Beruflich Dokumente
Kultur Dokumente
Research article
Open Access
ARTICLE INFO
Received: 4th Apr 2015
Revised: 23rd May 2015
Accepted: 29th Jun 2015
Authors details: 1Assistant Professor,
Department of Community Medicine,
Apollo Institute of Medical Sciences and
Research, Mumbai, Maharashtra, India
2
Assosicate Professor, Department of
Community Medicine, Apollo Institute of
Medical
Sciences
and
Research,
Mumbai, Maharashtra, India
Corresponding author: Saba Syed
Apollo Institute of Medical Sciences and
Research, Mumbai, Maharashtra, India
Mumbai, Maharashtra, India
Email: sabasyeddr@gmail.com
Keywords: HIV/AIDS Knowledge, Sexual
behaviour, Slum dwellers
ABSTRACT
Background: In India, currently 2.1 million people are living with HIV.
Prevention is the mainstay of the strategic response to HIV/AIDS in India.
Awareness rising brings behaviour change. People inhabiting slums have low
awareness and are more vulnerable to RTI/STIs and HIV/AIDS. Aims: To
assess HIV/AIDS knowledge, sexual behaviour, reported symptoms of
STI/RTIs along with the socio demographic profile of adult population of
urban slum dwellers. Methods: A cross sectional, qualitative study. The study
area, chosen by convenience sampling was an urban slum located in M East
Ward of Greater Mumbai. The study was finally conducted with 104
participants. Results: The mean age of surveyed participants was 23.5yrs
and nearly 38(40%) of participants were illiterate Age at first sexual
intercourse among the study participants was between 12-16 years for
23(22.10%) participants. Among study participants; 30(29%) of participants
do not have any knowledge about prevention and transmission of HIV/AIDS.
Conclusions: Urban slum residents in Mumbai have knowledge gap
regarding HIV/AIDS transmission and prevention. Initiation of sexual
intercourse is at an early age, a high percentage report symptoms of
STI/RTIs.
INTRODUCTION
[1]
[4]
Syed et al.,
740
Int J Med Res Health Sci. 2015;4(4):740-743
B.G.Prasad
Socioeconomic
Classification
Graduate
Married
Unmarried
Separated
Widow
a)Class I
b)Class II
c)Class III
d)Class IV
2
4
97
2
1
3
38
46
17
1.90
3.80
93.30
1.92
0.96
2.88
36.53
44.23
16.30
Syed et al.,
741
Int J Med Res Health Sci. 2015;4(4):740-743
Table 2: Knowledge regarding HIV/AIDS prevention & transmission among study participants
Knowledge of regarding HIV/AIDS Prevention and transmission
Yes
No
Dont know
Is HIV/AIDS Curable
HIV/AIDS Prevented By Consistent Condom Use
14(13.5%)
81(77.90%)
45(43.30%)
2(1.90%)
45(43.30%)
21(20.20%)
84(80.80%)
75(72.10%)
0(0.00%)
1(0.96%)
20(19.20%)
28(26.90%)
76(73.10%)
0(0.00%)
28(26.90%)
84(80.80%)
0(0.00%)
20(19.20%)
77(74.00%)
0(0.00%)
27(26.00%)
75(72.10%)
1(0.96%)
28(26.92%)
65(62.50%)
7(6.70%)
32(30.80%)
Syed et al.,
742
Int J Med Res Health Sci. 2015;4(4):740-743
22nd
7.
8.
9.
10.
11.
12.
13.
14.
ACKNOWLEDGMENT: Nil
Conflict of Interest: Nil
REFERENCES
1.
2.
3.
4.
5.
6.
NACO/National_AIDS_Control_Program/Prevention_
Strategies/ [Last accessed on March30 2015]
http://www.unaids.org/en/regionscountries/countries/i
ndia[Last accessed on February 28 2015]
http://www.worldbank.org/en/news/feature/2012/07/10
/hiv-aids-india[Last accessed on March30 2015]
Madise N. J. Are slum dwellers at heightened risk of
HIV infection than other urban residents? Evidence
from population-based HIV prevalence surveys in
Kenya. Health Place. 2012;18(5): 1144152.
K. Park, Epidemiology of Communicable Diseases,
Parks Textbook of Preventive and Social Medicine,
Syed et al.,
743
Int J Med Res Health Sci. 2015;4(4):740-743
DOI: 10.5958/2319-5886.2015.00145.9
Research article
Open Access
ARTICLE INFO
Received: 2nd May 2015
Revised : 14th July 2015
Accepted: 29th July 2015
Authors details: 1Third Year Junior
Resident, 2Associate Professor, 3Second
Year Junior Resident, Department of
Pharmacology,
Topiwala
National
Medical College and B. Y. L. Nair
Charitable Hospital, Mumbai Central,
Mumbai, Maharashtra, India
Corresponding
author:
Phatak
Abhishek M.
Topiwala National Medical College and
B. Y. L. Nair Charitable Hospital,
Mumbai Central, Maharashtra, India
Email: abhishekphatak9288@gmail.com
Keywords: Therapeutic drug
monitoring, Bioavailability,
Carbamazepine, Topiramate. Treatment
gap
ABSTRACT
Background: Large number of pharmaceutical companies manufactures
antiepileptic drugs in India. The price variations among the marketed drugs are
wide. Aims: The present study was aimed to find the cost of different oral
antiepileptic drugs available in Indian market as monotherapy, combination
therapy and number of manufacturing companies for each, to evaluate
difference in cost of different brands of same dosage of same active drug by
calculating percentage variation of cost. Methods and Materials: Cost of a drug
being manufactured by different companies, in the same strength and dosage
forms was obtained from Indian Drug Review Vol. XXI, Issue No.4, 2014 and
Current Index of Medical Specialties July-October 2014. The difference in the
maximum and minimum price of the same drug manufactured by different
pharmaceutical companies and percentage variation in price was calculated.
Results: The percentage price variation noted of long-established drugs was
Phenytoin (50mg): 140%, Carbamazepine (100mg): 1033%, Phenobarbital
(30mg) : 730%, Valproic acid (300mg) : 420%. Newer drugs Levetiracetam
(250mg): 75%, Lamotrigine (25mg): 66%, Topiramate (50mg): 108%,
Zonisamide (100mg): 19%. Combination drugs Phenobarbital + Phenytoin
(30+100) mg: 354.55%. Conclusion: The percentage price variation of different
brands of the same commonly used long-established oral antiepileptic drug
manufactured in India is very wide. The formulation or brand of Antiepileptic
drugs (AEDs) should preferably not be changed since variations in
bioavailability or different pharmacokinetic profiles may increase the potential for
reduced effect or excessive side effects. Hence, manufacturing companies
should aim to decrease the price variation while maintaining the therapeutic
efficacy.
INTRODUCTION
Epilepsy is a chronic non-communicable disorder of the
brain that affects people of all ages often interfering with
education and employment. Epilepsy is defined by
International League Against Epilepsy (ILAE) as a
condition characterized by recurrent (two or more)
epileptic seizures, unprovoked by any immediate
[1]
identified cause.
According to the World Health
Organization (WHO), of the 50 million people with
[2]
epilepsy worldwide, 80% reside in developing countries.
It is estimated that there are more than 10 million persons
with epilepsy in India. Its prevalence is about 1% in Indian
[3]
population. The prevalence is higher in the rural (1.9%)
[4,5]
compared to urban population (0.6%). The estimated
burden of epilepsy using the disability adjusted life years
(DALYs) accounts for 1% of the total burden of disease in
the world, excluding that due to social stigma and
[6]
isolation, which further add to the disease burden.
In many developing countries, people with epilepsy do not
receive appropriate treatment for their condition, a
phenomenon called treatment gap (TG), which is defined
as the number of people with active epilepsy not on
treatment (diagnostic and therapeutic) or on inadequate
treatment, expressed as a percentage of the total number
[7]
with active epilepsy.
The magnitude of epilepsy
744
Phatak et al.,
RESULTS
Valproic acid
Diazepam
Lorazepam
Clonazepam
Clobazam
500
750
25
9
32.00
85.00
153.00
106.05
378
25
1000
99.00
115.00
16
200
29.50
35.00
19
300
41.00
55.00
34
200
300
500
2
5
10
1
2
15
8
9
3
9
8
11
10
19.50
25.90
39.90
12.65
7.00
11.75
7.80
10.59
42.00
56.00
93.00
20.20
33.21
40.85
30.00
35.00
115
420
133
60
374
248
285
230
0.25
0.5
1
2
5
10
20
9
23
13
16
9
9
4
7.00
9.63
12.50
31.68
23.00
43.00
79.90
16.25
45.00
37.00
67.00
53.52
106.37
146.00
132
367
196
111
133
147
83
745
Phatak et al.,
INR: Indian rupees. The prices of 18 oral antiepileptic drugs (16 single and 2 combinations), available in 56 different
formulations were analyzed.
Table 2: Price variation among combination therapy
Drug
Formulation Doses
No of Manufa.
(mg)
Companies
Na valproate+ 2
200+87
7
valproic acid
333+145
7
Phenobarbital+ 1
30+100
3
phenytoin
INR: Indian rupees, Na: sodium
Table 3: Price variation in newer oral antiepileptic drugs
Drug
Formulation Doses
No.
of
(mg)
Manufacturing
Companies
Lamotrigine
3
25
4
Minimum
price (INR)
36.50
Maximum price
(INR)
62.50
% Price
variation
71.23
60.00
6.60
106.00
30.00
76.67
354.55
Minimum price
(INR)
Maximum price
(INR)
%
Price
variation
30.00
50.00
66
50
100
7
7
54.50
98.00
90.00
158.00
65
61
Gabapentin
100
300
400
3
10
5
36.20
98.75
119.50
44.00
131.00
152.00
22
33
27
Pregabalin
50
58.20
59.00
75
150
25
17
14
4
56.83
114.14
19.00
138.00
169.00
38.00
143
48
100
50
100
250
4
2
5
36.00
108.00
55.00
75.00
158.00
96.00
108
46
75
500
110.00
189.00
72
750
1000
50
100
150
4
2
2
3
11
168.00
290.00
57.00
87.79
26.39
280.00
360.00
59.40
104.70
42.00
67
24
4
19
59
300
12
48.33
75.00
55
450
110.00
120.00
600
10
90.00
134.00
49
Topiramate
Levetiracetam
Zonisamide
Oxcarbazepine
746
Phatak et al.,
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
CONCLUSION
The percentage price variation of different brands of the
same antiepileptic drug manufactured in India is very
wide. Considering the prevalence of epilepsy especially in
rural India where there are limited resources and poverty,
providing a broad overview of available antiepileptic drugs
and their prices is of utmost importance.There should be
education programs and marketing strategies so that
prescribers can select proper medication for their patients
14.
747
Phatak et al.,
748
Phatak et al.,
DOI: 10.5958/2319-5886.2015.00146.0
Research article
Open Access
ARTICLE INFO
Received: 9th May 2015
Revised : 2nd Jun 2015
Accepted: 22nd Jul 2015
1
University for
Development Studies, School of
Medicine and Health Sciences,Ghana
2
Ghana Health Service, TamaleGhana
Authors
details:
author:
Mahama
Saaka
University for Development Studies,
School of Medicine and Health
Sciences,Ghana
Email: mmsaaka@gmail.com
Corresponding
Pregnancy,
Haematological
Ghana
Haemoglobin,
status,
Northern
ABSTRACT
Introduction: Though nutrition is a key input to blood formation, little is
known about the extent maternal dietary quality contributes to the
haematological status of pregnant women in Northern Region of Ghana.
Objective: The aim of this study was to assess the independent
contribution of dietary diversity to haematological status of pregnant women
whilst controlling for potential confounding factors including malarial
infection. Methods: A cross-sectional study design was used on a sample
of 307 pregnant women in their third trimester. A structured questionnaire
was used to collect socio-demographic characteristics, obstetric and dietary
data related to anaemia. Overall dietary quality was assessed using the
dietary diversity score. Haemoglobin concentration (Hb) was measured
using portable HemoCueR Hb 301 system. Predictors of anaemia were
estimated using multiple linear regression analysis. Results: The mean Hb
was 10.81.4 g/dl and prevalence of anaemia (Hb<11.0 g/dl) was 46.3 %.
High dietary diversity score [Beta coefficient (), = 0.141 p < 0.001], multigravidity (=0.205) and high composite score for ANC content (= 0.201)
were associated with a decreased risk of anaemia in the third trimester of
pregnancy. Conclusion: The findings suggest the need to strengthen
interventions that focus on improving the consumption of diversified foods
particularly during pregnancy.
INTRODUCTION
In most developing countries maternal under nutrition
including micronutrient deficiencies is a leading cause of
[1]
maternal and child mortality and morbidity . Anaemia in
particular is one of the most prevalent public health
problems in Ghana. Anaemia is defined as a condition in
which the number and size of red blood cells or
haemoglobin concentration falls below an established cut
-off, consequently impairing the capacity of the blood to
[2]
transport oxygen around the body . According to recent
estimates, anaemia affects 60.0% pregnant women in
developing countries including Ghana and about 7.0 % of
[3,4]
cases are severe
.
The aetiological factors responsible for anaemia in
pregnancy are multiple and their relative contributions are
[5]
said to vary by geographical area and by season .
Admittedly, several predisposing factors contribute to
anaemia among pregnant women and these include sociodemographic, socio-economic status, multiparity, short
[6]
inter-pregnancy intervals and nutritional factors . The
relative importance of each of these varies from place to
place. In the Northern Region of Ghana, where anaemia is
of public health significance, very little is documented
regarding the role maternal dietary factors contribute to
haematological status. The role of diet on blood
biomarkers may be significant, but evidence of the
magnitude of this benefit is limited.
An understanding of association between dietary diversity
and haematological status may be complicated by other
factors including malarial infection and household socioeconomic status. This study sought to determine the
749
Saaka et al.,
750
Saaka et al.,
30 (66.7)
121(54.3)
8 (24.2)
Maternal 7-day dietary diversity
Low
162
High
139
69(46.9)
55(60.4)
18(28.6)
=15.2
p= .001
2
117(51.5)
25(33.8)
37(61.7)
105(43.6)
= 7.1
p=.008
=
6.3
p=.012
2
15 (33.3)
102(45.7)
25 (75.8)
=14.5
p=0.001
91 (56.2)
=11.4
p=.001
71 (43.8)
88 (63.3)
51 (36.7)
Table 2b: Bivariate Analysis of predictors of anaemia
among pregnant women
N
Anaemia
Characteristic
No
n (%)
Test
statistic
Yes
n (%)
160
71 (44.4)
89 (55.6)
High
141
88 (62.4)
53 (37.6)
= 9.7
p
=
0.002
ANC visit
<4
146
58 (39.7)
88 (60.3)
155
101(65.2)
54 (34.8)
=
19.5
p<
0.001
173
0-1
None
69 (39.9)
104 60.1)
90 (70.3)
38 (29.7)
=
27.3
p<
0.001
77
Parity
35 (45.5)
42 (54.5)
18
7 (38.9)
11 (61.1)
56 (58.9)
29 (37.7)
10.9
p=
128
=
8.9
2-3
194 114(58.8) 80 (41.2)
p=
At least 4
30
10 (33.3) 20 (66.7)
0.011
Doses of antimalarial prophylaxis (IPTp) with (SP)
1 dose
2 doses
95
77
39 (41.1)
48 (62.3)
751
Saaka et al.,
3 doses
111
65 (58.6)
46(41.4)
0.012
Table 3: Food groups consumption frequency in the past week (n= 307)
Frequency of foods consumption in the past week (% of women)
Type of food
Usually every day
4 to 6 times per week
1- 3 times per week
Meat
Poultry
Liver
Fish
Cereals
Roots & tubers
Legumes
Dairy products
Eggs
Fruits
Green leafy vegetables
58.0
2.3
14.3
18.6
97.1
84.7
58.0
2.0
4.2
22.5
37.5
34.2
19.2
43.0
30.6
2.3
11.7
34.9
22.8
16.3
30.6
44.6
7.2
50.8
53.8
41.7
0.7
1.3
7.1
45.0
39.4
36.2
14.3
Never/rarely
0.7
27.7
6.8
9.1
0.0
2.3
0.0
30.2
40.1
10.7
3.6
Collinearity
Statistics
Tolerance VIF
0.909
0.580
0.476
0.446
1.100
1.725
2.103
2.240
0.23
0.91
0.592
1.688
0.39
0.95
0.866
1.155
752
Saaka et al.,
753
Saaka et al.,
11. Vyas S, Kumaranayake L. Constructing socioeconomic status indices: how to use principal
components analysis. Health Policy Plan 2006;
21:45968.
12. Filmer D, Pritchett LH. Estimating wealth effects
without expenditure dataor tears: an application to
educational enrollments in states of India.
Demography 2001; 38:115-32.
13. Rutstein SO, Johnson K. DHS Comparative Reports
6: The DHS Wealth Index. Calverton, Maryland,
USA: ORC Macro, MEASURE DHS;2004; 6:4-10.
14. Howe LD, Hargreaves JR, Huttly SRA. Issues in the
construction of wealth indices for the measurement of
socio-economic position in low-income countries.
Emerging Themes in Epidemiology 2008; 5:3
15. Mockenhaupt FP, Rong B, Gunther M, et al. Anaemia
in pregnant Ghanaian women: importance of malaria,
iron
deficiency
and
haemoglobinopathies.
Transactions of the Royal Society of Tropical
Medicine and Hygiene. 2000;94:477-83.
16. McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist
B. Worldwide prevalence of anaemia, WHO vitamin
and mineral nutrition information system, 19932005.
Public Health Nutr 2009;12:444.
17. Ghana Statistical Service (GSS), Ghana Health
Service
(GHS),
ICF
International.
Ghana
Demographic and Health Survey. Accra, Ghana:
GSS, GHS, ICF International.;2015;6: 30-31
18. UNICEF. Multiple Indicator Cluster Survey (MICS)
Accra: UNICEF;2011.
19. Samuel TM, Thomas T, Finkelstein J, et al. Correlates
of anaemia in pregnant urban South Indian women: a
possible role of dietary intake of nutrients that inhibit
iron absorption. Public Health Nutr 2013;16(2):31624.
20. Galloway R, Dusch E, Elder L, et al. Womens
perception of iron deficiency and anaemia prevention
and control in eight developing countries Social
Science and Medicine 2002;55:52944.
21. Clerk CA. Efficacy of sulphadoxine-pyrimethamine
and amodiaquine alone or in combination as
intermittent preventive treatment in pregnancy in the
Kassena-Nankana district of Ghana: a randomized
controlled trial London, University of London; 2007;
PhD Thesis.
22. Kedir H, Berhane Y, Worku A. Khat Chewing and
Restrictive Dietary Behaviors Are Associated with
Anemia among Pregnant Women in High Prevalence
Rural Communities in Eastern Ethiopia. PLoS ONE
2013; 8(11):78601. .
23. Abriha A, Yesuf ME, Wassie MM. Prevalence and
associated factors of anemia among pregnant women
of Mekelle town: a cross sectional study BMC
Research Notes. 2014;7:888.
24. Gebremedhin S, Enquselassie F. Correlates of
anemia among women of reproductive age in
Ethiopia: evidence from Ethiopian DHS. Ethiopian J
Health Dev 2005; 25(1):2230.
25. Baig-Ansari N, Badruddin SH, Karmaliani R, et al.
Anemia prevalence and risk factors in pregnant
women in an urban area of Pakistan. Food Nutr Bull.
2008; 29(2):13239.
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DOI: 10.5958/2319-5886.2015.00147.2
Open Access
ARTICLE INFO
Received: 11th May 2015
Revised : 2nd Jun 2015
Accepted: 23rd Jul 2015
1,2
Department of
General Surgery, D Y Patil Medical
College, Mauritius
Authors
details:
author: Murali U
Department of General Surgery, D Y
Patil Medical College, Mauritius
Corresponding
Email: srimuralihospital2012@gmail.com
Incisional
hernia,
Complications, Co-morbidity, Obesity.
Keywords:
ABSTRACT
Background: Incisional hernia is a common iatrogenic complication of
abdominal surgery and is a cause of unwanted morbidity. The study was
reported for the first time from Republic of Mauritius. Aims & Objectives: The
objective of the study was to analyze the clinical pattern and effect of comorbidities on the clinical course of incisional hernias and repair. Methods: The
study is a cross sectional study conducted at a tertiary care hospital for over 22
months. 38 patients with incisional hernia were studied with special emphasis
laid on the predisposing factors and co-morbidities at the time of hernia repair.
Results: In this study the incidence of incisional hernia was prevalent in females
and occurrence was 3 times more than males. All hernias in females were the
result of a gynaecological operation. 68% (26 out of 38 patients studied) of
hernias were reported within 2 years of gynaecological operation. Majority of
patients presented with swelling and pain related to scar. Twenty two out of
thirty eight were operated and hernia repaired. Obesity was found to be the
most important factor when the effects of co-morbidities were studied. Fifteen
out of thirty eight (39.47%) patients came under the category of morbidly obese.
Conclusion: In patients with recurrent hernia control of obesity and other comorbidities before the attempt to repair hernia can be decisive.
INTRODUCTION
Incisional hernia is a problem of magnitude. It is also a
socioeconomic problem. For the individual patient
incisional hernia is an unexpected and hindering
complication, which can influence daily life in such a
manner that he or she could be consider disabled.
Repeated admissions and operations have a major impact
on the patient. When subsequent hernia repair does not
solve the problem, but results in recurrence or
complications, a patients quality of life may be seriously
affected.
Incisional hernia occurs in about 2-19% of patients after
[1, 2, 3, 4]
various incisions
. When the scar has a defect, the
abdominal contents may start protruding through it, due to
intra-abdominal pressure. Certain conditions like chronic
cough, chronic constipation, urinary obstruction, obesity,
pulmonary disease, repeated pregnancies and postoperative abdominal distension may further increase the
pressure unwantedly and increase the chance of incisional
[5, 6]
hernia
. Wound infection is probably an important risk
[7]
factor for the development of incisional hernia
and
[8, 1, 2]
wound dehiscence
. In spite of all precautions during
surgery and meticulous repairs to cure them, a number of
cases of incisional hernias are being reported with failures
of repairs leading to Recurrent incisional hernia.
Therefore, prevention of incisional hernia is warranted.
Our aim was to study the aetiopathogenesis and effects of
co-morbidities on the clinical course of incisional hernias
and repair.
MATERIALS & METHODS
Study design: It was a cross sectional, Descriptive study
756
Murali et al.,
for the hernia were infra umbilical midline (16) and supra
umbilical midline (13) (Table 1).
Lower segment caesarean section (LSCS) was the
commonest operation responsible for the incisional hernia
in 18 cases of this study followed by emergency
laparotomy (Table 1). The dimension of the defect was
studied in only 30 patients. The commonest defect size
was 12 sq. cm. observed in 7 followed by 8 sq.cm in 6 out
of 30 patients studied (Table 1). The time period
between the appearance of hernia and the operation
responsible for it showed that 26 out of 38 patients
reported about their hernia within 2 years of operation
(68.42%) (Table 2).
Morbid obesity was the commonest co-morbidity amongst
the patients (15) studied followed by hypertension in 14
patients (Table 3). Out of the 38 patients studied, 28
(73.68%) patients were obese (BMI over 25 kg/m2). Out of
these 28 patients, 15 came under the category of morbidly
obese with 3 in class III (BMI over 40 kg/m2), 4 in class II
(BMI over 35 kg/m2) and 8 in class I (BMI over 30 kg/m2).
Out of 38 patients, 22 were operated and repair of hernia
carried out. There was no recurrence or complications
observed in our study. There was no mortality.
757
Murali et al.,
4.
5.
6.
7.
8.
9.
758
Murali et al.,
759
Murali et al.,
DOI:10.5958/2319-5886.2015.00148.4
Research article
Open Access
ARTICLE INFO
ABSTRACT
th
Authors details:
Department
Medical Laboratory Science, College
Medical
Sciences,
University
Maiduguri, Nigeria
2
Chemical
Pathology,
College
Medical Sciences, University of
Maiduguri, Nigeria
of
of
of
of
INTRODUCTION
Iodine is an essential nutrient needed by the body in small
quantity but necessary for normal growth, development
[1-3]
and metabolism throughout a persons lifetime
. Iodine
is necessary for thyroid hormone synthesis. Thyroid
hormone influences general body metabolism, therefore,
iodine deficiency poses a threat throughout the lifecycle of
[4].
humans
Severe and mild iodine deficiency causes
harmful effects on brain and nervous system
dsevelopment in children and decrease ability to work and
[5,6]
think clearly in adults
. Iodine deficiency has been
associated with mental impairment, goiter, and some
complications in pregnancy, including stillbirth and
congenital anomalies. Inadequate iodine intake during
[4]
pregnancy may lead to irreversible fetal brain damage .
The recommended intake of iodide for adults is a
minuscule amount. Consuming seafood, vegetables
grown in iodine- rich soil and iodized salt easily meet the
[1,2, 6]
bodys need for iodine
. Urinary iodine (U.I) analysis
is the most common method for assessing population
wide iodine sufficiency and deficiency, because more than
90% of dietary iodine is excreted in the urine with normal
[7, 8]
renal function
. There is scarcity of information on
iodine status in this environment, since the Federal
Government campaign on iodized salt some years ago
hence the need for this pilot study.
Aim of the study: To determine the iodine status of nonpregnant females in the reproductive age group in this
environment.
MATERIALS AND METHOD
Study design: This study is a prospective case study.
Ethical approval: Ethical clearance was obtained from
the University of Maiduguri Ethical Committee. Personal
consent of the students were sought after explaining the
purpose of the research.
Sample size: The study Subjects comprised of 158
apparently healthy female students of University of
Maiduguri Borno State, Nigeria.
Inclusion criteria: Their ages ranged between 20-41
years and been resident in Maiduguri for at least seven
years. These groups of female students are in their
reproductive age and their iodine status may be of public
interest for better management. Female volunteers were
recruited within six (6) months.
Exclusion criteria: Those diagnosed with thyroid
disorders, obvious goiter, on medication with iodine
contain reasonable to influence patient iodine, on
antithyroid medications or on hormonal replacement
therapy, Females not in the reproductive age group,
Pregnant or breast feeding mothers
Methodology:
760
Musa et al.,
0(0)
4.43(7)
Mild (50-99)
46.84(74)
Sufficient (100-199)
48.73(77)
Excess (>300)
0(0)
DISCUSSION
The potential impact of iodine deficiency on the
intellectual development of large segments of the
populations in underdeveloped countries is of particular
concern, especially when all of the adverse effects of
iodine deficiency can be prevented by long-term,
[10],[11]
sustainable iodine prophylaxis
. Universal salt
iodization has been extremely effective at reducing the
burden of iodine deficiency and represents a major global
public health success. Iodine deficiency can be prevented
by iodization of table salt with one part of sodium iodide to
[12]
every 100,000 parts of sodium chloride
. Urinary iodine
excretion has been reported as a good marker of th e
dietary intake of iodine, and used as an index for
evaluating the degree of iodine deficiency, correction and
[10],[11],[15]
toxicity
. Many countries including Nigeria have
adopted massive salt iodization as a means of correcting
iodine deficiency disorders (IDD) in countries where they
[13]
were prevalent
. The World Health Organization gave
an epidemiologic criteria for assessing iodine nutrition
based on median urinary iodine concentrations in different
target groups i.e. school-age children (6 years or older)
with Median urinary iodine (g/l) < 20 indicates insufficient
iodine intake (severe iodine deficiency), 20-49 indicates
insufficient iodine intake (moderate iodine deficiency), 5099 indicates insufficient iodine (mild iodine deficiency),
100-199 indicates adequate iodine intake (adequate
iodine nutrition) and 200-299 indicates above
requirements iodine intake that may pose a slight risk of
more than adequate iodine intake in these populations.
Median urinary iodine (g/l) 300 indicates excessive
iodine intake with risk of adverse health consequences
(iodine-induced) of hyperthyroidism, autoimmune thyroid
[4]
disease etc .The consequence of excess iodine is JobBasdow or even
hypothyroidism and may lead to
malignant changes particularly the follicular type of thyroid
carcinoma From this study, the median urinary iodine
excretion in the population studied was 95.0g/l (table1),
which is below the recommended value of (100-199 g/l)
by WHO. The results from this study indicate that none of
the students had severe iodine deficiency. However, that
there were still moderate (4.4%) and high percentage
(46.84%) of mild iodine deficiency suggests insufficient of
iodine intake in our study population (table 2), which is of
great public health concern. This finding is consistent with
[14]
the findings of Mu et al , who reported mild to moderate
iodine deficiency across the populations including school
children. This study shows higher percentage of mild
deficiency compared to the findings of Onyeaghala et al
[15]
[16]
and Cosmos et al
. Iodized salt is widely available
commercially in this environment but the percentage in
the salt need to be evaluated in further study. It is likely
that household salt may not contain the recommended
level of iodine. Our study showed none of the student had
excess urinary iodine (table 2). This finding contradicts
[17]
the report of Delange et al , who reported high
concentrations of urinary iodine in some African countries
few years after the introduction of massive iodization
761
Musa et al.,
6.
CONCLUSION
9.
7.
8.
10.
11.
12.
13.
14.
15.
Conflict of Interest: Nil
REFERENCES
1.
2.
3.
4.
5.
16.
17.
18.
762
Musa et al.,
DOI:10.5958/2319-5886.2015.00149.6
Open Access
ABSTRACT
ARTICLE INFO
th
Postgraduate
Student, Department of Community
Medicine, Karnataka Institute of
Medical
Sciences,
Hubballi,
Karnataka
2
Professor
of
Department
of
Community Medicine & Director of
Karnataka Institute of Medical
Sciences, Hubballi, Karnataka
Authors
details:
INTRODUCTION
The nutritional status of children in the community is
alarming. Prevalence of stunting and wasting in children
aged less than 3 years is 44.9 % and 22.9 % respectively
[1]
. Nutritional status of children is an indicator of
nutritional profile of the entire community. Studies
conducted worldwide show that 150 million (26.6%) are
underweight, while 182 million (32.5%) are stunted all
over the world. More than half of the worlds
[2]
undernourished people live in India . Adequate Nutrition
is critical to child and its development .The period from
birth to two years of age is particularly important because
of the rapid growth and brain development that occurs
during this time. This period is often marked by growth
faltering, micronutrient deficiencies, and common
childhood illnesses such as diarrhoea, as transition of
diet of children from exclusive breastfeeding to solid
[3]
foods in addition to breast milk .The urban population is
rapidly expanding because of large scale migration to
cities for a possible better life. As a result, urban poverty
and hunger are increasing in many developing countries.
It is projected that more than half of the Indian population
will live in urban areas by 2020 and nearly one third of
this urban population will be of slum dwellers. The
ongoing process of rapid urbanization has deleterious
763
Anjana et al.,
e)
f)
764
Anjana et al.,
Table: 1.
Subjects
Socio-Demographic
profile
Socio-Demographic profile
Variable
Frequency
(N = 110 )
Sex
Male
7
Female
63
Religion
Hindu
43
Muslim
67
SES
Class 2
1
Class 3
33
Class 4
55
Class 5
21
Mothers
Illiterate
35
Education
Literate
75
Type
of Nuclear
27
Family
Joint
66
3 generation
17
of
Study
(%)
Nutritional
Status
42.7
57.3
39.1
60.9
0.9
30.0
50.0
19.1
31.8
68.2
24.5
60.0
15.5
25 (22.7 )
Normal
Underweight
85( 77.3)
52 (47.3 ) 58 ( 52.7)
41 (37.3 ) 69 ( 62.7)
38 (34.5)
72 ( 65.5)
34.5
62.7
65.5
Breastfeeding
Continuation after 6
52.7
47.3
Adequate Meal
Frequency Followed
53.6
46.4
Adequate Dietary
Diversity Followed
No
13.6
0.136
0.840
0.0049*
complementary
No
32
40
0.06
0.034*
0.05*
0.44
DISCUSSION
37.3
Timely Initiation of
Complementary feeding
40
45
52.7
47.3
16
09
No
77.3
22.7
Initiation of BF within 1
hour of Birth
Yes
86.4
Yes
765
Anjana et al.,
2.
3.
4.
5.
6.
7.
8.
9.
10.
CONCLUSION
The Infant and Young child feeding practices in this study
area were not satisfactory. Nearly half of the children
were underweight which can be attributed to the poor
IYCF practices. Although there have been numerous
efforts to improve the Mother and Child health by the
state as well as central through plenty of national
programs, yet persists the problem of malnutrition and
inadequate child feeding practices.
As the present study was cross-sectional, temporal
association cannot be found out. Hence there is a need
for large community based prospective study in this area
to determine the benefits of adequate IYCF practices and
health and nutrition education measures in improving the
nutritional status of children.
Acknowledgement: I extend my gratitude to all the staff
of Community medicine Department, KIMS Hubballi for
helping and supporting me in one or the way throughout
11.
12.
13.
766
Anjana et al.,
767
Anjana et al.,
DOI: 10.5958/2319-5886.2015.00150.2
Research article
Open Access
Rubha S , Vinodha R
ARTICLE INFO
Received: 2nd Jun 2015
Revised: 21st Jul 2015
Accepted: 5th Aug 2015
Authors details: 1Postgraduate student
in
Physiology,
Department
of
Physiology, Thanjavur Medical College,
Thanjavur, Tamilnadu, India
2
Professor & HOD, Department of
Physiology, Thanjavur Medical College,
Thanjavur, Tamilnadu, India
Corresponding author: Rubha S,
Department of Physiology, Thanjavur
Medical College, Thanjavur, Tamil Nadu,
India
Email: rubhasethuraman@yahoo.com
Keywords: Malnutrition, Children, Nerve
conduction velocity, Motor & Sensory
nerve conduction velocity
ABSTRACT
Background: Peripheral nerve conduction changes caused by malnutrition
can be shown clinically and electrophysiologically. They are produced
mainly due to deficiency of micro and macronutrients like vitamins,
minerals, protein, fat & Carbohydrate Aim : Protein energy malnutrition
(PEM) affects the myelination and growth of the nervous system. The
aim of this study was to assess the effects of PEM on peripheral
nerve conduction in children. Materials & Methods: Study group includes
40 malnourished children of 5 10 years of age from Raja Mirasudar
Hospital, Thanjavur based on Indian Academy of Paediatrics & WHO
classification for malnutrition. Control group consists of 40 normal
children of same age group. Nerve conduction study for median nerve
was performed using eight channel digital polygraph. Nerve conduction
velocity was evaluated. Results were analysed statistically using
unpaired student t test. Results : Nerve conduction study (NCS) showed
reduced motor and sensory nerve conduction velocity ( p < 0.05 ) in
children with Grade III malnutrition. Children with Grade I, II malnutrition
showed reduced sensory nerve conduction velocity ( p < 0.05 ).
Conclusion: The present study shows significant reduction in nerve
conducion velocity in children with malnutrition which may be due to
nutritional deficiency affecting myelination of peripheral nerves which
depends on duration and severity of malnutrition. So nerve conduction
study can be used to detect malnutrition at its early stage.
INTRODUCTION
WHO defines protein energy malnutrition as a range of
pathological conditions arising from coincidental lack in
varying proportions of proteins and calories, frequently
occurring in infants and young children usually
associated with infection. About 60 70% of children
have mild to moderate malnutrition and the remaining
[1]
are severely malnourished.
Protein energy malnutrition is known to be a major
[2]
health and nutrition problem in India.
Children
having birth order greater than or equal to 3 and
those not immunized had higher prevalence of
[3,4]
protein energy malnutrition.
A marginally adequate
diet, as weaning diets in developing countries does not
meet these increased needs. Protein energy malnutrition
is observed even in industrialized countries, associated
with the presence of clinical conditions that decrease
food intake or absorption of food. Dietary proteins are
the source of brain enzymes and neurotransmitters. The
quality of dietary proteins determines the quantity of
cerebral proteins and neurotransmitters. Thus the amino
acid profile of cerebral extracellular milieu is a function of
[5,6]
dietary proteins.
Malnutrition does not only risk the
population for anemia and repeated infection, but it
affects the developmental milestones and intellectual
development. This persistent influence will lead to
devastating effects in future. This burden continues in
generations, as
malnourished young girls become
Rubha et al.,
[7]
768
Int J Med Res Health Sci. 2015;4(4):768-770
Rubha et al.,
RESULTS
Statistical analysis was done by using SPSS version
20.The results were analysed using unpaired student
t test. Values were expressed as mean with standard
deviation. The control group was compared with
grade III & grade I,II malnourished group. p value <
0.05 was considered as statistically significant.
Table 1: Anthropometric measurements of case &
control group
Height for
age (cm)
Group
GradeI&II
123.0 9.67
Weight for
age (kg)
Age (years)
Mean SD
21.513.76
8.451.82
Grade III
103.4 7.56
15.322.96
Control
124.1 1.58
26.754.50
7.571.74
Table 2: Nerve conduction study results in study
group
Parameter
Control
Study group Study group
(m/sec)
group
(Grade III)
(Grade I& II)
MNCV
46.58 17 33.8117.9*
40.6620.0
SNCV
46.78
30.75 9.3*
38.9617.5*
12.1
*p < 0.05 Significant, MNCV= Motor nerve conduction
velocity, SNCV = Sensory nerve conduction velocity
DISCUSSION
Malnutrition is widely prevalent in all developing
countries and children are the worst sufferers. Early
development of malnutrition during the critical period of
brain development has devasating effect on brain
growth. This period extends from prenatal to early
postnatal life. Active synthesis of myelin occurs in this
period. Myelin is composed of protein & phospholipid
derived from cell membrane of oligodendrocytes in
central nervous system and from Schwann cells in
peripheral nervous system. Malnutrition in this period
results in physical, chemical, & functional changes in
brain. All changes occurring in this period are likely to be
irreversible that has a long lasting effect mainly due to
delay in myelination. Malnutrition results in poor
learning abilities, impaired cognitive functions and
[17]
school dropouts .
This study has shown significant reduction in nerve
conduction velocity in children with malnutrition. Motor &
sensory nerve conduction velocity is significantly
reduced in children with Grade III Malnutrition. Sensory
nerve conduction velocity is significantly reduced in
Grade I & II group.Sensory nerve conduction studies are
more sensitive than motor nerve conduction study in
[18] .
detecting early or mild demyelinating diseases
[19]
Shanthi ghosh et al
conducted nerve conduction
study in 67 children to assess the effect of malnutrition
on peripheral nervous system. Significant reduction in
nerve conduction velocity was observed in children with
severe protein energy malnutrition and ongoing longterm
malnutrition .They found that undernutrition produces
permanent molecular errors in brain membrane
composition and affects biochemical maturity of
769
Int J Med Res Health Sci. 2015;4(4):768-770
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
REFERENCES
1.
2.
3.
4.
Rubha et al.,
19.
20.
21.
770
Int J Med Res Health Sci. 2015;4(4):768-770
DOI: 10.5958/2319-5886.2015.00151.4
Research article
Open Access
Sowmiya R , Vinodha R
ARTICLE INFO
nd
ABSTRACT
Background: Migraine is worldwide common, chronic, Neurovascular
disorder, characterized by attacks of severe headache and an Aura
involving neurologic symptoms. Its pathogenesis was incompletely
understood whether of cortical or brainstem origin.
Aim: The present
study was undertaken to investigate brainstem auditory functions in
Migraine patients. Materials and Methods: The subjects were recruited
based on International Headache Society classification for Migraine.
Subjects with episodes of headache for at least 2yrs, 2 attacks per month in
last quarter year were included in the study. Forty subjects (16 Migraine
with Aura & 24 cases Migraine without aura) & forty age / sex matched
controls were selected. Brainstem auditory evoked potential was recorded
using 4-Channel polygraph (Neuro perfect plus). Electrodes were placed
according to 10 20 electrode placement system. Auditory stimulus in the
form of click sound is delivered through the headphones. Clicks were
delivered at a rate of 8-10 /sec. The intensity of the stimulus is set at 30db.
About 100 averages were recorded. BAEP waveforms - Wave I, III & V
latencies and the interpeak latencies were measured. The results were
analysed statistically using studentt test. Results: BAEP recording shows
significant prolongation in latencies of Wave I, III & V and the Interpeak
latency (IPL) I-III, III-V & I-V in Migraine with aura. In Migraine without aura,
there was significant prolongation of Wave I, III & V and III-V & I-VIPL
(P<0.05). Conclusion: Prolongation suggests that there is involvement of
brainstem structures in Migraine, thus BAEP can be used as an effective
tool in evaluation of Migraine.
INTRODUCTION
Headache is one of the most frequently encountered
[1]
Neurological symptom. Headache is caused by irritation
of pain sensitive Intracranial structures like Dural sinuses,
intracranial portions of Trigeminal , Glossopharyngeal,
Vagus and upper Cervical nerves ;large arteries and
venous sinuses. The structures which are insensitive to
pain are Brain parenchyma, Ependymal lining of
.[2]
ventricles and the Choroid plexus
Painful stimuli arising from the brain tissue above the
Tentorium cerebelli are transmitted via Trigeminal nerve
whereas impulses from posterior fossa are conveyed by
Glossopharyngeal, vagus and upper two cervical
[2]
nerves. Headache disorders can be classified into
Primary Headache disorder and Headache secondary to
structural brain disease.
Primary Headaches are disorders in which headache
and associated features occur in the absence of
exogenous cause. Migraine, Tension type headache and
Cluster headache are most common Primary headache
[3]
syndromes.
Migraine is the disorder of the brain characterized by
[4]
complex sensory dysfunction.
It is an Episodic
headache disorder and second most common type of
[2,3]
primary headache.
Migraine occurs at any age either
at childhood, adolescent or adult life , more common in
Sowmiya et al.,
771
Int J Med Res Health Sci. 2015;4(4):771-774
Control
Wave I
Mean SD
1.2720.293
Mean SD
1.12220.23
0.044
Wave III
3.9381 0.62
3.43230.64
0.009
Wave V
I III IPL
6.34441.40
2.66250.58
5.65100.92
2.27970.58
0.033
0.028
III V IPL
2.59060.57
2.24200.46
0.020
Parameters
(msec)
P value
I V IPL
5.25561.05
4.48880.82 0.005
BAEP study results showed significant prolongation in
latencies of Wave I, III & V with P value <0.05 in Migraine
patients when compared with controls. Also, the
interpeak latencies I- III, III- V & I- V were significantly
prolonged in study group, Migraine with aura than the
controls (Table 1). In Migraine without Aura III- V & I- V
IPL were significantly prolonged. (Table 2)
Table:2. Comparison of Brainstem Auditory Evoked
Potential Mean values in cases ( Migraine without
aura ) &Control group
Parameters
(msec)
Wave I
Wave III
Wave V
I III IPL
III V IPL
I V IPL
Migraine
without Aura
Control
Mean SD
Mean SD
1.390.359
3.79 0.56
6.33 0.82
2.39 0.42
2.56 0.52
4.950.67
1.12220.23
3.43230.64
5.65100.92
2.27970.57
2.24200.46
4.48880.82
P
value
0.000
0.029
0.004
0.411
0.014
0.022
772
Sowmiya et al.,
DISCUSSION
In the present study, Brainstem auditory Evoked Potential
parameters were evaluated in Migraine patients with and
without Aura and in control group. Migraine can best be
explained as a Brain state in which the cellular and
vascular functional changes occur at the same time due
to dysfunction of subcortical structures, brainstem and
diencephalic nuclei that modulate sensory inputs. These
nuclei act as a Migraine Mediator whose dysfunction will
lead to abnormal perception and activation of Trigeminal
Vascular System(TVS) which then activate the central
structures.
Thus, Migraine is mainly due to TVS activation generated
within the brain without a peripheral sensory input.
Migraine is the central sensory processing disorder,there
is dysfunction of descending brainstem pain modulatory
system. The hyperexcitability of the nociceptive circuitry
downstream is responsible for this central sensitization in
[12]
Migraine patients.
BAEP study reports showed significant prolongation of
Latencies and Interpeak latencies in Migraine when
compared with controls.
[13]
D Kaushal, S Sanjay Munjal, M Modi, N Panda
Evaluated BAEP in 25 Migraine patients. They reported
prolongation inwave I, III & V latencies and I-III & I- V
interpeak latencies and revealed that prolongation was
due to involvement of Brainstem structures as well as
activation of brainstem in Migraine patients. These results
were in accordance with our present study.
[14]
Anil K Dash et al ., Studied audiovestibular functions in
Migraine patients with and without vertigo. BAEP results
revealed that there was significant prolongation in
latencies of wave I, III & V and interpeak latencies I-III ,
III-V & I-V. This study concluded that BAEP abnormalities
are the earliest indicator of impending auditory
involvement in patients with Migraine. These results were
consistent with our present study.
[7]
Laila EL Mosly et al., Evaluated the effect of Migraine on
quality of life in females and associated changes in
evoked potentials. They measured BAEP in 30 Migraine
patients and reported
that there was prolongation of
wave III& wave V latency and I- III & I- V interpeak
latency due to hyperexcitability of the cerebral cortex but
no significant change in III V interpeak latency both
during an attack and in the interictal phase. These
results were similar with our present study.
[15]
Firat Y et al ., Measured auditory brainstem responses
in pediatric population during the period of an attack and
asymptomatic period of Migraine. There was prolongation
of wave V and I V Interpeak latency in Migraineurs.
These changes were due to transient impairment of
auditory brainstem function in Migraine patients. These
results were in accordance with our present study.Drake
[16]
ME et al., Measured BAEP in 50 common Migraine
cases. They found that there was significant prolongation
of I V and III- V interpeak latency in Migraine patients.
This study suggests that prolongation was due to
dysfunction of brainstem centers and possibly related to
endorphin or serotonin neurotransmission.
[17]
Sherifa A Hamed ,Amal Mohammed Elatter Evaluated
vestibular function in 58 Migraine patients(with and
773
Sowmiya et al.,
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
774
Sowmiya et al.,
DOI: 10.5958/2319-5886.2015.00152.6
Open Access
2 *
ARTICLE INFO
th
Authors details:
Professor and
2,3
Head, Junior Resident Department
of OBGY, JSS Medical College, JSS
University, Mysore, India
Corresponding author: Surakshith L
Gowda
Junior Resident Department of OBGY,
JSS Medical College, JSS University,
Mysore, India
Email: surakshithlgowda@gmail.com
Keywords: Gestational Diabetes
Mellitus, Maternal and Fetal
complications, Macrosomia,
Preeclampsia
ABSTRACT
Introduction: Women with Gestational Diabetes Mellitus (GDM) are at
increased risk for many other health concerns with short and long-term
implications for both mother and child. They are at higher risk for glucosemediated macrosomia, hypertension, birth trauma, respiratory distress,
hypoglycemia, hyperbilirubinemia with increased neonatal intensive care
unit (NICU) admissions. Postpartum complications include obesity and
impaired glucose tolerance in the offspring and diabetes and cardiovascular
disease in the mothers. Objectives: To study the incidence of maternal
and fetal co-morbidities associated with GDM. Materials and Methods:
This is a retrospective observational study where cases with GDM were
analyzed for maternal and fetal complications. Results: 189 cases were
detected to be Gestational Diabetes Mellitus, out of which 63.49% cases
developed co-morbidities with GDM. 11.11% cases developed
preeclampsia, 9.52% had polyhydramnios, 5.8% patients went into preterm
labour, 3 cases had Antepartum Haemorrhage and one case had
Postpartum Haemorrhage. 19.57% cases developed macrosomia,
hypoglycemia was seen in 7.40% babies and hyperbilirubinemia in 3.70%
babies. 6 Intra Uterine Deaths and 2 still borns were documented.
Conclusion: GDM is a condition which is worth monitoring and treating,
since it has been demonstrated that good metabolic control maintained
throughout gestation can reduce maternal and fetal complications.
INTRODUCTION
Gestational Diabetes Mellitus (GDM) is commonly
defined as carbohydrate intolerance that first becomes
[1]
apparent during pregnancy. Women with GDM are at
increased risk for many other health concerns with short
and long-term implications for both mother and child.
Women with GDM are at higher risk for glucosemediated macrosomia, hypertension, adverse pregnancy
outcomes (stillbirth, birth trauma, cesarean section, preeclampsia,
eclampsia,
respiratory
distress,
hypoglycemia,
hyperbilirubinemia,
polycythemia,
hypocalcemia, increased neonatal intensive care unit
admissions) and neonatal adiposity with its long-term
[2, 3]
sequelae including childhood obesity and diabetes.
Postpartum complications include obesity and impaired
glucose tolerance in the offspring and diabetes and
[3]
cardiovascular disease in the mothers. Women who
have GDM are at higher risk of developing T2DM in the
future.This risk has been shown to be as high as 50% for
[4]
future T2DM risk.
The ADA recommends that all
women with GDM be screened at six to 12 weeks after
delivery for persistent diabetes and then every three
[5]
years thereafter
where as the DIPSI recommends to
screen women with GDM at 6 weeks, 6 months and then
yearly thereafter for persistent diabetes. This condition is
worth monitoring and treating, since it has been
demonstrated that good metabolic control maintained
throughout gestation can reduce maternal and fetal
[1]
complications.
Ambarisha et al.,
775
Int J Med Res Health Sci. 2015;4(4):775-777
Ambarisha et al.,
776
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Ambarisha et al.,
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
777
Int J Med Res Health Sci. 2015;4(4):775-777
DOI: 10.5958/2319-5886.2015.00153.8
Research article
Open Access
ARTICLE INFO
Received: 10th June 2015
Revised: 24th August 2015
Accepted: 20th September 2015
Authors details: 1Assistant Professor,
Department of Community Medicine,
Grant Government Medical College,
Mumbai, Maharashtra, India. 2Research
Officer, NIRRH, Mumbai.
Corresponding author: Warbhe Priya A
Assistant Professor, Department of
Community Medicine, Grant Government
Medical College, Mumbai, Maharashtra,
India
Email: priyawarbhe@gmail.com
Keywords: Geriatric, Morbidity profile,
Adaptive measures, Health seeking
behaviour, Home environment survey
ABSTRACT
Background: Population ageing is a significant product of demographic transition.
Declining fertility and improved health and longevity have generated rising
proportions of the older population. Double burden of communicable and noncommunicable diseases affects the geriatric segment of the population with
variable health seeking behaviour. Objectives: To assess morbidity profile,
health seeking behaviour and home environmental survey for adaptive measures
in geriatric population from an urban community. Material and Methods: Crosssectional study stratified systematic random sampling was applied. Research tool
was interviewer based closed ended questionnaire. Adaptive measures as part of
environment survey were assessed. Proportions and Pearsons chi-square test
were calculated. Results: 64.1% participants were from 60-69 years age
category, 9.1% current smokers. 94.1% had 1-3 morbidities, 4.1% had 4-6
morbidities .37.3% gave a history of fall and 31.4% history of fracture. 13.6%
cataract operation, 16.8% procedure for fracture.10% had dental procedure.
54.2% went to UHC and GOVT/BMC hospitals for treatment and 78.6% received
both allopathic and ayurvedic treatment. History of fall was not associated with
adaptive measures in the house (p=0.952). Conclusions: Majority of the
participants suffered from old age related morbidities, hypertension emerged as a
major morbidity. Most of the participants relied on government hospitals for
treatment. Adaptive measures were lacking in most of the houses.
INTRODUCTION
The worlds population is ageing at an uncontrolled rate.
Population ageing is a major demographic trend
worldwide. Declining fertility and improved health and
longevity resulted in rising older population. Older
population has also increased because of improvement in
health services; educational status and economic
development. Ageing is a reward of recent years which is
due to improved public health, sanitation and
development. The global population aged 65 and over
was estimated to be 506 million as of midyear 2008, about
7 percent of the worlds population. (ranging from 13
percent to 21 percent) By 2040, the world is projected to
have 1.3 billion older people- accounting for 14 percent of
the total. The fastest growing portion of the older
population in many nations is the oldest- old, those aged
.[3,11,15]
80 years and above
India is also in a phase of demographic transition. As per
the 1991 census, the population of elderly in India was 57
million as compared to 20 million in 1951. There has been a
sharp increase in the number of elderly persons between
1991 and 2001 and it has been projected that the numbers
of elderly in India will increase to 100 million in 2013 and to
198 million in 2030.By the year 2050, the number of elderly
people would raise to about 324 million. India has thus
acquired the label of an ageing nation with 7.7% of its
population being more than 60 years old. India as the
second most populous country has 76.6 million people at or
[7]
over the age of sixty years.
According to recent WHO projection, over three-quarters of
death occurring in the developing world by the year 2020
Priya et al.,
Visual impairment
88
Locomotor disabilities
40
Neurological diseases
18.7
Cardiovascular diseases
Respiratory diseases
17.4
16.1
Skin diseases
13.3
778
[5]
779
Priya et al.,
Priya et al.,
780
history
and
[14]
Priya et al.,
Total
82
138
220(100)
781
8.
9.
10.
11.
12.
CONCLUSION
13.
Double burden of communicable and non-communicable
diseases affects older section of the population also which
is again emphasized in this study and supported by various
other studies. Also the fastest growing portion of the older
population is the oldest- old, those aged 80 years. Female
geriatric participants outnumber the male geriatric
participants. Hypertension emerged as major morbidity.
Majority of this population suffer from one or more of
morbidities, which are potentially preventable This increase
in life expectancy coupled with morbidities is just adding
years to life. Emphasis should be on adding life to years.
Community based health assessment programme with
home environment survey coupled with educating the
families and caretakers the importance of adaptive
measures in house to prevent fall and fracture can prevent
functional dependency of these elderly and improve quality
of life thus adding years to life.
14.
15.
ACKNOWLEDGMENT
A sincere thank to all the faculty members and the
participants of the study who made this study possible.
Conflict of Interest: Nil
REFERENCES
1.
2.
3.
4.
5.
6.
7.
782
Priya et al.,
DOI: 10.5958/2319-5886.2015.00154.X
Research article
Open Access
ARTICLE INFO
Received: 10th June 2015
Revised: 14th Aug 2015
Accepted: 9th Sep 2015
1
Authors
details:
Department
of
Physiology, Narayana Medical College,
Nellore,
Andhra
Pradesh,
India,
2
Department
of
Physiology,
Sri
Venkateswara Medical College, Tirupati,
Andhra Pradesh, India
ABSTRACT
Background and objectives: Regardless of prevailing advances in yoga
research, the immediate benefit of chandranadi pranayama (CNP) on heart rate
variability was not explored. Therefore, in this study, we planned to study the
immediate effect of CNP on heart rate, blood pressure and HRV. Methods: One
hundred and ten medical students were randomly divided into two groups;
control group (n=55) and CNP group (n=55). CNP group participants were
individually trained to perform CNP by an experienced yoga instructor with a
regularity of 6 breaths/min for five minutes. CG volunteers didnt undergo CNP,
Pre and post intervention HR, BP measurements and spectral analysis of HRV
was done in both the groups. The paired students t test was used to determine
significant differences. Results: There was a significant decrease in HR
(p<0.01), BP (p<0.05), LFnu (p<0.05), LF/HF (p<0.001) and increase in HFnu
(p<0.01) followed by five minutes of CNP in CNP group. Further, HR, SBP, DBP
was reduced by 9.10%, 4.80%, 7.75 % respectively. HRV results showed 7.59%
reduction in LFnu, 17.8% reduction in LF/HF and HF was increased by 12.37%.
There were no significant changes in CG. Conclusion: It is concluded that CNP
is beneficial in reducing HR, BP and to improve Sympathovagal balance. We
advise that this effective method be included with the management protocol of
hypertension and utilized when immediate reduction of blood pressure is
required in day-to-day as well as clinical situations.
INTRODUCTION
Yoga is mind-body practice which consists of relaxation,
meditation together with a group of physical exercises
carried out in sync with breathing. Being holistic, it will
be ideal means for achieving physical, mental, social
and spiritual well being of the practitioners. This may
be attained by methodical and well organized practice
of ashtanga (eight-limbed) yoga described by sage
Patanjali. The first two limbs of ashtanga yoga are
yama and niyama which are ethical code and
personal discipline for the development of our moral,
rd
th
spiritual and social aspects. 3 and 4 limbs are asana
and pranayama which help in our physical development
th
th
and improvement of physiological functions. 5 and 6
limbs are pratyahar and dharna for controlling our senses
[1]
and making our mind one-pointed, calm and alert .
Prana means breath, wind, life, energy, and vitality.
Ayama means length, stretching, restraint or expansion
It is the science of breath. There are many techniques of
pranayama. In humans, the left and right nostril will not
work at the same time. One of the nostrils is usually more
congested as compared to the other no matter if the nasal
passages are clean and unobstructed by mucus. This
congestion alternates between the right and left nostril
[2]
through the day and night .The influence of CNP on
cardio respiratory as well as autonomic function
[3,4,5]
parameters were investigated only these days
. with
exceptionally conflicting outcomes; the authors describing
increase, decline and no alterations in Respiratory rate
(RR), Heart rate (HR), and Galvanic skin response (GSR).
Furthermore, to the best of our understanding, the
immediate effect of chandranadi pranayama (CNP)
Chintala et al.,
783
RESULTS
Chintala et al.,
Control group
(n=55)
19.48 + 3.21
Age (year)
20.23 2.45
Gender
42/13
39/16
(male/female)
Height (cms)
172.56 34.45
171.67 31.23
Weight (kg)
67.51 12.45
65.44 11.19
2
BMI (kg/m )
22.7 6.24
22.21 5.92
2
BSA (m )
1.83 0.34
1.77 0.29
Data expressed as mean + SD
Table 2: Values of HR, SBP, DBP and HRV parameters
in Control group (Baseline and after 5mins),
Immediate effect of chandranadi pranayama.
Para
meter
HR
(bpm)
SBP
(mmhg)
DBP
(mmhg)
LFnu
HFnu
TP
(ms2)
LF-HF
Group II
( Interventional group CNP)
Parameter Baseline
Before
After CNP %
CNP
change
78.7+ 7.36 77.45 + 7.12 79.45 + 8.46 72.22+8.1** 9.10
119.4+ 12.6 118.43+11.2 118.24+13.5 112.6+12.3* 4.80
76.45+11.12 78.34+ 12.8 78.44+10.25 72.4+ 11.5*
7.75
1.7 + 0.55
1.63 + 0.34
784
4.
REFERENCES
1.
2.
3.
785
Chintala et al.,
DOI: 10.5958/2319-5886.2015.00155.1
Research article
Open Access
*Desireddy Neelima , Bandi Hari Krishna , Masthan saheb , Natham Mallikarjuna Reddy .
ARTICLE INFO
th
ABSTRACT
Background and objectives: Pellagra was vanished from most parts of
the world where it was formerly present due to its dietary modification.
However, it is still encountered among the jowar eating populations of India.
The information about the role of oxidative stress in pellagra was not
established. Therefore, in this study we assessed the oxidative stress
status by using malondialdehyde (MDA), total anti oxidant status (TAOS)
and redox ratio (RER) in clinically diagnosed pellagra patients. Materials
and methods: Clinically diagnosed pellagra patients aged between 18 to
40 years, both male and females were recruited (n=78) from department of
Dermatology. Age and gender matched controls (n=78) were recruited from
the student and residents of the hospital. Malondialdehyde (MDA) is a
marker of lipid peroxidation, Total Anti Oxidant Status (TAOS) and Redox
Ratio (RER) markers were assessed by using commercially available kits.
Results: There were no significant differences in the anthropometric
parameters. However, the oxidative stress markers MDA (p<0.05), RER
(p<0.001) were significantly high and TAOS was low (P<0.001) in pellagra
patients in comparison with age and gender matched controls. Conclusion:
The results of this study showed the increased MDA, RER levels and
decreased TAOS levels. Estimation of these markers at early stage will help
to take measures to prevent the progression of disease and develop
antioxidant strategies.
INTRODUCTION
Pellagra is derived from the Italian Pelle means skin
and Agra signifying rough, in reference to its thickened
rough skin. Pellagra has long been known to be a
nutritional disorder caused by cellular deficiency of niacin,
resulting from inadequate dietary supply of niacin and
[1]
tryptopan .
Pellagra has been reported from most parts of the world
where maize is consumed as a staple diet. Since the
Second World War, pellagra was vanished from most
parts of the world where it was formerly present due to its
dietary modification. However, it is still encountered
[2]
among the jowar eating populations of India .
Oxidative stress is defined as a state in which oxidation
exceeds the antioxidant systems in the body secondary
[3]
to a loss of the balance between them . It not only
causes hazardous events such as lipid peroxidation and
oxidative DNA damage, but also physiologic adaptation
phenomena and regulation of intracellular signal
transduction. Oxidative stress plays a pathological role in
the development of various diseases including diabetes,
atherosclerosis, or cancer. Systemic oxidative stress
results from an imbalance between oxidants derivatives
production and antioxidants defenses. Reactive oxygen
species (ROS) are generally considered to be detrimental
for health. However, evidences have been provided that
they can act as second messengers in adaptative
786
Neelima et al.,
Pellagra patients
37.34 7.58
Controls
38.32 6.4
Men/Women,
42/36
47/31
Height (cm)
163.44 + 5.24
161.98 + 6.4
Weight (Kg)
66.23 + 7.48
67.18 + 3.48
0.40 + 0.14
11.41 + 9.72
0.99 + 0.33***
9.08 + 9.08**
RER
28.52 + 15.12
9.17 + 3.9***
787
Neelima et al.,
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
788
Neelima et al.,
DOI: 10.5958/2319-5886.2015.00156.3
Open Access
Experiences,
Hermeneutic
ABSTRACT
Introduction: Globally, number of old age population is increasing with
advancement of biomedical technology. Old age is the time associated with
biological, psychological and social changes which situate elderly to acquire
different health related problems. Objectives: To find out lived experiences
of elderly regarding their health problems residing in homes of Kathmandu
city. Methods: Qualitative hermeneutic phenomenology approach was
adopted. Researcher selected purposively four elderly residing in an urban
area of Kathmandu Valley as the study participants. In-depth interview was
conducted by using in-depth interview guideline, as well as medical records,
field notes and observation clues were recorded. Interview was conducted in
Nepali Language and was audio taped. The recording was transcribed by the
researcher herself, and the data were analyzed thematically. Finally, different
sources of data were triangulated. Results: The four main themes identified
were physical health problems, impaired functional abilities, psychological
and social problems. Experienced physical health problems were joint pain,
hearing and vision deficit, chronic obstructive pulmonary disease, diabetes,
gastritis and fall injury. Impaired Functional abilities in performing activities of
daily living was commonly experienced problems. Loneliness and decreased
recent memory power were the psychological problems. Being neglected by
family members, financial constraints for treatment and improper care during
illness were the discerned social problems. Conclusion: Elderly are suffering
from different physical health problems, impaired functional abilities, as well
as various psycho-social problems. Thus, health promotional activities need
to be promoted for decreasing morbidity of elderly. Family members need to
be focused in the care of elderly through national policy.
INTRODUCTION
Globally, old age population is increasing at an
[1].
unprecedented rate
At present, 12 % of total population
is of old age. It is projected that the proportion of the world
[2]
population will be doubled by the year 2050 . Further,
[3]
this pace of ageing is faster in developing countries . In
Nepal, the ageing population above 60 years has been
double from 4.6 % in the year 2001 to 9.1 % in the year
[4]
2011 . Thus concern over the health of elderly is
increasing in Nepal with this unprecedented growth rate of
ageing population.
Old age is associated with increases in physical and
[5-7
mental health problems
]. Studies revealed that non
communicable diseases like cardiovascular diseases,
chronic
respiratory
diseases,
diabetes
and
musculoskeletal problems and cancer are common in old
[8age people adding burden related to disease conditions
10].
With advancing age elderly usually faces decline in
functional ability as a result of limited mobility, frailty or
[8]
other health related problems . Studies assessing
functional disability among elderly revealed that elderly
usually losses mobility in performing activities of daily
living. Mostly advanced aged elderly losses their abilities
of performing instrumental activities causing them
[11, 12]
dependent to others
.
789
Archana et al.,
Religi Marital
on
Status
Living
With
Hindu Widow
Son's
Family
Son's
family
Grands
on's
Family
Son's
Family
86
Female
Newar
Hindu Widow
91
Female
Brahmin
Hindu Widow
94
Female
Newar
Hindu Widow
790
Archana et al.,
791
Archana et al.,
Table
Frequenc
y
3
Super Codes
Musculoskeletal
problem
Supra
code
Physical
Health
Problems
Sensory
impairment
1
1
1
1
1
Respiratory
problem
Endocrine
792
Archana et al.,
problem
Gastritis
Cannot take
bath
independently
Decreases stamina to
go outside
Decrease strength to
walk vigorously
Need assistance for
going far places
Fear of getting disability
Forget some recent
activities
Loneliness
Not having assistance
during illness
Ignored
by
sons
family
1
2
Gastrointestinal
problem
Accident and
injury
Basic Functional Functional
activity
Impairment
decreased
Intermediate
functional
activity
decreased
4
3
2
Impaired
Cognition
Depressed
Family
Mistreatment
Psychologi
cal
Problems
Social
problem
2.
793
Archana et al.,
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
794
Archana et al.,
795
Archana et al.,
DOI: 10.5958/2319-5886.2015.00157.5
Open Access
Nagmoti
Dept
of
community
medicine,
Jawaharlal Nehru Medical College,
K.L.E.
University,
Belgaum,
Karnataka, India
Email: soumya160@gmail.com
Keywords:
Body
mass
index,
Anthropometry, Newborn, Maternal
height, Maternal weight
ABSTRACT
Introduction: Maternal body dimensions are the first determinants of neonatal
biometrics, especially their birth weight and length. Mothers nutritional status is
also known to be a key indicator of infants body dimensions and its early
growth features. Birth weight and length are clearly based on mothers
nutritional and anthropometric factors hence the present study was done to find
the association between BMI of mother and anthropometry of newborn among
all the delivered women in tertiary care hospital Aim: To study association
between BMI of mothers and anthropometry in newborn. To know the other
factors responsible for anthropometry of newborn. Methodology: 216 delivered
women were taken consent by predesigned questionnaire information was
collected regarding the socio-demographical data and the anthropometry of
newborn and mother was recorded. Statistical analysis was done by using
percentage and analysis of variance. Results: Our study showed association
between maternal BMI and weight with neonatal parameters except mid arm
circumference. There was no association between maternal heights with any of
the neonatal parameters. Conclusion: In our study we found the association
between Maternal BMI and Anthropometry of Newborn, Maternal Weight and
Anthropometry of Newborn, But no association was found between Maternal
height and Anthropometry of Newborn, so, by carrying out some intervention
during pregnancy to improve nutrition of the mother which has better effect on
the Anthropometry of newborn.
INTRODUCTION
.
Humans, including the embryo transfer, the size at birth is
primarily determined by the mother, whose influence acts
more through the intrauterine environment and transmitted
[1]
to her baby . There is interrelation between the body
physique of the mother, her nutritional status,
haemoglobin levels, socioeconomic class and her
exposure to passive smoking during pregnancy and
intrauterine growth and birth size of her neonate.
Significant positive correlations between maternal
anthropometric parameters and neonatal birth dimensions
were observed. These effects were more evident in female
babies than male babies as regards to BMI and head
circumference. This indicates that neonatal growth as
reflected by birth weight, length and head circumference,
are mostly influenced by maternal size. A study done in
Egypt showed that best predictor of birth weight as a
continuous variable was maternal weight at registration
compared to combination of initial weight and height of the
mother. A maternal pre gestational weight, weight at
delivery, gestational weight gain and height correlated
[1]
significantly with neonatal birth weight and birth length .
Birth weight determines the perinatal morbidity and
mortality, and maternal body dimensions are first
[2]
determinants of neonatal biometrics . Many studies have
been done to find association between non biometric
maternal factors and neonatal anthropometry.
Maternal nutritional status which is indicated through
weight, height and BMI could be considered to predict the
neonatal anthropometry hence the present study.
796
Nagmoti et al.,
06
2.8
20-24
161
74.6
25-29
34
15.7
30-34
15
6.9
Place of residence
Rural
111
51.4
Urban
105
48.6
01
0.5
Secondary
23
10.6
83.3
5.6
4.6
67.6
27.8
60.2
39.8
65.7
25.5
5.6
3.2
0.004
0.039
0.001
0.017
0.556
F2,207
12.234
5.125
10.481
7.796
0.495
<0.001
0.007
<0.001
0.001
0.622
F2,213
0.252
2.706
2.640
0.131
0.635
0.777
0.069
0.074
0.878
0.531
797
Nagmoti et al.,
DISCUSSION
Our study showed that maternal weight was positively
associated with birth weight of the newborn as the
maternal weight increased weight of the new born also
increased which was statistically significant with P value of
<0.001.Similar results were observed in the study done in
[3]
Sri Lanka with r value of 0.27
,similar findings in other
[1,4,5,6,7]
studies
.Our study showed that maternal weight was
positively associated with head circumference, chest
circumference and length of newborn. Similar results
[1]
were found in . Our study did not show association
between maternal weights with mid-arm circumference of
the newborn.
In our study maternal BMI was positively associated with
[1,2,3,5,10]
BW of newborn
. Similar results were found in
[6]
[7]
[8]
studies done in Saudi Arabia , Nigeria
,Nepal ,
[9]
Romania Our study showed that maternal BMI was
positively associated with HC of newborn. Similar results
[6]
were found in . Our study also showed that maternal BMI
was positively associated with CC of newborn. Our study
also showed that maternal BMI was positively associated
[1,10]
with length of newborn. Similar result were found in
.
Our study did not show association between maternal BMI
with MAC of newborn.
Our study did not show association between maternal
height and BW, Length, HC, CC and MAC of the newborn.
[11]
In contrast to our study, a study done in Australia
found
positive correlation between maternal height and HC of the
[1,9]
new born. Similar results were found in
CONCLUSION
In the present study we found positive association between
Maternal BMI and weight with anthropometry of Newborn
except for mid arm circumference. But maternal height was
not associated with any of the foetal parameters. Hence we
suggest some interventions during pregnancy to improve
nutritional status of the mother by which it is possible to
improve the Anthropometry of the newborn.
Limitation: Study was conducted for a period of 1 month
only hence it was not a representative study.
Acknowledgment: We thank the HOD and Staff of OBG
Department of JNMC, KLE University for permitting to
collect the data and the nurses of the postnatal ward for
their participation in the data collection.
Conflict of interest: Nil
REFERANCES
1.
2.
3.
798
Nagmoti et al.,
DOI: 10.5958/2319-5886.2015.00158.7
Open Access
Das Hirak , Kusre Giriraj , Shankarishan Priyanka , Nirmolia Tulika , Panyang Rita , Gogoi Arpita
ARTICLE INFO
Received: 16th Jun 2015
Revised: 12th Sep 2015
Accepted: 24th Sep 2015
Author
details1Assistant
Professor,
2
Associate Professor, Dept of Anatomy,
Comprehensive Facility for Diagnosis and
Management
of
Genetic
Diseases
(CFDMGD), Assam Medical College,
Dibrugarh, Assam, India
3
Scientist B, 4Senior Research Fellow,
Diagnostic Genetic Lab (CFDMGD),
Assam Medical College, Dibrugarh,
Assam, India
5
Assistant Professor of Pediatrics, Genetic
OPD (CFDMGD), Assam Medical College,
Dibrugarh, Assam, India
6
Assistant Professor of Pediatrics, Genetic
OPD (CFDMGD), Assam Medical College,
Dibrugarh, Assam, India
Corresponding author: Das Hirak
Assistant
Professor
of
Anatomy,
Comprehensive Facility for Diagnosis and
Management
of
Genetic
Diseases
(CFDMGD), Assam Medical College,
Dibrugarh, Assam, India
Email: ripples2006@rediffmail.com
ABSTRACT
Context: Down Syndrome or Trisomy 21, with three sets of chromosome
number 21 is the commonest chromosomal abnormality in newborn. There
are three types of Trisomy 21: Free Trisomy 21, Translocation Trisomy 21
and Mosaic Trisomy 21. Aims: The study aimed at finding the frequency of
Down syndrome and its various cytogenetic types in a population from
North East India. Methods and Materials: Karyotyping from G-Banded
peripheral lymphocyte of patients with suspected chromosomal abnormality
was done from peripheral blood and stained with Giemsa stain as per the
Standard Operating Protocol of the Diagnostic Genetic Laboratory
(CFDMGD). One to three ml of blood was withdrawn aseptically from each
patient. 20-30 spreads were analyzed for each case. For mosaics, 30-50
spreads were studied. The slides were analysed for detection of various
chromosomal abnormalities including Down syndrome (Trisomy 21). For the
translocation Down Syndrome cases, parents were investigated to
determine the parental carrier status. Results: 38 cases of Trisomy 21
were detected. Free Trisomy 21 was found in 92.11% cases, translocation
trisomy 21 was seen in 2.63% case and Mosaic Trisomy 21 was seen in
5.26% cases. Male: female ratio was 1.38:1. Conclusions: Knowledge of
the cytogenetic types has important clinical implications as it helps
clinician/geneticist determine the recurrence risk in subsequent pregnancies
and helps couples take an informed decision. This in turn would help in
decreasing the load of the disease in society.
INTRODUCTION
Down Syndrome (DS) or Trisomy 21 is the commonest
[1]
autosomal chromosomal abnormality in the newborns .
Incidence of Down Syndrome varies from 1 in 600 to 1 in
[1,2]
1000 in live born infants . In India, the reported
[1].
incidence of Down syndrome is 1 in 1250
Down syndrome is recognizable at birth. Dr. Langdon
Down (1828 1896) was the first to describe the clinical
[3]
features of Down Syndrome children precisely . Patients
present with characteristic phenotypic features of the face,
eyelids, tongue, etc., with retarded physical and mental
[4]
growth . However, the diagnosis may be difficult with the
diagnostic accuracy ranging from 100% in non disjunction
[5]
and translocation to as low as 37% in mosaicism .
Therefore confirmation of diagnosis by chromosomal
analysis is needed. This in turn helps to determine the risk
[2]
of recurrence and guides genetic counseling .
Down Syndrome patients may present in three varied
cytogenetic types: Free Trisomy 21, translocation trisomy
[6]
21 and mosaic trisomy 21 . Free trisomy 21 is the most
common variety, seen in 95% cases and occurs due to
[1]
paternal meiotic non disjunction .
799
cell lines, one with 46 chromosomes and the other with 47,
+21. The typical features of Down Syndrome may be less
marked depending on the percentage of normal to trisomy
[1]
21 cell lines . As diagnostic accuracy in such cases is
[5]
less , confirmation by cytogenetic tests is necessary.
However the incidences in Down syndrome show wide
variations among different populations. North East India
has a unique ethnic population different from the rest of
India. As no such study on Down syndrome have been
done so far in this region to the best of our knowledge,
this study may throw some light on the ethnic variations in
the frequency of Down syndrome.
Frequency
Type
Free Trisomy 21
Translocation Robertsonian
trisomy 21
translocation
of
various
13q;21q
14q;21q
15q;21q
21q;21q
21q;22q
Others
Reciprocal translocation
Mosaic trisomy 21
Total
types
of
Male Female %
22 13
92.11
1
2.63
2
5.26
22
16
100
DISCUSSION
The percentages of various types of trisomies were
compared with those found by other authors (Table 2).
Among the cases of Robertosonian translocation, Jyothy
[9]
[1]
et al.
and Jayalakshmma et al.
reported higher
percentage of t(14q;21q) (47.47% and 62.34%
respectively).
800
Table 2: Comparison of the frequency of various types of trisomy 21 among different authors
Author
Source/Populatio
n/Study group
Tota
l No.
Free
21
Egypt
673
Ireland
Malaysia
Jordan
Karnataka, India
West Bengal, India
Kosova
Albanian
Population
Dibrugarh, Assam
Translocati
on trisomy
21
Mosaic
trisomy 21
Non
classic
642(95.4%)
18(2.7%)
5(0.7%)
8(1.2%)
208
149
80
874
85
305
197(94.7%)
141(94.6%)
74(92.5%)
759(86.9% )
78(91.8%)
285(93.4%)
3(1.45%)
1(0.7%)
2(2.5%)
77(8.8% )
2(2.4%)
17(5.6%)
8(3.85%)
7(4.7%)
3(3.8%)
38(4.3%)
5(5.9%)
3(1%)
0
0
1(1.3%)
-
32
29(90.63%)
1(3.13%)
2(6.25%)
trisomy
[9]
801
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
802
DOI: 10.5958/2319-5886.2015.00159.9
Research article
Open Access
ARTICLE INFO
th
ABSTRACT
Purpose: To study the surgical outcome of triple procedure as penetrating
keratoplasty (PKP) with conventional extra capsular cataract extraction (ECCE)
with posterior chamber intraocular lens (PCIOL) implantation in patients with
both central corneal opacity and advanced cataract at rural set up.
Introduction: When corneal opacity and cataract present together then wellestablished and effective triple procedure is indicated. Prognosis for a clear
graft is good in triple, as graft endothelium does not touch the hard nucleus
which may occur in two steps or sequential surgery. It provides faster visual
rehabilitation. Being single step procedure it reduces patients hospital stay,
postoperative care and follows up visits. Methodology: In this hospital based
observational , three years longitudinal study, we studied the surgical outcome
of relatively rare one step triple procedure as PKP with conventional ECCE with
PCIOL implantation in sulcus or in bag, in patients with both central corneal
opacity and advanced cataract at rural set up. The outcome measures included
graft clarity on slit lamp, postoperative unaided visual acuity with Snellens chart
and the occurrence of postoperative complications after taking IEC permission
and informed written consent in local language from study patients. Results:
Out of 13 study patients mean age was 61.15yrs (Range50-80yrs). Follow up
range was 9-34 months. At final follow up 9 patients (69.23%) had clear grafts
and 61.52% patients gained visual acuity >6/24. Graft failure was the most
common post operative complication in 30.76% followed by Posterior capsular
opacification (PCO) in 15.38% patients which was treated well with YAG laser
capsulotomy. Conclusion: Triple procedure gives good results in respect to
graft clarity, unaided vision, and faster rehabilitation.
INTRODUCTION
Status of the cornea is crucial to achieve good outcome
after cataract extraction with intraocular lens implantation.
Pre-existing corneal disease must be managed
appropriately to get good results of cataract surgery.
Many times the corneal opacity and cataract present
together. In such cases, performing only penetrating
keratoplasty or only cataract surgery does not give good
visual outcome. Actually corneal pathologies needing
keratoplasty are often associated with cataract and
therefore combined surgery is mandatory. Triple
procedure
with
penetrating
keratoplasty
and
simultaneous cataract extraction with intra ocular lens
(IOL) implantation is usually preferred as single step
surgery because theoretically visual rehabilitation is more
rapid and patients require less post operative follow ups.
[1, 2]
803
Nigwekar S et al.,
st
Table 2: showing all study cases data: indication, pre and postop vision, complications and management
INDICATIOPKP/ EYE
Pre
V/A
Failed Graft / LE
CF 1F
Failed Graft/LE
Corneal Scar/RE
Corneal Scar/LE
Corneal Scar/RE
Corneal Scar/LE
Healed
Herpes
simplex keratitis /RE
Uveitis & Scar / RE
Corneal Scar /LE
Uveitis & Scar /LE
Corneal Scar /RE
Corneal Scar /RE
Failed Graft /RE
OP
Early
P.OP.V/A
Intervention
Graft clarity
at
last
follow up
final V/A
YAG
Laser
Capsulotomy
Refused PKP
Clear
6/12*
Hazy
HM
30
30
24
24
20
Endothelial
Graft Rejection
-----------------------------------------Graft Ulcer
CA-larynx death
Clear
Clear
Clear
Clear
Hazy
6/24
6/18
6/24
6/12
CF 1M
18
18
16
14
14
12
Graft Failure
-----Graft Failure
------------PCO
Hazy
Clear
Clear
Clear
Clear
Clear
HM
6/18
CF 4M
6/24
6/60
6/18*
Etiology
less V/A
6/18
Last
follow up
in months
36
HM
CF 2M
36
CF 2M
CF 1M
CF 2M
CF 5M
CF 1F
6/24
6/18
6/24
6/12
6/18
PL+
CF 1M
PL+
CF 1M
HM
CF 1M
CF 5M
6/18
CF 4M
6/24
CF 5M
CF 4M
PCO
of
Refused PKP
----Repeat PKP
-----------YAG
RE- Right Eye, LE- Left Eye, CF- Counting Finger, HM-Hand Movements, PL- Perception of Light.
Study showed all triple procedures were unilateral out of which 7 were performed in right eye. All patients had
preoperative visual acuity in the range of Perception of light (PL) + to counting finger (CF2) Meters. Most common
indication for the PKP was corneal scars and failed grafts. Out of 13 study patients (69.23%) 9 patients had clear grafts
and four (30.77%) graft failures
Table 3: showing graft failure complication in 4 patients and management outcome.
Indication Of PKP
Early Post
Etiology Of Less V/A
Intervention
Graft Clarity At
operative V/A
Last Follow Up
Endothelial graft rejection
Failed Graft
CF 2M
Refused Re PKP Hazy
Be Old HSV
6/18
Graft Ulcer
Ca-Larynx Death Hazy
Uveitis & Scar
CF 5M
Graft Failure
Refused Re PKP Hazy
Uveitis & Scar
CF 4M
Graft Failure
Repeat PKP
Clear
Final V/A
HM
CF 1M
HM
CF 4M
804
Nigwekar S et al.,
DISCUSSION
Triple procedure which was first described by Taylor in
1976, has now became a well-established and effective
surgical treatment for patients with both corneal and
lenticular opacities and indicated in whom corneal
[4]
surgery may accelerate the cataract formation Single
step triple procedure, reduces the patients hospital stay,
postoperative care and follows up visits especially in
elderly patients who usually have geriatric health
805
Nigwekar S et al.,
3.
4.
5.
6.
7.
8.
9.
806
Nigwekar S et al.,
DOI: 10.5958/2319-5886.2015.00160.5
Open Access
ARTICLE INFO
th
Authors details:
Junior Resident,
2
Professor,
Department
of
Orthopaedics, Rural medical college,
Pravara Institute of Medical Science,
Loni, Ahmednagar, Maharashtra, India
Corresponding author: Dhruvilkumar
Gandhi
Junior Resident, Department of
Orthopaedics, Rural medical college,
Pravara Institute of Medical Science,
Loni, Ahmednagar, Maharashtra, India
E-mail: drgandhi25@gmail.com
Keywords: Proximal third fractures,
distal third fractures, tibial plafond
fracture, tibial plateau fractures,
Hybrid fixator
ABSTRACT
Background: Tibial plateau fractures, Tibial plafond fractures, proximal 1/3
fractures of tibia are serious type of injuries which are found to be difficult to
treat. The injury is caused by high velocity RTA which apart from causing
fractures, cause extensive damage to soft tissue envelop. Aim: To study
functional and radiological outcome of compound comminuted fractures of
proximal and distal third tibia. Method: This is a descriptive longitudinal study
carried out in 15 patients operated for hybrid external fixation for compound
comminuted fractures of proximal and distal third tibia. Every patient was
assessed for common fracture site, healing time and functional outcome.
Results: Out of 15 patients 13 has good result 1 had varus deformity and
average fracture healing time with full weight bearing walking was 20 to 24
weeks. Conclusion:-The comminuted fractures of the proximal third or the
distal third fractures pose serious problems due the injury/ degloving of the
soft tissue envelop. The risk of infection secondary to internal fixation is very
high. Also it has been noted to have high incidence of post injury residual
deformity, & knee joint stiffness. Hence less invasive method of hybrid fixator
was tried which would minimize these problems and allow the biological
healing of the fracture. This technique is simple, user friendly, & can allow
adjustment even after frame application.
INTRODUCTION
Tibial plateau fractures, Tibial plafond fractures, proximal
1/3 fractures of tibia are serious type of injuries which are
found to be difficult to treat. The injury is caused by high
velocity RTA which apart from causing fractures, cause
extensive damage to soft tissue envelop.
The mechanism of injury is initial axial loading which
cause impaction fracture, or/ and Further continuation of
angular forces mainly valgus force leading to
comminution of fractures not only in tibial plateau but
[1]
also in proximal 1/3 of tibia.
Deforming force due to high velocity trauma caused
extensive damage to protective soft tissue cover, which
[2]
results in extensive skin & muscle necrosis. This is
secondarily complicated in a) deep infection, b) stiffness
of knee joint. This was more common in Schatzker type
[3, 4, 5]
IV, V, VI injuries.
All of these complications
causes poor outcome.
Initially these fractures were conserved and treated with
linear traction. But the incidence of varus or valgus
deformities with knee joint stiffness was much high.
Whenever open reduction is used for these fractures and
poor choice of incision is taken and it increases soft
tissue dissection causes flap necrosis, infection as well
as delayed union due to loss of haematoma.
Hence some less invasive technique was tried that would
help in the following:
Gandhi et al.,
807
Int J Med Res Health Sci. 2015;4(4): 807-810
RESULTS
Total fifteen patients were treated with hybrid fixator out
of this 9 were male and 6 were female. The age range of
the patients shown in table 1. The average hospital stay
was 12 -15 days, duration between injury & surgery was
10 -15 days. Non weight bearing followed up for 10 -12
weeks. Partial weight bearing started after 12 16
weeks. Frame was removed after 16 weeks, after the
removal of frame the patient was given long knee brace /
PTB brace. In 2 cases we had to continue PTB brace for
Gandhi et al.,
No of Patients
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
6-10
week
s
11-14
week
s
15-18
week
s
19-22
week
s
23-28
week
s
Proximal
Distal
0
Proximal
2
Distal
for
Full
injury&
Healing
Weight
Surg.
(In
Bearing
( In days)
Weeks)
(In
Result
weeks)
Proximal
11
12
15
Good
Distal
12
26
28
Fair
Proximal
11
23
24
Good
Proximal
13
25
24
Good
Distal
15
25
28
Fair
Proximal
10
16
18
Good
Distal
13
20
24
Good
Distal
13
22
25
Good
Proximal
10
21
24
Good
Distal
12
26
28
Good
Proximal
12
26
28
Good
Distal
14
15
19
Good
Proximal
15
23
27
Good
Distal
14
09
14
Good
808
Int J Med Res Health Sci. 2015;4(4): 807-810
Distal
10
17
20
Good
Gandhi et al.,
i)
809
Int J Med Res Health Sci. 2015;4(4): 807-810
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Gandhi et al.,
810
Int J Med Res Health Sci. 2015;4(4): 807-810
DOI: 10.5958/2319-5886.2015.00161.7
Open Access
ARTICLE INFO
th
ABSTRACT
Background: Paucity of drug related information and easy accessibility to
over-the-counter drugs has contributed to the high incidence of selfmedication. Strict regulations regarding drug dispensing and community
awareness of related issues is need of the hour. Aim: To do the Survey of
Knowledge, Attitudes and Practices about self medication in medical, non
medical and patients group in Pune region. Methods: This questionnaire
based study was carried out in postgraduate medical students,non-medical
graduate students and patients.Results: 30 from each group- Postgraduate
medical students, non-medical graduate students and patients participated
in the study. All of the post graduate medical students and non-medical
graduate students self medicate, 90% of patients self medicate. The reason
for self medication of 87% of post-graduate students is convenience and
that form on-medical graduate students and patients is commonly cost
saving. Conclusion: Media and pharmacists play an important role in
decision of self-medication in lesser educated population; this can be
modified into an advantage by utilizing it for creating awareness about the
growing antibiotic resistance in the society amongst the common population
and also making them aware of certain drug schedules of primary concern
to them. The awareness needs to be created in the common population ,
that certain patient sub-groups e.g. Patients on polypharmacy, pregnant
patients, those with liver/ kidney disorders and extremes of age should
possibly consult a physician before self-medicating even with OTC for
safety concerns. Therefore future research may be needed to study the
outcome of such patient education and its impact.
INTRODUCTION
Self-medication is defined as the selection and use of
medicines by individuals (or a member of the individuals'
family) to treat self-recognized or self-diagnosed
[1]
condition or symptoms
Paucity of drug related
information and easy accessibility to over-the-counter
drugs has contributed to the high incidence of selfmedication. Strict regulations regarding drug dispensing
and community awareness of related issues is need of
the hour.An epidemiological studyconducted in Brazil
included 1,509 working nurses, it reported a prevalence
[2].
of 24.2% of self-medicationin this subset of population
This study makes us aware of the fact that internationally
too, self medication has been on the rise.
In India certain common problems viz. headache, fever,
flu, diarrhoea and sore throat are being treated at home.
Whereas some minor ailments can be relieved with over
the counter (OTC) medications such as Paracetamol or
with some other traditional or herbal medicines, without
.[3]
physician consultation The trend is increasing among
[4]
youths and common among students.
Antibiotic resistance is a worldwide growing problem, with
negative patient outcomes. Antimicrobial-resistant
pathogens have become a threat to patients and have
5
also increased health care costs. Noncompliance with
infection control precautions and the inappropriate use of
antimicrobial agents have been identified as the main risk
Kasabe et al.,
[6,7]
811
Int J Med Res Health Sci. 2015;4(4):811-816
No
10
Patients
Yes
90
0
Medicos
100
0
Non-medicos
100
0
50
Percentage
100
150
812
Kasabe et al.,
6.67
56.67
Previous doctor's
prescription
60
Type of drug
0
Recommendation of on
line data base
Patients
Patients
Medicos
23.33
Opinion of friends
Non-medicos
20
40
60
100
percentage
90
Recommendation
community pharmacist
Medicos
0
50
Non-medicos
43.33
Opinion of family
member
63.33
53.33
The advertisement
publish on newspaper
63.33
Indication/Purpose of
he use
50
My own experience
16.67
Adverse reaction
80 100
Patients
30.00
Medicos
Non-medicos
53.33
50.00
76.67
80.00
36.67
33.33
50.00
73.33
20 %
40
60
80
100
120
813
Kasabe et al.,
Kasabe et al.,
814
Int J Med Res Health Sci. 2015;4(4):811-816
6.
7.
8.
CONCLUSION
All of the students receiving education of graduate level
or above ,self-medicate with the only reason of
convenience and the false belief that they have adequate
knowledge of drug ,dosage schedule and adverse effects
.Whereas lesser educated population mainly self
medicate to cut down cost on health-care ,though their
knowledge is totally limited about drugs ,schedule and
adverse effect. Media and pharmacists play an important
role in decision of self-medication in lesser educated
population; this can be modified into an advantage by
utilizing it for creating awareness about the growing
antibiotic resistance in the society amongst the common
population and also making them aware of certain drug
schedules of primary concern to them. The awareness
needs to be created in the common population , that
certain patient sub-groups e.g. patients on polypharmacy,
pregnant patients, those with liver/ kidney disorders and
extremes of age should possibly consult a physician
before self-medicating even with Over The Counter
Drugs OTC for safety concerns. Therefore future
research may be needed to study the outcome of such
patient education and its impact.
Limitation of study:sample size is small so more
research is required to study the effect of Self Medication
on antibiotic resistance and drug-drug interactions and
more research is required to study Self Medication in
patients suffering from different diseases .
Acknowledgements: I sincerely thank the College of
Engineering students and the Department of Medicine,
Surgery, Pharmacology, Skin, B.J.G.M.C. for their help.
Conflict of interest: Nil
9.
10.
11.
12.
13.
14.
15.
16.
17.
REFERENCES
18.
1.
2.
3.
4.
5.
Kasabe et al.,
19.
20.
815
Int J Med Res Health Sci. 2015;4(4):811-816
Kasabe et al.,
816
Int J Med Res Health Sci. 2015;4(4):811-816
DOI: 10.5958/2319-5886.2015.00162.9
Open Access
* Abdul Raoof Omer Siddiqui , Aliya Siddiqua , Nikhat Yasmeen , Madhuri Taranikanti , Sanghamitra Panda
ARTICLE INFO
ABSTRACT
Laparotomy,
surgery,
Laparoscopy,
Spirometry, Blood gas
Keywords:
Open
Lungs,
INTRODUCTION
Respiration is carried out by movements of thorax and
abdominal wall. Abdominal surgery involves division of
abdominal muscles which results in pain and restriction of
movements. This also associated with changes in
[1,2]
diaphragmatic function and atelectasis of the lung . A
fall in oxygen tension without significant change in carbon
dioxide tension has been reported by recent
[3,4]
studies .These changes are common in open surgeries.
Laparoscopic surgeries employ smaller incisions, inflation
of gas and are now replacing some procedures which
were done with open surgeries. As the incisions are small,
there is less pain and early recovery of respiratory
functions. With computerized spirometry it is possible to
measure several parameters in a relatively short
procedure.
Aim: The aim of our study was to compare recovery of
postoperative pulmonary function between open surgeries
and laparoscopic surgeries in the Indian population, as
few studies have been done in this region.
MATERIAL AND METHODS
Study design: The study was analytical, carried out
prospectively.
Inclusion criteria: Inclusion criteria were subjects of both
genders with age between 20 to 60 years, negative history
of respiratory illness, negative history of smoking habits,
and negative history of occupational exposure to irritants,
normal preoperative respiratory function and elective
surgery.
Exclusion criteria: Exclusion criteria were emergency
surgery, history of pulmonary disease and smoking habits.
817
Siddiqui et al.,
Paramet
er
FVC (L)
FEV1 (L)
FEV3 (L)
PEF (L/s)
FEF25%75% (L/s)
FEF 0.2 - 1.2
(L/s)
FEV1/FV
C (%)
Group
(Laparotomy)
Preoper
D2
ative
2.380.6
1.90.5
2.270.57
6.361.27
1.570.4
1.30.35
1.520.40
4.130.83
Group
(Laparoscopy)
Preoper
D2
ative
2.120.41
1.70.35
2.020.39
5.551.11
1.750.36**
1.420.30*
1.690.35**
4.580.92**
FEV3/FV
C (%)
paO2
(mmHg)
paCO2
(mmHg)
pH
Bicarbonate
(mEq/L)
7.390.03
nd
DISCUSSION
818
Siddiqui et al.,
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
819
Siddiqui et al.,
DOI: 10.5958/2319-5886.2015.00163.0
Open Access
Rakheja Mahima , Singh Pratyush , Shergill Ankur K , Guddattu Vasudeva ,*Solomon Monica C
ARTICLE INFO
th
Authors details:
Post graduate
3
Student,
Assistant
Professor,
5
Professor and Head, Department of
Oral Pathology and Microbiology,
Manipal College of Dental Sciences
Manipal University, Manipal
4
Senior Lecturer, Department of
Biostatistics,
Manipal
University,
Manipal
Corresponding author:
Solomon
Monica C, Professor and Head,
Department of Oral Pathology and
Microbiology, Manipal College of
Dental Sciences,
Email: solomonmc@gmail.com
Keywords: Oral squamous cell
carcinoma,
Cell
proliferation,
Immunohistochemistry,
Ki-67
expression, Morphometry, Prognosis
ABSTRACT
Background: Cancer cells exhibit a characteristic intrinsic ability of
uncontrolled cell proliferation which plays a vital role in tumor development and
progression. The Ki-67 antigen expression is strictly associated with cell
proliferation which detects the cells entering the cell cycle. In addition,
computer aided image analysis provides an objective and highly reproducible
histological evaluation of OSCC. Assessment of Ki-67 expression along with
morphometry may help in early and precise diagnosis and prognostication of
OSCC. Aims: To correlate the ki-67 expression and the morphometrical
parameters of oral squamous cell carcinomas and to assess the efficacy of the
correlation in OSCC prognostication. Methods and material: OSCC cases
(n=105) were examined immuno histochemically using Ki-67 antigen The
nuclear area (NA), cell area (CA), nuclear perimeter (NP) and cell perimeter
(CP) assessed using image J 1.34 software. The data was statistically
analyzed. Results: Highly significant correlation was found between Ki-67
expression and the advancing grades of OSCC (p<.0001). NA (p=0.025), CA
(p<.0001), NP (p=.027) and CP (p<.0001) of poorly differentiated OSCC were
significantly lower than well differentiated and moderately differentiated OSCC.
Follow up analysis revealed nuclear area and cell area to be higher in the
recurrent cases than the non recurrent ones. Conclusion: Assessment of Ki67 expression and morphometry help in early and precise diagnosis and
prognostication of OSCC. A correlation between Ki-67 expression and
morphometrical analysis could not be ascertained in this study. Further studies
with a larger sample number may provide more definitive results.
.
INTRODUCTION
Oral cancer ranks eighth in the cancer incidence ranking
worldwide. The World Health Organization anticipates a
worldwide escalation in the incidence of oral squamous
[1]
cell carcinomas (OSCC) in the subsequent decades .
Despite the steady improvements in treatment
modalities, the 5 year survival rate of OSCC is about
55% and it continues to stand poor. This implies the
need for early and accurate detection of OSCC in order
to bring down the associated high morbidity and mortality
[2]
rates . Upon its onset, OSCC progresses imperceptibly,
becoming evident only in a dangerously advanced state.
This may be due to patients negligence as it initially
presents with no remarkable symptoms, or due to
inappropriate diagnostic and prognostic assessment on
the behalf of the clinician and the pathologist. The latter
may be a result of lack of availability or utilization of
reliable techniques for the same. The current scenario
urges an enhanced comprehension of the tumor
behavior.
The intrinsic capacities of limitless replicative potential
and self-renewal are characteristics of cancer cells.
Uncontrolled proliferation indicates that the cells are
capable of acquiring further cellular alterations that
contribute to full malignant phenotype. The expression of
Mahima et al.,
820
Int J Med Res Health Sci. 2015;4(4):820-826
Mahima et al.,
Inter-class correlation (ICC) carried out for interobserver reproducibility between two observers.
821
Int J Med Res Health Sci. 2015;4(4):820-826
RESULTS
In the test group which included 105 OSCC cases,
positive Ki-67 expression in the nuclei of proliferating
tumor epithelial cells was found positive in all the cases
(100%). 5 tonsil cases were used as controls. 5 cases of
normal oral mucosa were also used for comparative
assessment of staining. The inter observer reproducibility
was analysed with inter-class correlation which revealed
a good reproducibility between the 2 observers
(ICC=.925)
Among the 105 cases of squamous cell carcinomas in
49/105 (47%) 30-50% of tumor cell expressed Ki 67.
Among the 35 cases of well differentiated tumors in
13/35 (37%) 30-50% of tumor cells expressed Ki 67
while in 17/35 (49%) cases <30% of cells were positive
for the biomarker. Among the 35 cases of moderately
differentiated tumors in 20/35 (57%) 30-50% of tumor
cells expressed Ki 67 while in 1/35 (2%) cases <30% of
cells were positive for the biomarker. Among the 35
cases of poorly differentiated tumors in 16/35 (46%) 3050% of tumor cells expressed Ki 67 while in 16/35 (46%)
cases <30% of cells were positive for the biomarker. On
statistical analysis with chi-square test, a highly
significant correlation was found between Ki-67
expression and the advancing grades of OSCC.
(p<.001)(Table 1)
The Ki-67 expression and labelling index was assessed
in the 105 cases of oral squamous cell carcinomas. The
mean labeling index among the well, moderate and
poorly differentiated OSCC was 29.84 13.04; 48.10
13.41 and 32.015 13.89 respectively. A one way Anova
test showed that there was a significant (p <.001)
variation in mean Ki-67 labeling index between the tumor
grades. A post hoc test with Tukeys HSD showed that
there was a significant (p <.001) association between Ki67 labelling index of well differentiated and moderately
differentiated and that between moderately differentiated
and poorly differentiated tumors.(Table 2 and Table 3)
Moderate
Proliferation
13 (37%)
Low
Proliferation
17 (49%)
Total
X2 Value
Well
High
Proliferation
5 (14%)
35
25.050
Moderate
14 (40%)
20 (57%)
1( 3%)
35
Poor
3 (8%)
16 (46%)
16 (46%)
35
df
4
P
value
.000
Table 2: One way Anova to compare the mean Ki-67 labelling index
Between groups
Within groups
total
Mahima et al.,
Sum of squares
.6964
18475.855
25439.988
df
2
102
104
Mean square
3482.066
181.136
F
19.224
Sig
.000
822
Int J Med Res Health Sci. 2015;4(4):820-826
Table 3: Comparison of the mean labelling index among the different grades Tukey HSD
(I) Grade
(J) Grade
Mean difference Std. Error
Sig.
95% confidence interval
(I-J)
Lower bound
Upper bound
Well
-18.25729*
3.21724
.000
-25.9092
-10.6054
-2.16686*
3.21724
.779
-9.8188
5.4850
Moderate
18.25729
3.21724
.000
10.6054
25.9092
16.09043*
3.21724
.000
8.4385
23.7423
Poor
2.16686
3.21724
.779
-5.4850
9.8188
*
Moderate
-16.09043
3.21724
.000
-23.7423
-8.4385
* The mean difference is significant at the .05 level.
Table 4: showing the relationship of Ki-67 expression with site of OSCC cases
site
Number of cases Number of cases of
Number of cases of Ki-67 Expression
of
Well Moderately
Poorly differentiated occurring with highest
differentiated
differentiated
OSCC
frequency (Mode)
OSCC
OSCC
Tongue - lateral border 2
14
6
3
(left/right)
Tongue - ventral/dorsal 2
1
1
aspect
Buccal mucosa
9
6
4
2
Buccal mucosa and 4
1
1,2
alveolus
Alveolar region
5
6
2
3
Retromolar region
2
1
2
Angle of mandible
1
1
2
lips
1
3
3
Vestibule and floor of
1
3
1
the mouth
Total cases (With the 26/35
31/35
18/35
details of the site of
OSCC)
(Ki-67 expression: 1 = high proliferation, 2 = moderate proliferation, 3 = low proliferation)
Table 5: Statistical analysis using One Way ANOVA test and multiple comparisons test (Post-Hoc test) with
2
Tuckey HSD method (values in micron )
Criteria
Grade of OSCC
Mean
Standard
Confidence
P-value
deviation
limit
Nuclear Area Well differentiated (a)
190.77 54.48
172.05, 209.49 .025
Moderately differentiated 192.11 46.86
176.02, 208.21 Post hoc:
(a) and (c)= .05
(b)
(b) and (c)= .042
Poorly differentiated (c)
162.04 52.57
1443.98,
180.10
Cell Area
Well differentiated (a)
542.29 139.91
494.23, 590.35 <.0001
Moderatelydifferentiated (b)
553.98 127.48
510.19, 597.77
Poorly differentiated (c)
414.72 127.68
370.85, 458.58 Post hoc:
(a)and (c)= <.0001
(b)and (c)= <.0001
Table 6: Statistical analysis using One Way ANOVA test and multiple comparisons test (Post-Hoc test) with
2
Tuckey HSD method (values in micron )
Criteria
Grade of OSCC
Mean Standard deviation Confidence limit
P-value
Nuclear
Well differentiated (a)
48.28 6.47
46.06, 50.51
.027
Perimeter
Post hoc:
Moderately differentiated 48.92 5.86
46.91, 50.94
(b) and (c)= .03
(b)
Poorly differentiated (c)
44.88 7.49
42.30, 47.46
Cell Perimeter
Well differentiated (a)
86.82 12.17
82.63, 91.00
<.0001
Post hoc:
Moderately differentiated 88.88 9.95
85.46, 92.30
(a) and (c)= . 001
(b)
(b) and (c) <.0001
Poorly differentiated (c)
76.38 13.08
71.89, 80.88
Mahima et al.,
Moderate
Poor
Well
Poor
well
823
Int J Med Res Health Sci. 2015;4(4):820-826
Morphometrical
Parameter
Nuclear area (NA)
Cell area (CA)
Nuclear perimeter
Cell perimeter
R (Pearson
Coefficient)
.123
.194
.148
.207
correlation
DISCUSSION
Mahima et al.,
824
Int J Med Res Health Sci. 2015;4(4):820-826
Mahima et al.,
of
Medical
REFERENCES
1.
2.
3.
825
Int J Med Res Health Sci. 2015;4(4):820-826
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Mahima et al.,
16.
17.
18.
19.
20.
21.
22.
23.
24.
826
Int J Med Res Health Sci. 2015;4(4):820-826
DOI: 10.5958/2319-5886.2015.00164.2
Open Access
ARTICLE INFO
st
ABSTRACT
Introduction: Meningiomas are tumors that arise from the meningothelial
cells. Most of these tumors are intracranial; some are intraspinal and few
extra cranial. There are many histological variants classified into three
grades depending on clinical behavior. Classification is important for
determining the modality of treatment. Objectives: To study the incidence,
location, sex and age predilection, histological variants and grading of
meningiomas based on WHO 2007 classification and recurrence if present.
Materials and methods: All128 cases of meningiomas. Based on
Histological features, typing and grading of meningiomas was done as per
the WHO 2007 classification of Meningiomas. Age, Sex incidence, Location
of meningiomas were studied. Results: Meningiomas comprised 25.25% of
all CNS tumors during the study period. Of 507 CNS tumors, 128 were
meningiomas. Most of them were intracranial, predominantly involving the
convexities of brain, females and the 41 50 age group. Of these, 116
were benign grade I tumors, 9 were grade II and 3 were grade III. The most
common histological variant was fibroblastic and meningothelial. Intraspinal
meningiomas were 16 (12.5%) cases with the psammomatous variant being
more common. Grade II and Grade III tumors located in parafalcine or
parasagittal area commonly recurred. Conclusion: Meningiomas are slow
growing tumors arising from the meningothelial cells accounting for 25.25%
of all CNS neoplasms showing a variety of histological patterns, more
common in women, predominantly Grade I tumors. Recurrence of tumors
depends on histological grade and extent of surgery.
INTRODUCTION
Harvey Cushing coined the name MENINGIOMA, in
1922 for the most common dural based tumor,
accounting for 15-30% of all primary intracranial
[1]
tumors. Meningiomas are mostly benign tumors but few
are malignant. The incidence of meningioma in India
ranges from 9-15 per cent of all intracranial neoplasms
according to a study by Dr A Vincent Thamburaj. These
tumors also occur extracranialy and intraspinaly. These
tumors are more common in middle aged women with a
th
th
peak during 4 -6 decade.(F: M intracranial 3.5:1 & Intra
spinal 10:1), There is no sex predisposition in elderly or
children. Based on histology and clinical behavior, WHO
classification categorizes meningiomas into three grades,
Grade I (benign), II (atypical) and III (malignant).Grade II
and Grade III meningiomas recur with greater
[2]
frequency. Histological grade of meningioma is
important in deciding subsequent therapeutic intervention
and management. Surgery is the treatment of choice for
Grade I tumors where as Grade II and grade III tumors
require both surgery and radiotherapy. Histological grade
and extent of surgical resection are very important
[2]
parameters to predict recurrence of tumors
Aim: The aim of this study was to determine the
incidence of Meningioma among all CNS tumors
occurring in the same period, Age and Sex predilection of
all meningiomas, their location, any site preference of the
histological variants, extent of surgical resection and
relation of grade to recurrence if present and correlate
Shrilakshmi et al.,
827
Int J Med Res Health Sci. 2015;4(4):827-831
in
Female
Male
Total
Convexities
32
41
37.27
Parafalcine
5.45
Parasagittal
Olfactory groove
Basifrontal
Sphenoidal
Suprasellar
Clinoidal
Petrous apex
Petroclival
Tentorial
CP angle
Foramen magnum
Cerebellum
Intraventricular
Total
6
2
6
9
3
1
1
1
3
10
1
1
78
4
1
1
7
1
1
1
1
2
32
10
3
7
16
4
1
1
2
4
10
2
1
2
110
9.09
2.73
6.36
14.54
3.64
0.91
0.91
1.82
3.64
9.09
1.82
0.91
1.82
100
%
12.5%
Thoracic
lumbar
Conus
Total
11
1
14
1
1
2
12
1
1
16
75%
6.25%
6.25%
100%
%
23.44
23.44
21.88
15.63
2.34
0.78
Secretory
2.34
Microcystic
0.78
Clear cell
2.34
Female
Male
Total
Percentage
Atypical
Papillary
3
-
3
1
6
1
4.69
0.78
3.13%
Rhabdoid
0.78
Anaplastic
Total
94
1
34
1
128
0.78
100
21 30
7.03%
31 40
17
25
19.53%
41 50
30
36
28.12%
51 60
26
28
21.88%
61 70
12
20
15.63%
71 80
4.68%
Total
94
34
128
100%
Shrilakshmi et al.,
12.5%
Transitional
Fibroblastic
2
2
0
0
2
2
12.5%
12.5%
Clear cell
6.25%
Total
14
16
100%
828
Int J Med Res Health Sci. 2015;4(4):827-831
DISCUSSION
Meningiomas account for 25 - 30% of all CNS tumours
and are the most common tumours arising from the
[1-3]
meninges. Most benign meningiomas occur in adult
women, but atypical and anaplastic forms seem to be
more common in men and the younger age group.
[4,5]
Childhood meningiomas are less common. Most
1
meningiomas are intracranial. 90% are supratentorial; the
anterior cranial fossa is involved far more frequently than
the posterior. Most of the intracranial tumors occur in the
convexities. Intraspinal Meningiomas constitute 25-46%
of all tumors occurring in the spinal cord and are more
[6,7]
common in the thoracic region.
Extracranial location is
rare. Histologically meningiomas are of three
grades.Grade I meningiomas comprise 90%, Grade II
Atypical meningiomas comprise between 4.7% to 7.2% of
meningiomas, whereas Grade III malignant meningiomas
[1-3]
comprise between 1.0% to 2.8%. Majority are positive
for EMA and 100% for Vimentin. High grade types may
[1]
be negative or weakly reactive for both. Irrespective of
the sex of the patient progesterone receptors are
expressed by many and lack of its expression is
[1-3]
associated with poor outcome.
Recurrence is not limited to meningiomas with malignant
histological features. Benign meningiomas can also recur
following incomplete resection, if large and associated
[8]
with monosomy14 and del(1p36). The extent of surgical
resection depends on the site, size of the tumor and its
relation to vital structures. Higher rates of recurrence are
seen in younger age, male sex, parasagittal location and
an aggressive histologic type. Reported recurrence rates
of grade I, II, and III meningiomas are 7- 25%, 29-52%,
[9,10]
50-94%, respectively.
The treatment in grade I tumors is total
[3,9]
resection. Surgery and adjuvant radiotherapy are the
treatment of choice in grade II and grade III
[9-10]
meningiomas.
Extent of surgical resection is one of
the most important factor in predicting recurrence along
with histological grading. Subtotal resections were
associated with more recurrence or re growth.
In the present study of a total of 507 CNS tumors,
Meningiomas were 128 and they comprised 25.25%
[11]
similar to various studies done by AB Shah et al ,
[12]
[13]
[14]
Ruberti R F , Intisar SH Patty et al , Zalata et al
[15]
and Ejaz Butt et al. The most common age group
involved was the 40- 50year was similar to studies done
[16]
by A B Shah et al, Ruberti et al,J amjoomet al
and
Intisar SH Patty et al. Two cases involved the paediatric
age group, constituting 1.56% which was similar to the
study on meningiomas in children done by Nirav Mehta et
[4]
al where childhood meningiomas accounted for 1.92%
of all meningiomas and a study done by Isabelle M
5
Germano et al where the incidence was 2.9%.
There were 110 intracranial meningiomas, constituting
85.94% of the total meningiomas similar to other studies
done by Jhamjoom et al, Intisar SH Patty et al and Zalata
et al. The most common location was the cerebral
convexities followed by the parasagittal area and the CP
angle similar to the various studies. Supratentorial
meningiomas are more common than infra tentorial
Shrilakshmi et al.,
829
Int J Med Res Health Sci. 2015;4(4):827-831
ACKNOWLEDGEMENT
This article could not have been compiled without the
able guidance of Dr P. Prema Latha, Professor and Head
of Department of Pathology, NRI College and Academic
Sciences, Chinnakakani.
Conflict of Interest: Nil
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
CONCLUSION
Meningiomas are slow growing tumors arising from the
meningothelial cells accounting for 25.25% of all CNS
neoplasms with a wide variety of histological patterns.
These tumors are more common in women and Grade I
tumors are predominant, Grade II and Grade III tumors
are less frequent. Recurrence of tumors depends on
histological grade and extent of surgery. The incidence,
sex predilection, histological types and behavior of
meningiomas in this part of the world and other studies
are similar despite geographic distance.
Shrilakshmi et al.,
11.
12.
13.
14.
830
Int J Med Res Health Sci. 2015;4(4):827-831
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
Shrilakshmi et al.,
831
Int J Med Res Health Sci. 2015;4(4):827-831
DOI: 10.5958/2319-5886.2015.00165.4
Open Access
1,
Shah Dev K , Khadka Rita , Yadav Ram Lochan , Khatri Sapkota Niraj , Sharma Deepak Yadav Prakash K
ARTICLE INFO
nd
Department of Physiology, B. P.
Koirala Institute of Health Sciences,
Dharan, Nepal
Corresponding author: Shan Dev,
Department of Physiology, Chitwan
Medical College (TU), Bharatpur,
Chitwan, Nepal
Email: devshahdr@yahoo.com
Keywords: Cetirizine, Drowsy, EEG,
Alpha wave, Beta wave
ABSTRACT
nd
INTRODUCTION
Despite subjective variations in experiencing the
drowsiness as an adverse effect of histamine H 1
[1]
antagonists can have potential serious implications.
Sedative effects of drugs impair the superior cognitive
functions which can severely impair daytime activities in
which concentration and a high degree of alertness and
skill are required. Under laboratory conditions,
nd
recommended doses of 2 generation antihistamines do
not produce drowsiness; however sedation at therapeutic
[2]
doses have been reported. Cetirizine is more sedating
[3,4]
than loratadine and terfenadine in some clinical trials.
Experiments revealed electroencephalogram (EEG)
power in alpha and theta-band is highly correlated with
[5]
drowsiness. The spectral parameters in EEG recordings
[6]
is useful in assessing the central sideeffects of drugs.
Aim of the study: The aim of our study was to find and
compare EEG changes in drowsy and non-drowsy
subjects after cetirizine administration.
MATERIALS & METHODS
Study design: This was cross-over, placebo-controlled,
double blind experimental study.
Study place: The study was conducted for one year in
the EEG laboratory of B. P. Koirala Institute of Health
Sciences (BPKIHS), Dharan, Nepal
832
Shah Dev et al.,
67.76(21.84 - 105.62)
25.9(12.24 - 76.1)
11.24(11 - 51.22)
0.045
NS
0.028
C4
29.48(16.34 - 66.18)
19.2(9.52 - 29.14)
8.8(7.32 - 21.72)
0.045
NS
0.021
0.045 NS
51.38(25.08 - 80.26)
30.52(10.06 - 59.36)
11.98(5.24 - 49.62)
NS
0.045 NS
18.32(11.74 - 26.98)
27.2(5.02 - 33.66)
6.76(3.14 - 20.16)
NS
alpha 3 (12.5-14 Hz) activity
0.032 NS
Fp2
3.68(3.08 - 6.72)
5.1(3.38 - 9.74)
2.5(1.96 - 3.58)
NS
0.018 NS
F4
4.58(3.7 - 7.74)
10.22(3.28 - 15.94)
3.54(2.8 - 5.86)
NS
0.016 NS
0.028
Fp1
3.9(2.84 - 7.38)
5.04(2.06 - 13.76)
3.3(1.98 - 4.46)
0.045 NS
0.021
O1
13.34(2.82 - 34.54)
11.08(3.94 - 40.38)
4.56(4.04 - 9.1)
p<0.05, considered statistical significant; NS=no statistical significant difference; p=Overall p value by Friedmans test; p1=
baseline vs. placebo; p2= baseline vs. Cetirizine. Fp1-Left prefrontal,Fp2-Right prefrontal, F4-Right frontal, F8-Right
anterior temporal, T5-Left posterior temporal, C4-Right central,P3-Left parietal,P4-Right parietal,O1-Left occipital,O2-Right
occipital,Cz-Midline central, Pz- midline parietal.
O2
T5
833
Shah Dev et al.,
Table 2: Comparison of power of EEG beta (14.5-32) activity among baseline, placebo and cetirizine conditions of
cetirizine treated symptomatic subjects(n=9)
Electrode
Baseline (n=9)
Placebo (n=9)
Cetirizine(n=9)
p
p1
p2
2
2
2
sites
V
V
V
0.032 NS
Pz
20.44(12.64 - 31.02)
21.24(15.44 - 29.14)
18.44(12.52 - 23.34)
NS
0.045 NS
F4
19.34(15.92 - 23.76)
24.94(14.3 - 31.58)
18.52(13.74 - 21.02)
NS
0.018 NS
0.028
O1
15.56(9.72 - 29.78)
15.9(10.82 - 16.96)
9.74(5.92 - 12.04)
p<0.05, considered statistical significant; NS=no statistical significant difference; p=Overall p value by Friedmans test; p1=
baseline vs. placebo; p2= baseline vs. Cetirizine. Pz- midline parietal, F4-Right frontal,O1-Left occipital.
Table 3: Comparison of power of EEG slow (0.5-6.5 Hz) activity among baseline, placebo and cetirizine conditions
of cetirizine treated asymptomatic subjects (n=21)
p
p1
p2
Electrode
Baseline (n=21)
Placebo (n=21)
Cetirizine (n=21)
2
2
2
sites
V
V
V
Slow (0.5-6.5 Hz) activity
0.009 NS
0.008
Cz
89.94(79.66 - 128.74)
95.18(80.18 - 129.22) 110.58(87.24- 145.5)
0.001 NS
0.004
Pz
82.2(64.38 - 98.1)
74.84(63.42 - 94.26)
87.88(71.82 - 110.3)
0.010 NS
0.007
T6
33.5(22.34 - 47.34)
31.62(27.64 - 51.96)
36.06(28.96 - 51.42)
0.013 NS
0.009
C3
58.68(48.86 - 70.44)
59.1(50.88 - 85)
63.9(53.52 - 90.48)
Alpha 1 (6.5-8 Hz) activity
0.012 NS
0.006
F3
6.8(5.52-10.64)
6.24(5.34-13.28)
9.26(7.7-11.7)
0.016 NS
0.003
C3
6.9(5.42-8.84)
6.64(4.78-13.44)
9.16(7-11.7)
p<0.05, considered statistical significant; NS=no statistical significant difference. p=Overall p value by Friedmans test; p1=
baseline vs. placebo; p2= baseline vs. Cetirizine. Cz-Midline central, Pz- midline parietal, T6-Right posterior temporal, C3Left central, F3-Left frontal.
Table 4: Comparison of power of EEG alpha 3 (10.5-12
Hz) activity between symptomatic and asymptomatic
subjects in cetirizine treated condition
Asymptomatic
Symptomatic
Electrode
p
subjects (n=21) subjects
sites
2
2
V
(n=9) V
Fz
10.92(6.8 - 17)
4(3.84 - 7.08)
0.015
Cz
13.46(7.96- 21.2) 4.96(4.58 - 7.28) 0.005
Pz
13.76(9.98- 29.9) 7.34(5.54 - 13.4) 0.032
Fp2
5.56(3.16 - 8.52) 2.5(1.96 - 3.58)
0.003
F8
3.78(1.94 - 5.96) 1.58(1.1 - 2.28)
0.012
F4
8.42(4.16- 12.84) 3.54(2.8 - 5.86)
0.009
C4
10.02(7.08- 15.1) 3.88(3.1 - 6.7)
NS
T4
2.24(1.38 - 4.28) 1.2(0.8 - 1.42)
0.009
T6
9.4(4.68 - 18.84) 3.44(2.94 - 8.44) NS
P4
12.62(8.6- 26.82) 7.8(3.9 - 9.7)
0.044
O2
18.24(8.04- 35.3) 5.66(3.62- 14.54) 0.028
Fp1
5.28(3.56 - 7.78) 3.3(1.98 - 4.46)
0.022
F7
2.64(1.94 - 4.4)
1.74(1.6 - 2.04)
NS
F3
6.6(4.68 - 11.78) 3.5(2.5 - 4.3)
0.011
C3
8.8(6.44 - 13.52) 3.66(2.84 - 4.88) 0.003
T3
2.52(1.4 - 3.68)
1.16(0.98 - 1.8)
0.014
T5
7.02(3.4 - 19.9)
2.92(2.32 - 4.76) 0.039
P3
10.12(7.58- 24.5) 4.48(3.26 - 8.92) 0.014
O1
19.26(5.98- 31.6) 4.56(4.04 - 9.1)
0.012
834
Shah Dev et al.,
3.
4.
5.
835
Shah Dev et al.,
6.
836
Shah Dev et al.,
DOI: 10.5958/2319-5886.2015.00166.6
Research article
Open Access
ARTICLE INFO
Received: 05th July 2015
Revised: 10th August 2015
Accepted: 20th Sep 2015
Authors details: 1Associate Professor,
2
Associate Professor, 3M.Sc, Microbiology,
MNR Medical College, Sangareddy
Corresponding author: B. Lakshmi
Associate Professor, Microbiology, MNR
Medical College, Sangareddy
Email: lakshmibapan@gmail.com
Keywords: Antibiogram, Gram negative
isolates, Imipenam, Multi drug resistance,
older generation antibiotics.
ABSTRACT
Introduction: Drug resistance is a serious medical problem. Indiscriminate use of
antibiotics has led to a state where multi drug resistant bacteria have become
increasingly prevalent. Therefore regular surveillance of important pathogens and
their resistant pattern is mandatory. Aim: To find out prevalence of organisms
causing infection and their sensitivity pattern. Material and methods: 676 clinical
samples were screened among which 156 Gram Negative(GN) Isolates were
processed for their antibiotic sensitivity profile against 12 different antibiotics.
Results: Escherichia coli is the most common isolate of 156 gram negative
isolates. Among all antibiotics, ampicillin is least sensitive (22%). Antibiotics with
good sensitivity are Imipenam, Meropenam (100%), Levofloxacin 94%, Amikacin
89% Ciprofloxacin 79%, Gentamycin 77%. Pseudomonas is 100% sensitive to
Amikacin. Conclusion: Antibiotic resistance in our area is still moderate. It is
essential to test for older generation antibiotics before deciding on higher
antibiotics for treatment which will have a tremendous impact on the treatment as
well as cost effectiveness. Regular surveillance helps in implementing better
therapeutic strategies.
INTRODUCTION
Microbiological infection plays a vital role in determining
the outcome as well as cost and duration of hospital stay
[1]
for admitted patients . Gram negative infections were
responsible for more severe infections and case fatality.
Severity of the cases increased by drug-resistant
pathogens in hospitalized patients with serious infections
such as pneumonia, urinary tract infections, skin and skinstructure infections and primary or secondary bacteremia
which is generally ascribed to the widespread use of
antimicrobial agents. In a recent report the Infectious
Diseases society of America specifically addressed three
categories of MDR- Multi Drug Resistant - gram negative
bacilli namely, extended spectrum cephalosporinresistant Escherichia coli and Klebsiella spp., MDR
Pseudomonas aeruginosa, and Carbapenam-resistant
Acinetobacter spp. Moreover there are now a growing
number of reports of cases of infections caused by gram
negative organisms for which no adequate therapeutic
options exist. This return to preantibiotic era has become
[2].
a reality in many parts of the world
So for the
prevention of nosocomial infections a thorough knowledge
of the infection rates and of the source, type and nature of
invading microorganisms along with risk factors
[2,3].
associated with infection is the starting point
Also
knowledge of the resistivity pattern of different clinical
isolates of hospital has been the global necessity for
control of emergence of resistance to antimicrobial
[3]
agents Furthermore this screening would provide a
valuable and critical data that could help physicians in
way of successful treatment in addition to health care
settings policy towards antimicrobial drug programming
and invention of new drugs. Therefore invitro antimicrobial
susceptibility testing has been done by many researchers
as a useful method to identify drug resistance pattern of
clinical isolates. Characterization of bacteria that are
837
Lakshmi et al.,
[6].
No of samples
312
209
55
67
33
676
Isolates
64
70
15
03
04
156
No of isolates
Percentage %
Esch.coli
64
41
Klebsiella spp
56
36
Proteus
14
Pseudomonas
13
8.3
Citrobacter
09
5.7
Ampicillin
Piperacillin
Cotrimoxazole
Gentamycin
Amikacin
Ciprofloxacin
Levofloxacin
Ceftazidime
Ceftriaxone
Cefaperazone
Imipenam
Meropenam
E.colin = 64
Klebsiella N=56
Proteus N = 14
PseudomonasN = 13
Citrobacter N = 09
5(7.9%)
7 (12.5%)
5 (35.7%)
5 (38.4%)
3 (33.3%)
59 (92.1%)
49 (87.5%)
9 (64.3%)
8 (61.5%)
6 (66.6%)
35 (54.7%)
27 (48.2%)
12 (85.7%)
9 (69.2%)
7 (77.7%)
29 (45.3%)
29 (51.8%)
2 (14.3%)
4 (30.8%)
2 (22.2%)
34 (53.2%)
19 (34%)
3 (21.5%)
6 (46.2%)
4 (44.5%)
30 (46.8%)
37 (66%)
11 (78.5%)
7 (53.8%)
5 (55.5%)
52 (81.3%)
42 (75%)
9 (64.3%)
12 (92.4%)
5 (55.5%)
12 (18.7%)
14 (25%)
5 (35.7%)
1 (7.6%)
4 (44.5%)
60 (93.75%)
49 (87.5%)
11 (78.6%)
13 (100%)
7 (77.7%)
4 (6.25%)
7 (12.5%)
3 (21.4%)
0 0%
2 (22.2%)
46 (72%)
50 (89.3%)
11 (78.6%)
12 (84.6%)
5 (55.5%)
18 (28%)
6 (10.7%)
3 (21.4%)
2 (15.4%)
4 (44.5%)
62 (96.9%)
53 (94.65%)
12 (85.8%)
12 (92.3%)
8 (88.9%)
2 (3.1%)
3 (5.35%)
2 (14.2%)
1 (7.7%)
1 (11.1%)
34 (53.2%)
29 (51.8%)
8 (57.2%)
10 (77.2%)
6 (66.6%)
30 (46.8 %)
27 (48.2%)
6 (42.8%)
3 (23.7%)
3 (33.4%)
34 (53.2%)
38 (67.9%)
10 (71.5%)
10 (77%)
5 (55.5%)
30 (46.8%)
18 (32.1%)
4 (28.5%)
3 (23%)
4 (44.5%)
37 (57.8%)
34 (60.7%)
9 (64.3%)
0-0
6 (66.6%)
27 (42.2%)
22 (39.3%)
5 (35.7%)
13 (100%)
3 (33.4%)
64 (100%)
56 (100%)
14 (100%)
13 (100%)
9 (100%)
00
00
00
00
0-0
64 (100%)
56 (100%)
14 (100%)
13 (100%)
9 (100%)
00
00
00
00
0-0
838
Lakshmi et al.,
Resistance
Ampicillin
35 (22.4%)
131 (84%)
Piperacillin
90 (57.7%)
66 (42.3%)
Cotrimoxazole
66 (42.3%)
90 (57.7%)
Gentamycin
120 (76.9%)
36 (23.1%)
CONCLUSION
Amikacin
140 (89.7%)
16 (10.3%)
Ciprofloxacin
123 (79%)
33 (21%)
Levofloxacin
147 (94.2%)
9 (5.8%)
Ceftazidime
87 (55.8%)
69 (44.2%)
Ceftriaxone
97 (62.2%)
59 (37.8%)
Cefaperazone
86 (55%)
70 (45%)
Imipenam
156 (100%)
0 (0%)
Meropenam
156 (100%)
0 (0%)
DISCUSSION
Antibiotics when first introduced were considered as a
magic bullet. A single injection of penicillin could eradicate
a life threatening infection. Unfortunately with time due to
malpractices or natural causes, most of the cheaper
antibiotics have lost their efficacy and more and more
expensive and complicated antibiotics were introduced
and marketed to combat simple infection. The microbial
pathogens as well as their antibiotic sensitivity pattern,
[7].
may change from time to time and place to place
Out of 156 Gram Negative bacterial isolates in our study,
Escherichia coli is the most common isolate followed by
[4,8,9].
Klebsiella spp similar to other studies
Most of these isolates are highly resistant to commonly
used antibiotics like ampicillin (84%) which correlated
[2,8]
closely with other studies
High sensitivity was noted to Amikacin (89%) and
Gentamycin (77%) in our study which is in tandem with
[3,4,9]
the work done by other authors
Also Pseudomonas
showed 100% sensitivity to amikacin in our study.
All isolates (100%) were susceptible to Imipenam and
[9,10].
Meropenam
44.23% were resistant to ceftazdime, 37.8% were
resistant to ceftriaxone, 44.87% were resistant to
[1,10].
cefperazone correlated well with other studies
Whereas 70-75% resistance to cephalosporins was
[9]
reported.
Sensitivity to cotrimoxazole (42%) in our work closely
correlates with the work of authors Kala yadav and
.[11,12].
Raminder sandhu
Quinolones were highly effective in our study. Only
21.15% isolates were resistant to ciprofloxacin and 5.8%
isolates were resistant to levofloxacin. Similar to the work
[1].
done by Patel Bhaumik
Contrast to our work, are studies which reported higher
[2,11]
drug resistance to quinolones,
aminoglycosides,
[ 13,14].
cephalosporins
Such variations in the antimicrobial
sensitivity pattern among different studies may be due to
ACKNOWLEDGEMENT
Mr.M. Ravi Varma, Vice chairman, Dr.V.Satya Prasad,
Professor, Department of Anatomy, Dr.G.Shobha Paul,
Professor and HOD Department of Microbiology, Dr. K.
Ambareesha, Department of Physiology, MNR Medical
College and Hospital for giving us the opportunity and
timely guidance.
Conflict of Interest: Nil
REFERENCES
1.
2.
3.
4.
839
Lakshmi et al.,
5.
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840
Lakshmi et al.,
DOI: 10.5958/2319-5886.2015.00167.8
Open Access
ARTICLE INFO
Received: 6th Jul 2015
Revised: 5th Sep 2015
Accepted: 18th Sep 2015
Authors details: 1Department of
Physical Therapy for Cardiovascular/
Respiratory Disorder and Geriatrics,
Faculty of Physical Therapy, Cairo
University, Egypt
2
Department of Physical Therapy for
Musculoskeletal Disorders, Faculty of
Physical Therapy, Cairo University,
Egypt
3
Ph.D. in Physical Therapy for
Musculoskeletal
Disorders,
Cairo
University Hospitals, Egypt
Corresponding
author:
Abdelaal
Ashraf AM, Faculty of Physical Therapy,
Cairo University, Egypt
E-mail: drashraf_pt79@yahoo.com
Keywords:
Diaphragm
&
Costal
Manipulation,
COPD,
Pulmonary
Function, Functional Capacity.
ABSTRACT
Background: Many manual procedures have long been involved in the
management of chronic obstructive pulmonary disease (COPD). Few
literatures evaluated the COPD responses to individual or multiple
manipulative techniques, so effects are unclear and poorly understood.
Aim: to explore ventilatory functions (VF) and functional capacity (FC)
responses to diaphragmatic or costal manipulation or both in COPD
patients. Methods: 195 male patients were randomly assigned into
diaphragmatic manipulation group (group-A; n= 46), rib raising group
(group-B; n= 53), both procedures group (group-C; n= 50) and control group
(group-D; n= 46). Treatment regimens were applied twice weekly for 12
weeks. Forced vital capacity (FVC), forced expiratory volume in one second
(FEV1) and FC (by 6 minute walk test "6MWT") were evaluated before and
after the study. Results: At the end of the study; FVC, FEV1 and 6MWT
mean values and percentages of increases were [3.63 0.56 (4.52%), 2.46
0.51 (14.42 %), 416.35 28.62 (3.82 %)], [3.56 0.38 (5.97 %), 2.43
0.48 (16.63), 415.28 37.81 (3.04 5)] and [3.930.54 (16.92), 2.86 0.5
(33.44 %), 433.03 46.76 (6.9 %)] for group-A, B and C respectively (P <
0.05). There were also significant differences in FVC, FEV1 and 6MWT
mean values between groups at the end of the study but in favor of group-C
(P< 0.05).Conclusions: Diaphragmatic and costal manipulative procedures
are effective therapeutic tools in improving VF and FC in COPD patients
especially if applied together.
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) is a
common treatable disorder with progressive, partially
[1,2]
reversible airflow limitation. COPD is characterized by a
[3]
gradual worsening of lung functions and health status.
Globally; COPD is associated with considerable morbidity
and mortality proportion, it is the fifth leading cause of
death in the world; with its mortality rate is expected to
[4]
increase more than 30% during the next 10 years. Even
with recent treatment advances; COPD continues as a
severely debilitating condition that is usually undiagnosed
[5]
until clinical symptoms become apparent. Exercise and
activity intolerance are the two main characteristic features
of COPD patients. Pulmonary, cardiovascular as well as
skeletal muscles dysfunctions are the main underlying
elements in limiting exercise capacity of COPD
[6]
patients. Although patients with COPD can greatly benefit
from exercise training in improving functional capacity (FC)
[7]
for satisfactory long periods, but presence of airflow
limitations and early breathlessness that may limit their FC
[8]
and exercise performance and may be clearly apparent
during low and moderate exercise intensities or even at
rest, directed researchers to seek alternative and
complementary procedures that can effectively and safely
benefit COPD patients. Therapeutic intervention designed
to counteract COPD changes and increase chest wall
841
Ashraf et al.,
842
Ashraf et al.,
843
Ashraf et al.,
Control group
(Group-D)
F-Value
P-Value
54.64 5.8
68.93 2.91
1.70 0.63
23.84 1.96
3.36 0.43
2.15 0.38
402.8 39.62
64.12 7.97
1.21
0.09
0.81
2.12
0.7
0.42
0.088
3.84
0.31
0.17
0.49
0.1
0.56
0.74
0.97
1.0
Table 2: Within groups comparison of FVC, FEV1, MVV and 6MWT mean value for the four groups (pre-posttest)
Both
Character
Diaphragmatic
Rib
Rising
Control group
Procedures
Manipulation (Group-A) (Group-B)
(Group-D)
(Group-C)
T-Value
-15-17.84-12.0315.7
FVC (Liter)
-19
-24
-16
-19
4.02
8.01
3.09
1.2
P-Value
T-Value
-5.64-38-36.65-3.77FEV1 (Liter)
-6
-39
-37
-4
1.06
1.31
2.84
4.85
P-Value
T-Value
-60.72-54.54-64.5318.33
6MWT (meter)
-45
-47
-49
-22
8
1.43
4.61
3.23
P-Value
Level of significance at P<0.05. = significant
Table 3: Post-hoc multiple comparisons mean percent changes (between groups) (P value).
Variable
Group
Group-A
Group-B
Group-C
Means
%
Means
%
Means
%
-40
FVC,
Group-B
0.47
0.21
4.703
-21
-4
-18
(FVC %)
Group-C
0.002
7.43
1
2.88
-4
-9
-13
-11
(P value)
Group-D
1.87
1.39
0.001
3.24
4.37
-51
FEV1,
Group-B
0.75
0.17
2.54
-5
-24
-6
-21
(FEV1 %)
Group-C
4.99
7.88
6.98
5.88
-17
-22
-12
(P value)
Group-D
0.001
4.43
0.002
6.71
1.57
-18
-164
6MWT,
Group-B
0.89
1.05
3.6
-92
-111
(6MWT %)
Group-C
0.04
3.23
0.02
1.14
-122
-111
-5
(P Value)
Group-D
0.04
2.1
0.04
3.58
3.3
Level of significance at P<0.05.
in group-D by (0.9 0.3 %) between the same evaluation
-22
points (P= 3.23 ) (Table 2). Between-groups comparison
revealed that there were statistically significant differences
in 6MWT mean values (P=0.001) and 6MWT mean
-162
percent changes (P=2.33 ) between groups at the poststudy evaluations; but in favor of the group-C, furthermore;
there was non-significant difference between group-A and
B in 6MWT mean values (P= 0.892) and 6MWT mean
percent changes (P= 0.08) (Table 3, Figure 1).
DISCUSSION
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12. Carlson RV, Boyd KM, Webb DJ. The revision of the
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American
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BoehringerIngelheim Pharmaceuticals Inc, 2011.
http://www.osteopathic.org/copd-guide. Miller WD.
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847
Ashraf et al.,
DOI: 10.5958/2319-5886.2015.00168.X
Research article
Open Access
ABSTRACT
ARTICLE INFO
th
Spine,
INTRODUCTION
Degenerative cervical spine disorders are referred to one
or more of the following process: decrease in signal
intensity of disc, posterior disc protrusion, anterior
compression of spinal cord and dura, disc space
[1]
narrowing, foraminal stenosis
or osteophytosis. Aging
process plays a significant role in the pathogenesis of
[1]
cervical spine degeneration . They are asymptomatic in
[3]
most of the cases . It can be hereditary in 73% of cases
[2]
[3;4]
, or sport related
,
The pathophysiology of cervical degenerative disease may
be multifactorial with both dynamic factors and static
factors that will lead to stenosis resulting in repetitive injury
[5]
to the spinal cord .
In United States a population study at Rochester, Minn,
shows the annual incidence of cervical radiculopathy for
men and women from all causes is 107.3 and 63.5 cases
[6]
per 100,000 populations, respectively . Another study
from Italy in 1996 reported a prevalence of cervical
radiculopathy from spondylosis as 3.5 cases per 1000
[7]
people .
In this study, we aim to study patterns of cervical
degenerative disease at King Abdulaziz University
848
Bangash et al.,
Age
Gender
level
involved
Factor B
r value
P value
Gender
0.254
120
0.005
level involved
history of
weakness
history of
numbness
0.222
75
0.05
0.339
81
0.002
0.254
120
0.005
level involved
Abnormal
reflexes
duration of
symptoms
0.076
75
0.516
0.26
96
0.01
0.34
63
0.006
849
Bangash et al.,
850
Bangash et al.,
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
851
Bangash et al.,
DOI: 10.5958/2319-5886.2015.00169.1
Research article
Open Access
ARTICLE INFO
th
ABSTRACT
Background: Protein energy malnutrition is the major cause of poor prognostic
outcome in patients on maintenance hemodialysis (MHD). The assessment of
nutritional status in patients on maintenance hemodialysis should be done both
subjectively and objectively by integrating clinical, biochemical and anthropometric
measurements. A study was conducted to assess the possible correlations
between the subjective global assessment-dialysis malnutrition score (SGA-DMS),
anthropometric measurements, and biochemical parameters in hemodialysis
patients. Methods: The study included 90 patients (55 males and 35 females; age
range of 25 to 73 years; mean age 52.62 11.7 years) undergoing twice/thrice
weekly maintenance hemodialysis for six months and above in the dialysis unit of
a tertiary care teaching hospital. The MHD patients were assessed by SGA -DMS,
anthropometry and biochemical indicators (serum albumin, iron, ferritin and
transferrin) of nutritional status. Results: According to the SGA-DMS 54.4 % were
moderate to severely malnourished, 31% were mild to moderately nourished and
14.4% were well nourished. There was a highly significant negative correlation
between SGA DMS and serum albumin, iron, transferrin; positive correlation
between SGA-DMS and ferritin (P<0.0001). Body mass index, upper arm
circumferences, and skin fold thickness had a highly significant negative
correlation with SGA-DMS (P<0.001), where as the lean body mass, total body
water and the fat free mass had a significant negative correlation (P<0.05).
Conclusion: SGA-DMS correlated with anthropometric and biochemical
parameters that are indicative of nutritional status. SGA DMS used in
conjunction with other objective nutritional assessment methods may be of greater
impact in determining nutritional status of hemodialysis patients.
INTRODUCTION
Protein energy malnutrition (PEM) is highly prevalent in
patients on maintenance hemodialysis (MHD) and is
strongly associated with poor clinical outcomes in these
[1]
patients. Dietary restriction, increased protein catabolism
due to inflammatory cytokines, anorexia, uremic toxins and
metabolic acidosis as well as a decrease in anabolic
hormones, contribute to malnutrition in chronic
[2]
hemodialysis patients. Assessment of nutritional status is
often ignored in many dialysis centers while periodical
assessment of the nutritional status by simple methods
could have a beneficial impact on the patients. Hence it
should be part of the follow-up of dialysis patients, and is
fundamental for preventing, diagnosing and treating PEM.
Early detection and management of PEM plays a pivotal
role in reducing complications and mortality in patients on
[3]
MHD.
According
to
the
National
Kidney
Foundation/Dialysis Outcome Quality Initiative Guidelines
(National Kidney Foundation, 2002), the assessment of
nutritional status in CKD patients on MHD should be made
by integrating clinical, biochemical and anthropometric
[4]
parameters. The anthropometric measurements includes
measurement of body mass index, lean body mass, skin
fold thickness, mid arm circumference (MAC) and mid arm
[5,6]
muscle circumference (MAMC).
852
Vanitha et al.,
853
Vanitha et al.,
55.06 8.02
51.87 11.89
0.157
57.71
10.03
23.34 3.39
22.11 2.59
20.63 3.59
0.02*
22.25 2.27
21.49 1.94
18. 65 4.27
< 0.0001**
Mid
arm
muscle
circumference (cm)
Triceps skin fold thickness
(mm)
2
Mid arm muscle area (cm )
18.46 1.53
18.05 1.47
15.82 3.23
< 0.0001**
12.01 2.67
10.96 1.92
9.27 3.47
0.004*
27.35 4.5
26.09 4.18
20.59 8.23
< 0.0001**
12.42 3.89
10.99 2.78
8.56 4.79
0.004*
46.85 6.31
45.68 6.97
42.27 9.17
0.141
55.04 8.43
54.38 9.33
53.71 6.49
0.782
31.92 3.87
31.89 4.41
30.44 5.46
0.381
44.33 5.37
44.29 6.17
42.27 7.58
0.385
10.36 3.42
9.46 2.18
8.24 2.37
0.261
3.44 0.562
3.66 0.34
3.26 0.431
< 0.0001**
64.84 17.78
0.002**
0.003*
170.16 39.09
< 0.0001**
88.92
75.43 24.40
32.72
261.36
277.5 70.43
Serum ferritin (ng/mL)
72.95
237.69
202. 29 35.93
Serum transferrin (mg/dL)
35.16
** P<0.001- highly significant; *P<0.05- significant
Serum iron (g/dL)
854
Vanitha et al.,
DISCUSSION
Nutritional assessment is a vital function of healthcare
providers. The nutritional status of hospitalized patients can
be assessed by a variety of methods. Subjective Global
Assessment Dialysis Malnutrition Score (SGA -DMS) is a
fully quantitative nutritional status assessment tool which is
widely used in patients on maintenance hemodialysis both
in clinical practice and in research.
In the present study, based on the SGA-DMS, 31.1% of the
patients were mild to moderately and 54.4% were moderate
to severely malnourished. A study conducted by Janardhan
et al, reported that 91% of patients on MHD were mild to
[20]
moderately malnourished.
Similarity Faintuch et al, also
reported severe malnutrition in 13% of their study
[21]
population.
In this study, SGA-DMS negatively correlated with
anthropometric measurements such as body weight, body
mass index, TSF and MAC and biochemical parameters
such as serum albumin, iron and transferrin. KalantarZadeh et al, found that SGA-DMS was significantly
correlated with anthropometric parameters like MAMC,
MAC, BMI, TSF and TIBC. A study done by Janardhan et
[20]
al, also reported the same.
Serum albumin has frequently been used as a marker of
nutritional status. In the present study, like many other
studies a statistically significant lower level of serum
albumin was observed in HD patients with moderate to
2.
3.
4.
5.
855
Vanitha et al.,
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
856
Vanitha et al.,
DOI: 10.5958/2319-5886.2015.00170.8
Research article
Open Access
ARTICLE INFO
Received: 14th July 2015
Revised: 24th Aug 2015
Accepted: 30thSep 2015
1
Authors
details:
MD, Assistant
2
Professor; MS, Assistant Professor;
3
MS, Senior Resident; 4MS, Professor &
Head
Dept.
of
Obstetrics
and
Gynaecology, SRMS Institute of Medical
Sciences, Bareilly, Uttar Pradesh, India
ABSTRACT
Introduction: The serum iron and ferritin concentrations decline after
midpregnancy. The amount of dietary iron, together with that mobilized from
stores, will be insufficient to meet the average demands imposed by
pregnancy. Without supplementation, the haemoglobin concentration and
hematocrit fall appreciably as the blood volume increases leading to iron
deficiency anaemia (IDA). Aims & objectives: To compare effectiveness of
weekly supplementation of 200 mg elemental iron with daily supplementation
of 100 mg elemental iron on iron indices along with haemoglobin and
hematocrit values in pregnant women. Materials & Methods: A prospective
randomised longitudinal study was conducted at a tertiary care teaching
hospital. Study included 100 pregnant women randomly allocated to two
groups. Group I (n=50) received daily iron and group II (n=50) received
weekly iron supplementation. During follow-up haemoglobin and hematocrit
values were estimated at 4, 8 , 12 and 16 weeks of iron supplementation. Iron
indices: serum iron, total iron binding capacity (TIBC) and serum ferritin were
estimated before and after 12 and 16 weeks of iron supplementation.
Results: Significant increase in haemoglobin, hematocrit and serum iron
levels was ovserved in both the groups (p < 0.001) but on intergroup
comparison it was significantly higher in group I than group II (p < 0.001).
Serum ferritin improved in both the groups but improvement was not
significant in weekly supplemented group. Compliance was better and sideeffects were less in group II as compared to group I (11.36% versus 39.9%).
Conclusion: The weekly supplementation with 200 mg of elemental iron of
pregnant women had desired effect on iron indices except for the serum
ferritin level which can be overcome by extending the supplementation to the
post-partum period.
INTRODUCTION
Iron deficiency anemia is one of the most common
nutritional disorders and presents as a widespread public
health problem in the world and especially in developing
[1]
countries including India . In India 62-88% pregnant
[2,3]
women suffer from anaemia
. Approximately 80% of all
[4]
anemias in pregnancy occur due to iron deficiency .
[5,6]
Anemia is associated with poor pregnancy outcome , in
the form of preterm birth, low birth weight, inability to
tolerate haemorrhage during labour leading to increase
incidence of infection etc.
In India despite the effort of the National anemia
prophylaxis programme since 1970 to supplement all
pregnant women with daily iron and folic acid, anaemia
[2,3]
still continues unabated . The reasons for the limited
success of iron supplementation are unclear but poor
compliance because of the related gastrointestinal side
effects of medicinal iron is commonly cited as an important
constraint.
In recent years, oral iron supplementation program has
been focused from daily doses to intermittent doses (once
or twice weekly). Many studies have been conducted in
various parts of world and most of the studies showed that
the increase in hemoglobin level were similar to daily
supplementation.
The hypothesis behind intermittent iron supplementation
has been based on mucosal block theory of iron
[7]
857
Bagchi et al.,
858
Bagchi et al.,
Table 1: Hematological values at the beginning and after 12 weeks and 16 weeks of supplementation period
Study groups
Baseline
12 weeks of
supplementation
16 weeks of
supplementation
Difference*
't' value*
'P'
value*
Group I (n=45)
GroupII (n=44)
10.22+0.59
10.29+0.71
11.04+0.45
10.76+0.69
11.45+0.55
11.07+0.64
1.23
0.78
9.76
5.064
<0.001
<0.001
Group I (n=45)
32.19+2.04
35.87+2.30
37.58+2.34
5.39
11.211
<0.001
GroupII (n=44)
32.94+2.46 34.81+1.76
* difference is between initial and 16 weeks values
35.63+1.99
2.69
5.244
<0.001
Hb
(g/dL)
Hct
(%)
Table 2: Iron indices at the beginning and after 12 weeks and 16 weeks of supplementation period
Study groups
Baseline
12 weeks of
supplementation
16 weeks of
supplementation
Difference*
t' value*
'P'
value*
Serum iron
(g/dL)
Group I (n=45)
79.06+33.55
105.16+25.01
134.50+19.37
55.44
9.599
<0.001
Group II (n=44)
77.85+35.79
93.43+34.13
107.01+29.98
29.16
4.143
<0.001
TIBC
(g/dL)
Group I (n=45)
549.33+166.33
608.11+119.05
440.91+105.32
-108.42
3.6943
0.0004
Group II (n=44)
528.75+146.98
629.85+175.37
464.54+139.52
-64.21
2.102
0.038
Serum
ferritin
(g/dL)
Group I (n=45)
50.05+29.68
82.42+30.09
117.44+20.22
67.39
12.588
<0.001
Group II (n=44)
58.82+36.36
58.92+26.49
70.70+24.08
12.21
1.861
0.0661
DISCUSSION
The present study aimed to evaluate the effect of weekly
compared with daily iron supplementation on iron indices
along with haemoglobin and hematocrit values in
pregnant women who attended the antenatal clinic, at our
hospital.
Though in our study the haemoglobin rise was more
significant in daily group, it increased to a significant level
[Table 1 (p<0.001)] in weekly group too and was
[17]
maintained to a safe level. In study by Mumtaz et al.
too, the hemoglobin rose to a significant level in weekly
group (p=0.0037).
The serum iron values increased to a significant level in
both groups but increase in daily group was significantly
more than weekly group (p<0.001). Similarly the TIBC
values increased up to 12 weeks of supplementation
thereafter there was fall in TIBC values which was
significant in both groups but in daily group the change
was significantly more than weekly group (p<0.001).
Serum ferritin value which is a sensitive indicator of iron
storage did not increase to a significant level (p=0.0661)
in weekly group but in daily group the increase was
significant (p<0.001). Similar results were found in the
[17]
study by Mumtaz et al.
where the serum ferritin level
increased to a significant level in daily group (p<0.001)
whereas in weekly group it did not change (p=0.16). In the
[18]
study by Sunil Gomber et al.
the ferritin values
continued to be remain low during pregnancy irrespective
of supplementation (p=0.63 within groups and p=0.40
between groups). In the study by A. Mukhopadhyay et al.
[19]
the baseline S. ferritin values were significantly
different in both groups (p=0.027) with a lower value in
weekly groups. There was no significant increase in S.
ferritin values in both daily (p=0.477) and weekly group
(p=0.680). Intergroup p values was 0.10. In study by
Ridwan et al.
, there were no significant within group
changes in serum ferritin concentrations. But a small
decrease in the weekly group together with a small
increase in the daily group, however caused a small but
significant difference between groups in treatment effect
[21]
(p=0.049). In study by SMZ Hyder et al. the baseline S.
ferritin values were higher in weekly group (p=0.06).
There was no significant difference in S. ferritin values at
6 weeks post-partum in both the groups. But in anaemic
subset of women a significantly (p<0.01) larger increment
in the daily regimen was observed than in the weekly at 6
weeks post-partum (Table-3).
Table 3: S. Ferritin levels in the two intervention
groups in different studies
Daily supplementation
Study
A.
Mukhopad
hyay et
al.18
Sunil
Gomber et
al.17*
Ridwan et
al.19
Mumtaz
etal.16
SMJ Hyder
et al.20**
Present
study
Initial
S.ferritin
(g/dl)
Final
S.ferritin
(g/dl)
18.41+21.9 27.7+19.8
Weekly
supplementation
Initial
Final
S.ferritin
S.ferritin
(g/dl)
(g/dl)
23.2+20.5
20.5+16.9
2.93
2.84
2.69
2.67
28.0+19.2
27.7+19.8
23.2+20.5
20.5+16.9
23.8+29.7
41.6+34.9
23.0+33.7
27.6+31.5
12.4
57.6
20.3
57.3
50.0+29.7
117.4+20.
58.82+36.4
71.04+24
859
Bagchi et al.,
10.
11.
12.
CONCLUSION
It can be concluded from this study that supplementation
of pregnant women once per week with 200 mg of
elemental iron is an effective option for prophylaxis in mild
anaemic or non-anaemic pregnant women in terms of
hematologic response
including iron indices under
conditions resembling routine antenatal care. Although
iron stores as indicated by S. ferritin were improved but
the improvement was not significant in weekly
supplemented group. This was probably because of
increased demands during pregnancy which outstripped
the supply. This can be overcome by extending the
supplementation to the post-partum period.
ACKNOWLEDGEMENT
13.
14.
15.
16.
17.
2.
3.
4.
5.
6.
7.
8.
9.
19.
20.
21.
860
Bagchi et al.,
DOI: 10.5958/2319-5886.2015.00171.X
Open Access
Nnadi, Mathias O N FWACS, FMCS, Bankole, Olufemi B FWACS, Fente Beleudanyo G FWACS, FMCS
2
ARTICLE INFO
Received: 26th Jul 2015
Revised: 10th Sep 2015
Accepted: 29th Sep 2015
Authors details:
1
Division of Neurosurgery, Department
of Surgery, University of Calabar
Teaching Hospital, Calabar, Nigeria.
2
Neurosurgical Unit, Department of
Surgery, Lagos University Teaching
Hospital, Lagos, Nigeria
3
Department of Surgery, Niger Delta
University Teaching Hospital, Okolobiri,
Bayelsa State, Nigeria
Institution the work is credited:
Division of Neurosurgery, Department of
Surgery, University of Calabar Teaching
Hospital, Calabar, Cross River State,
Nigeria.
Corresponding
author:
Nnadi,
Mathias, Division of Neurosurgery,
Department of Surgery, University of
Calabar Teaching Hospital, Calabar,
Nigeria.
Email: nnadimon@yahoo.com
ABSTRACT
Context: That unconscious man on the road being taken into the
ambulance was knocked down by a vehicle. The energy he absorbed from
the impact was proportional to the weight of the vehicle with its occupants,
and to the square of the velocity of the vehicle. That is a regular scenario
for the most unprotected and the most vulnerable road user, the pedestrian.
The need to know about him and protect him cannot be overemphasized.
Objective: To determine the etiologies, severity of traumatic brain injuries
and treatment outcome in pedestrians involved in road traffic accident.
Methods: It was a prospective, cross-sectional study involving pedestrians
with traumatic brain injuries from road traffic accidents managed in our
center over a four year period. Data were collected using structured
proforma which was component of our prospective data bank that was
approved by our hospital research and ethics committee. The analysis was
done using Environmental Performance Index (EPI) info 7 software. Result:
Seventy three patients were studied. There were 48 males. The mean age
was 25.08 years. Elderly patients were three. Fifty five patients had
vehicular accident. Twenty two patients were injured between 6AM and
10AM. Thirty two patients had mild head injuries. Favorable functional
outcome was seen in 82.19%, while mortality was 17.81%. Severity of
injury significantly affected the outcome. Conclusion: Our study showed
that the commonest cause of traumatic brain injuries in pedestrians was
vehicular accident. The mortality from traumatic brain injuries among
pedestrians was high. Severity of injury significantly affected the outcome.
861
Nnadi Mathias et al.,
Percent (%)
47.95
47.95
4.11
100
Percent (%)
30.14
16.44
27.40
23.29
2.74
100
Severe (%)
3 (20.00)
0 (0.00)
24 (43.64)
27 (36.99)
Motorcycle
Tricycle
Vehicle
Total
P = 0.5737
Contusion/he
morrhage
4
1
8
13
Diffuse
axonaI
injury
0
0
7
7
Edema
0
0
1
1
None
2
0
8
10
862
Nnadi Mathias et al.,
5 (%)
4 (%)
11(73.33) 13 (86.67)
3 (100)
3 (100)
39(70.91)
44 (80)
53(72.60) 60 (82.2)
DISCUSSION
In this study, there were more males (65.75%) than
[9]
females. In Bangalore, India, Pruthi et al in their study of
529 pedestrians with traumatic brain injuries, found 70.3%
males. The high incidence in males was due to males
being more active in search of means of livelihood for the
families. High percentage of males with traumatic brain
injuries from road traffic accident had been documented by
[10-12]
other authors.
There were only three (4.11%) elderly
patients in this study, while the rest were 35 children and
35 adults. The low percentage of elderly is a reflection of
life expectancy in developing countries like ours. High
percentage of elderly were seen in developed countries
[13,14]
where life expectancy are high.
High number of
pedestrian with traumatic brain injuries mirrors poverty
level in our society where the poor trek their ways to
[15]
school and work. Dandona et al
found that children of
highest household income were significantly less likely to
sustain pedestrian injury when compared to children from
low household incomes.
Majority of the patients were injured between 6AM and
10AM, and between 2PM and 6PM (57.53%). These are
peaks hours when people go to school and work, and
when they come back home after school and work. These
are the two major periods we experience traffic hold-ups in
our city. During these periods pedestrians and commuters
movement at T-junctions appear chaotic, trying to avoid
one another. In places with traffic light, the same scenario
occur because the lights do not have pedestrian phase.
The same thing is seen near schools, where children cross
roads at random, competing with vehicles. In few places
with Zebra-crossings, majority of the children as well as
majority of the drivers do not understand the meaning. In
few places where we have footbridges, iron barriers were
built under them, stretching up to two meters on both sides
to encourage pedestrians to use the bridges, still they trek
to the end of the barriers to run across the roads. Another
high incidence was between 6PM and 10PM. This could
be explained by high social life in our city. There is high
level of clubbing in the night with periods ranging from
6PM to early hours of the morning. Most of the excluded
patients were picked up on the roads during this period.
These people, under the influence of alcohol tried to cross
the roads and were knocked down. Lack of street lights
CONCLUSION
Majority of patients in this study were males and vehicle
was the commonest etiology. Peak hours for commuters
were when the majority of patients were injured. Less than
50% could do CT scan of the brain, and the commonest
cerebral lesion was contusion/intracerebral hemorrhage.
Favorable functional outcome was 82.19% while mortality
was 17.81%. Severity of the injury significantly affected
outcome.
863
Nnadi Mathias et al.,
13.
14.
15.
16.
REFERENCES
1.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
864
Nnadi Mathias et al.,
DOI: 10.5958/2319-5886.2015.00173.3
Open Access
ARTICLE INFO
th
Authors
details:
Assistant
Professor, Department of Community
Medicine, F.H. Medical College,
Tundla, Firozabad, Uattar Pradesh,
India
*Corresponding author: Sharma
Panchsheel
Assistant Professor, Department of
Community Medicine, F.H. Medical
College, Tundla, Firozabad, Uattar
Pradesh, India
Email: drpanchsheelsharma@yahoo.co.in
Keywords:
Awareness
HIV/AIDS,
Knowledge,
ABSTRACT
Background: HIV/AIDS affects the most productive age group, the
knowledge of which is clouded with many myths and misconceptions.
Objective: To determine the knowledge and awareness about various
aspects of HIV/AIDS among the students of MBBS first year. Methodology:
The students were asked to fill a pre-designed, structured, semi open ended
questionnaire. All efforts were made to ensure the originality of the
responses. Statistical Analysis: The data collected so, was analysed,
tabulated and presented in the forms of percentages and proportions.
Appropriate statistical tests applied, wherever applicable. Results: Among
the total of 122 respondents, all of them have heard about HIV/AIDS and
that it is caused by a virus. About 43.4% students believed that HIV infection
means AIDS. The place where HIV testing is done, was known to about
78%. Knowledge about the routes of spread included; through infected
injections (100%), through blood transfusion (98%), Unprotected Sexual
contact (97.5%), Infected Mother to child (86%). The respondents were
aware that it doesnt spread through touching/hand shaking (99.2%),
sharing food (93.4%), using common cups/glasses (89%), used
clothes/towels/soap (88.5%). About 80% responded to have discussed about
HIV/AIDS ever with anybody, while about 82% considered safe working with
a patient of HIV/AIDS. Conclusion: Most of students were aware about the
basic knowledge while they also had a misconception which implies that the
students should be equipped more, especially since the beginning of their
career.
INTRODUCTION
AIDS was recognised as an emerging disease in the
early 80s but has spread its tentacles throughout the
world, responsible for millions of the deaths within less
than twenty years. It affects the most productive age
group and causing premature deaths thereby. According
to the annual report of National Aids Control
Organization India has the third highest number of
estimated people living with HIV in the world as per the
HIV estimations 2012, with the estimated number of
[1]
people living with HIV/AIDS in India to be 20.89 lakh .
Also, India has worlds largest youth population with
people in the age group of 15-29 years comprising
almost 25 percent of the countrys population and
[2]
account for around 31% of HIV/AIDS burden
.
Moreover, still there are many myths and misconceptions
prevalent in the society regarding HIV/AIDS. For
instance, in a study conducted among the general public
in Karnataka (southern state of India), about one third of
the respondents thought it to be spread it just by
[3]
touching a patient who is HIV positive
Many studies have been conducted among the youth
population belonging to different streams such as
[4, 5]
[6,7]
students of high school
, senior secondary school
,
[8]
[9]
college students , nursing students , medical students
[10]
etc. These studies reflect varied knowledge and
awareness regarding this subject. The Medical students
constitute an important stakeholder as far the prevention
of AIDS is concerned, both in terms of being at the risk
868
Sharma et al.,
Sharma et al.,
Female(n=46)
Total (N=122)
5 (10.9%)
14 (30.4%)
12 (26.0%)
6 (13.0%)
9 (19.6%)
11 (9%)
33 (27.0%)
45 (36.9%)
17 (13.9%)
16 (13.1%)
869
Int J Med Res Health Sci. 2015;4(4):868-871
Female(n=46)
No
00 (00%)
02 (1.6%)
03 (2.5%)
10 (8.2%)
26 (21.3%)
72 (50.0%)
58 (47.5%)
91 (74.5%)
81 (66.4%)
42 (34.4%)
83 (68%)
89 (73%)
121 (99.2%)
114 (93.4%)
109 (89.3%)
108 (88.5%)
Total (N=122)
Dont Know
00 (00%)
00 (00%)
00 (0%)
7 (5.7%)
10 (8.2%)
18 (14.8%)
24 (19.7%)
03 (2.5%)
13 (10.7%)
7 (5.7%)
17 (14%)
10 (8.1%)
01 (0.8%)
02 (1.6 %)
02 (1.6%)
04 (3.3%)
P value*
Truck Drivers
28 (36.8%)
14 (30.4%)
42 (34.4%)
>0.05
49 (64.5%)
37 (80.4%)
86 (70.5%)
>0.05
42 (55.3%)
27 (58.9%)
69 (56.6%)
>0.05
33 (43.4%)
21 (27.6%)
23 (50.0%)
10 (21.7%)
56 (45.9%)
31 (29.4%)
>0.05
>0.05
Clients of FSWs
44 (57.9%)
29 (63.0%)
73 (59.8%)
Recipients of repeated Blood transfusion
38 (50.0%)
28 (60.9%)
66 (54.1%)
*p>0.05 Non significant, p<0.05 Significant
Table 4: Knowledge/ Awareness about prevention & treatment and Attitude towards HIV/AIDS
Variables concerned
Male (n=76)
Female(n=46)
Total
(N=122)
HIV positive means patient is having AIDS
33 (43.4%)
20 (43.5%)
53 (43.4%)
Availability of any drug against HIV
31 (40.8%)
14 (30.4%)
45 (36.9%)
Permanent cure for HIV/AIDS available
2 (2.6%)
2 (4.3%)
4 (3.3%)
Ever discussed HIV/AIDS with anybody
60 (78.9%)
38 (82.6%)
98 (80.3%)
Working with a patient of HIV/AIDS is safe
60 (78.9%)
41 (89.1%)
101 (82.8%)
HIV patient should not be excluded from society
64 (84.2%)
45 (97.8%)
109 (89.3%)
No problem in sharing room with a patient of HIV
43 (56.6%)
36 (78.3%)
79 (64.8%)
>0.05
>0.05
P
value
>0.05
>0.05
>0.05
>0.05
>0.05
<0.05
<0.05
DISCUSSION
Present study was conducted among the first year
students of MBBS, who have spent just 3 months in the
medical curriculum, at the time of survey. As far as the
basic knowledge about HIV/AIDS is concerned, then all
of the respondents were aware about the viral aetiology,
most of the students were aware about the routes of
transmission. This is similar to a study conducted among
first year medical students in Karnataka in which most of
[10]
the students were aware about routes of transmission .
In our study no significant difference was observed
between the knowledge of transmission among male and
[11]
female student, similar to Joshi et al .
Most of the students were aware that it doesnt spread
through touching/hand shaking. In a study conducted
among general population in Karnataka, about one third
of the respondents thought it to be spread it just by
Sharma et al.,
870
Int J Med Res Health Sci. 2015;4(4):868-871
ACKNOWLEDGMENT
The authors are thankful to the students who participated
in the study and the staff of department of community
medicine who actively participated in the data collection
of the study.
Conflict of interest: Nil
REFRENCES
1. Department of AIDS control. Annual Report 2013-14.
Ministry of Health & Family Welfare, Government of
India.
www.naco.gov.in/
upload/2014%20mslns/NACO_English%20201314.pdf
2. National AIDS Control Organization. Ministry of
Health & Family Welfare, Government of
India.http://www.naco.gov.in/NACO/Quick_Links/You
th
3. Unnikrishnan B, Mithra PP, Rekha T, Reshmi B.
Awareness and attitude of the general public toward
HIV/AIDS in coastal Karnataka. Indian J Community
Med 2010;35:142-46.
871
Sharma et al.,
DOI: 10.5958/2319-5886.2015.00173.3
Open Access
ARTICLE INFO
th
Authors
details:
Assistant
Professor, Department of Community
Medicine, F.H. Medical College,
Tundla, Firozabad, Uattar Pradesh,
India
*Corresponding author: Sharma
Panchsheel
Assistant Professor, Department of
Community Medicine, F.H. Medical
College, Tundla, Firozabad, Uattar
Pradesh, India
Email: drpanchsheelsharma@yahoo.co.in
Keywords:
Awareness
HIV/AIDS,
Knowledge,
ABSTRACT
Background: HIV/AIDS affects the most productive age group, the
knowledge of which is clouded with many myths and misconceptions.
Objective: To determine the knowledge and awareness about various
aspects of HIV/AIDS among the students of MBBS first year. Methodology:
The students were asked to fill a pre-designed, structured, semi open ended
questionnaire. All efforts were made to ensure the originality of the
responses. Statistical Analysis: The data collected so, was analysed,
tabulated and presented in the forms of percentages and proportions.
Appropriate statistical tests applied, wherever applicable. Results: Among
the total of 122 respondents, all of them have heard about HIV/AIDS and
that it is caused by a virus. About 43.4% students believed that HIV infection
means AIDS. The place where HIV testing is done, was known to about
78%. Knowledge about the routes of spread included; through infected
injections (100%), through blood transfusion (98%), Unprotected Sexual
contact (97.5%), Infected Mother to child (86%). The respondents were
aware that it doesnt spread through touching/hand shaking (99.2%),
sharing food (93.4%), using common cups/glasses (89%), used
clothes/towels/soap (88.5%). About 80% responded to have discussed about
HIV/AIDS ever with anybody, while about 82% considered safe working with
a patient of HIV/AIDS. Conclusion: Most of students were aware about the
basic knowledge while they also had a misconception which implies that the
students should be equipped more, especially since the beginning of their
career.
INTRODUCTION
AIDS was recognised as an emerging disease in the
early 80s but has spread its tentacles throughout the
world, responsible for millions of the deaths within less
than twenty years. It affects the most productive age
group and causing premature deaths thereby. According
to the annual report of National Aids Control
Organization India has the third highest number of
estimated people living with HIV in the world as per the
HIV estimations 2012, with the estimated number of
[1]
people living with HIV/AIDS in India to be 20.89 lakh .
Also, India has worlds largest youth population with
people in the age group of 15-29 years comprising
almost 25 percent of the countrys population and
[2]
account for around 31% of HIV/AIDS burden
.
Moreover, still there are many myths and misconceptions
prevalent in the society regarding HIV/AIDS. For
instance, in a study conducted among the general public
in Karnataka (southern state of India), about one third of
the respondents thought it to be spread it just by
[3]
touching a patient who is HIV positive
Many studies have been conducted among the youth
population belonging to different streams such as
[4, 5]
[6,7]
students of high school
, senior secondary school
,
[8]
[9]
college students , nursing students , medical students
[10]
etc. These studies reflect varied knowledge and
awareness regarding this subject. The Medical students
constitute an important stakeholder as far the prevention
of AIDS is concerned, both in terms of being at the risk
868
Sharma et al.,
Sharma et al.,
Female(n=46)
Total (N=122)
5 (10.9%)
14 (30.4%)
12 (26.0%)
6 (13.0%)
9 (19.6%)
11 (9%)
33 (27.0%)
45 (36.9%)
17 (13.9%)
16 (13.1%)
869
Int J Med Res Health Sci. 2015;4(4):868-871
Female(n=46)
No
00 (00%)
02 (1.6%)
03 (2.5%)
10 (8.2%)
26 (21.3%)
72 (50.0%)
58 (47.5%)
91 (74.5%)
81 (66.4%)
42 (34.4%)
83 (68%)
89 (73%)
121 (99.2%)
114 (93.4%)
109 (89.3%)
108 (88.5%)
Total (N=122)
Dont Know
00 (00%)
00 (00%)
00 (0%)
7 (5.7%)
10 (8.2%)
18 (14.8%)
24 (19.7%)
03 (2.5%)
13 (10.7%)
7 (5.7%)
17 (14%)
10 (8.1%)
01 (0.8%)
02 (1.6 %)
02 (1.6%)
04 (3.3%)
P value*
Truck Drivers
28 (36.8%)
14 (30.4%)
42 (34.4%)
>0.05
49 (64.5%)
37 (80.4%)
86 (70.5%)
>0.05
42 (55.3%)
27 (58.9%)
69 (56.6%)
>0.05
33 (43.4%)
21 (27.6%)
23 (50.0%)
10 (21.7%)
56 (45.9%)
31 (29.4%)
>0.05
>0.05
Clients of FSWs
44 (57.9%)
29 (63.0%)
73 (59.8%)
Recipients of repeated Blood transfusion
38 (50.0%)
28 (60.9%)
66 (54.1%)
*p>0.05 Non significant, p<0.05 Significant
Table 4: Knowledge/ Awareness about prevention & treatment and Attitude towards HIV/AIDS
Variables concerned
Male (n=76)
Female(n=46)
Total
(N=122)
HIV positive means patient is having AIDS
33 (43.4%)
20 (43.5%)
53 (43.4%)
Availability of any drug against HIV
31 (40.8%)
14 (30.4%)
45 (36.9%)
Permanent cure for HIV/AIDS available
2 (2.6%)
2 (4.3%)
4 (3.3%)
Ever discussed HIV/AIDS with anybody
60 (78.9%)
38 (82.6%)
98 (80.3%)
Working with a patient of HIV/AIDS is safe
60 (78.9%)
41 (89.1%)
101 (82.8%)
HIV patient should not be excluded from society
64 (84.2%)
45 (97.8%)
109 (89.3%)
No problem in sharing room with a patient of HIV
43 (56.6%)
36 (78.3%)
79 (64.8%)
>0.05
>0.05
P
value
>0.05
>0.05
>0.05
>0.05
>0.05
<0.05
<0.05
DISCUSSION
Present study was conducted among the first year
students of MBBS, who have spent just 3 months in the
medical curriculum, at the time of survey. As far as the
basic knowledge about HIV/AIDS is concerned, then all
of the respondents were aware about the viral aetiology,
most of the students were aware about the routes of
transmission. This is similar to a study conducted among
first year medical students in Karnataka in which most of
[10]
the students were aware about routes of transmission .
In our study no significant difference was observed
between the knowledge of transmission among male and
[11]
female student, similar to Joshi et al .
Most of the students were aware that it doesnt spread
through touching/hand shaking. In a study conducted
among general population in Karnataka, about one third
of the respondents thought it to be spread it just by
Sharma et al.,
870
Int J Med Res Health Sci. 2015;4(4):868-871
ACKNOWLEDGMENT
The authors are thankful to the students who participated
in the study and the staff of department of community
medicine who actively participated in the data collection
of the study.
Conflict of interest: Nil
REFRENCES
1. Department of AIDS control. Annual Report 2013-14.
Ministry of Health & Family Welfare, Government of
India.
www.naco.gov.in/
upload/2014%20mslns/NACO_English%20201314.pdf
2. National AIDS Control Organization. Ministry of
Health & Family Welfare, Government of
India.http://www.naco.gov.in/NACO/Quick_Links/You
th
3. Unnikrishnan B, Mithra PP, Rekha T, Reshmi B.
Awareness and attitude of the general public toward
HIV/AIDS in coastal Karnataka. Indian J Community
Med 2010;35:142-46.
871
Sharma et al.,
DOI: 10.5958/2319-5886.2015.00174.5
Open Access
Amol Sanap , Tushar Chaudhari , Binoti Sheth , Dhruvilkumar Gandhi , Kaustubh Gate , Arun AA
ABSTRACT
ARTICLE INFO
th
talipes
torsion,
surface,
INTRODUCTION
.
Congenital talipes equinovarus (CTEV) usually represents
congenital dysplasia of all musculoskeletal tissues distal to
knee. Incidence is 1-2 /1000 live births, more common in
Hawaiians and Caucasians compared to orientals, 50%
are bilateral, and male to female ratio is 2.5 : 1 .Most of
them are idiopathic but occasionally it may be associated
with other congenital malformations and syndromes such
[1,2]
as Arthrogryposis, myelomeningocoeletc . There have
been many methods for treatment of CTEV such as
Ponseti cast application method, External fixator
[3,4,5]
applications and various osteotomies
.Controversy
exists concerning the presence or absence of excessive
medial or internal tibial torsion. Many studies are
supporting the presence of tibial torsion in clubfoot. Many
of the observers have linked tibial torsion to recurrence of
[6,7]
deformity in treated clubfeet .The problem of whether
tibia has an abnormal torsion in clubfoot can only be
solved by measuring the relative alignment of its proximal
and distal articular surfaces ; this has not proved possible
in vivo . CT scans and ultrasonography have both been
used to produce images of the proximal and distal juxtaarticular surfaces of the tibia. These surfaces are thought
to relate closely to the plane of the nearby joint and can
therefore be used to measure tibial torsion. An
ultrasonography involves no ionising radiation and hence
872
Tushar et al.,
GROUP
Tibial Study
torsion
Comparison
Fig 1:
Determination
ultrasonography
of
proximal
tibial
plane
Meanexternal
torsion
in Mean Sum of
Rank Ranks
degrees
30
182.7
16.02 480.5
30
38.139.19
44.98 1349.5
Mann-Whitney U
15.500
p value
< 0.05*
by
873
Tushar et al.,
Fig 4:
Left half of image showing ultrasonographic
representation of proximal tibial plane with long black arrow
and right half showing the distal tibial plane with a short
black arrow.
DISCUSSION
Clubfoot deformity was first described by Hippocrates
around 300 B.C. Since then many people have done
research on clubfoot and its management. Descriptions
of pathological anatomy in clubfoot can be found in
some of the earliest orthopaedics writings and continue
to be essentially correct today, even as we have more
sophisticated methods of imaging to quantitate that
deformity.
Several authors have called attention to the internalrotation deformity within the long axis of the tibia, which
not infrequently accompanies congenital club-foot. Thus
every one interested in the treatment of club feet
recognizes this concomitant deformity, but opinion is
[10]
divided with regard to its correction. Campbell
in his
recent book stated that, with rare exception, the internalrotation deformity of the tibia may be disregarded from a
surgical viewpoint. In an endeavor to clarify his own
position, he reviewed a series of sixty-two consecutive
cases of congenital club feet that had been followed for
periods varying from two to five years, and the conclusion
was reached that not only does tibial torsion accompany
club-foot in a higher percentage of cases than was
formerly believed, but it also occurs in sufficient degree to
warrant surgical correction.
It was during the follow-up period on some cases of
bilateral club-foot that attention became focused upon
tibial torsion as a factor in recurrence of the deformity.
Previously it was noted that adduction was the chief
deformity recurring in those feet which relapse, and closer
observation has now- revealed that in over 90 percent of
these cases tibial torsion was present in the leg which
showed recurrence and absent in the others which had
maintained its correction.
Before the equinovarus deformity has been corrected it is
often difficult to determine whether internal rotation of the
tibia is present, or if present to what degree. However,
after the equinovarus has been corrected and the Child is
walking, it is easy to detect tibial torsion, since the child
invariably toes in on the affected side. A line dropped
from the anterior superior spine of the ilium, bisecting the
patella, will fall to the lateral border of the foot. Outside the
little toe, instead of between the great and second toes as
is normal. With the patella pointing straight forward,
874
Tushar et al.,
Staheli LT, Corbett M, Wyss C, King H. Lowerextremity rotational problems in children. Normal
values to guide management. The Journal of Bone
and Joint Surgery.1985; 67, 39-47.
Staheli LT, Engel GM. Tibial torsion: a method of
assessment and asurvey of normal children. Clinical
Orthopaedics and Related Research 1972; 86, 183-86
2.
3.
Penny JN.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
CONCLUSION
17.
Our results show that external torsion is diminished in the
affected
legs of patients with
congenital talipes
equinovarus. Thus they have a relative internal tibial
torsion, despite treatment involving repeated dorsiflexion
and eversion. Hence we propose that ultrasonogtraphy is
an inexpensive, readily available, less hazardous and
effective tool to find out the proximal and distal tibial
planes and to calculate the angle between them i.e. the
tibial torsion.
875
Tushar et al.,
DOI: 10.5958/2319-5886.2015.00175.7
Open Access
ARTICLE INFO
th
Author details:
Department of
Anatomy, All India Institute of Medical
Sciences, Patna, Bihar, India.
2
Department of Biochemistry &
Genetics,
Barkatullah
University,
Bhopal, Madhya Pradesh, India.
Corresponding author: Bheem Prasad,
1
ABSTRACT
Background: Study of hormonal imbalance and its implications in female
infertility are an interesting area that requires to be explored in recent time.
Hormonal imbalance can associated with irregular menstrual cycle,
Amenorrhea, obesity and infertility in women. Other medical conditions such
as polycystic ovarian syndrome, Endometriosis, stress, sexually transmitted
diseases and chromosomal anomalies may be responsible for infertility in
females. Objective: The aim of the present study was to evaluate the serum
levels of Follicle Stimulating hormone (FSH), Luteinizing hormone (LH) and
Prolactin hormone in infertile women that were referred from different infertility
clinics and centres. Materials and Methods: This study comprises total 176
female subjects with age ranging from 20 to 40 years and divided in two
groups. The total number of 88 infertile women along with 88 fertile women as
controls was included for the present study. Serum FSH, LH and Prolactin
levels were estimated by enzyme-linked immunosorbent assay (ELISA)
methods. Results: The results showed maximum infertile women were found
between the age group of 30-40 years. The Serum FSH, LH and Prolactin
levels among infertile women was 8.774.65, 7.645.16 and 18.597.50
respectively. Whereas, levels of FSH, LH and Prolactin in fertile women
showed that 6.714.12, 5.663.17 and 13.445.82 respectively. Conclusion:
In this study, we found that the hormone levels have statistically significant
with female infertility. The elevated levels of FSH, LH and Prolactin may be
one of the important causes for infertility in women.
INTRODUCTION
Infertility is described as failure to conceive after one year
[1]
of unprotected intercourse. The percent of infertility is
reported to be 10-15% worldwide. It is estimated that
infertility affects globally 50 to 80 million people and
currently 8-10 million infertile couples are estimated to be
[2]
in India. The major causes of female infertility may
include blockage of the Fallopian tubes, pelvic
inflammatory disease, age factors, chromosomal
anomalies,
Amenorrhoea
and
endocrinological
[1,3]
dysfunctions.
Infertility has been associated with
various anthropometric parameters and socioeconomic
[4,5]
conditions.
The association of age and infertility are
reported in several studies. The aged women decline their
[5,6]
fertility with time span.
Hormonal imbalances have been associated with female
infertility. The increased or decreased levels of FSH, LH
and Prolactin hormones may cause infertility. FSH and LH
hormones belong to glycoprotein family and play an
important role in follicular development and production of
[7-11]
oestrogen.
The study aimed to evaluate the serum
levels of Follicle Stimulating hormone, Luteinizing
hormone and Prolactin hormone in infertile women.
MATERIALS AND METHODS
Study design: Analytical cross sectional study
Study place and duration: All the subjects were enrolled
during July 2009 to January 2011 from different infertility
876
REFERENCES
1.
2.
877
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
878
DOI: 10.5958/2319-5886.2015.00176.9
Research article
Open Access
ARTICLE INFO
th
ABSTRACT
Introduction: The survival of a newborn or a child presenting with ambiguous
genitalia depends upon the timely diagnosis and institution of appropriate
medical care. We undertook this study with the aim to determine if appropriate
clinical and confirmatory diagnosis was arrived on time and if the treatment
instituted was relevant and satisfactory. Methods: All children who were
evaluated for ambiguous genitalia under the Department of Pediatric
Endocrinology over the preceding 18 years were invited for a review. Data
including time taken to make a clinical diagnosis, time taken to confirm the
diagnosis, reasons for delay if any, and appropriateness of the sex assigned for
rearing and treatment instituted were collected from the charts. Patients were
evaluated for adequacy of response to treatment, compliance, problems
encountered if any and subjective parental satisfaction. Results: A total of 165
children were diagnosed to have conditions with ambiguous genitalia and were
called for a review. 33 children attended the review. 15 were being raised as
boys and 18 as girls. 12 children had virilising congenital adrenal hyperplasia
(CAH), 6 had cryptorchidism, 6 had hypospadias, 3 had complete and 1 had
partial testicular feminisation, 2 had mixed gonadal dysgenesis (MGD), 2 had
hypogonadism and 1 was a true hermaphrodite. An appropriate clinical diagnosis
was made in 30childrenon the day one and a final confirmatory diagnosis was
made within a month in 23. Conclusion: In most conditions presenting with
ambiguous genitalia, a clinical and confirmatory diagnosis can be made in a short
duration. Initiation of appropriate treatment results in favourable outcomes in
terms of growth sexual identity and adaptation.
INTRODUCTION
A neonate with abnormal genitalia presents with a difficult
diagnostic and treatment challenge. Relevant clinical
findings and investigations are useful in making an
accurate diagnosis. Specific guidelines are available for
[1, 2, 3]
the same
. It becomes essential to make a definitive
diagnosis at the earliest to initiate appropriate treatment
and minimize complications.
Ambiguous genitalia is defined as a condition in which
there is difficulty in assigning sex of an individual based
[4]
on the appearance of external genitalia . The term
ambiguous genitalia applies to any confusing appearance
[5]
of the external genitalia .This includes any infant with
1. A phallus but bilaterally un palpable testes
2. Unilateral cryptorchidism and hypospadias
3. Penoscrotal or perineoscrotal hypospadias, even if
the testes are descended
If an infant has a phallus that is intermediate in size
between a normal penis and a normal clitoris, an
aberrantly located urethral opening, and at least one
impalpable gonad, the term ambiguous genitalia may be
[2]
used .
Aims and objectives
1. To identify the time interval from presentation to
diagnosis and the reason for any undue delay if
present.
2. To assess the appropriateness of the final diagnosis
based on the investigations done.
879
Praburam
Number of
Patients
Percentage
27
5 to 10 years
10 to 15 years
13
6
40
18
15
Number
Percentage
Biopsy awaited
10
Karyotype awaited
40
Hormonal
investigations
30
Delay in follow up
20
Total
10
100
All the patients who came for the review had diagnoses
[1]
which were appropriate as per the AAP guidelines .All
the patients with mixed gonadal dysgenesis, testicular
feminization or true hermaphroditism had undergone a
karyotyping. But only 4 patients with congenital adrenal
hyperplasia and 2 patients with perineoscrotal
hypospadias had had a karyotyping done. None of the
patients with cryptorchidism or hypogonadism were
subjected to karyotyping.
Medical management of children with CAH: All the 12
children with CAH claimed to be on very regular
treatment and apparently dont miss even a single dose
except on a very rare occasion. All of them were
satisfied with the outcome. They all had an understanding
of the risks of discontinuing treatment and the need to
modify drug dosages during illnesses. Also they were
compliant with the advices given. Height for age in all
rd
th
these was between the 3 and 97 centile, but the
th
growth velocity was below the 50 centile in 5 (41%).
Table 3: Height for Age at Review
Number
of patients
Percentage
58
42
>97 centile
Total
12
100
Final height
rd
<3 centile
rd
Total
33
100
Thirty of the 33 patients who attended the review had an
appropriate clinical diagnosis assigned on the day of
presentation. For 3 children an appropriate clinical
diagnosis was given only after a month since
th
3 to 50 centile
th
th
50 to 97 centile
th
880
Praburam
DISCUSSION
This study was undertaken as an audit of all the patients
with ambiguous genitalia treated in the Christian Medical
College and Hospital (CMCH), Vellore. Various aspects
including time interval between arrival of a patient and an
appropriate diagnosis, treatment compliance, outcome
and psychological aspects were studied.Of the total 165
patients with ambiguous genitalia treated in CMCH, 33
(20%) came for the review. This could be due to the fact
that most of the patients were from other states and were
probably unable to come for the review. But this could
also be that patients with good compliance or those who
were satisfied with their treatment alone came for the
review and thus give falsely good or confounding results.
There were a higher number of female patients, as many
conditions in patients with ambiguous genitalia favour
female sex of rearing as compared to a male sex of
rearing. Kulkarni et al, Erdogan S et al and Joshi et al in
their studies found 46XY to be the commonest karyotype
[6, 7, 8]
. As most of our patients did not have a karyotype
this could not be compared. The commonest condition in
our study was a virilizing congenital adrenal hyperplasia
in a female child (37% of all the patients). This is
consistent with other studies which have found CAH to be
the commonest cause of disorders of sexual
[9, 10, 11]
differentiation
. CAH was followed in frequency by
cryptorchidism and hypospadias. Other conditions
included partial and complete testicular feminization,
mixed gonadal dysgenesis, hypogonadism and true
hermaphroditism.
Most patients (91%) were assigned an appropriate
clinical diagnosis within the first day. There seemed to be
no undue delay in assigning a clinical diagnosis in any
patient. All patients with CAH were correctly diagnosed
clinically almost immediately on arrival. This is important
as appropriate diagnosis and prompt treatment is
essential for survival, given significant mortality even in
[12]
developed countries .A final diagnosis was assigned to
23 (70%) within 1 month. Delays in diagnosis in the
earlier days were mainly due to non-availability of
karyotyping facilities (40%). Diagnoses like mixed
gonadal dysgenesis and true hermaphroditism required a
biopsy be done before a final diagnosis was made. In
such conditions there was a delay in the final diagnosis
due to a delay in the surgeries, which were undertaken
only on a semi urgent basis. Hormonal investigations
were not always readily available in the earlier days
which resulted in a delay in 3 (30%) patients. Two
patients were lost to follow up and had to be called by
post for evaluation, which resulted in a delay.
Medical management was the cornerstone of patient with
CAH. Compliance with drugs was excellent among the
patients with CAH who came for the review. Hundred
percent of them (12 patients) had taken the drugs without
missing a single dose in the preceding 3 months. They
also claimed to have strictly adhered to the advice given
regarding the change in dosage during any illness.All the
patients with CAH who came for the review had heights
between the third and the ninety seventh centiles grossly
indicating adequate growth. Similar results were obtained
881
Praburam
CONCLUSION
Most patients were appropriately diagnosed without
undue delay. Instances where there was a delay could
have been rectified by easier access to investigations like
karyotyping and hormonal studies. With the facilities
currently available these studies can be carried out
without any delay.Both medical and surgical
management
were
associated
with
favorable
outcomes.Compliance with drugs and health promoting
advices was excellent among the patients who came for
the review.It is important to follow up patients with CAH
by their height velocity rather than the absolute height as
interventions can be carried out at an earlier
stage.Detailed counseling is needed to allay the fears
and doubts that would be expected in a parent of a child
with such conditions. Long term Indian studies involving a
significant number of adolescent and adult patients are
needed to address issues of long-term sexual identity,
orientation, satisfaction with the sex of rearing and
satisfaction with their marital and sexual life.
ACKNOWLEDGMENT
I would like to thank Dr. P. Raghupathy and Dr. Sarah
Mathai, Professors in Pediatrics, Department of Child
Health, Christian Medical College and Hospital, Vellore
for their guidance and support.
Conflict of Interest: Nil.
REFERENCES
1. American Academy of Pediatrics Committee on
Genetics. Evaluation of the newborn with
developmental anomalies of the external genitalia.
Pediatrics 2000;106:138-42.
2. Garry L. Warne, Jeffrey D. Zajac. Disorders of sexual
differentiation. Endocrinology and Metabolism Clinics
of North America. 1998, Dec; 27(4): 945-967.
3. ZoranKrsti, Sava Perovic, Slobodan Radmanovi,
SvetislavNeci, SvetislavNeci, eljkoSmoljani,
PredragJevti. Surgical treatment of intersex
disorders; Journal of Pediatric Surgery 1995,
September; 30(9): 1273 81.
4. Arnold G. Coran, Theodore Z. Polley Jr. Surgical
management of ambiguous genitalia in the infant and
child. Journal of Pediatric Surgery 1991, 26(7): 812820.
5. Norman P. Spack, Mary Deming Scott. In :John P.
Cloherty, Ann R. Stark, Eric C. Eichenwald (eds.),
Manual of neonatal care, Lippincott Williams and
th
Wilkins, 2004; 5 edition, p607.
6. Ketan Prasad Kulkarni, InushaPanigrahi, Reena
Das, SurinderKaur and Ram Kumar Marwaha.
Pediatric Disorders of Sex Development. Indian
Journal of Pediatrics 2009; 76 (9): 956-958.
7. Erdogan S et al. Etiological Classification and
Clinical Assessment of Children and Adolescents
with Disorders of Sex Development. J Clin Res Ped
Endo 2011;3(2):77-83.
882
Praburam
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
883
Praburam
DOI: 10.5958/2319-5886.2015.00177.0
Open Access
ARTICLE INFO
Received: 15th Sep 2015
Revised: 25nd Sep 2015
Accepted: 30th Sep 2015
1
Assistant Professor,
Post graduate student, Department of
Ophthalmology,
Rural
Medical
College,
Loni,
Ahmednagar,
Maharashtra,
Corresponding author: Tupe Parag N
Assistant Professor, Department of
Ophthalmology,
Rural
Medical
College,
Loni,
Ahmednagar,
Maharashtra,
Email: dr.paragtupe@rediffmail.com
Authors details:
2
Paediatric,
Ocular Anomaly.
Keywords:
Congenital,
ABSTRACT
Introduction: Most congenital anomalies are present long before the time
th
of birth, some in the embryonic period (up to the7 week of gestation) and
th
other in the fetal period (8 week to term) Purpose: To study the incidence
of congenital ocular anomalies in paediatric age group. Materials &
Methods: In this study total 9350 patients were screened. The age and sex
of the patient, gestational age, occurrence of consanguineous, distribution
of various subtype of congenital anomalies, subtype of congenital cataract,
age at presentation and diagnosis were noted. Results: The age variation
in the study was between 0-12 years. The maximum number of patients
were in the age group of 0-2 years. Male: female ratio was 1:1.4. Number
cases were reported in anterior segment with full term delivery.32 cases
having no positive history of consanguineous marriage. Total 12 cases
were found about chronic dacryocystitis, 8 cases of coloboma of iris and
choroid and each 5 cases of congenital cataract and Microhthalmos were
found. None of the cases had any history of antenatal, obstetric
complication, radiation and drug intake. Conclusion: A prevalence of
0.053% of congenital ocular anomalies. Most common anomaly was
congenital dacryocystitis (24%), congenital cataract and microphthalmos
being the second most common anomalies (14%) each.
INTRODUCTION
A congenital
anomaly is an abnormality that is present at
.
birth, even if not diagnosed until months or years later.
Most congenital anomalies are present long before the
th
time of birth, some in the embryonic period (up to the7
th
week of gestation) and other in the fetal period (8 week to
term). The anomaly covers all the major classes of
abnormalities of development which there are four major
[1]
categories as follow
Tupe Parag
884
20
with degree
Present
Agewise distribution of
congenital anomalies
0
0-2
2-4
4-6
12
6-8
2nd
3rd
14
36%
32
64%
eye
eye
0.03
and
0.05
with
0.01
12
0.11
Congenital ptosis
0.02
Congenital ectropion
0.01
Congenital esotropia
0.01
Congenital
0.02
Megalocornea
0.01
Aniridia
0.02
0.09
Heterochromia iridum
0.01
Congenital cataract
0.05
Congenital glaucoma
0.03
PHPV
0.02
0.02
0.01
Crouzons disease
0.02
Anophthalmos
Microphthalmos
microcornea
Orbital
cyst
rudimentary eye
dacryocystitis
corneal
opacity
and choroid
27
10
1st
Absent
Congenital
RESULTS
30
8-10
10-12
Tupe Parag
885
Anomaly observed
No of Laterality
cases
3
5
3 bilateral
5 bilateral
Average
age of
diagnosis
Day 1
4.4 years
Bilateral
7 Days
12
8 Bilateral 4 Unilateral
2 YRS
2
1
1
2
1 Bilateral 1 Unilateral
Bilateral
Unilateral
2 Bilateral
-
8.5 Yrs
Day1
1 Year
3.5 M
Aniridia
2
Coloboma of the iris
8
and choroid
Heterochromia iridium
1
(fig 1d)
Congenital cataract
5
(fig 1e)
Congenital glaucoma
3
PHPV
2
Coloboma of the disc
2
Leber optic atrophy
1
Crouzons disease
2
(fig 1f)
Yrs: Years, M : Months
Unilateral
2 Bilateral
3 Bilateral 5 Unilateral
1M
8.5 yrs
5.5Yrs
Unilateral
7 Yrs
5 Bilateral
5.1Yrs
3 Bilateral
1 Bilateral 1 Unilateral
2 Unilateral
Bilateral
Bilateral
-
2.6M
2.5 M
9M
6 Yrs
1.5Yrs
DISCUSSION
Tupe Parag
886
[14]
REFERENCE
1.
2.
3.
4.
5.
6.
7.
8.
CONCLUSIONS
In our study we noted a prevalence of 0.053% of
congenital ocular anomalies in the total population in
region of our study area. The age wise distribution of
congenital anomalies showed that the peak age at
presentation is in the first two years of life (56%). We
found a male preponderance in occurrence of congenital
ocular anomalies, with a sex ratio of 1:1.4. The incidence
of infants with congenital ocular anomalies that had
premature birth was 4%in our study. We found a positive
history of consanguinity in 36%of our study.
Amongst the ocular anomalies 82% involved the anterior
segment and only 8% posterior segment. We found that
40% of the congenital anomalies caused severe visual
impairment or blindness. All of these cases were bilateral.
Most common anomaly in our study was congenital
dacryocystitis
(24%),
congenital
cataract
and
microphthalmos being the second most common
anomalies (14%) each. The incidence of congenital
systemic anomalies associated with ocular anomalies in
our study was 10%. We noted that only 17% of
colobomatous defect of the uvea were complete. None of
Tupe Parag
9.
10.
11.
12.
13.
14.
15.
887
Tupe Parag
888
DOI: 10.5958/2319-5886.2015.00178.2
Letter to Editor
Open Access
ARTICLE INFO
Dear Editor,
Hepatitis B virus and C viruses (HBV and HCV, respectively) infects the liver
which results in a wide range of disease outcomes. Worldwide, over 7%
(350 million) and 3% (170 million) people are chronically infected with HBV
[1]
and HCV, respectively. HBV is transmitted through exposure to infective
1
Authors details: Professor & Head,
blood, semen, and other body fluids or through infected mothers to infants at
2
3
Associate Professor, Research
the time of birth. Transmission may also occur through transfusions of HBV4
Assistant, Lab Technologist,
contaminated blood and blood products, contaminated injections during
Department of Hepatology, Madras
medical procedures, and through transfusions of HCV-contaminated blood
Medical College, Rajiv Gandhi
and blood products, contaminated injections during medical procedures, and
[2]
Government General Hospital,
through injection drug use. Sexual transmission is also possible.
Chennai, Tamil Nadu
Individuals with chronic hepatitis B and/or C virus infection remain infectious
Corresponding author: Krishnasamy
to others and are at risk of serious liver disease such as liver cirrhosis or
[3,4]
Narayanasamy
hepatocellular cancer (HCC).
Study reports revealed that HBV and/or
1
Professor & Head, Department of
HCV infections are the major causes of morbidity and mortality in HIV
[5,6]
Hepatology, Madras Medical College,
positive population related to liver cirrhosis and hepatocellular carcinoma.
Rajiv Gandhi Government General
Though studies on the prevalence of HBV (rarely on HCV) among tribal
[7,8]
Hospital, Chennai, Tamil Nadu
population in India were available , there is no recent reports from
southern part of India. Hence, the present study was conducted to assess
Email: drkns_1963@yahoo.com
the prevalence of HBV and HCV among tribal population in Kotagiri, Nilgiris.
After obtaining the informed consent, blood samples (5 ml each) from a total
Keywords: Hepatitis B & C, Viral
of 196 participants (103 males and 93 females) were collected and sera
Markers, Tribal population, Nilgiris
were separated on site. Samples which showed positive for HBsAg and antiHCV by rapid test were confirmed by ELISA technique using commercial kits
Reliable Pro-detect Biomedical Ltd, India and Erba Lisa, Germany,
respectively. Of the 196 individuals screened, none of them was positive for
the viral markers. Several studies from India reported varying range of HBsAg and anti-HCV positivity among general and
[7,8]
tribal population
, whereas in our study none of them was found positive for the viral markers. The possible reason for
the absence of HBV and HCV infection in our study population may be due to the differences in their lifestyle,
sociodemographic factors and cultural practices. Though we found HBsAg and anti-HCV negativity, continuous
monitoring is necessary to prevent the spread of these hepatitis viruses among the tribal community.
Conflict of interest - No conflict of interest
rd
REFERENCES
1.
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6.
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8.
Shaw-Stiffel TA. Chronic hepatitis. In: Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious
Diseases, Churchill Livingstone; 2000; 5th edition: 1297-1321.
Ayele AG, Gebre-Selassie S. Prevalence and risk factors of Hepatitis B and Hepatitis C virus infections among
patients with chronic liver diseases in public hospitals in Addis Ababa, Ethiopia, ISRN Trop Med. 2013;
2013:563821.
Lok AS. Chronic hepatitis B. N Engl J Med. 2002;346(22):1682-1683.
Seeff LB. Natural history of chronic hepatitis C. Hepatology. 2002;36(5 Suppl 1):S35-46.
Andreoni M, Giacometti A, Maida I, Meraviglia P, Ripamonti D, Sarmati L. HIV-HCV co-infection: epidemiology,
pathogenesis and therapeutic implications. Eur Rev Med Pharmacol Sci. 2012;16(11):1473-1483.
Tien PC; Veterans Affairs Hepatitis C Resource Center Program; National Hepatitis C Program Office. Management
and treatment of hepatitis C virus infection in HIV-infected adults: recommendations from the Veterans Affairs
Hepatitis C Resource Center Program and National Hepatitis C Program Office. Am J Gastroenterol.
2005;100(10):2338-2354.
Batham A, Narula D, Toteja T, Sreenivas V, Puliyel JM. Sytematic review and meta-analysis of prevalence of
hepatitis B in India. Indian Pediatr. 2007;44(9):663-674.
Mukhopadhya A. Hepatitis C in India; J Biosci. 2008;33:465-473.
Krishnasamy et al.,
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Int J Med Res Health Sci. 2015;4(3): 889-889
DOI: 10.5958/2319-5886.2015.00179.4
Open Access
ARTICLE INFO
ABSTRACT
th
Keywords:
Electroconvulsive
therapy,
General
anesthesia,
Methohexital,
Mivacurium, Propofol
INTRODUCTION
Electroconvulsive therapy was first used to provoke
generalized epileptic seizures as treatment for
schizophrenia by Italian neurologist, lucio bini and ugo
cerletti on April 18, 1938 & was performed without
[1]
anesthesia for almost 30 years . Later came the period
of modified ECT- including the use of general
anesthesia & muscle relaxants, which led to its current
acceptance as a result of reduced physical & physiologic
trauma. The world health organization has now called for
a worldwide ban on unmodified ECT.
How does ECT work? ECT consists of programmed
electrical stimulation of the central nervous system to
initiate seizure activity. According to one theory, seizure
activity itself causes an alteration of the chemical
messengers in the brain known as neurotransmitters and
another theory proposes that ECT treatment adjusts the
stress hormone regulations in the brain, which may affect
energy sleep, appetite and mood. The electrical stimulus
results in generalized tonic activity for approximately 10
seconds followed by generalized clonic activity for
variable period lasting up to 120 seconds. The seizure
should ideally last for more than 15 seconds and less
than 120 seconds. Modified ECT is typically
administered as a series of treatments two to three times
a week for 6 to 12 treatments, in its acute phase
.Maintenance therapy can be performed at progressively
increasing intervals from once a week to once a month to
[2]
prevent relapses .
Indications: The National Institute of Clinical Excellence
[3]
(NICE) UK Guidelines 2009 recommend that the ECT
be considered for the patients who are suffering from 1. Acute, life threatening depression (high suicide risk
or very poor fluid intake)
2.
890
Int J Med Res Health Sci. 2015;4(4):890-895
891
Int J Med Res Health Sci. 2015;4(4):890-895
892
Int J Med Res Health Sci. 2015;4(4):890-895
893
Int J Med Res Health Sci. 2015;4(4):890-895
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
894
Int J Med Res Health Sci. 2015;4(4):890-895
895
Int J Med Res Health Sci. 2015;4(4):890-895
DOI: 10.5958/2319-5886.2015.00180.0
Open Access
ARTICLE INFO
th
ABSTRACT
Abdominal Tuberculosis (TB) most commonly affects ileo-caecal region.
Isolated stomach involvement by TB, without pulmonary infection is rare.
Clinical presentation of Stomach TB may be non-specific, radiological
findings non-contributory and superficial endoscopic biopsies may not be
able to settle the diagnosis. Many cases are diagnosed only after
histopathological examination of surgical specimens. High degree of
suspicion is needed for early diagnosis of gastric tuberculosis, if
unnecessary surgical interventions are to be avoided. A young patient who
was being treated as a case of chronic peptic ulcer for one year was
referred for treatment of gastric outlet obstruction. Histopathological
examination of gastrectomy specimen of the patient showed multiple
caseating granulomas characteristic of tuberculosis and presence of acidfast bacilli on Fite-Faraco staining, with no evidence of tuberculosis at
pulmonary or other body sites. This case of isolated gastric TB is reported
for its rarity.
tuberculosis,
INTRODUCTION
Extrapulmonary tuberculosis (TB) accounts for 10-15%
of all cases of TB and the incidence reaches higher in
[1]
patients with AIDS. Gastro-intestinal tract (GIT) is the
sixth most frequent extra pulmonary site involved by
tuberculosis (TB) and ileo-caecal region is the most
[2,3]
common site of involvement in GIT TB.
Gastroduodenal or isolated gastric TB is uncommon even in
parts of the world where intestinal TB is endemic
including India and stomach and duodenal TB comprises
[4,5]
1% each of abdominal TB.
The presenting symptoms
of gastric TB are non-specific and misleading and often
[6]
mimic peptic ulcer disease or malignancy.
Primary
isolated gastric TB in absence of pulmonary TB in
[7]
immune competent host is rare.
This rare occurrence
of isolated gastric TB presenting as gastric outlet
obstruction in a patient without evidence of pulmonary
TB or immunodeficient state is presented.
CASE REPORT
A 32 years old female was referred from a rural hospital
for abdominal distension and constipation since five
days. She gave history of abdominal pain since one year
associated with intermittent episodes of vomiting and low
grade fever off and on. Pain was localized to epigastrium
and umbilical region and was mild, intermittent in
character with no relation to food. The patient was being
treated as a case of chronic peptic ulcer without much
relief and has noticed significant loss of weight during
last six months. There was no history of cough,
hematemesis, diarrhea or malena and no past history of
Poflee et al.,
896
Int J Med Res Health Sci., 2015;4(4):896-898
Poflee et al.,
[2]
897
Int J Med Res Health Sci., 2015;4(4):896-898
Gupta
P,Guleria
S,Mathur
SR,Ahuja
V.
Gastroduodenal Tuberculosis: A Rare cause of
gastric outlet obstruction. Surgery Journal.2010; 5
(3-4):36-39
2. Sharma MP, Bhatia V. Abdominal Tuberculosis.
Indian J Med Res. 2004;120:305-15
3. Dasgupta A, Singh N, Bhatia A. Abdominal
Tuberculosis: A histopathological study with special
reference to intestinal perforation and mesenteric
vasculopathy.
Journal
of
laboratory
physician,Delhi.2010;1(2):56-61
4. Bandyopadhyay S, Bandyopadhyay R, Chatterjee U.
Isolated gastric tuberculosis presenting as
haematemesis. J Postgrad Med 2002; 48(1):72-73
5. Mukhopadhyay M, Rahaman QM, Mallick NR, Khan
D, Roy S, Biswas N. Isolated gastric tuberculosis: a
case report and review of literature. Indian J
Surg.2010; 75(5):412-413.
6. Ecka Rs, Wani ZA, Sharma M. Gastric Tubercolosis
with Outlet Obstruction: A Case Report Presenting
with a Mass Lesion. Case Reports in
Medicine.2013;Article ID 169051:1-3
7. Dixit R, Srivastava V, Kumar M, Shukla M, Pande M.
Primary Gastric Tuberculosis. World Journal of
Medical and Surgical Case Reports. 2012; 3:1-7
8. Reddy DB, Krishnan M.K.R. Tuberculosis of the
Stomach. Ind. J. Tub, 1962, X(1),1-10
9. Amarapurkar DN, Patel ND, Amrapurkar AD.
Primary Gastric Tuberculosis report of 5 cases.
BMC Gastroenterology. 2003; 3:6:1-4
10. Kim SE, Shim KN, Moon II H. A Case of Gastric
Tuberculosis Mimicking Advanced Gastric Cancer.
KJIM.2008; 21(1):62-67
11. Rao YG, Pande GK, Sahni P,Chattopadhyay
TK.Gastroduodenal
tuberculosis
management
guidelines, based on a large experience and a
review of the literature. Can J Surg. 2004; 47:364-8.
12. Gill RS, Gill SS, Mangat H, Logssetty S. Gastric
Perforation Associated with Tuberculosis: A case
Report. Case reports in Medicine.2011;Article ID
392769: 1-3.
Poflee et al.,
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Int J Med Res Health Sci., 2015;4(4):896-898
DOI: 10.5958/2319-5886.2015.00181.2
Open Access
ARTICLE INFO
th
ABSTRACT
In India, two-thirds of cutaneous tuberculosis cases are found to be lupus
vulgaris. Lupus vulgaris could be due to primary or secondary infection to
Mycobacterium tuberculosis. Innumerable cases of lupus vulgaris,
secondary to a systemic affliction i.e., arising from an underlying focus of
tuberculosis have been noted. Very few cases of primary lupus vulgaris
have been reported. It may appear as a solitary lesion in the skin at a site
of primary inoculation such as tattooing or ear-piercing. We hereby report
a case of lupus vulgaris in a 21-year-old female following ear-piercing.
Cutaneous examination revealed a soft, erythematous plaque-like growth,
involving the entire posterior aspect of both ear lobules completely
obscuring the site of ear piercing. It also involved the lower one thirds of
anterior aspect of both ear lobules. The overlying skin was smooth with
few indentations. Histopathological examination (Fig.2) revealed focal
hyperplastic changes in epidermis & multiple epithelioid cell granulomas &
a diffuse lymphocytic infiltrate in the entire dermis, extending into the
subcutaneous fat. On the basis of these clinical features &
histopathological examination findings, a diagnosis of lupus vulgaris was
made and she was started on anti-tuberculous treatment. The lesions
started regressing after 2weeks.
INTRODUCTION
Tuberculosis (TB) is one of the most common, rampant
infectious diseases in underdeveloped countries. In
countries like India, while great progress has been
made, TB is still very common; with 2.3 million new
[1]
cases diagnosed every year
.The pattern of
cutaneous TB has been changing over the last few
decades. By 1980s the incidence of cutaneous TB in
[2]
India had fallen to 0.15% . More recent reports
suggest that cutaneous TB is again becoming more
[2]
prevalent with incidence of 0.26% . A current problem
is that atypical and even standard presentations may be
overlooked, through lack of familiarity with the various
patterns that may occur.
Among the cases of cutaneous TB reported in India,
[2]
57.69% are found to be that of lupus vulgaris . These
lesions are acquired exogenously or endogenously,
although the former is significantly less common. Lupus
vulgaris can arise at the site of a primary inoculation
such as tattooing, ear piercing or following BCG
immunization.
CASE REPORT
A 21-year-old woman, presented to our out-patient
department, with a history of a fleshy growth in both ear
lobules since 3years. She first noticed the growth, at 2
weeks, following piercing of her ears for attaching
adornments. Interestingly the growth started at the site
of piercing and gradually progressed to involve the
entire posterior aspect of both ear lobules. She did not
complain of pain, itching, bleeding or any form of
899
Vaishnavi et al.,
3.
DISCUSSION
Ear piercing has been a popular practice in India since
time immemorial. The risk of acute complications
following ear-piercing, depends on the experience of
the piercer, on the hygiene-sanitation conditions under
which the procedure takes place and on general
piercing aftercare. Specific complications associated
with piercing the pinna include, hypertrophic /keloid
scarring, chondritis / perichondritis & incrustation. The
most common complication is infection, occurring in 10[3,4]
20% of cases . Microorganisms like staphylococcus
aureus, group A streptococci & pseudomonas species
are usually thought to be the causative organisms of
[6]
infections following ear piercing
. Less common
infective organisms associated with piercings are
[4]
coagulase negative staphylococci, Lactobacillus ,
[3,4]
Mycobacterium
tuberculosis
and
atypical
mycobacteria. Among the various forms of cutaneous
TB, lupus vulgaris is most common manifestation as is
[8]
evidently seen in 75% of the cases .
Vaishnavi et al.,
4.
5.
6.
7.
8.
9.
900
Int J Med Res Health Sci. 2015;4(4):899-901
Vaishnavi et al.,
901
Int J Med Res Health Sci. 2015;4(4):899-901
DOI: 10.5958/2319-5886.2015.00181.2
Open Access
ARTICLE INFO
th
ABSTRACT
In India, two-thirds of cutaneous tuberculosis cases are found to be lupus
vulgaris. Lupus vulgaris could be due to primary or secondary infection to
Mycobacterium tuberculosis. Innumerable cases of lupus vulgaris,
secondary to a systemic affliction i.e., arising from an underlying focus of
tuberculosis have been noted. Very few cases of primary lupus vulgaris
have been reported. It may appear as a solitary lesion in the skin at a site
of primary inoculation such as tattooing or ear-piercing. We hereby report
a case of lupus vulgaris in a 21-year-old female following ear-piercing.
Cutaneous examination revealed a soft, erythematous plaque-like growth,
involving the entire posterior aspect of both ear lobules completely
obscuring the site of ear piercing. It also involved the lower one thirds of
anterior aspect of both ear lobules. The overlying skin was smooth with
few indentations. Histopathological examination (Fig.2) revealed focal
hyperplastic changes in epidermis & multiple epithelioid cell granulomas &
a diffuse lymphocytic infiltrate in the entire dermis, extending into the
subcutaneous fat. On the basis of these clinical features &
histopathological examination findings, a diagnosis of lupus vulgaris was
made and she was started on anti-tuberculous treatment. The lesions
started regressing after 2weeks.
INTRODUCTION
Tuberculosis (TB) is one of the most common, rampant
infectious diseases in underdeveloped countries. In
countries like India, while great progress has been
made, TB is still very common; with 2.3 million new
[1]
cases diagnosed every year
.The pattern of
cutaneous TB has been changing over the last few
decades. By 1980s the incidence of cutaneous TB in
[2]
India had fallen to 0.15% . More recent reports
suggest that cutaneous TB is again becoming more
[2]
prevalent with incidence of 0.26% . A current problem
is that atypical and even standard presentations may be
overlooked, through lack of familiarity with the various
patterns that may occur.
Among the cases of cutaneous TB reported in India,
[2]
57.69% are found to be that of lupus vulgaris . These
lesions are acquired exogenously or endogenously,
although the former is significantly less common. Lupus
vulgaris can arise at the site of a primary inoculation
such as tattooing, ear piercing or following BCG
immunization.
CASE REPORT
A 21-year-old woman, presented to our out-patient
department, with a history of a fleshy growth in both ear
lobules since 3years. She first noticed the growth, at 2
weeks, following piercing of her ears for attaching
adornments. Interestingly the growth started at the site
of piercing and gradually progressed to involve the
entire posterior aspect of both ear lobules. She did not
complain of pain, itching, bleeding or any form of
899
Vaishnavi et al.,
3.
DISCUSSION
Ear piercing has been a popular practice in India since
time immemorial. The risk of acute complications
following ear-piercing, depends on the experience of
the piercer, on the hygiene-sanitation conditions under
which the procedure takes place and on general
piercing aftercare. Specific complications associated
with piercing the pinna include, hypertrophic /keloid
scarring, chondritis / perichondritis & incrustation. The
most common complication is infection, occurring in 10[3,4]
20% of cases . Microorganisms like staphylococcus
aureus, group A streptococci & pseudomonas species
are usually thought to be the causative organisms of
[6]
infections following ear piercing
. Less common
infective organisms associated with piercings are
[4]
coagulase negative staphylococci, Lactobacillus ,
[3,4]
Mycobacterium
tuberculosis
and
atypical
mycobacteria. Among the various forms of cutaneous
TB, lupus vulgaris is most common manifestation as is
[8]
evidently seen in 75% of the cases .
Vaishnavi et al.,
4.
5.
6.
7.
8.
9.
900
Int J Med Res Health Sci. 2015;4(4):899-901
Vaishnavi et al.,
901
Int J Med Res Health Sci. 2015;4(4):899-901
DOI: 10.5958/2319-5886.2015.00183.6
Open Access
Vedant R Awasthi , Rushikesh S. Haridas , Sumedh Kirdak , Pratik Shete , Shardul Kulkarni , Srivatshava
6,
7
8
Pendyala Ghosh AK , Deshpande JJ
ARTICLE INFO
th
Authors details:
Junior Resident,
7
8
Professor, Professor and Head,
Department of Medicine, Rural
Medical College, Loni, Ahmednagar,
Maharashtra, India
Corresponding author: Vedant RA,
Junior Resident, Department of
Medicine, Rural Medical College, Loni,
Ahmednagar, Maharashtra, India
Email: vedant.awasthi@gmail.com
ABSTRACT
Acromegaly is a rare disease caused due to hyper secretion of growth
hormone. Most of the cases of acromegaly are caused by pitutary adenoma
which can be microadenoma or macroadenomas. These adenomas are
never malignant, but can have significant morbidity and mortality. We report
a 35 year old female patient presented herewith classical presentation of
acromegaly with chief complain of weight gain, excessive sweating ,
widening of both hands and feet and was diagnosed as a case of
acromegaly due to macroadenoma of pirtutary gland, on the basis of typical
clinical features and hormonal parameters also radiological findings. Patient
underwent transsphenoidal surgical resection of macroadenoma and
recovered completely from the disease. Early recognition and diagnosis will
help to avoid the complications of disease.
Keywords: Acromegaly,
Macroadenoma, Growth hormone,
Insulin like growth factor 1
INTRODUCTION
Acromegaly is a rare disease occurs with a prevalence of
50 to 70 cases per million and an incidence of 3 cases
[1]
per million per year . Acromegaly is a rare disease
caused due to hyper secretion of growth hormone. Most
of the cases of acromegaly are caused by pitutary
adenoma
which
can
be
microadenoma
or
macroadenomas. These adenomas are never malignant,
[2,3]
but can have significant morbidity and mortality .
[3,4,5]
Clinical
features:
Cardiovasular SystemHypertension, Ventricular Hypertrophy, Cardiomyopathy,
Congestive Heart Failure Etc. Respiratory System- Sleep
apnoea, Upper airway obstruction due To macroglossia,
Gastointestinal System- Colon polyp, MetabolicDiabetes Mellitus, Imapaired Glucose Tolerance,
Muscluloskeletal- Prognathism, Frontal Bossing, Acral
Enlargment, Arthralgia, Myopathies Etc. Skin- Oily Skin,
Acnthosis
Nigricans,
VisceralomegalyGoiter,
Macroglossia,
Hepatomegaly,
Splenomegaly,
Neurological- Carpal Tunnel Syndrome, Aneurysm,
Headache, Local effect due to tumous- Visual field
defect, Cranial nerve palsy Etc.
[3,4]
Diagnosis:
The diagnosis of acromegaly is based
mainly on symptoms and signs with biochemical
investigation and radiography. The biochemical
diagnosis of acromegaly is done by raised level of
growth hormone and insulin like growth factor.
Acromegaly is mainly associated with raised levels of
IGF1 level. So normal IGF1 level excludes the diagnosis
in most of the patients. After diagnosis of acromegaly
based on biochemical investigation, documentation is
needed for pitutary adenoma which is most common
cause of acromegaly. In patient of acromegaly visual
Awasthi et al.,
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Int J Med Res Health Sci. 2015;4(4):907-910
C
Fig 2A: Hand xray shows tufting of terminal phalanges
arrow head appearance, 2B: Heel pad thickness is
increases (>18mm), 2C: Prominent supraorbital ridges, and
jaw, enlargement of pituitary fossa.
Awasthi et al.,
908
Int J Med Res Health Sci. 2015;4(4):907-910
DISCUSSION
Most of cases of acromegaly are caused by excessive
[9].
secretion of growth hormone i.e. 95% approximately
Pituitary tumors represented by 10-20% of somatotropic
adenomas and less commonly by lactotropic and
[10]
gonadotropic
adenomas .The
prevalence
of
acromegaly is 40 to 70 cases per million worldwide, it is
[11]
seen equally in both sexes . From diagnostic point of
view, about 8 to 10 years of delay is commonly observed
[12]
from the onset of symptoms to recognition . To improve
prognosis of disease early recognition and diagnosis and
[12]
management is necessory . Primary symptoms were
weight gain, sweating, headache and sometimes joint
[13]
pain etc . Which had been present for at least 4 years
before diagnosis. Acromegaly have multisystem
involvement cardiovascular, endocrinal, musculoskeletal,
cutaneous
neurological
and
also
psychiatric
[9,10,12].
disturbance
Diabetes mellitus was observed in
about 25% of cases. Due to counteraction of growth
hormone on effect of insulin. Complete clinical
examination, raised IGF-1 levels and MRI Brain showing
pitutary macroadenoma is a key to diagnosis in this
case. A diagnosis of acromegaly is made on the basis of
signs and symptoms of the condition, in addition to
[14]
biochemical testing . A pituitary MRI should be
obtained after biochemical testing to confirm the
presence of a pituitary macroadenoma. If the pituitary
tumor is found incidentally, and if acromegaly is
suspected based on signs or symptoms, IGF1 level
should be measured. IGF-binding protein 3 has been
shown to be another useful marker of growth hormone
[15].
excess, if other tests are inconclusive
Unless GH levels are controlled, survival is reduced by
an average of 10 years compared with an age-matched
[16]
control population . This patient was detected in early
phase hence these all serious complications were not
seen in this patient.
The goal of treatment is to control IGF-1 and GH
hypersecretion. Hence surgical resection of the GHsecreting adenomas is the initial treatment for most of
the patients. Transsphenoidal surgical resection by an
experienced surgeon is the preferred primary
16
treatment. Growth hormone level normalize within an
hour and IGF-1 levels comes down to baseline in three
to four days, as seen in this patient.
2.
3.
4.
5.
6.
7.
8.
CONCLUSION
9.
10.
Awasthi et al.,
11.
12.
13.
909
Int J Med Res Health Sci. 2015;4(4):907-910
Awasthi et al.,
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Int J Med Res Health Sci. 2015;4(4):907-910
DOI: 10.5958/2319-5886.2015.00184.8
Open access
ARTICLE INFO
ABSTRACT
th
Senior Resident,
Department of Medicine, Sawai Man
Singh Medical College, Jaipur, India
2
Senior Resident, Department of
Paediatrics, Sawai Man Singh Medical
College, Jaipur, India
Authors details:
author:
Lohmror
Anurag
Senior Resident, Department of
Medicine, Sawai Man Singh Medical
College, Jaipur, India
Email: dr.alohmror@rediffmail.com
Corresponding
Autoimmune hemolytic
anemia, Tuberculosis, Cold agglutinin
Keywords:
INTRODUCTION
Autoimmune hemolytic anemia (AIHA) occurs when a
patient produces pathologic antibodies that attach to and
lead to the destruction of their RBCs with consequent
anemia. AIHA can be classified as warm AIHA and cold
AIHA according to the characteristic temperature activity of
[1]
the antibodies . Occasionally, a patient may have mixed
cold and warm active antibodies. Primary (idiopathic) AIHA
[2]
is less frequent than secondary AIHA . Autoimmune
antibodies, particularly cold-reactive antibodies, are
sometimes produced following an infection or immune
[3,4,5,6]
defects or lympho proliferative disorders or drugs
.
These secondary cases are often challenging since not
only AIHA, but also the underlying disease must be
diagnosed and treated. Association of autoimmune
haemolytic anaemia with pulmonary tuberculosis has been
seldom reported. Tuberculosis being a common disease,
the association with hemolytic anemia should be
recognized and treated judiciously.
CASE REPORT
A 25 year old female presented to our department with a
history of fever associated with cough and fatigue. Physical
examination revealed pallor and mild splenomegaly. Blood
pressure, pulse rate and temperature were within normal
limits. Bilateral crepitations could be heard on chest
auscultation. Other findings on physical examination were
unremarkable. There was a past history of receiving blood
transfusion on four occasions. The laboratory investigations
demonstrated severe anemia (Hemoglobin 4.5 g/dl; MCV
74.3fl MCH 18.4pg MCHC 24.7g/dl) with a normal white
911
Anurag et al.,
CONCLUSION
Although rare, pulmonary tuberculosis may be associated
with autoimmune hemolytic anemia. Tuberculosis should be
considered as a differential diagnosis of the etiology of
secondary AIHA because administration of steroids alone
to treat AIHA in such untreated tuberculosis cases may be
detrimental to the patient.
ACKNOWLEDGEMENT: none
Conflict of Interest: Nil
REFERENCES
1.
912
Anurag et al.,
DOI: 10.5958/2319-5886.2015.00185.X
Open Access
ARTICLE INFO
th
ABSTRACT
Williams-Campbell syndrome is a rare entity of congenital bronchiectasis
due to developmental arrest in the tracheobronchial tree, in which extensive
loss of bronchial cartilage is associated with diffuse cystic bronchiectasis;
may be unilateral or bilateral. Clinical manifestations start from infancy with
subsequent recurrent pulmonary infection leading to respiratory failure.
Patients may survive into late adulthood and require lung transplantation.
We report such a rare case diagnosed on the basis of clinico-radiological
presentation and histopathological examination of the pneumonectomy
specimen. A 40 years patient was presented with severe breathlessness
and had history of recurrent episode of productive cough with low grade
fever since childhood for which he was admitted in hospital and treated
symptomatically. Chest roentgenogram revealed right hyperlucent lung,
deviation of trachea towards left; while the left lung showed multiple
scattered large thin walled cysts along with elevation of left dome of
diaphragm. High resolution computed tomography revealed multiple cystic
thin walled airways in the left hemithorax, suggestive of bronchiectasis with
collapse of left lung and compensatory hyperinflation of right lung along with
herniation of right upper lobe to the left.
INTRODUCTION
Bronchiectasis is the irreversible dilatation of bronchi and
bronchioles caused by destruction of smooth muscle and
elastic tissue, resulting from chronic necrotizing infections.
Williams-Campbell syndrome is a rare developmental
disorder of familial occurrence which results absence or
deficiency of cartilage in the bronchial walls distal to first
divisions of subsegmental bronchi and associated with
diffuse cystic bronchiectasis. This uncommon entity should
not be confused with congenital bronchiectasis which are
those of hereditary conditions, such as cystic fibrosis,
primary ciliary dyskinesia or immunodeficiency states; that
predispose to subsequent development of bronchiectasis.
On chest radiograph large thin walled cysts are found;
while high resolution computed tomography (HRCT) scan
characteristically shows central, cystic, thin-walled airways
that collapse upon expiration. Microscopic studies
document, dilated airways having thin walls, absent or
[1]
deficient cartilage with minimal inflammation. Although
most cases presented in childhood, some sporadic
[2,3]
subclinical cases maybe diagnosed in adults as well. .
Here we report such a rare case that had typical clinicoradiological presentation as well as histopathological
features of congenital bronchiectasis.
CASE REPORT
913
SuklaMitra et al.,
DISCUSSION
914
SuklaMitra et al.,
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
915
SuklaMitra et al.,
DOI: 10.5958/2319-5886.2015.00186.1
Open Access
Samanta DR , Bose Chaitali , Panda Sasmita , Upadhaya Ashis , Das Abhijit , Senapati SN
ARTICLE INFO
Received: 6th Jul 2015
Revised: 17th Aug 2015
Accepted: 16th Sep 2015
Author details: 1Assistant Professor,
Department of Medical Oncology,
Acharya Harihara Regional Cancer
centre, Cuttack, Odisha, India
2
Senior resident, 4Post graduate,
5
Professor and Head, Department of
Radiation Oncology, Acharya Harihara.
Regional Cancer centre, Cuttack,
Odisha, India
3
Assistant Professor Department of
Oncopathology,
Acharya
Harihara
Regional Cancer centre, Cuttack,
Odisha, India
ABSTRACT
Primary squamous cell carcinoma of renal pelvis is rare clinical entity with
only few cases have been reported in the literature. It is usually
associated with long standing renal calculi. Insidious onset of symptom
and inconclusive clinical and radiological features leads to locally
advanced or metastatic disease at presentation; resulting in poor
prognosis. Here we are reporting two cases of squamous cell carcinoma
of kidney having renal calculi to highlight its clinical presentation and to
document the association of squamous cell carcinoma in longstanding
nephrolithiasis due to its rarity.
Keywords: Carcinoma, Kidney, Renal stone, Squamous cell
INTRODUCTION
Primary carcinoma of the renal pelvis accounts for only 4[1]
5%of all the urothelial tumor. Transitional cell carcinoma
is the most common histopathological type followed by
[2]
squamous cell carcinoma and adenocarcinoma.
Primary squamous cell carcinoma of renal pelvis is a rare
clinical entity that constitutes only about 0.5-8% of renal
[3]
tumors. The lack of definite clinical presentation and
inconclusive imaging features result in advanced stage of
presentation.
Solid
mass,
hydronephrosis,
and
calcification are common but nonspecific radiological
finding that explain why this tumor is not diagnosed
before histopathological examination of resected surgical
[4]
specimen.
These tumors are high grade, highly
aggressive tumors with poor prognosis. Very few cases
of primary squamous cell carcinoma of kidney have been
reported in the literature. Here we present two cases of
squamous cell carcinoma of renal pelvis due to its rarity
and also to highlights the silent presentations of these
tumors and the need to keep in mind the association of
malignancies in patients having nephrolithiasis. This
report highlights the rarity and aggressiveness of
squamous cell carcinoma.
CASE SERIES
CASE: 1
A 65 years old male clinically presented in the
Department of Radiation oncology of our institute with
lose of weight, fever, vomiting on and off and intermittent
916
Chaitali et al.,
multiple
Fig
3:Photomicrograph
showing
Transitional
epithelium of renal pelvis and underlying stroma with
tumour tissue showing moderately differentiated
squamous carcinoma cells.(H & E ,10x]
CASE: 2
A 67 years old male patient presented in Radiation
oncology Department of our institute with history of
intermittent right flank pain of 6 months duration. There
was no history of hematuria, fever or dysuria. Clinical
examination showed mild tenderness in right renal angle.
A mass of about 169 cm was palpable in right
hypochondrium. It was firm and moving with respiration.
917
Chaitali et al.,
CONCLUSION
Primary squamous cell carcinoma of renal pelvis is a rare
aggressive tumor with poor prognosis. Due to no definite
pathognomic sign and symptoms, most of the patients
presented with advanced stage. As these tumors are
strongly associated with renal stones, patient with renal
stones and non-functioning kidney should be evaluated
with newer imaging technologies for early detection of the
tumor that may lead to a better outcome for the patients.
Conflict of Interest: The authors declare that there is no
conflict of interests
REFERENCES
1.
918
Chaitali et al.,
DOI: 10.5958/2319-5886.2015.00187.3
Open Access
ARTICLE INFO
th
Prabhu T
Department
of
Obstetrics
&
Gynaecology., Meenakshi
Medical
college and Research Institute,
Kancheepuram, Tamilnadu, India
Email: radhaprabhu54@ymail.com
Keywords: Recurrent cornual ectopic,
ABSTRACT
Cornual ectopic gestation is one of the causes of Maternal near miss
cases. In the modern era of IVF treatments and better imaging techniques,
more number of cases of cornual ectopic pregnancies is being diagnosed
and treated both by conservative and radical methods. Here, we report a
case of a recurrent cornual ectopic pregnancy in the early second trimester,
which was managed by hysterectomy due to uncontrolled haemorrhage.
Thirty five year old Mrs. S, Gravida 4, para2, with one previous ectopic
pregnancy presented to the obstetric casualty with acute abdominal pain at
15 weeks +2 days of gestation. On vaginal examination, there was right
fornicial fullness and both the fornices were tender. Cervical motion
tenderness was also present. On review of her previous records, dating scan
done at 8 to 9 weeks showed normal intrauterine pregnancy. An emergency
scan was carried out which revealed an empty uterine cavity with gestational
sac measuring 3.64.44.6 cms seen outside the uterus just above the
fundus with absent cardiac activity. There was evidence of
haemoperitoneum, therefore she was diagnosed with recurrent ruptured
ectopic pregnancy.
919
Radha Bai Prabhu et al.,
cornual resection,
salpingostomy or salpingectomy.
Radical surgery is necessary in cases where the
[8]
haemorrhage is life-threatening . Cornual pregnancy if
diagnosed early can be managed by systemic
[9]
methotrexate in accordance with RCOG guidelines .
Selective uterine artery embolization will be useful in
cases where there is methotrexate failure, to decrease the
[8]
vascularity and to prevent catastrophic haemorrhage .
Early diagnosis and appropriate management form the
mainstay in the conservative management.
CONCLUSION
Fig 1: Right ruptured cornual ectopic pregnancy 7.56
cms
DISCUSSION
Diagnosis of a cornual pregnancy poses great difficulty
especially in early trimesters, as the gestational sac will be
seen in an eccentric position, giving the appearance of an
eccentric intrauterine pregnancy. However the diagnosis
can be improved with transabdominal or transvaginal
[4]
ultrasound, using the following criteria: An empty uterus,
a gestational sac seen separately and <1cm from the most
lateral edge of the uterine cavity, the myometrial layer
surrounding the sac would be thin and a thin echogenic
line extends directly up to the centre of the gestational sac
representing either the interstitial portion of the fallopian
tube or the endometrial cavity. This is called the interstitial
line sign.
The incidence of recurrent cornual ectopic pregnancies is
unknown; nevertheless, this finding has already been
[5, 6]
reported
. Tubal pathology, together with assisted
conception and conservative management of cornual
pregnancy contributes to a higher risk of recurrence of
[5]
cornual pregnancy . Other factors associated with an
increased risk of ectopic pregnancies include prior
abdominal surgery, a ruptured appendix and uterine
developmental abnormalities. Proper diagnosis is
mandatory so as to avoid misdiagnosis of a normal
intrauterine pregnancy as a cornual pregnancy which can
happen in pregnancy occurring in an anomalous uterus
(bicornuate/ septate). 3D and 4D transvaginal ultrasound
is a valuable tool in making a correct diagnosis in these
situations , as well as will help in differentiating between
angular pregnancy and cornual pregnancy. In angular
pregnancy, the embryo is implanted in the lateral angle of
the uterine cavity, medial to the uterotubal junction and
round ligament while in cornual pregnancy; the embryo is
implanted lateral to the round ligament.
Cornual ectopic pregnancies are usually managed by the
conventional technique i.e hysterectomy. However in
recent years more conservative approaches have been
introduced into practice, but all conservative surgical
approaches have been associated with decreased fertility
rates and increased rates of uterine rupture in future
[7]
pregnancies . Conservative surgical approach consists of
5.
6.
7.
8.
9.
920
Radha Bai Prabhu et al.,
DOI: 10.5958/2319-5886.2015.00188.5
Open Access
ARTICLE INFO
th
ABSTRACT
Actinomycosis is a chronic disease characterized by abscess formation, tissue
fibrosis, draining sinuses and ulcers caused by the filamentous, gram-positive
anaerobic or microaerophilic bacterial species of the genus Actinomyces.
Actinomycosis mainly presents in three forms namely cervicofacial (31-65%),
abdominopelvic (20-36%) and thoracic (15-30%) respectively. Primary gastric
actinomycosis is extremely rare, with only 24 cases reported till date. We
present a case report of a thirty five years old female patient who was admitted
in a super specialty hospital with complaints of low grade intermittent fever,
abdominal pain and two discharging sinuses on anterior abdominal wall.
Clinical, radiological, microbiological and pathological evaluation revealed
findings suggestive of primary gastric actinomycosis with underlying gastric
adenocarcinoma in this patient. To the best of our knowledge, this is the first
ever report of primary gastric actinomycosis from India.
Keywords:
Actinomyces
spp.,
Primary gastric actinomycosis, Gastric
adenocarcinoma
INTRODUCTION
Actinomycosis is a chronic disease characterized by
abscess formation, tissue fibrosis, draining sinuses and
ulcers. It is caused by the filamentous, gram-positive
anaerobic or microaerophilic bacterial species of the
[1]
genus Actinomyces.
Actinomycosis mainly presents in
three forms: cervicofacial (31-65%), abdominopelvic (20[2,3]
36%) and thoracic (15-30%).
Abdominal actinomycosis
has often been called one of the greatest imitators in
[4]
clinical practice. It often presents as an indolent chronic
suppurative process with atypical symptoms that are
misdiagnosed as neoplasms and other inflammatory
[5]
diseases like tuberculosis or Crohns disease. There is a
predilection for appendix and ileocecal region of the bowel
and thus, it can easily mimic colonic adenocarcinoma,
intestinal tuberculosis, chronic appendicitis or regional
[6]
enteritis.
When outside the intestine, abdominal
actinomycosis generally grows by local spread with rare
incidences
of
haematogenous
or
lymphatic
[7]
dissemination.
Primary gastric actinomycosis is
[8-14]
extremely rare, with only 24 cases reported till date.
The rarity of gastric involvement by Actinomyces spp. has
been attributed to the high luminal acidity of stomach, as a
result of which, the organisms are either killed or their
[11]
growth is inhibited.
We hereby present a case of
primary gastric actinomycosis, which to the best of our
knowledge, is the first ever report from India.
Mohit et al.,
CASE REPORT
921
922
Mohit et al.,
923
Mohit et al.,
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
924
Mohit et al.,
DOI: 10.5958/2319-5886.2015.00189.7
Open Access
ARTICLE INFO
Received: 13th Aug 2015
Revised: 23rd Sep 2015
Accepted: 28th Sep 2015
1
Authors details:
Professor,
Department
of
Obstetrics
and
Gynaecology,
Government
Medical
College, Amritsar; 2Assistant Professor,
Department
of
Obstetrics
and
Gynaecology,
Government
Medical
College, Amritsar; 3 Assistant Professor,
Department of Medicine, Government
Medical College, Amritsar
Corresponding author: Ajay Chhabra,
Assistant
Professor
Medicine,
Government Medical College, Amritsar
Address: 429, Akash Avenue, Amritsar
Email: drajaychhabra@gmail.com
ABSTRACT
It is a rare occurrence for the rudimentary horn of uterus to harbour a
pregnancy and the usual outcome is devastating leading to a spontaneous
rupture in second trimester with the patient presenting in shock with
massive intra-peritoneal haemorrhage and if appropriate management is
not instituted in time it may lead to high rate of mortality. We report an
unusual case of rupture rudimentary horn pregnancy who presented as a
chronic ectopic with an adnexal mass and surprisingly with no sign of
shock. Diagnosis is often difficult in such a situation which puts the treating
gynaecologist in dilemma. High clinical suspicion supplemented with
radiological findings helped clinch the diagnosis and laparotomy was
performed followed by resection of the rudimentary horn to prevent future
complications.
Keywords:
Rudimentary
uterus,Mullerian anomaly
INTRODUCTION
The incidence of mullerian duct anomalies in general
.population is estimated to be 0.5%-3.2%.[1,2]Noncommunicating rudimentary horn is one of these
mullerian anomalies. A pregnancy implanting in this horn
is a rare event but when it happens, the implications can
be catastrophic. The incidence as reported by Johnsen is
1 in 100,000 patients making it an extremely rare
[3]
presentation. It usually ruptures in second trimester
leading to immediate fetal demise, massive intraperitoneal haemorrhage and shock. The clinical picture
mimics a ruptured tubal ectopic and a diagnosis is often
made at laparotomy only. Pre-rupture diagnosis is rare
and radiological. We report a rare case of ruptured
rudimentary horn pregnancy mimicking a chronic ectopic
[3]
with no features of shock.
horn,
ectopic
pregnancy,
unicornuate
CASE REPORT
A 25 year old gravida three and para two was referred to
Guru Nanak Dev Medical College and Hospital, Amritsar
with three months amenorrhoea and pain in abdomen for
a week. Pain was acute and severe before one week and
was relieved with analgesics. There was history of
fainting sensation at the same time. Over one week pain
had persisted but was dull and aching type. Patient had
no complaint of per vaginal bleed.
Obstetric history: Patient was G3P2L2A0 with history of
two term normal deliveries and last birth was 8 months
prior.
Menstrual history: Her past menstrual cycles were
regular, painless with normal blood flow. She was not
sure about her last menstrual period but vaguely
remembered her pregnancy to be of 3 months duration.
925
Int J Med Res Health Sci. 2015;4(4):925-927
926
Shergill Harbhajan et al.,
CONCLUSION
Being a rare entity and due to potentially atypical
presentations, diagnosis of rudimentary horn pregnancy
is often delayed and many a times it may surprise a
surgeon operating with provisional diagnosis of ectopic
pregnancy. This possibility should always be considered
in differential diagnosis of a woman presenting with acute
abdomen and/or features of shock in second trimester of
pregnancy. Surgical excision of a non-communicating
horn is always indicated even when diagnosis is
incidental.Ipsilateral fallopian tube should never be left in
such cases as they are a potential site of ectopc
pregnancy in future.
Conflict of Interest- nil
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
927
Shergill Harbhajan et al.,
DOI: 10.5958/2319-5886.2015.00190.3
Open Access
3,4
Dana Turliuc , Serban Turliuc , Iustin Mihailov Andrei Cucu , Gabriela Dumitrescu ,Claudia Costea
ARTICLE INFO
ABSTRACT
th
This case present a rare forensic case of cervical spinal gunshot injury of a
female by her husband, a professional hunter, during a family fight with a
shotgun fire pellets. The gunshot destroyed completely the cervical spinal
cord, without injury to the neck vessels and organs and with the patient
survival for seven days. We discuss notions of judicial ballistics,
assessment of the patient with spinal cord gunshot injury and therapeutic
strategies. Even if cervical spine gunshot injuries are most of the times
lethal for majority of patients, the surviving patients need the coordination
of a multidisciplinary surgical team to ensure the optimal functional
prognostic.
Keywords: cervical spinal cord gunshot injury, shotgun fire pellets, neck
gunshot wounds
INTRODUCTION
In the last years, due to increasing violence in urban
areas, spinal cord gunshot injuries have became an
important cause of morbidity and mortality, especially in
[1]
the young population .The incidence of spinal cord injury
caused by gunshot wounds varies considerably
[2,3]
depending on the country, with values from 13 to 44%
.
Attacks and aggression are the main causes of spinal
cord gunshot injuries among civilians, while accidental
[1]
[4,5]
shootings are rare . Patients are generally male
[6]
having ages from 15 to 34 years and in most cases of
spinal cord gunshot wounds, there occurs spinal cord
[7]
transection with complete neurological deficit .
Recently, the incidence of shotgun wounds by projectile
weapons with high energy has increased (rifles and
[8,9]
military weapons)
. Currently, the most common are
chest gunshot wounds, and the most devastating are
cervical spinal cord gunshot wounds, having a poor
prognosis,
producing
most
commonly
complete
[7,10,11]
neurological deficit
.
A report of the Statistical Office of the US Justice
Department in 1988 reported that 36% of victims with
gunshot wounds were females. The same report states
that there are twice more women than men victims of
crimes committed by spouses or family members. In 36%
928
Serban Turliuc et al.,
929
Serban Turliuc et al.,
2.
3.
4.
5.
6.
930
Serban Turliuc et al.,
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
931
Serban Turliuc et al.,
DOI: 10.5958/2319-5886.2015.00191.5
Open Access
Mane Makarand , Mane Priyanka , Mohite Rajsinh , Bhattad Prashant , Bangar Kushal , Mahajani Anup
ABSTRACT
ARTICLE INFO
Received: 17th Jul 2015
Revised: 7th Sep 2015
Accepted: 25th Sep 2015
Authors details: 1Assistant Professor,
4
Residents, Dept. of General Medicine,
Krishna Institute of Medical Sciences
Karad, Maharashtra, India
2
Assistant Professor, Dept. of
Microbiology, KIMS, Karad, Maharashtra,
India
3
Assistant Professor, Dept. of
Community Medicine, KIMS, Karad,
Maharashtra, India
Corresponding author:
Mohite
Rajsinh , Assistant Professor, Dept. of
Community Medicine,
Maharashtra, India
KIMS,
Karad,
Email: rajsinhmohite124@gmail.com
.
INTRODUCTION
Thalamus is a part of midbrain located below
hypothalamus below the ventricles. Thalamus receives
blood supply from both anterior and posterior circulations
of brain. The Artery of Percheron (AOP) is a rare
anatomical variant of brain circulation in which single
central arterial trunk arises from first segment (P1) of the
posterior cerebral artery. The AOP give rise to bilateral
medial thalamic perforants which supplies blood to
[1]
thalamus bilaterally . Occlusion of this artery leads to
sudden breakdown of perfusion of thalamus which leads
to bilateral paramedian thalamic infarct with or without
mesencephalic infarct. Prevalence and incidence of this
[2, 3]
syndrome is unknown,
however few cases were
reported from various parts of world as well as India since
it was first described by Percheron in year 1976 . Here
we report a case of 35 year old lady with acute bilateral
thalamic infarct with underlying cause of occlusion of
Artery of Percheron, as a rare case report from rural area
of Western Maharashtra, India.
CASE REPORT
A 35 years old female came with altered state of
consciousness i.e. stuporous state in Krishna hospital,
Karad, a tertiary health care centre loacated in rural
Western Maharashtra, India. Two hours ago of hospital
admission, she felt giddiness which then progressed to
stupour state. She had no history of fever, headache,
932
Int J Med Res Health Sci, 2015;4(4):932-933
DISCUSSION
CONCLUSION
Thalamus is a large collection of neuronal group within
the diencephalon. It participates in sensory, motor, and
limbic functions. Virtually all information that reaches the
cortex is processed by the thalamus, hence also called
as gateway to the cerebral cortex. Thalamus can be
divided into various nuclei, that project to wide regions of
the neocortex are the midline and intra-laminar nuclei.
The nuclei that project to specific areas include the
specific sensory relay nuclei and the nuclei concerned
with efferent control mechanisms. The specific sensory
relay nuclei include the medial and lateral geniculate
bodies, which relay auditory and visual impulses to the
auditory and visual cortices; and the ventral posterior
lateral (VPL) and ventral posteromedial nuclei, which
relay somato-sensory information to the post-central
gyrus. The ventral anterior and ventral lateral nuclei are
concerned with motor function. They receive input from
the basal ganglia and the cerebellum and project to the
motor cortex. The anterior nuclei receive afferents from
the mamillary bodies and project to the limbic cortex,
[4]
which may be involved in memory and emotion.
Infarction in thalamus may produce symptoms like
seizures, impairment in memory, confusion and
[5]
sometimes coma with vertical gaze palsy.
Thalamus receives blood supply from both anterior and
posterior circulations. The anterior thalamus is supplied
by thalamotuberal arteries arising from posterior
communication artery via anterior circulation. The
paramedian thalamic and rostral midbrain territories are
supplied by thalamoperforators, anterior branches of the
[6]
P1 segments of the posterior cerebral arteries (Fig 2).
Percheron G has described three variations in the blood
[1]
supply of the paramedian thalamus. One of them was
Artery of Percheron which arises from P1 and supplies to
bilateral thalamus and rostral midbrain. Many case series
[7]
like Matheus et al , have shown that occlusion of this
artery leads to bilateral paramedian thalamic infarct with
or without mesencephalic infarct.
2.
3.
4.
5.
6.
7.
933
Int J Med Res Health Sci, 2015;4(4):932-933