Indian Medical Gazette
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Editor: Mr. Amar Pandeya
ISSN: 0019 – 5863
Frequency: Monthly
Language: English
Open Access Peer-reviewed journal
Web site: https://medind.nic.in/ice/icem.shtml
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Item Absence of Association Between Serum Homocysteine Levels and Coronary Artery Disease.(2012-07) Mehta, Margeyi; Shah, JigishBackground: High prevalence of premature coronary artery disease is reported in Asian Indians. Traditional risk factors do not explain this excess. Elevated levels of homocysteine are reported to be associated with coronary artery disease amongst Europeans. Present study was carried out with objective to find any possible association between serum homocysteine levels and coronary artery disease Gujarati population of urban Vadodara. Methods: 21 Cases (individuals with coronary artery disease) and 20 controls were studied. Results: The mean homocysteine value amongst the cases was 12.9±2.3 ìmol/L and 12.8±2.4 ìmol/L in controls. There was no significant difference in the homocysteine levels between the groups studied. The prevalence of hyperhomocysteinemia, defined as a level of 17.1 μmol/L (the 95th percentile for serum homocysteine in the control group) was not significantly different among the groups. Conclusions: Elevated serum homocysteine levels are not associated with coronary artery disease in male subjects of Vadodara. However, the results must be interpreted with caution because of limited sample size.Item Acid-Base Imbalance and Dyselectrolytemia in Falciparum Malaria.(2014-08) Das, Karunakar; Sahoo, Aswini kumar; Sastry, Anand Sankar; Mahapatra, Subash ChandraMalaria is re-emerging as the major infectious killer and it is the top priority tropical disease of the World Health Organization. Indian sub-continent harbours a global threat in the form of epicenter of multidrug resistant plasmodium falciparum. High prevalence of Complicated Falciparum Malaria in Costal Andhra Pradesh requiring ICU admission with high morbidity and mortality prompted this study. 60 cases of falciparum malaria in 3 sub groups, i.e, uncomplicated falciparum, severe falciparum with ARF, severe falciparum without ARF are taken. In Group-II, i.e, severe falciparum with ARF pts., mean serum potassium is 5.06 -hyperkalemia, mean PaO2 and PaCO2 are 80.33 and 32.75 respectively and mean bicarbonate value is 19.83, mean PH is 7.10, which reflects underlying metabolic acidosis and compensatory respiratory alkalosis, also mortality is 6 in Group-II out of total 9 deaths. Hence electrolytes and acid-base disturbance, especially hyperkalemia and acidosis are important cause of mortality in severe falciparum malaria. In acute renal failure setting, which is associated with both hyperkalemia and acidosis, prognosis is worsened. “Humanity has but three great enemies : fever, famine and war; of these by far the greatest, by far the most terrible, is fever(William Osler).Item ACTIVO-I Study Report - A Retrospective Prescription Event Monitoring for Safety and Efficacy of Waist Circumference in the Management of Overweight and Obesity.(2014-03) Kharat, DeepakThe study was conducted on the combination of bioactive ingredients [Bioactives; Hoodia Gordonii, Hydroxycitric Acid (the active ingredient in Garcinia cambogia), Green tea extract, Ginger extract and Piperine] to estimate its safety and efficacy in decreasing the body weight (BW), body mass index (BMI) and waist circumference (WC) after treatment. Design and methods: The study was retrospective prescription event monitoring study. Total 99 overweight and obese patients (52 males and 47 females; mean age 45.45 ± 10.20 years) were enrolled in the study. Subjects were administered one capsule of Bioactives orally one hour before lunch and dinner daily for 90 days. All subjects were given standard advice regarding healthy food choices in their diet and physical activity. However, subjects were not advised to restrict dietary calorie intake. Clinical examination, BW, BMI and WC were estimated in all subjects at baseline and at the end of 30, 60 and 90 days. Observations: Bioactives was found to be significantly effective in decreasing BW by 4.36%, 7.12 % and 10.25% at 30, 60 and 90 days respectively and these results were statistically significant (p = 0.002, p <0.0001 and p <0.0001 respectively). BMI was also reduced with Bioactives by 5.11%, 9.83% and 11.88% at 30, 60 and 90 days respectively and results were statistically significant (p <0.0001, p <0.0001 and p <0.0001 respectively). Bioactives was found to be significantly effective in decreasing WC by 3.28%, 5.29% and 7.31% at 30, 60 and 90 days respectively and these results were statistically significant (p = 0.0023, p <0.0001 and p <0.0001 respectively). Bioactives can be rated as good to very good based on results observed on 66% patients. Side effect or adverse event was not reported in any case. Conclusion: Bioactives appears to be significantly effective in decreasing the BW, BMI and WC within 30, 60 and 90 days in overweight and obese patients. Bioactives has excellent tolerability as adverse event was not reported in any case.Item Acute Hepatitis Like Presentation of Budd Chiari Syndrome in a Child.(2012-02) Khanna, Alok; Abrol, Pankaj; Sood, Vijay Lakshmi; Agarwal, Shalini; Dalal, Jagjit SinghThe patient presented with progressively increasing ascites and pain abdomen but without any bleeding tendency, or encephalopathy. The initial diagnosis of acute hepatitis was proved wrong by contrast enhanced CT scan of abdomen which showed atretic hepatic veins. Atretic hepatic veins causing Budd Chiari Syndroem (BCS) is a rarity in literature.Item Acute Inversion of Uterus in Obstetrics.(2014-06) Basu, Debraj; Saboo, Varsha; Mondal, Tamal KrUterine inversion is an uncommon and unpredictable but potentially life threatening obstetric emergency. The typical presentation is that of severe postpartum haemorrhage and shock along with a mass either felt in the vagina or protruding outside the introitus. Early recognition and prompt management (by teamwork) by simultaneous correction of shock and repositioning of the inverted uterus are imperative in order to minimize the potential for maternal morbidity and mortality. There is a need for skills and drills training because of the rarity of acute inversion. Here is a present a case report of acute inversion of uterus following vaginal delivery and its management. The accompanying review of the literature provides helpful insights into the diagnosis and optimal management of this potentially life threatening condition.Item Adenocarcinoma Arising from Heterotopic Pancreas in Association with a Splenic Cyst.(2013-12) Bhattacharyya, Sudipta; Kundu, Tamalika; Dutta, SouvikWe report a rare case of adenocarcinoma arising from heterotopic pancreas in splenectomy specimen operated for a Splenic Cyst. This 40 year old female patient presented with vague upper abdominal pain and swelling. USG showed a large cyst within the spleen. The cyst along with the spleen is removed after laparotomy. The pancreas and other abdominal organs were unremarkable on ultrasonography and intraoperative examination. Gross examination showed a cyst with a smooth lining, entirely within the spleen. A small locule, communicating with the main cyst showed small papillary projections. On light microscopy, the cyst wall is lined by single layer of columnar cells. Section from papillary areas showed histological appearance of papillary adenocarcinoma. Remnant of normal pancreatic tissue was discovered at the wall of the cyst. We presume an origin from heterotopic pancreatic tissue in the spleen for this neoplasm and reporting the case for its rarity.Item Adult Coarctation of Aorta with Bicuspid Aortic Valve.(2012-11) Redkar, Neelam; Kamble, Aniket; Bendle, Meenakshi; Beedkar, Amey; Chavan, RadhikaCoarctation of the aorta is a congenital cardiac malformation that can go undiagnosed with only hypertension as a marker of its presence, because clinical signs can be subtle and overlooked if a complete physical examination is not performed. Here we present a case report of 20 year old young male patient with hypertension who was diagnosed to have Coarctation of Aorta and Bicuspid aortic Valve.Our patient was relatively asymptomatic until he presented with headache and exertional dyspnoea.Item An Adult Male Presenting with a Left Gluteal Region Hemangioma – An Unusual Site.(2015-03) Goyal, Subhash; Sharma, Pranav Kumar; Goyal, Rekha; Rashid, ArshadThe word “hemangioma” comes from the Greek haema- (αιμα), “blood”; angeio (αγγειο), “vessel”; -oma (-ωμα), “tumor”. A Hemangioma is a benign and usually selfinvoluting tumor of the endothelial cells that lines blood vessels, and is characterized by increased number of normal or abnormal vessels filled with blood. It usually appears in the initial weeks of life and grows most rapidly over the first six months. Usually, growth is complete and involution has commenced by twelve months. Half of all infantile hemangiomas have completed involution by age five, 70% by age seven, and most of the remainder by age twelve years1. In more severe cases hemangiomas may leave residual tissue damage. In infancy, it is the most common tumor 2.Item Agenesis of Gall Bladder: Its Emryological Basis and Clinical Significance.(2011-10) Chunder, Rajasri; Guha, Ranjit; Nandi, Swastik; Baral, KarabiCongenital absence of the gall bladder is a rare anomaly which may occur alone or with other malformations with incidence ranging from 0.01-0.05%. Awareness of this entity by clinicians and radiologists is essential because many of these patients present with biliary symptoms and have unnecessary operations. This presentation, coupled with the inability of standard abdominal ultrasonography to convincingly diagnose agenesis of the gallbladder, can put the surgeon in a diagnostic and intraoperative dilemma. Here we report a suspected case of chronic cholecystitis who underwent a laparoscopic cholecystectomy and was found to have a congenital absence of gall bladder and cystic duct. Standard pre-operative investigative modalities which were fallacious and misleading. The embryological basis and clinical significance have been discussed.Item Allgrove (AAA) Syndrome.(2012-03) Champatiray, Jyotiranjan; Singh, BipsaThis is the first reported case of Allgrove Syndrome in Paediatric Department, S. C. B. MCH in a six years old male child who presented with convulsion and altered sensorium. He had no tears since birth, dysphagia with regurgitation of food and later developed skin hyperpigmentation. Allgrove syndrome is a rare autosomal recessive syndrome characterized by progressive loss of cholinergic function resulting in alacrimia, achalasia cardia, addison’s disease and autonomic neuropathy. Early diagnosis will lead to significant reduction of morbidity and mortality which is usually due to unrecognized adrenal crisis.Item Aluminium Phosphide Poisoning.(2014-09) Sharma, Deepti; Meena, C P; Mittal, Lal Chand; Yadav, Govind; Meena, S RAluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.Item Amniotic Fluid Embolism.(2014-07) Devi, Ph Madhubala; Sarangthem, Babina; Th Meera; Singh, N RatanAmniotic Fluid Embolism (AFE) is a potentially fatal rare obstetric complication. In this paper, the death of a 30-year old apparently healthy parturient due to AFE is reported. She underwent Lower Segment Caesarean Section (LSCS) under spinal anaesthesia but after about half an hour of the operative procedure, she developed features of Acute Respiratory Distress Syndrome (ARDS) and shock, and died within five hours of the onset of the symptoms. The sudden death of an apparently healthy parturient may lead to medical negligence claims by the relatives. In developing countries, it still remains a post-mortem diagnosis and in the present case, histopathological examination findings helped in coming to a conclusive opinion of AFE.Item Amoxycillin Clavulanic Acid Induced Hepatotoxicity.(2014-05) Gursale, Santosh C; Burte, Narayan PDrug-related hepatotoxicity is a serious health problem, with broad implications for patients, healthcare providers, the pharmaceutical industry and governmental regulatory agencies. Herein we report a rare case of amoxycillinclavulanic acid combination induced liver injury of cholestatic pattern in 40 years old, well educated male patient. Patient gave history that though other drugs were given to him by his physician for fever with chills & rigors, malaise, bodyache, except amoxycillin-clavulanic acid combination all other drugs were well tolerated previously by the patient, without appearance of jaundice. So jaundice in this patient was most probably due to amoxycillinclavulanic acid combination. Though severe liver injury is rare, proper history should be taken while prescribing amoxycillin-clavulanic acid combination. Attention must be paid to potential side-effects of the drugs and close follow-up with patients is a medical necessity to evaluate adverse reactions, especially in case of amoxycillinclavulanic acid combination.Item Anaesthetic Considerations and Implications for Non Cardiac Surgery in a Patient Presenting with Aorto Occlusive Disease.(2014-04) Bansal, Teena; Hooda, SarlaPatients with peripheral vascular disease continue to challenge the anesthesiologist as these patients often have associated coronary artery disease. There is always a danger of myocardial ischemia and cardiac morbidity both intraoperatively and postoperatively in this group of patients. We here report a patient presenting with aorto occlusive disease posted for emergency laparotomy for intestinal obstruction.Item Antepartum Bleeding of Unknown Origin and Sequlae.(2014-02) Gosavi, Chhabra MAntepartum bleeding of unknown origin (ABUO) seems to be one of the most common causes of bleeding in third trimester of pregnancy, but has not been studied well. Objective : The present study was aimed to study the incidence, management strategies and the perinatal outcome in cases of ABUO. Methods : Cases diagnosed as ABUO and managed at the rural referral hospital over last 5 years were analyzed. The diagnosis of ABUO was by exclusion of placental abruption, placenta previa and possible causes of bleeding in the lower genital tract by clinical and ultrasonographic examination. Results : The incidence of ABUO was 0.60 % of births. Of all cases of antepartum haemorrage 18.1% were of teenage and of ABUO10.3% cases were of teenage cases compared to overall 5% cases teenage. Perinatal Mortality Rate (PMR) in cases of ABUO was 237, significantly higher than overall PMR of 66 (p value <0.001) during the study period. Preterm births were the most common cause of perinatal mortality in ABUO. Conclusion : Women with ABUO may not need special interventions, but when ABUO occurs preterm births and perinatal loss increase ,so deaths due to prematurity need to be prevented.Item Antibiotic Sensitivity Pattern of Gram Negative Bacilli Isolated from the Lower Respiratory Tract of Ventilated Patients in the Intensive Care Unit.(2014-05) Jethwani, Urmi; Trivedi, Pranav; Shah, NeelamThe causative organisms vary according to the patients’ demographics in the ICU, methods of diagnosis, the durations of hospital and ICU stay. It is necessary to study different etiological organisms and their antimicrobial susceptibility pattern for generating local antibiotic policy. Aims: To study the causative organisms and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to ICU. Methods and Material: Endotracheal aspirates from 200 patients admitted to the ICU were cultured, identified and antimicrobial susceptibility testing was performed by standard methods. Results: From 200 specimens, 69(34.5%) were culture positive. Total 96 isolates were recovered, from these 92 (96.87%) isolates were gram negative bacilli (GNB). In 34.78% specimens, two isolates were recovered. The most common Gram- negative organism being Acinetobacter spp. (31.25%) followed by Klebsiella spp. (21.87%), E-coli (21.87%) and Pseudomonas Spp. (17.7%). All GNBs were 100% sensitive to polymyxin B and colistin and resistant to piperacillin, ceftazidime and cotrimoxazole. 50% E-coli and 38% of Klebsiella pneumoniae strains were ESBL (extendedspectrum b-lactamase) producers. Conclusions: This study demonstrates the trend in antimicrobial susceptibility pattern of gram negative bacilli in intensive care unit. It is the most important for specific treatment of ventilator associated pneumonia patients and to generate local data periodically to decide empiric antimicrobial therapy.Item The Anticonvulsant Effect of Eupatorium Birmanicum DC Leave Extract Alone and in Combination with Phenytoin Against MES Seizure in Albino Mice.(2014-03) Babycha, L.; Singh, Th Imoba; Devi, M Medhabati; Joychandra, O; Bharati, R K; Valte, VTo evaluate the anticonvulsant activity of aqueous extract of Eupatorium birmanicum DC leave (EB) alone and in combination with phenytoin against MES seizure in albino mice. Method: Aqueous extract of EB was prepared using Soxhlet apparatus. The anticonvulsant effect of the extract was tested on prescreened albino mice at 3 doses (200, 400 & 800 mg/kg). After 1 hr of oral administration of EB the animals were subjected to MES seizures by convulsiometer with a current of 45 mA for 0.2 sec via transauricular electrodes and the duration of the THLE was recorded. Sub-anticonvulsant dose of phenytoin was also determined and the effect of its combination with the most effective dose of EB tested. Results: EB aqueous extract exhibited significant anticonvulsant activity in the MES model at doses 400 mg/ kg (p<0.01) & 800 mg/kg (p<0.001). This reduction in the duration of THLE at 800mg/kg of EB was further reduced significantly (p<0.001) when combined with subanticonvulsant doses of phenytoin (10mg/kg). Conclusion: The aqueous extract of E. birmanicum leaves showed significant anticonvulsant activity in MES seizure model in albino mice and it significantly increased the anticonvulsant effect of phenytoin in the same animal model.Item Assessment of Clinico-Morphological Patterns of Palpable Breast Lumps in Tripura.(2015-06) Ghosh, Sumana; Nath, Sanjay; Islam, HabibulBackground : With growing awareness in the general population, especially about breast pathologies, a lady with a breast lump is one of the commonest presentations in outpatient departments. Clinical examination would be followed in most patients with a confirmatory diagnosis under the microscope. Aim : The aim of the study is to evaluate the clinico-morphological patterns of palpable breast lump in Tripura. Methods: This retrospective study was conducted from January 2010 to January 2015 in Tripura Medical College and Dr BRAM Teaching Hospital. Study included all diagnosed cases of female breast lump during the above mentioned period. Detailed clinical data including age, site, side, family history and histological reports were retrieved from the records section. Observation: A total number of 140 cases studied ranging from 18 years to 80 years having a mean age of 49 years. Most common age group was seen in 18-30 years for benign lesions and 40- 60 years for malignant lesions. The commonest type of benign lesion was Fibroadenoma with 58 cases (76.3%) and in malignant lesions Infiltrating duct carcinoma was the commonest type with 32 cases (50%), followed by medullary carcinoma with 16 cases (25%). The disease was found on the left side in 91 cases (65%) and on the right side in 48 cases (34.3%) and bilateral in 1 case (0.71%). In cases of malignancy TNM Staging was available in 32 cases. Majority of the cases were stage II,Item Assessment of Efficacy and Safety of Fixed Dose Combination of 3% Biophytex LS 8740 and 5% Proteasyl TP LS 8657 Cream in the Treatment of Under Eye Dark Circles (Infra-orbital Hyperchromia).(2012-11) Kharkar, R D; . Ahluwalia, A; Karankumar, J; Phadke, NBackground: Under Eye Dark Circles is attributed to multiple factors. The treatment should address the various pathologies involved to provide the best possible effects. Aims: To assess the efficacy and safety of Wunder eye cream (a combination of 3% Biophytex LS 8740 and 5% Proteasyl TP LS 8657) in patients with under eye dark circles. Study Design: Open label, prospective, single arm and multicentric post marketing surveillance clinical study. Materials and Methods: 142 patients (125 males and 17 females) were evaluated in the study. Wunder Eye cream was applied twice daily on the affected under eye dark circle area for eight weeks. Parameters evaluated were area of under eye pigmentation, improvement in luminance of under eye skin, reduction in under eye puffiness and reduction in under eye wrinkles using a digital camera photographs after four and eight weeks of treatment. Safety evaluation was also done on the same time. The values were compared using Chi-Square test. Results: Early response was seen in 40% of patients with four weeks of treatment where 50% improvement in all the parameters was seen. With eight weeks of therapy about 92.3% of patients showed 50 to 100% improvement in the area of under eye pigmentation; 50% to 75% improvement was seen in 87.3% of patients for under eye pigmentation, in 80.1% patients for luminance of under eye skin, in 68% patients for under eye puffiness and in 67.4% of patients for under eye wrinkles. Conclusion: Wunder eye cream is a combination of botanical and yeast extracts was found to be effective against under eye dark circles.Item Assessment of Sociodemographic Factors Affecting Immunization Status of Children in Age Group of 12-23 Months in a Rural Area.(2013-05) Malkar, Vilas R; Joge, Umesh S; Khadilakar, Hrishikesh; Choudhari, Sonali G; Lakde, Rajesh NBackground: Immunization is a powerful and cost effective weapon against vaccine preventable diseases. In India ‘Expanded Programme of Immunization, (EPI) was launched in 1978. But today also immunization coverage in India is comparatively low and far from satisfaction. Objectives: 1. To assess immunization status of children in age group between 12-24 months. 2. To study the sociodemographic factors affecting immunization status. Method : 30*7 cluster sampling method was used to assess sociodemographic factors affecting immunization status of children in age group of 12-23 months in rural area of Beed district (Maharashtra) in India. Results : Out of total 210 children surveyed, 165 (78.57%) were fully immunized, 43(20.48%) were partially immunized and 2(0.95%) were unimmunized. Immunization status of child was found not to be associated with the gender and type of family of child. It was significantly associated with religion, place of birth and availability of immunization card. Immunization status of children went on significantly improving as their mother’s education level increased (p<0.05), but fathers education had no influence. Immunization status of children was found directly related to their socioeconomic class and inversely to birth order. The highest (86.25%) coverage for complete immunization was among the children having birth order II. Immunization status went on decreasing as birth order increased and was the lowest (50.00%) among those having birth order V. Conclusion : To improve immunization coverage in rural area improvement in female literacy and female education is necessary. Similarly improvement in socioeconomic status, limiting the family size and increasing hospital deliveries will lead to improvement in immunization coverage. Also parents should be encouraged to preserve immunization cards of their children as long as possible.