Professional Documents
Culture Documents
Coden: IJMRHS
Copyright@2014
ISSN: 2319-5886
th
Revised: 5 Dec 2014
Accepted: 5th Jan 2015
Assistant Professor, Department of General Surgery, Meenakshi Medical College and Research Institute, Kanchipuram.
Final year General Surgery PG, Department of General Surgery, Meenakshi Medical College and Research Institute,
Kanchipuram.
3
Final year PG, Department of Physiology, Meenakshi Medical College and Research Institute, Kanchipuram
2
Sundar et al.,
259
Sundar et al.,
Sundar et al.,
Number
of patients
(%)
32
45.7
Plantar, Metatarasal
Head,Mid Foot, Heel
Dorsum of Foot
Multiple Ulcers
28
10
0
40
14.3
0
Sundar et al.,
No. of patients
(%)
Neuropathic
36
51.4
Neuro-ischemia
23
32.8
Infection (Non-ischemic/
11
12.8
non-neuropathic)
Distribution of patients who had undergone
amputations: In our study majority of the patients
who had undergone both minor and major
amputations were in patients suffering from both
neuropathy and ischemia (Table 9). As per our
statistical analysis Chi square test was 21.40, 1 df and
the P value was <0.0001. Hence the proportion of
amputation cases among neuro-ischaemia patients
was significantly higher than the amputation cases in
neuropathy cases alone.
Table 9: Distribution of patients who had
undergone amputations
Categories
Minor
amputations
(Toe)
Major amputations
(Forefoot, BK,
AK)
Neuropathic (n=36)
4(11.1%)
Neuro-ischemia(n-23)
12 (52.2%)
4 (17.3%)
Infection(Non-ischemic
/non-neuropathic (n=9)
4 (44.4%)
1 (11.1%)
Healed *
Unhealed
**
Mortality
***
Neuropathic (n=36)
34 (94%)
20 (87%)
2(6%)
2 (9%)
1 (4.3%)
9(82%)
2 (18%)
Neuro-ischemia(n-23)
Infection(Non
ischemic/Non
neuropathic(n=9)
DISCUSSION
Aksoy et al5 in their study in Istanbul (turkey) on
diabetic foot ulcerations enrolled 66 patients of which
39 (59%) men and 27 (41%) women. In another
study by Unal et al6 on diabetic foot in 200 patients in
Karachi found that the percentages of males were 65
and female were 35. In our study also the results were
similar, males 46 (56.7%) and females 24 (34.3%).
Hence the complications of diabetic foot ulcers are
more common in males. Al Mahroos et al7 in their
study on diabetic patients with foot problems in
patients in Bahrain observed that the mean age of the
patients were 57.3 + 6.32 years. Ahmed M et al8 in
their study on evaluation of diabetic foot ulcer in 100
subjects observed that the age group of patients was
between 40 - 60 years. In our study done on 70
patients with diabetic foot ulcerations majority of the
patients fall between 51-60 years of age and mean
age of these patients was 55 + 5 years. This is
relevant to the above studies and our study proved
that the complications of diabetes are more common
in the older age group. Nalini Singh et al9 in their
study on prevalence and determinants of foot
ulceration in patients with type II diabetes observed
that the mean duration of diabetes was 4.3 years.
Kumar S et al[10] in their study on prevalence of foot
ulceration and its correlation with type II diabetes
showed that the mean duration of diabetes among the
patients was 7.4 years. In our study the duration of
diabetes was for 5.2 years, which signifies that as the
duration of diabetes increases, the foot is prone for
problems. In comparison to above studies our
patients with diabetes tend to develop foot ulceration
little earlier. Apelquist J et al3 in their study on
external risk factors for foot ulcerations and the
outcome of diabetic foot lesions in 314 patients
demonstrated that the external precipitating factors
were identified in 264 out of 314. Common factors
like ill-fitting shoes, socks, acute mechanical trauma,
stress ulcers and paronychia were named. In our
study majority of the patients had history of minor
trauma, either due to bare foot walking (or) ill-fitting
foot wear, leading to minor trauma and ulceration and
minor injuries like thorn prick. This signifies the need
for education on personal care of foot by selfexaminations and general awareness of foot problems
and measures to prevent them and stressing the
importance of proper footwear in diabetic patients.
262
Sundar et al.,
Sundar et al.,
Sundar et al.,
DOI: 10.5958/2319-5886.2015.00049.1
Coden: IJMRHS
Copyright@2014
ISSN: 2319-5886
th
Revised: 15 Sep 2014
Accepted: 25thJan 2015
Associate Professor, Department of Pharmacology, Sri Padmavathi Medical College for Women, Tirupati,
Andhra Pradesh, India
2
Assistant Professor, Department of Pharmacology, Meenakshi Medical college Hospital & Research Institute,
Kanchipuram, Tamil Nadu, India
*Corresponding author email: subbu2207@ yahoo.com
ABSTRACT
Introduction: The aim of this study is to analyze the utilization of antibiotics at our neonatal intensive care unit
(NICU). Neonatal sepsis is one of the most common causes of admission in NICU and the causative bacteria and
their respective sensitivity patterns based on the culture sensitive reports helps in achieving the antibiotic policy.
Methods: This study was done after obtaining the approval from Institutional Human Ethical Committee (IHEC)
of Sri Padmavati Medical College Hospital and Research Institute. The study was carried out during the period of
February 2013 to April 2013 at Department of Pediatrics, Neonatology division, the total number of antibiotics
used in neonatal intensive care unit (NICU) during the study period was identified and the percentage of the
antibiotic prescriptions, individual and fixed dose drug combinations is evaluated. Results: Ampicillin and
Gentamicin were the maximum (50%) empirically administered followed by the fixed dose combination of
Piperacillin and Tazobactam was used in nearly 16% of the babies. Conclusion: The study concludes the
prescription pattern at our neonatal intensive care unit complies with international studies and standards.
Key words: Antibiotics, Neonatology, Intensive care Unit, Prescription.
INTRODUCTION
The most common groups of drugs prescribed in
hospitals are antimicrobial agents. The major
admission particularly at neonatal intensive care unit
(NICU) is sepsis[1]. Major neonatal mortality and
morbidity worldwide is due to septicemia is a
recorded fact comprising various systemic infections
of the newborn such as septic shock, meningitis,
pneumonia, arthritis, osteomyelitis, and urinary tract
infections[2]. Empirical antibiotic therapy should
begin immediately on suspicion of septicemia
followed by cultures and sensitivity, later based on
report reevaluation of antibiotic treatment provided
Subash et al.,
39%
G.Negative
G.Positive
61%
Subash et al.,
Subash et al.,
268
Subash et al.,
DOI: 10.5958/2319-5886.2015.00050.8
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 10 Jan 2015
Accepted: 16th Mar 2015
EVALUATION OF RISK FACTORS FOR PRETERM DELIVERY AND CREASYS RISK SCORING
Anand Nalini I1, *Modi Nikunj K2, Sharma Hariom M 3
1
Professor, Department of Obstetrics and gynecology, 2 Assistant Professor, Department of Biochemistry, GGG
Hospital & M P Shah Govt. Medical College, Jamnagar, Gujarat, India
3
Professor & Head, Department of Biochemistry, Sir T Hospital & Govt. Medical College, Bhavnagar, Gujarat,
India
*Corresponding author: Modi Nikunj K Email: nikunjmodi86@yahoo.in
ABSTRACT
Background: Preterm birth is a poorly understood domain so it is a one of the most serious problem encountered
in case of pregnant women. Because of the incomplete knowledge of biochemical and molecular reasons for
preterm birth, many authors have shown interest in various predicting risk factors of preterm birth. Aim: This
study was undertaken to know risk factors for preterm delivery and to investigate the usefulness of the most
widely used creasy scoring system in identifying the high risk group of women at the tertiary care center of India.
In this study also included observation of perinatal mortality and morbidity associated with preterm deliveries.
Material and Methods: In the present study of 175 women who gave birth to preterm babies, detail history was
taken. Then all the Data were statistically analyzed based on percentage. Result: Preterm delivery is particularly
affected by precipitating of some risk factors (Hb, weight, parity of mother etc.). Conclusion: so we can say that
such risk factors acting as a precipitating factor for preterm deliveries. Awareness of such risk factors is essential
to plan public education programs and to consider appropriate perinatal care options for women at potentially
higher risk for preterm delivery.
Keywords: Preterm birth, Creasy scoring, Perinatal death
INTRODUCTION
One of the most important unresolved issues
currently confronting obstetricians is the prevention
of preterm birth (birth before 37 completed weeks of
gestation). Preterm birth is, worldwide, the most
challenging problem in obstetrics, but the prevention
of prematurity has been difficult and ineffective
because of its multifactorial and partly still unknown
etiology. Identification of those women who are
likely to deliver before term requires use of simple
diagnostic tools that can be applied to both
asymptomatic and symptomatic pregnant women. [1]
Many healthcare providers collect data on pregnant
women for assessment of preterm birth risk. Current
technology makes possible collection of a plethora of
Nalini et al.,
270
Nalini et al.,
No of preterm
delivery(out of 175)
28
85
22
Percentage
16 %
71.4 %
12.6 %
No of preterm
delivery(out of175)
27
148
Percentage
15.4 %
84.6 %
Nalini et al.,
Hb < 08 g/dl
14%
81%
271
Nalini et al.,
272
6.
7.
CONCLUSION
Our data in this study shows the correlation with
various risk factors to the preterm birth. From the
present study, it is concluded that to make creasy risk
score more specific and effective in the Indian
context, it should be modified by giving higher score
to women with low socioeconomic status, low
pregnancy weight, physical work during pregnancy
and low maternal age. A slightly modified scoring
system needs to be devised for Indian population.
More elaborate information about the components of
the scoring system is required for understanding the
need to devise it in Indian context.
8.
9.
10.
11.
12.
ACKNOWLEDGEMENT None
Conflict of Interest Nil
13.
REFERENCES
14.
Nalini et al.,
15.
16.
17.
18.
19.
20.
273
DOI: 10.5958/2319-5886.2015.00051.X
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 20 Dec 2014
Accepted: 24th Jan 2015
Department of Community Medicine and Public Health, 5Deans Office, Institute of Medicine, Tribhuvan
University, Kathmandu, Nepal
2
Valley College of Technical Sciences, Purbanchal University, Kathmandu, Nepal
4
Department of Health, University of Bath, Nepal
*Corresponding author email: karuna201@gmail.com
ABSTRACT
Introduction: Birth weight is a key predictor for risk of childhood illnesses and chances of survival; however in
developing countries less than half of newborns are weighed at birth. In Nepal, only 36% of children born were
weighed at birth. Nearly two thirds (63%) of deliveries take place at home and birth weight may not be known for
many babies, the mothers estimate of the babys size at birth could be used as an alternative. Aim and
Objective: This study assessed the accuracy of low birth weight as perceived by mothers and factors influencing
whether their perceptions were accurate. Methods: The study wasa facility based descriptive study carried out in
four hospitals with sample size of 1533. Hospital nurses interviewed mothers using a pre-tested tool. Data was
entered into EpiData 3.1 and analyzed using SPSS version 17 software package. Results: A total of 1533 mothers
were interviewed of which 75 did not respond. An overall 75% mothers accurately identified actual low birth
weight; and 25% mother perceived normal for actual low birth weight. Less percent of mothers <20years
(sensitivity=0.74), illiterate (sensitivity=0.74), and primigravida (sensitivity=0.74) identified actual low birth
weight than mothers 20years (sensitivity=0.75), literate (sensitivity=0.75) and multigravida (sensitivity=0.77).
Conclusion: The study concluded that 75% mothers recognized actual low birth weight of newborn, and 25%
mothers perceived normal for actually low birth weight. The percentage of women accurately identifying actual
low birth weight was slightly lower among mothers <20years, illiterate and primigravida as compared to mothers
20years, literate and multigravida.
Keywords: Lowbirth weight, Mothers perception, Facility based study, Nepal
INTRODUCTION
Birth weight indicates the health status of both
newborn and mother. Low Birth Weight (LBW), less
than 2.5 kg[1]. is the consequence of small maternal
size at conception; low gestational weight gain;
premature delivery; and pregnancy among younger
women2; and can have consequences on increasing
newborn morbidity and mortality[2]. Additionally,
knowing the birth weight can help providers and
family to take care of newborn at right time.
Shakya et al.,
Globally,15.5%ofallbirthsarebornwithLBW. Among
them 95.6% areindeveloping countries[3]. About 80%
intrauterine growth retarded (IUGR) newborns who
are LBW and full term are born in Asia[3]. Nepal has
an overall 21% LBW2 and little variation in different
studies, 12.76%[5], 21.6%[6], 11.9%[7]; similar to
prevalence of LBW in India 23%[7], 21.5%[9],
12.8%[7], and 17.3%[10]. More than half of infants in
the developing world are not weighed after birth[1] as
274
Int J Med Res Health Sci. 2015;4(2):274-280
Shakya et al.,
Actual
LBW (%)
Actual
NBW (%)
Total (%)
Low
364 (74.6)*
73 (7.5)
437 (30)
Normal
124 (25.4)
897 (92.5)**
1021 (70)
Total
488
970
1458
Table 2: Number of mothers with their profile, perceived low birth weight, and diagnostic indicators
Perception of
Diagnostic Indicators
Maternal
Actual
Actual
Total
mother on
Factors
LBW (%)
NBW (%)
(N=1458)(%) Sensitivity* Specificity*
birth weight
Low
62 (73.8)
9 (7.4)
71 (34.6)
0.74
0.93
Age <20 years Normal
22 (26.2)
112 (92.6)
134 (65.4)
(0.64-0.82)
(0.86-0.96)
Total
84 (41.0)
121 (59.0)
205 (14.1)
Low
302 (74.8)
64 (7.5)
366 (29.2)
0.75
0.92
Age 20 years Normal
102 (25.3)
785 (92.5)
887 (70.8)
(0.70-0.78)
(0.90-0.94)
Total
404 (32.2)
849 (67.8)
1253 (85.9)
Low
42 (73.7)
9 (10.6)
51 (35.9)
0.74
0.89
Illiterate
Normal
15 (73.7)
76 (89.4)
91 (64.1)
(0.61-0.83)
(0.81-0.94)
Total
57 (40.1)
85 (59.9)
142 (9.7)
Low
322 (83.4)
64 (16.6)
386 (29.3)
0.75
0.93
Literate
Normal
109 (11.7)
821 (88.3)
930 (70.7)
(0.70-0.79)
(0.91-0.94)
Total
431 (32.8)
885 (67.3)
1316 (90.3)
Low
256 (87.7)
36 (12.3)
292 (30.5)
0.74
0.94
Primigravida
Normal
91 (13.7)
573 (86.3)
664 (69.5)
(0.69-0.78)
(0.92-0.96)
Total
347 (36.3)
609 (63.7)
956 (65.6)
Low
108 (74.5)
37 (25.5)
145 (28.9)
0.77
0.90
Multigravida
Normal
33 (9.2)
324 (90.8)
357 (71.1)
(0.69-0.83)
(0.86-0.92)
Total
141 (28.1)
361 (71.9)
502 (34.4)
*calculated at 95% CI
DISCUSSION
This study assessed and analyzed perceived LBW and
the maternal factors that influence on her perception
on LBW. We asked mothers on her perception on
birth weight before she was told weight of her
newborn. We did not cover home based deliveries
because the birth weight was not recorded in home
delivery and thus cannot validate the perception of
mother on LBW. We also did not include multiple
births, preterm and still birth. Next, we are not aware
of this kind of study conducted in Nepal before. It
could be a unique study for Nepal. Though Nepal
Demographic health Survey (NDHS) uses mothers
perception to identify low or normal birth weight, but
to date there has been no study to determine whether
this is an accurate proxy indicator. This study fills
that gap.
A study conducted in Korea to identify factors
affecting the validity of self-reported data on health
services from community health survey; and in some
other countries have done similar studies using
diagnostic indicators [11, 12, 19, 20]; UNICEF and WHO
Shakya et al.,
Shakya et al.,
Shakya et al.,
26. Golding J, Shenton T. Low birth-weight and preterm delivery in South-east Asia. The WHO
International
Collaborative
Study
of
Hypertensive Disorders of Pregnancy. Soc Sci
Med, 1990;30(4): 497-502.
27. Tomeo CA. Reproducibility and validity of
maternal recall of pregnancy-related events.
Epidemiology, 1999; 10(6): 774-7.
280
Shakya et al.,
DOI: 10.5958/2319-5886.2015.00052.1
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 10 Dec 2014
Accepted: 30th Jan 2015
PhD. student, College of Dentistry, 2 Professor in polymer physic, Department of Physics, college of science,
University of Basrah, Basrah, Iraq.
3
Professor in polymer, Department of Chemistry, college of Education, University of Mosul, Mosul, Iraq.
*Corresponding author email: profkmziadan@gmail.com
ABSTRACT
Water sorption of dental composites affects dimensional stability, mechanical properties and bonding strength
with tooth structures. The diffusion coefficient of water through the resin should be identified. Methods: Ten new
composites fillings (M1-M10) were prepared from new Fluoroaluminosilicate powder composition and
BisGMA/TEGDMA together with the related compounds such as tri ethylene glycol dimethacrylate, N,NDimethyl amino ethyl methacrylate and Camphorquinone. Five disk shapes were prepared for each composite
using a stainless steel mold 15 mm in inner diameter and 1 mm in thickness, according to ISO 4049, the curing of
each composite disk for 40 sec. Each disk was immersed separately in water for 90 day all at (37 1). Water
sorption and solubility were calculated by using these measurements, Diffusion coefficients were also measured
with the solution of Ficks second law. Results: The water sorption (g/mm3) after 90 day immersion ranged from
14.98 g/mm3 (0.90) for M10 to 36.81g/mm3 (0.46) for M6. The solubility ranged from 3.3 g/mm3 (0.90) for
M6 to 8.55 g/mm3 (0.31) for M7, the equilibration time for water sorption was reached at 20 day. M6 had the
highest diffusion coefficient 6.25 10-9 cm2/s (3.46). Conclusion: This investigation revealed that M6 composite
filling was the best one due to the lowest water solubility while the other investigated fillings showed moderate to
high solubility values but all are in accordance with the International Standard ISO 4049.
Keywords: Water sorption, Solubility, Composites, Diffusion coefficient, Calcium Fluoroaluminosilicate.
INTRODUCTION
Materials left for long time in the oral environment
will undergo an interaction with oral fluids. Visible
light-curable polymeric composites are now routinely
used as filling materials for dental restorations. These
materials are based on polydimethacrylate matrix
resins along with silane-coated inorganic fillers. They
possess many advantages such as mechanical
properties comparable to commercial dental
amalgams and dental ceramics, excellent esthetic
quality and the ability to bond to enamel surface.
However, in aqueous environment they absorb water
and release unreacted components.
There are two different mechanisms that occur when
the previously mentioned dental restorative materials
Kareema et al.,
SiO2
Al2O3
M1
22
18
M2
22
19
M3
29
M4
CaF2
Al2PO4
AlF3
NaF
22
15
23
10
39
13
16.6
34.2
9.9
5.3
35
25
20
M5
39.52
23.6
13.65
3.62
9.7
9.91
M6
24.3
27.5
14.0
19.1
15.1
M7
33.9
17.5
15
10
M8
56.5
33.5
M9
48.9
29.1
15
M10
36.3
22
12
15.6
10
7
14.3
6.4
Kareema et al.,
(1)
(2)
(3)
The differential equation is solved for the region h<x<h with zero initial concentration of water and
with surfaces x=h kept at constant concentration c0
for t > 0: It should be noted here that the solution to
the Ficks second law (Eq. (3)) might alternatively be
expressed as
=
+ 2
=2
(1)
2(
(4)
For which
RESULTS
=2
/4
(4)
Kareema et al.,
values
for
DISCUSSION
Kareema et al.,
CONCLUSIONS
In this work, we conclude that the sorption and
solubility values are in accordance with the ISO
4049:2000. The studied dental material (teeth filling)
has shown that they have optimal physico-chemical
properties for an adequate behavior in the oral
aqueous environment, making it suitable for indirect
composite restorations.
ACKNOWLEDGMENT
Rafed M. extend his appreciation to Dr M. Atai for
his assistance and consultation in this work, thanks to
university of Basrah Dentistry College for their help.
Conflict of Interest: Nil
REFERENCES
1. Toledano M, Osorio R, Osorio E, Fuentes V,
Prati C, Garca-Godoy F. Sorption and solubility
of resin-based restorative dental materials.
Journal of Dentistry. 2003;31(1):43-50.
2. Braden M, Causton E, Clarke R. Diffusion of
water in composite filling materials. Journal of
Dental Research.1976;55(5):730-2.
3. Asaoka K, Hirano S. Diffusion coefficient of
water through dental composite resin. Bio
materials. 2003;24(6):975-9.
4. Pfeiffer P, Rosenbauer E-U. Residual methyl
methacrylate monomer, water sorption, and water
solubility of hypoallergenic denture base
materials. The Journal of Prosthetic Dentistry.
2004;92(1):72-8.
5. Vanlandingham M, Eduljee R, Gillespie J.
Moisture diffusion in epoxy systems. Journal of
applied polymer science. 1999;71(5):787-98.
6. Adamson MJ. Thermal expansion and swelling of
cured epoxy resin used in graphite/epoxy
composite materials. Journal of materials science.
1980;15(7):1736-45.
7. Li L, Yu Y, Wu Q, Zhan G, Li S. Effect of
chemical structure on the water sorption of
amine-cured epoxy resins. Corrosion Science.
2009;51(12):3000-6.
8. ISO4049. Dentistry-resin-based lling materials:
7.9 water sorption and solubility. 2000.
9. Kielbassa A, Schulte-Monting J, Garcia-Godoy
F, Meyer-Lueckel H. Initial in situ secondary
caries formation: effect of various fluoridecontaining restorative materials. Operative
dentistry. 2002;28(6):765-72.
10. Ling L, Xu X, Choi G-Y, Billodeaux D, Guo G,
Diwan R. Novel F-releasing composite with
improved mechanical properties. Journal of
Dental Research. 2009;88(1):83-8.
11. Akahane
S,
Hirota
K, Tomioka
K.
Fluoroaluminosilicate glass powder for dental
glass ionomer cement. Google Patents; 1988.
12. Al-Bader RM, M.Ziadan K, Al-Ajely MS. New
Glass Compositions Based on CalciumFluoroaluminosilicate for dental composite.
Journal of Advances in Chemistry. 2014;10
(5):2743-52.
13. Tamai Y, Tanaka H, Nakanishi K. Molecular
simulation of permeation of small penetrants
285
Kareema et al.,
14.
15.
16.
17.
286
Kareema et al.,
DOI: 10.5958/2319-5886.2015.00053.3
Coden: IJMRHS
Revised: 20th Dec 2014
Copyright @2014
ISSN: 2319-5886
Accepted: 27th Jan 2015
Associate professor, 2,5,6Assistant Professor, Department of pathology, Narayana Medical college and
Hospital, Nellore, Andhrapradesh, India
Shanthi et al.,
Shanthi et al.,
Total
Normal
smears
Inflammatory
smears
LSIL Mild
dysplasia
20-30
203 (20.3%)
31-40
24 (2.4%)
150 (15%)
25 (2.5%)
2 (0.2%)
2 (0.2%)
304 (30.4%)
53 (5.3%)
187 (18.7%)
36 (3.6%)
14 (1.4%)
11 (1.1%)
3 (0.3%)
41-50
287 (28.7%)
51 (5.1%)
148 (14.8%)
44 (4.4%)
22 (2.2%)
13 (1.3%)
8 (0.8%)
51-60
61 and
above
128 (12.8%)
22 (2.2%)
17 (1.7%)
11 (1.1%)
14 (1.4%)
9 (0.9%)
78 (7.8%)
15 (1.5%)
11 (1.1%)
10 (1%)
10 (1.0%)
9 (0.9%)
56 (5.6%)
23 (2.3%)
HSIL Moderate
severe dysplasia
Invasive
carcinoma
P<0.001.
Table 2: Epithelial abnormalities in menopausal and reproductive age group women
Age groups
Total
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
Invasive
carcinoma
Menopausal
449 (44.9%)
90 (9%)
192 (19.2%)
73 (7.3%)
37(3.7%)
33 (3.3%)
24 (2.4%)
Reproductive
551 (55.1%)
75 (7.5%)
372 (37.2%)
60 (6%)
22(2.2%)
17 (1.7%)
5 (0.5%)
P<0.001
Table 3: Epithelial abnormalities in relation to age at menarche
Normal
Inflammatory
LSIL mild
HSIL Moderate
Invasive
smears
smears
dysplasia
severe dysplasia
carcinoma
Total
Age at menarche
in years
10-11 Years
40 (4%)
4 (0.4%)
24 (2.4%)
2 (0.2%)
5 (0.5%)
5 (0.5%)
12 years
276 (27.6%)
38 (3.8%)
153 (15.3%)
43 (4.3%)
17 (1.7%)
21 (2.1%)
4 (0.4%)
13 years
418 (41.8%)
69 (6.9%)
230 (23%)
64 (6.4%)
25 (2.5%)
23 (2.3%)
7 (0.7%)
14 years
185 (18.5%)
39 (3.9%)
114 (11.4%)
13 (1.3%)
7 (0.7%)
3 (0.3%)
9 (0.9%)
81 (8.1%)
15 (1.5%)
43 (4.3%)
11 (1.1%)
5 (0.5%)
3 (0.3%)
4 (0.4%)
P<0.005
Table 4: Epithelial abnormalities in relation to age at marriage
Age at
marriage
10-14 yrs
15- 17 yrs
18yrs and
above
Total
151
(15.1%)
406
(40.6%)
443
(44.3%)
Normal
smears
31 (3.1%)
Inflammatory
smears
69 (6.9%)
LSIL Mild
dysplasia
21 (2.1%)
Invasive
carcinoma
6 (0.6%)
50 (5.0%)
210 (21 %)
55 (5.5%)
33 (3.3%)
39 (3.9%)
19 (1.9%)
84 (8.4%)
285 (28.5%)
57 (5.7%)
10 (1 %)
3 (0.3%)
4 (0.4%)
P<0.001
Table 5: Epithelial abnormalities in relation to marital life
289
Shanthi et al.,
Married life
Total
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
HSIL Moderate
severe dysplasia
Invasive
carcinoma
0-5 years
41 (4.1%)
7 (0.7%)
30 (3%)
4 (0.4%)
6-10 years
93 (9.3%)
18 (1.8%)
58 (5.8%)
15 (1.5%)
2 (0.2%)
11-20 years
267 (26.7%)
31 (3.1%)
187 (18.7%)
32 (3.2%)
5 (0.5 %)
10 (1%)
2 (0.2%)
21-30 years
285 (28.5%)
48 (4.8%)
165 (16.5%)
37 (3.7%)
19 (1.9%)
13 (1.3%)
3 (0.3%)
31 years and
above
314 (31.4%)
61 (6.1%)
124 (12.4%)
45 (4.5%)
33 (3.3%)
27 (2.7%)
24 (2.4%)
P<0.001
Table 6 Epithelial abnormalities in relation to parity
Parity
Total
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
HSIL Moderate
severe dysplasia
Invasive
carcinoma
56 (5.6%)
22 (2.2%)
31 (3.1%)
3 (0.3%)
83 (8.3%)
17 (1.7%)
51 (5.1%)
11 (1.1%)
1 (0.1%)
3 (0.3%)
2
3and
above
368 (36.8%)
53 (5.3%)
240 (24%)
53 (5.3%)
11 (1.1%)
8 (0.8%)
3 (0.3%)
493 (49.3%)
73 (7.3%)
242 (24.2%)
66 (6.6%)
47 (4.7%)
39 (3.9%)
26 (2.6%)
P<0.001
Table 7: Epithelial abnormalities in relation to economic status
Economic
status
Lower income
group
Middle income
group
Upper
group
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
Invasive
carcinoma
701
(70.1%)
119 (11.9%)
374 (37.4 %)
83 (8.3%)
50 (5%)
47(4.7%)
28 (2.8%)
289
(28.9%)
42 (4.2%)
185 (18.5%)
49 (4.9%)
9 (0.9%)
3 (0.3%)
1 (0.1%)
10 (1%)
4 (0.4%)
5 (0.5%)
1 (0.1%)
Total
income
P<0.001
Table 8: Epithelial abnormalities in relation to education status
Education status
No Formal
education
Primary
education
Higher education
Total
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
665 (66.5%)
HSIL Moderate
severe dysplasia
Invasive
carcinoma
103 (10.3%)
345 (34.5%)
88 (8.8%)
52(5.2%)
50 (5%)
27 (2.7%)
279 (27.9%)
51 (5.1%)
180 (18%)
39 (3.9%)
7 (0.7%)
2 (0.2%)
56 (5.6%)
11 (1.1%)
39 (3.9%)
6 (0.6%)
P<0.001
Table 9: Epithelial abnormalities and gynecological symptoms
290
Shanthi et al.,
Clinical
symptoms
Total
Normal
smears
Leucorrhoea
307 (30.7%)
Dysuria
Irregular
vaginal bleeding
Post menopausal
bleeding
Pain in Lower
abdomen
Mass per vagina
Routine
check up
Inflammatory
smears
LSIL Mild
dysplasia
HSIL Moderate
severe dysplasia
Invasive
carcinoma
16 (1.6%)
219 (21.9%)
56 (5.6%)
13(1.3%)
2 (0.2%)
1 (0.1%)
35 (3.5%)
8 (0.8%)
24 (2.4%)
3 (0.3%)
192 (19.2%)
15 (1.5%)
90 (9%)
31 (3.1%)
25(2.5%)
24(2.4%)
7 (0.7%)
71 (7.1%)
1 (0.1%)
13 (1.3%)
8 (0.8%)
8 (0.8%)
22(2.2%)
19 (1.9%)
194 (19.4%)
41 (4.1%)
121 (12.1%)
23 (2.3%)
8(0.8%)
1 (0.1%)
78 (7.8%)
25 (2.5%)
39 (3.9%)
7 (0.7%)
5(0.5%)
2 (0.2%)
123 (12.3%)
59 (5.9%)
58(5.8%)
5 (0.5%)
1 (0.1%)
P<0.001
Table 10: Epithelial abnormalities in relation to clinical lesions
Clinical lesions
Erosion cervix
Hypertrophied
cervix
Suspicious cervix
(growth/ bleeding
on touch)
Total
Normal
smears
230 (23%)
Inflammatory
smears
6 (0.6%)
LSIL mild
dysplasia
137 (13.7%)
HSIL Moderate
severe dysplasia
55 (5.5%)
19 (1.9%)
Invasive
carcinoma
13 (1.3%)
63 (6.3%)
10 (1%)
34 (3.4%)
12 (1.2%)
5 (0.5%)
1 (0.1%)
1 (0.1%)
82 (8.2%)
3(0.3%)
10(1%)
10 (1%)
32 (3.2%)
27 (2.7%)
Senile vaginitis
41 (4.1%)
9 (0.9%)
22 (2.2%)
4 (0.4%)
4 (0.4%)
2 (0.2%)
Polyp
4 (0.4%)
1 (0.1%)
2 (0.2%)
1 (0.1%)
155 (15.5%)
5 (0.5%)
123 (12.3%)
18 (1.8%)
8 (0.8%)
1 (0.1%)
87(8.7%)
29(2.9%)
40 (4%)
12(1.2%)
5(.5%)
1 (0.1%)
338 (33.8%)
105(10.5%)
203 (20.3%)
21 (2.1%)
8 (0.8%)
1 (0.1%)
Endocervicitis
Prolapsed
Normal
Total
Normal
smears
Inflammatory
smears
LSIL mild
dysplasia
Invasive
carcinoma
Cigarette smoking
Tobacco chewing
105(10.5%)
16 (1.6%)
41 (4.1%)
18 (1.8%)
12 (1.2%)
10 (1%)
8 (0.8%)
Immunosuppressive
drugs
1 (0.1%)
1 (0.1%)
DISCUSSION
The etiology of cervical neoplasia, which is
considered to be the third most common cancer in
women, has been studied epidemiologically for over
150 years 8. Epidemiologically cervical cancer
behaves like a sexually transmitted disease and is
more common in women who have multiple sexual
partners 9, or whose partners are promiscuous 10 and
is absent in virgins. Epidemiological data has shown
Shanthi et al.,
Shanthi et al.,
8.
CONCLUSION
Cervical carcinoma is caused not due to single
etiological factor but multiple independent risk
factors like age, age at menarche, age at marriage,
parity, educational and economic status, use of oral
contraceptives, cigarette smoking play role in the
pathogenesis. Due to simplicity, low cost and validity
of the Pap smear screening, it becomes apparent that
this test could be effectively used to detect early
cancer and premalignant changes in cervix uteri.
ACKNOWLEDGEMENT
9.
10.
11.
12.
13.
REFERENCES
1. Pisani P, Parkin DM, Bray F, Ferlay J. Estimates
of the world wide mortality from 25 cancer in
1990.Int J Cancer.1999;83:870-73.
2. Rajendra A Kalkar, Yogesh Kulkarini. Screening
for cervical cancer: an over view. Obstet Gynecol
India.2006; 56: 2.
3. Mohammed Shaoaib Khan, Fohadiya Yasin Raja
et al. Pap smear screening for precancerous
conditions of the cervical cancers. Pak J Med
Res.2005; 44(3):111-3.
4. Parkin DM, Laara E, Muir CS. Estimates of the
world wide frequency of sixteen major cancers in
1980. Int J Cancer.1988; 184-97.
5. Smith PA and Gray W. Cervical intraepithelial
neoplasia and squamous cell carcinoma of the
cervix: In Diagnostic cytopathology by Winifred
Gray and Grace T Mckee. Chapter 30,2nd edition
2003;721-53.
6. Parkin DM, Nguyen-Dinh X, Day NE. The
impact of screening on the incidence of cervical
cancer in England and Wales. Br J Obstet
Gynaecol.1985;92:150-57.
7. Paola Dey, Stuart Collins, Minaxi Desai, Cjaran
Woodman. Adequacy of cervical cytology
sampling with the cervex brush and the Ayles
14.
15.
16.
17.
18.
293
Shanthi et al.,
DOI: 10.5958/2319-5886.2015.00054.5
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 25 Jan 2015
Accepted: 16th Feb 2015
Russian Ilizarov Scientific Center Restorative Traumatology and Orthopaedics (RISC RTO), Ul'ianova Street, 6.
Kurgan, 640014. Russia,
2
Izhevsk state medical academy, Kommunarov str., 281, Izhevsk, Russia.
*Corresponding author email: kirnik@list.ru
ABSTRACT
Background: The problem of improving medical care for patients with the locomotor system injuries is very
important especially last time. Material and Methods: Canine open comminuted tibial fractures modelled
experimentally, wires with hydroxyapatite coating inserted intramedullary, osteosynthesis performed with the
Ilizarov fixator. Regenerated bones investigated 14-360 days after surgery using the techniques of light
microscopy, scanning and transmission electron microscopy, and X-ray electron probe microanalysis for
histologic sections . Results: It has been found that a zone of active reparative osteo- and angiogenesis forms
around the wires, as well as a bone sheath with the properties of osteogenesis conductor and inductor. Fracture
consolidation occurs early according to the primary type without cartilaginous and connective tissue formation in
bone adhesion. Presented morphological characteristics endovasal angiogenesis. Conclusion: The results of the
study evidence of the positive effect of intramedullary wires with hydroxyapatite coating on the course and
intensity of reparative osteogenesis during fracture healing
Key words: Transosseous osteosynthesis, Intramedullary wires, Hydroxyapatite coating, Fracture healing,
Reparative osteogenesis, Angiogenesis.
INTRODUCTION
The problem of improving medical care for patients
with the locomotor system injuries every year is
becoming increasingly important due to the increase
of injured persons in number, to that of disability and
mortality from injuries not having downward
tendency. However, osteosynthesis real terms remain
to be significant. The technique of directed
stimulation of bone tissue regeneration process is
practiced by using intramedullary wires with calcium
phosphate coating in order to optimize the conditions
for regenerated bone formation, as well as for
treatment period reduction, and complication
prevention [1, 2]. At the same time, the process of
reparative osteogenesis using those or other implants
Irianov et al.,
294
Irianov et al.,
RESULTS
Transverse fractures have been produced in tibial
shaft middle third of all the animals after surgery
(Figure 1, a). The height of diastasis between the
fragments is 0.5-1.0 mm. The signs of periosteal
reaction as cloud-like shadows appear in close
proximity to the fracture line by 8-10 days after
surgery. The formation of new bone cortex is
determined by X-rays 35 days after surgery (Figure 1,
b).
Fig: 1a
Fig: 1b
295
42, 90
17.271.08
180, 360
23.301.31
25.821.10
2.950.181
5.741.531
1.680.131
6.440.36
53.432.89
1.720.14
9.060.56
80.074.90
1.910.18
11.070.69
94.135.49
2.100.14
11.750.53
96.154.44
2.200.13
0.350.02
1.150.07
4.020.26
16.040.67
Cortical layer
24.971.28
Fig: 2b
296
Irianov et al.,
Irianov et al.,
DISCUSSION
Intramedullary osteosynthesis is known to provide
little-damage fixation of fractures, to allow earlier
weight-bearing of the operated limb, and to be one of
the main standard techniques for treating femoral and
tibial shaft fractures in most countries [3,4]. The main
disadvantage of intramedullary osteosynthesis is
considered the risk of damaging vessels and
circulation system of medullary canal which weakens
the osteogenic and osteoinductive potential of bone
marrow stromal pluripotent cells [5]. Experimental
studies have demonstrated that insertion of even thin
implant into the medullary cavity results in
significant blood supply disorders of the medullary
canal and cortex inside [6]. The possible mechanism of
the stimulating effect of intramedullary wire insertion
is connected with prolonged formation of the local
foci of granulation tissue in the medullary cavity. The
characteristic feature of the granulation tissue is the
expression of endotheliocyte migration phenotype,
and as a consequence angiogenesis activation
evidenced by intense formation of numerous
endothelial sprouts which generate capillary buds and
297
CONCLUSION
Thus, the results of the study evidence of the
positive effect of intramedullary wires with
hydroxyapatite coating on the course and
intensity of reparative osteogenesis during
fracture healing. The data obtained allow
recommending this relatively little-invasive
method of osteoreparation optimization to be
used in combination with other methods of
conservative and surgical treatment of bone
fractures, especially for sluggish reparative
processes in children, elderly and senile persons,
as well as in debilitated patients.
2.
3.
4.
5.
6.
7.
ACKNOWLEDGEMENT
We thank the staff of our institutions for their
help in carrying out experiments and supervision
over animals during all stages of work.
Conflict of Interest: Nil
REFERENCES
1. Coles CP, Gross M. Closed tibial shaft
fractures: management and treatment
298
Irianov et al.,
DOI: 10.5958/2319-5886.2015.00055.7
Copyright @2014
ISSN: 2319-5886
Accepted: 16th Jan 2015
Pooja et al.,
Mild(less than 5%
of total placental
area)
Mod(more than5%
less than 10% of
total placental
area)
Severe(more than
10% of total
placental area)
51
20
24
Place
No.
of
case
s
GangaR
Singal
(2013)9
Kotgirwar
(2011)10
PradeepS
Londhe11
Figen Barut12
Gediminas
Mejus13
Nayereh
Ghomian14
Gnyeli 15
Present
Study
Bhavnagar
100
Bhopal
55
nil
1.8
<0.01
Andhra
Pradesh
Turkey
Lithuania
374
5.4
10.6
<0.01
110
120
nil
4.2
92.7
49.2
<0.01
<0.01
Iran
46
8.7
39.1
<0.0001
Turkey
IndiaUdaipur
52
200
4
13
58
96
<0.05
<0.0001
*Highly
significant
p<0.01,p<0.05
RESULTS
Infarction
Infarction
Result
present in % of
cases
Contro Resea
l
rch
5
10
<0.01
p<0.0001,*Significant
DISCUSSION
Area of Infarction
Normal
pregnancies
group
(n = 100)
IUGR
pregnancies
group
(n = 100)
87
Nil
p value
<0.0001
*
Pooja et al.,
6.
CONCLUSION
Increased incidence of extensive infarction was seen
in cases of IUGR. These cases were associated with
low foetal weight. Every placenta shows many
degenerative features. Presumably these are to an
extent, physiologic sequence of evolution. However,
when they occur in excess, they must be considered
as pathological, particularly when they affect foetal
growth deleteriously.
7.
8.
9.
ACKNOWLEDGEMENT
Conflict of Interest-NIL
10.
REFERENCES
1. Vogel P. The current molecular phylogeny of
Eutherian
mammals
challenges
previous
interpretations of placental evolution. Placenta.
2005; 26:59196.
2. Pardo F, Arroyo P, Salomn C, Westermeier F,
Guzmn-Gutirrez E, Leiva A, Sobrevia L.
Gestational diabetes mellitus and the role of
adenosine in the human placental endothelium
and central nervous system. J Diabetes Metab.
2012; 2:10-11.
3. Barker DJ, Bagby SP, Hanson MA. Mechanisms
of disease: in utero programming in the
pathogenesis of hypertension. Nat Clin Pract
Nephrol. 2006;2:70007.
4. Sankar KD, Bhanu PS, Kiran S, Ramakrishna
BA, Shanthi V. Vasculosyncytial membrane in
relation to syncytial knots complicates the
placenta in preeclampsia: a histomorphometrical
study. Anat Cell Biol. 2012; 45:8691.
5. Akhlaq M, Nagi AH, Yousaf AW. Placental
morphology in pre-eclampsia and eclampsia and
11.
12.
13.
14.
15.
301
Pooja et al.,
DOI: 10.5958/2319-5886.2015.00056.9
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 4 Feb 2015
Accepted: 20th Feb 2015
Research article
COMPARISON OF ENDOSCOPIC SINUS SURGERY AND ANTRAL WASH OUT IN THE
MANAGEMENT OF SUBACUTE AND CHRONIC MAXILLARY SINUSITIS
*MuthuBabuK, Srinivasan MK., Sakthivel M, Kiran kumar C, Arvindh kumar G
Department of ENT, Meenakshi Medical College and Research Institute, Kanchipuram, Tamil Nadu, India
*Corresponding author: MuthuBabu. K ; Email: muthubabu67@gmail.com
ABSTRACT
Introduction: Sub acute and chronic maxillary sinusitis is commonly encountered in day to day ENT practice.
Here we compare the management options available in the treatment of these two conditions. Methodology:
Endoscopic sinus surgery and antral wash out are two well known and authentic procedures used in the
management of maxillary sinusitis. Here we evaluate the effectiveness and advantages of both the procedures in
the management of sub acute and chronic maxillary sinusitis. 40 patients were evaluated. 20 patients underwent
antral lavage and the remaining 20 underwent Endoscopic sinus surgery. Equal number of patients with sub acute
and chronic maxillary sinusits underwent both the procedures. Result: Evaluation was done based on the
symptoms, anterior rhinoscopy finding and radiological finding. Conclusion: Endoscopic sinus surgery is an ideal
management tool for chronic maxillary sinusitis. But sub acute maxillary sinusits can be treated as a day care
procedure by antral washout.
Keywords: Antral wash out, Endoscopic sinus surgery, Maxillary sinusitis.
INTRODUCTION
Sinusitis is classified as acute sinusitis 7days to 4
weeks duration, sub acute sinusitis 4 weeks to 12
weeks duration and chronic sinusitis more than 12
weeks duration, acute exacerbation of chronic
maxillary sinusitis and recurrent sinusitis more than
4 episodes per year [1]. Here we limit our study to sub
acute and chronic maxillary sinusitis. The differential
diagnosis is based upon the duration of symptoms and
sinus endoscpic finding [2]. We compare the
effectiveness of two authentic procedures, antral
washout and endoscopic sinus surgery. Sub acute
maxillary sinusitis usually clears up by repeated sinus
washout [3].
MATERIAL AND METHODS
Patients from the outpatient and inpatient Department
of ENT and head and neck surgery, Meenakshi
Medical College and Research Institute were taken up
302
Muthu Babu et al.,
Disease
Percentage of
patients improved
following antral
wash
Chronic
maxillary
sinusitis
Subacute
maxillary
sinusitis
Percentage of
patients improved
following endoscopic
sinus surgery
20%
90%
90%
90%
RESULTS
9 out of 10 patients who underwent antral wash out
for sub acute maxillary sinusitis were relieved of the
symptoms that they complained off. Anterior
rhinoscopy and nasal endoscopic evaluation also
improved
10
No. of patients
8
6
Subacute
Chronic
2
0
Antral wash
FESS
303
Muthu Babu et al.,
304
Muthu Babu et al.,
DOI: 10.5958/2319-5886.2015.00057.0
www.ijmrhs.com
Volume 4 Issue 2
nd
Received: 22 Dec 2014
Research article
Coden: IJMRHS
Revised: 5th Jan 2015
Copyright @2014
ISSN: 2319-5886
Accepted: 1stMar 2015
Associate Professor, 2Professor and Head, 3Assistant Professor, Department of Pharmacology, Dhanalakshmi
Srinivasan Medical College and Hospital, Siruvachur, Perambalur, Tamil Nadu
4
Assistant Professor, Department of Community Medicine, Dhanalakshmi Srinivasan Medical College and
Hospital, Siruvachur, Perambalur, Tamil Nadu
*Corresponding author email: skvmanju9208@yahoo.co.in
ABSTRACT
Background: India is the third largest producer and exporter of medicines to most of the countries. The World
Medicine Situation Report 2011 states that 65% persons in India do not have access to essential medicines. While,
huge unethical prescribing ofdrugs for monetary gains has been a second major cause of rural indebtedness. Aims
and Objectives: The primary objective of the study was to compare the Knowledge, Attitude and Practices of
Essential Medicines among Medical Practitioners of a Medical College and Private Medical General Practitioners
of an urban place, e.g. Perambalur District of South India. Materials and Methods: After ethical approval, the
study was started, in Dhanalakshmi Srinivasan Medical College and Hospital (DSMCH), Siruvachur-621113,
Perambalur, Tamil Nadu. It was a questionnaire based study. The faculties of the DSMCH and Medical Private
Practitioner of Perambalur district included as participants in the study. We distributed knowledge, attitude and
practice (KAP) based 15multiple choice questions on National Essential Medicine List, 2011 (NEML) to each
healthcare professionals (HCPs) to attempt within 15 minutes. Results: Overall, Knowledge, attitude and
practices regarding NEML 2011 were 57.06%, 38.36%; 51.16%, 51.82%; 21.73%, 28.7% to HCP from DSMCH
and HCP from Perambalur district, respectively. Whereas, 42.2 % HCPs from DSMCH and 44.7 % HCPs from
Perambalur district were prescribed branded and generic drugs both. Conclusion: The results data shows that
regular awareness programmes should be conducted to update knowledge, change attitude and practices regarding
essential medicines to serve the society as best as possible.
Key words: Essential Medicine List (EML), National Essential Medicine List (NEML), Knowledge, Attitude,
Practice, (KAP), Essential medicine.
INTRODUCTION
Access to essential medicines is a fundamental
human right. India is the third largest producer and
exporters of medicines to most of the
countries.[1]Whereas, huge unethical prescribing of
unnecessary drugs for monetary gains by health
service providers has been a second major cause of
rural indebtedness.[1] While, the World Medicine
Situation Report 2011 states that 65% persons in
Surendra et al.,
RESULTS
We formed two groups, 61 healthcare professionals
from DSMCH in group A (A_DSMCH_HCP) and
in group B (B_Perambalur_GP) 61 general
practitioners from Perambalur District. The
demography of the participated HCPs were the 11professor,
4-associate
professor,
22-assistant
professor, 4-senior resident (SR), 9-junior resident
(JR), 1-casualty medical officer (CMO), 7-pharmacist
and 3-dentist were participated in group A, out of
61 HCPs. While all 61 HCPs of group B were
General practitioners from various medical subjects.
Average age of the included HCPs was 39 years
and45 male, 16 female HCPs were from DSMCH,
while 49 male, 12 female HCPs were from
Perambalur District. We analyzed knowledge,
Attitude and Practices (KAP) about essential
medicines of 61 HCPs of A_DSMCH_HCP and 61
HCP of B_Perambalur_GP; Perambalur District.
Obtained responses data shown in table1, 2 and 3
respectively. Statistics: We used Epi. Info free
available online/offline software to calculate the
obtained responses in percent and applied Chi- square
test and calculated p-value of each questions
response.
Knowledge on National Essential Medicine & its
List2011: Overall, 57.06% HCP from DSMCH and
38.36% HCP from Perambalur district were aware
about EML 2011, while 21.98%, 28.86% HCP were
do not know about EML2011 from DSMCH and
Perambalur district respectively and even 20.98%,
32.82% HCP from DSMCH and Perambalur district
were not sure about knowledge of EML2011
respectively(Table 1).
Attitude about HCP for National Essential
Medicine & its List2011: Overall, 51.16% HCPs
from DSMCH attitude were strongly agree or
strongly like to attend/refer NEML2011, while;
51.82% HCPs from Perambalur district attitude was
strongly agree or strongly like to attend/refer
NEML2011. One side, 44.94% HCPs from DSMCH
were like to refer NEML, whereas 40.62% HCPs
from Perambalur district were like to refer
NEML(See details on Table 2).
Practices about National Essential Medicine & its
List2011 for HCPs:8.2 % HCPs from DSMCH
always prescribed generic drugs, whereas, 14.8%
306
Surendra et al.,
A-DSMCH_HCP
Dont
Not
Know
Sure
B-Perambalur_HCP
Know
Dont
Not Sure
Know
Q.1
39
(63.9%)
7
(11.5%)
15
(24.6%)
34
(55.7%)
30
(49.2%)
40
(65.6%)
20
(32.8%)
8
(13.1%)
11
(18%)
13
(21.3%)
6
(9.8%)
26
(42.6%)
46
(75.4%)
10
(16.4%)
5
(8.2%)
19
(31.2%)
22
(36.1%)
57.06%
21.98%
27 (44.3%)
Chisquared
PValue
10.8
0.005
38
17
(62.3%) (27.9%)
18
17(27.9%)
(29.5%)
22.9
7.3
0.03
32
(52.5%)
12
(19.7%)
17
(27.9%)
9.2
0.01
20
(32.8%)
19
(31.2%)
20
(32.8%)
22
(36.1%)
0.2
0.9
20.98%
38.36%
28.86%
32.82%
Abbreviations: *NLEM= National list of Essential Medicine, MOHFW= Ministry of Health and Family Welfare.
Table 2: Attitude Based Questions and obtained responses of both groups A and BHCPs
Attitude Based Questions
Q.6
Q.7
Q.8
A-DSMCH_HCP
Q.9
Q.10
B-Perambalur_GP
Dislike to
refer
0
Strongly
like to refer
17 (27.9%)
Like to
refer
Dislike to
refer
41(67.2%) 3(4.9%)
Dislike to
read/
attend
Strongly
like to read/
attend
Like to
read/
Attend
Dislike to
read/
attend
42
(68.9%)
1
(1.6%)
37
(60.7%)
19
(31.1%)
5
(8.2%)
Strongly
agree
Agree
Disagree
Strongly
agree
Agree
Disagree
40(65.6%)
18(29%)
3(4.9%)
37(60.7%)
19(31%)
5(8.2%)
Strongly
agree
Agree
Disagree
Strongly
agree
Agree
Disagree
18
(29.5%)
35(57.4%) 19(31%)
Strongly
Like
like
44
16
(72.1%)
(26.2%)
51.16%
44.94%
7(11.5%)
Dislike
1
(1.6%)
3.9%
25(40.9%) 29(47%)
Strongly
Like
like
42
16
(68.9%)
(26.2%)
51.82%
40.62%
7(11.5%)
Chisquared
3.1
17.9
0.6
PValue
0.2
0.000
0.7
3.8
0.2
1.05
0.6
Dislike
3
(4.9%)
7.54%
307
Surendra et al.,
Table3: Practice Based Questions and obtained responses of both groups A and BHCPs
Practice Based
Questions
Q.11. Have you
presented / not
presented numbers
of articles / posters on
Essential Medicine in last
three years?
Q 12. I prescribe/
dont
prescribe Generic /
branded /
both drugs.
Q 13. I always /
frequently / occasionally
prescribe /
dont prescribe essential
drugs.
Q 14. I prescribe/ dont
prescribe New drugs /
Old drugs /
both drugs.
Q15. I prescribe/ dont
prescribe
Zinc supplements
always / frequently
occasionally
to acute diarrhoeal
children.
Practice about EML2011
(Total percentage)
A-DSMCH_HCP
B-Perambalur_GP
Presented
Not Presented
Presented
Not Presented
1
(1.6%)
60
(98.4%)
61
(100%)
Branded
drugs
9
(14.8%)
Always
26
(42.6%)
new drugs
6
(9.8%)
Generic
drugs
Both (Branded
& Generic
drug)
5
38
(8.2%)
(62.3%)
Frequentl
y
Occasionally
30
(49.2%)
old
drugs
2
(3.3%)
Dont
Both
drugs
Branded
drugs
Generic
drugs
9
(14.8%)
22
(36.1%)
4
(6.6%)
Dont both
drugs
Always
3
(4.9%)
Prescribe
both drugs
43
(70.5%)
2
15
(3.3%)
(24.6%)
Dont both
new drugs
drugs
10
0
(16.4%)
Dont
Occasionally prescribe
Always
prescribe
Both
prescribe
drugs
Both (Branded
& Generic
drugs)
1
(1.6%)
Frequently
Prescribe
Occasionally
prescribe
Dont both
drugs
29
(47.5%)
9
(14.8%)
old drugs
both drugs
8
(13.1%)
Dont both
drugs
61
(100%)
Frequently
Prescribe
Occasionally
prescribe
Dont
prescribe
Both
drugs
5
(8.2%)
Freque
ntly
12
(19.7%)
14
(22.9%)
19
(31.2%)
16
(26.2%)
33
(54.1%)
18
(29.5%)
5
(8.2%)
21.73 %
20.9 %
42.2%
15.2%
28.7 %
20.9 %
44.7%
PValu
12.2
0.007
9.6
0.02
21.1
0.0001
24.2
Dont
both drugs
34
(55.7%)
Always
DISCUSSION
Chisqua
red
5.7%
Surendra et al.,
Surendra et al.,
2.
3.
4.
5.
6.
7.
8.
310
Surendra et al.,
DOI: 10.5958/2319-5886.2015.00058.2
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
rd
Revised: 23 Jan 2015
Accepted: 7th Feb 2015
MD Student, 2Professor, 3Assistant Professor, 4PhD student, Department of Microbiology, Santosh Medical
College, Ghaziabad, U.P, India
*Corresponding author email: dakshinabisht@hotmail.com
ABSTRACT
Introduction: Acinetobacter baumannii is one of the major pathogens causing nosocomial infections due to
emergence of resistance to various antimicrobial agents. Resistance due to antimicrobial degrading enzymes is
now a worldwide problem and a major reason of concern for the treating physicians. Keeping this in mind, the
present study was designed to isolate Acinetobacter baumannii and study various antimicrobial resistance
mechanisms in them. Materials and methods: A total of 50 A.baumannii isolates from various clinical samples
were screened for meropenem resistance for the detection of Carbapenemase and MBL production.
Carbapenemase production was confirmed by Modified Hodge Test whereas MBL by Disk Potentiation Test.
Cefoxitin resistance was used as a screening test for AmpC beta-lactamase production which was confirmed by
AmpC disk test. Results: Maximum isolation of A.baumannii was found in patients admitted in the Intensive care
unit with respiratory tract infection. Among the 50 A.baumannii strains, Carbapenemase production was observed
in 26.4%, MBL production in 52.9% and AmpC beta lactamase production in 56%. Conclusion: Our study
emphasizes on multi-drug resistant A.baumannii highlighting the antibiotic crisis as a result of emergence of
various bacteria that show resistance to various antibiotics. Acinetobacter epitomises this trend, as it is an
important nosocomial pathogen with a capability of cross-infection particularly in ICUs and a grave limitation of
treatment options, thus, requiring an urgent need to control the spread of MDR strains in the hospitals.
Keywords: Acinetobacter, Modified Hodge Test, Metallo-beta-lactamse, AmpC beta-lactamse
INTRODUCTION
For many years, Acinetobacter species were
considered to be saprophytic in the environment,
found as a major constituent of the flora of soil, water
and sewage and within the hospital environment.
However, due to a number of agents as well as host
factors, they have now emerged as important
nosocomial pathogens predominantly in ICU settings
most commonly affecting immuno-compromised
patients, although they have also been isolated as the
etiological agent of pneumonia in healthy individuals
[1].
Multi drug resistance in A.baumannii is not a new
phenomenon. They are known to be intrinsically
Richa et al.,
Richa et al.,
100%
80%
60%
40%
20%
0%
ANTIBIOTICS
Cefepime
Cefpodoxime
RESULTS
Ofloxacin
Imipenem
Meropenem
Gentamycin
Erythromycin
Piperacillin/tazob
Doxycycline
Colistin
Trimethoprim-
Tigecycline
Cefoxitin
RESISTANT
INTERMEDIATE
SENSITIVE
Table 1: Modified Hodge Test, Disc Potentiation Test and AmpC Disc Test
MBL
CARBAPENEMASE
AMPC
Screen Test
(Meropenem
resistance)
Confirmatory
Test (EDTA- disk
potentiating test)
Screen Test
(Cefoxitin
resistance)
Confirmatory Test
(AmpC disk test)
34 (68%)
16 (47.05%)
34 (68%)
50 (100%)
28 (56%)
9 (26.4%)
56%
26%
RESISTANCE MECHANISMS
Richa et al.,
Richa et al.,
16.
17.
18.
19.
20.
21.
22.
316
Richa et al.,
DOI: 10.5958/2319-5886.2015.00059.4
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 27 Jan 2015
Accepted: 10th Feb 2015
*Animesh Gupta1, Divya C V1, Diwakar K Singh1, Krutarth B2, Maria N2, Srinivas R1
1
Postgraduate, 2Assistant Professor, Department of Community Medicine, A J Institute of Medical Sciences &
Research Centre, Mangalore, Karnataka, India
*Corresponding author email: animesh245@gmail.com
ABSTRACT
Background: Health Care-Associated Infections (HCAI) affect millions of people each year and raise a great risk
for patients in health care settings, leading to high rates of morbidity and mortality. Objective: To estimate the
prevalence of HCAI and to explore the association between certain socio-demographic factors, invasive
procedures and mean duration of hospital stay with HCAI in a tertiary-care hospital. Materials and Methods:
Data was obtained from the patients who were admitted for more than 48 hours in the general wards and their
records in tertiary-care hospital for duration of 3 months (February 2014 to April 2014). Results: Among 290
patients, the prevalence of HCAI was estimated to be 11.7%. The prevalence of HCAI was proportionately less
among men (10.2%) than in women (14.2%), was more (15.6%) among patients who underwent invasive
procedures after admission and with mean duration of hospital stay of 12.47 days. Conclusion: Health CareAssociated Infections (HCAIs) were found to be significantly associated with increased duration of hospital stay
and invasive procedures done after admission. Prevalence was higher in patients aged more than 40 years.
Keywords: Health Care-Associated Infection, Prevalence
INTRODUCTION
Health Care-Associated Infections (HCAI) are the
infections acquired during hospital care which are not
present or incubating at admission. Infections
occurring more than 48 hours after admission are
usually considered hospital associated. [1]
HCAIs are an important public health problem in
developing as well as in developed countries.
Hospital-wide prevalence of HCAI in low- and
middle-income countries varied from 5.7% to 19.1%
with a pooled prevalence of 10.1% and even as high
as 15.5% in high quality studies.[2] Over 1.4 million
people worldwide suffer from HCAI at any given
time.1 The risk is 2 to 20 times higher in developing
than in developed countries.2
Animesh et al.,
Animesh et al.,
n=177
159 (89.8%)
100
n=113
97 (85.8%)
50
0
18(10.2%)
MALE
HAI
16 (14.2%)
FEMALE
NO INFECTION
Animesh et al.,
Animesh et al.,
9.
10.
11.
12.
Animesh et al.,
321
Int J Med Res Health Sci. 2015;4(2):317-321
DOI: 10.5958/2319-5886.2015.00060.0
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 20 Jan 2014
Accepted: 9th Feb 2015
Department of Microbiology, Tagore Medical College & Hospital, Chennai, Tamil Nadu, India
Department of Microbiology, Sri Manakula Vinayagar Medical College & Hospital, Puducherry, India
Jeyakumari et al.,
Jeyakumari et al.,
41-50 years
25
Antibody
type
No and % of
positive
samples
Dilution
(1 in 20)
Dilution
(1 in 40)
Dilution
(1 in 80)
Dilution
(1 in 160)
Dilution
(1 in 320)
S. typhi
Anti- TO
143 (28.7)
30 (6)
93 (18.7)
18 (3.6)
2 (0.4)
NIL
S. typhi
Anti-TH
157 (31.5)
18 (3.6)
120 (24.1) 15 (3.0)
3 (0.6)
1 (0.2)
S. paratyphi A
Anti-AH
14 (2.8)
7 (1.4)
6 (1.2)
NIL
NIL
NIL
S. paratyphi B
Anti-BH
11 (2.2)
7 (1.4)
4 (0.8)
NIL
NIL
NIL
The one sample T test showed that the observed value is different from the present recommended value and it is
statistically significant (P value < 0.01). (Table 3)
Table: 3. one sample T test
Name of the
agglutinins
Salmonella Oab
Salmonella Hab
Salmonella AHab
Salmonella BHab
Mean
Std. Deviation
Sig - ( 2 tailed)
P value
500
500
500
500
11.66
12.72
.76
.60
22.300
20.722
4.926
4.252
< 0.01
< 0.01
< 0.01
< 0.01
DISCUSSION
Bacterial culture remains the gold standard for
definitive diagnosis of enteric fever but lack of the
facility and cost limits its use in the developing
countries. [2] The widal test which detects
agglutinating antibodies to Salmonella enterica
Jeyakumari et al.,
Jeyakumari et al.,
ACKNOWLEDGEMENT
We would like to acknowledge and thank the Indian
council of Medical Research for sanctioning this
project (ICMR STS project 2012) to MS. Jaberlin
Sneha JA.
10.
11.
12.
13.
14.
15.
16.
17.
18.
326
Jeyakumari et al.,
DOI: 10.5958/2319-5886.2015.00061.2
ISSN: 2319-5886
Accepted: 12th Feb 2015
Part used
Extracted
i.e. Alcohol/ aqua
Dose
used
for
antifungal activity
Azadirachta indica
Piper betle
Ocimum tenuiflorum
Murraya koenigii
Hibiscus rosasinensis
Aloe vera
Coriandrum sativum
Mentha asiatica
Phyllanthus emblica
Citrus limon
Sapindus mukorossi
Alpinia galangal
Lawsonia inermis
Hibiscus rosasinensis
Neem
Betel leaf
Tulsi
Curry leaf
Hibiscus flowers
Aloevera
Coriander
Mint
Amla
Lemon
Soapnut
Dumparashtram
Henna
Hibiscus leaves
Leaf
Leaf
Leaf
Leaf
Flower
Leaf
Leaf
Leaf
Fruit
Fruit
Fruit
Root
Leaf
Leaf
Water
Water
Water
Water
Water
Water
Water
Water
Water
Water
Water
Water
Water
Water
1:10
1:5
1:5
1:5
1:5
1:20
1:5
1:5
1:20
1:20
1:20
1:5
1:10
1:5
328
10
Dove
Zone of
inhibition (1:40)
Nizoral
Vivel
Zone of
inhibition (1:20)
Pantene
Head
Inhibition zones in cm
RESULTS
Clear
Shampoo
331
Naga Padma et al.,
DOI: 10.5958/2319-5886.2015.00062.4
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 27 Jan 2015
Accepted: 22nd Feb 2015
Variable
15
99
73
13.6
90
66.36
65
13
16
15
59.0
11.8
14.5
13.6
104
108
20
52
94.5
98.1
18.1
47.2
27
49
00
24.5
44.5
0
84
76.3
60
64.5
aware
other
than
Condom
OCP
Injectable method
Permanent methods
Utilisation of other methods in
past*
OC Pills
Barrier method
Others
Counselling provided before
IUD insertion
Pelvic examination done before
IUD insertion
Mean duration of IUD use
36.95
months
18.89
*multiple answers
334
Priyanka et al.,
Total
N = 110
103
93.64
83
75.45
Duration of effectiveness of
IUCD
Side effects of IUCD (at least 2)
85
77.27
76
69.09
68
61.82
64
58.18
55
52
50.00
47.27
25
10
22.73
9.09
*multiple responses
Adverse events*
Encountered
by participants
Abdominal
pain/cramp
after insertion
Leucorrhea
Dysmenorrhea
Bleeding pattern changes
during MC
Expulsion
Fever with infection
No side effect
43
39.09
28
24
16
25.54
21.81
14.54
09
03
19
8.18
2.72
17.2
Yes
N=110*
51
44
36
28
28
24
25.54
25.54
21.81
46.36
40
32.72
88
80
60
55
36
33
54.5
50
32.7
30
31
23
17
17
15
13
05
07
03
28.1
20.9
15.4
15.4
13.6
11.8
4.5
6.3
2.7
*multiple responses
336
Priyanka et al.,
7.
8.
9.
10.
2.
3.
4.
5.
6.
11.
12.
13.
14.
15.
16.
Priyanka et al.,
338
Priyanka et al.,
DOI: 10.5958/2319-5886.2015.00063.6
AND
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 27 Jan 2015
Accepted: 20th Feb 2015
ANTIMICROBIAL
RESISTANCE
PATTERN AMONG
*DardiCharanKaurG1, MaralSanjivani.S2
1
Department of Microbiology, Maharashtra Institute of Medical Education & Research (MIMER), Talegaon
Dabhade, Pune, Maharashtra, India
2
Assistant Professor Symbiosis Institute of Health Sciences, Pune Maharashtra, India
*Corresponding author email: charan13@rediffmail.com
ABSTRACT
Background: Bacterial biofilms play an important role in urinary tract infections and is responsible for
persistence infections and also the higher antimicrobial resistance is seen in biofilm forming uropathogen as
compared to free floating bacteria. So the present study was undertaken with the aim to know the prevalence of
biofilm formation and antimicrobial resistant pattern of biofilm producer and non-biofilm producing
uropathogens. Materials & Methods: A total of 146 Gram negative bacilli and 62 S. aureus isolated from
patients suspected UTIs were tested for biofilm formation and antimicrobial susceptibility testing by Kirby-Bauer
disc diffusion method on Mueller Hinton agar as per CLSI guidelines. Result: Out of 208 isolates from urine,
Biofilm formation was noted in 122(58.66%) and no biofilm formation in 86(41.35%).[Strong Biofilm formation
in 76(36.54%) and weak biofilm formation in 46(22.12%).In our study, we noted biofilm and non-biofilm
forming microorganism showed mark difference in antimicrobial resistance pattern. In Staphylococcus aureus
striking difference was noted to ciprofloxacin (100% versus 33.33%) and azithromycin (96%versus 41.67%).
Isolates showed no resistance to linezolid. Whereas isolates of Pseudomonas aeruginosa to netilin (100% versus
42.86%).And in other Gram negative bacilli difference was noted to gentamicin (87.93% versus 13.43%) and
norfloxacin (84.48% versus 37.31%) Conclusion: Biofilm forming isolates showed higher antimicrobial
resistance as compared to non-biofilm producer. Thus, Uropathogen should be routinely screened for biofilm
formation.
Keywords: Uropathogen, Biofilm formation, Antimicrobial resistance pattern
INTRODUCTION
Urinary tract infections (UTIs) are the important
causes of morbidity affecting 150 million people
globally each year and also continue to be the most
common causes of infections in hospitalized
patients. [1, 2] It is the most common bacterial
infections in humans both in the community and
hospital settings, and in all age groups, and usually
requires urgent treatment. Malnutrition, poor hygiene,
low socio-economic status is associated with urinary
Charan et al.,
No of
Samples
E .coli
93
Staphylococcus
aureus
Pseudomonas
sps
62
21
Strong
Biofilm
formation
Weak
Biofilm
formation
Negative
Biofilm
formation
27(29.03)
16(17.20)
50(53.76)
32(51.61)
18(29.03)
12(19.35)
8(38.09)
6(28.57)
7(33.33)
Klebsiellasps
13
5(38.46)
3(23.07)
5(38.46)
Citrobactersps
13
4(30.77
3(23.07)
6(4615)
Proteus sps
Morganellamor
ganii
Serratiamarcesc
ens
Total
1
1
208
76(36.54%)
46(22.12%)
86(41.35%)
340
Charan et al.,
100
80
60
40
20
0
Sparfloxa
linezolid
Gentamy
Cotrimox
Ciproflox
Cefuroxi
Cefotaxi
Calithro
Cefopera
Ampiclox
Amikacin
120
100
80
60
40
20
0
Azithrom
Tobram
Ticarcillin
Piperaci
Netilin
Merope
Levoflo
Gentam
Ciprofl
Ceftazi
Cefoper
Cefepime
Biofilm formation(N=14)%
Non-Biofilm formation (N=7) %
Amikacin
120
100
80
60
40
20
0
Charan et al.,
Charan et al.,
4. http://www.infectioncontroltoday.com/news/2013
/10/women-most-often-suffer-utis-but-men-morelikely-to-be-hospitalized.aspx
5. P. Tenke, B. Kovacs, M. Jckel, and E. Nagy,
The role of biofilm infection in urology, World
Journal of Urology. 2006; 24(1):1320.
6. H.-C. Flemming and J. Wingender, The biofilm
matrix, Nature Reviews Microbiology. 2010;
8(9):62333.
7. Stewart, P.S. Mechanisms of antibiotic resistance
in bacterial biofilms. Ind. J. Med. Microbiol.
2002; 29: 107-13.
8. Forbes BA. Sahm DF, Weissfeld AS. Bailey and
Scott's Diagnostic microbiology. 12th edition,
chapter 57. Infection of the urinary tract. Mosby
Elsevier; 2007:842-55
9. Gordon D. Christensen,W. Andrew Simpson,
Alan L. Bisno, And Edwin H.
Beachey.
Adherence of Slime- Producing Strains of
Staphylococcus epidermidis to Smooth Surfaces.
Infection and Immunity, July 1982; Vol.
37(1):318-26.
10. Clinical and Laboratory Standard Institute.
Performance standards for antimicrobial disc
susceptibility tests, twentieth supplement.2012;
32(3):100-21.
11. U. Rmling and C. Balsalobre, Biofilm
infections, their resilience to therapy and
innovative treatment strategies, Journal of
Internal Medicine. 2012; 272(6):54161.
12. Sara M. Soto. Importance of Biofilms in Urinary
Tract Infections: New Therapeutic Approaches.
Advances in Biology. 2014; 13 http:/ dx.doi. org/
10.1155/2014/543974
13. G. Lucchetti, A. J. Silva, S. M. Y. Ueda, M. C. D.
Perez and L. M. J. Mimica, Infeces Do
TratoUrinrio: An- lise da Freqncia e Do
Perfil de Sensibilidade Dos AgentesCausadores
de Infeces Do TratoUrinrioEmPacientes Com
CateterizaoVesicalCrnica, Journal Brasileiro
de Patologia e Medicina Laboratorial. , 2005;
41(6) 383-89.
14. Syed M A, Ramakrishna P J, shaniyakoyakutty,
Arya B, ShakirVPA. Urinary Tract Infections
An overview on the Prevalence and the Antibiogram of Gram Negative Uropathogens in a
Tertiary Care Centre in North Kerala, India.
Journal of Clinical and Diagnostic Research.
2012; 6(7): 1192-95.
343
Charan et al.,
344
Charan et al.,
DOI: 10.5958/2319-5886.2015.00064.8
Copyright @2015
ISSN: 2319-5886
Accepted: 17th Feb 2015
HEPATITIS B VIRUS (HBV) AND SYPHILIS CO-INFECTIONS AMONG THE PEOPLE OF EKITI,
SOUTH-WEST, NIGERIA
*Akinbolaji Thompson J1, Odeyemi Festus A2, Adegeye Festus O3, Ojo Olalekan I4, Akinseye Funmilayo J5.
1
Haematology and Blood Transfusion Unit, Ekiti State University Hospital, Ado-Ekiti, Ekiti State, Nigeria
Kidney Clinics Nigeria, Kemta Housing Estate, Idi-Aba, Abeokuta, Ogun State, Nigeria
3
Clina-Lancet Laboratory 3, Jose Babatunde Ademola Adetokunbo Area, Victoria Island, Lagos
4
Primary Health Centre, Saki East Local Gvt, Oyo State
5
Medical Laboratory Services, State Specialist Hospital, Akure, Ondo State, Nigeria
2
Akinbolaji et al.,
Out of the One Thousand Six Hundred and ThirtyNine subjects screened for the presence of antibodies
to HBV and T. pallidum (syphilis), One Hundred and
One were positive to HBV giving rise to 6.16%,
Fifteen positive to syphilis infection amounting to
0.92% while only Five of the subjects were coinfected with both HBV and syphilis infections which
is 0.31%. the highest prevalence to HBV, syphilis and
co-infections were found in the age group 31-40 years
followed by 21-30 years as shown in the (table 1)
below
Table 1: Sero-prevalence of HBV and syphilis co-infection in different age groups among Ekiti people
HBV
Syphilis
Co-infection(HBV/syph)
Age-Groups
(years)
No. Exam.
No. Pos. %Pos.
No. Pos. %Pos.
No. Pos.
% Pos
10
53
11-20
154
06
3.90
01
0.65
21-30
709
44
6.21
05
0.71
02
0.28
31-40
410
40
9.75
08
1.95
03
0.73
41-50
178
09
5.06
01
0.56
51
135
02
1.48
Total
1639
101
6.16
15
0.92
05
0.31
346
Akinbolaji et al.,
774
865
1639
49
52
101
6.33
6.01
6.16
DISCUSSION
Hepatitis B virus (HBV) is important and has several
implications among the blood-borne viruses
transmissible through the parenteral route, by blood
transfusion, as well as by sexual intercourse. It does
not only establish asymptomatic persistent infection
but also cause significant morbidity and mortality
when transmitted through transfusion of blood and
blood products [10]. Prevalence of HBV has been
reported to vary between 2% in developed countries
where the prevalence is low to about 8% in
developing countries where infection is endemic with
sex, age and socioeconomic status as important risk
factors for infection [11, 12, 13]. In 2006, Centers for
Disease Control and Prevention (CDC) reported more
than 36,000 cases of syphilis in the United States, and
the rate of syphilis among homosexual men has been
rising consistently since 2000 [14].
The results of this study showed a higher prevalence
of hepatitis B infection (6.16%) than that of syphilis
infection (0.92%). The higher prevalence of hepatitis
B infection than syphilis infection in this study
correlates with reports of [15, 16, 17, 18] who all reported
the prevalence of hepatitis B infection to be higher
than that of syphilis infection in their various
researches, but it is against the reports of [19] who
reported higher prevalence for syphilis than hepatitis
B infection.
The prevalence of hepatitis B infection (6.16%) in
this study is a little higher than the reports of [18, 20, 21,
22]
who reported prevalence of hepatitis B infection to
be 4.7%, 5.9%, 5.3% and 4.9% respectively, and
much higher than the reports of [19, 23] who reported
09
06
15
1.16
0.69
0.92
02
03
05
0.26
0.35
0.31
Akinbolaji et al.,
2.
3.
4.
5.
6.
7.
8.
9.
11.
12.
13.
14.
15.
16.
17.
18.
Akinbolaji et al.,
19.
20.
21.
22.
23.
24.
25.
26.
27.
Hussain
T,
Kulshreshtha
KK, Shikha
Sinha, Yadav VS, Katoch VM. HIV, HBV,
HCV, and syphilis co-infections among
patients attending the STD clinics of district
hospitals in Northern India. International
Journal of Infectious Diseases. 2006; 10(5):
35863.
Afolabi AY, Abraham A, Oladipo EK,
Adefolarin AO and Fagbami AH. Transfusion
Transmissible Viral Infections among potential
Blood donors in Ibadan, Nigeria. Afr. J. Cln.
Exper. Microbiol. 2013; 14(2): 84-87.
Buseri FI, Seiyaboh E, and Jeremiah ZA.
Surveying Infections among Pregnant Women
in the Niger Delta, Nigeria. J Glob Infect Dis.
2010; 2(3): 20311
Landes M, Newell ML, Barlow P, Fiore
S, Malyuta
R, Martinelli
P, Posokhova
S, Savasi V, Semenenko I, Stelmah A, Tibaldi
C,Thorne C. Hepatitis B or hepatitis C
coinfection in HIV-infected pregnant women in
Europe. HIV Med. 2008; 9(7):526-34.
Adeleke MA, Adebimpe WO, SAM-Wobo SO,
Wahab AA, Akinyosoye LS, Adelowo TO.
Sero-prevalence of malaria, hepatitis B and
syphilis among pregnant women in osogbo,
Southwestern Nigeria. J. Infect. Dis. Immun.
2013; 5(2):13-17
Esan AJ, Omisakin CT, Ojo-Bola T, Owoseni
MF, Fasakin KA, Ogunleye AA. SeroPrevalence of Hepatitis B and Hepatitis C
Virue Co-Infection among Pregnant Women in
Nigeria. American Journal of Biomedical
Research.2014; 2(1): 11-15.
David OM, Oluduro AO, Ariyo AB, Ayeni D
and Famurewa O. Sero-epidemiological survey
of hepatitis B surface antigenaemia in children
and adolescents in Ekiti State, Nigeria. J.
Public Health Epidemiol. 2013; 5(1), 11-14.
Omisakin CT, Esan AJ, Fasakin KA, Owoseni
MF, Ojo-Bola O, Aina OO and Omoniyi DP.
Syphilis and Human Immunodeficiency Virus
Co-infection among Pregnant Women in
Nigeria: Prevalence and Trend. International
STD Research & Reviews. 2014; 2(2): 94-100.
Volf V, Marx D, Pliscova L, Sumega L, Celko
A. A survey of Hepatitis B and C prevalence
among the homeless community of Parague.
Eur. J. Pub. Health 2008; 18: 44-47.
28.
349
Akinbolaji et al.,
DOI: 10.5958/2319-5886.2015.00065.X
Coden: IJMRHS
Revised: 6th Feb 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 12th Feb 2015
Department of Pathology, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, India
Dermatology, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, India
3
Internal Medicine, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun, India
2
Nadia et al.,
Nadia et al.,
Borderline
Tuberculoid
(BT):
Epithelioid
granulomas with peripheral lymphocytes and
Langhans giant cells. Clear subepidermal zone, nerve
infiltration present. AFB may or may not be seen.
Borderline(BB): Epithelioid granulomas with
diffusely spread lymphocytes, presence of
subepidermal clear zone. AFB usually seen.
Borderline Leprosy (BL): Loose granulomas
composed of histiocytic cells with dense lymphocytic
infiltrate. AFB usually seen but large globi are not
present.
Lepromatous Leprosy (LL): Histiocytes and foam
cells are abundant. Lymphocytes are scanty, if
present they are diffusely spread. Nerves are without
cellular infiltrate or cuffing. Grenz zone is present.
AFB are numerous.
Indeterminate (I): Lymphocytes and histiocytes are
localized around skin structures. AFB are very
scanty.
Histoid Leprosy (HLL): Nodular form of leprosy.
Microscopy shows circumscribed histoid lepromas
characterized by predominance of histiocytes. AFB is
numerous.
All the biopsies were fixed in 10% formalin. Serial
sections of 5 thickness were cut and stained with
Haematoxylin and Eosin (H&E) along with Fite
Faraco to demonstrate Acid Fast Bacilli.
Histopathology findings described in detail epidermal
atrophy, subepidermal clear zone, distribution and
nature of epithelioid granulomas, density of
lymphocytes and nerve involvement along with
presence of acid fast bacilli.
RESULTS
A total of 118 cases of leprosy were studied over a
duration of 4 years (July 2010- July2014). There were
76 males and 42 females. The age of the patients
ranged from 8 years to 72 years. Majority of cases
(n=52, 44%) were in the 31-40 year age group
followed by 23.7 % in the 21-30 year age bracket.
The most common presenting complain was hypopigmented patch with loss of sensations (n=67,
56.7%) followed by erythematous macules
(n=27,22.8%), nodules (n=14,11.8%) and thickened
nerves (n=11,9.3%). (Figures 1,2). All the skin
biopsies were taken from the edge of the lesion.
Nerve biopsy was not performed in any case.
351
Int J Med Res Health Sci. 2015;4(2):350-354
TT
BT
BB
BL
LL
IL
Histoid
Nadia et al.,
11
55
06
16
24
01
05
8
3
6
-
BT BB BL
2
36
2
1
-
9
3
3
3
1
-
2
1
3
1
-
LL
1
4
19
01
IL Histoid Concord
ance
(%)
1
4
-
72.7
65.4
50.0
18.7
79.2
0
80.0
No. of cases
studied
%
correlation
353
Int J Med Res Health Sci. 2015;4(2):350-354
Nadia et al.,
354
Int J Med Res Health Sci. 2015;4(2):350-354
DOI: 10.5958/2319-5886.2015.00066.1
Coden: IJMRHS
Revised: 5thFeb 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 12th Feb 2015
Post graduate student, 2Associate Professor, 3Professor, 4Assistant Professor, Department of Ophthalmology,
Rural Medical College, Loni, Ahmednagar, Maharashtra, India
*Corresponding author email:sagar2986@rediffmail.com
ABSTRACT
Purpose: To study the association between refractive errors and senile cataract in rural area of western
MaharashtraMaterials & Methods: It is a prospective cross sectional study carried out on 420 eyes of 210
patients with senile cataract was included in the study. The age and sex of the patient, grade and the refractive
status of the cataract of the eyes were recorded. The grade of the cataract was recorded by the LOCS III (Lens
Opacities Classification System, version III). Refractive status was measured subjectively using retinoscope and
refractive error for each eye was converted into spherical equivalent units. Results: The age variation in the study
was between 60-85 years.The maximum number of patients was in the age group of 60-65 years.The spherical
equivalent ranged between -3.0 D to +4.25D.45.95% of the study population had a spherical equivalent between 2 to -1.73.81 % of the study population had a myopic refraction.20% had a hypermetropic refraction. Percentage
of patients with a score of nuclear opalescence and colour between 1.0-2.0 was 41.90%, between 2.1-3.0 was
26.67% and above 3.0 was 31.43%.Percentage of patients with a score of cortical cataract between 0.1-1.0 was
69.76% and with a grade between 2.1-3.0 was 26.91 %. Percentage of patients with a score of posterior
subcapsular cataract between 0.1-1.0 was 53.57% and with a grade between 2.1-3.0 was 39.05%. Conclusion:
The myopic refraction was associated with nuclear, cortical and posterior subcapsular cataract and this refractive
error was stastically significant with nuclear, cortical and posterior subcapsular cataract.
Keywords: Cataract, Refraction.
INTRODUCTION
Cataract is defined as opacity within the clear lens
inside the eye that reduces the amount of incoming
light and results in deterioration of vision. Natural
lens is a crystalline substance and a precise structure
of water and protein to create a clear passage for
light.
Cataract is one amongst the major cause blindness in
India accounting for nearly 50-80% of blindness in
both eyes in the country[1]. There are several known
risk factors for cataract formation. These include
individual factors like age, smoking, systemic factors
like diabetes mellitus, environmental factors like
Chaudhari et al.,
RESULTS
Table 1: Age and sex wise distribution of cases
studied
Males
Females
Total
60-65
No. (%)
59(63.44%)
No. (%)
83(70.94%)
No. (%)
142(67.62%)
66-70
19(20.43%)
26(22.22%)
45(21.43%)
250
71-75
13(13.98%)
2(1.71%)
15(7.14%)
200
76-80
6(5.13%)
6(2.86%)
81-85
2(2.15%)
2(0.95%)
Total
93(44.29%)
117(55.71%)
210(100%)
Total no eyes
Percentage
&Opalescence
No.
(%)
12
176
41.90%
2.13.0
112
26.67%
> 3.0
132
31.43%
Total
420
100%
Mean SD
1.74 0.47
225
164
150
No of eyes
Age in
years
100
31
50
0
0.1-1.0
1.1-2.0
2.1-3.0
Posterior subcapsular cataract
Total eyes
Percentage
No.
(%)
0.1-1.0
293
69.76%
1.1-2.0
14
3.33%
2.1-3.0
113
26.91%
Total
420
100
Mean SD
0.940.03
Cortical cataract
Chaudhari et al.,
26
84
310
-0.5 to 0.5
No. of
patients
Nuclear opalescence
1.0 2.0
176
2.1 3.0
112
> 3.0
132
Nuclear colour
1.0 2.0
176
2.1 3.0
112
> 3.0
132
Cortical cataract
0.1 1.0
293
1.1 2.0
2.1 - 3.0
14
113
Mean SD,
Spherical
equivalence
P value
-1.230.05
-1.030.08
-1.420.09
= 16.13,
p<0.05
-1.230.05
-1.030.08
-1.420.09
= 16.13,
p<0.05
-1.340.06
-1.560.09
-1.070.07
= 24.128,
p<0.05
= 26.415,
p<0.05
DISCUSSION
ASSOCIATION BETWEEN CATARACT AND
SPHERICAL EQUIVALENT:
For nuclear cataract:In my study, 193 eyes had
spherical equivalent between -2 to -1 and 92 eyes had
spherical equivalent of -1 to -0.5. The mean spherical
equivalent of -1.230.05D was found in the group
with a score between 1.0-2.0 while the group with a
score of more than 3.0 had-1.420.09D and mean
spherical equivalent of -1.030.08was found in the
group between 2.1 to 3. Myopic refraction being
Chaudhari et al.,
193 eyes had spherical equivalent between -2 to 1and 92 eyes had spherical equivalent to -1 to 0.5. The mean spherical equivalent of -1.560.07
was found in the group with a score of 2.1-3.0
and the mean spherical equivalent of 1.260.01D was found in the group with a score
of 0.1-1.0 and mean spherical equivalent of 1.310.05D was found in the group with the
score of 1.1 to 2. Myopic refraction was
associated with posterior subcapsular cataract in
this study. However there was statically
significant correlation found.
In the study by Kubo et al[7], mean spherical
equivalent of 1.85 5.09D was found in the group
with score 3-5 and the mean spherical equivalent of
0.97 4.39 D was found in the group with a score
1.0-2.0.In the Tanjong Pagar survey [8],posterior
subcapsular cataract correlated with myopic
refraction. Posterior subcapsular cataract was
associated with myopia,deeper anterior chamber,
thinner lens, and longer vitreous chamber.In the
Beaver Dam Eye study[9],no refractive association
was found with posterior subcapsular cataract. In
Singapore Malay study[10]. Myopia (spherical
equivalent less than 0.5D) was associated with
increased prevalence of posterior subcapsular
cataract.In blue mountain eye study, was supported
by the finding of an association between current
myopic refraction and PSC cataract (OR 2.5 ; CI 1.64.1). PSC was inversely associated with hyperopia.
High myopia was associated with PSC.In Tehran eye
study12, PSC shows a significantly higher prevalence
of myopia.
359
Chaudhari et al.,
DOI: 10.5958/2319-5886.2015.00067.3
Coden: IJMRHS
Revised: 10th Jan 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 27th Feb 2015
Registrar, 2Professor and Head, Department of Pulmonary Medicine, 3Professor, Department of Microbiology,
Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai
*Corresponding author email: drvishalgupta1985@gmail.com
ABSTRACT
Latent tuberculosis infection (LTBI) is a non- communicable asymptomatic condition, which might develop into
active tuberculosis. Health care workers in contact with active TB cases are at high risk. Impact of exposure in
high TB endemic population remains to be studied. Objective: To study the prevalence of IGRA positivity in
high risk health care worker and comparing with clinical and radiological data. Methods: From a tertiary care
institute, 40 subjects of which low risk subjects (16), high risk subjects / health care workers (24) were recruited
randomly. TSPOT TB spot counting was done and correlation with the clinical data and radiology was analysed.
Results: Out of 18 positive results, 16 were HCWs (66.67%), 2 were of low risk group (12.5%). Among the
HCWs, doctors had the maximum percentage of the positive results (71.42%). Administration related workers all
had negative results. Correlation was established between different antigens used. 8 subjects with normal chest x
ray also had TSPOT positive result. Conclusion: HCWs especially those proximally exposed are at greater risk
of having positive T SPOT assay. Chest X ray may not be an adequate screening tool. The exact significance and
clinical implication need study even in high endemic population.
Keywords: IGRAS, Interferon-, Health Care workers, Latent Tuberculosis
INTRODUCTION
Latent tuberculosis infection (LTBI) is a noncommunicable asymptomatic condition, which can
develop into active tuberculosis months or years later
[1]
. There are two principle approaches for tests used
in clinical practice to detect latent infection with M.
tuberculosis. These are, the in vivo tuberculin skin
test (TST), which uses a mixture of antigens obtained
as a protein precipitate from the liquid cultures of M.
tuberculosis, and the ex vivo interferon- release
assays (IGRAs), which are designed to identify a
memory of an adaptive immune response against
mycobacterial antigens [2].IGRAS most popularly
available includes the T SPOT TBTM and the
Quantiferon Gold (QFT-GTM). T SPOT-TBTM
measures release of IFN- from sensitized
Gupta et al.,
Pearson
Chi-Square
Continuity
7.88 1
.005
Correction
Likelihood
10.73 1
.001
Ratio
Fisher's
.003 .002
Exact Test
Linear-by9.57 1
.002
Linear
Association
No. of Valid 40
Cases
a. 0 cells (.0%) have expected count less than 5. The
minimum expected count is 6.80.
b. Computed only for a 2x2 table
361
Gupta et al.,
Result of T SPOT TB
Positive
Negative
5 (71.42%) 2 (28.6%)
5 (50%)
5 (50%)
Total
7
10
13
8 (61.53%)
0 (0 %)
0 (0%)
5 (38.47%)
0 (0)%
10 (100%)
18
22
10
40
<6
6 to 10
>10
PANEL B spots
<6
6-10
>10
22
0
0
0
4
0
2
1
11
NEGATIVE RESULT
POSITIVE RESULT
Gupta et al.,
Gupta et al.,
1.
2.
3.
4.
5.
6.
7.
8.
ACKNOWLEDGEMENT
I am extremely grateful to the staff, fellow residents
and administration for their valuable support in the
study. I am also grateful to the ICMR ( Indian
Council Of Medical Research ) and the Diamond
Jubilee Research Trust, KEM Hospital and RNTCP
(DOTS) programme for the support with funding of
this project. Special mention to Dr. Rupali
Suryavanshi ( Asst. Professor, Microbiology ) and Dr.
Jairaj Nair ( Asst. Professor, Pulmonary Medicine )
for their valuable help and technical expertise from
time to time.
9.
12.
REFERENCES
10.
11.
Gupta et al.,
365
Gupta et al.,
DOI: 10.5958/2319-5886.2015.00068.5
Copyright @2015
ISSN: 2319-5886
Accepted: 6th Mar 2015
Associate Professor, 3Prof and Head, Department of Biochemistry, 2Professor, Department of Pharmacology
Rural Medical College, Pravara Institute of Medical Sciences-Deemed University, Loni, Ahmednagar,
Maharashtra, India
*Corresponding author email: preetipadmanabhan@gmail.com
ABSTRACT
Background: Adolescents in India choose career in medicine under the influence and pressure from parents,
family members, peers and external sources. There are no measures taken to study whether these medical students
understand the demands and priorities of a career in medicine once they decide to choose it. Hence the study was
undertaken at PIMS-DU with Ist year MBBS students as participants. Aims: 1) Assess the factors influencing the
choice of MBBS. 2) Analyze the prior knowledge and awareness of medical students regarding the course. 3)
Their career trend in future. Material and Methods: All newly admitted students present at the orientation
programme in September 2014 at PIMS DU were included as participants. Their written responses to a 14 point
questionnaire were entered into a Microsoft Excel Spreadsheet and descriptive analysis was done. Results: A
majority of students had their parents and family members in medical profession indicating prior idea amongst the
students regarding the course, even when the choice was made at an early stage of academics or without
appearing for aptitude tests due to unawareness. Appearance for entrance exams to kept their options wide open
but caused unnecessary stress, anxiety and economic burden to parents. However, these participants had limited
knowledge about medical curriculum but had decisive ideas regarding future trend in career. Conclusions: Family
being strong motivator for career choice for medical students; should encourage students to undertake aptitude
tests, career guidance courses and investigate about future prospects to create a strong foundation as MBBS
students.
Keywords: Career, Medical students, Awareness, Medical curriculum.
INTRODUCTION
The personnels opting for medical profession must
have the right approach, aptitude, attitude, selfless
service motto and ability to work relentlessly for the
patients. Other attributes are ability to overcome
sleep, preparedness for a kaleidoscope of emotions,
service over economics and empathy [1].
To enable the medical students to make the right
choice of professional career, aptitude tests are
developed by trained expert psychologists to prevent
Padmanabhan et al.,
366
Padmanabhan et al.,
60
50
Percentage
40
Boys(%)
Girls (%)
30
51.06
20
31.82
23.4
10
45.45
2.12
23.4
13.64
0
17 yrs
18 yrs
9.09
20 yrs
19 yrs
Age in years
367
12 (27.27)
20 (42.55)
B .Pharm
00 (00.00)
Biotech
03 (6.82)
B.Sc
03 (6.82)
BAMS
02 (4.55)
Engineering
01 (2.27)
Any other
01 (2.27)
Not disclosed
08(18.18)
Awareness that ragging is prohibited
Yes
42 (95.45)
No
02 (4.55)
05 (10.64)
01 (2.13)
00 (0.00)
01 (2.13)
03 (6.82)
02 (4.26)
08 (17.02)
47 (100)
00 (0.00)
Parameter
Boys (%) Girls (%)
Any other member of the family in medical
profession
Mother
11 (25.00) 20 (42.55)
Father
09 (20.45) 07 (14.89)
Maternal uncle
08 (18.18) 11 (23.40)
Paternal uncle
07 (15.90) 03 (6.38)
Grandparents
05 (11.36) 03 (6.38)
Sister
03 (6.82)
03 (6.38)
None
01 (2.27)
00 (0.00)
Profession of family
Nursing
10 (22.73) 23 (48.94)
Hospital
12 (27.27) 08 (17.02)
administration
Pharmaceutical
08 (18.18) 08 (17.02)
Business
08 (18.18) 03 (6.38)
Bank
04 (9.09)
02 (4.26)
Education
01 (2.27)
02 (4.26)
Not disclosed
01 (2.27)
01 (2.13)
Girls (%)
02 (4.25)
41 (87.23)
0 (0.00)
04 (8.51)
0 (0.00)
42 (89.36)
02 (4.25)
03 (6.38)
Girls (%)
43 (91.49)
02 (4.26)
02 (4.26)
07 (14.89)
13 (27.66)
12 (25.53)
02 (4.26)
12 (27.66)
03 (6.38)
02 (4.26)
07 (14.89)
10 (21.28)
13 (27.65)
12 (25.53)
0 (0.00)
04 (8.51)
02 (4.26)
0 (0.00)
0 (0.00)
41 (87.23)
368
Padmanabhan et al.,
Padmanabhan et al.,
369
Padmanabhan et al.,
DISCUSSION
Our study indicates that amongst the total students
admitted for MBBS course at Pravara Institute of
Medical Sciences Deemed University (PIMS-DU)
the number of girl students admitted had
outnumbered the boy students. This trend of statistics
even extends to the number of attempts at the
entrance exam whether at PIMS-DU or at other
university entrance exam. Thus it appears that the girl
students are found to maintain their perseverance
regarding their career choice even when selecting
their course of study.
The medical profession faces a changing gender
composition with larger number of girls opting for
medicine as their career choice. Our study findings
are in unison with this fact. A study in the United
Kingdom showed an increase in feminization of the
medical profession [11].
The choice of a particular career is largely influenced
by certain factors; such as peer group influence and
parental influence. Family influence is an important
factor in career choice of the students [12].
Adolescents have young minds therefore develop
many attitudes about occupation and career as a
resultant effect of interactions with their families.
Family background according to our study provides
the basis from which their career plans and decision
making evolves.
Our study indicates that parents and other members in
the family have significant influence on career
choice. Teachers and friends contribute equally to the
decision of choosing MBBS as course of study.
Parents, family members of medical students
probably recognized their wards ability at an early
age and guided them into academically suitable
careers [13]. A study by Penick and Jepsen reported
that parental influence surpasses that of peer
influence [14].This fact bears resemblance to findings
of our study. But this is a variable factor since it is
pertaining to the students rapport with their parents
and peers. Our study also indicates that inner voice of
students can also influence and can be a guiding
factor regarding career choice. A study by Csinady et
al found that altruistic motivations were the most
370
Padmanabhan et al.,
CONCLUSION
The study is a subjective evaluation of the prior
371
372
Padmanabhan et al.,
DOI: 10.5958/2319-5886.2015.00069.7
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 5 Mar 2015
Accepted: 18th Mar 2015
Assistant Professor, 2Professor, Dept. of Radio diagnosis, S.R. T. R. Govt. Medical College, Ambajogai, Beed,
Maharashtra, India
3
Resident, Dept. of Pediatric, S. R. T. R. Govt. Medical College, Ambajogai, Beed, Maharashtra, India
*Corresponding author email: drsantoshnpawar@gmail.com
ABSTRACT
Context: The evolving role of CT in the study of pancreas is not only in its ability to directly define the presence
of an abnormality but it also surpasses the other imaging modalities in being able to demonstrate the extent of the
disease and its spread to contiguous areas by virtue of its being a non-organ specific investigation. The ability of
CT to image the pancreas adequately regardless of the bowel gas and fat gives it an advantage over ultrasound.
Objectives: To study age and size distribution in pancreatic diseases. To differentiate cystic from solid pancreatic
lesions. To differentiate inflammatory and neoplastic conditions with their characteristic imaging features. To
classify and grade pancreatitis with the help of CT imaging features. Methods: This study comprises 50 patients
of different age groups in whom there was clinical suspicion of pancreatic disorder. This includes 35 male and 15
female patients. Each patient had been studied by using plain and contrast computed tomography. Results:
Maximum no. of patients age was from 23 30. Pancreatic diseases were more commonly found in males than in
females. Inflammatory diseases were found to be more common than neoplastic masses. Chronic pancreatitis
were showing pancreatic duct dilatation, pancreatic atrophy and pancreatic calcification. Pseudocysts were
associated with chronic pancreatitis. Pancreatic carcinomas extent and metastases was studied accordingly.
Conclusion: CT alone is an excellent noninvasive imaging modality with a sensitivity of about 94% in diagnosing
pancreatic diseases when used judiciously in good clinical settings and accuracy of almost 100% when used in
conjunction with other imaging modalities like endoscopic retrograde colangiopancreatography, angiography and
biopsy whenever indicated.
Key words: pancreatic diseases, acute chronic pancreatitis, computed tomography
INTRODUCTION
Computed Tomography (CT) is a highly accurate,
non-invasive imaging modality of choice in
evaluating the pancreas[1]. CT enables the imaging of
the entire pancreas easily from the surrounding fat
and bowel air together with simultaneous imaging of
other abdominal organs.[2] It also enables detection of
unsuspected additional or ancillary abnormalities
which
may
be
responsible
for
clinical
[3,4]
manifestations .
Santosh et al.,
RESULTS
Table 1: Distribution of pancreatic Disorders
Diagnosed on CT (n=50)
Age( years) Male
%
Female
%
0-10
00
00
01
02
11-20
02
04
02
04
21-30
06
12
03
06
31-40
09
18
03
06
41-50
08
16
03
06
51-60
05
10
01
02
61-70
05
10
01
02
>70
00
00
01
02
Total
35
75%
15
30%
Comments: Pancreatic disorders were more common
in males than in females in this study. The
commonest age group affected was between 30 to 50
years.
Table 2 : Distribution of patients according to
various pancreatic pathologies.
Pathology
No.
%
Acute pancreatitis
16
32
Chronic pancreatitis
24
48
Pancreatic carcinoma 09
18
Other
01
02
Total
50
100
Comments: The other constitute of only one case of
pancreatic cyst associated with VHL ( von Hipple
Lindau) syndrome.The commonest pathology in this
study was chronic pancreatitis followed by acute
pancreatitis and pancreatic carcinoma.
Table 3: Age and sex distribution of acute
pancreatitis ( n=16)
Age
( years)
0-10
11-20
21-30
31-40
41-50
51-60
61-70
>70
Total
Male
--1
5
3
1
2
-12
--6.2
31.2
18.7
06.2
12.5
-75%
Female
--1
2
---1
4
Total
--6.25
12.5
----6.2
--2
7
3
1
2
1
16
--12.50
43.75
18.75
6.25
12.50
6.25
100%
374
Santosh et al.,
Grade [7]
No. of patients
%
A
0
-B
4
25.00
C
3
18.75
D
7
43.75
E
2
12.50
Grading : [7]
Grade A: Normal pancreas
Grade B: Focal or diffuse enlargement of the gland,
including contour irregularity, non homogenous
attenuation of gland, dilatation of the pancreatic duct,
foci of small fluid collections with in the gland.
Male
Female
Total
-02
05
04
03
03
01
18
-8.33
20.83
16.66
12.5
12.5
4.16
75%
01
01
02
-01
-01
06
4.16
4.16
8.33
-4.16
-4.16
25%
01
03
07
04
04
03
02
24
4.16
12.5
29.16
16.66
16.66
12.5
8.33
100%
Santosh et al.,
Santosh et al.,
Santosh et al.,
10.
11.
12.
13.
14.
15.
16.
379
Santosh et al.,
DOI: 10.5958/2319-5886.2015.00070.3
ISSN: 2319-5886
Accepted: 21st Mar 2015
Department of Orthopedics, MNR Medical College, Sangareddy, Medak Dist-, Telangana 500055
Department of Microbiology, Mallareddy Medical College for Women, Suraram X Roads, Hyderabad 500055
381
Mallikarjuna et al.,
No. of patients
1
58
29
34
Percentage%
0.8%
48.%
23.8%
28%
Flexion type
19
0
Results
Loss of
carrying
angle
No. of
cases
Loss of
carrying
angle %
of cases
Loss of
movement
No. of
cases
Loss of
movement
.% of
cases
Excellent
112
92%
102
83,6%
Good
Fair
Poor
010
00
00
08%
00
00
16
00
O4
13.2%
00
3.2%
12
0
No. of .cases.
64
39
19
0
Percentage%
52%
32%
16%
0
No. of cases
3
4
Percentage
2.4%
3.2%
0
2
9
0
1.6%
7.2%
No of cases
Vascular injury
Nerve injury
Infection
Restriction of motion
Deformity [varus or valgus]
Myositis ossificans
Total
00
00
00
04
00
00
04 patients
00
00
00
3%
00
00
3.2
Loss of
(range)
0-50
Good
6-100
Fair
10-150
Poor
15-20
movement
No
cases
102
00
83.6
%
13.2
%
00
3.2%
16
of
382
Mallikarjuna et al.,
Mallikarjuna et al.,
5.
6.
7.
8.
CONCLUSION
Our study concludes that posterior approach gives
better visualization of fracture, the delineated ulnar
nerve enables passing of k wires without injury.
Median nerve injuries protected by pinning the k wire
100 postero-lateral to coronal plane. Triceps sparing
approach has less scaring so better flexion and
extension, cross k wire gives more stability to enable
early mobilization.
9.
10.
ACKNOWLEDGEMENT
11.
12.
13.
14.
15.
16.
Mallikarjuna et al.,
385
Mallikarjuna et al.,
DOI: 10.5958/2319-5886.2015.00071.5
Copyright @2015
ISSN: 2319-5886
Accepted: 9th Mar 2015
Priyanka et al.,
386
Percentage
[%]
64.5
33.3
2.2
Number
20 25
26 30
> 30
29
15
1
Gram stain
GNB
GNB
GNB
Number
8
1
1
%
38.2
4.7
4.7
GNB
4.7
GPC
GPC
5
2
23.8
9.6
GPC
4.7
9.6
Number
14.5
20
14
6
41.7
29.2
12.5
Cephalosporin-beta lactamase
inhibitor
10.4
Nitrofurantoin
14
29.2
Miscellaneous
4.2
Priyanka et al.,
Priyanka et al.,
CONCLUSION
It is concluded from the present study that there was a
high prevalence of ASB among pregnant women. It is
therefore imperative that early screening of
bacteriuria in pregnancy must be considered as a part
of routine antenatal care. Urine culture should be
performed as screening and diagnostic tool of UTI in
pregnancy. Escherichia coli was the most common
isolated organism followed by CONS. All pregnant
women with UTI should be treated. Cephalosporins
were the most commonly prescribed antimicrobials
followed by Nitrofurantoin. Periodic and continuous
follow up is mandatory to reduce the consequences of
ASB and symptomatic UTI.
ACKNOWLEDGEMENT
We sincerely thank all the subjects who gave consent
and participated in the present study.
Conflict of Interest: Nil
REFERENCES
1. Prakasam KA, Kumar KD, Vijayan M. A cross
sectional study on distribution of urinary tract
infection and their antibiotic utilisation in Kerala.
International
Journal
of
Reasearch
in
Pharmaceutical and Biomedical Sciences.
2012;3(3):1125-30.
389
Priyanka et al.,
390
DOI: 10.5958/2319-5886.2015.00072.7
Coden: IJMRHS
Copyright @2015 ISSN: 2319-5886
th
Revised: 28 Feb 2015
Accepted: 16th Mar 2015
M. Sc. Public Health (PG Student), Centre for Social Medicine, Pravara Institute of Medical Science, Loni,
Ahmednagar, Maharshtra
2
Assistant Professor, Centre for Social Medicine, Pravara Institute of Medical Science, Loni, Ahmednagar,
Maharshtra
*Corresponding author email: aaloksinghph@gmail.com/aaloksinghph@outlook.com
ABSTRACT
Background: Sex preference is choice of selecting the sex of children by their parents or family members. The
objective of the study was to study the existence of sex preference among rural community. Material and
methods: A Cross-sectional study was carried out among 200 ever married women of reproductive age group.
Random digits sampling method was used to select 10 villages in Rahata Tehsil of Ahmednagar, while systematic
sampling was applied for selection of 20 samples in each village. Results: In the previous sex preference for male
child was 37.3%, 58.75%, 88.5%, 100% and 100% from firstchild to fifth respectively, while female preference
and either sexpreference was decreasing. In the current sex preference for male, female and either was 36.8%,
25% and 38.2% respectively. Future sex preference was 40.9% for male child, 22.7% for female child and 36.4%
for either sex. The main reason for son preference was for old age care and support, to continue the family name
and earning member in the family. Conclusion: Study confirms that son preference still existsin the rural
community of Maharashtra. Attitude for son preference is mainly because of the economic earning, old age care
and continuation of the family nameamong all groups.
Keywords:Fertility preference, Sex preference, Son preference
INTRODUCTION
Sex preference is choice of selecting the sex of
children by their parents or family members. It is
observed from historical evidences that, human
beings have tried to influence the sex of their
offsprings, through termination of pregnancy,
infanticide and neglected care. In the mid of the 20th
century, due to revolution in technologies, easy
detection of sex in pregnancy became possible which
then led to sex selective abortions. Parents mostly
prefer male child and ultimately the sex ratio is
imbalanced. Son preference, low status of women,
social and financial security associated with sons,
socio-cultural practices, including a dowry and
Aalok et al.,
Male
(%)
84 (52.8)
29 (36.2)
9 (34.6)
1 (16.6)
1 (50)
124 (45.4)
Female
(%)
75 (47.1)
51 (63.7)
17 (65.3)
5 (83.3)
1 (50)
149(54.5)
Total
children(%)
n=159 (100)
n=80 (100)
n=26 (100)
n=6 (100)
n=2 (100)
N=273 (100)
Preference
2nd
child
47
(58.75)
19
(23.75)
14
(17.5)
80
(100)
3rd
child
23
(88.5)
2 (7.7)
4th
child
6
(100)
0
1 (3.8)
26
(100)
6
(100)
5th
child
2
(100)
0
Total
138
(50.5)
40
(14.65)
0
95
(34.79)
2
273
(100) (100)
Female
Either
Outcome
of
Total
2ndchild
Male (%)
37
29 (36.3)
Female(%)
40 (93)
43
51 (63.7)
Total (%)
47(59)
80
80 (100)
1 (2.3)
2 (4.7)
19 (23.8) 14 (17.5)
Aalok et al.,
2 (8.3)
Female 28 (93.3)
Total
30 (55.6)
Total (%)
16 (66.7)
6 (25)
24 (100)
0 (0 )
2 (6.7)
30 (100)
16 (29.6)
8 (14.8)
54 (100)
The respondents who had one child and desire for the
second child were 54, among those respondents who
had one female child, 93.3% of respondentspreferred
male child in the future.
Attitude towards sex preferences:According to the
majority of respondents, they preferred male child in
old age care and support, i.e. 66.5%, to continue the
family name (47%), active and earning member of
the family (26%), other reasons were business,
agriculture, funeral values, societal values etc.
DISCUSSION
Sex preference
First child
Second child
Third child
Male(%)
36 (40.9)
2 (15.4)
1 (100)
Female(%)
20 (22.7)
3 (23.1)
Either(%)
32 (36.4)
8 (61.5)
Total(%)
88 (100)
13 (100)
1 (100)
Aalok et al.,
395
Aalok et al.,
DOI: 10.5958/2319-5886.2015.00073.9
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
Revised: 10th Feb 2015
Accepted: 31st Mar 2015
Nikita et al.,
[1]
Nikita et al.,
RESULTS
Table 1: Results of the Drug susceptibility testing
Mycobacterium
tuberculosis strains
Strains sensitive to
all four standard
first line anti-TB
drugs (H, R, Z, E)
Strains resistant to
all four standard
first line anti-TB
drugs (H, R, Z, E)
Total
No growth of
M.tb observed in
drug containing
media
No.
Growth of
M.tb observed in
drug containing
media
No.
No growth of
M.tb observed
in
drug
containing
media
No.
Growth of M.tb
observed in
drug
containing
media
No.
No growth of
M.tb observed
in
drug
containing
media
No.
Growth of M.tb
observed in
drug
containing
media
No.
10
10
10
17
17
17
398
Nikita et al.,
Figure 1: Summary
ACKNOWLEDGEMENT
The authors would like to thank the Indian Council of
Medical Research for the research grant awarded to
the first author (undergraduate student from II
MBBS) to conduct this experimental pilot study
through its Short Term Studentship program. The
authors express their sincere thanks to Ms Puja A.
Parulekar (Senior Laboratory Technician at IRL, Goa
Medical College and Dr Cigy C Borges,
Nikita et al.,
REFERENCES
1. World Health Organisation (WHO). Global
Tuberculosis Report 2013. Geneva: WHO; 2013.
2. World Health Organisation (WHO). Global
Tuberculosis Report 2014. Geneva: WHO; 2014.
3. World Health Organisation (WHO). Global
Tuberculosis Report 2012. Geneva: WHO; 2012.
4. Colijn C, Cohen T, Ganesh A, Murray M.
Spontaneous Emergence of Multiple Drug
Resistance in Tuberculosis before and during
Therapy. PLoS ONE.2011; 6(3): e18327. Doi:
10.1371/journal.pone.0018327.
5. Selkon JB.. The emergence of isoniazid-resistant
cultures in patients with pulmonary tuberculosis
during treatment with isoniazid alone or isoniazid
plus PAS. Bull. World Health Organ. 1964; 31:
27394.
6. Klenner FR. Massive doses of vitamin C and the
virus diseases. South Med Surg. 1951 Apr; CIII
(4): 101-7.
7. McConkey M, Smith DT. The Relation of
Vitamin C Deficiency to Intestinal Tuberculosis
in the Guinea Pig. J. Exp. Med. 1933; 58: 503
512.
8. Taneja NK, Dhingra S, Mittal A, Naresh M,
Tyagi
JS.
Mycobacterium
tuberculosis
transcriptional adaptation, growth arrest and
dormancy phenotype development is triggered by
vitamin C. PLoS One. 2010; 5: e10860.
9. Vilchze C, Hartman T, Weinrick B, Jacobs W R.
Mycobacterium tuberculosis is extraordinarily
sensitive to killing by a vitamin C-induced
Fenton reaction. Nat Commun.2013; 4: 1881.
10. Narwadiya SC, Sahare KN, Tumane PM,
Dhumne UL, Meshram VG. In vitro
antituberculosis effect of vitamin C contents of
medicinal plants. Asian J. Exp. Biol. Sci. 2011; 2:
15154.
11. Directorate General of Health Services, Ministry
of Heath and Family Welfare, Central TB
Division. Revised National TB Control
Programme Training Manual for Mycobacterium
tuberculosis Culture and Drug Susceptibility
Testing. New Delhi: 2009: 1-76.
12. Alvarado JD, Palacios VN. Effect of temperature
on the aerobic degradation of vitamin C in citric
fruit juices. Arch Latinoam Nutr. 1989 Dec;
39(4): 601-12.
400
Nikita et al.,
DOI: 10.5958/2319-5886.2015.00074.0
Coden: IJMRHS
Revised: 20th Mar 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 30thMar 2015
Family Physician, 2Consultant Family Medicine, Public Health & Epidemiology, at Ministry of Health, Bahrain
Hasan et al.,
RESULTS
<30
Gender
30-40
>40
Male
42
9
48
56.0
18.8
39.3
Female
Not married
Married
No
Yes
Bahraini
Non-Bahraini
39
19
68
15
36
78
7
49.4
35.2
46.3
62.5
45.6
47.6
21.9
Current
marital status
Having
Children
Nationality
0.57
0.33
0.35
0.01
High Depersonalization
N
%
P value
18
31.0
0.01
23
4
35
30.7
8.3
28.7
38
36
66
50.7
75.0
54.1
19
16
38
7
16
50
4
24.1
29.6
25.9
29.2
20.3
30.5
12.5
38
19
85
14
51
83
19
48.1
35.2
57.8
58.3
64.6
35.6
59.4
0.15
0.84
0.21
0.07
0.01
0.28
0.08
0.5
0.91
DISCUSSION
This study was concerned to demonstrate the interrelationship of the three most important aspects of
Burnout which are: Emotional exhaustion (EE),
Depersonalization (DP) and Personal accomplishment
(PA) among secondary care physicians of the
ministry of health in Bahrain. There are a lot of
factors which have been studied and have proved the
strong association among those aspects.
In this study, it was found that doctors who spent 510 years of practicing medicine whom are mainly
training doctors who carry most of the work load and
decision making have a high levels of
depersonalization
and
emotional
exhaustion.
Moreover, physicians who were in the age group of
(30-40) have shown strong exhibition of burnout
among them with a rate of (41.1%). Both of these
results reflects the fact that older doctors has less
burnout than their younger beers which is similar to
previous literature.[18, 21, 22] This protective effect of
older age of physician might be due to the increase in
financial security and cultural factors that attribute
older age with more respect and trust from patients.
The study found no significant difference in burn out
between males and female participants which is
similar to what had been previously shown in other
studies[3,27,28]. This might be due to equally distributed
work load regardless of gender
It was found that Bahraini doctors have lower levels
of emotional exhaustion in comparison to NonBahraini doctors.
This may be attributed to the fact that non Bahraini
doctors has a lower expectations from the work and
actually for most of them working in Bahrain may
make them feel that they have achieved certain goals
In their careers, especially financial. They are less
involved in argumentation with senior colleagues and
higher authorities, and social and political issues. In
addition, they also have- in general- a good working
deal that include allowances for housing, annual
airline tickets to the home country plus school fees
for their children[18, 29, 30].
Limitations of this study were its cross-sectional
design which creates difficulties in ascertaining
causality. Several factors from in or outside work
might have influenced both the perception of the
work and the level of burnout and therefore might be
404
Hasan et al.,
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
Hasan et al.,
27.
28.
29.
30.
31.
32.
406
Hasan et al.,
DOI: 10.5958/2319-5886.2015.00075.2
Copyright @2014
ISSN: 2319-5886
Accepted: 31st Mar 2015
Professor, 3,6Senior Resident, 4Resident, Department of Anaesthesia, 5Senior Resident, Department of ENT,
GMC Amritsar, India.
*Corresponding author: Kulwinder S Sandhu Email: gsandhu2454@gmail.com
ABSTRACT
Purpose: General anaesthesia for oral surgeries in paediatric patients is always challenging for an
anaesthesiologist. Aim was to compare halothane+propofol and sevoflurane+propofol in paediatric patients
undergoing adenotonsillectomy without muscle relaxant. Method: In a double blind manner, eighty patients of 310 years were premedicated with inj. Atropine and randomly divided into two groups of forty each. In Group A,
priming was done with 50% oxygen+50% nitrous oxide+4% halothane for 1 minute, after loss of eye lash reflex
and centralisation of pupil intravenous cannulation done. Inj. midazolom, lignocaine and Propofol were given
and trachea was intubated. Maintenance was done with 1-2% halothane+ nitrous oxide+ oxygen and continuous
propofol infusion. Similar technique was used in group B except for priming done with sevoflurane 7% and
maintenance with 2-3%. Both groups were compared for induction, intubating conditions, haemodynamics and
emergence characteristics. Results: Induction was rapid in group B as time for loss of eye lash reflex and
centralisation of pupil was less in group B (21.8812.6 &114.4028.8 seconds) as compared to group A
(33.054.0 & 140.0512.1 sec) p<0.001. Intubating conditions were excellent but mean intubation time was less
in group B as compared to group A p<0.001. Heart rate and blood pressure remained on lower side in group A.
Emergence was significantly rapid in group B. No side effect or complications were noted. Conclusion: Both
groups provided excellent intubating conditions but sevoflurane+propofol group was better as it provided faster
induction and rapid recovery from anaesthesia with more stable haemodynamics as compared to
Halothane+propofol group.
Keywords: General anaesthesia, Paediatric, Halothane, Sevoflurane, Propofol.
INTRODUCTION
General anaesthesia for adeno-tonsillectomy in
paediatric patients is always challenging for an
anaesthesiologist as there is sharing of the airway
with the surgeon, limited access and risk of soiling
the airway with blood. Children with adenotonsillar
hypertrophy can have nasal obstruction, reactive
airways and sometimes obstructive sleep apnoea.[1]
They are at increased risk of desaturation,
laryngospasm and airway obstruction during
induction of anaesthesia.[2] Hence induction in these
patients is preferred with potent inhalational agents,
Sandhu et al.,
407
Sandhu et al.,
Sandhu et al.,
RESULTS
In the present study both groups were comparable
with respect to age, sex ratio, weight, duration of
surgery and baseline haemodynamic parameters as
shown in table: 1. During induction, time taken for
loss of eye lash reflex and centralisation of pupil was
significantly less in group B as compared to group A
(P=0.00). Mean time taken from induction of
anaesthesia to intubation of trachea (intubation time)
was also significantly less in group B as compared to
group A. (table: 2). However intubating conditions
were excellent and comparable in both the groups.
There was complete jaw relaxation, open vocal cords
on laryngoscopy with no coughing, no laryngospasm,
no limb movements or struggling during intubation in
both the groups. None of the patient had oxygen
desaturation in both groups during induction and
intubation. During maintenance of anaesthesia, none
of the patient required non depolarising muscle
relaxant in both the groups. Total amount of propofol
required during maintenance of anaesthesia in group
A (88.112 34.54 milligram) and group B (98.187
34.02milligram) was also comparable
(P=0.193).Mean heart rate remained on lower side in
group A as compared to group B at all measured
intervals from 2nd to 60th minutes and the difference
between the two groups was highly significant
(p=0.00). But after 60 minutes, heart rate remained
409
Significance
NS
NS
NS
52.23 8.163
118.35 6.747
51.85 5.304
122.85 9.638
0.808
0.068
NS
NS
117.08 8.337
113.23 9.449
0.058
NS
72.85 5.811
71.73 8.608
0.495
NS
Sandhu et al.,
410
Group A
(Halothane+ propofol) n=40
33.05 4.015
140.05 12.106
Group B(Sevoflurane+
propofol) n=40
21.88 12.652
114.40 28.811
211.8811.305
189.3033.087
No cyanosis
No pain on I/v access
No laryngospasm
No body movement
Jaw relaxation complete 1
Vocal cord position open 1
No Cough- 1
No limb movement 1
No laryngospasm 1
Total score 5
19.084.492
No cyanosis
No pain on i/v access
No laryngospasm
No body movement
Jaw relaxation complete 1
Vocal cord position open 1
No Cough- 1
No limb movement 1
No laryngospasm 1
Total score 5
15.783.886
11.782.516
10.754.776
Parameters
Quality of induction
Intubation parameters
(total score)
p value
Significance
0.000
0.000
HS
HS
0.000
HS
---
---
---
---
0.001
0.233
NS
Sandhu et al.,
Sandhu et al.,
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
414
Sandhu et al.,
DOI: 10.5958/2319-5886.2015.00076.4
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 7 Mar 2015
Accepted: 17th Mar 2015
Zvornicanin et al.,
416
Zvornicanin et al.,
DOI: 10.5958/2319-5886.2015.00077.6
www.ijmrhs.com
Volume 4 Issue 2
Coden: IJMRHS
th
Received: 20 Jan 2015
Revised: 28th Feb 2015
Review article
Vijay Kumar Konuri1, Mohammed Abdul Hannan Hazari2, Ravi Kumar K , Chandrasekhar M ,
5
Associate Professor, Department of Anatomy, All India Institute of Medical Sciences, Raipur, Chhattisgarh,
India
2
Associate Professor, Department of Physiology, Deccan College of Medical Sciences, Kanchanbagh, Hyderabad,
Telangana, India
3
Professor & HOD, Department of Physiology, Apollo Institute of Medical Sciences and Research, Jubilee Hills,
Hyderabad, Telangana, India.
*Corresponding author email: vkkonuri@gmail.com
ABSTRACT
The pacemaker of the mammalian heart had developed a robust and yet a flexible system in the course of
evolution whose function is based on multiple interactions at the sub-cellular, cellular and finally at the tissue
level. These, in turn, should respond to extrinsic signals. Cardiac action potentials were explained for a long time
based on the changes that occur at the cell surface. New hypothesis was put forward at the turn of the century that
pointed to the role of intracellular calcium clock. Discovery of ryanodine receptors, fluorescence labeling
techniques, confocal imaging and finally computer modeling of physiological processes had brought about a
noticeable change that allowed development of a new concept of pacemaker automaticity. Reviewing all these
developments we hereby put forward a few theoretical formulations that can turn out to be new instruments in
advancing our knowledge of cardiac physiology. We had theorized that cardiac muscle is an emergent property of
smooth muscle in the course of evolution, and that pacemaker activity of the cardiac muscle underwent a phase
transition that finally led to the evolution of a structural pacemaker.
Keywords: Heart, Pacemaker, Automaticity, Evolution
INTRODUCTION
The sino-atrial node (SAN) pacemaker cells produce
billions of incessant and uninterrupted beats in the
course of the life time of an individual. It is evident
that the pacemaker of the mammalian heart has
developed a robust and yet a flexible system in the
course of evolution [1]. Robustness indicates the failsafe properties and flexibility signifies the
adaptability to changes in the demands made on it.
The pacemaker function is based on multiple
417
Vijaykumar et al.,
418
Vijaykumar et al.,
Fig 2: Phase transition and emergence of cardiac muscle from smooth muscle with maintenance of legacy
in some aspects
419
Vijaykumar et al.,
420
Vijaykumar et al.,
8.
9.
10.
11.
12.
13.
14.
15.
421
Vijaykumar et al.,
DOI: 10.5958/2319-5886.2015.00078.8
Coden: IJMRHS
Revised: 7th Mar 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 25th Mar 2015
Rishabh et al.,
Rishabh et al.,
Rishabh et al.,
Rishabh et al.,
Rishabh et al.,
Rishabh et al.,
Rishabh et al.,
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Rishabh et al.,
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
Rishabh et al.,
60.
61.
62.
63.
64.
65.
431
Rishabh et al.,
DOI: 10.5958/2319-5886.2015.00079.X
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 16 Jan 2015
Accepted: 26th Jan 2015
Resident, 2Professor,
Kolkata, India
4,6
Case report
A 13 year old girl presented with blurring of vision
since a week .She underwent ophthalmic assessment
in a private eye clinic where she was found to have
bilateral hypertensive retinopathy. She was then
admitted to our SSKM hospital, initially in the
general medicine ward where she underwent full
work up and physical examination. She was later
transferred to the surgical unit. Her history revealed
that she had complaints of palpitation, throbbing
headache and occasional sweating for the last 7
month. She also had associated weight loss. However
her appetite, bowel and bladder habits were normal.
On admission she had a bp of 180/110 mm of Hg and
a pulse rate of 130/mint. On abdominal examination
no lump was found. On USG a large (3.92x 4.21) cms
hetrogenous mass with cystic degeneration above
superior pole of left kidney was found. CECT
abdomen revealed (4.5 x 3.9) cms cystic sol with
enhancing thick walled mass in the left adrenal gland.
Biochemical tests showed high value of 24 hour
urinary metanephrine level (14.36) microgram/litre
and elevated level of normetanephrine (1445.1)
microgram/litre. There was no drug history of
ephedrine, amphetamines, methlxanthines etc use in
this patient which could have lead to false elevated
metanephrine level. Serum levels of Ca2+,PTH,
phosphate, calcitonin were all normal. Preoperatively
she received prazosin & propnanolol. She underwent
left adrenalectomy under GA following which she
was shifted to ICU where constant monitoring of her
vitals was undertaken. She was hypotensive and had
to be put on noradrenaline drip for 3 days. She was
started on oral diet by 5th postop. day and was
discharged on the 7th day. She was followed up with a
repeat test of serum and urinary markers which
showed normal results. Her pathological report
showed a well encapsulated tumor composed of large
polygonal cells, vesicular nuclei, small nucleoli and
abundant eosinophilic granular cytoplasm, arranged
in Zellballen, surrounded by elaborate vascular
network which was consistent with a diagnosis of
benign pheochromocytoma [fig 1&2]. On 6 months
follow up she has been healthy and enjoying a good
quality of life without any visual problem.
Saha et al.,
REFERENCES
1. Armstrong R, Sridhar M, Greenhalgh KL, Howell
L, Jones C, Landes C, McPartland JL, Moores C,
Losty PD & Didi M. . Phaeochromocytoma in
children. Archives of Disease in Childhood2008
;93(10):899 -04.
2. Kloos RT, Gross MD, Francis IR, Korobkin M,
Shapiro B. Incidentally Discovered Adrenal
Masses. Endoc Rev 1995; 16:460-84
3. Jain SK, Agarwal N. Asymptomatic Giant
Pheochromocytoma. J Assoc Physic India
2002;50:842-4.
4. Michael G. Caty, Arnold G. Coran, Michael
Geagen,et al. Current diagnosis and treatment of
pheochromocytoma in children: experience with
22 con-secutive tumors in 14 patients. Arch Surg,
1990,125: 978- 81.
5. Sawin RS. Functioning adrenal neoplasm. Semin
Pediatr Surg, 1997; 6:156-63
6. Levine C, Skimmine J, Levine E. Familial
pheochromocytomas with unusual associations. J
Pediatr Surg,1992,27: 447-51,
7. Caty MG, Coran AG, Geagen M, Thompson NW.
Current diagnosis and management of
pheochromocytoma in children. Arch Surg 1990;
125: 978-81.
8. Chen TY, Liang CD, Shieh CS, Ko SF, Kao ML.
Reversible hypertensive retinopathy in a child
with bilateral pheochromocytoma after tumor
resection. J Formos Med Assoc 2000; 99: 945-47.
9. McClellan MW. Pheochromocytoma: evaluation,
diagnosis, and treatment. World Journal of
Urology. 1999; 17(1):3539.
10. Barontini M, Levin G, Sanso G Characteristics of
pheochromocytoma in a 4- to 20-year-old
population. Ann NY Acad Sci2006; 1073:307.
CONCLUSION
A high index of suspicion and early diagnosis is key
to successful management in pheochromocytomas .A
high blood pressure in a child should prompt
thorough search for this condition. Preoperative
stabilization of blood pressure is crucial in preventing
intraoperative
catastrophe
of
uncontrolled
hemorrhage.
Conflict of Interest: Nil
434
Saha et al.,
DOI: 10.5958/2319-5886.2015.00080.6
Coden: IJMRHS
Revised: 20th Jan 2015
Copyright @2014
ISSN: 2319-5886
Accepted: 4th Feb 2015
Junior Resident, 2Professor, 3Professor & Head, Department of Dermatology, Venerology and Leprosy,
4
Professor & Head, Department of Pathology, Rajah Muthiah Medical College and Hospital, Annamalai
University, Tamil Nadu, India.
*Corresponding author email: shumezh@gmail.com
ABSTRACT
Necrolytic Acral Erythema (NAE) is a recently described, poorly understood, rare dermatological entity, which is
frequently associated with Hepatitis C Virus (HCV) infection. This report describes a 53 year old male with a 6
month history of well demarcated, reddish brown to hyperpigmented, scaly skin over dorsum of both hands and
feet. Investigations revealed hypothyroidism and low serum zinc levels. Patient also tested seropositive for HCV.
Histopathological examination revealed hyperkeratosis and subcorneal clefting along with areas of necrosis.
Patient was started on oral zinc along with treatment for hypothyroidism, and improved symptomatically in 2
weeks. Early recognition of NAE is of prime importance to dermatologists as it allows diagnosis of HCV in
previously unaware patients and gives way for efficacious treatment.
Keywords: Necrolytic erythema, Hepatitis C, HCV
INTRODUCTION
Necrolytic acral erythema (NAE) belongs to the
group of necrolytic erythemas which include
acrodermatitis
enteropathica, pellagra, biotin
deficiency, essential fatty acid deficiency and
necrolytic migratory erythema. These conditions are
both histologically and clinically similar but differ in
their etiology. [1] NAE is a recently described, poorly
understood, rare dermatological entity. NAE is
characterised by erythematous to violaceous, scaly
plaques on the acral sites. It is frequently associated
with Hepatitis C Virus (HCV) infection and is now
considered a diagnostic cutaneous marker for the
disease. Recognition of NAE requires clinicopathological correlation and a high degree of
suspicion. NAE responds well to oral zinc therapy
and treatment of the underlying HCV infection with
interferon alpha. We report a case of NAE from
Southern India.
Shumez et al.,
CASE REPORT
A 53 yr old man, farmer by profession, presented to
the dermatology department with dry, rough,
thickened skin over the hands and legs for the past 6
months. The lesions initially started on the legs and
then progressed to involve the hands in about 2
weeks. It was associated with itching and burning
sensation on sun exposure. Patient also gave history
of loose stools since 3 weeks. Stools were watery in
consistency, about 4-5 episodes per day, not
associated with blood or mucus. It was associated
with pain abdomen. Patient was not an alcoholic or
on any medications. Family and personal history were
non-contributory in our case.
Cutaneous examination showed well demarcated,
reddish brown to hyperpigmented, rough, thick, scaly
skin with cracks over both lower limbs extending up
to the knee and both upper limbs extending just above
the elbow joints (Figures 1a and b).
435
Int J Med Res Health Sci. 2015;4(2):435-438
Shumez et al.,
436
DISCUSSION
NAE is an infrequently described dermatologic
entity. [2] It was first described by El Darouti et al in a
case series of 7 Egyptian patients in 1996. [3] It
belongs to the group of necrolytic erythemas. This
group of dermatoses also includes acrodermatitis
enteropathica, pellagra, biotin deficiency, essential
fatty acid deficiency, and necrolytic migratory
erythema. These conditions share many histological
and clinical similarities but have diverse etiologies.
NAE is often associated with HCV infection.
The initial lesion is often erythema with vesicles and
flaccid bullae, especially around the periphery of
plaques.[3,4,5] Chronic lesions appear as erythematous
to violaceous plaques with thick scale, erosions and
crusting, and often have a dark red rim.[1,3,4,5,6]
Lesions are predominantly found on acral sites.[1,4.7,8]
The most common site of NAE plaques is the dorsal
aspect of feet.[1,3,4,7,8,9] However, absence of lesions
over feet is not critical for diagnosis.
Scaly, erythematous lesions on acral locations can be
observed in both psoriasis and NAE. NAE has dark,
verrucous scales as opposed to the silvery white
scales of psoriasis. Furthermore, NAE can present
with flaccid blisters and it typically spares the palms
and soles. Histologically, the lesions of psoriasis do
not possess the necrotic keratinocytes seen with NAE.
[5, 9]
ACKNOWLEDGEMENT: None
Shumez et al.,
Shumez et al.,
438
Int J Med Res Health Sci. 2015;4(2):435-438
DOI: 10.5958/2319-5886.2015.00081.8
Coden: IJMRHS
Copyright @2014
ISSN: 2319-5886
th
Revised: 10 Dec 2014
Accepted: 22nd Feb 2015
Dept. of Anatomy, Khaja Bandanawaz Institute of Medical Sciences, Gulbarga, Karnataka, India
Dept. of Anatomy, ESIC Medical College, Gulbarga, Karnataka, India
2, 3
CASE REPORT
During the routine osteology class for the MBBS I
phase students, in the department of anatomy, ESIC
Medical College, Gulbarga, an anatomical variation
of the supra scapular notch where two bony bridges
converting it into a double supra scapular foramina
was found in one left scapula. Dimensions of bony
bridges and foramina were as follows:
Superior band: Length- 1.2cm, Thickness:
Medially-4mm, Centre-3mm & Laterally-3mm
Fig1: Shows double suprascapular foramen .SBSuperior band, SF-Superior foramen, IB-Inferior
band, IF-Inferior foramen
439
Vanitha et al.,
DISCUSSION
Suprascapular neuropathy is infrequent condition that
occurs in only 1-2% cases of shoulder pain [4]. Causes
includes trauma caused by repetitive over head
abduction in athletes and in volley ball players,
rotator cuff tear, compression of the nerve at the
suprascapular notch or spinoglenoid notch or by
supraglenoid and paralabral cysts [4]. The incidence of
complete ossification of the STSL (superior
transverse scapular ligament ) depends on population
and has been found to vary from 4 to 12.5% [5] . A
familial case of the ossification of the STSL causing
entrapment neuropathy of the Suprascapular nerve
affecting both father & son has also been described,
suggesting that the ossification may have a genetic
basis [6].
Ticker et al., studied anatomy of Suprascapular nerve
and demonstrated partial and complete ossification of
supra scapular ligament and multiple bands including
the first report of a trifid superior transverse scapular
ligament [7]. Alon et al., reported a case of bilateral
Suprascapular nerve entrapment due to ossification of
bifid Transverse scapular ligament in a female patient
[8]
. Rengachary et al., classified Suprascapular notch
into 6 types [9].
Very few cases of double supra scapular foramen has
been reported in literature till now. Michal P et al.,
studied 610 scapulae by 3D CT scan and found one
case of double suprascapular foramen on left side in
56-year-old Caucasian female [10]. Probable cause for
the formation of double suprascapular foramen was
also explained in their study which could be because
of ossification of STSL & ACSL [11], ossification of
the bifid STSL, partial ossification of the trifid STSL
or ossification of the bifid ACSL. The entrapment of
the supra scapular nerve by the ossified STSL may
result in symptoms like pain in the shoulder region
and also result in wasting and weakness of
supraspinatus & infraspinatus muscles. [12]
CONCLUSION
Suprascapular neuropathy is an uncommon cause of
shoulder pain and weakness and therefore is
frequently misdiagnosed. As a consequence,
misdiagnosis can lead to inappropriate conservative
treatment or unsuccessful surgical procedure. It has to
be differentiated from other conditions like rotator
cuff tears. Knowledge of such an anatomical variation
Vanitha et al.,
441
Vanitha et al.,
DOI: 10.5958/2319-5886.2015.00082.X
Copyright @2014
ISSN: 2319-5886
Accepted: 12th Feb 2015
Assistant Professor, 2 Resident, 3,4 Resident, Department of Orthopaedics, M S Ramaiah Medical College &
Hospitals, Bengaluru, Karnataka, India
*Corresponding author email: dr_daksh@yahoo.com
ABSTRACT
Sternum fractures are a rare entity and occur either due to direct trauma or indirectly associated to a flexion
compression injury. Earlier literatures used to describe the association of sternum fractures with upper thoracic
vertebral fractures. To the best of our knowledge very few cases have been described in literature with
concomitant lumbar vertebral fracture with associated sternum fracture. We hereby report a rare presentation of a
flexion distraction injury leading to a concomitant sternum fracture with a L1 vertebral burst fracture.
Keywords: Lumbar spine burst fracture, Corpus sterna fracture, Flexion distraction injury
INTRODUCTION
Sternum fractures in the literature has been described
as a marker for a high velocity trauma with many
associated injuries [1].Other than cases with a direct
trauma to sternum, rarely an isolated sternal fracture
is seen. In the literature the rib sternum complex has
been described as a fourth column to the spine
suggesting a high chances of associated spine injury
with a sternum fracture[2,3]. But most of the cases
described in the literature involve only the upper
thoracic vertebrae. According to a study done by
Fowler[4], flexion compression force leads to
displaced fractures of sternum with the distal
fragment displaced anterior to the proximal fragment
and opposite for distraction injuries. Such injuries are
more commonly seen during high velocity road
traffic accidents.
The level of sternum involvement with the associated
level of vertebral involvement was described by Max
J. Scheyerer et al in their study with statistically
significant association of manubrium sterni i.e. upper
sternum involvement with upper thoracic and lower
Daksh etal.,
Fig: 5a
443
Daksh etal.,
Fig: 5b
Fig: 5c
Fig: 5d
CONCLUSION
A concomitant lumbar spine injury with a sternum
fracture is a rare entity, but it is essential for all
orthopaedic surgeons to be aware of such injury
patterns and its associated complications. Such rare
injuries also help us to understand the mechanism of
trauma. Missing or delay in diagnosing such fractures
may lead to undue complications and increase
mortality.
Fig 5a, 5b,5c,5d: MRI Lumbosacral spine showing
L1 compression fracture
ACKNOWLEDGEMENT:Nil
DISCUSSION
REFERENCES
444
Daksh etal.,
4.
5.
6.
7.
8.
9.
10.
445
Daksh etal.,
DOI: 10.5958/2319-5886.2015.00083.1
ISSN: 2319-5886
Accepted: 4th Mar 2015
Professor, 2Post Graduate Student, 3Associate Professor, Department of Ophthalmology, Rural Medical College,
Loni, Ahmednagar, Maharashtra
Hair Follicles
of
DISCUSSION
Nigwekar et al.,
Nigwekar et al.,
449
Nigwekar et al.,
DOI: 10.5958/2319-5886.2015.00084.3
Coden: IJMRHS
Revised: 7th Feb 2015
Copyright @2015
ISSN: 2319-5886
Accepted: 17th Feb 2015
Post Graduate Student, 2,3,4Senior lecturer, 5Reader, 6Professor, Department of Oral Medicine & Radiology, SRM
Dental College & Hospital, Chennai, Tamil Nadu, India
Nehru et al.,
Fig3: CT 3D Reformatting
451
Nehru et al.,
Nehru et al.,
10.
11.
12.
13.
15.
14.
REFERRENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
16.
17.
18.
19.
453
Nehru et al.,
DOI: 10.5958/2319-5886.2015.00085.5
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 20 Feb 2015
Accepted: 6th Mar 2015
Senior Registrar, 2Postgraduate student, 3Professor & Head,4Associate Professor, Department of Obstetrics and
Gynaecology, Regional Institute of Medical Sciences Imphal, Manipur, India
5
Assistant Professor Department of Pathology Regional Institute of Medical Sciences Imphal, Manipur, India
* Corresponding author email: drsumankatewa@gmail.com
ABSTRACT
Fibroepithelial stromal polyps are site-specific mesenchymal lesions that typically occur in women of
reproductive age group and present more commonly in vagina than cervix or vulva. These polyps usually do not
grow larger than 5 cm in diameter and are most commonly identified during routine gynecological examination.
Although benign, sometimes their clinical features may overlap with those of malignant neoplasms so
histopathological examination of the polyp is often necessary to make a definitive diagnosis.
Key words: Fibroepithelial stromal polyps, cervix, vulva.
INTRODUCTION
Fibroepithelial stromal polyps (FEPs) are also known
as Acrochordons or skin tags. These are site specific
mesenchymal lesions which show a predilection for
the neck, axilla, and groin and are typically seen in
adult obese women. FEPs of the lower genital tract
often develop in young to middle-aged women and
are more common in the vagina than vulva and rarely
seen in cervix. [1]These polyps are thought to be
hormone sensitive and are usually seen in
reproductive age group. however they can also be
seen in postmenopausal women who are on hormone
replacement therapy. These lesions display a wide
range of morphologic appearances and usually
present as polypoid or pendunculated growth. Mostly
the size of lesions is 1x2 cm but rarely it can reach an
extremely large size up to 15- 20 cm.[2] Small lesions
are usually asymptomatic and are detected during
routine
gynaecological
examination.
Symptomatology of large lesions includes general
discomfort with sensation of a mass as well as
bleeding and discharge due to secondary infection of
Pratima et al.,
Pratima et al.,
Funding:
Nil,
Conflict
of
REFERENCES
1. Carter
PE,
Russell
P.
Bilateral
fibroepithelialpolypi of labium minus with
atypical stromal cells. Pathology, 1992;24(1):37
39
2. Bozgeyik Z. Giant fibroepithelial stromal polyp
of the vulva:extended field-of-view ultrasound
and computed tomographic findings. Ultrasound
Obstet Gynecol 2007, 30(5):79192.
3. Nucci MR, Young RH, Fletcher CD. Cellular
pseudo sarcomatous fibroepithelial stromal
polyps of the lower female genital tract: an under
recognized lesion often misdiagnosed as sarcoma.
Am J SurgPathol 2000; 24(2):231-40
4. Laskin WB, Fetsch JF, Tavassoli FA. Superficial
cervicovaginal myofibroblastoma: fourteen cases
of a distinctive mesenchymal tumor arising from
the specialized subepithelialstroma of the lower
female genital tract. Hum Pathol 2001;
32(7):715-25.
5. Nucci MR, Olivia E: Gynecologic Pathology: A
Volume in Foundations in Diagnostic Pathology
Series. Elsevier/Churchill Livingstone; 2009:31
32.
6. Sharma S, Albertazzi P, Richmond I. Vaginal
polyps and hormones--is there a link? A case
series. Maturitas 2006; 53(3):351-55
7. Thappa DM. Skin tags as markers of diabetes
mellitus: An epidemiological study in India. J
Dermatol. 1995;22(10):729-31
8. Dane C, Dane B, Cetin A, Erginbas M, Tatar Z.
Association of psoriasis and vulva fibroepithelial
polyp. Am J ClinDermatol. 2008;9(5):333-5
9. Han X. Giant cell fibroblastoma of the vulva at
the site of a previous fibroepithelial stromal
polyp: a case report. J Low Genit Tract Dis2007,
11(2):112117.
10. Pearl Crombleholme WR, Green JR, Bottles K.
Fibroepithelial polyps of the vagina in pregnancy,
Am J Perinatol 1991;8:236-8
456
Pratima et al.,
DOI: 10.5958/2319-5886.2015.00086.7
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 27 Jan 2015
Accepted: 1st Mar 2015
Post Graduate, 3Professor& Head, Department of Otorhinolaryngology, Shri B.M. Patil Medical College,
Hospital &Research Centre, BLDE University, Vijayapur, Karnataka, India
2
Post Graduate in the Department of Pathology, Shri B.M. Patil Medical College, Hospital &Research Centre,
BLDE University, Vijayapur, Karnataka, India
*Corresponding author email: rohitjhagnh1@gmail.com
ABSTRACT
Myoepithelioma of the salivary glands is a rare benign neoplasm with incidence of less than 1% of all salivary
gland neoplasms. The most common site is the parotid gland followed by minor salivary glands. These tumors
occur at any age with peak incidence in the third & fourth decade. Here we report a case of plasmacytoid
myoepithelioma of the minor salivary glands of soft palate which was conclusively diagnosed on FNAC and
further confirmed by histopathological studies. The rarity of the tumor and the site has been emphasized.
Key words: Myoepithelioma, Minor salivary gland, Plasmacytoid variant, Soft palate.
INTRODUCTION
Myoepithelioma is believed to be rare entity in the
tumours of salivary glands with less than 100 cases
reported in the literature. It was first described by
Sheldon in 1943 and was considered as variant of
pleomorphic adenoma. [1] But now-a-days most
authors consider myoepithelioma as a distinct
pathological
entity,
composed
entirely
of
myoepithelial cells behaving much more aggressively
than pleomorphic adenoma. Myoepithelioma arises
from myoepithelial cells which are usually present in
ductal epithelium of secretary glands like salivary,
sweat and mammary glands. [2] Myoepithelial cells are
characterised by intracytoplasmic myofilaments,
intercellular desmosomes and myogenic markers. [3]
Histopathologically there are five variants; spindle
cell, plasmacytoid, epithelioid, clear cell and mixed
variant. Spindle cell variant is the most common
followed by plasmacytoid variant.
Majority of myoepitheliomas present as painless,
slow growing, well circumscribed, smooth surfaced
Rohit et al.,
Rohit et al.,
CONCLUSION
Myoepithelioma- plasmacytoid variant of the palatal minor salivary glands is a rare entity. It is relatively
more aggressive than other benign neoplasms of
salivary glands. Management is surgical excision
which should include margins of normal tissue and
long term follow up for recurrence.
To conclude, myoepithelioma should be kept in mind
as differential diagnosis when dealing with an
intraoral sub mucosal mass inspite of their rarity at
that location.
:
:
:
DOI: 10.5958/2319-5886.2015.00087.9
Copyright @2015
ISSN: 2319-5886
Accepted: 22nd Feb 2015
Assistant Professor, 2Professor, Department of Gynecology, Guru Gobind Singh Medical College &Hospital,
Faridkot, Punjab, India
3
Professor, Department of Radiology, Guru Gobind Singh Medical College &Hospital, Faridkot, Punjab, India
*Corresponding author email: nishigargdr@yahoo.co.in
ABSTRACT
It is very rare to see rupture of uterus in an unscarred uterus. But in cases of previous abortions or cesarean
section or scarred uterus, uterine rupture is seen in few cases. Silent uterine rupture is very rare. If there is fetal
demise & presenting part is very high up in pelvis not responding to routine induction, possibility of rupture
uterus should be kept in mind. Ultrasound has an important role in the diagnosis of silent uterine rupture. A case
of silent uterine rupture of unscarred uterus with fetal demise, that remained undiagnosed for many weeks, is
described.
Keywords: Uterine rupture, Unscarred, Silent, Fetal demise
INTRODUCTION
Rupture of the unscarred pregnant uterus is a rare
event, estimated to occur in 1/5700 to 1/20,000
pregnancies.[1-4].In one series, there were 25 uterine
ruptures in women with unscarred uteruses and these
events accounted for 13 percent of ruptures in this
study.[4] The incidence of rupture in unscarred and
scarred uteruses was 0.7 and 5.1 per 10,000
deliveries, respectively. The pathogenesis of rupture
of the unscarred uterus is not well-defined. Rupture in
these cases has been attributed to inherent or acquired
weakness of the myometrium, disorders of the
collagen matrix (Ehlers-Danlos type IV)[5-8], and
abnormal architecture of the uterine cavity
(bicornuate uteri, uterus didelphys, blind uterine
horns). [9-11] Over distension of the uterine cavity,
whether absolute or relative to the size of the cavity,
may be the major physical factor associated with
rupture in such cases. Over distension has even been
reported as a cause of rupture of the non gravid
uterus. [12] Uterine rupture is an uncommon but is a
Nishi et al.,
460
461
Fig 4 : Hemoperitoneum
462
463
DOI: 10.5958/2319-5886.2015.00088.0
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 10 Feb2015
Accepted: 27th Feb 2015
Post-graduate, 2Professor and Head, Department of Anaesthesia and Critical Care,Silchar Medical College and
Hospital, Silchar, Assam, India
*Corresponding author email: dr.gini22@yahoo.com
ABSTRACT
Failure to inject a drug through the epidural catheter because of epidural catheter connector malfunction is a rare
complication. In this report, we describe a case of epidural catheter connector malfunction in a 45 years old
male undergoing emergency explorative laparotomy for haemoperitoneum under general anaesthesia and insertion
of epidural catheter for post operative analgesia. After insertion of catheter after completion of surgery, drug
could not be injected in the catheter. After common causes like kinking, knotting, occluded catheter were ruled
out, the cause was found to be in the epidural catheter connector assembly which is not encountered frequently.
This case warrants that anaesthesiologists must also be aware of rare causes and the preventive steps to avoid such
complications.
Keywords: Epidural catheter connector assembly, Blockage of epidural catheter
INTRODUCTION
Epidural technique of anaesthesia is now widely
usedby anaesthesiologists all over the world. By
placing an epidural catheter, regional anaesthesia can
be performed and prolonged by injecting local
anaesthetic drug and postoperative analgesia [1] can
also be provided by injecting epidural local
anaesthetics or narcotics [2]. Adequate post operative
epidural analgesia fastens the recovery as it decreases
the stress response and the load on cardio respiratory,
renal system and leads to decrease in morbidity and
prevent further complications like thrombosis,
embolism [3, 4] etc. Every patient has the right for
adequate pain relief after surgery. Failure to inject
drug through a catheter is a well known [5, 6]
complication which can be due to kinking or knotting
of the catheter but rarely may be because of
connector assembly malfunction.
CASE REPORT
A 45 year old, 70 kg male patient was put for
emergency
exploratory
laparotomy
for
Ravneet et al.,
DISCUSSION
Though epidural route is routinely used for regional
anaesthesia and analgesia in terms of PCEA, post
operative analgesia, pain relief in chronic
conditions[7]but the failure of the block remains a
great concern to the anaesthesiologist. 14% of all
failure of epidural block has been found to be due to
technical reasons [8].Failure to inject the drug through
the catheter can be due to various reasons:
Malposition of tip of catheter, blocked tip of catheter
by blood clot[9], kinking , knotting[9], transection of
catheter, manufacturing defect[10] or rarely connector
assembly[11]
The connector used in this case hadtwo parts. It was a
type of snap catheter connector [12]. It had a
transparent flap and a yellow base. The catheter
passes through the yellow base and the transparent
flap clicks over the base and holds the catheter in
place i.e. in the port for catheter at the base. The
connector assembly has a midline arch in the upper
flap which holds the catheter [11] and helps in correct
placement of the catheter in the connector. A distinct
click sound confirms correct placement of the
connector which can then be attached to the syringe.
Filters may be used which provide an additional
degree of safety in preventing bacterial infections.
Minimal dead space enables accurate dosing. A high
pressure resistance up to 7 bars enhances safety
during manual injection. It provides proper grip, thus
providing more secure catheter connection [12].
Kinking and knotting can occur if more than adequate
length is inserted into the epidural space.
Anaesthesiologist must be aware not to advance the
epidural catheter more than 5 cm into the epidural
space as greater length of the epidural catheter
increases the risk of complications like
kinking/curling/knotting[13,14,15] which subject the
patient to further complications. As these are the
common causes of catheter blockage that can be
thought of, these should be ruled out by carefully
observing the length and depth of the catheter. As in
our case, when all other causes were ruled out,
catheter was withdrawn carefully from the patient and
the procedure abandoned. Then the connector
assembly was properly examined as the catheter
seemed to be patent. Failure to inject drug through the
connector could be because of two causes: inadequate
length of catheter in connector which may partially
occlude it
465
Ravneet et al.,
4.
5.
6.
7.
8.
9.
10.
ACKNOWLEGEMENT
11.
12.
13.
14.
15.
16.
466
Ravneet et al.,
DOI: 10.5958/2319-5886.2015.00089.2
Coden: IJMRHS
Copyright @2015
ISSN: 2319-5886
th
Revised: 20 Feb 2015
Accepted: 24th Feb 2015
Associate Professor, 2Professor, 3Post graduate, Department of Pathology, Adichunchanagiri Institute of Medical
Sciences, B.G. Nagara, Nagamangala taluk, Mandya, Karnataka
*Corresponding author: Amita K Email: dramitay@gmail.com
ABSTRACT
Plasma cell granuloma is a rare reactive tumor- like lesion composed of polyclonal plasma cells. It primarily
affects the lungs but occurs in other anatomic locations such as orbit, paranasal sinuses, larynx, tonsils, ears,
tongue, lip, oral cavity and gingiva. A 65- year old female presented with the chief complaint of swelling over the
right upper gingiva and mobility of right upper 2nd and 3rd molar teeth since 3-4 months At histopathology due to
presence of uniform population of plasma cells a histopathological diagnosis of plasma cell rich lesion was made
with a differential diagnosis of extramedullary plasmacytoma and plasma cell granuloma. However,
immunohistochemical staining for kappa and lambda chains showed a polyclonal process and antibodies to
CD138 were strongly positive, confirming the diagnosis of plasma cell granuloma. The case describes a rare
condition of plasma cell granuloma occurring at an unusual site. Authors also emphasize the importance of
immunohistochemistry in differential diagnosis of plasma cell rich lesions.
Key words: Gingiva, Immunohistochemistry, Plasma cell
INTRODUCTION
Plasma cell granuloma is a rare, reactive, nonneoplastic lesion composed of polyclonal plasma
cells. This entity in the gingiva was first described in
1968 by Bhaskar, Levin and Firch. [1] This lesion does
not have a sex predilection and may occur at any age.
The exact incidence and etiopathogenesis is unclear.
However, it may arise due to periodontitis
orperiradicular inflammation due to a foreign body or
an idiopathic antigen. Parasitic etiology has also been
postulated.[2] It affects various organs like lungs,
paranasal sinuses, reticuloendothelial system, orbit,
ears, larynx, tonsils, lip, oral cavity and rarely
gingiva.[3] In exceptional cases, synchronous and
metachronous
involvement
has
also
been
[2]
documented. Histopathologically, it is composed of
polyclonal population of plasma cells in a
Amita et al.,
CASE REPORT
A 65- year old female presented with the chief
complaint of swelling over the right upper gingiva
and mobility of right upper 2nd and 3rd molar teeth
since 3-4 months. There was no history of rapid
increase in the size of swelling. There was no history
of trauma. On clinical examination, a solitary, welldefined swelling measuring 1.5 x 1cms, involving the
upper free gingival margin and part of the attached
margin was present. The swelling was mildly tender,
had a smooth pink surface and was bleeding on
probing the gingival crevices. There was no
exudation of pus. Patient was not a case of diabetes
mellitus. A provisional diagnosis of pyogenic
granuloma was made. Excision biopsy was done and
specimen sent for histopathologic examination.
Routine hematoxylin and eosin stain was done.
Immunohistochemical staining for ki67, CD138,
kappa and lambda immunoglobulin light chains was
done.
Histopathological examination of the specimen
revealed sub- epithelial sheets and clusters of plasma
cells in perivascular location with many Russell and
Dutcher bodies (Figure 1A and B) There was
evidence of binucleation and multinucleation(Figure
1 C). At places few plasma cells showed coarse
chromatin and prominent nucleoli (plasmablasts)
(Figure 1 D). No other inflammatory cells were seen.
Hence a histopathological diagnosis of plasma cell
rich lesion was made with a differential diagnosis of
extramedullary plasmacytoma and plasma cell
granuloma.
Amita et al.,
Amita et al.,
6.
7.
8.
9.
10.
470
Amita et al.,
DOI: 10.5958/2319-5886.2015.00090.9
Copyright @2015
ISSN: 2319-5886
Accepted: 31st Mar 2015
Tinmaswala et al.,
Tinmaswala et al.,
473
Tinmaswala et al.,
DOI: 10.5958/2319-5886.2015.00091.0
ISSN: 2319-5886
Accepted: 29th Mar 2015
Assistant Professor, 2Professor and HOD, Department of Pathology, 3Associate Professor, Department of
Surgery, NRI Institute of Medical Sciences, Bheemunipatnam, Andhra Pradesh
Lakshmi et al.,
Lakshmi et al.,
476
Lakshmi et al.,