exp. Derm. 2007; 32 : 218 -9
9. Luciana Takata Ponters, Andre Luiz Siiao, Fernando dos Ramos Seuling et. al. : Mohs Micrographic Surgery on recurrent trichoblastoma - Surg. Cosmet Dermatol 2012 ; 4(1) : 93 – 6
10. Laxmi Rao, Vidya Monappa, Mohammed Musheb: Cutaneous nodule on face: Admantinoid Trichoblastoma – A unique tumour – Our Dermatol. Online 2013; 4(2) : 218 – 220
11. Pragati J. karmarkar, Sadhna D. Mahore, Arone R. Wilkinson: Solitary Trichoblastoma – Jour. Pathol. Microbiol. [Serial online] 2009 [cited 2014 Nov. 5]; 52 :277 – 278
12. Sigrid Regauer, Christine Beham-schmid, Murat Okcu et al: Trophoblastic carcinoma (‘Malignant Trichoblastoma’) with lymphatic and hematogenous metastasis – Mod. Pathol. 2000 ; 13(6), 673 -678
Introduction: Many viral infections have prominent skin manifestations. Most commonly encountered are herpes simplex, molluscum contagiosum and human papilloma virus which causes verruca vulgaris, condyloma acuminatum, deep palmoplantar wart and verucca plana. They are of increased significance in immunocompromised patients. Most of the viral lesions are diagnosed clinically and serologically, some require biopsy confirmation. Aims and objectives: To identify the specific histological changes in individual viral lesions. To differentiate the lesions that can clinically mimic as bullous lesion or soft tissue mass. Materials and Methods: The skin biopsies received in the department of pathology, SMVMCH for a period of 3 years from 2011 to 2013 were taken for this study. Results: Out of 2160 skin biopsies studied, 31 patients were diagnosed to have skin manifestations of various viral infections. The most commonly encountered entity was Verruca vulgaris (14), followed by condyloma accuminatum (6), deep palmoplantar wart (4), molluscum contagiosum (4), herpes (2) and verucca plana (1). The most characteristic histological findings that helped in the diagnosis were, intranuclear inclusions in herpes; cytoplasmic viral inclusion bodies in MC, deep palmoplantar wart; koilocytes in Verruca and condyloma .These were also associated with other epidermal changes. Conclusion: Virus can produce warty, bullous and mass like lesions which can mimic non infectious conditions. Histopathological evaluation serves as a valuable tool for identification of virus induced skin changes and aids in appropriate management of these lesions. In our study most common infection was HPV.
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3. Kempf W et al. Dermatopathology. 1sted.Germany: Springer; 2008.32-34.
4. Michelle ML et al. An Armamentarium of Wart Treatments. Clin Med Res. Dec 2006; 4(4): 273–293.
5. Kuykendall-Ivy TD et al. Evidence-based review of management of nongenital cutaneous warts.Cutis 2003; 71:213–222.
6. Correlation between Human Papillomavirus (HPV) Type and Histology of Warts. Journal of Investigative Dermatology 1982; 78: 160–164.
7. Lowry DR et al. In: Freedberg IM, Eisen AZ, Klaus W, Austen KF, Goldsmith LA, Katz SI, eds. Fitzpatrick’s dermatology in general medicine. 6th ed. New York: McGraw-Hill Inc; 2003; 2:2119–2131.
8. Baseman JG et al. The epidemiology of human papillomavirus infections. J Clin Virol 2005; 32(1):16–24.
Screening for microalbuminuria as an early marker of diabetic nephropathy in type 2 diabetic patients
Background: One of the early complications of type 2 diabetes mellitus is diabetic nephropathy which is reported as the leading cause of premature deaths due to renal failure. This study was conducted to see the prevalence of microalbuminuria in type 2 diabetic patients. Materials and Methods: This cross sectional study was carried out in the Diabetic Clinic of Sri Ramachandra Medical Centre, Chennai, India. Subjects were selected based on a detailed questionnaire. Blood and urine sample of 95 type 2 diabetic patients and 30 normal subjects between the ages of 45-63 years were collected to analyze fasting plasma glucose, post prandial glucose, Glycated hemoglobin, Blood urea nitrogen, creatinine and microalbuminuria. Results: There were 38 microalbuminuria positive cases out of 95 diabetic patients (p<0.001). The prevalence of microalbuminuria was higher in older patients and increased with increase in duration of diabetes. Conclusion: There is significant association between the duration of diabetes and microalbuminuria in type 2 diabetic patients.
1. Cheema A, Adeloye D, Sidhu S, Sridhar D, Chan KY. Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis.J Glob Health. 2014 Jun; 4(1):010404.
2. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27:1047-1053.
3. Kern EF, Erhard P, Sun W, Genuth S, Weiss MF.Early urinary markers of diabetic kidney disease: a nested case-control study from the Diabetes Control and Complications Trial (DCCT). Am J Kidney Dis. 2010 May; 55(5):824-34.
4. King H, Auberti RE, Herman WH. Global burden of diabetes, 1995–2025. Prevalence, numerical estimated and projections. Diabetes Care 1998; 2:1414–31.
5. Ramachandran A, Snehalatha C, Latha E, et al. Rising prevalence of NIDDM in an urban population in India. Diabetologia 1997; 40:232–7.
6. Kilaru P, Bakris GL. Microalbuminuria and progressive renal disease. J Hum Hypertens. 1994 Nov; 8(11):809-17.
7. Yokoyama H, Aoki T, Imahori M, Kuramitsu M. Subclinical atherosclerosis is increased in type 2 diabetic patients with microalbuminuria evaluated by intima-media thickness and pulse wave velocity. Kidney Int. 2004 Jul; 66(1):448-54.
8. Neil A, Hawkins M, Potok M, et al. A Prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care 1993; 7:996–03.
9. Roshan B, Stanton RC. A story of microalbuminuria and diabetic nephropathy. J Nephropathol. 2013 Oct; 2(4):234-40.
10. Badal SS, Danesh FR. New insights into molecular mechanisms of diabetic kidney disease. Am J Kidney Dis. 2014 Feb; 63(2 Suppl 2):S63-83.
11. Packham DK, Alves TP, Dwyer JP, Atkins R, de Zeeuw D, Cooper M, Shahinfar S, Lewis JB, Lambers Heerspink HJ. Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database. Am J Kidney Dis. 2012 Jan; 59(1):75-83.
12. Collins VR, Dowse GK, Finch CF, et al. Prevalence and risk factors for micro and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes 1989; 38:1602–10.
13. Gupta DK, Verma LK, Khosla PK, et al. The prevalence of microalbuminuria in diabetes: a study from north India. Diabetes Res Clin Pract 1991; 12:125–8.
14. Klein R, Klein BEK, Moss SE. Prevalence of microalbuminuria in older-onset-diabetes. Diabetes Care 1993; 16:1325–9.
15. John L, Rao PS, Kanagasabapathy AS. Prevalence of diabetic nephropathy in non insulin dependent diabetes. Indian J Med Res 1991; 94:24–9.
16. Vijay V, Snehalatha C, Ramachandran A, et al. Prevalence of proteinuria in non-insulin dependent diabetes. J Assoc Physicians India 1994; 42:792–4.
17. Woerle HJ1, Neumann C, Zschau S, Tenner S, Irsigler A, Schirra J, Gerich JE, Göke B. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance of postprandial glycemia to achieve target HbA1c levels. Diabetes Res Clin Pract. 2007 Aug; 77(2):280-5.
18. Haddadinezhad S, Ghazaleh N. Relation of fasting and postprandial and plasma glucose with hemoglobinA1c in diabetics. Int J Diabetes Dev Ctries. 2010 Jan; 30(1):8-10.
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20. Colagiuri S, Cull CA, Holman RR; UKPDS Group. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes?: U.K. prospective diabetes study 61.Diabetes Care. 2002 Aug; 25(8):1410-7.
Effect of BMI and nutritional status on physical fitness index in response to short term moderate intensity exercise in sedentary young adults
Mona Kharbanda1*, G Indra Kumar2, Shweta Kumari Shah
Introduction: The current study was conducted to see the relationship between nutritional status of an individual, its body mass index and its physical performance so as to improve the physical fitness of low body mass index subjects bringing their better performance. The study was carried out in 58 young healthy sedentary medical students who were asked to perform short term limited duration exercise on bicycle ergograph. Each subject served as its own control. Subjects were introduced a pretested questionnaire for assessing nutritional status, Cardiorespiratory profile, status of nervous system, physical activity and related problems, history of past and present illness to find out any condition affecting physical performance of the subject. Physical activity level was assessed by different tests assessing their flexibility, coordination, Equilibrium, agility, strength and endurance. Physical activity Rating scale and VO2 max was used to assess the physical fitness. Physical fitness index was calculated using the formula. Pearson’s correlation coefficient was to determine the relation between BMI and Nutritional status score. Pearson’s correlation coefficient also determined the relation between nutritional status score and physical fitness index. Observed data revealed that subjects with poor nutritional status and obese subjects had lower level of physical fitness score. Physical fitness score was found to have a significant negative correlation with BMI in underweight and overweight subjects. It could thus be concluded that population having normal body mass index showed greater improvement in aerobic work capacity of study population which shows that sedentary medical students need proper nutrition, education and physical exercise to go a long way.
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11. Kusal. K. Das et al (2001).Physical fitness: A longitudinal study among Muslim children of Bijapur (Karnataka).Indian J Physiol Pharmacol 45(4): 457-462.
Histopathological study of xanthogranulomatous reaction in various sites
Introduction: Xanthogranulomatous inflammation is a chronic inflammatory disease. Histologically characterized by collection of foamy macrophages admixed with polymorphonuclear leukocytes, plasma cells and lymphocytes in a mosaic like pattern along with marked fibrosis and organ destruction. Most common sites are gall bladder, kidney, followed by lymph nodes and urogenitial tract. They mimic malignant neoplasm both radiologically and clinically. Usually they are incidental findings in the histopathological sections. They can be induced or associated with neoplastic and inflammatory processes. Materials and Methods: Histopathologically diagnosed cases of xanthogranulomatous reaction from the department of pathology, SMVMCH for a period of 2 years from 2012 to 2013 were taken for this study. Observation and Results: Totally 16 patients were diagnosed to have xanthogranulomatous reaction in various sites. It was found in association with various conditions like radicular cyst, anal fistula, cholecystitis, synovitis, pyelonephritis, mastitis, serous cystadenoma of ovary, vaginal wall mullerian cyst, epididymo-orchitis and ruptured epidermal cyst. PAS showed diffuse granular cytoplasmic staining which differentiates it from malakoplakia. Conclusion: Most xanthogranulomas present as a mass lesion extending to adjacent structures and can mimic infiltrating carcinoma. It may also accompany inflammatory signs like pain, fever, leukocytosis due to delayed type hypersensitivity reaction. Therefore distinguishing infections from neoplasm for further management is important. So histopathology is essential for confirmation of the lesion.
1. Arun A et al. Multiple generalized xanthogranuloma in adult: case report and treatment. Indian J Dermatol 2011; 56(2): 197–199.
2. Kazunari Mado et al. Xanthogranulomatous appendicitis. Indian Journal of Surgery 2013; 75(5): 405-406.
3. Chuang YF et al. Xanthogranulomatous appendicitis. J Formos Med Assoc 2005; 104(10):752-4.
4. Li L et al. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med 2011; 135(5):671-4.
5. Koo JS et al. Xanthogranulomatous mastitis: clinicopathology and pathological implications. Pathol Int 2009; 59(4):234-40.
6. Juan Rosai. Rosai and Ackerman’s Surgical Pathology. 9th ed. New Delhi: Elsevier; 2004.
7. Ozde RD et al. Surgical Pathology of the GI Tract, Liver, Biliary tract and Pancreas. 2ed. Piladelphia: Elseiver; 2009.
8. FlDiagnostic Histopathology of Tumors, Christopher D. M. Fletcher, 4ed.
9. Weidner et al. Modern Surgical Pathology. 2nd ed. Piladelphia: Elseiver; 2009.
10. Ming Z et al. Genitourinary Pathology: A volume in foundations in diagnostic pathology series.
11. Gattuso et al. Differential diagnosis in surgical pathology. 2nd ed. Piladelphia: Elseiver; 2010.
Reduction en masse in a strangulated direct inguinal hernia
M L Sankar Narayanan, S Surya, K Balaji Singh, T Mohanapriya, T Manuneethimaran, K Arunkumar, E Premanandh, N Nitesh, T R Karthikhaeyan
Background: Direct or Internal Inguinal Hernia is quite commonly encountered in elderly people due to laxity of posterior wall following repeated distention and straining. It is uncommon to undergo complication such as obstruction, strangulation, perforation in a direct , complete inguinal hernia. Hernial Reduction En Masse is rare to encounter and requires high degree of clinical suspicion, more likely to be unnoticed and can end up being fatal to the patient. We report a case of a strangulated, direct, complete inguinal hernia which perforated following spontaneous En Masse reduction.
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Implications of serum urea and creatinine estimation in prostate cancer
Demographic and epidemiological transitions in developing countries like India have shown an increasing trend in burden of non communicable diseases like cardiovascular disease, diabetes as well as cancer. Previously, it was thought that the prevalence of prostate cancer in India is far lower as compared to the western countries but due to various reasons it is becoming clear that we are not very far behind the rate from western countries. Since prostate disorders have an association with end stage renal disease and is also age related, this study focuses on the utility of blood levels of urea, creatinine, as a possible aid in the diagnosis of prostate cancer. The study was conducted in the Department of Biochemistry in collaboration with the Department of Surgery in MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana. The clinical and laboratory findings of 100 subjects (age ≥ 30 years) with biopsy-confirmed prostate related disorders as BPH, carcinoma of prostate, prostatomegaly were taken from hospital records dated January 2013 to September 2014. Out of 100 subjects, 7 (7%) had elevated serum urea, 17 (17%) had elevated serum creatinine and 7 (7%) had elevated levels of both. 29 (29%) patients had elevated serum PSA levels out of which 2 (6.8%) had elevated serum urea, 9 (31%) had elevated serum creatinine, and 2 (6.8%) had elevated serum levels of both. Majority of subjects were in the age group of 61-70 years whereas serum PSA levels were highest in the age group of 71-80 years. Therefore, increased serum urea and/or creatinine could be an early hint towards prostate cancer and it is recommended that males ≥40 years of age should undergo screening for serum PSA levels every 5 years.
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3. Sinha R, Anderson DE, Mc Donald SS, Greenwald P: Cancer risk and diet in India. J Postgrad Med. 2003; 49:222-8.
4. Jain S, Saxena S, Kumar A: Epidemiology of prostate cancer in India: Meta Gene. 2014; 2: 596–605.
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6. Miele ME: Percent free PSA as an additional measure in a prostate cancer screen: Clin Lab Sci. 2001; 14(2):102- 7.
7. Jacobson DJ, Robert RO: The association between benign prostatic hyperplasia and chronic kidney disease in community dwelling men: Kidney Int. 2005; 67(6):2376- 82.
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9. Wada Y, Nakanishi J, Takahashi W, Kai N, Nakayama Y, Yamashita Y et al: Mass screening for prostate cancer in patients with end-stage renal disease: a comparative study: BJU Int. 2006; 98(4):794-7.
10. Roddam AW, Rimmer J, Nickerson C, Ward AM: Prostate specific antigen: bias and molarity of commercial assays for PSA in use in England: Ann Clin Biochem. 2006; 43:35-48.
11. Lamb EJ, Price CP: Kidney function test. In: Burtis CA, Ashwood ER, Burn DE (editors): Teitz textbook of Biochemistry and Molecular Diagnosis. 5thedition. Philadelphia: Elsevier. 2012; chapter 25: p699-707.
12. Lepor H: Epidemiology and natural history of benign prostatic hyperplasia: Rev Urol. 2004; 9:S3-S10.
Pecoma of the ischiorectal fossa presenting in pregnancy - a rare presentation of a rare tumor
Perivascular epitheloid cell tumor (PEComa) is an uncommon entity composed of distinctive perivascular epitheloid cells with variable immuno reactivity for melanocytic and muscle markers. They are recently described tumors, and in the last decade there have been reports of similar tumors in various sites, such as uterus, retro peritoneum, breast, cardiovascular and central nervous system. However in our opinion, such a tumor has not been reported in pregnancy till now. Here we report a case of PEComa occurring in a 22 year old pregnant lady in the ischiorectal fossa, and describe the diagnostic and surgical challenges faced. We also highlight the peculiar clinical and morphological features of the case. The importance of considering PEComas in the differential diagnosis even in pregnancy, the need to arrive at a conclusive preoperative diagnosis and the requirement for immune histochemical work up have been discussed, with a revision of the concerning scientific literature.
1. Folpe AL (2002) Neoplasms with perivascular epithelioid cell differentiation (PEComas). In: Fletcher CDM, Unni KK, EpsteinJ, Mertens F (eds) Pathology and genetics of tumours of softtissue and bone. Series: WHO Classification of tumours. IARCPress, Lyon, pp 221–222
2. Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. PEComas: the past,present and the future(2008).Virchows Arch 452:119–132
3. Apitz K (1943) Die Geschwülste und Gewebsmissbildungen der Nierenrinde. II Midteilung. Die mesenchymalenNeubildungen. Virchows Arch 311:306–327
4. The European Chromosome 16 Tuberous Sclerosis Consortium (1993) Identification and characterization of the tuberous sclerosis gene on chromosome 16. Cell 75:1305–1315.
5. Folpe et al .Perivascular Epithelioid Cell Neoplasms of Soft Tissue and Gynecologic Origin: A Clinicopathologic Study of 26 Cases and Review of the Literature. American Journal of Surgical Pathology: December 2005 - Volume 29 - Issue 12 - pp 1558-1575 Original Article
6. Fadare O. Perivascular epithelioid cell tumor (PEComa) of the uterus: an outcome-based clinicopathologic analysis of 41 reported cases. AdvAnatPathol. 2008 Mar; 15(2):63-75.
7. Pea M, Martignoni G, Zamboni G, et al. Perivascular epithelioid cell. Am J SurgPathol 1996; 20:1149–1153.
8. Fadare O, V Prakash,YYilmaz, et al. Perivascular epithelioid cell tumor (PEComa) of the uterine cervix associated with intraabdominal "PEComatosis": A clinicopathological study with comparative genomic hybridization analysis. World Journal of surgical oncology 2005, 3:25.
9. Hornick JL, Fletcher CD. PEComa: what do we know so far? Histopathology. 2006 Jan;48(1):75-82
A double blind randomised controlled clinical trial of Isoamyl-2-cyanoacrylate with N-butyl cyanoacrylate
Introduction: Closure of wounds with bioadhesives was proved to be efficacious and well tolerable. It also produces scar thinner than the sutures. Now it is require comparing the efficacy of various bioadhesives available in the market by a phase III clinical trial. Aim: To compare the efficacy and tolerability of Isoamyl-2-cyanoacrylate bya control clinical trial using n-Butyl cyanoacrylate as the control. Methodology: it is a double blind, randomised controlled clinical trial of Isoamyl-2-cyanoacrylate with n-butyl cyanoacrylate in patients of inguinal hernia in the age group of 18 – 40 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: The scar was of better quality in the 3rd month for the test group. The increase in the scar scale was statistically significant for Isoamyl and n-butyl cyanoacrylate using paired student ‘t’ test p<0.05. The difference in the scar quality between the two groups using unpaired ‘t’ test was not statistically significant.
1. Lazarus MS, Cooper DM, Knighton DR. definitions and guidelines for assessment of wounds and avaluation of healing Arch dermatology 1994 130:489-493.
2. McGrouthier DA, Wounds, tissue repair and scars. In:mann CV, Russell RCG, Williams NS(eds) Bailey and Love’s short practice of surgery. 22ed 1995:8-16
3. Robbins SL Inflammation and healing 5thed “Pathological basis of diseases†1974; 51-150
4. Paecock EE junior wound healing in the scientific management of surgical patients: 1sted 1983: 27-63
5. Albert NJ: wound healing: Dermatologic clinics. Oct 1993:11; (4): 629-808
6. AVS. Rama Rao. A textbook of Biochemistry. 6thedn. LKS publishers. The cells and some special tissue p130
7. Caterson B, Lowther Da: Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. BiochemBiophysActa, 1978, 540:412
8. Singer AJ, Hollander JE, Tissue adhesives for laceration closure JAMA 1997; vol 278:703
9. PJB Murray: Closure of skin wounds with Adhesive Tape: British Medical Journal 1963 Oct: vol26;1030
10. Thomas B Burns, MC et al. a New Tissue Adhesive for Laceration repair in children. The journal of Paediatrics June 1998; vol 132(6): 1067-1070
11. NG Rothnie, GW Taylor: Sutureless skin closure. A clinical trial. British Medical Journal 1963 Oct vol 26; 1027-30
12. Dalvi et al: Journal of post graduate medicine 1986 32(2) 97-100
13. Use of cyanoacrylate tissue adhesive for closing facial lacerations in children; David P Watson; British Med Journal 1989 vol. 299 page 1014.
To assess the knowledge of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) among medical interns at tertiary care hospital in Raigad district, Maharashtra
The Maharashtra government has launched Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in the state since July 2012 for below poverty line patients. In this scheme, all procedure from registration of patient to the discharge is done online. The present study was conducted to assess the knowledge of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) among medical Interns and find out the technical difficulties faced by them while working with RGJAY at tertiary care hospital. All MBBS interns (96) who have completed 6 months of internship were selected for the study. A predesigned and pre-tested, questionnaire was given to interns when they come in RGJAY OPD and asked to fill the form after written consent. The data was analysed using Microsoft excel and SPSS. Total 96 interns were participated in the study. Most of the interns (97.9%) were aware about Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). Main source of information was RGJAY OPD. About 91.70% interns told that they didn’t get any pre internship training for these technical procedures under RGJAY. About 80% interns were properly guided by Aarogyamitra. Majority of interns (91.70%) had experienced technical difficulties and about 76.14% interns responded that their difficulties had been resolved in RGJAY OPD. Out of all procedures, interns stated that, to fill online pre-auth registration (35.40%) and Discharge update (43.80%) were the most complicated procedure. Majority of interns (82.3%) reported that there should be separate staff for RGJAY on line procedures, 90 % interns reported that RGJAY OPD needs upgraded infrastructure; about 87.5% interns reported that pre-training should be given. There are many medical insurance schemes are operating in the country but for effective implementation and utilization of schemes, proper information, training, education and communication is needed at programme level as well as community level.
1. Shaikh Md Altaf Shaikh Ibrahim, Pathan Mohsin Khan Aslam Khan, Rajeev Gandhi Jeevandayee Aarogya Yojana –An overview of Health Insurance Scheme of Govt. of Maharashtra. Asian Journal of Management Sciences 02 (03) 2014; 132-134.
2. http://www.jeevandayee.gov.in/RGJAY/FrontServlet?requestType=CommonRHandactionVal=RightFrameandpage=undefined>>RGJAYandpageName=RGJAYandmainMenu=AboutandsubMenu=RGJAY
3. http://www.mahaarogya.gov.in/projectandschemes/Jeevandaiaarogya/default.htm.
4. M.P Tambe, Rajiv Gandhi Jeevandayee Arogya Yojana of Maharashtra: IPHA Maharashtra Newsletter Vol9, No1, 2012.
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6. Harshad Thakur, soumitra Ghosh. Case study report on Social Exclusion and Rashtriya Swasthtya BimaYojana in Maharashtra. Deonar, Mumbai: School of Health services Studies, Tata Institute of Social sciences; May 2013.
7. Shankar Prinja, Manmeet Kaur, Rajesh Kumar. Universal Health insurance in India: ensuring equity, efficiency and quality. IJCM2012; vol 37, issue 3, p 142-149.
Introduction: To study the effect of intravenous metoprolol in severe hypertension. The use of betablockers in the management of severe hypertension was not considered for the fear of paradoxical rise in blood pressure, but it has been found that IV metoprolol is safe and effective in the management severe hypertension with careful clinical monitoring even in the absence of ICU facility. (Khokhani 1993) Materials and Methods: Patient presenting with severe hypertension of unknown etiology were taken for the study. The study has been carried out at GMC, Aurangabad for about three years. Metoprolol (Betaloc) was given intravenously at the rate of 1mg/min.Systolic, diastolic blood pressure and heart rate recorded at various intervals. Adverse reaction if any noted Result: The study has been carried out for three years on 34 cases of severe hypertension, admitted at GMC Aurangabad. After giving IV Metoprolol the fall in systolic, diastolic blood pressure was statistically significant The fall starts at the end of five minutes and continued up to ninety minutes. Our study compared with this study, (Kokhani et al 1993), it is observed that results in both studies are same. No side effect observed during the study. Conclusion: After the administration of IV Metoprolol the fall in blood pressure and heart rate was statistically significant. A safe diastolic blood pressure (≤ 110 mm of hg) effect were observed during the study and does not require scrupulous monitoring was achieved. It is thus concluded that IV Metoprolol is a safe and effective drug in patient of severe hypertension. No side effects were observed during the study and does not require scrupulous monitoring.
1. Khokhani RC, Karnik ND, Gandhi VP et al: Intravenous metoprolol in hypertensive urgencies and emergencies. JAPI, 1993, Vol. 41: No. 11, P. 724.
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Groundwater development in chevella basin, Ranga reddy district, Andhra Pradesh, India
Groundwater is one of the fresh water sources which are neither unlimited nor protected deterioration. In most of the times due to excess usage of groundwater resulted in drying up of the open and tubular wells, increasing the salt concentration, causing sea water intrusion near coastal areas and depletion of the water resource. Now a days most of the people recognized water quality as one of the important aspect in their life as its quantity. Present study is an attempt to analyse the impact of rainwater harvesting structures on groundwater quality in the Chevella basin. pH, TDS, Hardness, Bicarbonates, Chlorides, Sulphates, Nitrates, Fluorides, Calcium, Magnesium, Sodium, Potassium and Iron are measured/estimated for the years 2010-2013 (Pre and Post-monsoon periods) using standard analytical techniques. The study supports that the rainwater harvesting has improved the quality of groundwater in Chevella basin.
1. APHA (1985) Standard methods for the examination of water and waste. 16th ed. Am pub Health Assoc. Washington, DC, p 100.
2. Brown E, Skougstad MW, Fishmen MJ (1983) Method for collection and analyzing of water samples for dissolved minerals and gases. US Govt. Printing Office, Washington, DC, p 75.
3. Revelle R (2004) Criteria for recognizing seawater in groundwater. Am Geophys Union Trans 22:593–597.
4. Singh VS, Saxena VK, Prakash BA, Mondal NC, Jain SC (2004) Augmentation of groundwater resources in saline ingress coastal deltaic area. NGRI-Tech. Report. No. NGRI-2004-GW-422, pp 1–61.
A comparative study of Isoamyl-2-cyanoacrylate with sutures
Introduction: Closure of wounds with bioadhesives was proved to be efficacious and well tolerable. Therefore it is necessary to do a study which should compare the bioadhesives and sutures. Aim: To compare the efficacy of Isoamyl-2-cyanoacrylate with sutures in patients with bilateral inguinal hernia. Methodology: it is a comparative study of Isoamyl-2-cyanoacrylate with sutures in patients of bilateral inguinal hernia in the age group of 18 – 65 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: The scar obtained with bioadhesive is of better quality in the 3rd month and 6th month for the test group than that of suture. Though more expensive than sutures where economically feasible Isoamyl 2 cyanoacrylate offers a well acceptable alternative to suture.
1. Lazarus MS, Cooper DM, Knighton DR. definitions and guidelines for assessment of wounds and avaluation of healing Arch dermatology 1994 130:489-493.
2. McGrouthier DA, Wounds, tissue repair and scars. In:mann CV, Russell RCG, Williams NS(eds) Bailey and Love’s short practice of surgery. 22ed 1995:8-16
3. Robbins SL Inflammation and healing 5thed “Pathological basis of diseases†1974; 51-150
4. Paecock EE junior wound healing in the scientific management of surgical patients: 1sted 1983: 27-63
5. Albert NJ: wound healing: Dermatologic clinics. Oct 1993:11; (4): 629-808
6. AVS. Rama Rao. A textbook of Biochemistry. 6thedn. LKS publishers. The cells and some special tissue p130
7. Caterson B, Lowther Da: Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. BiochemBiophysActa, 1978, 540:412
8. Singer AJ, Hollander JE, Tissue adhesives for laceration closure JAMA 1997; vol 278:703
9. PJB Murray: Closure of skin wounds with Adhesive Tape: British Medical Journal 1963 Oct: vol26;1030
10. Thomas B Burns, MC et al. a New Tissue Adhesive for Laceration repair in children. The journal of Paediatrics June 1998; vol 132(6): 1067-1070
11. NG Rothnie, GW Taylor: Sutureless skin closure. A clinical trial. British Medical Journal 1963 Oct vol 26; 1027-30
12. Dalvi et al: Journal of post graduate medicine 1986 32(2) 97-100
13. Use of cyanoacrylate tissue adhesive for closing facial lacerations in children; David P Watson; British Med Journal 1989 vol. 299 page 1014.
Awareness of pharmacovigilance among medical students
Objective: To assess the awareness of Pharmacovigilance among Medical students. Materials and Methods: The study was conducted by Department of Pharmacology of Hassan Institute of Medical Sciences, Hassan among II year medical students after obtaining permission from Institutional Ethical Committee. A questionnaire containing 14 questions with 2 – 5 options were given to each student and they were asked to tick one best suitable option. The questionnaire was based on previous study about Pharmacovigilance and was suitably modified for students. The completed questionnaire was analysed and frequency is expressed as percentage. Results: A total of 96 students who were in II MBBS participated in the study. Most of the students had correct understanding regarding Pharmacovigilance and knew the role of Pharmacovigilance in identifying the safety of drugs. 94% of the students were well aware of activities involved in Pharmacovigilance. 50% of the students haven’t come across any article about adverse drug reaction (ADR). 81% felt that all unwanted events are not due to medicine alone.73% were aware of drugs banned because of ADR. 92% were aware of the measures to be taken when an ADR is suspected. Majority of the participants agreed that all health care professionals are responsible for reporting ADR and it is a professional obligation. Conclusion: The study results revealed that students were aware of Pharmacovigilance, but there was lack of professional obligation towards reporting ADR. Though Pharmacovigilance is being taught as part of Undergraduate curriculum, the students should be involved in more activity based and problem based learning.
1. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies: JAMA 1998; 279:1200-5.
2. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra cost and attributable mortality: JAMA 1997; 277: 301-6.
3. Oshikoya KA, Awobusuyi JO. Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria: BMC Clin Pharmacol 2009; 9:14.
4. Feely J, Moriarty S, O’Connor P. Stimulating reporting of adverse drug reactions by using a fee: BMJ 1990; 300: 22-23.
5. Kharkar M, Bowalekar S. Knowledge, attitude and perception/practices (KAP) of medical practitioners in India towards adverse drug reaction (ADR) reporting: Perspectives in Clinical research 2012;3(3):90-94.
6. Rehan HS, Ravinder KS, Deepti C. Comparision of knowledge, attitude and practices of resident doctors and nurses on adverse drug reaction monitoring and reporting in a tertiary care hospital: Indian Journal of Pharmacology 2012:44(6); 699-703.
7. Khan SA, Goyal C, Chandel N, Rafi M. Knowledge, attitude and practice of doctors to adverse drug reaction reporting in a teaching hospital in India: An observational study: Journal of Natural Science, Biology and Medicine. 2013:4(1); 191-196.
8. Gupta P, Udupa A. Adverse drug reaction reporting and Pharmacovigilance: Knowledge, attitudes and perceptions amongst resident doctors: J Pharma Sci Res 2011:3; 1064-9.
9. Ravi Shankar P, Subish P, Mishra P, Dubey AK. Teaching Pharmacovigilance to medical students and doctors: Indian J Pharmacol 2006:38(5); 316-319.
10. Radhakrishnan R, Sudha V, Danturulu MV. An educational intervention to assess knowledge attitude practice of Pharmacovigilance among health care professionals in an Indian tertiary care teaching hospital: International Journal of PharmTech Research April – June 2011:3(2); 678-692.
11. Sonali AP, Jaiswal KM, Sontakke SD, Bajait CS, Gaikwad A. Evaluation of awareness about Pharmacovigilance and Adverse drug reaction monitoring in resident doctors of tertiary care teaching hospital: Indian Journal of Medical Sciences 2012; 66: 55-61.
A rare cause of intestinal obstruction: ileal squamous cell carcinoma - a case report
Introduction: Small bowel obstruction caused by metastatic lesion from other primary cancer is a rare event. The most common types of tumor metastasizing to the small bowel are malignant melanoma, carcinoma from lung, breast, and ovary, and choriocarcinoma Idelevich et al. reviewed the literature and found that between 1988 and 2005, only 36 cases have been reported. Interestingly, the most common primary cancer in these cases was lobular breast carcinoma (47%), followed by lung cancer (11%) and malignant melanoma (8%), most of which are adenocarcinoma.. Rarely however, does it selectively affect the small bowel in the form of an isolated metastatic stricture. We are reporting such a case of terminal ileum obstruction due to metastatic deposit of invasive cervical squamous cell carcinoma, 8 months after total abdominal hysterectomy, emphasizing role of meticulous searching of lymph nodes during surgery of cervical carcinoma to avoid such fatal complication.
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2. Idelevich E, Kashtan H, Mavor E, Brenner B. Small bowel obstruction caused by secondary tumors. Surg Oncol 2006:15:29-32 [PubMed]
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4. Howley, P. R. and Morson, B. C.: Tumours of the small intestine. In, "Abdominal Operations." Editors: R.. Maingot, 7th Edition. Appleton-Century Crofts, New York, 1980, pp.1972.
5. Hendrikson, E.: Quoted by Bradley Watson, P. J. and Leiman, G.: Ileal metastasis in cervical carcinoma. A case report. South Afr. Med. J., 50: 1937-1938, 1976
6. Farmer, R. G. and Hawk, W. A.: Metastatic tumours of the small bowel. Gastroenterology, 47:496-504, 1964.
Students’ perception of effective learning experiences in government medical college
Objective: To obtain students feedback on teaching methodologies and evaluation methods for the betterment of teaching and learning pharmacology. Material and Methods: The study was done by Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan. A questionnaire containing 14 questions were given to second MBBS students who were due to appear for examination. They were supposed to tick one suitable option. Descriptive statistics is used for analysis of data. Frequency expressed as percentage. Results: Total response of 93.33% was observed. Most of the students preferred blackboard as the teaching media which imparts knowledge (65.3%) and better interaction between student and teacher (81.6%). Majority of students felt that cardiovascular system (47.9%), Hormones (32.6%), Autonomic Nervous system (31.6) and Clinical pharmacology (27.55%) as most interesting topics in Pharmacology. Central nervous system (40%) was mentioned as the most difficult topic to understand. 69% mentioned Tutorials and 52% Group discussion as most useful method in preparing for University exams. Students preferred textbooks and class notes (41.8%) for studying pharmacology. As a part of pharmacology practicals, Clinical pharmacology (44.9%), Prescription writing and Problem solving exercises (26.5%) was preferred. Most of the students felt that special topics like Emergency drugs (57%) and Rationale use of drugs (23%) should be discussed in lectures/ practicals. 65% of students felt Pharmacology to be integrated with other subjects. Conclusion: Collaboration of various teaching methods if adopted will ensure in depth knowledge acquisition and improved performance in exam. Incorporation of clinically oriented teaching program will guide students to study the subject from futuristic point of view. Frequent feedback from students may help teachers plan the curriculum and improve the teaching.
1. Ruth N: Communicating student evaluation of teaching results: rating interpretation guides: Assess Eval High Educ 2000; 25:121-134.
2. Desai M: Changing face of pharmacology practicals for medical undergraduates: Indian J Pharmacology 2009;41:151-2
3. Hariharan TS: Need for changes in the practical pharmacology curriculum of medical undergraduates: Indian J Pharmacol 2004; 36:181.
4. Garg A, Rataboli PV, Muchandi K: Students’ opinion on the prevailing teaching methods in pharmacology and changes recommended: Indian J Pharmacol 2004; 36; 155-8.
5. Kaufman M, Mann V: Achievement of Students in a Conventional and Problem Based Learning (PBL) Curriculum: Adv Health Sci Edu 1999; 4:245-60.
6. Victoroff KZ, Hogan S: Students’ perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique: J Dental Edu 2006; 70:124-132.
7. Sekhri K, Singh H: Teaching methodologies in pharmacology: A survey of students’ perceptions and experiences: J of Education and Ethics in Dentistry January-June 2013; 2(1): 40-44.
8. Chavda N, Yadav P, Chaudhari M, Kantharia ND: Second year student’s feedback on teaching methodology and evaluation methods in Pharmacology: National Journal of Physiology, Pharmacy and Pharmacology 2011; 1:23-31.
9. Badyal DK, Bala S, Kathuria P: Student evaluation of teaching and assessment methods in Pharmacology: Indian J Pharmacol April 2010; 42(2): 87-89.
10. Shenfield GM: Integrating clinical Pharmacology teaching with general practice: Br J Clin Pharmacol 1998; 45:399-401.
Efficacy of oral fenofibrate in the management of unconjugated hyperbilirubinemia in neonates- A prospective study
B L Anantha Narayana Gowda, H M Viswanathakumar, Yamuna B N, Arun Daniel J
Background: Fenofibrate is one of the commonest drugs to treat hyperlipidemia in adults. It also has the ability to induce bilirubin conjugation apart from its hypolipidemic action. Objective: To study the efficacy of oral fenofibrate in reducing bilirubin levels in neonates with significant unconjugated hyperbilirubinemia. Materials and methods: A prospective study was conducted ina tertiary care hospital at Tumkur, Karnataka between June 2013 and April 2014 following up a cohort of 100 neonates. Efficacy of oral fenofibrate was determined by comparing 50 neonates who received oral fenofibrate as well as phototherapy (exposed group) with those who received phototherapy alone (unexposed group), by measuring direct and indirect bilirubin levels at 12, 24, and 48 hours. Results: There was no significant difference in bilirubin levels at 12 (p=0.22), 24 (p=0.08) and 48 hours (p=0.07) respectively among the two groups. Conclusion: Oral fenofibrate did not prove efficacious in reducing bilirubin levels in neonates with significant unconjugated hyperbilirubinemia.
1. Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatrics. 2006 Jul;118(1):276–9.
2. Jennifer G, Robinson, Anne C, Goldberg. Treatment of adults with Familial Hypercholesterolemia and evidence for treatment: Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. J Clin Lipidol 2011 Jun;5:18-27.
3. Newman TB, Liljestrand P, Jeremy RJ, Ferriero Dm et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006 May;354:1889-1900.
4. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia in the new-born 35 or more weeks of gestation. Pediatrics 2004 Oct;114(4):1134-5. 2.
5. Piazza AJ, Stoll BJ. The fetus and the neonatal infant- Digestive system disorders (Kernicterus). In: Nelson Text Book of Pediatrics (Vol. I). RM Kliegman, RE Behrman, HB Jenson, BF Stanton (Eds.); 18th Edn.; Saunders: An imprint of Elsevier, Philadelphia; 2008:761-5.
6. Dennery PA. Pharmacological interventions for the treatment of neonatal jaundice. Seminars in Neonatalogy 2002;7(2):111-9.
7. Bennet PN, Brown MJ. Clinical Pharmacology (Section 5). 10th Edn. Churchill Livingstone: An Imprint of Elsevier, New Delhi. 2008;474-5.
8. Kutz K, Kandler H, Gugler R, Fevery J. Effect of Clofibrate on the metabolism of bilirubin, Bromosulphophthalein and indocyanine green and on the biliary lipid composition in Gilberts syndrome. Clinical Science 1984;66(4):389-7.
9. Gabilan JC, Benattar C, Lindenbaum A. Clofibrate treatment of neonatal jaundice. Pediatrics 1990;86(4):647-8.
10. Kumar B, Agarwal PK, Chorishi A, Dhaneria M. Fenofibrate: a novel approach in treating uncomplicated neonatal hyperbilirubinemia. People’s journal of scientific research 2012 Jul;5(2):5-8.
11. Mohammadzadeh A, Farhat SH, Iranpour R. Effect of Clofibrate in jaundiced term newborns. Indian J Pediatr 2005;72(2):123-6.
Aberrant Right Renal Artery- A Case Report
S G Kawale, G L Maske, A D Kannamwar, S E Shaikh, S V Pandit
During routine undergraduate dissection of abdomen in middle aged male cadaver we encountered an unusual variation. This was aberrant right renal artery arising from superior mesenteric artery. There were no variation on left side and other branches of abdominal aorta and there courses were normal. Clinical implication and embryological basis of this type of variation will be discussed
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4. Neelesh Kanaskar., Vaishali Paranjape., Jyoti Kulkurni., Sapna Shevade. Double Accessory Right Renal Arteries.2012. IOSR Journal Of Dental and Medical Science., vol 1 (5). Pg- 17-20.
5. Joseph C. Cerny., Daniel Karsch., Aberrant Renal Artery. Urology. December1973. vol 2 (6). Pg-623-626.
Clinical evaluation of Isoamyl 2- cyanoacrylate: a novel tissue adhesive
Even in present day surgical practice, closure of wounds with sutures consumes more time. With advancement of surgical methods like staples and tapes which are used in closure of wounds leave a disfigured scar. Therefore it is necessary to minimise the scar as well as the time consumption with use of newer methods like bioadhesives. Aim: To study the effect of Isoamyl-2-cyanoacrylate on patients with surgical wounds (combined phase I and II) Methodology: it is a combined Phase I and II clinical trial conducted in patients of inguinal hernia in the age group of 18 – 40 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: the wound closure using bioadhesive is excellent with minimal scar formationand the difference is significant at 95% level of confidence. It is well tolerated.
1. Lazarus MS, Cooper DM, Knighton DR. definitions and guidelines for assessment of wounds and avaluation of healing Arch dermatology 1994 130:489-493.
2. McGrouthier DA, Wounds, tissue repair and scars. In:mann CV, Russell RCG, Williams NS(eds) Bailey and Love’s short practice of surgery. 22ed 1995:8-16
3. Robbins SL Inflammation and healing 5thed “Pathological basis of diseases†1974; 51-150
4. Paecock EE junior wound healing in the scientific management of surgical patients: 1sted 1983: 27-63
5. Albert NJ: wound healing: Dermatologic clinics. Oct 1993:11; (4): 629-808
6. AVS. Rama Rao. A textbook of Biochemistry. 6thedn. LKS publishers. The cells and some special tissue p130
7. Caterson B, Lowther Da: Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. BiochemBiophysActa, 1978, 540:412
8. Singer AJ, Hollander JE, Tissue adhesives for laceration closure JAMA 1997; vol 278:703
9. PJB Murray: Closure of skin wounds with Adhesive Tape: British Medical Journal 1963 Oct: vol26;1030
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Annular pancreas – a case report and review of the literature
B Selvaraj, K Senthil Kumaran, G P Sekar
Introduction: Annular pancreas is a very rare congenital problem that can manifest clinically from neonatal age to adulthood. Here we present a rare case of Annular pancreas which presented in neonatal period. The child presented with bilious vomiting and the AXR revealed classical Double bubble appearance. Laparotomy revealed the diagnosis and we did Kimura’s diamond shaped Duodeno-duodenostomy. Postoperatively we gave peripheral TPN for 10 days.
1. Ravitch MM, Woods AC Jr. Annular pancreas.AnnSurg1950; 132:1116–1127 2. Baggott BB, Long WB. Annular pancreas as acause of extrahepatic biliary obstruction. Am JGastroenterol1991; 86:224–226 3. Lecco TM. ZurMorphologie des Pankreasannulare.SitzungbAkadWissensch1910; 119:391–406 4. Baldwin WA. A specimen of annular pancreas. Anat Rec 1910; 4:299–304 5. Lin SZ. Annular pancreas. Etiology, classification and diagnostic imaging. Chin Med J (Engl) 1989; 102:368. 6. Hill, ID, Lebenthal, E. Congenital abnormalities of the exocrine pancreas. In: Pancreas: Pathology, Pathobiology and Disease, 2nd ed, Go, VL, Dimagno, EP, Gardner, JD, et al (Eds), Raven Press, New York 1993. p.1029. 7. Annular pancreas: a new classification and clinical observations.JohnstonDW.Can J Surg. 1978 May; 21(3):241-4. 8. Zyromski NJ, Sandoval JA, Pitt HA, et al. Annularpancreas: dramatic differences between childrenand adults. J Am CollSurg2008; 206:1019–1025 9. Kiernan PD, ReMine SG, Kiernan PC, ReMine WH. Annular pancreas: May Clinic experience from 1957 to 1976 with review of the literature. Arch Surg 1980; 115:46. 10. Hays DM, Greany EM Jr, Hill JT. Annular pancreas as a cause of acute neonatal duodenal obstruction. Ann Surg 1961; 153:103. 11. Sencan A, Mir E, Günsar C, Akcora B. Symptomatic annular pancreas in newborns. Med SciMonit 2002; 8:CR434. 12. Zyromski NJ, Sandoval JA, Pitt HA, et al. Annular pancreas: dramatic differences between children and adults. J Am CollSurg 2008; 206:1019. 13. Urayama S, Kozarek R, Ball T, et al. Presentation and treatment of annular pancreas in an adult population. Am J Gastroenterol 1995; 90:995. 14. Chen YC, Yeh CN, Tseng JH. Symptomatic adult annular pancreas. J ClinGastroenterol 2003; 36:446. 15. England RE, Newcomer MK, Leung JW, Cotton PB. Case report: annular pancreas divisum--a report of two cases and review of the literature. Br J Radiol 1995; 68:324. 16. Maker V, Gerzenshtein J, Lerner T. Annular pancreas in the adult: two case reports and review of more than a century of literature. Am Surg 2003; 69:404. 17. Gilinsky NH, Lewis JW, Flueck JA, Fried AM. Annular pancreas associated with diffuse chronic pancreatitis. Am J Gastroenterol 1987; 82:681. 18. Green JD, Fieber SS, Buniak B. Annular pancreas with dilated biliary and pancreatic ducts. Am J Gastroenterol 1993; 88:467. 19. Shan YS, Sy ED, Lin PW. Annular pancreas with obstructive jaundice: beware of underlying neoplasm. Pancreas 2002; 25:314. 20. Yogi Y, Shibue T, Hashimoto S. Annular pancreas detected in adults, diagnosed by endoscopic retrograde cholangiopancreatography: report of four cases. GastroenterolJpn 1987; 22:92. 21. Poki HO, Holland AJ, Pitkin J. Double bubble, double trouble. PediatrSurgInt 2005; 21:428. 22. Imamoglu M, Cay A, Sarihan H, Sen Y. Rare clinical presentation mode of intestinal malrotation after neonatal period: Malabsorption-like symptoms due to chronic midgut volvulus. PediatrInt 2004; 46:167. 23. Yoshizato T, Satoh S, Taguchi T, et al. Intermittent 'double bubble' sign in a case of congenital pyloric atresia. Fetal DiagnTher 2002; 17:334. 24. Malone FD, Crombleholme TM, Nores JA, et al. Pitfalls of the 'double bubble' sign: a case of congenital duodenal duplication. Fetal DiagnTher 1997; 12:298. 25. Dowsett, J.F., Rode, J. and Russell, R.C.G. (1989) Annu- lar pancreas: A clinical, endoscopic, and immunohisto- chemical study. Gut, 30, 130-135. 26. Jarikji Z, et al.: The tetraspanin Tm4sf3 is localized to the ventral pancreas andregulates fusion of the dorsal and ventral pancreatic buds. Development. 136:1791-1800 2009 27. Bitgood MJ, McMahon AP: Hedgehog and Bmp genes are coexpressed at manydiverse sites of cell–cell interaction in the mouse embryo. Dev Biol. 172:126-138 1995 28. Hebrok M, et al.: Regulation of pancreas development by hedgehogsignaling. Development. 127:4905-4913 2000 29. Itoh Y, Hada T, Terano A, et al. Pancreatitis in the annulus of annular pancreas demonstrated by the combined use of computed tomography and endoscopic retrograde cholangiopancreatography. Am J Gastroenterol 1989; 84:961. 30. Jimenez JC, et al.: Annular pancreas in children: a recent decade’s experience. J Pediatr Surg. 39:1654-1657 2004 31. Hays DM, Greaney EM Jr, Hill JT: Annular pancreas as a cause of acute neonatalduodenal obstruction. Ann Surg. 153:103-112 1961 32. Kiesewetter WB, Koop CE: Annular pancreas in infancy. Surgery. 36:146-159 1954 33. Merrill JR, Raffensperger JG: Pediatric annular pancreas: twenty years’ experience. J Pediatr Surg. 11:921-925 1976 34. De Ugarte DA, Dutson EP, Hiyama DT. Annular pancreas in the adult: management with laparoscopic gastrojejunostomy. Am Surg 2006; 72:71. 35. Thomford NR, Knight PR, Pace WG, Madura JA. Annular pancreas in the adult: selection of operation. Ann Surg 1972; 176:159. 36. Benger JR, Thompson MH. Annular pancreas and obstructive jaundice. Am J Gastroenterol 1997; 92:713. 37. Claviez A, Heger S, Bohring A: Annular pancreas in two sisters. Am J MedGenet. 58:384 1995 38. Lainakis N, et al.: Annular pancreas in two consecutive siblings: an extremely rarecase. Eur J Pediatr Surg. 15:364-368 2005 39. Montgomery RC, et al.: Report of a case of annular pancreas of the newborn in twoconsecutive siblings. Pediatrics. 48:148-1501971 40. Hebrok M, et al.: Regulation of pancreas development by hedgehogsignaling. Development. 127:4905-4913 2000 11044404 41. Kamisawa T, et al.: A new embryologic hypothesis of annularpancreas. Hepatogastroenterology. 48:277-278 2001 42. Ben-David K, Falcone RA Jr, Matthews JB:Diffuse pancreatic adenocarcinomaidentified in an adult with annular pancreas. J Gastrointest Surg. 8:565-568 2004 43. Benger JR, Thompson MH: Annular pancreas and obstructive jaundice. Am JGastroenterol. 92:713-714 1997 44. Foo FJ, et al.: Ampullary carcinoma associated with an annular pancreas. JOP. 8:50-54 2007 45. Kamisawa T, et al.: Biliary carcinoma risk in patients with pancreaticobiliarymaljunction and the degree of extrahepatic bile ductdilatation. Hepatogastroenterology. 53:816-818 2006 46. Dowsett, J.F., Rode, J. and Russell, R.C.G. (1989) Annular pancreas: A clinical, endoscopic, and immunohisto- chemical study. Gut, 30, 130-135.
Tight tendoachilles as etiological factor in plantar fasciitis
Terence Derryl L. Dsouza, Ronald Menezes, Arun Mathew Cyriac
Introduction: Plantar fasciitis is a commonly encountered problem and could be secondary to a plethora of causes. Among the various causes suggested, tight TA is one of the frequently implicated etiology in many previous studies. Our study was to test this hypothesis of tight tendoachilles in cases with Plantar fasciitis using a foot pressure plate analysis.Among the 33 patients clinically diagnosed as PF only 5 had Point of Maximum Pressure anteriorly suggesting the co existence of tight TA in these cases. However overall results showed no staitsically significant association of tight tendoachilles with plantar fasciitis.
1. Kaya, BK: Plantar fasciitis in athletes. J Sport Rehabil.1996; 5: 305-20. 2. Huguenin L, Brukner PD, McCrory P, et al. Effect of dry needlingof gluteal muscles on straight leg raise: a randomised,placebo controlled, double blind trial. Br J Sports Med. 2005; 39:84-90. 3. Nunez-Samper M, Pizarroso S, Llanos-Alcala LF. Biomecánica, Medicina y cirugÃa del pie. Barcelona: Ediciones Masson; 2007 4. Lapidus PW, Guidotti FP. Painful heel: report of 323 patients with 364 painful heels. Clin Orthop. 1965;39:178 5. Taunton JE, Ryan M, Clement DB, McKenzie DC, Lloyd-Smith R. Plantar fasciitis: a retrospective analysis of 267cases. Phys Ther Sport. 2002;3:57-65 6. Riddle, D.L., and D.B. Freeman. Management of a patient with a diagnosis of bilateral plantar fasciitis and Achilles tendinitis. Phys. Ther. 1988.68(12):1913-1916. 7. Patel A, DiGiovanni B. Association between plantar fasciitis and isolated contracture of the gastrocnemius. Foot Ankle Int. 2011; 32:5-8.
Trichoblastoma: an unusual visitor to a surgeon
Mahendra Bendre, Nandkishore Narwade, Abhijit Bagul, Abid Raval
Trichoblastoma is a rare, benign adnexial tumour arising from follicular germinative cells, presenting as a solitary mass of brown/black nodule usually on head or neck in adult males. It is a dermal, epithelial and stromal neoplasm consisting of proliferation of basaloid cells in a stroma resembling perifollicular fibrous structures. A biopsy is essential for diagnosis as it may closely resemble a basal cell carcinoma or rarely undergo malignant transformation. Complete surgical excision is the treatment of choice. We present herewith a rare case of a giant trichoblastoma on thigh along with a a comprehensive review of the whole subject.
1. Ackerman A. B., de Virag PA, Chong chitnant N.: Neoplasm with follicular differenciation, Philadelphia: Le and Febigner – 1993. P. 357 – 412 2. Ackerman A.B., Reddy V.B., Soyer H.P.: Trichoblastoma. In: Neoplasms with follicular differenciation. 2nd ed. Newyork : Ardor serbendi , 2001 : 405 – 622 3. Girish Kamat, Balasab Yelikar, Savita Shettar et al: Pigmented Trichoblastoma with sebaceous hyperplasia – Indian Jour. Dermatol Venerol Leprol 2009 ; 75 : 506 – 8 4. Headington J.T.: Differenciating neoplasms of hair germ – Jour. Clin. Pathol. 1970 ; 23(6) : 464 – 71 5. Headington J.T.: Tumours of hair follicle – A review – Am. Jour. Of Pathol. 1976 ; 85 : 479 – 514 6. Han Kyoung Cho, Ji-Sun Song, Won Hyoung Kang et. al. : Pigmented Trichoblastoma arising from the nevus sebaceous – A rare case in Korea – Ann. Dermatol vol 21, no. 4, 2009 7. Kristen A. Zellar, Deborah F. Billimire : Trichoblastoma :Management of a rare skin lesion – Jour. Of Paediatric Surgery (2012), 47, 250 -252 8. Kim J.V., Kim Y.C.: Trichoblastoma and Syringocystadenoma papilliferrum arising in nevus sebaceom in 4 yr old boy : Cli. Exp. Derm. 2007; 32 : 218 -9 9. Luciana Takata Ponters, Andre Luiz Siiao, Fernando dos Ramos Seuling et. al. : Mohs Micrographic Surgery on recurrent trichoblastoma - Surg. Cosmet Dermatol 2012 ; 4(1) : 93 – 6 10. Laxmi Rao, Vidya Monappa, Mohammed Musheb: Cutaneous nodule on face: Admantinoid Trichoblastoma – A unique tumour – Our Dermatol. Online 2013; 4(2) : 218 – 220 11. Pragati J. karmarkar, Sadhna D. Mahore, Arone R. Wilkinson: Solitary Trichoblastoma – Jour. Pathol. Microbiol. [Serial online] 2009 [cited 2014 Nov. 5]; 52 :277 – 278 12. Sigrid Regauer, Christine Beham-schmid, Murat Okcu et al: Trophoblastic carcinoma (‘Malignant Trichoblastoma’) with lymphatic and hematogenous metastasis – Mod. Pathol. 2000 ; 13(6), 673 -678
Clinicopathological study of viral skin lesions
V Sriram, S Sowmya
Introduction: Many viral infections have prominent skin manifestations. Most commonly encountered are herpes simplex, molluscum contagiosum and human papilloma virus which causes verruca vulgaris, condyloma acuminatum, deep palmoplantar wart and verucca plana. They are of increased significance in immunocompromised patients. Most of the viral lesions are diagnosed clinically and serologically, some require biopsy confirmation. Aims and objectives: To identify the specific histological changes in individual viral lesions. To differentiate the lesions that can clinically mimic as bullous lesion or soft tissue mass. Materials and Methods: The skin biopsies received in the department of pathology, SMVMCH for a period of 3 years from 2011 to 2013 were taken for this study. Results: Out of 2160 skin biopsies studied, 31 patients were diagnosed to have skin manifestations of various viral infections. The most commonly encountered entity was Verruca vulgaris (14), followed by condyloma accuminatum (6), deep palmoplantar wart (4), molluscum contagiosum (4), herpes (2) and verucca plana (1). The most characteristic histological findings that helped in the diagnosis were, intranuclear inclusions in herpes; cytoplasmic viral inclusion bodies in MC, deep palmoplantar wart; koilocytes in Verruca and condyloma .These were also associated with other epidermal changes. Conclusion: Virus can produce warty, bullous and mass like lesions which can mimic non infectious conditions. Histopathological evaluation serves as a valuable tool for identification of virus induced skin changes and aids in appropriate management of these lesions. In our study most common infection was HPV.
1. David E. Elder. Lever’s Histopathology of the skin. New Delhi:10th ed. Wolters Kluwer/Lippincott Williams and Wilkins;2008.631-662. 2. Barnhill RL et al. Dermatopathology. 3rded.NewDelhi: McGraw-Hill Inc; 2010.495-515. 3. Kempf W et al. Dermatopathology. 1sted.Germany: Springer; 2008.32-34. 4. Michelle ML et al. An Armamentarium of Wart Treatments. Clin Med Res. Dec 2006; 4(4): 273–293. 5. Kuykendall-Ivy TD et al. Evidence-based review of management of nongenital cutaneous warts.Cutis 2003; 71:213–222. 6. Correlation between Human Papillomavirus (HPV) Type and Histology of Warts. Journal of Investigative Dermatology 1982; 78: 160–164. 7. Lowry DR et al. In: Freedberg IM, Eisen AZ, Klaus W, Austen KF, Goldsmith LA, Katz SI, eds. Fitzpatrick’s dermatology in general medicine. 6th ed. New York: McGraw-Hill Inc; 2003; 2:2119–2131. 8. Baseman JG et al. The epidemiology of human papillomavirus infections. J Clin Virol 2005; 32(1):16–24.
Screening for microalbuminuria as an early marker of diabetic nephropathy in type 2 diabetic patients
Satyajeet Giri, Ben S Ashok, Rakesh Kumar Saroj
Background: One of the early complications of type 2 diabetes mellitus is diabetic nephropathy which is reported as the leading cause of premature deaths due to renal failure. This study was conducted to see the prevalence of microalbuminuria in type 2 diabetic patients. Materials and Methods: This cross sectional study was carried out in the Diabetic Clinic of Sri Ramachandra Medical Centre, Chennai, India. Subjects were selected based on a detailed questionnaire. Blood and urine sample of 95 type 2 diabetic patients and 30 normal subjects between the ages of 45-63 years were collected to analyze fasting plasma glucose, post prandial glucose, Glycated hemoglobin, Blood urea nitrogen, creatinine and microalbuminuria. Results: There were 38 microalbuminuria positive cases out of 95 diabetic patients (p<0.001). The prevalence of microalbuminuria was higher in older patients and increased with increase in duration of diabetes. Conclusion: There is significant association between the duration of diabetes and microalbuminuria in type 2 diabetic patients.
1. Cheema A, Adeloye D, Sidhu S, Sridhar D, Chan KY. Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis.J Glob Health. 2014 Jun; 4(1):010404. 2. Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27:1047-1053. 3. Kern EF, Erhard P, Sun W, Genuth S, Weiss MF.Early urinary markers of diabetic kidney disease: a nested case-control study from the Diabetes Control and Complications Trial (DCCT). Am J Kidney Dis. 2010 May; 55(5):824-34. 4. King H, Auberti RE, Herman WH. Global burden of diabetes, 1995–2025. Prevalence, numerical estimated and projections. Diabetes Care 1998; 2:1414–31. 5. Ramachandran A, Snehalatha C, Latha E, et al. Rising prevalence of NIDDM in an urban population in India. Diabetologia 1997; 40:232–7. 6. Kilaru P, Bakris GL. Microalbuminuria and progressive renal disease. J Hum Hypertens. 1994 Nov; 8(11):809-17. 7. Yokoyama H, Aoki T, Imahori M, Kuramitsu M. Subclinical atherosclerosis is increased in type 2 diabetic patients with microalbuminuria evaluated by intima-media thickness and pulse wave velocity. Kidney Int. 2004 Jul; 66(1):448-54. 8. Neil A, Hawkins M, Potok M, et al. A Prospective population-based study of microalbuminuria as a predictor of mortality in NIDDM. Diabetes Care 1993; 7:996–03. 9. Roshan B, Stanton RC. A story of microalbuminuria and diabetic nephropathy. J Nephropathol. 2013 Oct; 2(4):234-40. 10. Badal SS, Danesh FR. New insights into molecular mechanisms of diabetic kidney disease. Am J Kidney Dis. 2014 Feb; 63(2 Suppl 2):S63-83. 11. Packham DK, Alves TP, Dwyer JP, Atkins R, de Zeeuw D, Cooper M, Shahinfar S, Lewis JB, Lambers Heerspink HJ. Relative incidence of ESRD versus cardiovascular mortality in proteinuric type 2 diabetes and nephropathy: results from the DIAMETRIC (Diabetes Mellitus Treatment for Renal Insufficiency Consortium) database. Am J Kidney Dis. 2012 Jan; 59(1):75-83. 12. Collins VR, Dowse GK, Finch CF, et al. Prevalence and risk factors for micro and macroalbuminuria in diabetic subjects and entire population of Nauru. Diabetes 1989; 38:1602–10. 13. Gupta DK, Verma LK, Khosla PK, et al. The prevalence of microalbuminuria in diabetes: a study from north India. Diabetes Res Clin Pract 1991; 12:125–8. 14. Klein R, Klein BEK, Moss SE. Prevalence of microalbuminuria in older-onset-diabetes. Diabetes Care 1993; 16:1325–9. 15. John L, Rao PS, Kanagasabapathy AS. Prevalence of diabetic nephropathy in non insulin dependent diabetes. Indian J Med Res 1991; 94:24–9. 16. Vijay V, Snehalatha C, Ramachandran A, et al. Prevalence of proteinuria in non-insulin dependent diabetes. J Assoc Physicians India 1994; 42:792–4. 17. Woerle HJ1, Neumann C, Zschau S, Tenner S, Irsigler A, Schirra J, Gerich JE, Göke B. Impact of fasting and postprandial glycemia on overall glycemic control in type 2 diabetes Importance of postprandial glycemia to achieve target HbA1c levels. Diabetes Res Clin Pract. 2007 Aug; 77(2):280-5. 18. Haddadinezhad S, Ghazaleh N. Relation of fasting and postprandial and plasma glucose with hemoglobinA1c in diabetics. Int J Diabetes Dev Ctries. 2010 Jan; 30(1):8-10. 19. UK Prospective Diabetes Study 7: response of fasting plasma glucose to diet therapy in newly presenting type II diabetic patients, UKPDS Group.Metabolism. 1990 Sep; 39(9):905-12. 20. Colagiuri S, Cull CA, Holman RR; UKPDS Group. Are lower fasting plasma glucose levels at diagnosis of type 2 diabetes associated with improved outcomes?: U.K. prospective diabetes study 61.Diabetes Care. 2002 Aug; 25(8):1410-7.
Effect of BMI and nutritional status on physical fitness index in response to short term moderate intensity exercise in sedentary young adults
Mona Kharbanda1*, G Indra Kumar2, Shweta Kumari Shah
Introduction: The current study was conducted to see the relationship between nutritional status of an individual, its body mass index and its physical performance so as to improve the physical fitness of low body mass index subjects bringing their better performance. The study was carried out in 58 young healthy sedentary medical students who were asked to perform short term limited duration exercise on bicycle ergograph. Each subject served as its own control. Subjects were introduced a pretested questionnaire for assessing nutritional status, Cardiorespiratory profile, status of nervous system, physical activity and related problems, history of past and present illness to find out any condition affecting physical performance of the subject. Physical activity level was assessed by different tests assessing their flexibility, coordination, Equilibrium, agility, strength and endurance. Physical activity Rating scale and VO2 max was used to assess the physical fitness. Physical fitness index was calculated using the formula. Pearson’s correlation coefficient was to determine the relation between BMI and Nutritional status score. Pearson’s correlation coefficient also determined the relation between nutritional status score and physical fitness index. Observed data revealed that subjects with poor nutritional status and obese subjects had lower level of physical fitness score. Physical fitness score was found to have a significant negative correlation with BMI in underweight and overweight subjects. It could thus be concluded that population having normal body mass index showed greater improvement in aerobic work capacity of study population which shows that sedentary medical students need proper nutrition, education and physical exercise to go a long way.
1. Nixon PA. Orien, Stein DM., Exercise testing in children Ped Pulmonol 1988 5: 107-122. 2. Calles –Escandon, J and E.S Horton.1992.The thermogenic role of exercise in the treatment of morbid obesity A critical evaluation. American journal of Clinical Nutrition 55:533S- 537S. 3. Poehlman, E.T. 1989.A review: Exercise and its influence on resting energy metabolism in Man. Medicine and Science in Sports and Exercise 21 :515-25. 4. Di Pietro L.1995. Physical activity, body weight and adiposity: An epidomological perspective. In Exercise and Sport Sciences Reviews, vol. 23, ed. J.O. Holloszy, 275-303.Baltimore: Williams and Wilkins. 5. Rising, R et al. 1994. Determinants of total energy expenditure: Variability in physical activity. American Journal of Clinical Nutrition 59: 800-804. 6. I government in.mht, India reworks obesity guidelines, BMI lowered, Published on 11/26/2008-12:40:52 PM, accessed at 9.00 p.m. on 17/11/2009. 7. Rimm, A. A, and P.L. White. 1979.Obesity: Its risks and hazards. In Obesity in America, U.S Department of Health, Education and Welfare. NIH Publication No 79-359. 8. Schulz,L,O, and D.A Schoeller.1994.A compilation of total daily energy expenditures and Body weights in healthy adults. American Journal of Clinical Nutrition 60: 676 -81. 9. Buskirk, E.R. et al. 1963.Energy balance of obese patients during weight reduction: Influence of diet restriction and exercise. Annals of New York academy of Science 110 (part II) : 918-40. 10. Houtkooper L.B, and S.B. Going 1994. Body composition: How should it be measured? Does It affect performance?.Sports Science Exchange vol.7, no 5.Barrington,IL: Gatorade Sports Science Institute. 11. Kusal. K. Das et al (2001).Physical fitness: A longitudinal study among Muslim children of Bijapur (Karnataka).Indian J Physiol Pharmacol 45(4): 457-462.
Histopathological study of xanthogranulomatous reaction in various sites
Ronald J Bosco, S Sowmya
Introduction: Xanthogranulomatous inflammation is a chronic inflammatory disease. Histologically characterized by collection of foamy macrophages admixed with polymorphonuclear leukocytes, plasma cells and lymphocytes in a mosaic like pattern along with marked fibrosis and organ destruction. Most common sites are gall bladder, kidney, followed by lymph nodes and urogenitial tract. They mimic malignant neoplasm both radiologically and clinically. Usually they are incidental findings in the histopathological sections. They can be induced or associated with neoplastic and inflammatory processes. Materials and Methods: Histopathologically diagnosed cases of xanthogranulomatous reaction from the department of pathology, SMVMCH for a period of 2 years from 2012 to 2013 were taken for this study. Observation and Results: Totally 16 patients were diagnosed to have xanthogranulomatous reaction in various sites. It was found in association with various conditions like radicular cyst, anal fistula, cholecystitis, synovitis, pyelonephritis, mastitis, serous cystadenoma of ovary, vaginal wall mullerian cyst, epididymo-orchitis and ruptured epidermal cyst. PAS showed diffuse granular cytoplasmic staining which differentiates it from malakoplakia. Conclusion: Most xanthogranulomas present as a mass lesion extending to adjacent structures and can mimic infiltrating carcinoma. It may also accompany inflammatory signs like pain, fever, leukocytosis due to delayed type hypersensitivity reaction. Therefore distinguishing infections from neoplasm for further management is important. So histopathology is essential for confirmation of the lesion.
1. Arun A et al. Multiple generalized xanthogranuloma in adult: case report and treatment. Indian J Dermatol 2011; 56(2): 197–199. 2. Kazunari Mado et al. Xanthogranulomatous appendicitis. Indian Journal of Surgery 2013; 75(5): 405-406. 3. Chuang YF et al. Xanthogranulomatous appendicitis. J Formos Med Assoc 2005; 104(10):752-4. 4. Li L et al. Xanthogranulomatous pyelonephritis. Arch Pathol Lab Med 2011; 135(5):671-4. 5. Koo JS et al. Xanthogranulomatous mastitis: clinicopathology and pathological implications. Pathol Int 2009; 59(4):234-40. 6. Juan Rosai. Rosai and Ackerman’s Surgical Pathology. 9th ed. New Delhi: Elsevier; 2004. 7. Ozde RD et al. Surgical Pathology of the GI Tract, Liver, Biliary tract and Pancreas. 2ed. Piladelphia: Elseiver; 2009. 8. FlDiagnostic Histopathology of Tumors, Christopher D. M. Fletcher, 4ed. 9. Weidner et al. Modern Surgical Pathology. 2nd ed. Piladelphia: Elseiver; 2009. 10. Ming Z et al. Genitourinary Pathology: A volume in foundations in diagnostic pathology series. 11. Gattuso et al. Differential diagnosis in surgical pathology. 2nd ed. Piladelphia: Elseiver; 2010.
Reduction en masse in a strangulated direct inguinal hernia
M L Sankar Narayanan, S Surya, K Balaji Singh, T Mohanapriya, T Manuneethimaran, K Arunkumar, E Premanandh, N Nitesh, T R Karthikhaeyan
Background: Direct or Internal Inguinal Hernia is quite commonly encountered in elderly people due to laxity of posterior wall following repeated distention and straining. It is uncommon to undergo complication such as obstruction, strangulation, perforation in a direct , complete inguinal hernia. Hernial Reduction En Masse is rare to encounter and requires high degree of clinical suspicion, more likely to be unnoticed and can end up being fatal to the patient. We report a case of a strangulated, direct, complete inguinal hernia which perforated following spontaneous En Masse reduction.
1. John G. Appleton, Esq., Luton. Strangulated direct inguinal hernia in a female. original communicators, British medical journal. 150-1, Feb19, 1859. 2. J. Luke, â€Cases of strangulated hernia reduced†en masse,†with observations,†Medico-Chirurgical transactions, vol.26, pp.159-187, 1843. 3. H.E. Pearse,†Stangulated hernia reduced ’en masse’,†Surgery, Gynecology and Obstetrics, vol.53, pp. 822-828, 1931. 4. R.M. Zollinger Jr., â€Classification of ventral and groin hernias,†in Nyhus and Condon’s Hernia, R.j. Fitzgibbons and A.G. Greenburg, Eds.,pp.71-79, Lippincott Williams and Wilkins, Philadelphia, Pa, USA, 5th edition,2002.
Implications of serum urea and creatinine estimation in prostate cancer
Mukund Joshi, Suvarna Prasad, Kuldip Singh Sodhi, Rajesh Pandey, Jasbir Singh, Subhash Goyal
Demographic and epidemiological transitions in developing countries like India have shown an increasing trend in burden of non communicable diseases like cardiovascular disease, diabetes as well as cancer. Previously, it was thought that the prevalence of prostate cancer in India is far lower as compared to the western countries but due to various reasons it is becoming clear that we are not very far behind the rate from western countries. Since prostate disorders have an association with end stage renal disease and is also age related, this study focuses on the utility of blood levels of urea, creatinine, as a possible aid in the diagnosis of prostate cancer. The study was conducted in the Department of Biochemistry in collaboration with the Department of Surgery in MM Institute of Medical Sciences and Research, Mullana, Ambala, Haryana. The clinical and laboratory findings of 100 subjects (age ≥ 30 years) with biopsy-confirmed prostate related disorders as BPH, carcinoma of prostate, prostatomegaly were taken from hospital records dated January 2013 to September 2014. Out of 100 subjects, 7 (7%) had elevated serum urea, 17 (17%) had elevated serum creatinine and 7 (7%) had elevated levels of both. 29 (29%) patients had elevated serum PSA levels out of which 2 (6.8%) had elevated serum urea, 9 (31%) had elevated serum creatinine, and 2 (6.8%) had elevated serum levels of both. Majority of subjects were in the age group of 61-70 years whereas serum PSA levels were highest in the age group of 71-80 years. Therefore, increased serum urea and/or creatinine could be an early hint towards prostate cancer and it is recommended that males ≥40 years of age should undergo screening for serum PSA levels every 5 years.
1. Lalitha K, Suman G, Pruthvish S, Mathew A, Murthy NS: Estimation of time trends of incidence of prostate cancer-an Indian scenario: Asian Pacific J Cancer Prev. 2012; 13(12): 6245-50. 2. Perin NN: Global variation in cancer incidence and mortality: Current Sci. 2001; 81:465-74. 3. Sinha R, Anderson DE, Mc Donald SS, Greenwald P: Cancer risk and diet in India. J Postgrad Med. 2003; 49:222-8. 4. Jain S, Saxena S, Kumar A: Epidemiology of prostate cancer in India: Meta Gene. 2014; 2: 596–605. 5. Weinstein SJ, Mackrain K, Stolzenberg-Solomon RZ, Selhub J, Virtamo J, Albanes D: Serum creatinine and prostate cancer risk in a prospective study: Cancer Epidemiol Biomarkers Prev. 2009; 18(10):2643-9. 6. Miele ME: Percent free PSA as an additional measure in a prostate cancer screen: Clin Lab Sci. 2001; 14(2):102- 7. 7. Jacobson DJ, Robert RO: The association between benign prostatic hyperplasia and chronic kidney disease in community dwelling men: Kidney Int. 2005; 67(6):2376- 82. 8. Irani J, Millet C, Levillian P, Dore B, Begon F, Aubert J: Serum to urinary prostate specific antigen ratio: its impact in distinguishing prostate cancer when prostate specific antigen level is 4-10 ng/ml:. J Urol. 1997; 157(1):185-8. 9. Wada Y, Nakanishi J, Takahashi W, Kai N, Nakayama Y, Yamashita Y et al: Mass screening for prostate cancer in patients with end-stage renal disease: a comparative study: BJU Int. 2006; 98(4):794-7. 10. Roddam AW, Rimmer J, Nickerson C, Ward AM: Prostate specific antigen: bias and molarity of commercial assays for PSA in use in England: Ann Clin Biochem. 2006; 43:35-48. 11. Lamb EJ, Price CP: Kidney function test. In: Burtis CA, Ashwood ER, Burn DE (editors): Teitz textbook of Biochemistry and Molecular Diagnosis. 5thedition. Philadelphia: Elsevier. 2012; chapter 25: p699-707. 12. Lepor H: Epidemiology and natural history of benign prostatic hyperplasia: Rev Urol. 2004; 9:S3-S10.
Pecoma of the ischiorectal fossa presenting in pregnancy - a rare presentation of a rare tumor
S Shameema, R N Visweswara, V Saradha
Perivascular epitheloid cell tumor (PEComa) is an uncommon entity composed of distinctive perivascular epitheloid cells with variable immuno reactivity for melanocytic and muscle markers. They are recently described tumors, and in the last decade there have been reports of similar tumors in various sites, such as uterus, retro peritoneum, breast, cardiovascular and central nervous system. However in our opinion, such a tumor has not been reported in pregnancy till now. Here we report a case of PEComa occurring in a 22 year old pregnant lady in the ischiorectal fossa, and describe the diagnostic and surgical challenges faced. We also highlight the peculiar clinical and morphological features of the case. The importance of considering PEComas in the differential diagnosis even in pregnancy, the need to arrive at a conclusive preoperative diagnosis and the requirement for immune histochemical work up have been discussed, with a revision of the concerning scientific literature.
1. Folpe AL (2002) Neoplasms with perivascular epithelioid cell differentiation (PEComas). In: Fletcher CDM, Unni KK, EpsteinJ, Mertens F (eds) Pathology and genetics of tumours of softtissue and bone. Series: WHO Classification of tumours. IARCPress, Lyon, pp 221–222 2. Martignoni G, Pea M, Reghellin D, Zamboni G, Bonetti F. PEComas: the past,present and the future(2008).Virchows Arch 452:119–132 3. Apitz K (1943) Die Geschwülste und Gewebsmissbildungen der Nierenrinde. II Midteilung. Die mesenchymalenNeubildungen. Virchows Arch 311:306–327 4. The European Chromosome 16 Tuberous Sclerosis Consortium (1993) Identification and characterization of the tuberous sclerosis gene on chromosome 16. Cell 75:1305–1315. 5. Folpe et al .Perivascular Epithelioid Cell Neoplasms of Soft Tissue and Gynecologic Origin: A Clinicopathologic Study of 26 Cases and Review of the Literature. American Journal of Surgical Pathology: December 2005 - Volume 29 - Issue 12 - pp 1558-1575 Original Article 6. Fadare O. Perivascular epithelioid cell tumor (PEComa) of the uterus: an outcome-based clinicopathologic analysis of 41 reported cases. AdvAnatPathol. 2008 Mar; 15(2):63-75. 7. Pea M, Martignoni G, Zamboni G, et al. Perivascular epithelioid cell. Am J SurgPathol 1996; 20:1149–1153. 8. Fadare O, V Prakash,YYilmaz, et al. Perivascular epithelioid cell tumor (PEComa) of the uterine cervix associated with intraabdominal "PEComatosis": A clinicopathological study with comparative genomic hybridization analysis. World Journal of surgical oncology 2005, 3:25. 9. Hornick JL, Fletcher CD. PEComa: what do we know so far? Histopathology. 2006 Jan;48(1):75-82
A double blind randomised controlled clinical trial of Isoamyl-2-cyanoacrylate with N-butyl cyanoacrylate
S T Balamurali
Introduction: Closure of wounds with bioadhesives was proved to be efficacious and well tolerable. It also produces scar thinner than the sutures. Now it is require comparing the efficacy of various bioadhesives available in the market by a phase III clinical trial. Aim: To compare the efficacy and tolerability of Isoamyl-2-cyanoacrylate bya control clinical trial using n-Butyl cyanoacrylate as the control. Methodology: it is a double blind, randomised controlled clinical trial of Isoamyl-2-cyanoacrylate with n-butyl cyanoacrylate in patients of inguinal hernia in the age group of 18 – 40 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: The scar was of better quality in the 3rd month for the test group. The increase in the scar scale was statistically significant for Isoamyl and n-butyl cyanoacrylate using paired student ‘t’ test p<0.05. The difference in the scar quality between the two groups using unpaired ‘t’ test was not statistically significant.
1. Lazarus MS, Cooper DM, Knighton DR. definitions and guidelines for assessment of wounds and avaluation of healing Arch dermatology 1994 130:489-493. 2. McGrouthier DA, Wounds, tissue repair and scars. In:mann CV, Russell RCG, Williams NS(eds) Bailey and Love’s short practice of surgery. 22ed 1995:8-16 3. Robbins SL Inflammation and healing 5thed “Pathological basis of diseases†1974; 51-150 4. Paecock EE junior wound healing in the scientific management of surgical patients: 1sted 1983: 27-63 5. Albert NJ: wound healing: Dermatologic clinics. Oct 1993:11; (4): 629-808 6. AVS. Rama Rao. A textbook of Biochemistry. 6thedn. LKS publishers. The cells and some special tissue p130 7. Caterson B, Lowther Da: Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. BiochemBiophysActa, 1978, 540:412 8. Singer AJ, Hollander JE, Tissue adhesives for laceration closure JAMA 1997; vol 278:703 9. PJB Murray: Closure of skin wounds with Adhesive Tape: British Medical Journal 1963 Oct: vol26;1030 10. Thomas B Burns, MC et al. a New Tissue Adhesive for Laceration repair in children. The journal of Paediatrics June 1998; vol 132(6): 1067-1070 11. NG Rothnie, GW Taylor: Sutureless skin closure. A clinical trial. British Medical Journal 1963 Oct vol 26; 1027-30 12. Dalvi et al: Journal of post graduate medicine 1986 32(2) 97-100 13. Use of cyanoacrylate tissue adhesive for closing facial lacerations in children; David P Watson; British Med Journal 1989 vol. 299 page 1014.
To assess the knowledge of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) among medical interns at tertiary care hospital in Raigad district, Maharashtra
Roza Bhaisare, Madhavi Mankar, Rajesh Goel, Seema Anjenaya, Pradeep Sawardekar, Pandurang Thatkar, Rupali Guja
The Maharashtra government has launched Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) in the state since July 2012 for below poverty line patients. In this scheme, all procedure from registration of patient to the discharge is done online. The present study was conducted to assess the knowledge of Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY) among medical Interns and find out the technical difficulties faced by them while working with RGJAY at tertiary care hospital. All MBBS interns (96) who have completed 6 months of internship were selected for the study. A predesigned and pre-tested, questionnaire was given to interns when they come in RGJAY OPD and asked to fill the form after written consent. The data was analysed using Microsoft excel and SPSS. Total 96 interns were participated in the study. Most of the interns (97.9%) were aware about Rajiv Gandhi Jeevandayee Arogya Yojana (RGJAY). Main source of information was RGJAY OPD. About 91.70% interns told that they didn’t get any pre internship training for these technical procedures under RGJAY. About 80% interns were properly guided by Aarogyamitra. Majority of interns (91.70%) had experienced technical difficulties and about 76.14% interns responded that their difficulties had been resolved in RGJAY OPD. Out of all procedures, interns stated that, to fill online pre-auth registration (35.40%) and Discharge update (43.80%) were the most complicated procedure. Majority of interns (82.3%) reported that there should be separate staff for RGJAY on line procedures, 90 % interns reported that RGJAY OPD needs upgraded infrastructure; about 87.5% interns reported that pre-training should be given. There are many medical insurance schemes are operating in the country but for effective implementation and utilization of schemes, proper information, training, education and communication is needed at programme level as well as community level.
1. Shaikh Md Altaf Shaikh Ibrahim, Pathan Mohsin Khan Aslam Khan, Rajeev Gandhi Jeevandayee Aarogya Yojana –An overview of Health Insurance Scheme of Govt. of Maharashtra. Asian Journal of Management Sciences 02 (03) 2014; 132-134. 2. http://www.jeevandayee.gov.in/RGJAY/FrontServlet?requestType=CommonRHandactionVal=RightFrameandpage=undefined>>RGJAYandpageName=RGJAYandmainMenu=AboutandsubMenu=RGJAY 3. http://www.mahaarogya.gov.in/projectandschemes/Jeevandaiaarogya/default.htm. 4. M.P Tambe, Rajiv Gandhi Jeevandayee Arogya Yojana of Maharashtra: IPHA Maharashtra Newsletter Vol9, No1, 2012. 5. WHO. The World Health report. Health system: improving performance. Available from: htpp://www.who.int/whr/2000/en/.[Last cited on 2000]. 6. Harshad Thakur, soumitra Ghosh. Case study report on Social Exclusion and Rashtriya Swasthtya BimaYojana in Maharashtra. Deonar, Mumbai: School of Health services Studies, Tata Institute of Social sciences; May 2013. 7. Shankar Prinja, Manmeet Kaur, Rajesh Kumar. Universal Health insurance in India: ensuring equity, efficiency and quality. IJCM2012; vol 37, issue 3, p 142-149.
Intravenous metoprolol in severe hypertension
Pravin N Soni, Seema P Soni
Introduction: To study the effect of intravenous metoprolol in severe hypertension. The use of betablockers in the management of severe hypertension was not considered for the fear of paradoxical rise in blood pressure, but it has been found that IV metoprolol is safe and effective in the management severe hypertension with careful clinical monitoring even in the absence of ICU facility. (Khokhani 1993) Materials and Methods: Patient presenting with severe hypertension of unknown etiology were taken for the study. The study has been carried out at GMC, Aurangabad for about three years. Metoprolol (Betaloc) was given intravenously at the rate of 1mg/min.Systolic, diastolic blood pressure and heart rate recorded at various intervals. Adverse reaction if any noted Result: The study has been carried out for three years on 34 cases of severe hypertension, admitted at GMC Aurangabad. After giving IV Metoprolol the fall in systolic, diastolic blood pressure was statistically significant The fall starts at the end of five minutes and continued up to ninety minutes. Our study compared with this study, (Kokhani et al 1993), it is observed that results in both studies are same. No side effect observed during the study. Conclusion: After the administration of IV Metoprolol the fall in blood pressure and heart rate was statistically significant. A safe diastolic blood pressure (≤ 110 mm of hg) effect were observed during the study and does not require scrupulous monitoring was achieved. It is thus concluded that IV Metoprolol is a safe and effective drug in patient of severe hypertension. No side effects were observed during the study and does not require scrupulous monitoring.
1. Khokhani RC, Karnik ND, Gandhi VP et al: Intravenous metoprolol in hypertensive urgencies and emergencies. JAPI, 1993, Vol. 41: No. 11, P. 724. 2. Ferguson RK, Peter H, Vlasses: Hypertensive emergencies and urgencies. JAMA, 28th Mar 1986, Vol. 255: No. 12. 3. Third Joint National Committee on Detection: Evaluation and Treatment of high blood pressure. Arch. Inter. Med., May 1984, Vol. 144. 4. Manoria PC: Ultra rapid beta blocker in hypertensive emergencies. JAPI, 1995, Suppl-2. “BETA BLOCKERSâ€, p. 12-14. 5. Pandey MR, Upadhaya LR, Dhungal S, Pillai KK, Nenpani RP, Regmi HH : Prevalence of hypertension in rural community of Nepal. Ind. Heart J., 1981, 33: 269-89. 6. Kaplan NM: Clinical hypertension, 4th ed., Baltimore. The Williams-Wilkins Co., 1986, 1-56. 7. Kaplan NM: Clinical hypertension, 6th ed., Baltimore. The Williams-Wilkins Co., 1994, 281 - 97. 8. Goodman, Gilmans , Hoffman Brian B, Lefkowitz RJ, Andrenergic receptor antagonists in Goodman and Pergaman Press, 1991, 1991, 8th ed., p.221-243. 9. Taylor SH, Silke B et al: Intravenous beta blockade in coronary heart disease. NEJM, 1982. 306:631-35. 10. Vakil, The study of hypertensive heart disease in Indians. Ind. Heart J., 1950, 2:31.
Groundwater development in chevella basin, Ranga reddy district, Andhra Pradesh, India
Penumaka Ramesh, Srinu Naik, P Sankara Pitchaiah
Groundwater is one of the fresh water sources which are neither unlimited nor protected deterioration. In most of the times due to excess usage of groundwater resulted in drying up of the open and tubular wells, increasing the salt concentration, causing sea water intrusion near coastal areas and depletion of the water resource. Now a days most of the people recognized water quality as one of the important aspect in their life as its quantity. Present study is an attempt to analyse the impact of rainwater harvesting structures on groundwater quality in the Chevella basin. pH, TDS, Hardness, Bicarbonates, Chlorides, Sulphates, Nitrates, Fluorides, Calcium, Magnesium, Sodium, Potassium and Iron are measured/estimated for the years 2010-2013 (Pre and Post-monsoon periods) using standard analytical techniques. The study supports that the rainwater harvesting has improved the quality of groundwater in Chevella basin.
1. APHA (1985) Standard methods for the examination of water and waste. 16th ed. Am pub Health Assoc. Washington, DC, p 100. 2. Brown E, Skougstad MW, Fishmen MJ (1983) Method for collection and analyzing of water samples for dissolved minerals and gases. US Govt. Printing Office, Washington, DC, p 75. 3. Revelle R (2004) Criteria for recognizing seawater in groundwater. Am Geophys Union Trans 22:593–597. 4. Singh VS, Saxena VK, Prakash BA, Mondal NC, Jain SC (2004) Augmentation of groundwater resources in saline ingress coastal deltaic area. NGRI-Tech. Report. No. NGRI-2004-GW-422, pp 1–61.
A comparative study of Isoamyl-2-cyanoacrylate with sutures
S T Balamurali
Introduction: Closure of wounds with bioadhesives was proved to be efficacious and well tolerable. Therefore it is necessary to do a study which should compare the bioadhesives and sutures. Aim: To compare the efficacy of Isoamyl-2-cyanoacrylate with sutures in patients with bilateral inguinal hernia. Methodology: it is a comparative study of Isoamyl-2-cyanoacrylate with sutures in patients of bilateral inguinal hernia in the age group of 18 – 65 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: The scar obtained with bioadhesive is of better quality in the 3rd month and 6th month for the test group than that of suture. Though more expensive than sutures where economically feasible Isoamyl 2 cyanoacrylate offers a well acceptable alternative to suture.
1. Lazarus MS, Cooper DM, Knighton DR. definitions and guidelines for assessment of wounds and avaluation of healing Arch dermatology 1994 130:489-493. 2. McGrouthier DA, Wounds, tissue repair and scars. In:mann CV, Russell RCG, Williams NS(eds) Bailey and Love’s short practice of surgery. 22ed 1995:8-16 3. Robbins SL Inflammation and healing 5thed “Pathological basis of diseases†1974; 51-150 4. Paecock EE junior wound healing in the scientific management of surgical patients: 1sted 1983: 27-63 5. Albert NJ: wound healing: Dermatologic clinics. Oct 1993:11; (4): 629-808 6. AVS. Rama Rao. A textbook of Biochemistry. 6thedn. LKS publishers. The cells and some special tissue p130 7. Caterson B, Lowther Da: Changes in the metabolism of the proteoglycans from sheep articular cartilage in response to mechanical stress. BiochemBiophysActa, 1978, 540:412 8. Singer AJ, Hollander JE, Tissue adhesives for laceration closure JAMA 1997; vol 278:703 9. PJB Murray: Closure of skin wounds with Adhesive Tape: British Medical Journal 1963 Oct: vol26;1030 10. Thomas B Burns, MC et al. a New Tissue Adhesive for Laceration repair in children. The journal of Paediatrics June 1998; vol 132(6): 1067-1070 11. NG Rothnie, GW Taylor: Sutureless skin closure. A clinical trial. British Medical Journal 1963 Oct vol 26; 1027-30 12. Dalvi et al: Journal of post graduate medicine 1986 32(2) 97-100 13. Use of cyanoacrylate tissue adhesive for closing facial lacerations in children; David P Watson; British Med Journal 1989 vol. 299 page 1014.
Awareness of pharmacovigilance among medical students
Deepak P, Jayashree V Nagaral
Objective: To assess the awareness of Pharmacovigilance among Medical students. Materials and Methods: The study was conducted by Department of Pharmacology of Hassan Institute of Medical Sciences, Hassan among II year medical students after obtaining permission from Institutional Ethical Committee. A questionnaire containing 14 questions with 2 – 5 options were given to each student and they were asked to tick one best suitable option. The questionnaire was based on previous study about Pharmacovigilance and was suitably modified for students. The completed questionnaire was analysed and frequency is expressed as percentage. Results: A total of 96 students who were in II MBBS participated in the study. Most of the students had correct understanding regarding Pharmacovigilance and knew the role of Pharmacovigilance in identifying the safety of drugs. 94% of the students were well aware of activities involved in Pharmacovigilance. 50% of the students haven’t come across any article about adverse drug reaction (ADR). 81% felt that all unwanted events are not due to medicine alone.73% were aware of drugs banned because of ADR. 92% were aware of the measures to be taken when an ADR is suspected. Majority of the participants agreed that all health care professionals are responsible for reporting ADR and it is a professional obligation. Conclusion: The study results revealed that students were aware of Pharmacovigilance, but there was lack of professional obligation towards reporting ADR. Though Pharmacovigilance is being taught as part of Undergraduate curriculum, the students should be involved in more activity based and problem based learning.
1. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: A meta-analysis of prospective studies: JAMA 1998; 279:1200-5. 2. Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra cost and attributable mortality: JAMA 1997; 277: 301-6. 3. Oshikoya KA, Awobusuyi JO. Perceptions of doctors to adverse drug reaction reporting in a teaching hospital in Lagos, Nigeria: BMC Clin Pharmacol 2009; 9:14. 4. Feely J, Moriarty S, O’Connor P. Stimulating reporting of adverse drug reactions by using a fee: BMJ 1990; 300: 22-23. 5. Kharkar M, Bowalekar S. Knowledge, attitude and perception/practices (KAP) of medical practitioners in India towards adverse drug reaction (ADR) reporting: Perspectives in Clinical research 2012;3(3):90-94. 6. Rehan HS, Ravinder KS, Deepti C. Comparision of knowledge, attitude and practices of resident doctors and nurses on adverse drug reaction monitoring and reporting in a tertiary care hospital: Indian Journal of Pharmacology 2012:44(6); 699-703. 7. Khan SA, Goyal C, Chandel N, Rafi M. Knowledge, attitude and practice of doctors to adverse drug reaction reporting in a teaching hospital in India: An observational study: Journal of Natural Science, Biology and Medicine. 2013:4(1); 191-196. 8. Gupta P, Udupa A. Adverse drug reaction reporting and Pharmacovigilance: Knowledge, attitudes and perceptions amongst resident doctors: J Pharma Sci Res 2011:3; 1064-9. 9. Ravi Shankar P, Subish P, Mishra P, Dubey AK. Teaching Pharmacovigilance to medical students and doctors: Indian J Pharmacol 2006:38(5); 316-319. 10. Radhakrishnan R, Sudha V, Danturulu MV. An educational intervention to assess knowledge attitude practice of Pharmacovigilance among health care professionals in an Indian tertiary care teaching hospital: International Journal of PharmTech Research April – June 2011:3(2); 678-692. 11. Sonali AP, Jaiswal KM, Sontakke SD, Bajait CS, Gaikwad A. Evaluation of awareness about Pharmacovigilance and Adverse drug reaction monitoring in resident doctors of tertiary care teaching hospital: Indian Journal of Medical Sciences 2012; 66: 55-61.
A rare cause of intestinal obstruction: ileal squamous cell carcinoma - a case report
Debasish Bhattacharya, Subhadip Khatua, Abhijit Banerjee
Introduction: Small bowel obstruction caused by metastatic lesion from other primary cancer is a rare event. The most common types of tumor metastasizing to the small bowel are malignant melanoma, carcinoma from lung, breast, and ovary, and choriocarcinoma Idelevich et al. reviewed the literature and found that between 1988 and 2005, only 36 cases have been reported. Interestingly, the most common primary cancer in these cases was lobular breast carcinoma (47%), followed by lung cancer (11%) and malignant melanoma (8%), most of which are adenocarcinoma.. Rarely however, does it selectively affect the small bowel in the form of an isolated metastatic stricture. We are reporting such a case of terminal ileum obstruction due to metastatic deposit of invasive cervical squamous cell carcinoma, 8 months after total abdominal hysterectomy, emphasizing role of meticulous searching of lymph nodes during surgery of cervical carcinoma to avoid such fatal complication.
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Students’ perception of effective learning experiences in government medical college
Sahana G N, Deepak P
Objective: To obtain students feedback on teaching methodologies and evaluation methods for the betterment of teaching and learning pharmacology. Material and Methods: The study was done by Department of Pharmacology, Hassan Institute of Medical Sciences, Hassan. A questionnaire containing 14 questions were given to second MBBS students who were due to appear for examination. They were supposed to tick one suitable option. Descriptive statistics is used for analysis of data. Frequency expressed as percentage. Results: Total response of 93.33% was observed. Most of the students preferred blackboard as the teaching media which imparts knowledge (65.3%) and better interaction between student and teacher (81.6%). Majority of students felt that cardiovascular system (47.9%), Hormones (32.6%), Autonomic Nervous system (31.6) and Clinical pharmacology (27.55%) as most interesting topics in Pharmacology. Central nervous system (40%) was mentioned as the most difficult topic to understand. 69% mentioned Tutorials and 52% Group discussion as most useful method in preparing for University exams. Students preferred textbooks and class notes (41.8%) for studying pharmacology. As a part of pharmacology practicals, Clinical pharmacology (44.9%), Prescription writing and Problem solving exercises (26.5%) was preferred. Most of the students felt that special topics like Emergency drugs (57%) and Rationale use of drugs (23%) should be discussed in lectures/ practicals. 65% of students felt Pharmacology to be integrated with other subjects. Conclusion: Collaboration of various teaching methods if adopted will ensure in depth knowledge acquisition and improved performance in exam. Incorporation of clinically oriented teaching program will guide students to study the subject from futuristic point of view. Frequent feedback from students may help teachers plan the curriculum and improve the teaching.
1. Ruth N: Communicating student evaluation of teaching results: rating interpretation guides: Assess Eval High Educ 2000; 25:121-134. 2. Desai M: Changing face of pharmacology practicals for medical undergraduates: Indian J Pharmacology 2009;41:151-2 3. Hariharan TS: Need for changes in the practical pharmacology curriculum of medical undergraduates: Indian J Pharmacol 2004; 36:181. 4. Garg A, Rataboli PV, Muchandi K: Students’ opinion on the prevailing teaching methods in pharmacology and changes recommended: Indian J Pharmacol 2004; 36; 155-8. 5. Kaufman M, Mann V: Achievement of Students in a Conventional and Problem Based Learning (PBL) Curriculum: Adv Health Sci Edu 1999; 4:245-60. 6. Victoroff KZ, Hogan S: Students’ perceptions of effective learning experiences in dental school: a qualitative study using a critical incident technique: J Dental Edu 2006; 70:124-132. 7. Sekhri K, Singh H: Teaching methodologies in pharmacology: A survey of students’ perceptions and experiences: J of Education and Ethics in Dentistry January-June 2013; 2(1): 40-44. 8. Chavda N, Yadav P, Chaudhari M, Kantharia ND: Second year student’s feedback on teaching methodology and evaluation methods in Pharmacology: National Journal of Physiology, Pharmacy and Pharmacology 2011; 1:23-31. 9. Badyal DK, Bala S, Kathuria P: Student evaluation of teaching and assessment methods in Pharmacology: Indian J Pharmacol April 2010; 42(2): 87-89. 10. Shenfield GM: Integrating clinical Pharmacology teaching with general practice: Br J Clin Pharmacol 1998; 45:399-401.
Efficacy of oral fenofibrate in the management of unconjugated hyperbilirubinemia in neonates- A prospective study
B L Anantha Narayana Gowda, H M Viswanathakumar, Yamuna B N, Arun Daniel J
Background: Fenofibrate is one of the commonest drugs to treat hyperlipidemia in adults. It also has the ability to induce bilirubin conjugation apart from its hypolipidemic action. Objective: To study the efficacy of oral fenofibrate in reducing bilirubin levels in neonates with significant unconjugated hyperbilirubinemia. Materials and methods: A prospective study was conducted ina tertiary care hospital at Tumkur, Karnataka between June 2013 and April 2014 following up a cohort of 100 neonates. Efficacy of oral fenofibrate was determined by comparing 50 neonates who received oral fenofibrate as well as phototherapy (exposed group) with those who received phototherapy alone (unexposed group), by measuring direct and indirect bilirubin levels at 12, 24, and 48 hours. Results: There was no significant difference in bilirubin levels at 12 (p=0.22), 24 (p=0.08) and 48 hours (p=0.07) respectively among the two groups. Conclusion: Oral fenofibrate did not prove efficacious in reducing bilirubin levels in neonates with significant unconjugated hyperbilirubinemia.
1. Maisels MJ, Kring E. The contribution of hemolysis to early jaundice in normal newborns. Pediatrics. 2006 Jul;118(1):276–9. 2. Jennifer G, Robinson, Anne C, Goldberg. Treatment of adults with Familial Hypercholesterolemia and evidence for treatment: Recommendations from the National Lipid Association Expert Panel on Familial Hypercholesterolemia. J Clin Lipidol 2011 Jun;5:18-27. 3. Newman TB, Liljestrand P, Jeremy RJ, Ferriero Dm et al. Outcomes among newborns with total serum bilirubin levels of 25 mg per deciliter or more. N Engl J Med 2006 May;354:1889-1900. 4. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia in the new-born 35 or more weeks of gestation. Pediatrics 2004 Oct;114(4):1134-5. 2. 5. Piazza AJ, Stoll BJ. The fetus and the neonatal infant- Digestive system disorders (Kernicterus). In: Nelson Text Book of Pediatrics (Vol. I). RM Kliegman, RE Behrman, HB Jenson, BF Stanton (Eds.); 18th Edn.; Saunders: An imprint of Elsevier, Philadelphia; 2008:761-5. 6. Dennery PA. Pharmacological interventions for the treatment of neonatal jaundice. Seminars in Neonatalogy 2002;7(2):111-9. 7. Bennet PN, Brown MJ. Clinical Pharmacology (Section 5). 10th Edn. Churchill Livingstone: An Imprint of Elsevier, New Delhi. 2008;474-5. 8. Kutz K, Kandler H, Gugler R, Fevery J. Effect of Clofibrate on the metabolism of bilirubin, Bromosulphophthalein and indocyanine green and on the biliary lipid composition in Gilberts syndrome. Clinical Science 1984;66(4):389-7. 9. Gabilan JC, Benattar C, Lindenbaum A. Clofibrate treatment of neonatal jaundice. Pediatrics 1990;86(4):647-8. 10. Kumar B, Agarwal PK, Chorishi A, Dhaneria M. Fenofibrate: a novel approach in treating uncomplicated neonatal hyperbilirubinemia. People’s journal of scientific research 2012 Jul;5(2):5-8. 11. Mohammadzadeh A, Farhat SH, Iranpour R. Effect of Clofibrate in jaundiced term newborns. Indian J Pediatr 2005;72(2):123-6.
Aberrant Right Renal Artery- A Case Report
S G Kawale, G L Maske, A D Kannamwar, S E Shaikh, S V Pandit
During routine undergraduate dissection of abdomen in middle aged male cadaver we encountered an unusual variation. This was aberrant right renal artery arising from superior mesenteric artery. There were no variation on left side and other branches of abdominal aorta and there courses were normal. Clinical implication and embryological basis of this type of variation will be discussed
1. Standring S., Grays anatomy. The anatomical Basis Of Clinical Practice. 40th ed. 2008. Urogenital System. Ch. 74. Pg-1231-32. 2. T. Ramesh Rao. Aberrant Renal Artery and Its Clinical Sinignificant. International Journal Of Anatomical Variation. 2011. Pg-37-39. 3. Moore K. L., Persaud TVM. The Developing Human, Saunders. An Imprint Of Esevier. 9th ed., Pg- 175-176. 4. Neelesh Kanaskar., Vaishali Paranjape., Jyoti Kulkurni., Sapna Shevade. Double Accessory Right Renal Arteries.2012. IOSR Journal Of Dental and Medical Science., vol 1 (5). Pg- 17-20. 5. Joseph C. Cerny., Daniel Karsch., Aberrant Renal Artery. Urology. December1973. vol 2 (6). Pg-623-626.
Clinical evaluation of Isoamyl 2- cyanoacrylate: a novel tissue adhesive
S T Balamurali
Even in present day surgical practice, closure of wounds with sutures consumes more time. With advancement of surgical methods like staples and tapes which are used in closure of wounds leave a disfigured scar. Therefore it is necessary to minimise the scar as well as the time consumption with use of newer methods like bioadhesives. Aim: To study the effect of Isoamyl-2-cyanoacrylate on patients with surgical wounds (combined phase I and II) Methodology: it is a combined Phase I and II clinical trial conducted in patients of inguinal hernia in the age group of 18 – 40 years who were admitted in the surgical ward of Government General Hospital, Chennai. Result and Conclusion: the wound closure using bioadhesive is excellent with minimal scar formationand the difference is significant at 95% level of confidence. It is well tolerated.
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