2017-01-19T02:17:59Z http://www.medknow.com/oai2
oai:medknow.com:62860 2010-05-01 all journal:Afr_J_Paediatr_Surg
Use of ropivacain and lidocaine for axillary plexus blockade Felfernig, M Marhofer, P Weintraud, M Huber, G Duma, A Nosa, A Kapral, S Objective: The use of certain peripheral nerve blocks in paediatric patients is gaining increasing popularity, although distinctive characteristics of the juvenile anatomy, psychological barriers, time constraints on block placement, and risks of neurotoxic and cardio toxic side effects are still mentioned. However, newer agents like Ropivacaine and Levobupivacaine seem to offer excellent alternatives to Bupivacaine and Lidocaine, especially for use in paediatric patients. Materials and Methods: We evaluated Ropivacaine 0.5% and Lidocaine 1.0% using axillary plexus blockade as a single-shot technique in 50 children in the age group of 2 to 10 years and undergoing short upper limb surgery. The primary objectives were to compare onset time, duration and quality of block and the incidence of breakthrough pain. Results: Onset time was longer in the Ropivacaine group (15.4 minutes) than in the Lidocaine group (8.2 minutes). The duration of the effect was greater in patients in the Ropivacaine group (337 minutes) than in the Lidocaine group (137 minutes). Duration appeared to vary with patient's age but this effect was not statistically significant. Conclusion: Axillary plexus anaesthesia provides satisfactory perioperative pain relief in infants undergoing short-trauma surgery. Apart from its safety, these results underline that Ropivacaine 0.5% can be recommended for axillary brachial plexus block in children. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/101/62860 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62859 2010-05-01 all journal:Afr_J_Paediatr_Surg
Congenital diaphragmatic hernia: A 4-year experience in a single centre Ozdogan, T Durakbasa, C Mutus, M Iscen, M Background: This study aimed to evaluate congenital diaphragmatic hernia (CDH) patients in our department during a 4-year period. Patients and Methods: A retrospective study of 10 cases of CDH patients managed in the Neonatology and Pediatric Surgery Units of Goztepe Teaching Hospital from 2000 to 2004. Results: The mean birth weight of the patients was 2,600 g and the mean gestational age was 37.6 weeks. The mean admission time for the patients was 10.4 h. The mortality rate was 50%, comprising two deaths before operation and one during operation. The surviving infants followed for 1 year are free of any symptoms and complications. Conclusion: Conventional ventilation is an other treatment modality, especially in order to gain time before surgical operation for newborns with CDH. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/105/62859 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62858 2010-05-01 all journal:Afr_J_Paediatr_Surg
Worms and war: A case report of trauma and tropical disease intersecting Masumbuko, CK Hawkes, M Background: We report a case of heavy intestinal infestation with Ascaris lumbricoides complicating the surgical management of a gunshot injury to the abdomen. Co-existent traumatic and infectious pathologies in this case highlight the complex burden of illness among children living in areas of violent conflict, with clinical relevance to trauma surgeons in the tropics. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/107/62858 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62856 2010-05-01 all journal:Afr_J_Paediatr_Surg
Prenatal ultrasonic diagnosis of conjoint twins Akinola, RA Ottun, TA Tayo, AO Akanji, AO Akinola, OI Background: A primipara with multiple pregnancy who booked for antenatal care at 21 weeks presented with vaginal bleeding and pedal oedema at the 27<sup> th</sup> week. She had had five previous ultrasound scans that gave conflicting results. Materials and Methods: The patient was therefore sent for a confirmatory scan, which was performed using a linear 3.5 MHz transducer of a dynamic imaging dedicated, concept MC ultrasound scan machine. Results: A diagnosis of conjoint twins was made. The twin was joined from the mandible to the abdomen. Although they cried at birth, they died a few minutes after. The pregnancy was terminated by caesarian section at the patient's request. The patient did well postpartum and was discharged on the 5<sup> th</sup> postoperative day. Records confirm that this is the first case seen in this hospital, which has been in existence for 18 years. Conclusion: To diagnose conjoint twins by ultrasound, one needs the expertise and careful scanning techniques, as the diagnosis may be easily missed, especially if the union is extensive. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/110/62856 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62853 2010-05-01 all journal:Afr_J_Paediatr_Surg
Foreign body oesophagus in a neonate: A common occurrence at an uncommon age Zameer, M Kanojia, RP Thapa, BR Neonatal ingestion of foreign body is a very uncommon occurrence. We describe a 25-day-old neonate who had a large-sized stone impacted in the cervical oesophagus. The stone was accidently lodged by one of the elder siblings while playing. The stone, after failure to be retrieved endoscopically, was successfully removed by open esophagotomy. The case describes the unusual occurrence at a very uncommon age. It also re-affirms the successful role of open surgery in such situations, which are otherwise commonly treated endoscopically. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/114/62853 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62851 2010-05-01 all journal:Afr_J_Paediatr_Surg
Thyroid cervico-thoracic teratoma in a 14-month old child Mohammad, MA Cervical teratoma (CT) is a rare disease which accounts for approximately three to five per cent of all teratomas in children. Airway compromise is the most serious postnatal complication of cervical teratoma. Prenatal diagnosis is crucial for early recognition of neck masses that could obstruct the airway. We present our experience in the management of a huge cervico-thoracic teratoma in a 14-month old Nigerian child. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/117/62851 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62850 2010-05-01 all journal:Afr_J_Paediatr_Surg
Primary Burkitt's lymphoma of the ovary Cyriac, S Srinivas, L Mahajan, V Sundersingh, S Sagar, TG Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/120/62850 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62847 2010-05-01 all journal:Afr_J_Paediatr_Surg
Transperineal migration of a portion of a writing pen into the urinary bladder Ekenze, SO Ezomike, UO Offor, I Enyanwuma, IE Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/121/62847 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62845 2010-05-01 all journal:Afr_J_Paediatr_Surg
Splenic abscess in children: A concern of management Wiwanitkit, V Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/123/62845 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62844 2010-05-01 all journal:Afr_J_Paediatr_Surg
A simple procedure for management of urethrocutaneous fistulas; post-hypospadias repair Mohamed, S Mohamed, N Esmael, T Khaled, S Objectives : The treatment of urethral fistulas is quite challenging. We try to evaluate the results of a simple procedure in post-hypospadias urethral fistula repair. Materials and Methods: In the period from 2003 to 2007, 35 patients with 35 fistulas, with an average age 3.5 years [range: 2-8], were classified into coronal 12, mid-penile 13 and proximal 10. Based on the size they were grouped into two - either less than 5 mm (20) or more than 5 mm (15). Midline relaxing incision was used for large fistulas and then covered with a vascularised flap dartos-based flap [flip flap] in 19 and tunica vaginalis in 16. If a patient had more than one small fistula adjacent to each other, they were joined into a large single fistula and then repaired. Results: We have successfully repaired all urethrocutaneous fistulas using our protocol, with success rate [97.3] 1/35. Conclusions: Dorsal midline urethral incision (DUMI), with dartos flip flap or tunica vaginalis coverage is an appropriate procedure to repair midline and proximal urethral fistulas. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/124/62844 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62842 2010-05-01 all journal:Afr_J_Paediatr_Surg
Childhood trauma: The neglected childhood killer disease Gupta, DK Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/61/62842 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62843 2010-05-01 all journal:Afr_J_Paediatr_Surg
Is nonoperative management of adhesive intestinal obstruction applicable to children in a resource-poor country? Osifo, OD Ovueni, ME Background: Nonoperative management of adhesive intestinal obstruction gives good results in adults but there are scant studies on its outcome in children. This study reports outcomes and experiences with nonoperative and operative management of adhesive intestinal obstruction in children in a resource-poor country. Patients and Methods: This is a retrospective analysis of records of children who were managed with adhesive intestinal obstruction at the University of Benin Teaching Hospital between January 2002 and December 2008. Results: Adhesive intestinal obstruction accounted for 21 (8.8%) of 238 children managed with intestinal obstruction. They were aged between 7 weeks and 16 years (mean 3 ± 6.4 years), comprising 13 males and eight females (ratio 1.6:1). Prior laparotomy for gangrenous/perforated intussusception (seven, 33.3%), perforated appendix (five, 23.8%), perforated volvulus (three, 14.3%), penetrating abdominal trauma (two, 9.5%) and perforated typhoid (two, 9.5%) were major aetiologies. Adhesive obstruction occurred between 6 weeks and 7 years after the index laparotomies. All the 21 children had initial nonoperative management without success, owing to lack of total parenteral nutrition and monitoring facilities. Outcomes of open adhesiolysis performed between 26 and 48 h in six (28.6%) children due to poor response to nonoperative management, 11-13 days in 12 (57.1%) who responded minimally and 2-5 weeks in three (14.3%) who had relapse of symptoms were encouraging. Exploration of the 21 adhesive obstructions confirmed small bowel obstruction due to solitary bands (two, 9.5%), multiple bands/adhesions (13, 61.9%) and encasement, including one bowel gangrene (six, 28.6%). Postoperatively, the only child who had recurrence during 1-6 years of follow-up did well after a repeat adhesiolysis. Conclusion: Nonoperative management was unsuccessful in this setting. Open adhesiolysis may be adopted in children to prevent avoidable morbidities and mortalities in settings with limited resources. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/66/62843 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62846 2010-05-01 all journal:Afr_J_Paediatr_Surg
Primary swenson's pull-through in children with chronic constipation: A preliminary report Badmus, TA Lawal, AO Katung, AI Background: The discrepancy in diameters of the resected ends coupled with the heavy faecal loads in the colon of chronically constipated children with Hirschsprung's disease makes definitive primary pull-through procedure quite difficulty in this group. Patients and Methods: Four consecutive patients (aged 5 months to 11 years) who presented with chronic constipation were given warm saline enema along with Castor oil per oram twice daily for 1 week before and 2 weeks after full-thickness biopsies that confirmed Hirschsprung's disease. All patients had intravenous Cefuroxime or Ceftriaxone plus Metronidazole at induction of anaesthesia. Intra-operatively, the levels of resections were 6-8 cm proximal to the most contractile part of the colon adjacent to the transition zone observed after complete division of mesenteric vessels. Results: There were three males and one female, aged 5 months to 11 years. The levels of aganglionosis were in the rectosigmoid region, except one in the descending colon. There was one case each of anastomotic stenoses, mild enterocolitis and deep peri-anal excoriation. The bowel motions were two to four times daily within 1 month post-operatively. Conclusion: It can be concluded from this preliminary study that with pre-operative saline enema and oral Castor oil for about 3 weeks in chronically constipated children with Hirschsprung's disease primary pull-through procedures can be performed successfully. However, further prospective work is required with this method. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/71/62846 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62848 2010-05-01 all journal:Afr_J_Paediatr_Surg
A histopathological study of ovarian neoplasms in children in a tertiary hospital of northern Nigeria Mohammed, A Malami, SA Calvin, B Abdullahi, K Background: Information concerning the frequency and pattern of ovarian tumours in children is scant, more so in northern Nigeria. In view of this, we reviewed ovarian biopsies obtained from children in Zaria over a 25-year period. Materials and Methods: Ovarian tumours occurring in 48 patients of age 15 years and below were reviewed and classified using the current World Health Organization (WHO) histological classification of ovarian tumours. Results: Ovarian tumours in children accounted for 8.6% of all cases of tumours seen in all age groups over the period. Among all the malignant tumours seen in this period, 32% occurred in children, and Burkitt's lymphoma accounted for 31.2% of these. Germ cell tumours accounted for 58.0% while epithelial tumours had a frequency of 2.1%. Conclusion: Burkitt's lymphoma is the most common childhood ovarian tumour in Zaria, northern Nigeria. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/75/62848 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62849 2010-05-01 all journal:Afr_J_Paediatr_Surg
Breast tumours of adolescents in an African population Umanah, IN Akhiwu, W Ojo, OS Background: Tumours of the breast are uncommon in childhood and adolescence. Patients in this age group often require a different approach to diagnosis and treatment. The purpose of this study is to highlight the clinicopathologic features of breast tumours in adolescents in a Nigerian city. Materials and Methods: Eighty-four breast tumour materials from patients aged 10-19 years were analyzed over a 10-year period at the Department of Pathology, University of Benin Teaching Hospital (UBTH), Benin City, Edo State, Benin City, Nigeria. Results: A majority of the breast tumours were benign. Fibroadenoma was the most common tumour with 46 cases (54.8%), followed by fibrocystic changes with 15 cases (17%). Malignancy was extremely rare in this group, with only one case (1.2%) of an invasive ductal carcinoma. Histologically, most tumours were indistinguishable from the adult types. Conclusion: Fibroadenoma is the most common breast tumour in adolescents in Benin City, Nigeria. Breast cancer and male breast tumours are rare in this age group. Routine complete physical examination of children and adolescents should include breast examination. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/78/62849 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62852 2010-05-01 all journal:Afr_J_Paediatr_Surg
Mechanical small bowel obstruction in children at a tertiary care centre in Kashmir Shiekh, KA Baba, AA Ahmad, SM Shera, AH Patnaik, R Sherwani, AY Background: Small bowel obstruction is the commonest surgical emergency encountered in childhood. We observed that intestinal obstruction caused by ascariasis is one of the leading causes of death in our children and consumes a major portion of our hospital resources. Other causes include intussusception, adhesions, volvulus, hernias, and worm obstruction. The aim of this study was to analyze the presentation, diagnosis, management of mechanical bowel and complication of obstruction in children. Patients and Methods : The study was conducted from Jan 2005 to Dec 2007 in the Department of Pediatric Surgery at Sheri- Kashmir Institute of Medical Sciences, Srinagar, Kashmir. All patients who presented in the emergency department with the diagnosis of intestinal obstruction were recruited. Patients with a dynamic obstruction were excluded from the study. Diagnosis was based on history and radiological findings. Data regarding the type of management, operative findings, operative procedure and post-operative complications were collected. Results: There were 207 patients admitted for intestinal obstruction. Males and females were equally affected. Most of the children (55%) were aged 3-5 years. The causes of obstruction included ascariasis 131 (63.2%), adhesion 23 (11.1%), intussusception 21 (10.1%), obstructed hernia 17 (8.2%), and volvulus 11 (5.3%). One hundred twenty-six patients needed an operative intervention and 81 were treated conservatively. The operative procedures performed included enterotomy in 37 (29.3%), milking of worms in 18 (14.2%), resection anastomosis in 31 (24.6%) and adhesiolysis in 13 (10.3%). Appendicular perforation was seen in 4 (1.9%) and worm in gall bladder in 1 (0.5%) patients. Surgical complications were wound infection in 18 (14.2%), burst abdomen in 5 (3.9%) and fecal fistula in 3 (2.3%) patients. Conclusion: Intestinal obstruction is associated with considerable morbidity and mortality in children. Obstruction by ascariasis constituted the majority of intestinal obstruction in this study. Efforts should be made to eradicate ascariasis in endemic areas through proper sanitation, hygiene and use of antihelminthics. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/81/62852 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62854 2010-05-01 all journal:Afr_J_Paediatr_Surg
Splenic artery embolisation for portal hypertention in children Meisheri, IV Kothari, PR Kumar, A Deshmukh, A Background: Bleeding from esophageal varices is one of the most common causes of serious gastrointestinal haemorrhage in children. We analysed our experience with the use of splenic artery embolisation and variceal sclerotherapy for bleeding oesophageal varices. Patients and Methods: Records of all patients treated for bleeding oesophageal varices caused by portal hypertension from 1998 to 2004 were retrospectively analysed. Patients were followed up for five years. Results: Out of 25 patients treated, ten belonged to sclerotherapy (group A), eight to combined sclerotherapy and embolisation (group B), and seven to only embolisation (group C). The patients were selected randomly, only two patients who had active bleed recently were directly sclerosed. The splenic artery was embolised at the hilum using steel coils in 15 patients with portal hypertension and hypersplenism. Follow-up findings showed decrease in splenic mass, varices, and hyperdynamic flow. Conclusion: In spite of few patients and a short period of follow-up, our results pointed out that a serious consideration should be given to this procedure, as it slowed the sequel of portal hypertension and the complications associated with it. Patients who were embolised and followed up for five years had lesser rebleeds and complications than sclerotherapy patients. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/86/62854 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62855 2010-05-01 all journal:Afr_J_Paediatr_Surg
Undesended testis: How extensive should the work up be? Shera, AH Baba, AA Gupta, SK Gupta, G Sherwani, AY Aim: The aim of this study was to highlight various anomalies associated with undescended testis and to determine how much work up is necessary for this condition. Material and Methods: The study was conducted in the department of Pediatric Surgery SKIMS Srinagar, Kashmir. All patients between 0-14 years of age who attended out patient department (OPD) from January 2002 to December 2003 with maldescent of testes were included in the study. Detailed relevant history and physical examination findings were recorded in all the cases. Baseline investigations were performed along with ultrasonography of the abdomen. In relevant cases other investigations like intravenous urography, micturating cystourethrography, CT scan and laparoscopy were performed as and when indicated. Results: A total of 250 cases of undescended testis were registered during this period. Maximum number of cases were in the age group of 5-10 years. In 130 (52%) cases the right testis was undescended while 75 (30%) had left sided undescended testis and 45 (18%) had bilateral undescended testis. Maldescended testis comprised 11% of the admissions. The majority of cases were having gestational age of 37 weeks or more. The associated anomalies picked up on investigations included duplication of upper urinary tract (3.2%), hydronephrosis and polycystic kidney (0.8% each), horseshoe kidney, ectopic kidney, crossed renal ectopia (0.4% each) Posterior urethral valves, Prune belly syndrome (0.4%) and spina bifida (0.4%). On detailed clinical examination of genitalia several abnormalities were picked which included hydrocele, hypospadias, hernia, chordee, micropenis and ambiguous genitalia. Conclusion: We recommend ultrasonography to be done in all cases of undescended testis in addition to a thorough history and physical examination. Intravenous pyelography, micturating cystourethrogram, CT scan and other investigations should be performed selectively based on history, physical examination or ultrasound findings. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/92/62855 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62857 2010-05-01 all journal:Afr_J_Paediatr_Surg
Typhoid ileal perforation in children in Benin city Osifo, OD Ogiemwonyi, SO Background: Typhoid ileal perforation is a common complication of typhoid fever, a multi-systemic infection, which is endemic in many developing countries. Objective: This study reviews and compares the incidence, morbidity and mortality at the University of Benin Teaching Hospital with other referral centres located in areas with similar socioeconomic and population status. Materials and Methods: The incidence, morbidity and mortality of typhoid ileal perforation in children treated among Edo People at the University of Benin Teaching Hospital, Nigeria, in the period from 1993 to 2007 were retrospectively studied and compared with centres in localities of similar socioeconomic and population status. Results: Twelve children, all of middle class parents who resided in suburban community with poor water supply and substandard sewage disposal, accounted for 70.6% patients with typhoid ileal perforation managed over 15 years while 29.4% occurred in adults. The children comprised seven males and five females (M/F ratio 1.4:1), aged between five and 13 (average 9) years. This number seen over 15 years in this centre was extremely low when compared with other referral centres; as many as 191 patients were seen over 10 months in one of the centres. The few patients seen were traced to cultural beliefs in Benin City, which influenced proper sewage disposal by the about four million Edo people, especially those living in rural areas. Consequently, no child from the rural area with clean natural water supply or urban areas with pipe born water supply where sewages are disposed of properly had typhoid perforation. Unacceptably high morbidity (100%) and mortality (75%) due to late referrals were recorded in comparison with other centres. Conclusion: Proper sewage disposal may have influenced the low incidence in this centre but early referral is advocated so as to reduce the high associated morbidity and mortality. Medknow Publications 2010-05-01 http://www.afrjpaedsurg.org/text.asp?2010/7/2/96/62857 en Copyright 2017 African Journal of Paediatric Surgery.
oai:medknow.com:62933 2010-05-01 all journal:Ann_Card_Anaesth
Pregnancy and non-valvular heart disease - Anesthetic considerations Maitra, G Sengupta, S Rudra, A Debnath, S Non-valvular heart disease is an important cause of cardiac disease in pregnancy and presents a unique challenge to the anesthesiologist during labor and delivery. A keen understanding of the underlying pathophysiology, in addition to the altered physiology of pregnancy, is the key to managing such patients. Disease-specific goals of management may help preserve the hemodynamic and ventilatory parameters within an acceptable limit and a successful conduct of labor and postpartum period Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/102/62933 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62935 2010-05-01 all journal:Ann_Card_Anaesth
Comparison of three dose regimens of aprotinin in infants undergoing the arterial switch operation Verma, YS Chauhan, S Bisoi, AK Gharde, P Kiran, U Das, SN To determine the most effective dose regimen of aprotinin for infants undergoing arterial switch operation for transposition of the great arteries in reducing blood loss and postoperative packed red blood cell (PRBC) requirements. A total of 24 infants scheduled for arterial switch operation for transposition of the great arteries were included in the study. The infants were randomly assigned to one of the three groups. Group I (n = 8) patients received aprotinin in a dose of 20,000 kallikrein inhibiting units (KIU)/kg after induction of anesthesia, 20,000 KIU/kg was added to the pump prime, and 20,000 KIU/kg/hour infusion for three hours after weaning from bypass; group II (n = 8) patients received aprotinin 30,000 KIU/kg after induction of anesthesia, 30,000 KIU/kg was added to the pump prime and 30,000 KIU/Kg/hour infusion for three hours after weaning from bypass; group III patients (n = 8) received aprotinin 40,000 KIU/kg after induction of anesthesia, 40,000 KIU/kg was added to the pump prime and 40,000 KIU/kg/hour infusion for three hours after weaning from bypass. Postoperatively, the cumulative hourly blood loss and PRBC requirements were noted up to 24 hours from the time of admission in the intensive care unit (ICU). Use of blood and blood products were noted. Coagulation parameters such as hematocrit, activated clotting time (ACT), fibrinogen, prothrombin time (PT), international normalized ratio (INR), platelet count, and fibrin degradation products (FDP) were investigated before cardiopulmonary bypass (CPB), after protamine administration, and at four hours postoperatively in the ICU. The number of infants reexplored for increased mediastinal drainage was recorded. Renal functions were monitored by measuring urine output (hourly) and serum urea (mg%) and serum creatinine (mg%) at 24 hours. The sternal closure time was comparable in all the three groups. Cumulative blood loss (ml/kg/24 hours) was greatest in group I (17.30 ± 7.7), least in group III (8.14 ± 3.17), whereas in group II, it was 16.45 ± 6.33 (P = 0.019 group I versus group III; (P = 0.036 group II versus group III). Postoperative PRBC requirements were significantly less in high dose group III (P = 0.008, group I versus III; p = 0.116, group II versus group III) . Tests for coagulation performed at four hours postoperatively, viz. ACT, PT, INR, FDP, and platelets were comparable in the three groups. Urine output on CPB was comparable in all the groups. Serum urea and creatinine showed no significant difference between the three groups twenty four hours postoperatively. Aprotinin dosage regimen of 40,000 KIU/kg at induction, in CPB prime and postoperatively for three hours was most effective in reducing postoperative blood loss and PRBC transfusion requirements. Aprotinin does not have any adverse effect on renal function. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/110/62935 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62938 2010-05-01 all journal:Ann_Card_Anaesth
Sevoflurane causes less arrhythmias than desflurane after off-pump coronary artery bypass grafting: A pilot study Hemmerling, TM Minardi, C Zaouter, C Noiseux, N Prieto, I Background: Volatile anesthetics provide myocardial protection during cardiac surgery. Sevoflurane and desflurane are both efficient agents that allow immediate extubation after off-pump coronary artery bypass grafting (OPCABG). This study compared the incidence of arrhythmias after OPCABG with the two agents. Materials and Methods: Forty patients undergoing OPCABG with immediate extubation and perioperative high thoracic analgesia were included in this controlled, double-blind study; anesthesia was either provided using 1 MAC of sevoflurane (SEVO-group) or desflurane (DES-group). Monitoring of perioperative arrhythmias was provided by continuous monitoring of the EKG up to 72 hours after surgery, and routine EKG monitoring once every day, until time of discharge. Patient data, perioperative arrhythmias, and myocardial protection (troponin I, CK, CK-MB-ratio, and transesophageal echocardiography examinations) were compared using t-test, Fisher's exact test or two-way analysis of variance for repeated measurements; P < 0.05. Results: Patient data and surgery-related data were similar between the two groups; all the patients were successfully extubated immediately after surgery, with similar emergence times. Supraventricular tachycardia occurred only in the DES-group (5 of 20 patients), atrial fibrillation was significantly more frequent in the DES group versus SEVO-group, at five out of 20 versus one out of 20 patients, respectively. Myocardial protection was equally achieved in both groups. Discussion: Ultra-fast track anesthesia using sevoflurane seems more advantageous than desflurane for anesthesia, for OPCABG, as it is associated with significantly less atrial fibrillation or supraventricular arrhythmias after surgery. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/116/62938 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62942 2010-05-01 all journal:Ann_Card_Anaesth
Comparison of B-type natriuretic peptide and left ventricular dysfunction in patients with constrictive pericarditis undergoing pericardiectomy Kapoor, PM Aggarwal, V Chowdhury, U Choudhury, M Singh, SP Kiran, U Chronic constrictive pericarditis (CCP) due to tuberculosis has high morbidity and mortality in the periopeartive period following pericardiectomy because of left ventricular (LV) dysfunction. Brain-type natriuretic peptide (BNP) is considered a marker for both LV systolic and diastolic dysfunction. We undertook this prospective study in 24 patients, to measure the BNP levels and to compare it with transmitral Doppler flow velocities, that is, the E/A ratio (E = initial peak velocity during early diastolic filling and A = late peak flow velocity during atrial systole), as a marker of diastolic function and systolic parameters, pre- and post-pericardiectomy, at the time of discharge. The latter parameters have been taken as a flow velocity across the mitral valve on a transthoracic echo. There was a significant decrease in the mean values of log BNP (6.19 ± 0.33 to 4.65 ± 0.14) (P = 0.001) and E/A ratio (1.81 ± 0.21 to 1.01 ± 0.14) (P = 0.001) post pericardiectomy, with a positive correlation, r = 0.896 and 0.837, respectively, between the two values at both the time periods. There was significant improvement in the systolic parameters of the LV function, that is, stroke volume index, cardiac index, systemic vascular resistance index, and delivered oxygen index. However, no correlation was observed between these values and the BNP levels. We believe that BNP can be used as a marker for LV diastolic dysfunction in place of the E/A ratio in patients with CCP, undergoing pericardiectomy. However, more studies have to be performed for validation of the same. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/123/62942 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62945 2010-05-01 all journal:Ann_Card_Anaesth
Echocardiographic evaluation and comparison of the effects of isoflurane, sevoflurane and desflurane on left ventricular relaxation indices in patients with diastolic dysfunction Sarkar, S GuhaBiswas, R Rupert, E This prospective randomized study aims to evaluate and compare the effects of isoflurane, sevoflurane and desflurane (study drugs) on left ventricular (LV) diastolic function in patients with impaired LV relaxation due to ischemic heart disease using transesophageal Doppler echocardiography. After approval of the local ethics committee and informed consent, 45 patients scheduled for coronary artery bypass grafting surgery were enrolled in the study. Patients were selected by a preoperative Transthoracic Echocardiographic diagnosis of impaired relaxation or Grade 1 Diastolic Dysfunction. They randomly received fentanyl and midazolam anesthesia with 1 MAC of isoflurane (n=16), sevoflurane (n=14) or desflurane (n=15). Hemodynamic parameters and TEE derived ventricular diastolic relaxation indices before and after the study drug administration were compared. LV filling pressures were kept constant throughout the study period to exclude the effect of the loading conditions on diastolic function. Four patients in the sevoflurane group and three in the desflurane group were excluded from the study, after baseline TEE examination revealed normal diastolic filling pattern. All the three study drugs significantly reduced the systemic vascular resistance index with a significant increase in cardiac index. Mean arterial pressure was reduced by all the drugs, although the decrease was not statistically significant. Hemodynamic changes were comparable between all the three groups. In terms of LV relaxation indices, all three agents led to a significant improvement in diastolic function. Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly Transmitral and Tissue Doppler E/A and Em/Am ratios improved significantly accompanied by a significant decrease in deceleration time and isovolumetric relaxation time. The effect of all three agents on diastolic relaxation parameters was comparable. In conclusion , Isoflurane, sevoflurane and desflurane, do not appear to have a detrimental effect in patients with early diastolic dysfunction. On the contrary, these inhalational agents actually improve the LV relaxation. A significant reduction in afterload produced by these vapors can be a possible reason for these findings. The positive effect of these inhalational agents on LV relaxation can have a profound effect on the perioperative anesthetic management of patients with diastolic dysfunction. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/130/62945 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62946 2010-05-01 all journal:Ann_Card_Anaesth
Acute hemodynamic effects of inhaled nitroglycerine, intravenous nitroglycerine, and their combination with intravenous dobutamine in patients with secondary pulmonary hypertension Mandal, B Kapoor, PM Chowdhury, U Kiran, U Choudhury, M Objectives: The presence of pulmonary artery hypertension (PAH) affects the prognosis of patients; therefore, it is important to treat it. The aim of this study is to compare the acute hemodynamic effects of inhaled nitroglycerine (iNTG), intravenous nitroglycerine (IV NTG) alone and their combination with intravenous dobutamine (IV DOB) during the early postoperative period, in patients with PAH undergoing mitral valve or double valve replacement surgery. Materials and Methods: In the study, 40 patients with secondary PAH were administered iNTG 2.5 μg/kg/min, IV NTG 2.5 μg/kg/min, a combination of iNTG 2.5 μg/kg/min + IV DOB 10 μg/kg/min, and IV NTG 2.5 μg/kg/min + IV DOB 10 μg/kg/min for 10 minutes each following valve replacement surgery, in random order. The hemodynamic parameters were recorded before (T0) and immediately after the intervention. (T1). Results: iNTG effectively decreased mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance index (PVRI), and the PVR / SVR ratio, without affecting arterial pressures, systemic vascular resistance or mixed venous oxygen saturation (SvO<sub> 2</sub> ). IV NTG produced both systemic and pulmonary vasodilation along with a significant fall in SvO<sub> 2</sub> . The combination of iNTG and IV DOB caused a significant decrease in mPAP and PVRI, with no significant change in SVRI, PVR / SVR ratio, and SvO<sub> 2</sub> . A combination of IV NTG + IV DOB caused both pulmonary and systemic vasodilatation with a significant decrease in SvO<sub> 2</sub> . None of the drugs caused any significant change in the cardiac index. Conclusion: All drugs were of similar efficacy in reducing the pulmonary vascular resistance index. Only iNTG produced selective pulmonary vasodilatation, while IV NTG and its combination with IV dobutamine had a significant concomitant systemic vasodilatory effect. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/138/62946 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62927 2010-05-01 all journal:Ann_Card_Anaesth
Atrial septal defect closure on cardiopulmonary bypass in a sickle cell anemia: Role of hydroxyurea and partial exchange transfusion Gosavi, KS Dash, SK Shah, BN Upasani, CB Partial exchange transfusion during cardiopulmonary bypass, while conducting cardiac surgery may be a useful technique in patients with high level of sickle hemoglobin. Along with this preoperative use of hydroxyurea and alternative analgesic modalities such as transcutaneous electrical nerve stimulation in postoperative period may be beneficial, in our opinion. A 16-year-old female of Turner's syndrome having sickle cell anemia scheduled for closure of arterial septal defect on cardiopulmonary bypass was managed with partial exchange transfusion and warm cardioplegia. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/145/62927 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62929 2010-05-01 all journal:Ann_Card_Anaesth
Tricuspid valve excision using off-pump inflow occlusion technique: Role of intra-operative trans-esophageal echocardiography Gadhinglajkar, S Sreedhar, R Karunakaran, J Misra, M Somasundaram, G Mathew, T A pacing system infection may lead to infective endocarditis and systemic sepsis. Tricuspid valve surgery may be required if the valve is severely damaged in the process of endocarditis. Although, cardiopulmonary bypass is the safe choice for performing right-heart procedures, it may carry risk of inducing systemic inflammatory response and multi-organ dysfunction. Some studies have advocated TV surgery without institution of CPB. We report tricuspid valve excision using the off-pump inflow occlusion technique in a 68-year-old man. We also describe role of intra-operative TEE as a monitoring tool at different stages of the surgical procedure. . Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/148/62929 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62934 2010-05-01 all journal:Ann_Card_Anaesth
Anesthetic management for surgical repair of Ebstein's anomaly along with coexistent Wolff-Parkinson-White syndrome in a patient with severe mitral stenosis Sinha, PK Kumar, B Varma, PK Ebstein's anomaly (EA) is the most common cause of congenital tricuspid regurgitation. The associated anomalies commonly seen are atrial septal defect or patent foramen ovale and accessory conduction pathways. Its association with coexisting mitral stenosis (MS) has uncommonly been described. The hemodynamic consequences and anesthetic implications, of a combination of EA and rheumatic MS, have not so far been discussed in the literature. We report successful anesthetic management of a repair of EA and mitral valve replacement in a patient with coexisting Wolff-Parkinson-White (WPW) syndrome. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/154/62934 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62936 2010-05-01 all journal:Ann_Card_Anaesth
Periodontal diseases: A risk factor to cardiovascular disease Saini, R Saini, S Saini, SR Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/159/62936 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62939 2010-05-01 all journal:Ann_Card_Anaesth
TEE images of adult anomalous left coronary artery from pulmonary artery Goel, S Baloria, KA Selot, N Panigrahi, B Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/162/62939 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62941 2010-05-01 all journal:Ann_Card_Anaesth
A large angiosarcoma of the right atrium involving tricuspid valve and right ventricle Nath, MP Dhawan, N Chauhan, S Kiran, U Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/165/62941 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62944 2010-05-01 all journal:Ann_Card_Anaesth
A rare case of myxoma in the right ventricular outflow tract extending to the pulmonary artery Tempe, DK Dutta, D Minhas, H Garg, M Virmani, S Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/167/62944 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62947 2010-05-01 all journal:Ann_Card_Anaesth
Anesthesia for robotic cardiac surgery: An amalgam of technology and skill Chauhan, S Sukesan, S The surgical procedures performed with robtic assitance and the scope for its future assistance is endless. To keep pace with the developing technologies in this field it is imperative for the cardiac anesthesiologists to have aworking knowledge of these systems, recognize potential complications and formulate an anesthetic plan to provide safe patient care. Challenges posed by the use of robotic systems include, long surgical times, problems with one lung anesthesia in presence of coronary artery disease, minimally invasive percutaneous cardiopulmonary bypass management and expertise in Trans-Esophageal Echocardiography. A long list of cardiac surgeries are performed with the use of robotic assistance, and the list is continuously growing as surgical innovation crosses new boundaries. Current research in robotic cardiac surgery like beating heart off pump intracardic repair, prototype epicardial crawling device, robotic fetal techniques etc. are in the stage of animal experimentation, but holds a lot of promise in future Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/169/62947 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62943 2010-05-01 all journal:Ann_Card_Anaesth
Dynamic RVOT obstruction after transatrial/transpulmonary repair of valvular and infundibular pulmonary stenosis and VSD closure: Role of dobutamine/epinephrine infusion Neema, PK Sethuraman, M Singha, S Rathod, RC Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/176/62943 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62940 2010-05-01 all journal:Ann_Card_Anaesth
Catastrophic course of free floating right heart thrombus in elective surgery Samad, K Khan, MF Qureshi, R Hoda, MQ Ullah, H Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/178/62940 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62937 2010-05-01 all journal:Ann_Card_Anaesth
Intraoperative evaluation of left atrial myxoma using real-time 3D transesophageal echocardiography Gadhinglajkar, S Sreedhar, R Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/180/62937 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62932 2010-05-01 all journal:Ann_Card_Anaesth
Pulsus alternans after aortic valve replacement: Intraoperative recognition and role of TEE Gadhinglajkar, S Sreedhar, R Jayant, A Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/181/62932 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62931 2010-05-01 all journal:Ann_Card_Anaesth
Emergency resuscitative dialysis: The importance of identification of cannulation site Rao, PB Gurjar, M Azim, A Baronia, AK Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/184/62931 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62928 2010-05-01 all journal:Ann_Card_Anaesth
Transesophageal echocardiaography evaluation of thoracic aorta Nair, HC Trans-esophageal echocardiaography is a sensitive, minimally invasive, diagnostic tool which gives real time functional image of the aorta. It helps in the diagnosis of pathologies of aorta like atherosclerosis, aneurysm and aortic dissection. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/186/62928 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62925 2010-05-01 all journal:Ann_Card_Anaesth
Errors in cardiac anesthesia - A deterrent to patient safety Chakravarthy, M Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/87/62925 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62926 2010-05-01 all journal:Ann_Card_Anaesth
Perioperative management of pulmonary hypertension Tempe, DK Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/89/62926 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:62930 2010-05-01 all journal:Ann_Card_Anaesth
Fast-tracking in pediatric cardiac surgery - The current standing Mittnacht, AJ Hollinger, I Fast-tracking in cardiac surgery refers to the concept of early extubation, mobilization and hospital discharge in an effort to reduce costs and perioperative morbidity. With careful patient selection, fast-tracking can be performed in many patients undergoing surgery for congenital heart disease (CHD). In order to accomplish this safely, a multidisciplinary coordinated approach is necessary. This manuscript reviews currently used anesthetic techniques, patient selection, and available information about the safety and patient outcome associated with this approach. Medknow Publications 2010-05-01 http://www.annals.in/text.asp?2010/13/2/92/62930 en Copyright 2017 Annals of Cardiac Anaesthesia.
oai:medknow.com:65348 2010-05-01 all journal:Indian_J_Anaesth
Critical incident reporting and learning system: The black pearls Harsoor, SS Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/185/65348 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65351 2010-05-01 all journal:Indian_J_Anaesth
Medication error in anaesthesia and critical care: A cause for concern Kothari, D Gupta, S Sharma, C Kothari, S Medication error is a major cause of morbidity and mortality in medical profession, and anaesthesia and critical care are no exception to it. Man, medicine, machine and modus operandi are the main contributory factors to it. In this review, incidence, types, risk factors and preventive measures of the medication errors are discussed in detail. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/187/65351 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65354 2010-05-01 all journal:Indian_J_Anaesth
Tight bag Parthasarathy, S Ravishankar, M Tight bag is a clinical situation where excessive pressure needs to be applied to a reservoir bag of a breathing system to an intubated patient, which may or may not produce satisfactory ventilation. The various clinical scenarios and the appropriate steps for its prevention are described. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/193/65354 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65357 2010-05-01 all journal:Indian_J_Anaesth
Telemedicine and anaesthesia Chatrath, V Attri, JP Chatrath, R Telemedicine is the use of electronic information and communication technology to provide and support healthcare when distance separates the participants. India is characterised by low penetration of healthcare services where primary healthcare facilities for rural population are highly inadequate. The majority of doctors practice in urban and semi-urban areas, whereas the major proportion of population lives in rural areas. This calls for the innovative methods for utilisation of science and technology for the benefit of our society. There are few reports in the literature which support the use of telemedicine technology for pre-operative assessment, intra-operative consultation, monitoring and post-operative follow-up, which is discussed in this article. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/199/65357 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65359 2010-05-01 all journal:Indian_J_Anaesth
A comparative study of intrathecal and epidural buprenorphine using combined spinal-epidural technique for caesarean section Ipe, S Korula, S Varma, S George, GM Abraham, SP Koshy, LR Neuraxial opioids provide excellent analgesia intraoperatively and postoperatively while allowing early ambulation of the patient by sparing sympathetic and motor nerves. A prospective, randomised double blind study was conducted involving 90 patients of ASA 1 physical status coming for elective cesarean section to evaluate the analgesic effect of neuraxial buprenorphine. They were allocated into three groups. Spinal local anaesthetic was used as the main stay of anaesthesia for surgery and spinal and epidural analgesia with opioids continued as the main stay for postoperative analgesia. All the groups were given 0.5% Bupivacaine intrathecally for the surgery. Besides this, group I was given 150 mcg Buprenorphine intrathecally and group II and III were given 150 mcg and 300 mcg Buprenorphine respectively, epidurally. In the present study, we observed that 150 mcg of Buprenorphine given intrathecally provided much longer duration of analgesia compared to 150 mcg of Buprenorphine given epidurally. Increasing the epidural dose of Buprenorphine from 150 mcg to 300 mcg proved to produce prolonged analgesia comparable to intrathecal Buprenorphine without compromising patient safety and neonatal outcome. The minor side effects were more with intrathecal Buprenorphine than epidural Buprenorphine. We concluded that 300 mcg of Buprenorphine epidurally is equianalgesic to 150 mcg Buprenorphine intrathecally. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/205/65359 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65362 2010-05-01 all journal:Indian_J_Anaesth
Comparison of two approaches of infraclavicular brachial plexus block for orthopaedic surgery below mid-humerus Trehan, V Srivastava, U Kumar, A Saxena, S Singh, CS Darolia, A The brachial plexus in infraclavicular region can be blocked by various approaches. Aim of this study was to compare two approaches (coracoid and clavicular) regarding success rate, discomfort during performance of block, tourniquet tolerance and complications. The study was randomised, prospective and observer blinded. Sixty adult patients of both sexes of ASA status 1 and 2 requiring orthopaedic surgery below mid-humerus were randomly assigned to receive nerve stimulator guided infraclavicular brachial plexus block either by lateral coracoid approach (group L, n = 30) or medial clavicular approach (group M, n = 30) with 25-30 ml of 0.5% bupivacaine. Sensory block in the distribution of five main nerves distal to elbow, motor block (Grade 1-4), discomfort during performance of block and tourniquet pain were recorded by a blinded observer. Clinical success of block was defined as the block sufficient to perform the surgery without any supplementation. All the five nerves distal to elbow were blocked in 77 and 67% patients in groups L and M respectively. Successful block was observed in 87 and 73% patients in groups L and M, respectively (P > 0.05). More patients had moderate to severe discomfort during performance of block due to positioning of limb in group M (14 vs. 8 in groups M and L). Tourniquet was well tolerated in most patients with successful block in both groups. No serious complication was observed. Both the approaches were equivalent regarding success rate, tourniquet tolerance and safety. Coracoid approach seemed better as positioning of operative limb was less painful, coracoids process was easy to locate and the technique was easy to learn and master. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/210/65362 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65364 2010-05-01 all journal:Indian_J_Anaesth
Lateral approach for supraclavicular brachial plexus block Sahu, DK Sahu, A A lateral approach described by Volker Hempel and Dr. Dilip Kotharihas been further studied, evaluated and described in detail in the present study. The aim of this study was to evaluate lateral approach of supraclavicular brachial plexus block, mainly in terms of successes rate and complication rate. The study was conducted in secondary level hospital and tertiary level hospital from 2004 to 2008. It was a prospective nonrandomized open-level study. Eighty-two patients of both sexes, aged between 18 and 65 years with ASA Grade I and II scheduled to undergo elective major surgery of the upper limb below the midarm, were selected for this new lateral approach of brachial plexus block. The onset and duration of sensory and motor block, any complications and need for supplement anaesthesia were observed. Success and complication rate were calculated in percentage. Average onset and duration of sensory and motor block was calculated as mean ± SD and percentage. Out of 82 patients, 75 (92%) have got successful block with no significant complication in any case. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/215/65364 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65366 2010-05-01 all journal:Indian_J_Anaesth
Comparative evaluation of ASA classification and ACE-27 index as morbidity scoring systems in oncosurgeries Thomas, M George, NA Gowri, BP George, PS Sebastian, P The primary intention of the study was to find out whether Adult Comorbidity Evaluation Index (ACE-27) was better than the American Society of Anaesthesiologists' (ASA) risk classification system in predicting postoperative morbidity in head and neck oncosurgery. Another goal was to identify other risk factors for complications which are not included in these indexes. Univariate and multivariate analyses were performed on 250 patients to determine the impact of seven variables on morbidity-ACE-27 grade, ASA class, age, sex, duration of anaesthesia, chemotherapy and radiotherapy. In univariate analysis ACE-27 index, ASA score, duration of anaesthesia, radiotherapy and chemotherapy were significant. As both comorbidity scales were significant in univariate analysis they were analyzed together and separately in multivariate analysis to illustrate their individual strength. In the first multivariate analysis (excluding ACE-27 grade) ASA class, duration of anaesthesia, radiotherapy and chemotherapy were significant. The positive predictive value (PPV) of this model to predict morbidity was 60.86% and negative predictive value (NPV) was 77.9%. The sensitivity was 75% and specificity 62.2%. In the second multivariate analysis (excluding ASA class) ACE-27 grade, duration of anaesthesia and radiotherapy were significant. The PPV of this model to predict morbidity was 62.1% and NPV was 76.5%. The sensitivity was 61.6% and specificity 70.9%. In the third multivariate analysis which included both ACE-27 grade and ASA class only ASA class, duration of anaesthesia, radiotherapy and chemotherapy remained significant. In conclusion, ACE-27 grade and ASA class were reliable predictors of major complications but ASA class had more impact on complications than ACE-27 grade. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/219/65366 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65368 2010-05-01 all journal:Indian_J_Anaesth
Caudal ropivacaine-clonidine: A better post-operative analgesic approach Kaur, J Bajwa, SK Bakshi, G Singh, K Panda, A The aim was to determine qualitative and quantitative aspects of caudal block, haemodynamic effects, and post-operative pain relief of ropivacaine 0.25% versus ropivacaine 0.25% with clonidine for lower abdominal surgeries in paediatric patients. A double-blind study was conducted among 44 paediatric patients in the Department of Anaesthesiology and Intensive Care of our institute. A total of 44 ASA-I paediatric patients between the ages of 1 and 9 years, scheduled for elective hernia surgery, were enrolled in this randomised double-blind study. The caudal block was administered with ropivacaine 0.25% (Group I) and ropivacaine 0.25% and clonidine 2 μg/kg (Group II) after induction with general anaesthesia. Haemodynamic parameters were observed before, during and after the surgical procedure. Post-operative analgesic duration, total dose of rescue analgesia, pain scores and any side effects were looked for and recorded. All the results were tabulated and analysed statistically. The variables in the two groups were compared using the non-parametric tests. For all statistical analyses, the level of significance was P < 0.05. Forty-four patients were enrolled in this study and their data were subjected to statistical analysis: 22 patients in both the groups were comparable with regard to demographic data, haemodynamic parameters and other vitals and were statistically non-significant (P>0.05). The duration of analgesia was significantly prolonged in Group II (P<0.05). The dose requirement for post-operative pain relief was also significantly lesser in Group II. The incidences of side effects were almost comparable and non-significant. A caudal block with 0.25% of isobaric ropivacaine combined with 2 μg/kg of clonidine provides efficient analgesia intra-operatively and prolonged duration of analgesia post-operatively. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/226/65368 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65370 2010-05-01 all journal:Indian_J_Anaesth
Evaluation of the effect of intrathecal clonidine to decrease shoulder tip pain in laparoscopy under spinal anaesthesia Ghodki, PS Sardesai, SP Thombre, SK Sixty ASA grade I/II patients scheduled for elective short laparoscopic procedures under spinal anaesthesia were divided into two groups of 30 each. The first group (group C) received 3.5 ml of hyperbaric bupivacaine with 30 mcg of clonidine. The second group (group B) received plain bupivacaine 3.5 ml. Till date, the limiting factor for use of spinal anaesthesia for laparoscopy was patient's discomfort due to shoulder tip pain. From our study it can be concluded that bupivacaine along with clonidine in low doses provides good sedation and analgesia in intraoperative and post-operative period and at the same time abolishes shoulder tip pain during laparoscopic procedures. In addition, no significant changes in haemodynamics occur with the low dose of clonidine used. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/231/65370 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65372 2010-05-01 all journal:Indian_J_Anaesth
Combined femoral and sciatic nerve blocks for lower limb anaesthesia in anticoagulated patients with severe cardiac valvular lesions Tantry, TP Kadam, D Shetty, P Bhandary, S Peripheral nerve block (PNB) in anticoagulated patients is controversial and guidelines are not defined. We report two patients with severe cardiac valvular lesions, who underwent emergency surgeries for lower limb. Both the patients were on anticoagulants, warfarin and heparin in one and aspirin and clopidogrel in the other, with abnormal coagulation profile in the former. Combined femoral and sciatic nerve blocks were used as a sole anaesthetic technique. Postoperatively, the patients were evaluated for bleeding complications at the injection site using high-frequency ultrasound probe. Both had uneventful surgery and recovery. A close postoperative monitoring following PNBs in anticoagulated patients is necessary. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/235/65372 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65373 2010-05-01 all journal:Indian_J_Anaesth
Indoxacarb poisoning: A rare presentation as methemoglobinaemia Chhabra, R Singh, I Tandon, M Babu, R Indoxacarb is a broad-spectrum non-organophosphorus oxidiazine insecticide widely used in farming. Once absorbed it acts on sodium channels and blocks the flow of sodium ions. We report a case of indoxacarb poisoning in a farmer following suicidal consumption, manifested as unconsciousness, cyanosis and stationary SpO<sub> 2</sub> values. Methemoglobinaemia was suspected on clinical presentation which was successfully managed with inj. methylene blue and other symptomatic and supportive treatment. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/239/65373 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65375 2010-05-01 all journal:Indian_J_Anaesth
Anaesthetic management of a child with "cor-triatriatum" and multiple ventricular septal defects - A rare congenital anomaly Sabade, S Vagrali, A Patil, S Kalligudd, P Dhulked, V Dixit, MD Gan, M Dayal, A Cor-triatriatum is a rare congenital cardiac anomaly. It accounts for 0.1% of congenital heart diseases. Its association with multiple ventricular septal defects (VSD) is even rarer. A five-month-old baby was admitted with respiratory distress and failure to thrive. Clinical examination revealed diastolic murmur over mitral area. Chest X-ray showed cardiomegaly. Haematological and biochemical investigations were within normal limits. Electrocardiogram showed left atrial enlargement. 2D echo showed double-chambered left atrium (cor-triatriatum), atrial septal defect (ASD) and muscular VSD with moderate pulmonary arterial hypertension. The child was treated with 100% oxygen, diuretics and digoxin and was stabilized medically. We used balanced anaesthetic technique using oxygen, air, isoflurane, fentanyl, midazolam and vecuronium. Patient was operated under cardiopulmonary bypass (CPB) with moderate hypothermia. Through right atriotomy abnormal membrane in the left atrium was excised to make one chamber. VSD were closed with Dacron patches and ASD was closed with autologous pericardial patch. Patient tolerated the whole procedure well and was ventilated electively for 12h in the intensive care unit. He was discharged on the 10<sup> th</sup> postoperative day. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/242/65375 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65376 2010-05-01 all journal:Indian_J_Anaesth
Anaesthetic management of difficult airway due to retropharyngeal abscess Rao, MS Vishwanathan, PN A one-and-half-year old girl weighing 7.5 kg presented with a history of neck swelling, difficulty in swallowing and breathing. She was posted for incision and drainage on an emergency basis. Diagnosis was confirmed by neck X-ray and computed tomography scan as retropharyngeal abscess. Here we present the successful anaesthetic management of this child at JSS Medical College Hospital, Mysore. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/246/65376 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65377 2010-05-01 all journal:Indian_J_Anaesth
Transversus abdominis plane block for an emergency laparotomy in a high-risk, elderly patient Patil, SS Pawar, SC Divekar, VM Bakhshi, RG A 72-year-old male patient with gall bladder perforation and small intestinal obstruction from impacted gall stone was posted for emergency laparotomy. He had congestive heart failure, severe hypertension at admission and history of multiple other coexisting diseases. On admission, he developed pulmonary oedema from systolic hypertension which was controlled by ventilatory support, nitroglycerine and furosemide. Preoperative international normalized ratio was 2.34 and left ventricular ejection fraction was only 20%. Because of risk of exaggerated fall in blood pressure during induction of anaesthesia (general or neuraxial), a transversus abdominis plane block via combined Petit triangle and subcostal technique was administered and supplemented with Propofol sedation. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/249/65377 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65374 2010-05-01 all journal:Indian_J_Anaesth
Fatal thyrocardiac event Khutia, SK Roy, B Mandal, MC Das, S Atrial fibrillation occurs frequently (2-20%) in chronic hyperthyroidism patients. Poorly treated thyrotoxic patients may present with a life-threatening cerebrovascular accident giving little scope to revert the situation. At times, it is difficult to make a patient euthyroid with conventional management. The definitive treatment of choice is <sup> 131</sup> I, radioiodine. An adjusted dose of an oral anticoagulant is highly efficacious for the prevention of all types of strokes. Timely intervention by a skilled airway manager with right instruments is the key to success in airway management. A 50-year-old thyrotoxic, semiconscious male presented with a sudden onset of haemiplegia. He had chronic AF, a huge thyroid swelling with gross tracheal deviation and dilated cardiomyopathy. A CT scan showed infarction in the left middle cerebral artery territory. After initial improvement with conservative management, patient's condition deteriorated in the next 48 h. Repeat CT scan showed increase in the infarct size with haemorrhage and midline shift. Finally, he died despite all resuscitative measures. Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/255/65374 en Copyright 2017 Indian Journal of Anaesthesia.
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Dr. (Miss) Rupa Bai Furdoonji: World's first qualified lady anaesthetist Ala, N Bharathi, K Subhaktha, P Gundeti, M Ramachari, A Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/259/65371 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65349 2010-05-01 all journal:Indian_J_Anaesth
Capnography-guided awake nasal intubation in a 4-month infant with Pierre Robin syndrome Sharma, R Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/262/65349 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65350 2010-05-01 all journal:Indian_J_Anaesth
Utility of BIS for sedation management during monitored anaesthesia care Parida, S Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/263/65350 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65352 2010-05-01 all journal:Indian_J_Anaesth
Management of a patient with Huntington's disease under spinal anaesthesia Juwarkar, SJ Juwarkar, CS Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/263/65352 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65353 2010-05-01 all journal:Indian_J_Anaesth
Indigenous device for in circuit delivery of bronchodilator drugs through MDI Singh, B Gupta, N Panigrahi, BP Arora, D Govil, P Das, S Singh, M Tobin, R Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/264/65353 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65355 2010-05-01 all journal:Indian_J_Anaesth
Boneless occiput and awake fibreoptic intubation in lateral position Goyal, K Rath, GP Chowdhury, T Mahajan, C Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/265/65355 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65356 2010-05-01 all journal:Indian_J_Anaesth
Indigenous neonatal facemask Raiger, LK Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/266/65356 en Copyright 2017 Indian Journal of Anaesthesia.
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Use of suction catheter as an aid to intubation in emergency situation of intraoral bleeding Aseem, M Palaria, U Bhadani, UK Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/267/65358 en Copyright 2017 Indian Journal of Anaesthesia.
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Centenarians: Hip fractures and peripheral lower limb nerve blocks Lakshmanan, A Ajith, A Rao, SM Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/268/65360 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65361 2010-05-01 all journal:Indian_J_Anaesth
Oculocardiac reflex during endoscopic transsphenoidal removal of pituitary adenoma Choudhury, T Prabhakar, H Singh, GP Bindra, A Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/269/65361 en Copyright 2017 Indian Journal of Anaesthesia.
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Unusual presentation of hypocalcaemia in a peri-operative period-cause unknown Wadhwa, R Kalra, S Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/270/65363 en Copyright 2017 Indian Journal of Anaesthesia.
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Parenteral nutrition: Few more facts Roy, PM Pant, V Das, J Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/272/65365 en Copyright 2017 Indian Journal of Anaesthesia.
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How is that? Knotting of a peripherally inserted central venous catheter Roy, GB Cheriyan, AA Rymbai, ML Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/272/65367 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:65369 2010-05-01 all journal:Indian_J_Anaesth
Thiopentone - Medicolegal views Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/275/65369 en Copyright 2017 Indian Journal of Anaesthesia.
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Corrigendum Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/245/65415 en Copyright 2017 Indian Journal of Anaesthesia.
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Dr. Ashok Jain Tandon, N Medknow Publications 2010-05-01 http://www.ijaweb.org/text.asp?2010/54/3/258/65412 en Copyright 2017 Indian Journal of Anaesthesia.
oai:medknow.com:62959 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Topical corticosteroid use in children: Adverse effects and how to minimize them Saraswat, A Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/225/62959 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
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n-index: A novel and easily-calculable parameter for comparison of researchers working in different scientific fields Namazi, MR Fallahzadeh, MK Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/229/62960 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62961 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Topical treatment in vitiligo and the potential uses of new drug delivery systems Garg, BJ Saraswat, A Bhatia, A Katare, OP Vitiligo is a psychologically devastating condition. Topical therapy is employed as first-line treatment in localized vitiligo. Currently, several topical agents are available in many forms viz. methoxsalen (solution and cream), trioxsalen (solution), corticosteroids (gel, cream, ointment and solution) and calcineurin inhibitors (ointment and cream). Although topical therapy has an important position in vitiligo treatment, side-effects or poor efficacy affect their utility and patient compliance. Novel drug delivery strategies can play a pivotal role in improving the topical delivery of various drugs by enhancing their epidermal localization with a concomitant reduction in their side-effects and improving their effectiveness. The current review emphasizes the potential of various phospholipid based carriers viz. liposomes, transferosomes, ethosomes, lipid emulsions, solid lipid nanoparticles and organogels in optimizing and enhancing the topical delivery of anti-vitiligo agents, whilst reducing the side effects of drugs commonly used in its topical treatment. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/231/62961 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62962 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Invisible dermatoses Mysore, V 'Invisible dermatoses' is a concept which has not received wide recognition, but is nevertheless very important both clinically and histologically. The term invisible dermatoses has been used in two contexts: a) Diseases, with out definite clinical features, and are therefore "invisible" to the clinician, but yet can be diagnosed by special investigations. b) Dermatoses which present with definite and obvious clinical features, but subtle or hidden histological features and are therefore "invisible" histologically. Diagnosis of such diseases represents a great challenge to both the dermatologist and dermatopathologist. This article discusses such diseases and offers clues and tools for their diagnosis. Diagnosis of such 'Invisible dermatoses' needs proper awareness, recognition of subtle features, special stains, special investigations such as immunofluorescence and histochemistry and proper clinicopathological correlation. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/239/62962 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62963 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Irritancy potential of 17 detergents used commonly by the Indian household Austoria, AJ Lakshmi, C Srinivas, CR Anand, CV Mathew, AC Background: Detergents are used by almost every household in the developed and developing world. Soap and most detergents are anionic surfactants and attack the horny layer of the skin and increase its permeability with little or no inflammatory change and may result in hand eczema, which is very distressing and incapacitating. Aim: To evaluate the irritant potential of common household detergents (laundry and dish wash) used by the Indian population using a 24-hour patch test and to convincingly educate the patients on the detergents less likely to cause irritation in the particular individual. Methods: Seventeen commonly used detergents found in Indian market were included in the study, of which, 12 were laundry detergents (powders - seven, bar soap - five) and five were dish wash detergents (powder - one, liquid - one, bar soap - three). The irritant potential of the 17 detergents were evaluated in 30 volunteers. Thirty microliters of each of the detergent bar solutions, distilled water (negative control), and 20% SDS (positive control) were applied to Finn chambers with a micropipette and occluded for 24 hours. Erythema, scaling, and edema were graded in comparison to the reaction at the negative control site (distilled water) for each volunteer separately. The scoring of erythema / dryness and wrinkling on a 0 - 4 point scale and edema on another 0 - 4 point scale was based on the Draize scale. The pH of each of the detergent solutions was determined using litmus papers (Indikrom papers from Qualigens fine chemicals). Results: The difference between detergents (F value) was significant for erythema / dryness and wrinkling (F = 3.374; p = 0.000), but not significant for edema (F = 1.297; p = 0.194). [Table 2] lists the means for erythema / dryness and wrinkling, and edema. The F value of the totals of the means for erythema / dryness and wrinkling and edema was significant (F = 2.495; p = 0.001). The pH of all the detergents was found to be alkaline except Pril utensil cleaner which tested acidic (pH 6). The positive control, 20% SDS also tested acidic (pH 6). Conclusion : Similar to patch testing in allergic contact dermatitis, 24-hour patch testing with detergent solutions (8% w/v), will educate the patient on what detergent to avoid. This may bring down the total medication requirement and frequent hospital consultations for these patients. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/249/62963 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62964 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Topical placental extract: Does it increase the efficacy of narrowband UVB therapy in vitiligo? Majid, I Background: Narrowband UVB therapy is presently one of the most effective therapies for generalized vitiligo. Many topical agents have been used in combination with narrowband UVB therapy to increase its efficacy in causing repigmentation in vitiligo. Placental extract is used topically usually in combination with sun exposure to cause repigmentation of vitiligo lesions. Aims: The present study aims to study whether the efficacy of narrowband UVB therapy would be enhanced by addition of topical placental extract to the treatment regimen. Methods: Ninety patients with vitiligo having more or less bilaterally symmetrical lesions on the face, trunk or limbs and receiving narrowband UVB therapy were enrolled for the study and instructed to apply topical placental extract (placentrex) lotion on their vitiligo lesions on the right side of the body. The other side of the body received narrowband UVB therapy alone and served as the control side. The extent of repigmentation achieved was assessed by VASI scoring and compared between the symmetrical lesions present on the two sides at monthly intervals and at the end of study period. Results: Seventy-eight patients with 218 symmetrically distributed lesions, excluding those present on the hands or feet, were evaluated for study results at the end of treatment period. The time to onset of repigmentation as well as the mean NB-UVB dosage required was the same on the two sides. The mean repigmentation achieved was 63% (VASI score of 3.69) on the right (placental extract) sided lesions in comparison with 62% (VASI score of 3.60) on the left (control) sided lesions. Greater than 90% repigmentation was achieved in 70 symmetrical lesions in 24 patients. Of these 70 lesions, 39 were located on the right side of the body while 31 belonged to the left side of the body. Conclusions: Addition of the topical placental extract was seen to have a modest but a statistically insignificant effect on the efficacy of NB-UVB therapy in causing repigmentation in vitiligo. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/254/62964 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62965 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Clinicopathological study of itchy folliculitis in HIV-infected patients Annam, V Yelikar, BR Inamadar, AC Palit, A Arathi, P Background: Itchy folliculitis are pruritic, folliculo-papular lesions seen in human immunodeficiency virus (HIV)-infected patients. Previous studies have shown that it was impossible to clinically differentiate between eosinophilic folliculitis (EF) and infective folliculitis (IF). Also, attempts to suppress the intense itch of EF were ineffective. Aims: The present study is aimed at correlating clinical, histopathological and immunological features of itchy folliculitis in HIV patients along with their treatment. Methods: The present prospective study lasted for 36 months (September, 2005 to August, 2008) after informed consent, data on skin disorders, HIV status and CD4 count were obtained by physical examination, histopathological examination and laboratory methods. Results: Of 51 HIV-positive patients with itchy folliculitis, the predominant lesion was EF in 23 (45.1%) followed by bacterial folliculitis in 21 (41.2%), Pityrosporum folliculitis in five (9.8%) and Demodex folliculitis in two (3.9%) patients. The diagnosis was based on characteristic histopathological features and was also associated with microbiology confirmation wherever required. EF was associated with a lower mean CD4 count (180.58 ± 48.07 cells/mm<sup> 3</sup> , P-value < 0.05), higher mean CD8 count (1675.42 ± 407.62 cells/mm3) and CD8/CD4 ratio of 9.27:1. There was significant reduction in lesions following specific treatment for the specific lesion identified. Conclusion: Clinically, it is impossible to differentiate itchy folliculitis and therefore it requires histopathological confirmation. Appropriate antimicrobial treatment for IF can be rapidly beneficial. The highly active antiretroviral therapy along with Isotretinoin therapy has shown marked reduction in the lesions of EF. Familiarity with these lesions may help in improving the quality of lives of the patients. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/259/62965 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62966 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Giant granular cell tumor of the vulva Mehta, V Balachandran, C Rao, L Geeta, V A 55-year-old lady presented with a large skin colored growth on her vulva since the age of 15 years, which gradually increased to the present state, with the development of a new lesion on her left thigh. There were no systemic symptoms. Biopsy followed by immunohistochemistry showed features consistent with a granular cell tumor. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/263/62966 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62968 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Ellis-van Creveld syndrome with facial hemiatrophy Bhat, YJ Baba, AN Manzoor, S Qayoom, S Javed, S Ajaz, H Ellis-van Creveld (EVC) syndrome is a rare autosomal recessive congenital disorder characterized by chondrodysplasia and polydactyly, ectodermal dysplasia and congenital defects of the heart. We present here a case of a 16-year-old short-limbed dwarf with skeletal deformities and bilateral postaxial polydactyly, dysplastic nails and teeth, also having left-sided facial hemiatrophy. The diagnosis of EVC syndrome was made on the basis of clinical and radiological features. To the best of our knowledge, this is the first report of EVC syndrome with facial hemiatrophy in the medical literature from India. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/266/62968 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62971 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Vulvar vestibular papillomatosis Wollina, U Verma, S Vulvar vestibular papillomatosis is considered an anatomical variant of the vulva. Recognition of this condition enables one to distinguish it from warts and therefore avoid unnecessary therapy. A 29-year-old lady presented to this clinic with a history of 'small growths' in her vulva since two years. Examination identified skin colored translucent papules; some of them appeared digitate and were seen on the vestibule and inner aspect of both labia minora. They were soft to feel and non-tender. Few lesions looked like elongated pearly penile papules. A provisional diagnosis of vestibular papillomatosis was made and a biopsy was done. It showed finger-like protrusions of loosely arranged subdermal tissue with blood vessels and which were covered by normal mucosal epithelium. No koilocytes were seen and the diagnosis of vestibular papillomatosis was confirmed. We believe that this is the first case report of vulvar vestibular papillomatosis in Indian dermatologic literature. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/270/62971 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62972 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Nodular amelanotic melanoma Nalamwar, R Kharkar, V Mahajan, S Chikhalkar, S Khopkar, U We report a case of 65-year-old male patient who presented with multiple erythematous papules coalescing to form a nodular mass over posterior aspect of right thigh of six months duration. His general and systemic examinations were within normal range except for right inguinal lymphadenopathy. Biopsy from the lesion was done, which showed diffuse infiltrate of nests of atypical melanocytes extending upto reticular dermis. Malignant cells were positive for S100 and human melanin black 45(HMB 45). Hence, a diagnosis of amelanotic melanoma (AM) - Clarke level IV and TNM stage III was reached. MRI of involved leg showed fungating soft tissue mass in the posterolateral aspect of right thigh and metastatic right inguinal adenopathy. Fine needle aspiration cytology (FNAC) from the right inguinal nodes confirmed metastasis of melanoma. The patient was referred to oncosurgery department for further management. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/273/62972 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62974 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Cutaneous sporotrichosis: Unusual clinical presentations Mahajan, VK Sharma, NL Shanker, V Gupta, P Mardi, K Three unusual clinical forms of sporotrichosis described in this paper will be a primer for the clinicians for an early diagnosis and treatment, especially in its unusual presentations. Case 1, a 52-year-old man, developed sporotrichosis over pre-existing facial nodulo-ulcerative basal cell carcinoma of seven-year duration, due to its contamination perhaps from topical herbal pastes and lymphocutaneous sporotrichosis over right hand/forearm from facial lesion/herbal paste. Case 2, a 25-year-old woman, presented with disseminated systemic-cutaneous, osteoarticular and possibly pleural (effusion) sporotrichosis. There was no laboratory evidence of tuberculosis and treatment with anti-tuberculosis drugs (ATT) did not benefit. Both these cases were diagnosed by histopathology/culture of S. schenckii from tissue specimens. Case 3, a 20-year-old girl, had multiple intensely pruritic, nodular lesions over/around left knee of two-year duration. She was diagnosed clinically as a case of prurigo nodularis and histologically as cutaneous tuberculosis, albeit, other laboratory investigations and treatment with ATT did not support the diagnosis. All the three patients responded well to saturated solution of potassium iodide (SSKI) therapy. A high clinical suspicion is important in early diagnosis and treatment to prevent chronicity and morbidity in these patients. SSKI is fairly safe and effective when itraconazole is not affordable/ available. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/276/62974 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62975 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
'Custard apple' scalp Inamadar, AC Palit, A Ragunatha, S Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/281/62975 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62976 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Effects of intravenous pulse dexamethasone on total leukocyte count and absolute lymphocyte count Natarajan, K Srinivas, CR Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/283/62976 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62977 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Syncephalastrum species producing mycetoma-like lesions Amatya, R Khanal, B Rijal, A Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/284/62977 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62978 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Contact dermatitis to parthenium simulating lichen nitidus De, D Jindal, R Kanwar, AJ Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/286/62978 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62980 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Occupational allergic contact dermatitis due to teak wood Rao, R Balachandran, C Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/287/62980 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
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Extensive keloids over lesions of air-borne contact dermatitis: An unusual manifestation Jindal, R De, D Kanwar, AJ Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/289/62982 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62984 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Smooth muscle hamartoma presenting as a morphea-like plaque Tirado-Sanchez, A Santamaria-Roman, A Ponce-Olivera, RM Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/290/62984 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
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Dupuytren's disease Saraf, S Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/291/62985 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62988 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Familial combined hypercholesterolemia type II b presenting with tuberous xanthoma, tendinous xanthoma and pityriasis rubra pilaris-like lesions Bhagwat, PV Tophakhane, RS Kudligi, C Noronha, TM Thirunavukkarasu, A Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/293/62988 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62989 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Doc, I can't taste my food! Madnani, NA Khan, KJ Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/296/62989 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
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Lupus band test Mehta, V Sarda, A Balachandran, C Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/298/62983 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62981 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Immune reconstitution inflammatory syndrome after initiation of highly active anti-retroviral therapy in HIV/AIDS Mohanty, K Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/301/62981 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62979 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Depressed plaques over back in a 35-year-old male Jain, A De, D Dogra, S Saikia, UN Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/305/62979 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62973 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Phacomatosis cesioflammea: First case report from India Goyal, T Varshney, A Phacomatosis cesioflammea is a rare condition defined by the simultaneous presence of both vascular and pigmentary nevus in the same patient. We report a case of a 4-year-old Indian female child who presented with diffuse dermal melanosis on the upper shoulders, upper anterior chest and lower back and extending to involve both sides of the arms and forearms, generalized port-wine stain on the back, shoulders and both upper limbs with sparing of the right palm. At places, the two types of lesions were superimposed on each other and were also present discretely on the back, but in close proximity to each other. There was the presence of melanosis bulbi on the right side of the eye. She was otherwise normal. She was clinically diagnosed as a case of phacomatosis pigmentovascularis cesioflammea. The nonallelic twin spotting phenomenon has been proposed in the pathogenesis of this disorder. Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/307/62973 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62986 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Polydactyly of triphalangeal thumb Saraf, S Parihar, RS Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/307/62986 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62987 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Bilateral cutaneous leishmaniasis presenting as eczema-like eruptions on the hands Nasiri, S Robati, RM Marefat, A Saeedi, M Sarrafi-rad, N Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/307/62987 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62990 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Incomplete pachydermoperiostosis Kudligi, C Bhagwat, PV Thirunavukkarasu, A Tophakhane, RS Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/307/62990 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62991 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Popping papules over the feet Raychaudhury, T George, R Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/308/62991 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62970 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
IAL Textbook of Leprosy - Hemanta Kumar Kar and Bhushan Kumar Jerajani, HR Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/309/62970 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62969 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Sexually Transmitted Infections and HIV - An illustrated guide to management - Veerakathy Harindra, Verapol Chandeying, and N. Usman Thappa, DM Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/311/62969 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:62967 2010-05-01 all journal:Indian_J_Dermatol_Venereol_Leprol
Current best evidence from dermatology literature Sahni, K De, D Medknow Publications 2010-05-01 http://www.ijdvl.com/text.asp?2010/76/3/312/62967 en Copyright 2017 Indian Journal of Dermatology, Venereology, and Leprology.
oai:medknow.com:69373 2010-05-01 all journal:Indian_J_Hum_Genet
Sickle cell hemoglobinopathies in district Bhopal Sajid, M Sawke, GK Ambhore, J Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/100/69373 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69374 2010-05-01 all journal:Indian_J_Hum_Genet
Significance of t (8: 14) in CLL? Lakshmaiah, KC Tejinder, S Kumari, P Gowri, MM Satheesh, CT Lokanatha, D Jacob, AL Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/102/69374 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69325 2010-05-01 all journal:Indian_J_Hum_Genet
Integration of modern genetic knowledge and technology into public health in India Ghosh, K Gorakshakar, A Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/45/69325 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69326 2010-05-01 all journal:Indian_J_Hum_Genet
Genetics in public health: Rarely explored Aswini, YB Varun, S The availability and the integration of genetic information into our understanding of normal and abnormal growth and development are driving important changes in health care. These changes have fostered the hope that the availability of genetic information will promote a better understanding of disease etiology and permit early, even pre-symptomatic diagnosis and preventive intervention to avoid disease onset. Hence, our aim was to review and provide the insight into the role of genetics in public health and its scope as well as barriers. The use of genetics along with their goals and essential public health functions are discussed. From the era of eugenics to the present era, this area has seen many turns in which geneticists have put through their effort to tie together the strings of both molecular genetics and public health. Though still the dark clouds of eugenics, the predictive power of genes, genetic reductionism, non-modifiable risk factors, individuals or populations, resource allocation, commercial imperative, discrimination and understanding and education are hanging above. The technological and scientific advances that have fundamentally changed our perception of human diseases fuel the expectations for this proactive health. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/47/69326 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69327 2010-05-01 all journal:Indian_J_Hum_Genet
Haplotype diversity and linkage disequilibrium at the DRD2 locus among the tribes of western and southern regions of India Aggarwal, A Gauniyal, M Pattanayak, I Kshatriya, GK Background: Dopamine receptor D2 (DRD2) is an important gene having functional significance in the fields of neuropsychiatry and pharmacology and also has importance in evolutionary studies. Materials and Methods: This study was undertaken to find out the haplotype distribution and linkage disequilibrium (LD) pattern for the three TaqI sites (TaqI 'A', TaqI 'B' and TaqI 'D') in the DRD2 gene in 232 unrelated individuals from five ethno-linguistically distinct endogamous tribal populations; Siddis and Gonds of Uttara Kannada district, Karnataka; Varli and Kolgha of Valsad district, Gujarat; and Dangi Konkana of Dang district, Gujarat. The genotype data obtained after molecular analysis of the three DRD2 sites was subjected to statistical analysis such as calculation of allele frequencies, haplotype frequencies among others. Subsequently, a neighbor-joining tree was also constructed from the data obtained. Results: The three DRD2 sites were found to be polymorphic in all the populations. All the populations showed high levels of heterozygosities. Out of the eight possible haplotypes, most populations shared seven haplotypes. Of all the populations, Siddis showed the highest frequency of the ancestral haplotype B2D2A1 (11.4%). Significant LD was found to exist for TaqI 'A' and TaqI 'B' sites in both the populations. Conclusion: The findings are in concurrence with those from other Indian studies, especially from Dravidian-speaking South Indian populations. Similar pattern of diversity observed for ethnically and linguistically diverse populations in the present study is indicative of complex structure of Indian populations. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/55/69327 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69328 2010-05-01 all journal:Indian_J_Hum_Genet
Opportunity for natural selection among some selected population groups of Northeast India Das, FA Sikdar, M Background: Selection potential based on differential fertility and mortality has been computed for seven population groups inhabiting different geographical locations of Northeast India. Materials and Methods: Crow's as well as Johnston and Kensinger's index have been used for the present purpose. Results and Conclusion: Irrespective of the methodology, the total index of selection was found to be highest among the Deoris followed by the Kaibartas. The lowest selection index was found among the Oraon population. If the relative contribution of fertility and mortality components to the total index is considered to be multiplicative, it is observed that in all these communities the fertility component exceeds that of mortality component, which may indicate initiation of demographic transitional phase in the selected populations with the betterment of healthcare and socioeconomic condition within the last few decades. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/61/69328 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69348 2010-05-01 all journal:Indian_J_Hum_Genet
Genetic variations of β-MYH7 in hypertrophic cardiomyopathy and dilated cardiomyopathy Tanjore, R RangaRaju, A Vadapalli, S Remersu, S Narsimhan, C Nallari, P Context: Hypertrophic cardiomyopathy (HCM) is known to be manifested by mutations in 12 sarcomeric genes and dilated cardiomyopathy (DCM) is known to manifest due to cytoskeletal mutations. Studies have revealed that sarcomeric mutations can also lead to DCM. Therefore, in the present study, we have made an attempt to compare and analyze the genetic variations of beta-myosin heavy chain gene (β-MYH7), which are interestingly found to be common in both HCM and DCM. The underlying pathophysiological mechanism leading to two different phenotypes has been discussed in this study. Till date, about 186 and 73 different mutations have been reported in HCM and DCM, respectively, with respect to this gene. Aim: The screening of β-MYH7 gene in both HCM and DCM has revealed some common genetic variations. The aim of the present study is to understand the pathophysiological mechanism underlying the manifestation of two different phenotypes. Materials and Methods: 100 controls, 95 HCM and 97 DCM samples were collected. Genomic DNA was extracted following rapid nonenzymatic method as described by Lahiri and Nurnberger (1991), and the extracted DNA was later subjected to polymerase chain reaction (PCR) based single stranded conformation polymorphism (SSCP) analysis to identify single nucleotide polymorphism (SNP)s/mutations associated with the diseased phenotypes. Results and Conclusion: Similar variations were observed in β-MYH7 exons 7, 12, 19 and 20 in both HCM and DCM. This could be attributed to impaired energy compromise, or to dose effect of the mutant protein, or to even environmental factors/modifier gene effects wherein an HCM could progress to a DCM phenotype affecting both right and left ventricles, leading to heart failure. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/67/69348 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69350 2010-05-01 all journal:Indian_J_Hum_Genet
Association of polymorphisms in leptin receptor gene with obesity and type 2 diabetes in the local population of Coimbatore Murugesan, D Arunachalam, T Ramamurthy, V Subramanian, S Background: Candidate gene association studies are very relevant to the area of clinical pharmacology. As information on candidate genes and candidate single nucleotide polymorphisms increases, a number of such candidates can be studied in a population to explore their association with their susceptible disease. One such attractive and popular Single Nucleotide Polymorphism (SNP) candidate for obesity is the gene coding for leptin receptor. The leptin receptor gene (LEPR) polymorphism plays an important role in obesity and type 2 diabetes. But the role of this polymorphism is not yet studied in Indian population. Hence, the study focused to explore the association of leptin receptor polymorphisms (K109R, Q223R and K656N) with obesity and type 2 diabetes in both diabetic and non-diabetic subjects recruited from the local population of Coimbatore. Materials and Methods: Genotypic analysis for the three polymorphisms has been made for 300 subjects (150 diabetic and 150 non-diabetic) with the age range of 40-60 years using conventional Polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) techniques in a case-control fashion. Allele frequencies were estimated based on the gene count method. Correlation was made with phenotypic variables including body mass index (BMI), waist-to-hip ratio (WHR), insulin and leptin levels for those polymorphisms. Results and Conclusion: Among the polymorphisms tested in this study, significant association with BMI (P < 0.05), WHR (P < 0.05) leptin (P < 0.001) and insulin (P < 0.0001) was observed for the SNP Q223R, whereas in the case of the other two polymorphisms the association was not statistically significant. The significance value was calculated based on the c<sup>2</sup> test. The controls are also found to have a higher frequency of homozygous mutants for Q223R and are significantly associated with obesity. These findings support the hypothesis that Q223R polymorphism is associated with obesity. It can be speculated that the controls showing the same allele may develop Type 2 diabetes at a later stage and Q223R can act as a strong marker. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/72/69350 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69351 2010-05-01 all journal:Indian_J_Hum_Genet
Null association between ACE gene I/D polymorphism and diabetic nephropathy among multiethnic Malaysian subjects Jayapalan, JJ Muniandy, S Chan, SP Background: Wide inter-ethnic allelic variations of the Angiotensin Converting Enzyme (ACE) i nsertion-deletion (I/D) gene polymorphism were thought to be responsible for the conflicting gene-diabetic nephropathy disease association worldwide. We have investigated the genetic susceptibility of the ACE gene to diabetic nephropathy in the multiethnic Malaysian population. Materials and Methods: A total of 137 healthy (control) and 256 diabetic subjects were recruited. The diabetic subjects were further subdivided according to their nephropathy status based on urinary albumin-creatinine ratio (ACR) and glomerular filtration rate (GFR). Triple primer polymerase chain reaction (PCR) was used for ACE I/D genotyping. Subsequently, populationwide genetic analysis and gene-disease association studies were performed. Results: The genotype frequencies in all subgroups were in Hardy-Weinberg equilibrium. Similar allelic and genotypic frequency of ACE I/D gene polymorphism was observed between healthy controls versus pooled type 2 diabetes mellitus (T2DM) subjects, and normoalbuminuria versus microalbuminuria, macroalbuminuria and End Stage Renal Failure (ESRF) (P > 0.05). Neither ethnicity nor gender exerted any influence on the ACE I/D gene polymorphism (P > 0.05), with the exception of the Chinese ethnic group which exhibited a higher frequency of ID genotype (P = 0.042). A multinomial logistic regression model showed that predictive factors including age, systolic blood pressure (SBP), high density lipoprotein (HDL) and glycosylated hemoglobin (HbA1C) were independently associated with diabetic nephropathy, in that order. Conclusion: The I/D polymorphism of the ACE gene is not significantly associated with both T2DM and/or diabetic nephropathy in this Malaysian population regardless of ethnicity and gender. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/78/69351 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69370 2010-05-01 all journal:Indian_J_Hum_Genet
Investigation of chromosomal aberrations in Egyptian hepatocellular carcinoma patients by fluorescence in situ hybridization Aly, MS Bahnassy, AA Abdel-Rahman, ZN Background and Aims: Hepatocellular carcinoma (HCC) is a very common and highly malignant tumor, associated mainly with chronic viral hepatitis, cirrhosis of any cause, aflatoxin exposure and ethanol consumption. Cytogenetic analysis on HCC has been limited because of poor hepatocyte growth in vitro. Conventional cytogenetic studies have demonstrated frequent abnormalities of specific chromosomes in HCC. Molecular cytogenetic approaches have been applied only rarely in the characterization of HCC. The main aim of this study was to evaluate genetic aberrations of different chromosomes in HCC. The study included 35 patients with HCC, who have been diagnosed and treated at National Cancer Institute, Cairo University, Egypt. The clinico-pathologic features of the studied patient were collected from patient's files. Materials and Methods: Interphase cytogenetics by fluorescence in situ hybridization with the use of a panel of centromere-associated DNA probes for chromosomes 1, 4, 8, 9, 13, 17, 20 and Y were performed on paraffin-embedded HCC specimens. Results: The most common chromosomal aberrations detected were gain of chromosomes 8 in 12 cases (34.28%), 17 in 6 cases (17.14%). Loss of chromosome Y was detected in 6 of male cases (30%). Monosomy 4 was also detected in 5 cases (14.28%). Negative correlation could be detected only between chromosome 4 and 8. (r = -0.381, P < 0.05). Correlations between gain or loss of chromosomes and the different clinicopathologic parameters in the patients investigated, indicated negative correlation between: chromosome Y and age and chromosome 1 and cirrhosis. Conclusion: Gains and losses of DNA found in this study probably involve oncogenes and tumor suppressor genes that play a role in the puzzle of hepatocarcinogenesis. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/87/69370 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69371 2010-05-01 all journal:Indian_J_Hum_Genet
Triploidy in a fetus following amniocentesis referred for maternal serum screening test at second trimester Bagherizadeh, E Oveisi, M Hadipour, Z Saremi, A Shafaghati, Y Behjati, F Amniocentesis was carried out at 17 weeks gestation in a 27-year-old woman, following an abnormal maternal serum screening (MSS) test. MSS test was carried out primarily to estimate the risk of trisomy for chromosome 21. The maternal serum markers used were alpha-fetoprotein (AFP), human chorionic gonadotrophin (hCG), and unconjugated estriol (uE3), together with maternal age. The fetus was identified as screen-positive for Edward's syndrome (trisomy 18), with low uE3, normal AFP and hCG levels. The calculated risk for trisomy 18 was more than 1:50. To identify any possible chromosomal abnormality, cytogenetic investigation was carried out on the amniotic fluid sample. The fetus's karyotype showed triploidy with 69, XXX chromosome complement in all the metaphase spreads obtained from three different cultures, using GTG banding technique. Upon termination of the fetus, gross abnormalities indicative of triploidy were present in the fetus. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/94/69371 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:69372 2010-05-01 all journal:Indian_J_Hum_Genet
Phenotypic correlations in a patient with ring chromosome 22 Demirhan, O Tunç, E Ring chromosome 22, a rare cytogenetic anomaly, has been described in over 60 cases in the medical literature. The aim of this report was to present a case carrying ring chromosome 22, and her family. It is a case report of a patient presented at Medical Faculty of Ηukurova University in Turkey. An 8-year-old girl with ring chromosome 22 and her family were evaluated cytogenetically and clinically. A chromosome analysis of the proband revealed a de novo 46,XX,r(22)(p11.2;q13) karyotype. Our subject demonstrated the prominent features of this syndrome including profound mental retardation, language impairment, dysmorphic features, lack of speech, hyperactivity, and behavioral disorders. There is lack of consistency between the physical abnormalities that we observed in our subject and those observed for such patients in the literature. The wide range of manifestations observed in patients with this cytogenetic alteration is probably due to size differences in the deleted region. Medknow Publications 2010-05-01 http://www.ijhg.com/text.asp?2010/16/2/97/69372 en Copyright 2017 Indian Journal of Human Genetics.
oai:medknow.com:79402 2010-05-01 all journal:Indian_J_Med_Res
Healthy weight--healthy blood pressure Sharma, AM Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/597/79402 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79401 2010-05-01 all journal:Indian_J_Med_Res
Tobacco use among women : gendered perspective to be included in global tobacco control policies Minh, HV Nga, PT Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/600/79401 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79400 2010-05-01 all journal:Indian_J_Med_Res
Is intra-abdominal obesity a unique risk factor for metabolic syndrome in non-diabetics? Vega, GL Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/603/79400 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79399 2010-05-01 all journal:Indian_J_Med_Res
New vistas in treating diabetes--insight into a holistic approach Kutty, BM Raju, TR Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/606/79399 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79398 2010-05-01 all journal:Indian_J_Med_Res
Possible involvement of granulocyte oxidative burst in Nrf2 signaling in cancer Jaganjac, M The activation process of granulocytes is accompanied by the intense production of reactive oxygen species (ROS). Overproduction of ROS is cytotoxic, damages macromolecules and can lead to the occurrence of lipid peroxidation. Cellular defense against the toxicity of ROS is enhancement of detoxifying enzymes activation. Regulation of many detoxifying enzymes is mediated by the antioxidant response element (ARE) that is located in the promoter region of related genes. In eukaryotes, there are only few transcription factors known to be activated by ROS. One of them is NF-E2-related factor 2 (Nrf2). Normally, Nrf2 is present in the cytoplasm as an inactive Keap1-Nrf2 complex. However, after direct attack by ROS, Nrf2 is released from Keap1 repression and translocated into nucleus where it binds with ARE sequence to initiate gene expression. ROS may also influence nuclear factor-kappaB (NF-kappaB) intracellular signaling repressing the Nrf2-ARE pathway at transcriptional level. Since ROS are crucial in granulocyte-mediated tumor cell lysis the induction of NF-kappaB signaling pathway may be an important mechanism in suppressing the tumor growth. Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/609/79398 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79397 2010-05-01 all journal:Indian_J_Med_Res
Evidence-based National Vaccine Policy. Madhavi, Y Puliyel, JM Mathew, JL Raghuram, N Phadke, A Shiva, M Srinivasan, S Paul, Y Srivastava, RN Parthasarathy, A Gupta, S Ranga, U Lakshmi, VV Joshi, N Nath, I Gulhati, CM Chatterjee, P Jain, A Priya, R Dasgupta, R Sridhar, S Dabade, G Gopakumar, KM Abrol, D Santhosh, MR Srivastava, S Visalakshi, S Bhargava, A Sarojini, NB Sehgal, D Selvaraj, S Banerji, D India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form. Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/617/79397 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79396 2010-05-01 all journal:Indian_J_Med_Res
Visceral & subcutaneous abdominal fat in relation to insulin resistance & metabolic syndrome in non-diabetic south Indians Sandeep, S Gokulakrishnan, K Velmurugan, K Deepa, M Mohan, V Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/629/79396 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79395 2010-05-01 all journal:Indian_J_Med_Res
Effect of pranayama & yoga-asana on cognitive brain functions in type 2 diabetes-P3 event related evoked potential (ERP) Kyizom, T Singh, S Singh, KP Tandon, OP Kumar, R Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/636/79395 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79394 2010-05-01 all journal:Indian_J_Med_Res
Association of serum lipoprotein ratios with insulin resistance in type 2 diabetes mellitus Tangvarasittichai, S Poonsub, P Tangvarasittichai, O Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/641/79394 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79393 2010-05-01 all journal:Indian_J_Med_Res
Multi-center surveillance for pneumonia & meningitis among children (<2 yr) for Hib vaccine probe trial preparation in India Gupta, M Kumar, R Deb, AK Bhattacharya, SK Bose, A John, J Balraj, V Ganguly, NK Kant, L Kapoor, AN Watt, J Shearer, J Santosham, M Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/649/79393 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79392 2010-05-01 all journal:Indian_J_Med_Res
Association of methylenetetrahydrofolate reductase gene polymorphisms & colorectal cancer in India. Chandy, S Ramachandra, N Krishnamoorthy, S Ramaswamy, G Savithri, HS Krishnamoorthy, L Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/659/79392 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79391 2010-05-01 all journal:Indian_J_Med_Res
Efficacy of hydrocortisone acetate/hyaluronidase vs triamcinolone acetonide/hyaluronidase in the treatment of oral submucous fibrosis Singh, M Niranjan, HS Mehrotra, R Sharma, D Gupta, SC Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/665/79391 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79390 2010-05-01 all journal:Indian_J_Med_Res
A comparison of bromocriptine & cabergoline on fertility outcome of hyperprolactinemic infertile women undergoing intrauterine insemination. Motazedian, S Babakhani, L Fereshtehnejad, S Mojthahedi, K Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/670/79390 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79389 2010-05-01 all journal:Indian_J_Med_Res
Comet assay : a prognostic tool for DNA integrity assessment in infertile men opting for assisted reproduction Shamsi, MB Venkatesh, S Tanwar, M Singh, G Mukherjee, S Malhotra, N Kumar, R Gupta, NP Mittal, S Dada, R Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/675/79389 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79388 2010-05-01 all journal:Indian_J_Med_Res
Tissue distribution & elimination of capsaicin, piperine & curcumin following oral intake in rats Suresh, D Srinivasan, K Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/682/79388 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79387 2010-05-01 all journal:Indian_J_Med_Res
Adult attention deficit/hyperactivity disorder : one year follow up Sitholey, P Agarwal, V Tripathi, A Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/692/79387 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79386 2010-05-01 all journal:Indian_J_Med_Res
Hypoglycaemic effects of fermented mycelium of Paecilomyces farinosus (G30801) on high-fat fed rats with streptozotocin-induced diabetes Lu, H Jian, C Chen, S Chen, T Lee, S Chang, C Weng, C Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/696/79386 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79385 2010-05-01 all journal:Indian_J_Med_Res
Novel detection of parvovirus B19 DNA & IgM antibodies in patients with non-occlusive gangrene of stomach & bowel. Kishore, J Dash, NR Saxena, R Krishnani, N Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/702/79385 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79384 2010-05-01 all journal:Indian_J_Med_Res
Spatio-temporal variations in adult density, abdominal status & indoor resting pattern of Culex quinquefasciatus Say in Panaji, Goa, India. Kaliwal, MB Kumar, A Shanbhag, AB Dash, AP Javali, SB Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/711/79384 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79383 2010-05-01 all journal:Indian_J_Med_Res
Emergence of fluoroquinolone resistance in Shigella isolated from Andaman & Nicobar Islands, India Roy, S Bhattacharya, D Thanasekaran, K Ghosh, AR Manimunda, SP Bharadwaj, AP Singhania, M Sugunan, AP Vijayachari, P Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/720/79383 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79382 2010-05-01 all journal:Indian_J_Med_Res
An objective measure of antibiotic use for febrile illness in a rural paediatric population using high performance liquid chromatography Mathew, BS Fleming, DH Gupta, M Kumar, R Kumar, D Chandy, SJ Balraj, V Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/723/79382 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79652 2010-05-01 all journal:Indian_J_Med_Res
Book Reviews Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/726/79652 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79653 2010-05-01 all journal:Indian_J_Med_Res
Some forthcoming scientific events Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/730/79653 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:79654 2010-05-01 all journal:Indian_J_Med_Res
Announcements Medknow Publications 2010-05-01 http://www.ijmr.org.in/text.asp?2010/131/5/731/79654 en Copyright 2017 Indian Journal of Medical Research.
oai:medknow.com:98926 2010-05-01 all journal:Indian_J_Med_Sci
Analysis of patients with post-chemotherapy Arthralgia and Arthritis in breast cancer Amiri, AH Rafiei, A Objective: Evaluate the characteristics of arthropathy and musculoskeletal pain after chemotherapy in patients with breast cancer. Materials and Methods: In this study, we evaluate the characteristics of 15 patients with joint symptoms after receiving chemotherapy for breast cancer. Demographic information including sex, age, time of rheumatologic findings after starting of chemotherapy, and time of improvement after starting of medication, and laboratory findings detected for each patient. Results: Patients comprised 15 women with mean age 43.4 ± 10.6 years that received classic chemotherapy for breast cancer according to stage of disease including cyclophosphamide, and tamoxifen. Joint symptoms usually began about 6 months after the first session of chemotherapy. Patients had an average of 2 tender joints and 1 hour of morning stiffness. None of patients were positive for anti-nuclear antibody, and just 1 patient was positive for rheumatoid factor. Non-steroidal anti-inflammatory drugs, disease modifying anti-rheumatic drugs (DMARD), corticosteroids, and venlafaxine were prescribed. 5 patients did not show an improvement and were also given low dose oral corticosteroids. Follow-up was available for all patients. 13 patients showed favorable responses, characterized by a significant decrease (more than 50%) in morning stiffness, pain, and tender joint counts after a mean of 3 months' treatment. 9 patients had complete resolution of symptoms and stopped all medications. Conclusion: Chemotherapy-related arthropathy is not rare, and the prognosis is fairly good with early treatment using NSAID, DMARD, and corticosteroids. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/197/98926 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98935 2010-05-01 all journal:Indian_J_Med_Sci
Clinical profile of abdominal tuberculosis in children Shah, I Uppuluri, R Aim: A retrospective study was conducted in children, suffering from abdominal TB, attending Pediatric TB clinic from 2007 to 2009. Materials And Methods: Age-wise distribution and type of abdominal TB were analyzed with clinical features. Results : Out of 285 children with TB, 32 (11.2%) had abdominal tuberculosis. Male: Female ratio was 2.1:1. 7 (21.9%) children were < 5 years of age, 15 (46.9%) children were 5 - 10 years of age, and 10 (31.2%) children were > 10 years of age. The most common clinical features were fever in 24 (75%), pain in abdomen in 17 (53.1%), loss of weight in 15 (46.9%), raised ESR in 14 (43.8%), and loss of appetite in 13 (40.6%) children. TB contact was present in 10 (31.2%), and 7 (21.9%) children had tuberculosis in the past. 28 (87.5%) children had received BCG vaccine, and 17 (53.1%) had a positive Mantoux test. Extra-abdominal tuberculosis was found in 17 patients (53.1%). Duration of fever was more in children less than 5 years of age (127 ± 66 days) than that in children between 5 -10 years (37 ± 30 days) and in > 10 years of age (73 ± 66 days), which is statistically significant (P = 0.0228). Lymph node TB (17 patients, 53.1%) was found to be the commonest, followed by intestinal (10 patients, 31.2%) and peritoneal TB (4 patients, 12.5%). 18 (56.2%) of the total patients had recovered, 7 (21.9%) of all patients failed first line therapy and had to be started on second line drugs, of which 4 (12.5%) were proven to have drug-resistant TB. Conclusion : Abdominal TB is seen in 11.2% of children affected with TB, of which over 53% will have extra-abdominal manifestations. Common clinical and laboratory features include fever, pain in abdomen, loss of weight, loss of appetite, and raised ESR. The duration of fever is more in children of younger age group. Lymph node TB is the most common type of abdominal TB. Drug-resistant TB is seen in at least 12.5% of the patients. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/204/98935 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98942 2010-05-01 all journal:Indian_J_Med_Sci
Characteristics of rotavirus gastroenteritis in hospitalized children in Pune Borade, A Bais, AS Bapat, V Dhongade, R Background : Diarrheal diseases affect millions of people around the world and have the greatest impact on children, especially those in developing countries. Rotavirus is now known to contribute significantly to the etiology of diarrheal diseases in both developing and developed countries. Objective : To study demographic, clinical, and laboratory characteristics of rotavirus infection in cases of acute diarrhea admitted in the hospital who were below the age 5 years. Materials and methods : It was a prospective study conducted from June 2009 to June 2011 to determine characteristics, clinical profile, and antigenemia of rotavirus. The study group included patients up to 5 years of age hospitalized with a diagnosis of acute gastroenteritis. Statistical analysis was done using the chi-square test. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 17.0. Results : From the 246 cases studied in the hospitalized patients of acute gastroenteritis, 88 cases (35.77%) were found to be positive for rotavirus infection. The occurrence of infection was found to be most common in the age group of 11-20 months (38.63%) followed by the age group of 0-10 months (23.86%). There was no association with the sex of the child. In rotavirus-positive patients, associated features were fever in 48.86%, vomiting in 29.54%, and pain in abdomen in 53.4% of cases. Seasonal variation of rotavirus infection was observed in the present study with peak in the winter season. It was found that 5.68% cases which were positive for rotavirus in their stool samples were positive for rotavirus present in their urine sample, suggesting extraintestinal manifestation of rotavirus. Conclusion : It is concluded that in spite of clean hygienic condition and vaccination rotavirus is still an important cause of infantile diarrhea in urban area like Pune. There is association between the occurrence of rotavirus and degree of dehydration, fever, vomiting, and pain in abdomen. Peak incidence was found in the months of December and January. There is association between the occurrence of rotavirus in stool and rotavirus in blood. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/210/98942 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98949 2010-05-01 all journal:Indian_J_Med_Sci
Methylenetetrahydrofolate reductase polymorphism (c677t) in muslim population of eastern uttar pradesh, India Rai, V Yadav, U Kumar, P Yadav, SK Objective : The aim of the present study was to investigate the distribution of methylenetetrahydrofolate reductase (C677T) polymorphism in the Muslim population of eastern Uttar Pradesh. Materials and Methods: Total 56 subjects were analysed for MTHFR C677T polymorphism. C677T mutation analysis was done according to the PCR-RFLP (Polymerase chain reaction-Restriction fragment length polymorphism) method. Results : The frequencies of three genotypes CC, CT, and TT were 0.857, 0.125, and 0.07, respectively, and the frequency of mutated T allele was found to be 0.080. Conclusion : Genotypes and allele frequencies revealed the low prevalence of MTHFR C677T polymorphism in Indian Muslims. C677T mutation has been suggested to be positively associated with the risk of several congenital and multifactorial disorders. The low frequency of T/T genotype in the Muslim population may be due to malnutrition in pregnant women, because of insufficient intake of folate is considered to be a survival disadvantage for foetuses with T/T genotype. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/219/98949 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98960 2010-05-01 all journal:Indian_J_Med_Sci
Quality of life in post-traumatic orthopedically handicapped patients Malik, P Garg, R Gulia, A Kumar, N Sidhu, BS Sharma, KC Objectives : The study was planned to assess quality of life (QOL) and factors affecting it in post-traumatic orthopedically handicapped patients. Materials and Methods: This is hospital-based cross-sectional study which involves 68 patients with traumatic orthopedic handicapped injury in the Department of Orthopaedeics, Rehabilitation center and Psychiatry, Government Medical College, Patiala between May 07 and Aug 08. Details of injury were taken on semistructured proforma. All patients underwent detailed psychiatric assessment using International Classification of Disease-10 (ICD-10) and divided into two groups. Group A contains handicapped patients with psychiatric morbidity and remaining patients without psychiatric morbidity were included in Group B. Further, both groups were subjected to Quality Of Life Scale (QOLS) to assess QOL. Results : QOL was poor in handicapped patients and was affected by severity of injury. Temporal association was seen between psychiatric morbidity and QOL in handicapped patients. Conclusion : The QOL must be assessed at every stage of treatment for better adjustment of handicapped patients. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/224/98960 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98961 2010-05-01 all journal:Indian_J_Med_Sci
Acute buried bumper syndrome: An endoscopic peg tube salvage approach Bhat, G Suvarna, D Pai, CG Acute buried bumper syndrome is an uncommon complication of percutaneous endoscopic gastrostomy (PEG) tube placement. If not recognized and treated appropriately, it can lead to serious complications including death. We report a case of an acute buried bumper syndrome, successfully managed with PEG tube repositioning through the original tract, without the need of replacement. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/234/98961 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98962 2010-05-01 all journal:Indian_J_Med_Sci
Gestational choriocarcinoma presenting as hemothorax Saha, K Basuthakur, S Jash, D Bandyopadhyay, A Choriocarcinoma include a spectrum of chorionic neoplasms that may be gestational or non-gestational. By virtue of their high vascularity and affinity of trophoblast for blood vessels, metastases often occur early, and the most common site of such metastases is the lung. Metastatic pleural effusions from choriocarcinoma are infrequent. Pleural seeding usually results from extension of a sub-pleural peripheral nodule. We describe a case of gestational choriocarcinoma whose clinical presentation was medical like hemothorax as in our case rather than gynecologic. Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/237/98962 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98963 2010-05-01 all journal:Indian_J_Med_Sci
Donor deferral guidelines for skin infections: is there need to re- evaluate? Sachdev, S Kaur, R Sinha, P Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/241/98963 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:98964 2010-05-01 all journal:Indian_J_Med_Sci
Prevalence of histone family e 1 (hfe) mutant alleles in a tamilian cohort from Vellore, South India Danda, S Eapen, CE Kuruvilla, KA Santhosh, S Kurian, G Chandy, GM Medknow Publications 2010-05-01 http://www.indianjmedsci.org/text.asp?2010/64/5/242/98964 en Copyright 2017 Indian Journal of Medical Sciences.
oai:medknow.com:72236 2010-05-01 all journal:Indian_J_Occup_Environ_Med
The healthy workplace initiative Shanbhag, SM Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/29/72236 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72237 2010-05-01 all journal:Indian_J_Occup_Environ_Med
An overview of caspase: Apoptotic protein for silicosis Tumane, RG Pingle, SK Jawade, AA Nath, NN Silicosis is a chronic lung disease characterized by granulomatous and fibrotic lesions, which occurs due to accumulation of respirable silica mineral particles. Apoptosis is an important phenomenon of cell death in silicosis. The relationship between silica dust and its exposure is well established. But, the complex chain of cellular responses, which leads to caspase activation in silicosis, has not been fully discovered. Caspase activation plays a central role in the execution of apoptosis. Silica-induced apoptosis of the alveolar macrophages could potentially favor a proinflammatory state, occurring in the lungs of silicotic patients, resulting in the activation of caspase prior to induction of the intrinsic and extrinsic apoptosis pathways. Recent studies indicated that apoptosis may involve in pulmonary disorders. This review summarizes the current knowledge about the underling mechanism of biochemical pathways in caspase activation that have been ignored so far in silicosis. In addition, caspase could be a key apoptotic protein that can be used as an effective biomarker for the study of occupational diseases. It may provide an important link in understanding the molecular mechanisms of silica-induced lung pathogenesis. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/31/72237 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72238 2010-05-01 all journal:Indian_J_Occup_Environ_Med
Multinomial logistic regression model to assess the levels in trans, trans-muconic acid and inferential-risk age group among benzene-exposed group Mala, A Ravichandran, B Raghavan, S Rajmohan, HR There are only a few studies performed on multinomial logistic regression on the benzene-exposed occupational group. A study was carried out to assess the relationship between the benzene concentration and trans-trans-muconic acid (t,t-MA), biomarkers in urine samples from petrol filling workers. A total of 117 workers involved in this occupation were selected for this current study. Generally, logistic regression analysis (LR) is a common statistical technique that could be used to predict the likelihood of categorical or binary or dichotomous outcome variables. The multinomial logistic regression equations were used to predict the relationship between benzene concentration and t,t-MA. The results showed a significant correlation between benzene and t,t-MA among the petrol fillers. Prediction equations were estimated by adopting the physical characteristic viz., age, experience in years and job categories of petrol filling station workers. Interestingly, there was no significant difference observed among experience in years. Petrol fillers and cashiers having a higher occupational risk were in the age group of ≤24 and between 25 and 34 years. Among the petrol fillers, the t,t-MA levels with exceeding ACGIH TWA-TLV level was showing to be more significant. This study demonstrated that multinomial logistic regression is an effective model for profiling the greatest risk of the benzene-exposed group caused by different explanatory variables. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/39/72238 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72239 2010-05-01 all journal:Indian_J_Occup_Environ_Med
Climate change and health: Research challenges for health in the developing countries Pandve, HT Climate change has emerged as one of the most important environmental issues ever to confront humanity. Recent events have emphatically demonstrated our growing vulnerability to climate change, and health hazards are a major concern. Research pertaining to the effects of climate change on human health is the need of the hour. This paper discusses the broad challenges in health research in developing countries with specific reference to climate change. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/42/72239 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72240 2010-05-01 all journal:Indian_J_Occup_Environ_Med
Mercury and health care Rustagi, N Singh, R Mercury is toxic heavy metal. It has many characteristic features. Health care organizations have used mercury in many forms since time immemorial. The main uses of mercury are in dental amalgam, sphygmomanometers, and thermometers. The mercury once released into the environment can remain for a longer period. Both acute and chronic poisoning can be caused by it. Half of the mercury found in the atmosphere is human generated and health care contributes the substantial part to it. The world has awakened to the harmful effects of mercury. The World Health Organization and United Nations Environmental Programme (UNEP) have issued guidelines for the countries' health care sector to become mercury free. UNEP has formed mercury partnerships between governments and other stakeholders as one approach to reducing risks to human health and the environment from the release of mercury and its compounds to the environment. Many hospitals are mercury free now. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/45/72240 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72241 2010-05-01 all journal:Indian_J_Occup_Environ_Med
Low back pain predict sickness absence among power plant workers Murtezani, A Hundozi, H Orovcanec, N Berisha, M Meka, V Background: Low back pain (LBP) remains the predominant occupational health problem in most industrialized countries and low-income countries. Both work characteristics and individual factors have been identified as risk factors. More knowledge about the predictors of sickness absence from LBP in the industry will be valuable in determining strategies for prevention. Objectives: The aim of this longitudinal study was to investigate whether individual, work-related physical risk factors were involved in the occurrence of LBP sickness absence. Methods: A follow-up study was conducted among 489 workers, aged 18-65 years, at Kosovo Energetic Corporation in Kosovo. This cross-sectional study used a self-administered questionnaire to collect data on individual and work-related risk factors and the occurrence of LBP sickness absence. Logistic regression models were used to determine associations between risk factors and the occurrence of sickness absence due to LBP. Results: Individual factors did not influence sickness absence, whereas work-related physical factors showed strong associations with sickness absence. The main risk factors for sickness absence due to LBP among production workers were extreme trunk flexion (OR = 1.71, 95% CI = 1.05-2.78) as well as very extreme trunk flexion (OR = 6.04, 95% CI = 1.12-32.49) and exposure to whole-body vibration (OR = 1.75, 95% CI = 1.04-2.95). Conclusion: Reducing sickness absence from LBP among power plant workers requires focusing on the working conditions of blue-collar workers and risk factors for LBP. Increasing social support in the work environment may have effects in reducing sickness absence from LBP. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/49/72241 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72242 2010-05-01 all journal:Indian_J_Occup_Environ_Med
A study of neurologic symptoms on exposure to organophosphate pesticides in the children of agricultural workers Rastogi, SK Tripathi, S Ravishanker, D Pesticides are used extensively throughout the world in agriculture and in pest control as well as for community health purposes. Organophosphate (OP) pesticide self-poisoning is an important clinical problem in rural regions of the developing world that kills an estimated 200,000 people every year. Unintentional poisoning kills far fewer people but is an apparent problem in places where highly toxic OP pesticides are available. Neurologic dysfunction is the best documented health effect of pesticide exposure. High-level exposure has both acute and long-term neurologic signs and symptoms, and adverse effects have been reported in most type of pesticides, including organophosphate (OP), carbamate, organochlorine, and pyrethroid insecticides, herbicides, fungicides, and fumigants. Acute OP pesticide exposure can involve in wide range of both central and peripheral neurologic symptoms. Increased neurologic symptom prevalence may provide early evidence of neurologic dysfunctions, before clinically measurable signs are evident. In this study, we analyzed the cross-sectional data on neurologic signs and symptoms from 225 rural children, both males (n = 132) and females (n = 93) who were occupationally and paraoccupationally exposed to methyl OPs (dichlorvos, fenthion, malathion, methyl parathion) and ethyl OPs (chlorpyrifos, diazinon, ethyl parathion) as they belonged to agricultural families handling, mixing, and spraying the OP pesticides. The children completed a specially designed questionnaire (Q16) on neurologic symptoms associated with pesticide exposure with their parental help. A suitable reference group consisting of rural children (n = 50) never involved in pesticide handling (neither outdoor nor indoor) belonging to similar socioeconomic strata included in the study to compare the prevalence of various neurologic symptoms between the two groups. Among all the neurologic self-reported symptoms, headache, watering in eyes, and burning sensation in eye/face were the most important clinical manifestations attributed to OP pesticide exposure. These symptoms could probably be the consequence of chronic effects of most pesticides on the central nervous system. The muscarinic symptoms reported the maximum prevalence of salivation (18.22%), whereas lacrimation was observed in 17.33% cases, followed by diarrhea in 9.33% cases. The nicotinic clinical manifestations of acute OP poisoning revealed excessive sweating in 13.78% cases and tremors in 9.3% cases followed by mydriasis in 8.4% exposed children. The characteristic cholinergic symptoms, such as insomnia, headache, muscle cramps, weakness, and anorexia were also reported by both male and female exposed children. The high frequency of neurologic symptoms observed in the study may be due to parasympathetic hyperactivity due to the accumulated ACh resulting from AChE inhibition. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/54/72242 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:72243 2010-05-01 all journal:Indian_J_Occup_Environ_Med
Study of lead exposure to children residing near a lead-zinc mine Choudhari, R Sathwara, NG Shivgotra, VK Patel, S Rathod, RA Shaikh, S Shaikh, MI Dodia, S Parikh, DJ Saiyed, HN This lead exposure study was conducted in a total of 452 school children in the age group of 9-14 years. Two hundred and ninety-eight exposed children came from the villages situated within a 2.5 km radius of the lead-zinc mine whereas the comparative group children were selected from the villages at least 10 km away from mine. Environmental monitoring study suggested that lead levels in air and water samples near the mining areas were within the Central Pollution Control Board prescribed standards. Lead levels in about 80% of the children were less than 10 μg/dl. Medical examination of all children did not show any signs related to lead toxicity but central nervous system-related symptoms, as reported by the subjects during medical examination, were found to be higher in the exposed group when compared with the comparative group. The values of physical growth parameters of the exposed group were comparable with that of the comparative group for both girls and boys. Hence, the physical growth of children was found to be unaffected by the observed level of lead exposure. To safeguard the health of the children residing near the mining area, various preventive and control measures were suggested. Medknow Publications 2010-05-01 http://www.ijoem.com/text.asp?2010/14/2/58/72243 en Copyright 2017 Indian Journal of Occupational and Environmental Medicine.
oai:medknow.com:62640 2010-05-01 all journal:Indian_J_Ophthalmol
On being editor of (Indian) medical journals: A steeple chase Nayak, BK Joshi, VR Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/187/62640 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62641 2010-05-01 all journal:Indian_J_Ophthalmol
Changes in central retinal artery blood flow after ocular warming and cooling in healthy subjects Shamshad, MA Amitava, AK Ahmad, I Wahab, S Context: Retinal perfusion variability impacts ocular disease and physiology. Aim: To evaluate the response of central retinal artery (CRA) blood flow to temperature alterations in 20 healthy volunteers. Setting and Design: Non-interventional experimental human study. Materials and Methods: Baseline data recorded: Ocular surface temperature (OST) in °C (thermo-anemometer), CRA peak systolic velocity (PSV) and end diastolic velocity (EDV) in cm/s using Color Doppler. Ocular laterality and temperature alteration (warming by electric lamp/cooling by ice-gel pack) were randomly assigned. Primary outcomes recorded were: OST and intraocular pressure (IOP) immediately after warming or cooling and ten minutes later; CRA-PSV and EDV at three, six and nine minutes warming or cooling. Statistical Analysis: Repeated measures ANOVA. Results: (n = 20; μ±SD): Pre-warming values were; OST: 34.5±1.02°C, CRA-PSV: 9.3±2.33cm/s, CRA-EDV: 4.6±1.27cm/s. OST significantly increased by 1.96°C (95% CI: 1.54 to 2.37) after warming, but returned to baseline ten minutes later. Only at three minutes, the PSV significantly rose by 1.21cm/s (95% CI: 0.51to1.91). Pre-cooling values were: OST: 34.5±0.96°C, CRA-PSV: 9.7±2.45 cm/s, CRA-EDV: 4.7±1.12cm/s. OST significantly decreased by 2.81°C (95% CI: -2.30 to -3.37) after cooling, and returned to baseline at ten minutes. There was a significant drop in CRA-PSV by 1.10cm/s (95% CI: -2.05 to -0.15) and CRA-EDV by 0.81 (95% CI: -1.47 to -0.14) at three minutes. At six minutes both PSV (95% CI: -1.38 to -0.03) and EDV (95% CI: -1.26 to -0.02) were significantly lower. All values at ten minutes were comparable to baseline. The IOP showed insignificant alteration on warming (95% CI of difference: -0.17 to 1.57mmHg), but was significantly lower after cooling (95% CI: -2.95 to -4.30mmHg). After ten minutes, IOP had returned to baseline. Conclusion : This study confirms that CRA flow significantly increases on warming and decreases on cooling, the latter despite a significant lowering of IOP. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/189/62641 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62642 2010-05-01 all journal:Indian_J_Ophthalmol
The relation between intraocular pressure change and plasma natriuretic peptide under simulated hypobaric conditions Karadag, R Sen, A Yildirim, N Basmak, H Golemez, H Cakir, E Akin, A Purpose: To ascertain whether the changes in intraocular pressure (IOP) that occur during hypobaric hypoxic exposure are related to plasma N-terminal pro-brain natriuretic peptide (BNP) levels. Materials and Methods: The study group comprised 26 healthy participants (all male, mean age 23.1 years). IOP was measured at local ground level, (792 m above sea level), then while in a chamber providing hypobaric hypoxic conditions (the subjects were exposed to a pressure equivalent to 9144 m for 1-3 min), and again after exit from the chamber. In each condition, the mean of three consecutive measurements of IOP was calculated for each eye. For BNP measurements, blood samples were drawn before the participants entered the chamber and just after they left the chamber. Results: IOP during hypobaric hypoxic exposure (18.00 ± 3.70 mmHg) was significantly greater than that before (15.66 ± 2.10 mmHg, P < 0.001) or after (16.10 ± 2.63 mmHg, P = 0.001) the exposure. IOP levels before and after the exposure were not significantly different (P = 0.136). Plasma BNP levels measured before and after exposure to hypobaric hypoxic conditions were not significantly different (P = 0.462). Conclusion: Plasma BNP levels did not change after short-term hypobaric hypoxic exposure, while the IOP increased. This increase may have been caused by some other systemic factors. As the hypobaric hypoxic conditions were reversed, IOP decreased to normal levels. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/195/62642 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62643 2010-05-01 all journal:Indian_J_Ophthalmol
Profile of angle closure in a tertiary care center in north India Ichhpujani, P Pandav, SS Ramasubramanian, A Kaushik, S Purpose: To study the demographic and clinical profile of the types of primary angle closure patients presenting at a tertiary care center in North India. Materials and Methods: Clinic records of patients diagnosed as primary angle closure were reviewed. International Society of Geographical and Epidemiological Ophthalmology (ISGEO) classification scheme was used to categorize patients. Demographic and clinical data including prior management was collected and analyzed. Main Outcome measures were age, sex, symptomatology, best corrected visual acuity (BCVA), intraocular pressure (IOP), gonioscopy, optic disc assessment and visual field defects. Logistic regression model and receiver operating curve (ROC) were calculated for predictors of type of glaucoma. Results: Eight hundred and fourteen patients (1603 eyes; males: 380, females: 434) were diagnosed to have various subtypes of angle closure. Mean (±SD) age at presentation was significantly higher for males (57.57 ± 11.62 years) as compared to females (53.64 ± 10.67 years) ( p0 <.0001). Primary angle closure glaucoma (PACG) was most frequently diagnosed subtype (49.38%) followed by Primary angle closure (PAC) (39.68%) and Primary angle closure suspect (PACS) (10.93%) respectively. The three subtypes differed significantly among their mean IOP (on ANOVA, F = 14.04; P < .0001 using Greenhouse-Geisser correction). Univariate analysis was done to find significant predictors for the outcome of PACG. Logistic regression model and ROC containing the significant predictors yielded a very high AUC of 0.93 with strong discriminatory ability for PACG. Conclusion: In our hospital-based study, the significant predictors for the outcome of PACG included male gender, diminution of vision, the presence of pain and worsening grades of BCVA. Nearly half of PACG presented with advanced disease. In spite of one-third of the patients being diagnosed as angle closure prior to referral, only 8.34% had iridotomy (laser or surgical) done. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/199/62643 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62644 2010-05-01 all journal:Indian_J_Ophthalmol
Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors Wani, VB Kumar, N Sabti, K Raizada, S Rashwan, N Shukkur, MM Harbi, M Aims: The aim of the study was to report the incidence of retinopathy of prematurity (ROP) and severe ROP and identify the risk factors for their development in a large nursery in Kuwait. Materials and Methods: This was a retrospective, interventional, non-comparative, hospital-based study. Retrospective review of ROP records of premature babies having either birth weight of less than 1501 g or gestational age at birth of 34 weeks or less and born between January 2001 and August 2003. Statistical Analysis: By univariate and multivariate logistic regression analysis. Results: Out of the 599 babies studied, 38.9% developed ROP and 7.8% needed treatment for severe ROP. Multivariate analysis showed low birth weight (OR 13.753, 95% CI 3.66-51.54; ( P < 0.001), gestational age (OR 13.75, 95% CI 3.66-51.54; P < 0.001), surfactant (OR 1.72, 95% CI 1.04-2.83; P = 0.032) and stay in the intensive care unit for longer than 15 days (OR 2.25, 95% CI 1.05-4.85; P = 0.033) to be significant for the development of any ROP. Low birth weight (OR 22.86, 95% CI 3.86-134.82; P = 0.001), bacterial sepsis (OR 3.27, 95% CI 1.51-7.05; P = 0.002) and need for surfactant (OR 4.41, 95% CI 0.94 -20.56; P = 0.059) were found to be the risk factors for severe ROP needing laser treatment. Conclusion: The incidence of both any ROP and ROP needing treatment are comparable to other studies. Low birth weight is the most important risk factor for both any ROP and severe ROP. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/204/62644 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62645 2010-05-01 all journal:Indian_J_Ophthalmol
Profile of asymmetrical retinopathy of prematurity in twins Azad, R Chandra, P Patwardhan, SD Gupta, A Background: In twin births, both babies have the same gestational age and pre-natal conditions. However, twins may develop a varied retinopathy of prematurity (ROP) course depending on birth weight and other systemic factors. Objective: To study the profile of asymmetric ROP in twins Design: Retrospective study Setting: Tertiary ROP referral eye hospital. Materials and Methods: The profile of 56 pairs of twins with ROP were studied and analyzed for differences in zone or need for treatment, while studying possible causes for the varied outcome. Results: In 45 pairs of twins (80%) the disease progressed identically in both eyes, while in 11 pairs (20%) the ROP showed differences in zone or need for treatment. Four of these pairs were discordant. In 3 of these 4 pairs, the heavier birth weight twin had a more severe ROP course. Conclusions: Twins can present with asymmetric ROP course, and it is therefore essential to examine both twins as per screening protocols. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/209/62645 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62646 2010-05-01 all journal:Indian_J_Ophthalmol
Transcanalicular diode laser-assisted dacryocystorhinostomy Drnovsek-Olup, B Beltram, M Objective: We present a prospective, non-comparative case series study of 126 consecutive diode laser-assisted transcanalicular dacryocystorhinostomy (TCL-DCR) procedures on 122 patients. We analyzed success rate, procedure time and amount of laser energy needed for a 5 mm osteotomy. Materials and Methods: One hundred and twenty-two patients with nasolacrimal duct obstruction were included in the study. The procedure was performed under general anesthesia, and the nasal mucosa was anesthetized. An endoscope was used for examination of the lacrimal pathways. The site of osteotomy was determined with transillumination of the lateral nasal wall. We achieved osteotomy by applying laser energy via an optic fiber. We used a 980 nm diode laser with power of 10 Watts. We inserted a bicanalicular silicone stent as the last step. Success of procedure was absence of epiphora (subjective), or patency of the lacrimal drainage system on irrigation (objective). Results: We performed 126 successive endoscopic laser (EL-DCR) with bicanalicular intubation in 122 patients. The average procedure time was 12 min, and on average 245 Joules of laser energy was needed. The silicone stents were removed three to eight months after surgery. We observed absence of epiphora and a patent nasolacrimal duct on irrigation in 105 out of 126 treated eyes. Eighteen patients had epiphora despite a patent nasolacrimal duct on irrigation. This yields a success rate of 83.3%, with an average follow-up period of 12 months. Conclusions: The 980 nm EL-DCR with bicanalicular intubation is a new contribution to the field of lacrimal surgery. It is a minimally invasive quick procedure yielding a high success rate. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/213/62646 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62647 2010-05-01 all journal:Indian_J_Ophthalmol
Comparison of Eyemetrics and Orbscan automated method to determine horizontal corneal diameter Venkataraman, A Mardi, SK Pillai, S Purpose: To compare horizontal corneal diameter measurements using the Orbscan Eyemetrics function and Orbscan corneal topographer. Materials and Methods: Seventy-three eyes of 37 patients were included in the study. In all cases, the automated white-to-white (WTW) measurements were obtained using Orbscan by two observers. Using the Eyemetrics function, the WTW was measured manually by the same observers from limbus to limbus using the digital caliper passing through the five point corneal reflections on the Orbscan real image. The data was analyzed using SPSS software for correlation, reliability and inter-rater repeatability. Results: The mean horizontal corneal diameter was 11.74±0.32mm (SD) with the Orbscan and 11.92±0.33mm (SD) with Eyemetrics Software-based measurement. A good positive correlation (Spearman r = 0.720, P = 0.026) was found between these two measurements. The coefficient of inter-rater repeatability was 0.89 for the Orbscan and 0.94 for the Eyemetrics software measurements on the anterior segment images. The Bland and Altman analysis showed large limits of agreement between Orbscan WTW and Eyemetrics WTW measurements. The intra-session repeatability scores for repeat measurements for the Orbscan WTW and Eyemetrics measurements were good. Conclusion: Eyemetrics can be used to measure WTW and the Eyemetrics measured WTW was longer than the WTW measured by Orbscan. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/219/62647 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62648 2010-05-01 all journal:Indian_J_Ophthalmol
Outcomes of cataract surgery in a rural and urban south Indian population Vijaya, L George, R Rashima, A Raju, P Arvind, H Baskaran, M Ve, RS Purpose: To assess the visual outcome after cataract surgery in a south Indian population. Materials and Methods: Population-based cross-sectional study of subjects aged 40 years or more. Three thousand nine hundred and twenty-four rural subjects from 27 contiguous villages and 3850 urban subjects from five randomly selected divisions were studied. All subjects underwent a comprehensive ophthalmic examination that included visual acuity, refraction, slit-lamp biomicroscopy, applanation tonometry, gonioscopy, and dilated retinal examination. Statistical Analysis: Chi square test, t test and multivariate analysis were used. Results: Five hundred and twenty-eight (216 males, 312 females, 781 eyes) rural subjects (13.5%, 95% confidence interval (CI) 12.4% to 14.6%) and 406 (197 males, 209 females, 604 eyes) urban subjects (10.5%, 95% CI 9.6-11.5%) had undergone cataract surgery. Outcome of cataract surgery was defined based on visual acuity. Using best-corrected visual acuity for classification, the single most important cause for visual impairment was cystoid macular edema in the aphakic group and posterior capsule opacification in the pseudophakic group. Aphakia (visual acuity of <20/60 to ≤20/400 - odds ratio (OR) 1.8; 95% CI 1.3 to 2.6%, visual acuity of <20/400 - OR 6.2; 95% 4.0 to 9.8%), rural residence (visual acuity of <20/60 to ≤20/400 - OR 3.2; 95% CI 2.2 to 4.5% and visual acuity of <20/400 - OR OR 3.5; 95% CI 2.3 to 5.5%) were associated with visual impairment. The urban cataract-operated population had significantly more pseudophakics ( P < 0.001), men ( P = 0.02) and literates ( P < 0.001). In the rural group the prevalence of cataract surgery (13.5% vs. 10.5%, P < 0.001) and number of people that had undergone cataract surgery within three years prior to examination ( P < 0.001) were significantly greater. In 30% of rural and 16% of urban subjects uncorrected refraction was the cause of visual impairment. Conclusions: Surgery-related complications were major causes for visual acuity of < 20/60. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/223/62648 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62649 2010-05-01 all journal:Indian_J_Ophthalmol
Presentation of retinoblastoma in pregnancy Nandedkar, VS Joshi, AR Kabra, N Deshpande, NN A 22-year-old female in her third trimester of pregnancy was referred to our department for sudden loss of vision with a painful blind eye. It was diagnosed as retinoblastoma clinically and radiologically. Histopathology and immunohistochemistry confirmed the diagnosis. This case is one of its kind because retinoblastoma occurring during pregnancy had not been reported in literature so far. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/229/62649 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62650 2010-05-01 all journal:Indian_J_Ophthalmol
Residual triamcinolone acetonide at macular hole after vitreous surgery Kumar, A Sinha, S Gupta, A Post traumatic macular holes have shown successful anatomic outcomes with vitrectomy with internal limiting membrane (ILM) peeling and gas injection. Intraocular use of triamcinolone acetonide (TA) crystals is gaining popularity in patients for visualization of the vitreous cortex, posterior vitreous detachment induction and ILM peeling during macular hole surgery. However, the possibility of residual steroid crystals clogging the hole at the conclusion of surgery exists. In our case, residual TA was observed biomicroscopically in the fovea on the seventh day after surgery, Optical Coherence Tomography (OCT) image of the eye showed a hyper reflective mass corresponding to the TA. However, a repeat OCT carried out four weeks after surgery showed recovery of the foveal morphologic features to an almost normal depression, with closure of the hole. Residual TA crystals in the macular hole post vitreous surgery may not interfere with ultimate macular hole closure or visual improvement. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/232/62650 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62651 2010-05-01 all journal:Indian_J_Ophthalmol
Spontaneous bilateral peripapillary, subhyaloid and vitreous hemorrhage with severe anemia secondary to idiopathic thrombocytopenic purpura Majji, AB Bhatia, K Mathai, A A 42-year-old female presented to us with a complaint of sudden painless loss of vision in both eyes of three days duration. Visual acuity was 20/100 for distance in both eyes. Fundus examination showed bilateral peripapillary hemorrhages, with subhyaloid and vitreous hemorrhage in both eyes. Hematological investigations revealed hemoglobin (HB 7 gm %) and severe thrombocytopenia (12,000/ ul). She was referred to a hematologist where a diagnosis of idiopathic thrombocytopenic purpura (ITP) was made. She was treated for systemic condition with regular ophthalmic follow-up. Over the next nine months, retinal hemorrhages completely resolved and the patient regained her visual acuity. The purpose of this case report is to highlight the clinical presentation of severe anemia, which is different from previous reports and the role of an ophthalmologist in first detecting the Idiopathic thrombocytopenic purpura (ITP), which led to successful recovery. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/234/62651 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62652 2010-05-01 all journal:Indian_J_Ophthalmol
Solitary giant molluscum contagiosum presenting as lid tumor in an immunocompetent child Vardhan, P Goel, S Goyal, G Kumar, N We report the case of a three-year-old male child who presented with a single painless subcutaneously located upper lid mass of 1.2 Χ 1.5 cm with a central depression. The mass could be easily separated from overlying skin on complete excision biopsy and showed a never described before whitish brain like appearance consisting of multiple lobes and gyri, which histopathologically proved to be molluscum contagiosum (MC). Tests to investigate underlying immunodeficiency did not show any evidence of immunocompromised state. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/236/62652 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62653 2010-05-01 all journal:Indian_J_Ophthalmol
A rare and an unusually delayed presentation of orbital actinomycosis following avulsion injury of the scalp Hegde, V Puthran, N Mahesha, S Anupama, B We report a rare case of orbital swelling presenting one year after head trauma. An initial fine needle aspiration cytology revealed it to be an infected organizing hematoma. However, broad-spectrum antibiotics did not resolve the infection and the orbital lesion continued to grow in size, as evaluated by magnetic resonance imaging. Incisional biopsies were done, which were reported as orbital actinomycosis. Patient has responded well to treatment with penicillin. This case is of interest due to the delayed presentation of an orbital complication of head trauma and the rare infection with actinomyces. It also highlights the importance of using appropriate antibiotics, as well as the need for long-term treatment. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/238/62653 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62654 2010-05-01 all journal:Indian_J_Ophthalmol
Unilateral situs inversus of optic disc associated with reduced binocularity and stereoacuity resembling monofixation syndrome Kothari, M Chatterjee, DN Situs inversus of the optic disc is a rare, usually bilateral, congenital embryological abnormality associated with high myopia, optic disc coloboma or tilted optic disc. It is characterized by emergence of the retinal vessels in an anomalous direction with dysversion of the optic disc. In this report we present a 13-year-old boy diagnosed with isolated, unilateral situs inversus of the optic disc associated with reduced binocularity and stereoacuity resembling a monofixation syndrome. The clinicians should be aware of this association and assess the binocularity in patients with unilateral optic disc or macular anomalies. Conversely, patients with reduced binocularity and stereoacuity should be carefully evaluated for macular or optic nerve anomalies, if not associated with strabismus, anisometropia and eccentric fixation. Typical fundus picture, optical coherence tomography and multifocal electro retinogram of the patient would be instructive to a clinician. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/241/62654 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62655 2010-05-01 all journal:Indian_J_Ophthalmol
The Chennai glaucoma study: Prevalence and risk factors for glaucoma in cataract operated eyes in urban Chennai George, R Arvind, H Baskaran, M Ramesh, SV Raju, P Vijaya, L We report the prevalence and risk factors for glaucoma among aphakes and pseudophakes in 3850 subjects who participated in a population-based study in urban south India. The subjects underwent an ophthalmic examination including applanation tonometry, gonioscopy, optic disc evaluation and frequency doubling perimetry. Glaucoma was diagnosed using the International Society of Geographical and Epidemiological Ophthalmology (ISGEO) criteria. Thirty eight, 15 aphakes and 23 pseudophakes (0.99% of 3850 subjects) of the 406 persons who had undergone cataract surgery were diagnosed with glaucoma. Aphakes/pseudophakes were at higher risk of glaucoma as compared to the phakic population (Odds Ratio: 2.71, 95% CI: 1. 94, 3.38, p=0.001). On multivariate analysis, older age and higher intra ocular pressure were risk factors for glaucoma. Blindness attributable to glaucoma was detected in 20% of aphakic and 4.3% of pseudophakic eyes. Glaucoma was a significant cause of morbidity in those who had undergone cataract surgery in this urban population. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/243/62655 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62656 2010-05-01 all journal:Indian_J_Ophthalmol
Pleomorphic adenoma of a subconjunctival ectopic lacrimal gland Patyal, S Banarji, A Bhadauria, M Gurunadh, VS This report describes a case of pleomorphic adenoma of an ectopic lacrimal gland arising subconjunctivally in the lateral fornix in a 13-year-old girl. The tumor was removed surgically in toto with the capsule. This is probably the first reported case. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/245/62656 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62657 2010-05-01 all journal:Indian_J_Ophthalmol
Bilateral simultaneous acute angle closure caused by sulphonamide derivatives: A case series Senthil, S Garudadri, C Rao, HB Maheshwari, R The sulphonamide group of drugs is implicated in bilateral acute angle closure (AAC) due to an idiosyncratic response. We report a series of three cases with bilateral AAC caused by different sulphonamide derivatives, their presentation and management. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/248/62657 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62658 2010-05-01 all journal:Indian_J_Ophthalmol
Acute postoperative endophthalmitis by Gemella haemolysans Nalamada, S Jalali, S Reddy, AK Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin. Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/252/62658 en Copyright 2017 Indian Journal of Ophthalmology.
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Etiology and management of hyperimmunoglobulinemia E syndrome Gonzalez-Granado, LI Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/254/62659 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62660 2010-05-01 all journal:Indian_J_Ophthalmol
Authors' reply Arora, VL Usha, KR Khazei, HM Kusagur, S Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/254/62660 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62661 2010-05-01 all journal:Indian_J_Ophthalmol
Lens-sparing pars plicata vitrectomy for stage 4 retinopathy of prematurity Shah, PK Narendran, V Kalpana, N Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/255/62661 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62662 2010-05-01 all journal:Indian_J_Ophthalmol
Authors' reply Bhende, P Gopal, L Sharma, T Verma, A Biswas, RK Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/255/62662 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62663 2010-05-01 all journal:Indian_J_Ophthalmol
Uveal melanoma with extrascleral extension and systemic metastasis complicating into retinal detachment and cataract formation Chandravanshi, SL Lakhtakia, S Rathore, MK Dwivedi, PC Rahud, JS Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/256/62663 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62664 2010-05-01 all journal:Indian_J_Ophthalmol
Authors' reply Khetan, V Gupta, K Ravindra, ME Lingam, G Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/257/62664 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62665 2010-05-01 all journal:Indian_J_Ophthalmol
Psychosocial and emotional impact of strabismus on Indian families Gogate, P Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/257/62665 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62666 2010-05-01 all journal:Indian_J_Ophthalmol
Authors' reply Kothari, M Balankhe, S Gawade, R Toshnival, S Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/258/62666 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62667 2010-05-01 all journal:Indian_J_Ophthalmol
The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractive glaucoma in Indian eyes Murali, A Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/259/62667 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62668 2010-05-01 all journal:Indian_J_Ophthalmol
Authors' reply Parihar, JK Vats, DP Maggon, R Mathur, V Singh, A Mishra, SK Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/260/62668 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62670 2010-05-01 all journal:Indian_J_Ophthalmol
Serous retinal detachment and multiple retinal pigment epithelial detachments, following hemodialysis for multi-organ failure Basu, S Das, T Padhi, TR Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/261/62670 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:62672 2010-05-01 all journal:Indian_J_Ophthalmol
Keratoconus: A review of presentation patterns Sinha, R Gupta, N Sharma, N Gupta, R Titiyal, JS Medknow Publications 2010-05-01 http://www.ijo.in/text.asp?2010/58/3/263/62672 en Copyright 2017 Indian Journal of Ophthalmology.
oai:medknow.com:68402 2010-05-01 all journal:Indian_J_Palliat_Care
Aggressive palliative surgery in metastatic phyllodes tumor: Impact on quality of life Kapali, AS Singh, M Deo, S Shukla, NK Muduly, DK Metastatic phyllodes tumor has very few treatment options. Phyllodes tumor in metastatic setting has limited role of surgery, radiotherapy and chemotherapy or combined treatment. Most of the patients receive symptomatic management only. We present a case of metastatic phyllodes tumor managed with aggressive margin negative resection of primary tumor leading to palliation of almost all the symptoms, which eventually led to improved quality of life and probably to improved survival. The improved quality of life was objectively assessed with Hamilton depression rating scale. Surgery may be the only mode of palliation in selected patients that provides a better quality of life and directly or indirectly may lead to improved survival. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/101/68402 en Copyright 2017 Indian Journal of Palliative Care.
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Disease, dignity and palliative care Rajagopal, MR Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/59/68400 en Copyright 2017 Indian Journal of Palliative Care.
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'BREAKS' protocol for breaking bad news Narayanan, V Bista, B Koshy, C Information that drastically alters the life world of the patient is termed as bad news. Conveying bad news is a skilled communication, and not at all easy. The amount of truth to be disclosed is subjective. A properly structured and well-orchestrated communication has a positive therapeutic effect. This is a process of negotiation between patient and physician, but physicians often find it difficult due to many reasons. They feel incompetent and are afraid of unleashing a negative reaction from the patient or their relatives. The physician is reminded of his or her own vulnerability to terminal illness, and find themselves powerless over emotional distress. Lack of sufficient training in breaking bad news is a handicap to most physicians and health care workers. Adherence to the principles of client-centered counseling is helpful in attaining this skill. Fundamental insight of the patient is exploited and the bad news is delivered in a structured manner, because the patient is the one who knows what is hurting him most and he is the one who knows how to move forward. Six-step SPIKES protocol is widely used for breaking bad news. In this paper, we put forward another six-step protocol, the BREAKS protocol as a systematic and easy communication strategy for breaking bad news. Development of competence in dealing with difficult situations has positive therapeutic outcome and is a professionally satisfying one. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/61/68401 en Copyright 2017 Indian Journal of Palliative Care.
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Ethics and medico legal aspects of "Not for Resuscitation" Salins, NS Pai, SG Vidyasagar, MS Sobhana, M Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/66/68404 en Copyright 2017 Indian Journal of Palliative Care.
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Preventive palliation in the elderly - Organizing health camps for the rural aged Dam, A Datta, N Mohanty, UR Karn, RK Singh, D Kumar, S Most of the needs of elders for support and assistance in the later stages of life are fulfilled by informal helpers. The position of a large number of older persons has become vulnerable due to which it cannot be taken for granted that their children will be able to look after them when they need care in old age, specially in view of the longer life span implying an extended period of dependency and higher costs to meet health and other needs. The condition of the rural elderly is even more pitiable, contrary to our beliefs, as availability, affordability and accessibility to medicare facilities are poor. We undertook the task of organizing a health camp in a rural set-up with the idea of implementing our concept of "preventive palliation" in which excellent palliative care was coupled with a pinch of prevention, like routine checks of blood pressure, routine physical check-ups, etc, so that any aberration can be detected early and necessary rectification measures can be implemented. These periods of routine check-ups can also be used to assess the psycho-social, cultural and emotional problems, if any. Such an approach, say every monthly, gives the elderly something to look forward to and ensures a high degree of customer satisfaction and greatly reduces the burden on the current health system. The challenges faced and the data obtained from this study were shocking. The elderly living in rural areas of the tribal state of Jharkhand suffer from poor physical and mental health, a factor which was rather unexpected in the Indian cultural system in the rural setting. Simple strategies like implementing routine health check ups with provision of "nutritious meal program" can go a long way in mitigating these problems in a cost-effective and simple manner. To make the government-based programs accessible and available to the end-users, participation of local bodies like NGOs is mandatory. Preventive palliation, a concept introduced by Kosish, is the way forward for providing palliative care to the rural-based elderly in most parts of India. This concept takes into account the local cultural, social, financial and long term feasibility and sustainability aspects of the care process. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/70/68407 en Copyright 2017 Indian Journal of Palliative Care.
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The role of dentist in palliative care team Mol, RP The palliative doctor gives the 'touch of God' as he/she takes care of the terminally ill patient. The oncologist encounters great difficulties in managing oral cavity problems of these patients. A trained dental doctor can help other doctors in dealing with these situations. But the general dental surgeon does not have enough idea about his part in these treatments. The community is also unaware of the role that a nearby dentist can play. Adequate training programs have to be conducted and awareness has to be created. A trained dentist will be a good team mate for the oncologist or radiotherapist or other doctors of the palliative care team. In this paper, a brief attempt is made to list a few areas in which a palliative care dentist can help other members of the palliative care team and also the patient in leading a better life. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/74/68408 en Copyright 2017 Indian Journal of Palliative Care.
oai:medknow.com:68409 2010-05-01 all journal:Indian_J_Palliat_Care
Occupational care giving conditions and human rights: A study of elderly caregivers in Botswana Kangethe, S The article aims to explore and discuss the occupational care giving conditions pitting them against human rights. The article's objective is to initiate discussions and generate literature pertaining to occupational care giving load and assessing the human rights challenge it poses. The article uses analysis of the literature review from an array of eclectic data sources. The following factors were found besetting the caregivers' human rights: (1) Aging; (2) Cultural and community attitudes towards care giving; (3) Risk of contagion; (4) Health hazards and lack of compensation. Recommendations: (1) Adoption of grandparents/grandchildren care symbiosis system; (2) Government remuneration policy for caregivers; (3) Mainstreaming of gender education to encourage men and youth develop an interest in care giving; (4) Institution of laws and policies by countries to provide for the compensation of caregivers' occupational hazards and risks. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/79/68409 en Copyright 2017 Indian Journal of Palliative Care.
oai:medknow.com:68406 2010-05-01 all journal:Indian_J_Palliat_Care
Care of terminally Ill cancer patients: An intensivist's dilemma Bajwa, SK Kaur, J Background and Context: Treatment of terminally ill cancer patients always poses great challenges especially when these critical patients are admitted in intensive care unit (ICU). The severity of their diseases throws a clinical and ethical dilemma to the treating intensivist. Aims and Objectives: To evaluate the benefits of intensive care treatment in terminally ill cancer patients and also to find out whether optimal utilization of critical care resources has got any positive financial, psychological and clinical outcome. Materials and Methods: A retrospective evaluation of 53 terminally ill cancer patients, who got admitted to ICU of our department, was carried out. Majority of these patients presented with terminal phase of illness involving multi-organ pathologies with diverse range of symptoms. These patients were provided ventilatory, symptomatic and supportive treatment on patient-to-patient basis. Strict and vigilant monitoring of all vital parameters was carried out. At the end of study, all the data was compiled systematically and was subjected to statistical analysis using non parametric tests. Results: The demographic profile of such patients was highly variable with regard to educational, social and financial status (P<0.05). The most common group of cancer was hematological malignancies (24.53%) followed by lung cancer (18.87%), uteri-ovarian (15.09), colorectal (13.2%) and others. Significant number (P<0.05) of patients (64.15%) required mechanical ventilation and ionotropic support (79.24%). Mortality increased with increasing number of organ system involvement and reaching up to 100% with involvement of 5 or more organ systems. Conclusions: ICU care is the best form of treatment for terminally ill but resources should be used optimally so that a young deserving patient should not be sacrificed for the scarcity of resources. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/83/68406 en Copyright 2017 Indian Journal of Palliative Care.
oai:medknow.com:68405 2010-05-01 all journal:Indian_J_Palliat_Care
Caring for dying and meeting death: Experiences of Iranian and Swedish nurses Iranmanesh, S Axelsson, K Sävenstedt, S Häggström, T Objective: Our world is rapidly becoming a global community, which creates a need to further understand the universal phenomena of death and professional caring for dying persons. This study thus was conducted to describe the meaning of nurses' experiences of caring for dying people in the cultural contexts of Iran and Sweden. Materials and Methods: Using a phenomenological approach, phenomenon of caring for dying people was studied. Eight registered nurses who were working in oncology units in Tehran, Iran and eight registered nurses working in hospital and home care in North part of Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics. Results: The findings were formulated based on two themes included: (1) "Sharing space and time to be lost", and (2) "Caring is a learning process. Conclusions: The results showed that being with dying people raise an ethical demand that calls for personal and professional response, regardless of sex, culture or context. The physical and organizational context must be supportive and enable nurses to stand up to the demands of close relationships. Specific units and teamwork across various personnel seem to be a solution that is missing in Iran. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/90/68405 en Copyright 2017 Indian Journal of Palliative Care.
oai:medknow.com:68403 2010-05-01 all journal:Indian_J_Palliat_Care
Palliative management of malignant bowel obstruction in terminally Ill patient Thaker, DA Stafford, BC Gaffney, LS Mr. P was a 57-year-old man who presented with symptoms of bowel obstruction in the setting of a known metastatic pancreatic cancer. Diagnosis of malignant bowel obstruction was made clinically and radiologically and he was treated conservatively (non-operatively)with octreotide, metoclopromide and dexamethasone, which provided good control over symptoms and allowed him to have quality time with family until he died few weeks later with liver failure. Bowel obstruction in patients with abdominal malignancy requires careful assessment. The patient and family should always be involved in decision making. The ultimate goals of palliative care (symptom management, quality of life and dignity of death) should never be forgotten during decision making for any patient. Medknow Publications 2010-05-01 http://www.jpalliativecare.com/text.asp?2010/16/2/97/68403 en Copyright 2017 Indian Journal of Palliative Care.
oai:medknow.com:70471 2010-05-01 all journal:Indian_J_Pharm_Sci
Chloroquine-induced pruritus Aghahowa, SE Obianwu, HO Isah, AO Arhewoh, IM Chloroquine-induced pruritus remains one of the most common side-effects in the use of chloroquine in the prophylaxis and treatment of uncomplicated malaria before the advent of artemisinin-based combination therapies. It has been reported to vary from a tolerable to intolerable intensity among susceptible individuals resulting in disruption of treatment and development of resistance to the drug thus leading to therapeutic failures as reported. This scourge is quite challenging due to the complex physiologic mechanism that has not been fully elucidated. Factors observed to be responsible in the induction of pruritus such as age, race, heredity, density of parasitaemia; impurities in formulations, plasmodial specie, dosage form and metabolites have been discussed in this review. Efforts to ameliorate this burden have necessitated the use of drugs of diverse pharmacological classes such as antihistamines, corticosteroids and multivitamins either alone or as a combination. This review is to look into the use of chloroquine retrospectively, and consider its re-introduction due to its safety. Efficacy can be attained if the pruritic effect is resolved. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/283/70471 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70472 2010-05-01 all journal:Indian_J_Pharm_Sci
Optimization of luminescent assay for screening of cyclin-dependent kinase 2 inhibitors Suthar, MP Patel, MM Cyclin-dependent kinases are most extensively studied targets for cancer chemotherapy since the tumor cells exhibit false checkpoints and can proliferate even if the genome is compromised. Cyclin-dependent kinases ensure the tight regulation of the cell cycle execution by mediating phosphorylation of cellular proteins. Deregulation of the cyclin-dependent kinase 2 activity by cellular and external factors leads to many diseases like cancers. Different methods like radiolabeled, fluorescence and luminescence are available for screening of library of compounds against kinases. However, bioluminescent methods offer several advantages like low background and no effect of fluorescent compound interference. Present study is focused on development, optimization and validation of cyclin-dependent kinase 2 assay which is suitable for identification potent and selective, ATP competitive and non-competitive inhibitors of cyclin-dependent kinase 2. The aim of present investigation was to optimize the assay for cyclin-dependent kinase 2/cylin A and cyclin-dependent kinase 2/cyclin E with use of bioluminescence based biochemical reaction. Both cyclin-dependent kinase 2 which are cyclin-dependent kinase 2/cyclin A and cyclin-dependent kinase 2/cyclin E complexes, have different affinity for ATP. Therefore, both isoform analogs of cyclin-dependent kinase 2 were optimized separately. Optimum cyclin-dependent kinase 2/cyclin A and cyclin-dependent kinase 2/cyclin E concentration were found to be 250 ng/well and 200 ng/well, respectively. Optimum substrate (histone H1) concentration was found to be 2.5 mg/ml for both cyclin-dependent kinase 2 analogs. Optimum reaction time was found to be 20 min for both cyclin-dependent kinase 2/cyclin complexes. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/290/70472 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70473 2010-05-01 all journal:Indian_J_Pharm_Sci
Non-wood fibre production of microcrystalline cellulose from Sorghum caudatum: Characterisation and tableting properties Ohwoavworhua, FO Adelakun, TA The microcrystalline cellulose is an important ingredient in pharmaceutical, food, cosmetic and other industries. In this study, the microcrystalline cellulose, obtained from the stalk of Sorghum caudatum was evaluated for its physical and tableting characteristics with a view to assessing its usefulness in pharmaceutical tableting. The microcrystalline cellulose, obtained from the stalk of Sorghum caudatum, obtained by sodium hydroxide delignification followed by sodium hypochlorite bleaching and acid hydrolysis was examined for its physicochemical and tableting properties in comparison with those of the well-known commercial microcrystalline cellulose grade, Avicel PH 101. The extraction yield of this microcrystalline cellulose, obtained from the stalk of Sorghum caudatum was approximately 19%. The cellulose material was composed of irregularly shaped fibrous cellulose particles and had a moisture content of 6.2% and total ash of 0.28%. The true density was 1.46. The flow indices showed that the microcrystalline cellulose, obtained from the stalk of Sorghum caudatum flowed poorly. The hydration, swelling and moisture sorption capacities were 3.9, 85 and 24%, respectively. Tablets resulting from these cellulose materials were found to be without surface defects, sufficiently hard and having disintegration time within 15 min. The study revealed that the microcrystalline cellulose, obtained from the stalk of Sorghum caudatum compares favourably with Avicel PH 101 and conformed to official requirement specified in the British Pharmacopoeia 1993 for microcrystalline cellulose. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/295/70473 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70474 2010-05-01 all journal:Indian_J_Pharm_Sci
Determination and validation of zonisamide and its four related substances by HPLC and UV-spectrophotometry Hosseini, M Alipour, E Farokhsir, A A selective and sensitive liquid chromatographic method has been developed for simultaneous determination of zonisamide and its four related substances in pharmaceutical dosage forms. The assay involved an isocratic elution in perfectsil Target C18 column using a mobile phase composition of disodium hydrogen phosphate buffer, acetonitrile and methanol (650:150:200 v/v, pH adjusted to 3±0.05) with flow rate 1.2 ml/min and analyte monitored at 240 nm. Also a simple and precise spectrophotometric method was developed for dissolution studies. These proposed methods are sensitive, accurate, reproducible and useful for the routine determination of zonisamide in pharmacy. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/302/70474 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70475 2010-05-01 all journal:Indian_J_Pharm_Sci
Development and validation of a reversed-phase HPLC method for the determination of hydroxybenzene in a cream formulation Shabir, GA A rapid, sensitive and specific reversed-phase high performance liquid chromatographic method with diode-array detection has been developed and validated for the determination of hydroxybenzene (0.494%, w/w) in a commercially available cream pharmaceutical formulation. Isocratic chromatography was performed on a C18 column with methanol-water 60:40 (v/v) containing 0.1% phosphoric acid (v/v) as mobile phase at a flow rate of 1.0 ml/min. UV detection was at 254 nm. Linearity of the method was excellent (r <sup>2</sup> = 0.9999). The relative standard deviation values for intra- and inter-day precision studies were < 1% and the recovery of hydroxybenzene was >99%. The limit of detection and quantitation for hydroxybenzene was found to be 13.5 η g/ml and 2 μg/ml, respectively. The method was also validated for specificity and robustness. The method was found to be robust and can be reliably used to determine the hydroxybenzene content of marketed formulations. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/307/70475 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70476 2010-05-01 all journal:Indian_J_Pharm_Sci
Development and validation of a RPLC method for the determination of 2-phenoxyethanol in senselle lubricant formulation Shabir, GA Bradshaw, TK Shar, GQ Arain, SA A new and simple reversed-phase liquid chromatographic method has been developed and validated for the determination of 2-phenoxyethanol preservative (0.3%, w/w) in senselle lubricant formulation. The separation was achieved with acetonitrile-tetrahydrofuran-water (21:13:66, v/v/v) as mobile phase, a C <sub>8</sub> column, and UV detection at 258 nm. The calibration curve is linear (r <sup>2</sup> = 0.9999) from 20-140% of the analytical concentration of 0.75 mg/ml. The mean percent relative standard deviation values for intra- and inter-day precision studies are <1%. The recovery of 2-phenoxyethanol ranged between 99.76 and 100.03% from lubricant formulation. The limits of detection and quantitation are determined to be 0.094 and 0.15 mg/ml, respectively. The method was found to be robust and can be successfully and reliably used to determine the 2-phenoxyethanol preservative content of marketed formulations. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/312/70476 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70477 2010-05-01 all journal:Indian_J_Pharm_Sci
Study of the complexation behaviour of fexofenadine with β-cyclodextrin Sapkal, NP Kilor, VA Shewale, BD Bhusari, KP Daud, AS Fexofenadine is a selective histamine H <sub>1</sub> receptor antagonist, used for relief of the symptoms of allergy. However its aqueous solubility is very poor. Solid inclusion complexes of fexofenadine and β-cyclodextrin were prepared at the molar ratios of 1:1 and 1:2 by kneading, and coprecipitation methods to improve its solubility. Characterization of the complexes was performed using infrared spectroscopy, X-ray diffractometry, and in vitro dissolution studies. Fexofenadine was found to exhibit interaction with β-cyclodextrin both in solid and liquid state. Phase solubility studies indicated that fexofenadine forms a stable complex with β-cyclodextrin. Both IR spectroscopy and X-ray diffractometry studies indicated interaction of fexofenadine with β-cyclodextrin. Kneading method at 1:1 and co-precipitation method at 1:1 and 1:2 molar ratios showed significant interaction. In vitro dissolution studies confirmed the same results. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/318/70477 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70478 2010-05-01 all journal:Indian_J_Pharm_Sci
Binding modes of 2,4-diaminoquinazoline and 2,4-diaminopteridine analogs to P. falciparum dihydrofolate reductase enzyme: Molecular docking studies Adane, L Bharatam, PV A molecular docking study was carried out on 28 compounds belonging to 2,4-diaminoquinazoline and 2,4-diaminopteridine analogs using Glide, FlexX and GOLD programs and the X-ray crystallographic structures of the quadruple mutant (1J3K:pdb) and wild type (1J3I:pdb) Plasmodium falciparum dihydrofolate reductase enzyme. The experimental conformation the bound ligand WR99210 was precisely reproduced by the docking procedures as demonstrated by low (<2.00 Ε) root-mean-square deviations. The results indicated that most of the compounds dock into the active sites of both the wild type and quadruple mutant P. falciparum dihydrofolate reductase enzymes. Visual inspection of the binding modes also demonstrated that most of the compounds could form H-bond interactions with the key amino acid residues (Asp54, Ile14 and Leu/Ile164) and with better docking scores than the bound compound (5). Their long side chains orient in the hydrophobic portion of the active site which is occupied by trichloro aryloxy side chain of WR99210 (5). Thus, avoid potential steric clashes with Asn108 (mutated from Ser108). Such a clash is known to be responsible for the resistance of the P. falciparum to pyrimethamine and cycloguanil. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/324/70478 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70479 2010-05-01 all journal:Indian_J_Pharm_Sci
Medicinal plants used in wound care: A study of Prosopis africana (Fabaceae) stem bark Ezike, AC Akah, PA Okoli, CO Udegbunam, S Okwume, N Okeke, C Iloani, O The effects of the methanol extract of the stem bark of Prosopis africana (Guill., Perrott. and Rich.) Taubert (Fabaceae) on bleeding/clotting and coagulation time, excision and dead space wounds were studied in rats. Also, the extract was subjected to antibacterial, and acute toxicity and lethality (LD <sub>50</sub> ) tests. The extract significantly (P<0.05) reduced bleeding/clotting and coagulation time in rats. It also reduced epithelialization period of excision wounds in rats and inhibited the growth of laboratory strains of Staphylococcus aureus, Bacillus subtilis, Salmonella typhi, Pseudomonas aeruginosa and Klebsiella pneumoniae to varying extents. Acute toxicity and lethality (LD <sub>50</sub> ) test on the extract established an LD <sub>50</sub> of 774 mg/kg (i.p) in mice while phytochemical analysis gave positive reactions for alkaloids, saponins, tannins, flavonoids, steroids, terpenoids and carbohydrates. The results of this study demonstrate the beneficial effects of the stem bark of P. africana in wound care. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/334/70479 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70480 2010-05-01 all journal:Indian_J_Pharm_Sci
In vitro evaluation of Terminalia arjuna on calcium phosphate and calcium oxalate crystallization Chaudhary, A Singla, SK Tandon, C Urinary stones are one of the oldest and the most common afflictions in humans. This disease has tormented humans since the earliest records of civilization. Ten percent of men and 3 % of women have a stone during their adult lives. Calcium containing stones are the most common comprising about 75 % of all urinary calculi, which may be in the form of pure calcium oxalate (50 %) or calcium phosphate (5 %) or a mixture of both (45 %). A number of plants have been mentioned in the Indian ayurvedic system, which plays a vital role in the inhibition of kidney stones. In the present study, the inhibitory potency of crude extracts or fractions of successive solvent extractions of Terminalia arjuna bark was evaluated on various stages of formation of calcium phosphate and on the growth of calcium oxalate monohydrate crystals in vitro. Results obtained indicated that Terminalia arjuna bark has the potential to inhibit the formation of both calcium phosphate and calcium oxalate crystals in vitro. Butanol fraction of Terminalia arjuna extract was the most effective in inhibiting formation of calcium phosphate and calcium oxalate crystals in vitro. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/340/70480 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70481 2010-05-01 all journal:Indian_J_Pharm_Sci
Preparation and In vitro / In vivo characterization of spray dried microsphere formulation encapsulating 4-chlorocurcumin Gogu, PK Jithan, AV The objective of the present study was to prepare and characterize in vitro and in vivo performance of a sustained release microsphere formulation of 4-chlorocurcumin, a novel curcumin analogue. A spray dried technique with ethylcellulose as the polymer was used in the preparation of these microspheres. Microspheres were characterized for drug content, particle size and shape, in vitro drug release and the drug-polymer interaction. To assess in vivo performance, both pharmacokinetics and hepatoprotective activity were investigated. Results were compared with an equivalent i.v. solution. The microspheres of 4-chlorocurcumin with ethylcellulose were successfully prepared using a spray-dried technique. These microspheres were able to sustain the release of the drug both in vitro as well as in vivo. Microspheres offered better pharmacokinetic and hepatoprotective properties to the drug compared to its solution form. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/346/70481 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70482 2010-05-01 all journal:Indian_J_Pharm_Sci
Sub-chronic hepatotoxicity of Anacardium occidentale (Anacardiaceae) inner stem bark extract in rats Okorie, O Okonta, JM Okonkwo, CJ The extracts of Anacardium occidentale have been used in the management of different cardiovascular disorders in Nigeria. These have necessitated the assessment of the toxicity of this plant extract in sub-chronic administration. The inner stem bark of Anacardium occidentale was extracted with 80 % methanol and quantitatively analysed for antinutrients and some heavy metals. The phytochemical compositions and acute toxicity of the extract were determined also. Toxicity profiles of the extract on some liver function parameters were evaluated following a sub-chronic oral administration at doses of 1.44 and 2.87 g/kg. The phytochemical screening of extract revealed the presence of high amount of tannins, moderate saponins and trace of free reducing sugars. The antinutrient levels were 5.75 % (tannins), 2.50 % (oxalates), 2.00 % (saponins), 0.25 % (phytate) and 0.03 % (cyanide). The quantity of iron detected from dried crude was 8.92 mg/100 g, while lead and cadmium were non-detectable. The extract had LD <sub>50</sub> of 2.154 g/kg p.o. in mice. Sub-chronic administration of the extract significantly increased the serum levels of alanine aminotransaminase and aspartate aminotransaminase, which are indicative of liver damage. The serum levels of alkaline phosphatase and total protein of the treated animals were not significantly increased. The effects of sub-chronically administered extract on hepatocytes were minimal as the serum alkaline phosphatase; total bilirubin and total protein levels in treated animals were not significant (p< 0.05). Thus, sub-chronic administrations of Anacardium occidentale inner stem bark extract did not significantly (p< 0.05) depress the function of hepatocytes in Wistar rats. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/353/70482 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70483 2010-05-01 all journal:Indian_J_Pharm_Sci
Microwave assisted synthesis and biological activity of novel coumarinyltriazolothiadiazoles Kumar, PM Ravi, TK Chawla, R Bhuvana, S Sonia, G Gopalakrishnan, S A series of new 3-(4-methylcoumarinyl-7-oxymethyl)-6-substitutedphenyl-5,6-dihydro-s-triazolo (3,4-b)(1,3,4)-thiadiazoles 2(a-j) have been synthesized by reacting 5-(4-methyl coumarinyl-7-oxymethyl)-4-amino-3-mercapto(4H)-1,2,4-triazole with various aromatic aldehydes by microwave assisted organic synthesis. The structure of the compounds 2 (a-j) has been confirmed by IR, <sup>1</sup> H NMR and mass spectral data. All the compounds were screened for antimicrobial and antioxidant activity. Among the compounds tested, compounds 2d (4-dimethyl amino phenyl derivative) and 2h (3,4-dimethoxy phenyl derivative) showed better antimicrobial and antioxidant activity than rest of the compounds in the series. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/357/70483 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70484 2010-05-01 all journal:Indian_J_Pharm_Sci
Isolation and characterization of a process impurity in tizanidine hydrochloride Gore, VG Mahajan, A Kumar, M A new process impurity was detected during the HPLC analysis of Tizanidine hydrochloride (I) batches. The impurity (II) was isolated by preparative HPLC and characterized by NMR and Mass spectral analysis as 5-S-ethyl-N-(4,5-dihydro-1H-imidazol-2-yl)-2,1,3-benzothiadiazol-4-amine hydrochloride. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/360/70484 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70485 2010-05-01 all journal:Indian_J_Pharm_Sci
Design and synthesis of some novel 4-(4-substituted aryl) semicarbazones as anticonvulsant agents Singh, A Pande, C Gahtori, P Pandeya, SN Stables, JP In the present study, a series of 4-(4-substituted aryl) semicarbazones were synthesized from substituted anilines and subsequently evaluated for their anticonvulsant activities. The anticonvulsant activities were established by the anticonvulsant drug development (ADD) programme NIH, USA using experimental animal, adult male FCM mice (20-25 g) and adult Sprague-Dawley rats (100-150 g) and screened against electroshock seizure, subcutaneous metrazole and minimal neurotoxicity tests in mice. Compound 7 was found equipotent to carbamazepine in both MES and ScPTZ tests. This study has highlighted the importance of distal alkyl chain which influences the anticonvulsant activity. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/363/70485 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70486 2010-05-01 all journal:Indian_J_Pharm_Sci
Comparative study of proton pump inhibitors on dexamethasone plus pylorus ligation induced ulcer model in rats Sajjan, M Palkar, MB Koti, BC Viswanathaswamy, A The present study was designed to compare ulcer protective effect of proton pump inhibitors viz. omeprazole, rabeprazole and lansoprazole against dexamethasone plus pylorus ligation induced ulcer model. Dexamethasone (5 mg/kg) was used as an ulcerogen. Dexamethasone suspended in 1% CMC in water was given orally to all the rats 15 min after the pylorus ligation. Omeprazole (20 mg/kg), rabeprazole (20 mg/kg), and lansoprazole (20 mg/kg) were administered by oral route 30 min prior to ligation was used for ulcer protective studies, gastric secretion and mucosal studies. Effects of proton pump inhibitors were determined by the evaluation of various biochemical parameters such as ulcer index, free and total acidity, gastric pH, mucin, pepsin and total proteins. Oral administration of proton pump inhibitors showed significant reduction in gastric acid secretion and ulcer protective activity against dexamethasone plus pylorus ligation induced ulcer model. The % protection of omeprazole, rabeprazole and lansoprazole was 84.04, 89.36 and 79.78, respectively. Rabeprazole significantly inhibited the acid-pepsin secretion and increased the gastric mucin secretion. The observations made in the present study suggest that rabeprazole is the most effective gastric antisecretory and ulcer healing agent as compared to omeprazole and lansoprazole. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/367/70486 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70487 2010-05-01 all journal:Indian_J_Pharm_Sci
Evaluation of antiseizure activity of essential oil from roots of Angelica archangelica Linn. in mice Pathak, S Wanjari, MM Jain, SK Tripathi, M In the present study, the effect of essential oil of the root of Angelica archangelica Linn. was evaluated against electrically and chemically induced seizures. The seizures were induced in mice by maximal electroshock and pentylenetetrazol. The effect of essential oil of the root of Angelica archangelica on seizures was compared with standard anticonvulsant agents, phenytoin and diazepam. The essential oil of the root of Angelica archangelica suppressed duration of tonic convulsions and showed recovery in maximal electroshock induced seizures while it delayed time of onset of clonic convulsions and showed mortality protection in pentylenetetrazol induced seizures. The essential oil of the root of Angelica archangelica also produced motor impairment at the antiseizure doses. The study indicated that the essential oil exhibited antiseizure effect. The antiseizure effect may be attributed to the presence of terpenes in the essential oil. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/371/70487 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70488 2010-05-01 all journal:Indian_J_Pharm_Sci
Anticonvulsant activity of schiff bases of 3-amino-6,8-dibromo-2-phenyl-quinazolin-4(3H)-ones Paneersalvam, P Raj, T Ishar, M Singh, B Sharma, V Rather, BA Schiff bases (9a-l) of 3-amino-6,8-dibromo-2-phenyl-quinazolin-4-(3H)-ones (8) with various substituted aldehydes were obtained by refluxing 1:1 molar equivalents of the reactants in dry ethanol for 6 h. The aminoquinazoline (8) was inturn obtained from 3,5-dibromoantharlinic acid via intermediate (7). All the synthesized compounds (9a-l) were evaluated for their anticonvulsant activity on albino mice by maximal electroshock method using phenytoin as a standard. The compound (9l) bearing a cinnamyl function displays a very high activity (82.74 %) at dose level of 100 mg/kg b.w. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/375/70488 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70489 2010-05-01 all journal:Indian_J_Pharm_Sci
Microwave-assisted synthesis of an important intermediate of benazepril Mistry, B Medhane, D Mohanraj, K Ghone, SA Rapid and efficient methods for the synthesis of an important intermediate of benazepril ethyl 3-phthalimido-2,3,4,5-tetrahydro-1H-[1]benzazepin-2-one-1-acetate under the influence of microwave irradiation are described. A comparative study of conventional and microwave assisted method is briefly discussed. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/378/70489 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70490 2010-05-01 all journal:Indian_J_Pharm_Sci
A stability-indicating HPLC method for assay of lercanidipine hydrochloride in tablets and for determining content uniformity Kaila, HO Ambasana, MA Thakkar, RS Saravaia, HT Shah, AK A simple, precise and accurate HPLC method has been developed and validated for assay of lercanidipine hydrochloride in tablets and for determination of content uniformity. An isocratic separation was achieved using a Chromasil YMC Pack C <sub>8</sub> , 150 Χ 4.6 mm i.d., 5μm particle size columns with a flow rate of 1 ml/min and using a UV detector to monitor the elute at 240 nm. The mobile phase consisted of 0.02 M ammonium dihydrogen phosphate buffer:methanol (35:65, v/v) with pH 3.5 adjusted with phosphoric acid. The method was validated for specificity, linearity, pre-cision, accuracy, robustness and solution stability. The specificity of the method was deter-mined by assessing interference from the placebo and by stress testing of the drug (forced degradation). The method was linear over the concentration range of 20-80 μg/ml (r <sup>2</sup> = 0.9992) with a limit of detection and quantitation of 0.1 and 0.3 μg/ml respectively. Intraday and interday system and method precision were determined and accuracy was between 99.3-101.9 %. The method was found to be robust and suitable for assay of lercanidipine hydrochloride in a tablet formulation and for determination of content uniformity. Degradation products resulting from the stress studies did not interfere with the detection of lercanidipine hydrochloride and the assay is thus stability-indicating. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/381/70490 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70491 2010-05-01 all journal:Indian_J_Pharm_Sci
RP-HPLC method for simultaneous estimation of frusemide and amiloride hydrochloride in tablet formulation Nagori, BP Solanki, R A new reverse phase high performance liquid chromatography method for the simultaneous estimation of frusemide and amiloride hydrochloride in tablet formulation is developed. The determination was carried out on a HIQ SIL, C18 (250Χ4.6 mm, 5 μm) column using a mobile phase of 50 mM phosphate buffer solution:acetonitrile (50:50 v/v, pH 3.0). The flow rate was 1.0 ml/min with detection at 283 nm. The retention time for frusemide was 3.038 min and for amiloride hydrochloride 10.002 min. Frusemide and amiloride hydrochloride showed a linear response in the concentration range of 20-200 μg/ml and 10-100 μg/ml, respectively. The results of analysis have been validated statistically and by recovery studies. The mean recoveries found for frusemide was 99.98% and for amiloride hydrochloride was 100.09%. Developed method was found to be simple, accurate, precise and selective for simultaneous estimation of frusemide and amiloride hydrochloride in tablets. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/384/70491 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70492 2010-05-01 all journal:Indian_J_Pharm_Sci
Screening of ethanol, petroleum ether and chloroform extracts of medicinal plants, Lawsonia inermis L. and Mimosa pudica L. for antibacterial activity Akter, A Neela, FA Islam, MS Alam, MF Organic extracts (ethanol, petroleum ether and chloroform) of two medicinal plants Lawsonia inermis L. and Mimosa pudica L. were proven for antibacterial properties against 15 Gram-positive and Gram-negative human pathogenic bacteria. Among the three types of extracts tested, ethanol extract was found to possess maximum antibacterial activity. The diameter of the zone of inhibition of bacterial growth showed that Gram-negative bacteria are more sensitive than Gram-positive bacteria to plant extracts. Between the two plants species studied, Lawsonia inermis extract showed more antibacterial activity compared to Mimosa pudica extract. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/388/70492 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70493 2010-05-01 all journal:Indian_J_Pharm_Sci
Protective effect of ethanol extract of Gymnosporia montana (Roth) Bemth. in paracetamol-induced hepatotoxicity in rats Patel, PB Patel, TK Shah, P Baxi, SN Sharma, HO Tripathi, CB The aim of the present study was to explore the hepatoprotective activity of the ethanol extract of leaves of Gymnosporia montana (Roth) Bemth. (Family: Celastraceous) against paracetamol-induced hepatotoxicity. Hepatotoxicity in Wistar rats was induced by a single intraperitoneal dose of 500 mg/kg of paracetamol and studied by comparing parameters such as serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, alkaline phosphatase and histopathological examination of liver. Pre and post-treatment with ethanol extract of Gymnosporia montana (Roth) Bemth. at doses of 50 and 100 mg/kg was studied by comparing the above mentioned parameters with silymarin (100 mg/kg) as standard. Both doses of ethanol extract of Gymnosporia montana (Roth) Bemth. were found to be hepatoprotective. Extract at the dose of 100 mg/kg produced effects comparable to those of silymarin. The present study indicates that alcohol extract of Gymnosporia montana (Roth) Bemth. possessed significant hepatoprotective activity. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/392/70493 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70494 2010-05-01 all journal:Indian_J_Pharm_Sci
Effect of plant extracts formulated in different ointment bases on MDR strains Pawar, PL Nabar, BM Extracts of Aloe vera whole plant, Eucalyptus globulus leaves, Ficus infectoria bark, Ficus religiosa bark and Piper betel leaves were studied for antibacterial activity on resistant and sensitive strains, isolated from skin and soft tissue infections. A combination of hot alcoholic extracts of Ficus infectoria, Ficus religiosa and Piper betel were found to be more effective against all the isolates. The combined extract was formulated in different ointment bases such as polyethylene glycol, gelatin, sodium alginate, carbopol, cream base and honey. These were then evaluated to find a suitable base for preparation of an ointment. In vitro study of the release of antimicrobials and kill-time studies of the herbal ointments was carried out against multi-drug resistant isolate of Pseudomonas. The ointment showed bactericidal activity within 2 h against the resistant strain of Pseudomonas spp. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/397/70494 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70496 2010-05-01 all journal:Indian_J_Pharm_Sci
Rapid liquid chromatographic method for the determination of roflumilast in the presence of degradation products Barhate, VD Deosthalee, P A forced degradation study on roflumilast drug substance was conducted under the conditions of hydrolysis, oxidation, thermal and photolysis. The method was developed and optimized by analyzing forcefully degraded samples. The best separation was achieved on a Zorbax SB C18 1.8 ΅m column with 0.005 M ammonium formate buffer pH 3.5 and acetonitrile as mobile phase in a 13 min run time. The proposed method was able to resolve all the possible degradation products formed during stress study. The drug was stable to neutral, thermal and photolytic conditions but unstable to acidic, alkaline and oxidative conditions at 80Ί for 24 h. The degradation products resulting from stress study did not interfere in assay and related substances of roflumilast and thus the method can be regarded as stability indicating. An alternate method was also developed on a conventional 250Χ4.6 mm, 5 ΅m column wherein runtime was 38 min. Thus rapid resolution high throughput column was able to reduce the run time from 38 min to 13 min. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/401/70496 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:70498 2010-05-01 all journal:Indian_J_Pharm_Sci
Use of drugs and cost of treatment of diarrhea in secondary level government hospitals in Maharashtra Rao, PH Kabra, SG A prescription audit was carried out among the outpatient attendees of 31 secondary level hospitals under Maharashtra Health Systems Development Project. Use of drugs and cost of treatment of diarrhoea were studied using the prescriptions for diarrhoea collected for the prescription audit. Average number of drugs prescribed per prescription for treatment of diarrhoea was 3.7. It was higher than average number of drugs per prescription in the Maharashtra Health Systems Development Project hospitals in general. About three fourths of the prescriptions contained oral rehydration salts. Furazolidone and metronidazole were prescribed in about half of the prescriptions. Cotrimoxazole was prescribed in about one fourth of prescriptions. About 60% of the prescriptions contained other drugs. The average cost of prescription for diarrhoea was Rs. 14 and increased with the number of drugs prescribed. Average cost of prescription was the highest for those written by general practitioners. Pathological tests were indicated only in case of 11%. Medknow Publications 2010-05-01 http://www.ijpsonline.com/text.asp?2010/72/3/404/70498 en Copyright 2017 Indian Journal of Pharmaceutical Sciences.
oai:medknow.com:66830 2010-05-01 all journal:Indian_J_Pharmacol
Access to essential medicines and standard treatment for chronic diseases Kotwani, A Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/127/66830 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66833 2010-05-01 all journal:Indian_J_Pharmacol
Animal models and biomarkers of neuropathy in diabetic rodents Shaikh, AS Somani, RS Diabetic neuropathy (DN) is a multifactor complication of diabetes. It is a late finding in type 1 diabetes, but can be an early finding in type 2 diabetes. The cause of DN is still unclear and, like other complications of diabetes, it may be the result of various pathological conditions. Animal models and biomarkers of DN have been extensively used in neuropathic research. The most useful model of DN should exhibit the key feature present in human pathology. Diabetic rodents show behavioral, functional, structural and molecular biomarkers and they are widely used as models to investigate the etiology of DN as well as to screen the efficacy of the potential therapeutic interventions. We have reviewed the different animal models and biomarkers of neuropathy in diabetic rodents of either type 1 or type 2 diabetes. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/129/66833 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66834 2010-05-01 all journal:Indian_J_Pharmacol
Topiramate for anger control: A systematic review Varghese, BS Rajeev, A Norrish, M Background : Uncontrolled anger while being most commonly associated with personality disorders could also be part of many other conditions such as chronic low back ache and post-traumatic stress disorder. The intensity of anger as an emotional state at a particular time is known as "State Anger," whereas how often angry feelings are experienced over time is known as "Trait Anger." Anger could also manifest as expression of anger toward other persons or objects in the environment (Anger-Out), holding in or suppressing angry feelings (Anger-In) and controlling angry feelings by preventing the expression of anger toward other persons or objects in the environment or controlling suppressed angry feelings by calming down or cooling off (Anger Control). Objective : To prove the effectiveness of topiramate in the control of anger as compared to placebo and to disprove that its use leads to psychiatric adverse events by systematically reviewing the available randomized controlled trials. Materials and Methods : The basic search was performed in MEDLINE (1966 through November 2008) combined with the optimal search strategy for randomized controlled trials described in the Cochrane Reviewers' Handbook. To update this search, we regularly screened citations from PubMed till November 2008 for eligible studies or reviews that might include eligible studies. The Cochrane Central Register of Controlled Trials (CENTRAL) was searched using the terms "topiramate" and "anger or aggression." In addition, we screened bibliographies of reviews and identified articles. Randomized clinical trials wherein study participants were aggressive adults were included. Results : We could arrive at a weighted mean difference of -3.16 (-3.64 to -2.68) in State Anger. The reduction in the score was highest in borderline personality disorder (BPD) patients as compared to those with low back ache. Trait Anger dropped by -2.93 (-3.49 to -2.37), especially in female BPD patients. Anger In reduced more or less uniformly across the studies by -1.43 (-1.84 to -1.03). Anger Out decreased by -2.8 (-3.19 to -2.42). This effect was minimal among the male BPD patients. Anger Control uniformly increased across the four studies by 2.32 (2.00-2.64). There is sufficient evidence to suggest that topiramate is significantly effective in stabilizing the "trait anger" while reducing the "state anger." "Anger Out" and "hostility" were significantly reduced. "Anger In" was the feature that was the least affected, although this was significant. This suggests that topiramate is effective in controlling anger. There was no suggestion of topiramate precipitating psychomorbidity. Conclusions : Topiramate appears to be a safe and effective drug in the management of anger/aggression. Additional research is needed to determine whether these results can be reproduced and how long lasting are the benefits of long-term treatment with topiramate. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/135/66834 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66835 2010-05-01 all journal:Indian_J_Pharmacol
Effect of saturated fatty acid-rich dietary vegetable oils on lipid profile, antioxidant enzymes and glucose tolerance in diabetic rats Kochikuzhyil, BM Devi, K Fattepur, SR Objective : To study the effect of saturated fatty acid (SFA)-rich dietary vegetable oils on the lipid profile, endogenous antioxidant enzymes and glucose tolerance in type 2 diabetic rats. Materials and Methods : Type 2 diabetes was induced by administering streptozotocin (90 mg/kg, i.p.) in neonatal rats. Twenty-eight-day-old normal (N) and diabetic (D) male Wistar rats were fed for 45 days with a fat-enriched special diet (10%) prepared with coconut oil (CO) - lauric acid-rich SFA, palm oil (PO) - palmitic acid-rich SFA and groundnut oil (GNO) - control (N and D). Lipid profile, endogenous antioxidant enzymes and oral glucose tolerance tests were monitored. Results : D rats fed with CO (D + CO) exhibited a significant decrease in the total cholesterol and non-high-density lipoprotein cholesterol. Besides, they also showed a trend toward improving antioxidant enzymes and glucose tolerance as compared to the D + GNO group, whereas D + PO treatment aggravated the dyslipidemic condition while causing a significant decrease in the superoxide dismutase levels when compared to N rats fed with GNO (N + GNO). D + PO treatment also impaired the glucose tolerance when compared to N + GNO and D + GNO. Conclusion : The type of FA in the dietary oil determines its deleterious or beneficial effects. Lauric acid present in CO may protect against diabetes-induced dyslipidemia. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/142/66835 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66836 2010-05-01 all journal:Indian_J_Pharmacol
Effect of centchroman coadministration on the pharmacokinetics of metformin in rats Lal, J Jain, GK Objectives : To study the effect of centchroman, a non-steroidal oral contraceptive, coadministration on the pharmacokinetics of metformin in rats. Materials and Methods : The pharmacokinetic interaction of metformin was studied in normal Sprague-Dawley female rats with and without centchroman coadministration. Blood samples were analyzed using a validated high-performance liquid chromatography method to generate the pharmacokinetic profile of metformin. The C <sub>max</sub> and t <sub>max</sub> were directly read from the concentration-time data. Other pharmacokinetic parameters were estimated using non-compartmental analyses. Results : Metformin was monitored up to 10 h, and it exhibited a double-peak phenomenon. The C <sub>max 1,</sub> 2.62 ± 0.32 μg/ml, and C <sub>max</sub> <sub>2,</sub> 2.96 ± 0.65 μg/ml, occurred after 0.75 and 3 h post-dose, respectively. The mean residence time (MRT), AUC <sub>0-4 h</sub> and volume of distribution (Vd/F) were 4.20 ± 0.30 h, 8.53 ± 1.89 μg.h/ml and 14.24 ± 5.42 L/kg, respectively. Following centchroman coadministration, metformin showed significantly (P < 0.05) higher C <sub>max</sub> (C <sub>max 1,</sub> 3.96 ± 0.55 μg/ml and C <sub>max 2,</sub> 5.21 ± 0.59 μg/ml), AUC <sub>0-4 h</sub> (12.28 ± 0.73 μg.h/ml) and Vd/F (18.29 ± 1.19 L/kg), but lower MRT (3.19 ± 0.36 h) than the values obtained after metformin dosing alone. However, AUC<sub>0-t</sub> (17.74 ± 5.58 μg.h/ml) and clearance (3.76 ± 0.80 L/h/kg) remained unchanged. Conclusions : The results indicate that centchroman coadministration increases the rate but not the extent of absorption of metformin in rats. However, it does not seem to alter the pharmacokinetics of metformin to clinically significant levels. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/146/66836 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66837 2010-05-01 all journal:Indian_J_Pharmacol
Attitude and opinion towards essential medicine formulary Sharma, S Kh, R Chaudhury, RR Objective : The Delhi State Drug Policy was adopted in 1994 following which the first Essential Medicines List (EML) was developed in 1996. The Delhi State Essential Medicines Formulary was brought out in 1997. A need was felt to revise the formulary to match with the EML as the EML is renewed every 2 years. Materials and Methods : A survey was undertaken to elicit the opinions of the doctors practicing in the state on the usefulness of the formulary before revising and printing the updated version. The survey covered dispensaries, 10-20 bedded hospitals, 100-bedded hospitals and two tertiary care hospitals. Discussions were focused on questionnaires on attitudes toward adopting Essential Medicines Formulary using a 10-point scale. Results : Of the 200 doctors approached, only 90 doctors completed the questionnaire. Sixty-nine respondents (76.6%) had received the copy of the formulary. Most practitioners welcomed the formulary and were satisfied with the coverage and selection of the medicines. Most respondents (76.9%) agreed that a well-developed formulary would improve the quality of the public health care system, although they had reservations about the authority, relevance and effect on professional autonomy. Conclusion : About 74% of the respondents used the formulary in clinical practice as a source of medicine information, which makes its regular revision necessary. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/150/66837 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66838 2010-05-01 all journal:Indian_J_Pharmacol
Comparison of the efficacy and tolerability of telmisartan and enalapril in patients of mild to moderate essential hypertension Akat, PB Bapat, TR Murthy, MB Karande, VB Burute, SR Background : Theoretically, angiotensin II receptor blockers (ARBs) have certain advantages over angiotensin-converting enzyme inhibitors, but the contribution of these advantages to the clinical effect of ARBs is not known. Objective : To compare the efficacy and tolerability of telmisartan with enalapril in patients of essential hypertension. Materials and Methods : Patients of mild to moderate hypertension were randomized to receive either 40 mg of telmisartan or enalapril 10 mg once a day orally for 12 weeks. At each visit, the systolic blood pressure (BP), diastolic BP and heart rate of each patient were recorded. Investigations such as hemogram hemoglobin, total leucocytes count (Hb, TLC), serum creatinine, serum glutamic oxaloacetic transaminase, serum glutamic pyruric transaminase (SGOT, SGPT) random blood sugar and urine examination were performed at baseline and after 12 weeks of the treatment period. Results : The mean reduction in systolic BP in the telmisartan/enalapril group was 26.38 ± 10.98/26.74 ± 8.24 mmHg while the mean reduction in diastolic BP in the telmisartan/enalapril group was 14 ± 2.98/9.71 ± 4.23 mmHg, respectively, at 12 weeks. When the reduction in systolic BP in the two groups was compared, there was no significant difference between the groups (P > 0.05). However, the mean reduction in diastolic BP achieved with telmisartan at 12 weeks was significantly higher (P < 0.001) than that achieved with enalapril after the corresponding period. The overall frequency of adverse-effects was similar. However, in the enalapril group, the incidence of dry cough was higher as compared to that in the telmisartan group (11.43% vs. 0%, respectively; P < 0.05). Conclusion : Telmisartan produces a greater reduction in diastolic BP than enalapril and is free from the adverse-effect of dry cough that is commonly encountered with enalapril. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/153/66838 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66839 2010-05-01 all journal:Indian_J_Pharmacol
Antidiarrheal activity of extracts and compound from Trilepisium madagascariense stem bark Teke, GN Kuiate, J Kuete, V Teponno, RB Tapondjou, LA Vilarem, G Objective : The present study was performed to evaluate the preventive and curative antidiarrheal effects of the methanol extract, fractions and compound from the stem bark of Trilepisium madagascariense in rats. Materials and Methods : The methanol extract from the stem bark of T. madagascariense, its fractions (n-hexane, ethyl acetate, n-butanol and aqueous residue) and compound (obtained from further column chromatography of the ethyl acetate fraction) were evaluated for the antidiarrheal activity in rats. These test samples (at 100, 200 and 400 mg/kg for the extract and fractions and 2.5 mg/kg for compound) were assayed on the latent periods, purging indices and fecal frequencies in castor oil-induced diarrhea. Gastrointestinal transit and castor oil-induced enteropooling assays were conducted. Shigella-induced diarrhea was assayed. Blood chemistry and fecal Shigella load were examined. Results : The fractionation of the ethyl acetate fraction from the methanol extract of T. madagascariense afforded a known compound [isoliquiritigenin (1)]. Compound 1 increased the latent period of diarrhea induction (179.40 min) compared to the saline control (60.80 min). The purging indices, fecal frequencies and intestinal enteropooling decreased with an increase in the dose of test samples. The blood cell counts, sera creatinine and fecal Shigella load decreased significantly (P ≤ 0.05) in the plant extract-treated rats compared to the saline control. Conclusion : The results of our study, being reported for the first time, provide clear evidence that the methanol extract, fractions and isoliquiritigenin from T. madagascariense stem bark possess antidiarrheal activities. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/157/66839 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66840 2010-05-01 all journal:Indian_J_Pharmacol
Antiamnesic effect of stevioside in scopolamine-treated rats Sharma, D Puri, M Tiwary, AK Singh, N Jaggi, AS The present study was undertaken to explore the potential of stevioside in memory dysfunction of rats. Memory impairment was produced by scopolamine (0.5 mg/kg, i.p.) in animals. Morris water maze (MWM) test was employed to assess learning and memory. Brain acetylcholinestrase enzyme (AChE) activity was measured to assess the central cholinergic activity. The levels of brain thiobarbituric acid-reactive species (TBARS) and reduced glutathione (GSH) were estimated to assess the degree of oxidative stress. Scopolamine administration induced significant impairment of learning and memory in rats, as indicated by a marked decrease in MWM performance. Scopolamine administration also produced a significant enhancement of brain AChE activity and brain oxidative stress (increase in TBARS and decrease in GSH) levels. Pretreatment of stevioside (250 mg/kg dose orally) significantly reversed scopolamine-induced learning and memory deficits along with attenuation of scopolamine-induced rise in brain AChE activity and brain oxidative stress levels. It may be concluded that stevioside exerts a memory-preservative effect in cognitive deficits of rats possibly through its multiple actions. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/164/66840 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66841 2010-05-01 all journal:Indian_J_Pharmacol
Efficacy study of Prunus amygdalus (almond) nuts in scopolamine-induced amnesia in rats Kulkarni, KS Kasture, SB Mengi, SA Objective : Cognitive disorders such as amnesia, attention deficit and Alzheimer's disease are emerging nightmares in the field of medicine because no exact cure exists for them, as existing nootropic agents (piractam, tacrine, metrifonate) have several limitations. The present study was undertaken to investigate the effect of Prunus amygdalus (PA) nuts on cognitive functions, total cholesterol levels and cholinesterase (ChE) activity in scopolamine-induced amnesia in rats. Materials and Methods : The paste of PA nuts was administered orally at three doses (150, 300 and 600 mg/kg) for 7 and 14 consecutive days to the respective groups of rats. Piracetam (200 mg/kg) was used as a standard nootropic agent. Learning and memory parameters were evaluated using elevated plus maze (EPM), passive avoidance and motor activity paradigms. Brain ChE activity and serum biochemical parameters like total cholesterol, total triglycerides and glucose were evaluated. Results : It was observed that PA at the above-mentioned doses after 7 and 14 days of administration in the respective groups significantly reversed scopolamine (1 mg/kg i.p.)-induced amnesia, as evidenced by a decrease in the transfer latency in the EPM task and step-down latency in the passive avoidance task. PA reduced the brain ChE activity in rats. PA also exhibited a remarkable cholesterol and triglyceride lowering property and slight increase in glucose levels in the present study. Conclusion : Because diminished cholinergic transmission and increase in cholesterol levels appear to be responsible for the development of amyloid plaques and dementia in Alzheimer patients, PA may prove to be a useful memory-restorative agent. It would be worthwhile to explore the potential of this plant in the management of Alzheimer's disease. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/168/66841 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66842 2010-05-01 all journal:Indian_J_Pharmacol
Expression of TNF-α and RANTES in drug-induced human gingival overgrowth Subramani, T Dhanaraj, L Senthilkumar, K Periasamy, S Abraham, G Rao, S Objectives : Regulated on activation, normal T cell expressed and secreted (RANTES) is a chemokine that is produced by fibroblasts, lymphoid and epithelial cells of the mucosa in response to various external stimuli. RANTES expression has been demonstrated in a variety of diseases characterized by inflammation, including asthma, transplantation-associated accelerated atherosclerosis, endometriosis and fibrosis. RANTES mRNA is quickly up-regulated by tumor necrosis factor (TNF)-α stimulation. Cyclosporine A (CsA) is widely used in organ transplant patients, often causing various side-effects including gingival overgrowth, which is fibrotic in nature. This study was carried out to assess the mRNA expression of TNF-α and RANTES in healthy individual, chronic periodontitis and CsA-induced gingival overgrowth tissues. Materials and Methods : Gingival tissue samples were collected from chronic periodontitis, CsA-induced gingival overgrowth patients and healthy individuals. Total RNA was isolated and reverse transcription polymerase chain reaction (RT-PCR) was performed for TNF-α and RANTES expression. Results : The results suggest that CsA-induced gingival overgrowth tissues expressed significantly increased TNF-α and RANTES compared to control and chronic periodontitis. Conclusion : The findings of the present study suggest that CsA can modify the expression of TNF-α and RANTES in drug-induced human gingival overgrowth. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/174/66842 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66843 2010-05-01 all journal:Indian_J_Pharmacol
Cleistanthus collinus induces type I distal renal tubular acidosis and type II respiratory failure in rats Maneksh, D Sidharthan, A Kettimuthu, K Kanthakumar, P Lourthuraj, AA Ramachandran, A Subramani, S Background and Purpose : A water decoction of the poisonous shrub Cleistanthus collinus is used for suicidal purposes. The mortality rate is 28%. The clinical profile includes distal renal tubular acidosis (DRTA) and respiratory failure. The mechanism of toxicity is unclear. Objectives : To demonstrate features of C. collinus toxicity in a rat model and to identify its mechanism(s) of action. Materials and Methods : Rats were anesthetized and the carotid artery was cannulated. Electrocardiogram and respiratory movements were recorded. Either aqueous extract of C. collinus or control solution was administered intraperitoneally. Serial measurements of blood gases, electrolytes and urinary pH were made. Isolated brush border and basolateral membranes from rat kidney were incubated with C. collinus extract and reduction in ATPase activity was assessed. Venous blood samples from human volunteers and rats were incubated with an acetone extract of C. collinus and plasma potassium was estimated as an assay for sodium-potassium pump activity. Results : The mortality was 100% in tests and 17% in controls. Terminal event in test animals was respiratory arrest. Controls had metabolic acidosis, respiratory compensation <sub>,</sub> acidic urine and hyperkalemia. Test animals showed respiratory acidosis, alkaline urine and low blood potassium as compared to controls. C. collinus extract inhibited ATPase activity in rat kidney. Plasma K <sup>+</sup> did not increase in human blood incubated with C. collinus extract. Conclusions and Implications : Active principles of C. collinus inhibit proton pumps in the renal brush border, resulting in type I DRTA in rats. There is no inhibition of sodium-potassium pump activity. Test animals develop respiratory acidosis, and the immediate cause of death is respiratory arrest. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/178/66843 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66844 2010-05-01 all journal:Indian_J_Pharmacol
Determination of the antiulcer properties of sodium cromoglycate in pylorus-ligated albino rats Srivastava, V Viswanathaswamy, A Mohan, G Objectives : To study the ulcer protective property of sodium cromoglycate in pylorus-ligated rats and the biochemical role in ulcer protection by various biochemical tests. Materials and Methods : The ulcer protective effect of sodium cromoglycate was studied using a Pyloric Ligation Model using Wistar albino rats. The antiulcer effect of sodium cromoglycate 40 mg/kg b.w., i.p., was compared with the reference drug ranitidine 27 mg/kg b.w., i.p. The ulcer index was calculated and other biochemical parameters like free acidity, total acidity, pH, mucin, pepsin and volume of gastric juice were determined. Results : Pylorus ligation showed a significant (P < 0.01) reduction in gastric volume, free acidity, total acidity and ulcer index as compared to the control. Conclusion : Sodium cromoglycate has activity equipotent to ranitidine. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/185/66844 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66845 2010-05-01 all journal:Indian_J_Pharmacol
Zidovudine-induced reversible pure red cell aplasia Balakrishnan, A Valsalan, R Sheshadri, S Pandit, VR Medep, V Agrawal, RK Hematological abnormalities are frequent among human immunodeficiency virus (HIV)-infected patients and may be directly attributable to the virus or may be caused by opportunistic infections, neoplasms or drugs that cause bone marrow suppression or hemolysis. Pure red cell aplasia (PRCA) is an uncommon hematological disorder that causes anemia. We report a 37-year-old male with HIV infection who developed PRCA 6 weeks after commencing Zidovudine and recovered following cessation of the drug. This is the first case of Zidovudine-induced PRCA reported from the Indian subcontinent. Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/189/66845 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66846 2010-05-01 all journal:Indian_J_Pharmacol
Reproductive profile of artemisinins in albino rats Rath, B Jena, J Samal, S Rath, B Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/192/66846 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66847 2010-05-01 all journal:Indian_J_Pharmacol
Biliary pseudolithiasis secondary to ceftriaxone therapy Zaki, SA Shanbag, P Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/193/66847 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66848 2010-05-01 all journal:Indian_J_Pharmacol
A mathematical model to understand the mechanisms of action of class 1 antiarrhythmic drugs Jain, DK Arya, RK Jain, AK Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/195/66848 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66849 2010-05-01 all journal:Indian_J_Pharmacol
Irbesartan in experimental diabetic nephropathy Mahajan, R Gupta, K Singh, NR Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/197/66849 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:66850 2010-05-01 all journal:Indian_J_Pharmacol
Authors' reply Vaishya, R Singh, J Lal, H Medknow Publications 2010-05-01 http://www.ijp-online.com/text.asp?2010/42/3/197/66850 en Copyright 2017 Indian Journal of Pharmacology.
oai:medknow.com:69022 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Finasteride and male breast cancer: Does the MHRA report show a link? Shenoy, NK Prabhakar, SM Finasteride is an important drug for the management of androgenetic alopecia. However, there are concerns about the possible side effects of the drug such as impotence. Recently stray reports have appeared about the occurrence of male breast carcinoma in patients who received the drug. These have been looked in to by Medicines and Health care products Regulatory Agency (MHRA). This article summarizes the MHRA report. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/102/69022 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69023 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Reconstruction of a large scalp defect by the sequential use of dermal substitute, self-filling osmotic tissue expander and rotational flap Wollina, U Bayyoud, Y Large scalp defects pose a challenge for the surgeon. Here, we present a 31-year-old male patient with a soft tissue defect on the temple with exposed bone. To allow reconstruction, we placed a self-filling osmotic expander in the subgaleal pocket for 12 weeks. The final volume of the tissue expander was 300 mL. In the last step, a rotational flap was created after removal of the tissue expander from its pocket. Thereby, a tension-free suturing was possible. The post-surgical healing was uncomplicated. Osmotic tissue expanders are a valuable tool for the closure of large tissue defects without the necessity of repeated filling procedures. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/106/69023 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69025 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Circumscribed congenital alopecias harbouring dual lesions Rao, S Janaki, A Kamakshi, D Srinivasan, V Treatment of alopecia is often challenging for the clinician as it includes a spectrum of lesions ranging from congenital to acquired causes. We present three cases of congenital circumscribed alopecia, present since birth, clinically diagnosed as nevus sebaceous. Histopathological examination of the excised tissue showed syringocystadenoma papilliferum with dermatophytosis in one and nevus sebaceous with dermatophytosis in the other two cases. Although complete excision is the treatment of choice for these lesions, an antifungal agent is needed to eradicate the concurrent superficial mycosis. A careful histopathological examination of the lesional skin helps in identifying such unexpected dual lesions that would need further treatment. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/111/69025 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69026 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Basal cell carcinoma over chest wall (Sternum) treated with dufourmentel flap: Report of a case with review of literature Jain, VK Verma, SS Verma, AS Munjal, KR Swarnakar, B Basal cell carcinoma (BCC) is the most common malignancy of the skin, accounting for approximately 70-80% of all cutaneous cancers. The commonest site of basal cell carcinoma is the face; 80% arise above a line from the corner of the mouth to the ear lobe. The lifetime ultraviolet radiation damage is the most important factor in its pathogenesis, and the vast majority is observed on sun-exposed skin. BCCs can develop in sun-protected areas, but its occurrence is rare. Here we are reporting a case of rare site of BCC with review of literature in a 65-year-old male who presented with a lesion over anterior chest wall. A clinical diagnosis of BCC was made and patient was subjected to excision biopsy. Biopsy revealed it to be a BCC and it was treated with a Dufourmentel flap. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/115/69026 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69027 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Giant lipoma of posterior neck with bleeding decubitus ulcer: A rare entity Varma, M Kala, S Singh, RK Verma, S Giant lipomas are benign soft tissue tumours. They are found relatively rarely on the posterior part of the neck. Bleeding pressure ulcer in this giant tumour is a rare presentation. Surgical interventions in these tumours are very challenging because, sometimes, extension to the spinal cord and malignant change may occur, especially in old age. Knowledge of the anatomy and meticulous surgical techniques are needed for such giant lipomas. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/119/69027 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69028 2010-05-01 all journal:J_Cutan_Aesthet_Surg
A case of papillary growth from the areola Mathur, AV Kudesia, S Anand, M Singh, M Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/122/69028 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69029 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Acne scar subcision Chandrashekar, BS Nandini, AS Subcision is a simple and safe office surgery procedure for treatment of depressed acne scars. It can easily be combined with other treatments such as laser, dermaroller and scar revisions for maximum efficacy. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/125/69029 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69030 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Q-switched Nd: YAG in the treatment of xanthelasma palpebrarum Kaliyadan, F Dharmaratnam, AD Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/127/69030 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69031 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Silicone gel for hypertrophic scars Wiwanitkit, V Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/128/69031 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69032 2010-05-01 all journal:J_Cutan_Aesthet_Surg
From the literature Anitha, BS Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/129/69032 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69013 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Hair transplantation surgery - Its current status Mysore, V Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/67/69013 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69014 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Review of factors affecting the growth and survival of follicular grafts Parsley, WM Perez-Meza, D Great strides have been made in hair restoration over the past 20 years. A better understanding of natural balding and non-balding patterns along with more respect for ageing has helped guide proper hairline design. Additionally, the use of smaller grafts has created a significantly improved natural appearance to the transplanted grafts. Inconsistent growth and survival of follicular grafts, however, has continued to be a problem that has perplexed hair restoration surgeons. This review attempts to explore the stresses affecting grafts during transplantation and some of the complexities involved in graft growth and survival. These authors reviewed the literature to determine the primary scope of aspects influencing growth and survival of follicular grafts. This scope includes patient selection, operating techniques, graft care, storage solutions and additives. The primary focus of the hair restoration surgeons should first be attention to the fundamentals of hair care, hydration, temperature, time out of body and gentle handling. Factors such as advanced storage solutions and additives can be helpful once the fundamentals have been addressed. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/69/69014 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69015 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Follicular unit extraction hair transplant Dua, A Dua, K Hair transplantation has come a long way from the days of Punch Hair Transplant by Dr. Orentreich in 1950s to Follicular Unit Hair Transplant (FUT) of 1990s and the very recent Follicular Unit Extraction (FUE) technique. With the advent of FUE, the dream of 'no visible scarring' in the donor area is now looking like a possibility. In FUE, the grafts are extracted as individual follicular units in a two-step or three-step technique whereas the method of implantation remains the same as in the traditional FUT. The addition of latest automated FUE technique seeks to overcome some of the limitations in this relatively new technique and it is now possible to achieve more than a thousand grafts in one day in trained hands. This article reviews the methodology, limitations and advantages of FUE hair transplant. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/76/69015 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69016 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Controversy: Is there a role for adjuvants in the management of male pattern hair loss? Rajput, RJ Patients with hair loss are seeking treatment at a younger age and during earlier stages. Not all need hair transplants. Because of the lack of assured management and the fear of side-effects, patients are turning to ineffective alternative remedies from self-claimed experts. In this report, we discuss the available treatment options and how best they can be used in combination to produce satisfactory results. The traditional approach consists of administration of drugs such as minoxidil and finasteride. We propose a hypothesis that nutritional supplements, 2% ketoconazole shampoo and low-level laser therapy along with finasteride 1 mg used once in 3 days with 2% minoxidil used everyday, given in a cyclical medicine program may be useful to manage hair loss and achieve new hair growth. The scientific rationale for such an approach is explained. The need for further studies to establish the efficacy of the regime is stressed upon. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/82/69016 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69018 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Hair transplantation: Preventing post-operative oedema Gholamali, A Sepideh, P Susan, E Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/87/69018 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69019 2010-05-01 all journal:J_Cutan_Aesthet_Surg
The use of botulinum toxin as primary or adjunctive treatment for post acne and traumatic scarring Goodman, GJ Background : Botulinum toxin has been utilised successfully in many facial and extra facial regions to limit superfluous movement. Scars, whether traumatic or disease-related, are treated with many modalities. Objective: To assess the available literature concerning the prophylactic use of botulinum toxin for the improvement in the cosmetic outcome of scars induced by surgery and to examine its role in the treatment of established scars alone, as also combined with other modalities. Material and Methods : The results of the prophylactic use of botulinum toxin to limit the resultant scarring from surgery are examined by a literature review. The primary and adjunctive use of botulinum toxin in the treatment of post acne and post surgical and traumatic scars is explored by case examples. Results : Literature review and personal experience shows good Improvement in the appearance of scars with the use of botulinum toxin alone or with other adjuvant modalities in the treatment of scars. Conclusion : Botulinum toxin would appear to be useful both in the prophylaxis and treatment of certain types of scars. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/90/69019 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69020 2010-05-01 all journal:J_Cutan_Aesthet_Surg
An assessment of the efficacy and safety of cross technique with 100% TCA in the management of ice pick acne scars Bhardwaj, D Khunger, N Background : Chemical reconstruction of skin scars (CROSS) is a technique using high concentrations of trichloroacetic acid (TCA) focally on atrophic acne scars to induce inflammation followed by collagenisation. This can lead to reduction in the appearance of scars and cosmetic improvement. Aims : The aim of this pilot study is to investigate the safety of the CROSS technique, using 100% TCA, for atrophic ice pick acne scars. Settings and Design : Open prospective study. Materials and Methods : Twelve patients with predominant atrophic ice pick post acne scars were treated with the CROSS technique, using 100% TCA, applied with a wooden toothpick, at two weekly intervals for four sittings. Efficacy was assessed on the basis of the physician's clinical assessment, photographic evaluation at each sitting and patient's feedback after the fourth treatment, and at the three-month and six-month follow-up period, after the last treatment. Results : More than 70% improvement was seen in eight out of ten patients evaluated and good results (50 - 70% improvement) were observed in the remaining two patients. No significant side effects were noted. Transient hypopigmentation and hyperpigmentation was observed in one patient each. Physician's findings were in conformity with the patient's assessment. Three months after the last treatment, one patient noted a decrease in improvement with no further improvement even at the six-month follow-up period. Conclusion : The CROSS technique with 100% TCA is a safe, efficacious, cost-effective and minimally invasive technique for the management of ice pick acne scars that are otherwise generally difficult to treat. In few patients the improvement may not be sustained, probably due to inadequate or delayed collagenisation. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/93/69020 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69021 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Novel technology in the treatment of acne scars: The matrix-tunable radiofrequency technology Ramesh, M Gopal, MG Kumar, S Talwar, A Background : Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims : To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design : A prospective study of 30 randomly selected patients with acne scars was carried out. Materials and Methods : Thirty healthy patients with different types of acne scars - ice pick, box and rolling type - were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025%) and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS) at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results : The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement) in four, good (35-60% improvement) in 18 and moderate to poor (<35% improvement) in eight. A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment. The patients reported a pinkish tone for 2-3 days. Importantly, with the help of some slight make up, all the 30 patients could return to work the following day. Conclusion : Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars, because of the effective results coupled with a low downtime. Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/97/69021 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
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Editorial comment Goldman, A Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/110/69024 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:69017 2010-05-01 all journal:J_Cutan_Aesthet_Surg
Editorial comment Mysore, V Medknow Publications 2010-05-01 http://www.jcasonline.com/text.asp?2010/3/2/86/69017 en Copyright 2017 Journal of Cutaneous and Aesthetic Surgery.
oai:medknow.com:197536 2010-05-01 all journal:J_Diabetol
Association between food patterns and metabolic syndrome in China Shi, Z Hu, X Yuan, B Hu, G Pan, X Dai, Y Holmboe-Ottesen, G Byles, J The objective of this paper is to investigate the association between a vegetable rich food pattern and the metabolic syndrome among Chinese adults. A cross-sectional household survey of 2849 men and women aged 20 years and over was undertaken in 2002 in Jiangsu Province (response rate 89.0%). Nine hundred fifty six participants free from metabolic syndrome in 2002 participated in a follow up survey in 2007. At baseline, food intake was assessed by food frequency questionnaire. Factor analysis was used to identify food patterns. Food intake was measured by food weighing plus consecutive individual 3 day food records. Height, weight and any individual components of the metabolic syndrome were measured both in 2002 and 2007. The prevalence of metabolic syndrome by the modified ATP III definition was 12.9% in men and 19.6% in women. A four-factor solution explained 30.5% of the total variance in food frequency intake. The 'vegetable rich' food pattern (whole grains, fruits and vegetables) was positively associated with vegetable oil and energy intake in both genders. Prevalence of metabolic syndrome increased across the quartiles of 'vegetable rich' food pattern. After adjusting for socio-demographic and other three distinct food patterns, the 'vegetable rich' pattern was independently associated with metabolic syndrome at baseline. Compared with the lowest quartile (Q1) of 'vegetable rich' pattern, the highest quartile (Q4) had a higher risk of metabolic syndrome (men: odds ratio [OR]: 1.68, 95% confidence interval [CI] 1.02-2.79; women: OR: 1.75, 95%CI 1.17-2.62). The 'vegetable rich' food pattern was also positively associated with incident metabolic syndrome among women in 2007. The healthfulness of 'vegetable rich' food pattern is dependent on variety and amounts of other foods used and total intake of energy and various nutrients. Medknow Publications 2010-05-01 http://www.journalofdiabetology.org/text.asp?2010/1/2/1/197536 en Copyright 2017 Journal of Diabetology.
oai:medknow.com:197543 2010-05-01 all journal:J_Diabetol
Introducing physical activity to type 2 Diabetes Mellitus patients and those at risk: learning points from the Netherlands Hopman-, RM Jongert, M Van-Hespen, A Chorus, A Type 2 Diabetes Mellitus (DM) is one of the major diseases for which strong evidence exists that physical activity prevents onset and may counteract progress. However, it is not so easy to change physical activity behaviour in people that are usually inactive. As type 2 DM has a high incidence and prevalence in the Netherlands, it has been chosen as a priority for a national effort called "De Beweegkuur" (based on the idea of Exercise on prescription). It is known that tailored exercise counseling is most helpful. However, it will be more (cost) effective if only a few profiles exist in which patients could be divided and treated. The first aim was developing such patient profiles. The second aim was to get an impression of how "De Beweegkuur" meets the possibilities of general practitioners (GPs) and physiotherapists and how the profiles could be handled by them. Therefore a qualitative study was performed. Information from an internet literature search and some patient focus group interviews was used as basis for a consensus meeting to formulate criteria for patient profiles. Eleven GPs and 38 physiotherapists were interviewed about existing practices, attitudes, and barriers to change. Three different patient profiles were developed. GPs saw type 2 DM patients and those at risk four times a year on average. According to these GPs, barriers for patients to change their physical activity were: cost (programmes are not yet in health insurance), anxious to exercise because of fatigue, and overweight. Physiotherapists who deliver programmes complain that GPs are not very willing to prescribe physical activity and to let their patients join special programmes from "De Beweegkuur". It is recommended to use the newly developed patient profiles to make it easier for the GPs and physiotherapist s to divide patients in sub groups. This will enhance a more tailor-made guidance through the existing PA stimulating programme possibilities that are referred to "De Beweegkuur". Also, local cooperation between professionals should be improved Medknow Publications 2010-05-01 http://www.journalofdiabetology.org/text.asp?2010/1/2/2/197543 en Copyright 2017 Journal of Diabetology.
oai:medknow.com:197546 2010-05-01 all journal:J_Diabetol
Assessment of the risk for metabolic syndrome in prediabetes and newly-diagnosed type 2 diabetes Tankova, TI Chakarova, NY Dakovska, LN Kalinov, KB Atanassova, IA The aim of the present study was to assess the risk for metabolic syndrome (MetS) in subjects with pre- diabetes - impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and in newly- diagnosed type 2 diabetes (NDD). The metabolic syndrome parameters (according to 2005 IDF definition) and high-sensitive C-reactive protein (hsCRP) were measured in 727 subjects - 238 with IFG, 184 with IGT and 305 with NDD. The unadjusted prevalence of MetS was 84.03% in IFG, 89.13% in IGT and 89.51% in NDD. The odds ratio (OR) for prevalent MetS was 8.82 (95% CI, 3.19 -19.8, p<0.001) in IFG, 11.26 (95% CI, 4.18 -24.6, p<0.001) in IGT and 4.87 (95% CI, 2.10 -9.50, p<0.001) in NDD. Of the different studied parameters, the OR for metabolic syndrome was significant for female sex - 2.31 (95% CI, 1.45-4.35, p=0.009), fasting plasma glucose - 2.30 (95% CI, 1.56 -3.40, p<0.001), waist circumference - 1.36 (95% CI, 1.12-1.42, p<0.001), HDL -cholesterol - 0.273 (95% CI, 0.14-0.52, p=0.01) and triglycerides - 3.84 (95% CI, 2.61-5.66, p<0.0001). Significantly higher hsCRP level s were found in all groups with MetS as compared to those without MetS. The prevalence of MetS in pre-diabetes is rather high, being similar to that in newly-diagnosed type 2 diabetes. The risk for MetS is even higher in pre-diabetes as compared to NDD. Therefore IFG and IGT should be considered not just as conditions of altered glucose metabolism but also in relation to their association with cardiovascular risk factors. Medknow Publications 2010-05-01 http://www.journalofdiabetology.org/text.asp?2010/1/2/3/197546 en Copyright 2017 Journal of Diabetology.
oai:medknow.com:197547 2010-05-01 all journal:J_Diabetol
Type 2 Diabetes and obesity: A review Hussain, A Hydrie, M. Claussen, B Asghar, S The article reviews the relationship between type 2 diabetes and obesity. This also includes types of obesity and its genetic predisposition. The modern generalization of sedentary life and caloric abundance has created new physiological conditions capable of changing the level of expression of a number of genes involved in fuel metabolism and body weight regulation. It is likely that the genetic variants or alleles of these genes have in the past participated in the adaptation of human physiology to its evolutionary constraints. In this article, we underscore the importance of obesity in relation to disorders of diverse etiologies characterized by disturbances of free fatty acids, visceral adiposity and insulin resistance. Further, we have investigated the role of selecting the traits to be subjected to quantitative genetic analysis in the occurrence of obesity Medknow Publications 2010-05-01 http://www.journalofdiabetology.org/text.asp?2010/1/2/4/197547 en Copyright 2017 Journal of Diabetology.
oai:medknow.com:197553 2010-05-01 all journal:J_Diabetol
Androgen Deprivation Therapy Increases the Risk of Diabetes and Non - cancer Mortality in Prostate Cancer patients: A Meta- analysis Tunio, MA Rafi, M Qayyum, A Hashmi, A Androgen deprivation therapy (ADT) with Luteinizing hormone releasing hormone analogues or bilateral subcapsular orchiectomy is the mainstay of treatment in high risk localized and metastatic prostate cancer along with other modalities. ADT is associated with increased fat mass and insulin resistance, but the risk of incident diabetes and non-cancer mortality during this treatment has not been well studied. We conducted a meta-analysis to see whether androgen deprivation therapy is associated with an increased incidence of diabetes and cardiovascular diseases. The MEDLINE, CANCERLIT, COCHRANE library database, and the search engines, were searched to identify, prospective, randomized, controlled studies in prostate cancer patients receiving short, long term or no ADT and risk of incident diabetes and non cancer mortality. Comprehensive Meta-analysis software version 2.0 was used for the analysis. Four prospective trials with a total patient population of 1, 15,119 were identified. Pooled results from these trials showed an increase d risk of diabetes in patients treated with long term ADT (p= 0.0001) as well as increased non -cancer mortality (Odds ratio 1.69; p < 0.001. Main cause of non-cancer death was sudden cardiac death (SCD). The resultant funnel plot of meta- analysis showed lack of publication bias. This meta-analysis shows increased risk of diabetes and cardiovascular diseases in prostate cancer patient on long term androgen deprivation therapy; already existing diabetes also deteriorated. The results of this study warrants active surveillance of patients on androgen deprivation therapy. Medknow Publications 2010-05-01 http://www.journalofdiabetology.org/text.asp?2010/1/2/5/197553 en Copyright 2017 Journal of Diabetology.
oai:medknow.com:71993 2010-05-01 all journal:J_Fam_Community_Med
Psuedomyxoma peritonei secondary to adenocarcinoma of the cecum Al-Buainain, H Al-Jehani, Y Moghazy, K Al-Quorain, A Pseudomyxoma peritonei is a rare progressive disease. Patients commonly present with a picture of acute appendicitis or with increasing abdominal girth. We present a case of a 71 year old man who presented with right iliac fossa pain, fever and vomiting. His abdominal examination revealed right iliac fossa mass which was confirmed radiologically. Diagnostic laparoscopy showed jelly like material along with a right iliac fossa mass. The aspirate was negative for malignancy initially. Due to persistance and progression of his disease he underwent right hemicolectomy. Histopathological diagnosis showed moderately differentiated adenocarcinoma of the cecum Duke's C2. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/103/71993 en Copyright 2017 Journal of Family and Community Medicine.
oai:medknow.com:71994 2010-05-01 all journal:J_Fam_Community_Med
A forgotten complication of diaper dermatitis: Granuloma gluteale infantum Al-Faraidy, NA Al-Natour, SH Granuloma Gluteale Infantum (GGI) is a rare condition of unclear etiology, <sup>[1]</sup> presenting as asymptomatic cherry red nodules in the diaper area appearing in the setting of primary irritant contact dermatitis. <sup>[2]</sup> A 50 day old infant with GGI is presented to emphasize that the condition may be easily missed, and that it may result from the misuse of fluorinated topical steroids used to treat a rash in the diaper area. This is the first case reported from Saudi Arabia. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/107/71994 en Copyright 2017 Journal of Family and Community Medicine.
oai:medknow.com:71987 2010-05-01 all journal:J_Fam_Community_Med
Metabolic syndrome and cardiovascular risk Alshehri, AM The constellation of dyslipidemia (hypertriglyceridemia and low levels of high-density lipoprotein cholesterol), elevated blood pressure, impaired glucose tolerance, and central obesity is now classified as metabolic syndrome, also called syndrome X. In the past few years, several expert groups have attempted to set forth simple diagnostic criteria for use in clinical practice to identify patients who manifest the multiple components of the metabolic syndrome. These criteria have varied somewhat in specific elements, but in general, they include a combination of multiple and metabolic risk factors. The most widely recognized of the metabolic risk factors are atherogenic dyslipidemia, elevated blood pressure, and elevated plasma glucose. Individuals with these characteristics, commonly manifest a prothrombotic state as well as and a proinflammatory state. Atherogenic dyslipidemia consists of an aggregation of lipoprotein abnormalities including elevated serum triglyceride and apolipoprotein B (apoB), increased small LDL particles, and a reduced level of HDL cholesterol (HDL-C). The metabolic syndrome is often referred to as if it were a discrete entity with a single cause. Available data suggest that it truly is a syndrome, ie, a grouping of atherosclerotic cardiovascular disease (ASCVD) risk factors, that probably has more than one cause. Regardless of cause, the syndrome identifies individuals at an elevated risk for ASCVD. The magnitude of the increased risk can vary according to the components of the syndrome present as well as the other, non-metabolic syndrome risk factors in a particular person. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/73/71987 en Copyright 2017 Journal of Family and Community Medicine.
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Oral rehydration salts, zinc supplement and rota virus vaccine in the management of childhood acute diarrhea Telmesani, AM Acute diarrhea remains a major cause of morbidity and mortality in children. Since the introduction of oral rehydration salts (ORS) mortality has dropped to less than 50% worldwide. Low osmolarity ORS improved the outcome and reduced the hospitalization further. Zinc difficiency has been found to be associated with severe episodes of acute diarrhea. Zinc supplement in developing countries did reduce the incidence and prevalence of diarrhea. In addition, Zinc supplement significantly reduced the severity of diarrhea and duration of the episode. In the Americas and Europe, Rota virus vaccine was 90% effective in preventing severe episodes of severe rotavirus gastroenteritis. This review concludes that low osmolarilty ORS, zinc supplementation and rotavirus vaccine are major factors in reducing the morbidity, mortality and hospitalization resulting from to acute gastroenteritis in childhood. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/79/71988 en Copyright 2017 Journal of Family and Community Medicine.
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Influence of age, gender, and prodromal symptoms on sudden death in a tertiary care hospital, eastern Saudi Arabia Nofal, HK Abdulmohsen, MF Background: Sudden death (SD) remains an important worldwide public health problem. The incidence of SD and causes vary in different societies, and these differences are influenced also by demographic and clinical factors such as age, gender and prodromal symptoms and signs. This six-year study describes the influence of these factors on SD. Materials and Methods: This is a retrospective study of SD in all age groups undertaken in King Fahd Hospital of the University (KFHU), Eastern Saudi Arabia. All cases of death (1273 total, 1050 expected death and 223 cases of sudden unexpected death) that occurred between January 1, 2000 and December 31, 2005 were investigated and subsequently analyzed on demographic and clinical parameters of the deceased patients. The statistical analysis was performed as appropriate to illustrate any possible association between different demographic variables and SD. Results: There were 223 cases of SD (17.5%) out of 1273 total deaths in KFHU in the 6-year study period. There was a definite influence of age on the incidence of sudden death (SD) as it increased clearly at the two ends of the age spectrum, 32.2% of the cases were infants (from birth to 12 months), and 31.4% were elderly (> 60 year-old). However, among infantile age group, the highest frequency of SD (22.2% of the cases) was among the neonates. There was also a significant trend of gender influence on the incidence of SD which was higher in men than women (56% vs. 42%). The influence of prodromal symptoms and signs on SD was variable. Dyspnea and cough as major symptoms of cardiovascular and respiratory disease were the most frequent presenting symptoms in 32.3% of the cases, followed by fever as a sign of infections in 11.7%, premature infants in 10.8%, circulatory collapse in 9.4%, and angina in 7.6% of the cases. Conclusion: The current study indicated a definite influence of age, gender and prodromal symptoms on the incidence of SD. The highest incidence occurred in the two extremes of age scale as compared to other age groups. Incidence was also higher in men than women. Meanwhile, the major prodromal symptoms and signs were dyspnea and cough, fever, premature birth, circulatory collapse, and angina pectoris.. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/83/71989 en Copyright 2017 Journal of Family and Community Medicine.
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The relation of age to the severity of Type I diabetes in children Al-Fifi, SH Objective: To study the relationship between the age and severity of Type 1 diabetes in children 0 - 5 years and more than 5 years of age admitted to Aseer Central Hospital, Southwestern Saudi Arabia over a 7-year period. Materials and Methods: A retrospective review of children less than 13 years of age with Type 1 diabetes admitted to the Pediatric Department, between 1st January 2000 to 31st December 2006. Results: A total of 181 children with Type1 diabetes were admitted to the hospital during this period. Of these, 27.6% were children 5 years or less, while 72.4% were more than 5 years of age. The duration of symptoms was longer in younger children compared to older patients. Diabetic ketoacidosis was present in 31.4% of the younger children, and in 15.3% of the children more than 5 years old. Hospital stay was also longer in children less than 5 years of age. Most significant differences were in the younger children's group and affected the biochemical test results. Conclusion: The present study showed that more younger children present to the hospital late, and in a state of diabetic ketoacidosis compared to older patients. Efforts should be directed at improving the knowledge and skills of the primary health care personnel to be able to diagnose and refer these cases earlier. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/87/71990 en Copyright 2017 Journal of Family and Community Medicine.
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Developing questionnaires for students' evaluation of individual faculty's teaching skills: A Saudi Arabian pilot study Al-Rubaish, AM Hassan, A Al, AA Mokabel, F Hegazy, M Wosornu, L Background: The National Commission for Academic Accreditation and Assessment is responsible for the academic accreditation of universities in the Kingdom of Saudi Arabia (KSA). Requirements for this include evaluation of teaching effectiveness, evidence-based conclusions, and external benchmarks. Aims: To develop a questionnaire for students' evaluation of the teaching skills of individual instructors and provide a tool for benchmarking. Setting: College of Nursing, University of Dammam [UoD], May-June 2009. Materials and Methods: The original questionnaire was "Monash Questionnaire Series on Teaching (MonQueST) - Clinical Nursing. The UoD modification retained four areas and seven responses, but reduced items from 26 to 20. Outcome measures were factor analysis and Cronbach's alpha coefficient. Results: Seven Nursing courses were studied, viz.: Fundamentals, Medical, Surgical, Psychiatric and Mental Health, Obstetrics and Gynecology, Pediatrics, and Family and Community Health. Total number of students was 74; missing data ranged from 5 to 27%. The explained variance ranged from 66.9% to 78.7%. The observed Cornbach's α coefficients ranged from 0.78 to 0.93, indicating an exceptionally high reliability. The students in the study were found to be fair and frank in their evaluation. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/91/71991 en Copyright 2017 Journal of Family and Community Medicine.
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A practical discussion to avoid common pitfalls when constructing multiple choice questions items Al-Faris, EA Alorainy, IA Abdel-Hameed, AA Al-Rukban, MO This paper is an attempt to produce a guide for improving the quality of Multiple Choice Questions (MCQs) used in undergraduate and postgraduate assessment. Multiple Choice Questions type is the most frequently used type of assessment worldwide. Well constructed, context rich MCQs have a high reliability per hour of testing. Avoidance of technical items flaws is essential to improve the validity evidence of MCQs. Technical item flaws are essentially of two types (i) related to testwiseness, (ii) related to irrelevant difficulty. A list of such flaws is presented together with discussion of each flaw and examples to facilitate learning of this paper and to make it learner friendly. This paper was designed to be interactive with self-assessment exercises followed by the key answer with explanations. Medknow Publications 2010-05-01 http://www.jfcmonline.com/text.asp?2010/17/2/96/71992 en Copyright 2017 Journal of Family and Community Medicine.
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Synergistic properties of methylxanthine with cadmium and mercury on dermatophytes Background: Methylxanthine has many antimicrobial effects on different types of organisms. Synergism actions between methylxanthine and cadmium or mercury on dermatophytes were tested. Aims: To determine the synergistic property between methylxanthine and cadmium or mercury on the growth of dermatophytes. Materials and Methods: Two isolated strains of dermatophytes (Trichophyton mentagrophytes and Epidermophyton floccosum) that clinical isolated were treated with the mixtures of methylxanthine either with cadmium or with mercury by using colony diameter method. Percentage inhibition was also calculated based on perpendicular colony diameters of grown fungi. Results: Cadmium had high ability to increase inhibitory action of methylxanthine agents on dermatophytes. Epidermophyton floccosum revealed more susceptibility to tested mixture than those of Trichophyton mentagrophytes. Mercury exhibited variable effects on dermatophytes after mixing with methylxanthine. Conclusions : Effective concentrations of methylxanthine on dermatophytes decreased in the presence of cadmium and mercury. Variable susceptibility of two species of dermatophytes to prepared mixture was noted. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/101/62878 en Copyright 2017 Journal of Global Infectious Diseases.
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In Vitro antibacterial activity of ibuprofen and acetaminophen Background: Ibuprofen and acetaminophen are common chemical agents that have anti-inflammatory, antipyretic, and analgesic activity. Aims: To detect any potential antibacterial effects of ibuprofen and acetaminophen on pathogenic bacteria. Materials and methods: Ibuprofen and acetaminophen were tested for antibacterial activity against seven isolates of bacteria including gram positive bacteria (Staphylococci aureus and Bacillus subtilis) and gram negative bacteria (E. coli, Enterobacter aerogenes, Enterobacter cloacae, Salmonella typhi and Paracoccus yeei). Spectrophotometer assay was applied to determine the antibacterial activities of ibuprofen and acetaminophen. Three controls were included in this study: Ampicilline sodium (20 μg/ml); cefotaxime sodium (20 μg/ml) and chemical free medium. Results: Staphylococcus aureus and Paracoccus yeei were susceptible to lower concentrations of ibuprofen and acetaminophen (MIC=1.25 mg/ml), while two strains of Enterobacter exhibited resistance to these agents. Conclusions: Ibuprofen and acetaminophen showed a potential antibacterial effect on isolated strains of bacteria. They had the same ability to inhibit bacterial growth. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/105/62880 en Copyright 2017 Journal of Global Infectious Diseases.
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School environment and sanitation in rural India Majra, JP Gur, A Context : A school child educated about the benefits of sanitation and good hygiene behavior is a conduit for carrying those messages far beyond the school walls, bringing lasting improvement to community hygienic practices. Aims : To study the status of school environment and sanitation in rural India. Settings and Design: Government schools in rural Karnataka, cross sectional study. Materials and Methods: Twenty schools were randomly selected for the study. Informed consent was taken from the Heads of the schools. A pre tested close ended questionnaire was used to get the information. The minimum standards for sanitation of the school and its environment in India were used as the guiding principles to evaluate the appropriateness/ adequacy of the various attributes. Statistical analysis used: Percentages and proportions. Results : Out of 20 schools selected, one fourth of the schools were located/ sited at inappropriate places. Only half of the schools had appropriate/ adequate structure. Eighteen (90%) of the schools were overcrowded. Ventilation and day light was adequate for 12(60%) and 14(70%) of the schools respectively. Cleanliness of school compound/classrooms was adequate in 80% of the schools. There were no separate rooms for serving the midday meals in any of the schools under study. Eighteen (90%) of the schools were having drinking water points. Liquid and solid waste disposal was insanitary in six (30%) and eight (40%) of the schools respectively. Only half of the schools had adequate latrines for boys and 60% for girls. Only two (10%) of the schools had adequate hand washing points with soap. Conclusions : Environment and sanitation facilities at many of the schools are not fully satisfactory. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/109/62882 en Copyright 2017 Journal of Global Infectious Diseases.
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Primary cutaneous histoplasmosis in a HIV-positive individual Vasudevan, B Ashish, B Amitabh, S Mohanty, AP A 31-year-old human immunodeficiency virus-positive male who presented to the Dermatology Outpatient Department with complaints of red, raised lesions on the face of 2 weeks duration was, on examination, found to have multiple papulonodular lesions on the face with associated cervical and axillary lymphadenopathy. There was history of local injury on the face 6 months prior to the development of symptoms. Skin biopsy revealed multiple round to oval spores with surrounding halo intracellularly, confirming the diagnosis of cutaneous histoplasmosis. No systemic involvement was detected on further investigations. The patient responded to oral antifungals in a short duration, confirming the local nature of the presentation. This is probably the first time in the literature that a primary cutaneous manifestation of histoplasmosis is being described in an immunocompromised individual. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/112/62884 en Copyright 2017 Journal of Global Infectious Diseases.
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Field evaluation of the bio-efficacy of three pyrethroid based coils against wild populations of anthropophilic mosquitoes in Northern Tanzania Msangi, S Mwang'onde, BJ Mahande, AM Kweka, EJ Aims: This study aims to assess the feeding inhibition and repellency effect of three brands of mosquito coils in experimental huts (East African design). Evaluated products were all pyrethroid-based mosquito coils - Kiboko<sup>;</sup> , Total<sup>;</sup> and Risasi<sup>;</sup> . Mosfly (0.1% D-allethrin) was a positive control. Indoor resting behavior, feeding inhibition and induced exophily were measured as responses of burnt coil smoke in huts. Materials and methods: Resting mosquitoes were collected inside the huts, in window traps and verandah traps using mechanical aspirators. Identified to species level and sex. Results: A total of 1460 mosquitoes were collected, 58.9% (n=860) were Anopheles gambiae s.l while 41.1% (n=600) Culex quinquefasciatus. Indoor resting mosquitoes in all treated huts were significantly reduced than in negative control (DF=4, F=18.6, P < 0.001). Species found to rest indoors were not statistical different between the positive control (Mosfly coil) and other three treated huts (DF=3, F=1.068, P=0.408). Cx.quinquefasciatus had significantly higher induced exophily in all treatments comparing to An.gambiae s.l (DF=1, F=5.34, P=0.050). Comparison between species (An.gambiae s.l and Cx. quinquefasciatus) for the feeding inhibition among treated huts was not statistically significant (DF=1, F=0.062, P=0.810). Conclusion: Introduction of several personal protection measures will be ideal to supplement the existing gap in reducing the man vector contacts hence lowering the disease transmission. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/116/62885 en Copyright 2017 Journal of Global Infectious Diseases.
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Effect of different hosts on feeding patterns and mortality of mosquitoes (Diptera: Culicidae) and their implications on parasite transmission Kweka, EJ Mwang'onde, BJ Lyaruu, L Tenu, F Mahande, AM Aim: The host-response to hematophagus insects is still an important parameter in understanding disease transmission patterns. We investigated the feeding and mortality rates of three mosquito species, namely Culex quinquefasciatus, Aedes aegypti and Anopheles arabiensis against three different hosts. Materials and Methods: Unfed three to five-day-old female mosquitoes were released in a tunnel box that had a rabbit or guinea pig or mice as a host. The feeding succession patterns of mosquitoes in different hosts were An. arabiensis, Cx. quinquefasciatus and A. aegypti. Results: Mosquito mortality rate was 54.9% for mosquitoes introduced in mice as a host, 34.3% in the Guinea pig and 10.8% for those that introduced in the rabbit. Conclusion: The presence of defensive and tolerable hosts in environment emphasizes the relevance of studying epidemiological impact of these behaviors in relation to diseases transmission. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/121/62873 en Copyright 2017 Journal of Global Infectious Diseases.
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A current perspective on leishmaniasis Clem, A There are many challenges facing the successful control and eradication of cutaneous and visceral leishmaniasis. Leishmaniasis is still endemic in many poverty stricken and war torn areas. Through the use of an extensive literature review, this article examined the global disease burden of cutaneous and visceral leishmaniasis. Surveillance and control measures for leishmaniasis being used by the World Health Organization were also discussed in this article. Finally, potential new treatments and possible vaccines for leishmaniasis were reviewed in this article. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/124/62863 en Copyright 2017 Journal of Global Infectious Diseases.
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The biology and control of leishmaniasis vectors Claborn, DM Vector control remains a key component of many anti-leishmaniasis programs and probably will remain so until an effective vaccine becomes available. Technologies similar to those used for control of adult mosquitoes, specifically interior residual sprays and insecticide-treated nets, are currently at the forefront as disease control measures. This article provides a review of literature on the biology and control of sand fly vectors of leishmaniasis in the context of changing disease risks and the realities of modern vector control. The Literature Retrieval System of the Armed Forces Pest Management Board, Washington, DC, was the primary search engine used to review the literature. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/127/62866 en Copyright 2017 Journal of Global Infectious Diseases.
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Immunological perspectives of leishmaniasis Nylen, S Gautam, S Leishmania parasites have been widely used in experimental models to understand generation, maintenance and failure of immune responses underlying resistance and susceptibility to infection. The clinical outcomes of Leishmania infection depend on the infecting species and the immune status of the host. Noticeably most people exposed Leishmania never develop overt disease. Understanding the immunological events that result in failure or successful control of the parasites is fundamental to both design and evaluation of vaccines and therapies against the leishmaniases. Recent studies visualizing immune response to Leishmania major in the skin have given new insights into the different immune cells acting as hosts the parasite during different stage of infection. Control of Leishmania infection and disease progression has been associated with generation of T-helper (Th) 1 and Th2 responses respectively. Though still valid in several aspects, the Th1/Th2 paradigm is an oversimplification in need of revision. Th2 polarization has never explained severity of human leishmanial disease and a number of other T-cell subsets, including regulatory T- and Th17- cells, have important roles in susceptibility and resistance of both experimental and human leishmanial disease. This review gives an updated overview of immunological response considered to be of importance in protection, susceptibility, disease progression and cure of leishmaniasis, with a special emphasis on human diseases. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/135/62876 en Copyright 2017 Journal of Global Infectious Diseases.
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Treatment strategies for mucocutaneous leishmaniasis Palumbo, E Mucocutaneous is an infection caused by a single celled parasite transmitted by sand fly bites. There are about 20 species of Leishmania that may cause mucocutaneous leishmaniasis. Some Leishmania species are closely linked to humans and are therefore found in cities (L. tropica) whereas some others are more traditionally associated with animal species and therefore considered zoonoses (L. major). The evidence for optimal treatment of mucocutaneous leishmaniasis is patchy. Although the cutaneous form of the disease is often self-limiting, it does result in significant scarring and can spread to more invasive, mucocutaneous disease. Therefore, treatment may be considered to prevent these complications. Drugs for systemic and topical treatment are presented and discussed with regard to their application, use and adverse effects. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/147/62879 en Copyright 2017 Journal of Global Infectious Diseases.
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Treatment of visceral leishmaniasis Moore, EM Lockwood, DN The available treatment options for visceral leishmaniasis (VL) have problems relating to efficacy, adverse effects and cost, making treatment a complex issue. We review the evidence relating to the different methods of treatment in relation to - efficacy and toxicity of the drugs in different areas of the world; ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give intramuscular, intravenous or oral therapy; the sex and child-bearing potential of the patient and the immune status of the patient. The high mortality of untreated/ poorly treated VL infection makes the decisions paramount, but a unified and coordinated response by each area is likely to be more effective and informative to future policies than an ad hoc response. For patients in resource-rich countries, liposomal amphotericin B appears to be the optimal treatment. In South Asia, miltefosine is being used; the combination of single dose liposomal amphotericin B and short course miltefosine looks encouraging but has the problem of potential reproductive toxicities in females. In Africa, the evidence to switch from SSG is not yet compelling. The need to monitor and plan for evolving drug failure, secondary to leishmania parasite resistance, is paramount. With a few drugs the options may be limited; however, we await key ongoing trials in both Africa and India to explore the effects of combination treatment. If safe and reliable combinations are revealed by the ongoing studies, it is far from clear as to whether this will avoid leishmania parasite resistance. The development of new drugs to add to the armamentarium is paramount. Lessons can be learnt from the management of diseases such as tuberculosis and malaria in terms of planning the switch to combination treatment. As important as establishing the best choice for specific antileishmanial agent is ensuring treatment centers, which can best manage the problems encountered during treatment, specifically malnutrition, bleeding, intercurrent infections, drug side effects and detecting and treating underlying immunosuppression. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/151/62883 en Copyright 2017 Journal of Global Infectious Diseases.
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Liposomal amphotericin B and leishmaniasis: Dose and response Sundar, S Chakravarty, J Liposomal amphotericin B has been used with increasing frequency to treat visceral leishmaniasis (VL). It is the treatment of choice for immunocompetent patients in the Mediterranean region and the preferred drug for HIV/VL co-infection. Although there is a regional variation in the susceptibility of the parasite a total dose of 20 mg/kg is effective in immunocompetent patients. Randomized clinical trials of liposomal amphotericin B in the treatment and secondary prophylaxis of HIV-VL coinfected patients is urgently needed to optimize treatment in this subset. With the availability of Liposomal amphotericin B at a preferential pricing in the endemic areas, short course combination therapy can become a viable alternative. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/159/62886 en Copyright 2017 Journal of Global Infectious Diseases.
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Drug resistance in leishmaniasis Chakravarty, J Sundar, S The treatment options of leishmaniasis are limited and far from satisfactory. For more than 60 years, treatment of leishmaniasis has centered around pentavalent antimonials (Sb<sup> v</sup> ). Widespread misuse has led to the emergence of Sb<sup> v</sup> resistance in the hyperendemic areas of North Bihar. Other antileishmanials could also face the same fate, especially in the anthroponotic cycle. The HIV/ visceral leishmaniasis (VL) coinfected patients are another potential source for the emergence of drug resistance. At present no molecular markers of resistance are available and the only reliable method for monitoring resistance of isolates is the technically demanding in vitro amastigote-macrophage model. As the armametrium of drugs for leishmaniasis is limited, it is important that effective monitoring of drug use and response should be done to prevent the spread of resistance. Regimens of simultaneous or sequential combinations should be seriously considered to limit the emergence of resistance. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/167/62887 en Copyright 2017 Journal of Global Infectious Diseases.
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Leishmaniasis vaccine: Where are we today? Kedzierski, L Leishmaniasis is a disease that ranges in severity from skin lesions to serious disfigurement and fatal systemic infection. WHO has classified the disease as emerging and uncontrolled and estimates that the infection results in two million new cases a year. There are 12 million people currently infected worldwide, and leishmaniasis threatens 350 million people in 88 countries. Current treatment is based on chemotherapy, which relies on a handful of drugs with serious limitations such as high cost, toxicity, difficult route of administration and lack of efficacy in endemic areas. Vaccination remains the best hope for control of all forms of the disease, and the development of a safe, effective and affordable antileishmanial vaccine is a critical global public-health priority. Extensive evidence from studies in animal models indicates that solid protection can be achieved by immunization with defined subunit vaccines or live-attenuated strains of Leishmania. However, to date, no such vaccine is available despite substantial efforts by many laboratories. The major impediment in vaccine design is the translation of data from animal models to human disease, and the transition from the laboratory to the field. Furthermore, a thorough understanding of protective immune responses and generation and maintenance of the immunological memory, the most important and least-studied aspect of antiparasitic vaccine development, during Leishmania infection is needed. This review focuses on recent findings in antileishmania vaccine field and highlights current difficulties facing vaccine development and implementation. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/177/62881 en Copyright 2017 Journal of Global Infectious Diseases.
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Elderly diabetic patient with surgical site mucormycosis extending to bowel Patel, AK Vora, HJ Patel, KK Patel, B Mucormycosis is rare in clinical practice. Most infections are acquired by inhalation; other portals of entry are traumatic implantation and ingestion in immunocompromised host. Mucormycosis is life threatening infection in immunocompromised host with variable moratlity ranging from 15 -81% depending upon site of infection. General treatment principles include early diagnosis, correction of underlying immunosuppression and metabolic disturbances, adequate surgical debridement along with amphotericin therapy. We describe surgical site mucormycosis extended to involve large bowel in elderly diabetic patient. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/186/62877 en Copyright 2017 Journal of Global Infectious Diseases.
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Chronic otomycosis due to Malassezia Spp Latha, R Sasikala, R Muruganandam, N We report the case of a 31-year-old male presenting with complaints of mild pain in the right ear for three months and hypoacusis for 10 days. On otoscopic examination, a thin, papery, white material was extracted from his ear and sent for fungal identification. This material revealed presence of Malassezia spp - with characteristic "spaghetti and meat ball appearance". The patient was treated with 2% acetic acid, hydrocortisone and Clotrimazole powder for one week and he resolved completely. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/189/62875 en Copyright 2017 Journal of Global Infectious Diseases.
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Mycotic giant cell epitheliomatous inverted papilloma of the gingiva Mohammed, N Kumar, A Vanessa, JT Syed, AS This report presents histopathological evidence of mycotic infection of the gingival epithelium followed by inverted verrucous giant cell epitheliomata of the gingiva. Sections from biopsy tissue revealed intercellular spaces of the parabasal squamous epithelium parasitized by Periodic Acid Schiff stain positive branching septate hyphae and conidia of morphological appearance of Trichophyton. Epithelial cells presented epitheliomatous proliferation with formation of giant cells showing phagocytosed fragments of mold. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/191/62871 en Copyright 2017 Journal of Global Infectious Diseases.
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Mycetoma due to Nocardia farcinica Adhikari, L Dey, S Pal, R Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/194/62868 en Copyright 2017 Journal of Global Infectious Diseases.
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Eschar- A forgotten focus of concern Senthilkumaran, S Balamurgan, N Karthikeyan, V Thirumalaikolundusubramanian, P Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/195/62867 en Copyright 2017 Journal of Global Infectious Diseases.
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Sporadic case of visceral leishmaniasis in Sikkim, India Adhikari, L Tsering, D Dhakal, OP Gupta, A Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/196/62865 en Copyright 2017 Journal of Global Infectious Diseases.
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Antibacterial effects of persica mouth wash on Helicobacter pylori growth Teymournejad, O Sattari, M Mobarez, AM Esmaeili, D Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/197/62864 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62862 2010-05-01 all journal:J_Global_Infect_Dis
Hepatitis A in young adults in the golestan province, northeast of Iran Abdolvahab, M Behnaz, K Sima, B Teimoorian, M Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/198/62862 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62861 2010-05-01 all journal:J_Global_Infect_Dis
Corticosteroid therapy in dengue infection- opinions of junior doctors Rajapakse, S Ranasinghe, C Rodrigo, C Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/199/62861 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62869 2010-05-01 all journal:J_Global_Infect_Dis
State of the globe: Catheterizations continue to cultivate urinary infections Nasr, A Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/81/62869 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62870 2010-05-01 all journal:J_Global_Infect_Dis
Urinary catheterization in medical wards Bhatia, N Daga, MK Garg, S Prakash, SK Aims : The study aims to determine the: 1. frequency of inappropriate catheterization in medical wards and the reasons for doing it. 2. various risk factors associated with inappropriate catheterization, catheter associated urinary tract infections (CAUTI) and bacterial colonization on Foley's catheters (BCFC). Settings and Design: Hospital-based prospective study. Materials and Methods: One hundred and twenty five patients admitted consecutively in the medical wards of a tertiary care hospital, who underwent catheterization with a Foley's catheter, at admission, have been included in the study. Patient profiles were evaluated using the following parameters: age, sex, diagnosis, functional status, mental status, indication, duration and place of catheterization, development of BCFC and CAUTI. Statistical tests used: Chi-square test. Results: Thirty-six out of 125 (28.8%) patients included were inappropriately catheterized. BCFC developed in 52.8% and 22.4% were diagnosed with a CAUTI. The most frequent indication for inappropriate catheterization was urinary incontinence without significant skin breakdown (27.8%). The risk factors for inappropriate catheterization were female sex (RR=1.29, 95% CI=0.99, 1.69, P<0.05) and catheterization in the emergency (RR=0.74, 95% CI=0.61, 0.90, P<0.05). The risk factors for developing a BCFC were age>60 years (RR=0.65, 95% CI=0.48, 0.89, P<0.05), non-ambulatory functional status (RR=0.57, 95% CI=0.39, 0.84, P<0.01), catheterization in the emergency (RR=2.01, 95% CI=1.17, 3.46, P<0.01) and duration of catheterization>3 days (RR=0.62, 95% CI=0.43, 0.89, P<0.01). The risk factors for acquiring a CAUTI were age>60 years (RR=0.47, 95% CI=0.25, 0.90, P<0.05), impaired mental status (RR=0.37, 95% CI=0.18, 0.77, P<0.01) and duration of catheterization>3 days (RR=0.24, 95% CI=0.10, 0.58, P<0.01). Conclusions : Inappropriate catheterization is highly prevalent in medical wards, especially in patients with urinary incontinence. The patients catheterized in the medical emergency and female patients in particular are at high risk. Careful attention to these factors can reduce the frequency of inappropriate catheterization and unnecessary morbidity. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/83/62870 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62872 2010-05-01 all journal:J_Global_Infect_Dis
Intestinal helminthiasis in children of Gurez valley of Jammu and Kashmir State, India Wani, SA Ahmad, F Zargar, SA Amin, A Dar, ZA Dar, PA Introduction : This paper is a part of the helminthological studies carried out on school-going children of the Kashmir Valley and deals with the status of intestinal helminths in the children of Gurez Valley and to assess epidemiological factors associated with the extent of endemic disease so that control measures are adopted. Material and Methods : Stool samples were collected from 352 children from Gurez Valley. The samples were processed using Kato-Katz thick smear technique, and microscopically examined for intestinal parasites. Results : Of the 352 children surveyed, 75.28% had one or more types of intestinal helminthes. Prevalence of Ascaris lumbricoides was highest (71.18%), followed by Trichuris trichiura (26.42%), Enterobius vermicularis (13.92) and Taenia saginata (5.39%). Conditions most frequently associated with infection included the water source, defecation site, personal hygiene, and the extent of maternal education. Conclusion : The study shows a relatively high prevalence of intestinal helminths and suggests an imperative for the implementation of control measures. Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/91/62872 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:62874 2010-05-01 all journal:J_Global_Infect_Dis
Searching for cutaneous leishmaniasis in tribals from Kerala, India Simi, SM Anish, TS Jyothi, R Vijayakumar, K Philip, RR Paul, N Background : In India, indigenous cases of cutaneous leishmaniasis (CL) are mainly confined to the northwestern region. But now, more and more case reports are coming in from other parts of India. In January 2009, a 26-year-old lady residing in a forest area in Thiruvananthapuram district of Kerala State presented with bluish red nodules on her upper extremities, of six months duration, which was clinically more in favor of cutaneous leishmaniasis. She had never gone out of the district of Thiruvananthapuram in her life. Aim : To investigate whether the patient hails from a new endemic focus of cutaneous leishmaniasis. Setting and Design : An epidemiological investigation in the form of a survey was carried out in March 2009 by a multidisciplinary team among 63 persons residing in the Mele Aamala and Aayiramkala forest tribal settlements in Kuttichal Panchayat of Thiruvananthapuram district. Material and Methods : History taking and clinical examination of 38 persons in the area with special consideration to skin lesions was undertaken. Microbiological and histopathological examination of the skin lesions was done. Breeding places of sand fly and possible reservoirs of Leishmania were also simultaneously investigated. Statistical analysis used : The data obtained was tabulated as frequency and percentage. Chi-square test was done to find out the statistical significance of differences in distributions. Results : Out of the 38 persons examined, active lesions were found in 12 persons and six had healed lesions. Tissue samples were obtained from seven out of the 12 suspected cases. Four of them showed Leishman Donovan (LD) bodies in tissue smears. Out of the cultures taken from three patients, one showed promastigote forms in Novy McNeal Nicolle (NNN) medium. Histopathological study was done in five patients and two patients had LD bodies, one had epithelioid cell granuloma and the other two had mixed infiltrate with predominantly macrophages. All the three investigations were carried out in three patients and out of them one showed positivity in all the three investigations and the rest two were positive in tissue smear and histopathological examination. Sandflies collected from the area gave an indirect evidence of its role in the disease transmission in the area. Conclusion : The clinical, microbiological and histopathological evaluation of the skin lesions was consistent with cutaneous leishmaniasis. But none of the patients gave history of travel outside the district before the onset of the disease and no one had newly moved into this area within the last two years. So this may be considered as probably a new focus of cutaneous leishmaniasis Medknow Publications 2010-05-01 http://www.jgid.org/text.asp?2010/2/2/95/62874 en Copyright 2017 Journal of Global Infectious Diseases.
oai:medknow.com:69329 2010-05-01 all journal:J_Hum_Reprod_Sci
Endometrial osseous metaplasia: Clinicopathological study of a case and literature review Umashankar, T Patted, S Handigund, RS Endometrial osseous metaplasia is an uncommon clinical entity with the presence of bone in the endometrium. Most of the cases clinically present with secondary infertility following an abortion. Various theories have been proposed and the most accepted theory is metaplasia of the stromal cells into osteoblastic cells that produce the bone. It is important to distinguish this condition from the mixed mullerian tumor of the endometrium to avoid hysterectomy. Removal of these bony bits leads to spontaneous conception. We present one such case in a 25-year-old female patient presented with secondary infertility. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/102/69329 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69331 2010-05-01 all journal:J_Hum_Reprod_Sci
Septate uterus with hypoplastic left adnexa with cervical duplication and longitudinal vaginal septum: Rare Mullerian anomaly Nigam, A Puri, M Trivedi, SS Chattopadhyay, B A large analysis of all the studies in the period from 1950 to 2007 suggests that the prevalence of congenital uterine anomalies in the general population is 6.7%; and in the infertile population, 7.3%. We report a rare case of unilateral hypoplastic fallopian tube and ovary with septate uterus, cervical duplication, longitudinal vaginal septum. To the best of our knowledge, this is the first report of such a congregation of anomalies. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/105/69331 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69333 2010-05-01 all journal:J_Hum_Reprod_Sci
Successful expectant management of tubal heterotopic pregnancy Baxi, A Kaushal, M Karmalkar, HK Sahu, P Kadhi, P Daval, B Expectant management for tubal heterotopic pregnancy could be considered as a successful option in a symptom-free patient where the ectopic embryo has a limited craniocaudal length with no cardiac activity. We report the obstetric outcome after expectant management for a right tubal heterotopic pregnancy. Heterotopic pregnancy was first recognized at 6 weeks gestation in a 32-year-old salpingectomized woman with an 8-year history of subfertility who conceived after in utero transfer of three embryos obtained by in vitro fertilization. Expectant management and close ultrasonographic and clinical monitoring were done. The intrauterine pregnancy proceeded unremarkably. A cesarean section was performed for breech presentation, and it allowed the delivery of a healthy 2260-g male infant. The examination of the adnexa showed a pre-rupture of the right fallopian tube. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/108/69333 en Copyright 2017 Journal of Human Reproductive Sciences.
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Hyperprolactinemia with normal serum prolactin: Its clinical significance Agarwal, M Das, A Singh, SA Amenorrhea and infertility with an added feature of galactorrhea makes a provisional diagnosis of hyperprolactinemia. But again, normal serum prolactin with all clinical features of hyperprolactinemia might question the diagnosis and further management. The answer lies in the heterogeneity of the peptide hormone - the immunoactive and the bioactive forms. This has been further illustrated with the help of a case which had been treated with cabergoline. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/111/69334 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69335 2010-05-01 all journal:J_Hum_Reprod_Sci
A rare case of intact rudimentary horn pregnancy presenting as hemoperitoneum Jain, R Gami, N Puri, M Trivedi, SS The availability of technological advances like ultrasonography (USG) and magnetic resonance imaging (MRI) has made the diagnosis of rudimentary horn pregnancy possible at an early gestation. However, in advanced pregnancy, such cases can sometimes pose a diagnostic dilemma and are recognized only when patient presents with abdominal pain and collapse and is taken for laparotomy. We report one such rare case of a nulliparous female who was carrying on well with her pregnancy till she developed symptoms of acute abdomen at 28 weeks of gestation. She underwent USG and MRI but it was only after laparotomy that a final diagnosis of a pregnancy in a rudimentary horn with placenta percreta perforating through the fundus could be made. There was a significant amount of hemoperitoneum; however, the horn was intact and the fetus could be salvaged. We excised the rudimentary horn with ipsilateral tube and ovary. Post operatively, both the mother and the baby were discharged in healthy condition. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/113/69335 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69336 2010-05-01 all journal:J_Hum_Reprod_Sci
Diagnosis of primary ovarian cancer Wiwanitkit, V Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/116/69336 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69338 2010-05-01 all journal:J_Hum_Reprod_Sci
A386G polymorphism and infertility Wiwanitkit, V Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/116/69338 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69339 2010-05-01 all journal:J_Hum_Reprod_Sci
Influenza, swine flu, sperm quality and infertility: A story Wiwanitkit, V Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/116/69339 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69330 2010-05-01 all journal:J_Hum_Reprod_Sci
From the Editor's desk Rao, KA Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/61/69330 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69332 2010-05-01 all journal:J_Hum_Reprod_Sci
The impact of female obesity on the outcome of fertility treatment Pandey, S Pandey, S Maheshwari, A Bhattacharya, S The rising prevalence of obesity has had a profound impact on female reproductive health. Increased body mass index (BMI) is associated with ovulatory subfertility and anovulatory infertility. Overweight and obese women have poorer outcomes following fertility treatment. They respond poorly to clomiphene induction of ovulation and require higher doses of gonadotrophins for ovulation induction and superovulation. Ovarian stimulation for assisted reproduction produces fewer follicles resulting in the harvest of fewer oocytes. Fertilization rates are poorer and the embryo quality is impaired in younger women who are obese. Pregnancy rate in some studies is lower and there is an increased risk of early pregnancy loss. Weight loss regularizes menstrual cycles and increases the chance of spontaneous ovulation and conception in anovulatory overweight and obese women. Gradual sustained weight loss is beneficial whereas crash dieting is detrimental. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/62/69332 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69337 2010-05-01 all journal:J_Hum_Reprod_Sci
Perspective on plasma membrane cholesterol efflux and spermatozoal function Sheriff, DS Ali, EF The process of sperm maturation, capacitation, and fertilization occur in different molecular milieu provided by epididymis and female reproductive tract including oviduct. The different tissue environment with different oxygen tension and temperature may still influence the process of sperm maturation and capacitation. Reactive oxygen species (ROS) is reported to be an initial switch that may activate the molecular process of capacitation. Therefore, the generation of reactive oxygen species and its possible physiological role depends upon a balance between its formation and degradation in an open environment provided by female reproductive tract. The sensitivity of the spermatozoa to the action of ROS may be due to its exposure for the first time to an oxygen rich external milieu compared to its internal milieu in the male reproductive tract. Reduced temperature in testicular environment coupled with reduced oxygen tension may be the right molecular environment for the process of spermatogenesis and spermiogenesis. The morphologically mature spermatozoa then may attain its motility in an environment provided by the caput epididymis wherein, the dyenin motor can become active. This ability to move forward will make the spermatozoa physiologically fit to undertake its sojourn in the competitive race of fertilization in a new oxygen rich female reproductive tract. The first encounter may be oxygen trigger or preconditioning of the spermatozoa with reactive oxygen species that may alter the spermatozoal function. Infertility is still one of the major global health problems that need medical attention. Apart from the development of artificial methods of reproduction and development of newer techniques in the field of andrology focuses attention on spermatozoal structure and metabolism. Therefore, understanding the molecular mechanisms involved in fertilization in general and that of sperm capacitation in particular may help lead to new and better techniques for enhancing fertility, identifying and treating certain forms of male infertility, and preventing conception. One remarkable insight is the importance of membrane cholesterol efflux in initiating transmembrane signaling events that confer fertilization competence. The identity of the physiologically relevant cholesterol acceptors and modulators of cholesterol efflux is therefore of great interest. Still, it is clear that cholesterol efflux represents only a part of this story. The involvement of phospholipid translocation in mediating dynamic changes in the membrane, rendering it conducive to transmembrane signaling, and the modulation of membrane components of signal transduction cascades by cholesterol or phospholipids will yield important insights into the links between environmental sensing and transmembrane signaling in the sperm. Understanding the membrane molecular events will ultimately provide new and exciting areas of investigation for the future. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/68/69337 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69340 2010-05-01 all journal:J_Hum_Reprod_Sci
Transfer of human frozen-thawed embryos with further cleavage during culture increases pregnancy rates Joshi, BV Banker, MR Patel, PM Shah, PB Aim: To compare the pregnancy rate following transfer of frozen-thawed embryos with or without overnight culture after thawing. Settings and Design: This is a retrospective analysis of frozen-thawed embryo transfer (FET) cycles performed between January 2006 and December 2008. Materials and Methods: Out of 518 thaw cycles, 504 resulted in embryo transfers (ETs). Of the total FET cycles, 415 were performed after an overnight culture of embryos (group A); and in 89 cycles, ET was performed within 2 hours of embryo thawing (group B). Statistical Analysis: The data were statistically analyzed using chi-square test. Results: We observed that with FET, women ≤30 years of age had a significantly higher (P=0.003) pregnancy rate (PR=28.9%) as compared to women >30 years of age (17.5%). A significantly higher (P<0.001**) pregnancy rate was also observed in women receiving 3 frozen-thawed embryos (29%) as compared to those who received less than 3 embryos (10.7%). The difference in PR between group A (PR=24.3%) and group B (PR=20.3%) was not statistically significant. However, within group A, ET with cleaved embryos showed significantly ( P≤0.01) higher pregnancy rate compared to the uncleaved embryos, depending on the number of cleaved embryos transferred. Conclusion: No significant difference was noticed between FETs made with transfer of embryos with overnight culture and those without culture. However, within the cultured group, transfer of embryos cleaved during overnight culture gave significantly higher PR than transfers without any cleavage. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/76/69340 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69341 2010-05-01 all journal:J_Hum_Reprod_Sci
Comparative evaluation of pregnancy outcome in gonadotrophin-clomiphene combination vs clomiphene alone in polycystic ovarian syndrome and unexplained infertility-A prospective clinical trial Mukherjee, S Sharma, S Chakravarty, BN Objectives: A large prospective clinical trial was conducted to compare the efficacy of single dose uFSH and clomiphene citrate combination with clomiphene citrate alone for ovulation induction to improve the pregnancy rate. Materials and Methods: The study was a randomized, prospective clinical trial. Totally, 1527 infertile women (4381 cycles) with polycystic ovarian syndrome (PCOS) (n=911/2573 cycles) and unexplained infertility (n=616/1808 cycles) were randomized into two groups. Group A received single dose of uFSH on D <sub>3</sub> of menstrual cycle along with clomiphene. Group B received clomiphene only for ovulation induction. We compared the pregnancy rate and miscarriage rate between two groups. Results: Group A had a pregnancy rate of 17% compared to 8.3% of Group B which was significantly higher (P=0.0001). The miscarriage rate was 11% in Group A and 10% in Group B which was not significant (P=0.99). Pregnancy rates in PCOS women were 22% in Group A and 9.3% in Group B which shows significantly higher pregnancy rate (P=0.0001) in anovulatory infertility. But in unexplained infertility, there was no significant difference in pregnancy rate between Group A (11%) and Group B(6.3%). Miscarriage rates were 8.8% and 9.5% in Group A and Group B, respectively, in PCOS women and 14% and 13% in women with unexplained infertility. Conclusion: Addition of single dose of uFSH improves pregnancy outcome particularly in anovulatory infertility (WHO II). Correction of unexplained infertility may need more than simple correction of possible subtle ovulatory effect. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/80/69341 en Copyright 2017 Journal of Human Reproductive Sciences.
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Effect of bromocriptine on the severity of ovarian hyperstimulation syndrome and outcome in high responders undergoing assisted reproduction Sherwal, V Malik, S Bhatia, V Context: Ever since ovarian hyperstimulation syndrome (OHSS) was recognized as a clinical entity, various treatment modalities have been tried to prevent its occurrence and reduce its severity. Many recent studies have evaluated the role of dopamine agonists in reducing the incidence of OHSS. Objectives: To assess the effectiveness of dopamine agonist bromocriptine in reducing the incidence and severity of OHSS in patients undergoing assisted reproduction and its effect on pregnancy rates. Settings and Design: It was a prospective study in which patients at high risk of developing OHSS undergoing assisted reproduction were recruited. Materials and Methods: The study was carried out from August 2008 to August 2009 in patients undergoing assisted reproduction and included 40 patients at high risk for developing OHSS. Tablet bromocriptine 2.5 mg was prescribed for a period of 16 days starting from day of ovum pick up. Patients were analyzed on the basis of incidence of moderate and severe OHSS, timing of onset of OHSS (early/late), hospitalization rate, pregnancy rates and tolerability of medication and were compared with a historical group of high responders matched for age and BMI. Statistical Analysis: Student's t test and proportion test were used. Results: There was a significant reduction in the incidence of moderate OHSS (P=0.037), early OHSS (P=0.012) as well as the number of admissions (P=0.030). Average duration of hospitalization was also significantly reduced (P=0.036). In the study group, the incidence of clinically significant OHSS was 17.5% as compared to 40.9% in the control group. No difference was detected between the groups in clinical pregnancy rates (P=0.0054). Conclusion: Bromocriptine reduced the incidence and severity of clinically significant OHSS in high risk patients without affecting the pregnancy rates. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/85/69342 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69343 2010-05-01 all journal:J_Hum_Reprod_Sci
Demographic characteristics and clinical profile of poor responders in IVF / ICSI: A comparative study Padhy, N Gupta, S Mahla, A Latha, M Varma, T Background: Ovarian response varies considerably among individuals and depends on various factors. Poor response in IVF yields lesser oocytes and is associated with poorer pregnancy perspective. Cycle cancellation due to poor response is frustrating for both clinician and the patient. Studies have shown that women conceiving after poor ovarian response have more pregnancy complications like PIH and preeclampsia than women with normal ovarian response. In addition, poor ovarian response could be a predictor of early menopause. This paper studies various demographic and clinical profiles of poor responders and tries to look at the known and unknown factors which could contribute to poor ovarian response in IVF. Materials and Methods: Data were collected retrospectively from 104 poor responders who had less than four oocytes at retrieval and compared with 324 good responders for factors like age, BMI, type of sub fertility, duration of sub fertility, environmental factors like stress at work, smoking, pelvic surgery, chronic medical disorder, indication of IVF, basal FSH, mean age of menopause in their mothers etc. Results: Among the poor responders, 60.57% were above 35 years of age compared to 36.41% in control group, which is statistically significant. Mean age of menopause in mother was found to be four years earlier in poor responder group. Male factor and unexplained infertility were significantly (P<0.05) higher in good responders (P<0.05). Significant proportion (31.73%) of women in study group had undergone some pelvic surgery (P<0.05). Conclusion: Apart from age, prior pelvic surgery also could be used as predictors for poor ovarian response. Heredity also plays a major role in determining ovarian response. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/91/69343 en Copyright 2017 Journal of Human Reproductive Sciences.
oai:medknow.com:69344 2010-05-01 all journal:J_Hum_Reprod_Sci
Correlation of human sperm centrosomal proteins with fertility Hinduja, I Baliga, NB Zaveri, K Objective: The centrosome is the microtubule organizing center (MTOC) paternally inherited by the zygote during fertilization. As the centrosome is located in the midpiece of the sperm tail, we presume that oligoasthenozoospermic sperm samples should also have abnormal concentrations of centrosomal proteins. This study therefore aims to determine if there is any correlation between sperm centrosomal proteins, centrin, a and g-tubulin, in sperm samples from normozoospermic and oligoasthenozoospermic men. Materials and Methods: Proteins were extracted from the normozoospermic and oligoasthenozoospermic sperm samples and analyzed by Western Blot and ELISA for centrin, α and γ-tubulin. Results: The levels of centrin, α and γ-tubulin are markedly lower in oligoasthenozoospermic sperm samples as compared to the normozoospermic sperm samples. Conclusions: Lower centrosomal protein expression in sperm samples of oligoasthenozoospermic infertile males may be a possible cause for their reduced fertility status. Further studies on these proteins are warranted to design rational approaches for the diagnosis and treatment of male infertility. Medknow Publications 2010-05-01 http://www.jhrsonline.org/text.asp?2010/3/2/95/69344 en Copyright 2017 Journal of Human Reproductive Sciences.
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Publish and share…. Aggarwal, S Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/55/95250 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95252 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
The biologic basis for surgical therapies Horowitz, RA Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/56/95252 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95253 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Photodynamic therapy: A new vista in management of periodontal diseases Doshi, Y Patil, PS Shah, N Dixit, S Shah, M Aim: The purpose of this review was to evaluate the effectiveness of photodynamic therapy (PDT) for periodontitis. This review also elucidates application of photodynamic therapy for noninvasive management of periodontitis without leading to bacterial resistance. Background: Periodontal diseases are one of the major causes of tooth loss in adults and are considered primarily an anaerobic bacterial infections caused by the so-called red complex species. Bacteria present in a biofilm community, enzymes, endotoxins, and other cytotoxic factors lead to tissue destruction and initiate chronic inflammation. Since many years pioneers have been working to provide logical and cost-effective therapy for management of periodontitis. Periodontal researchers have found that PDT is advantageous to suppress anaerobic bacteria. Clinical Significance: Applications of PDT in dentistry are growing rapidly. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap surgery may be reduced, patient comfort may increase, and treatment time may decrease. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodonto-pathogens. The introduction of laser along with photosensitizers has brought a revolutionary change. Conclusion: The application of photodynamic therapy in management of periodontal diseases is very valuable. The therapy should be combined with nonsurgical periodontal therapy. Proper clinical application of photodynamic therapy can and will help patients who are systemically compromised and cannot undergo surgical therapy. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/57/95253 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95257 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Tracking of Actinobacillus actinomycetemcomitans in subgingival plaque of aggressive periodontitis patients Kheur, S Hazarey, VK Kapley, A Purohit, H Background: Actinobacillus actinomycetemcomitans is thought to be one of the etiological agents in aggressive periodontitis as well as indicated in various systemic diseases. Objective: To evaluate the prevalence of A. actinomycetemcomitans in the subgingival plaque of aggressive periodontitis patients. Study Design: Initially, under the selective growth conditions, the isolates were picked from the plaques and their identification was confirmed by polymerase chain reaction using primers specific for A. actinomycetemcomitans subgingival plaque of 15 patients diagnosed clinically and on radiographic criteria as aggressive periodontitis was inoculated on the Tryptic Soy agar with Bacitracin and Vancomycin culture media for 3-5 days under microaerophilic conditions. The positive colonies were selected based on biochemical tests for further analysis using reported primers for A. actinomycetemcomitans. Results: The results showed that 66.67% of aggressive periodontitis patients and 6.67% of control group of normal patients showed evidence of presence of A. actinomycetemcomitans in the subgingival microflora. Conclusion: This is the first study of its kind in an Indian population whereby almost all aggressive periodontitis patients showed evidence of A. actinomycetemcomitans. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/64/95257 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95261 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
An evaluation of the fracture resistance of class 2 amalgam restorations with different cavity designs on maxillary premolars Shashank, K Chole, DG Ranga, B Aims and Objectives: The aim of this work was to compare the fracture resistance values of "Mesio-occlusal" preparation, "slot" preparation with "conventional grooves," "box-only," and "MOD" preparation. Materials and Methods: A total of 60, noncarious extracted maxillary premolars were selected and divided into four groups, consisting of 15 teeth each -- group A: "Mesio-occlusal" preparation, group B: "slot" preparation (conventional grooves), group C: "box-only" preparation (long grooves), group D: "MOD" cavity preparation. All the specimens were subjected to compressive axial load in triaxial testing machine at a cross head speed of 1.2 mm/min at an inclination of 13.5°. Results: Group A ("Mesio-occlusal") preparation had the least fracture resistance value and group D ("MOD") cavity preparation had the highest fracture resistance. There was a significant difference in fracture load found between groups B and C. Conclusion: Amalgam restorations with "Mesio-occlusal" preparations had the least fracture resistance. Amalgam restorations with "slot" preparations had better fracture resistance than "box-only" preparation. Amalgam restorations with "MOD" preparations had the highest fracture resistance. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/70/95261 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95264 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Evaluation of the sealing ability of bone cement as furcation perforation repair material when compared with mineral trioxide aggregate and calcium phosphate cement: An in-vitro study Chordiya, R Hiremath, H Metgud, S Heda, A Aim: This study was undertaken to compare the sealing ability of bone cement as furcation perforation repair material when compared with mineral trioxide aggregate and calcium phosphate cement. Materials and Methods: A total of 70 sound mandibular molars were selected for this study. The sample teeth were randomly divided into five groups: group I - n=20, perforation repair material used, mineral trioxide aggregate; group II - n=20, perforation repair material used, calcium phosphate cement; group III - n=20, perforation repair material used, bone cement; group IV - positive control, n=5, the furcation were not repaired with any material; group V - negative control, n=5, furcation area intact, no perforation done. The teeth were immersed in silver nitrate solution for 2 hours and then rinsed with photographic developer solution for 6 hours. They were then sectioned in a longitudinal direction and examined under a stereomicroscope. In each section the actual values of dye leakage were calculated from outer margins of perforation to the level of pulpal floor and were then subjected to statistical analysis. Results: An unpaired 't' test revealed that different groups exhibited significantly different dye penetrations (P<0.01). Conclusion: Furcation perforation repaired with MTA showed minimum microleakage (mean 54.5%), calcium phosphate cement showed maximum microleakage (100%), and bone cement showed moderate dye leakage (87.8%). Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/75/95264 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95267 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Peripheral ossifying fibroma Mani, A Mhaske, S Marawar, PP Lagdive, S Kalburge, JV The peripheral ossifying fibroma (POF) is an exophytic gingival mass of fibrous connective tissue covered with a surface epithelium associated with the formation of randomly dispersed foci of a mineralized product consisting of bone, cementum-like tissue, or dystrophic calcifications having a recurrent rate of nearly 20%. It is one of the most common reactive gingival lesions, which have often been called by the generic term "epulis." This case report describes the clinical and histopathological findings of POF, its differential diagnosis, and treatment. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/82/95267 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95273 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
A novel tissue engineering technique for regeneration of lost interdental papillary height Surana, R Ashtaputre, V Doiphode, S Kharat, K Rakhewar, P Mhaske, M Open interdental spaces caused by papillary gingival recession are one of the most common problems faced in dentistry. Surgical and nonsurgical periodontal treatments for regeneration of lost papillary height have been reported with limited success. The present study reports effectiveness of autologous cultured fibroblast injections, a tissue engineering technique for papillary regeneration. A black triangle caused by Tarnow's and Nordland's class I papillary gingival loss was reported in maxillary anterior region of a young male patient. An autologous gingival biopsy was cultured in a biotechnology lab for the growth and expansion of fibroblasts. Cultured fibroblast suspension was injected into the receded papilla twice at an interval of 5 days. Follow-ups were recorded on the 6th day, 15 <sup>th</sup> day, at 1 month and at 2 months. Complete fill of black triangle was noted at the end of 2 months. No inflammatory or immune reactions were noted at the site of injection. Autologous cultured fibroblast injections are safe, efficacious, and an acceptable treatment option for the regeneration of lost papillary height. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/86/95273 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95275 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Pleomorphic adenoma of the hard palate Garde, JB Raikwar, K Kulkarni, A Pleomorphic adenoma is the most common benign salivary gland tumor, which has elements of both epithelial and mesenchymal tissues. The tumor most commonly arises in the parotid or submandibular glands. Infrequently, it may arise from the minor salivary glands. We report a case of pleomorphic adenoma of minor salivary gland of palate in an 18-year-old young female patient for which the surgical treatment was rendered and with no evidence of recurrence. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/92/95275 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95276 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Implant-based rehabilitation of a large mandibular odontogenic keratocyst with 7-year follow-up Garde, JB Kulkarni, AU Dadhe, DP Odontogenic keratocyst is a unique cyst because of its locally aggressive behavior, high recurrence rate, and characteristic histological appearance. In this case report we present a 25-year-old male patient with a large odontogenic keratocyst and treatment with enucleation and chemical cauterization followed by dental implants with a 7-year follow-up. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/95/95276 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:95277 2010-05-01 all journal:J_Int_Clin_Dent_Res_Organ
Overcoming esthetic challenges in the smile zone using the "roll flap procedure" Wagle, RG Shanbhag, C Pavaskar, RS Hard and soft tissue alveolar ridge deformities occur following the extraction of teeth, creating functional and esthetic tooth replacement challenges, especially in the esthetic zone. A surgical technique using a roll flap technique for ridge augmentation is discussed which when combined with conventional fixed partial dentures for tooth replacement creates a template of the labial and interproximal sulcus at the edentulous site, allowing for the molding of an ovate pontic resulting in greatly improved esthetics in an esthetically compromised case. This results in vastly improved restorative emergence profiles with minimal or no change in the height of the labial gingival margin and the form and height of the interproximal papillae with adjacent teeth. This technique enhances soft tissue contours adjacent to the definitive restoration that vary little from those of the original natural tooth. Medknow Publications 2010-05-01 http://www.jicdro.org/text.asp?2010/2/2/98/95277 en Copyright 2017 Journal of the International Clinical Dental Research Organization.
oai:medknow.com:103482 2010-05-01 all journal:J_Orofac_Sci
A Study to Assess the Oral Health Status of Institutionalized Blind Children in Mysore City, Karnataka Naveen, N Reddy, C Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/12/103482 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103483 2010-05-01 all journal:J_Orofac_Sci
The Effect of Eugenol Containing and Eugenol Free Temporary Cements on the Microleakage in Resin Bonded Restorations - An In-Vitro Study Mathew, J James, R Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/16/103483 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103484 2010-05-01 all journal:J_Orofac_Sci
Prevalence of Dental Fluorosis in Rural Areas of Bagalkot District, Karnataka, India Veeresh, DJ Geetha, NT Prathap, K Goutham, BS Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/23/103484 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103485 2010-05-01 all journal:J_Orofac_Sci
Bibliometric Study of Publication by Indian Oral and Maxillofacial Pathologists Between 1996 – 2007: A Medline Approach Shamala, RK Rooban, T Anusa, AM Reddy, B Ranganathan, K Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/28/103485 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:102948 2010-05-01 all journal:J_Orofac_Sci
Guest Editorial Singer, SR Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/3/102948 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103486 2010-05-01 all journal:J_Orofac_Sci
A Comparison of Gingival Inflammation Related to Retraction Cords Using Biochemical Analysis of Gingival Crevicular Fluid Kishore, KK Anche, S Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/33/103486 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103487 2010-05-01 all journal:J_Orofac_Sci
Concomitant Occurrence of Periapical Cemental Dysplasia and Compound Odontoma in the Anterior Mandible : Report of a Case Lee, G Singer, SR Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/37/103487 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:102949 2010-05-01 all journal:J_Orofac_Sci
Dental Caries and Body Mass Index in Children of Nellore Gokhale, N Sivakumar, N Nirmala, S Abinash, M Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/4/102949 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103488 2010-05-01 all journal:J_Orofac_Sci
Large Fibro-Lipoma of Tongue Removed Via Punch Biopsy : An Intra-Oral Application of the Narrow Hole Extrusion Technique (NHET) Philipone, E Yoon, AJ Zegarelli, D Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/41/103488 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103489 2010-05-01 all journal:J_Orofac_Sci
Solitary Neurofibroma of the Inferior Alveolar Nerve Rinaggio, J Philipone, E Wilk, R Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/44/103489 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103490 2010-05-01 all journal:J_Orofac_Sci
Hemangioma of Tongue Treated with Sclerosing Agent : A Case Report Samatha, Y Vardhan, TH Kiran, AR Mahalakshmi, M Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/47/103490 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103491 2010-05-01 all journal:J_Orofac_Sci
Mesiodens Taking the Position of Maxillary Left Primary Central Incisor: A Case Report Nuvvula, S Velpula, L Kiranmayi, M Nirmala, S Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/50/103491 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103492 2010-05-01 all journal:J_Orofac_Sci
Osteoblastoma Involving Maxilla : An Unusual Case Report with Review of Literature Saikhedkar, R Wanjari, S Nirwan, A Prasad, H Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/53/103492 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103493 2010-05-01 all journal:J_Orofac_Sci
Differential Diagnosis of White Lesions of Oral Mucosa Jayanthi, P Ranganathan, K Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/58/103493 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103494 2010-05-01 all journal:J_Orofac_Sci
Oral Defensins - The Antimicrobial Polypeptides Reddy, VS Sumanthi, J Anuradha, C Shekar, PC Chandra, KL Reddy, B Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/64/103494 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:103481 2010-05-01 all journal:J_Orofac_Sci
Cytological Changes and Pattern of Keratinization in Palatal Mucosa of Reverse Smokers : A Pilot Study Rajkumar, NG Bharath, TS Manjunath, K Saraswathi, TR Ramachandran, CR Medknow Publications 2010-05-01 http://www.jofs.in/text.asp?2010/2/2/7/103481 en Copyright 2017 Journal of Orofacial Sciences.
oai:medknow.com:62172 2010-05-01 all journal:Med_Law_Cases_Doct
Escape of an IPD patient - Protocol to indemnify the hospital/nursing home from legal consequences <ol><li>In case an IPD patient leaves or escapes from the hospital/nursing home without being duly discharged - <ol type='a'><li>Forthwith give a written intimation to the nearest police station about the same and take proper acknowledgment with time and date. </li><li>Next, send a letter to the patient by 'registered post acknowledgment due' at the address written in the admission form clearly recording that the patient has left without being discharged. </li><li>Duly preserve the police and postal acknowledgment with the patient's medical records. </li><li>This protocol must be followed even in case of mentally unstable patient who may have simply escaped and the relatives/attendants/friends may also be searching for the patient.</li></ol> </li></ol> In case any untoward incident happens with the patient or the patient commits any illegal act after escaping, the aforementioned protocol will help in protecting the hospital and the doctors against the legal consequences arising from the same. Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/53/62172 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62173 2010-05-01 all journal:Med_Law_Cases_Doct
Legal necessity of involving an anesthetist during a surgery/procedure <ol><li>Every doctor must seriously contemplate the necessity of involving an anesthetist while planning an intervention no matter how simple or innocuous the procedure/surgery may seem. In case of dilemma, it is advisable to involve an anesthetist rather than not involving one. Proceeding with a surgery/procedure without an anesthetist where the presence of an anesthetist is indicated, is per se negligence. </li><li>Not giving test dose of anesthesia drugs or sensitivity test where indicated, is negligence. </li><li>In case a medical mishap occurs, the reasons for the mishap as well as the justification for following that particular line of treatment must be specifically and carefully recorded. </li><li>The responsibility of the patient's care in transit during transfers is on the transferring hospital. </li><li>Hospitals and nursing homes, government or otherwise, that charge fees from some patients and provide free services to other patients, are liable for negligence before the consumer courts for both the categories of patients. </li><li>Medical records of a patient who has suffered during a medical mishap must be preserved carefully and for a longer period. </li><li>Inform the patient/relatives/friends/attendants about the occurrence of a medical mishap or accident at the first opportunity.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/55/62173 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62174 2010-05-01 all journal:Med_Law_Cases_Doct
Conducting surgery/procedure with abnormal vitals - Precautions <ol><li>Performing a surgery/procedure on a patient with abnormal vitals requires greater caution and due deliberations. In such cases <ol type='a'><li>Proceed only if your action is justified in medical science and where such a course is absolutely necessary. </li><li>Taking a second opinion would be advisable. </li><li>The reason/s for proceeding must be prominently recorded in the patient's medical records. </li><li>Take high-risk consent from the patient clearly explaining and recording the necessity to proceed. </li><li>Contemplate the complications that may arise during or after the procedure and make necessary preparations to deal with the same. Duly record the aforesaid.</li></ol> </li><li>Every transfer/ of an IPD patient must be accompanied by a discharge or a transfer certificate/note/summary. </li><li>Every investigation must be justified and solely in the patient's interest. </li><li>In cases where an IPD patient is advised transfer, the time of giving such advice must be prominently recorded. Delay in transferring a patient after giving such advice could be construed as negligence. In case of delay, reasons thereof must be specifically recorded. </li><li>Courts give great weight to medical records of the patients prepared and maintained by the hospital/doctor during the normal course and generally don't dispute their genuineness.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/57/62174 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62175 2010-05-01 all journal:Med_Law_Cases_Doct
Wealthier the patient, higher the compensation granted by courts <ol><li>The court in awarding compensation in cases of medical negligence, takes the financial status and the earning capacity of the patient into consideration. Thus patients who are rich or those who earn higher will be paid higher compensation even though the act of negligence and the consequences arising therefrom could be the same in case of a poorer patient. (In the present case, the court has observed that income tax returns of the patient can be taken into consideration in deciding the amount of compensation.) </li><li>Consumer courts can direct the delinquent doctor/hospital to pay to the patient on two counts <ol type='a'><li>Reimbursement of the actual medical expenses incurred by the patient in getting himself treated in another hospital as well as in/by the delinquent hospital/doctors. </li><li>Compensation on account of loss of business and mental harassment and agony suffered by the patient.</li></ol> </li><li>Treating a patient with outdated treatment is per se negligence.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/59/62175 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62176 2010-05-01 all journal:Med_Law_Cases_Doct
Liability of the principal surgeon - Captain of the surgical team <ol><li>The principal surgeon / interventionist will be liable in courts for any mistake committed by any member of the surgery team, whether medical, para-medical or nursing, during the course of surgery. </li><li>Once a mistake is discovered, all efforts must be directed toward remedial steps rather than in covering up the wrong. Law takes a harsh view of such cover-up attempts. </li><li>Standard protocol in counting swabs and instruments must be strictly followed. </li><li>Appropriate steps must be taken to avoid mixing up of patients lined up for surgery, especially in case of anesthized or unconscious patients. It has proved to be a potential source of error in surgery, worldwide. </li><li>Standard protocols must be followed and appropriate precautions taken to ensure that the wrong side or the wrong digit of the hand / foot or wrong organ of the body is not operated on.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/61/62176 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62177 2010-05-01 all journal:Med_Law_Cases_Doct
How much importance must be given to the advice, suggestion or diagnosis of the referring doctor? <ol><li>In cases where the referring doctor has expressed certain doubts or has made differential diagnosis, the consulting doctor may take the same into consideration but it is not mandatory to first rule out those possibilities and then proceed with exploring other options. If the consulting doctor has reasons to believe that the said suspicions are not at all worth considering, he or she may simply choose to ignore the same and pursue an entirely different line. But in such cases, the reasons to differ with the possibilities expressed by the referring doctor must be briefly but specifically recorded by the consulting doctor in the medical records of the patient. </li><li>Consultants are bound to answer the question/s, if any, framed by the referring doctor.</li><li>Ensure that post-surgery/procedure instructions regarding the time after which water and food can be given to the patient and the type of food that can be given to the patient are strictly followed. These instructions must also be recorded in the patient's medical records. </li><li>Conduct appropriate investigations to arrive at a definite diagnosis and to rule out other possibilities at the earliest. </li><li>In case of complications or if the patient is not responding to the treatment, involving or conferring with senior consultants is advisable and the said fact must be duly recorded.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/63/62177 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62178 2010-05-01 all journal:Med_Law_Cases_Doct
Dates in hospital bills - Relevance in courts and precautions <ol><li>It is advisable that bills of IPD, patients' are either drawn datewise or there should be some indication of the date on which a particular investigation was performed or a consumable was indented. (In the present case, the patient's allegation that too many investigations were performed only on the day of the patient's death was sought to be substantiated by producing bills of the hospital [OP]. The hospital's [OP] defense was that although the investigations were carried out on different dates, the bills for the same were raised on the last day. This defense is believable as hospitals normally raise bills at intervals of 3-5 days or on the day of discharge/death. But, probably this explanation was rejected by the court.) </li><li>Giving inflated bills is both negligence and cheating, a criminal offence. </li><li>Conducting investigations without any justification is negligence. Every investigation that is advised must be relevant and for proper reasons. This precaution is all the more necessary when any test has to be repeated. </li><li>Advice/repeat appropriate investigations at appropriate time, neither too early nor too late. </li><li>Premature discharge of a patient is negligence. </li><li>Make efforts to reach a proper diagnosis at the earliest. </li><li>Every medical act must be duly recorded with date and time. </li><li>IPD patients are legally entitled to receive copies of the medical records. The original medical records are the properties of the hospital.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/65/62178 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:62179 2010-05-01 all journal:Med_Law_Cases_Doct
Marking the presence of the doctor/s involved with the patient - A legal requisite <ol><li>Every consultant who visits an IPD patient must put his or her signature along with appropriate remarks, date and time on the medical records of the patient. </li><li>In any procedure/surgery, all the doctors who are involved, including physicians, other specialists, junior assistants and anesthetist/s must record their presence by signing at appropriate places in the patient's medical records. , </li><li>The principal surgeon/interventionist must seriously contemplate on involving appropriate specialists for a particular surgery/procedure. In case of a dilemma, it is advisable to include a particular specialist in the surgical team rather than not including one. </li><li>Performing a procedure/surgery to correct an earlier medical mistake should ideally be done absolutely free of cost or at the most actual expenses must only be taken. There are reported cases where the courts have expressly taken a lenient view in such cases. </li><li>If the patient refuses to follow some medical advice, inform the patient/relatives/attendants/friends of the consequences and take their written endorsement of having received the advice. In cases where consequences could be serious, withdrawing from the treatment or discharging an IPD patient against medical advice are the other options that must be seriously considered. </li><li>All the physical abnormalities and deformities of the patient that have been observed must be specifically recorded in the patient's medical records. </li><li>A properly drafted and elaborate "discharge against medical advice" must be taken from the patients who seek such discharge.</li></ol> Medknow Publications 2010-05-01 http://www.mlcd.in/text.asp?2010/3/5/67/62179 en Copyright 2017 Medical Law Cases for Doctors.
oai:medknow.com:65527 2010-05-01 all journal:Neurol_India
Another small step toward understanding hydrocephalus Pattisapu, JV Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/339/65527 en Copyright 2017 Neurology India.
oai:medknow.com:65528 2010-05-01 all journal:Neurol_India
Non-functional pituitary adenomas Chacko, G Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/341/65528 en Copyright 2017 Neurology India.
oai:medknow.com:65531 2010-05-01 all journal:Neurol_India
Stroke in young: An Indian perspective Prasad, K Singhal, KK The issue of stroke in young in India has long been of interest to neurologists in the country. The age group for stroke in young has been variable between different studies but perhaps should be restricted to 15-49 years as this age group tends to have a unique set of causes and risk factors. There is no evidence indicating higher incidence of stroke in young in India than in other countries. Age-specific incidence rates from recent population-based studies from India are comparable to the western populations. Though the traditional risk factors of stroke play a significant role in young age group also, the presence of high number of cryptogenic strokes, cardioembolic and venous strokes makes diagnostic evaluation in this age group more challenging. This review aims at defining the age group for stroke in young, focuses on incidence of stroke in young on the basis of different population-based studies and details the risk factors and diagnostic approach of different stroke subtypes in young. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/343/65531 en Copyright 2017 Neurology India.
oai:medknow.com:65534 2010-05-01 all journal:Neurol_India
Management strategies in chronic inflammatory demyelinating polyradiculoneuropathy Patel, K Bhanushali, M Muley, SA Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic, proximal and distal, asymmetrical or symmetrical, motor and sensory demyelinating polyneuropathy with a progressive course for at least 2 months. The accurate diagnosis is crucial as CIDP is amenable to treatment. Recent advances have provided new strategies and options for management of this syndrome. In this article, we review the clinical and diagnostic features as well as discuss recent insights and treatment strategies along with our experience in the management of patients with CIDP. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/351/65534 en Copyright 2017 Neurology India.
oai:medknow.com:65569 2010-05-01 all journal:Neurol_India
Structural and functional neuroimaging in intractable epilepsy Chinchure, S Kesavadas, C Thomas, B Medical management remains unsatisfactory in about a third of patients with epilepsy and some of them are candidates for resective epilepsy surgery. Structural and functional neuroimaging plays an important role in the identification of the precise cortical region responsible for seizures and is very crucial for a good surgical outcome. Furthermore, identification of eloquent cortical areas near the region to be resected is essential to avoid postoperative neurologic deficit. The magnetic resonance imaging (MRI) protocol for epilepsy can be individually tailored depending on the seizure semiology and possibly electroencephalography. New MRI techniques demonstrate the structure of the brain in fine detail, help in understanding the underlying pathology, and demonstrate functional activity of the brain with high spatial and temporal resolution. Metabolic imaging techniques, such as positron emission tomography (PET) and single photon emission tomography (SPECT) visualize metabolic alterations of the brain in the ictal and interictal states. In MR-negative epilepsy patients, these techniques may have localizing value. The proper use and interpretation of the findings provided by these new technologies is crucial. In this review article, we discuss various conventional and advanced MRI techniques, interpretation of various findings, and the role of functional imaging modalities, such as functional MRI, PET, and SPECT in the localization of epileptogenic substrate as well as for understanding the pathophysiology, propagation, and neurochemical correlates of epilepsy. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/361/65569 en Copyright 2017 Neurology India.
oai:medknow.com:65601 2010-05-01 all journal:Neurol_India
Cerebrospinal fluid absorption disorder of arachnoid villi in a canine model of hydrocephalus Zhao, K Sun, H Shan, Y Mao, BY Zhang, H Background: Hydrocephalus results from inadequate passage of cerebrospinal fluid (CSF) from its point of production within the cerebral ventricles to its point of absorption into systemic circulation. Aims: The objective of this study was to investigate the disorders of CSF absorption by arachnoid villi during the different phases of hydrocephalus. Materials and Methods: Silicone oil was injected into the fourth ventricle of 15 canines as an experimental group. Saline solution (0.9% NaCl) was injected in another nine canines as a control group. In order to block CSF transport through the cribriform plate, an external ethmoidectomy was performed in five dogs from experimental group and three dogs from control group at three days (acute stage), two weeks (sub-acute stage), and 12 weeks (chronic stage) respectively. Tritiated water was injected into the canines' cortical subarachnoid space and blood levels were measured at intervals of 1h, 4h, 8h, 16h and 48h respectively. Time-concentration curve of tritiated water was drafted. The area under the curve (AUC) was calculated for variance analysis and t-testing. Results: In the chronic group, the tritiated water concentration rose slowly to a peak at 16h. It was significantly lower than other groups at 1h, 4h, 8h and 16h, but was higher than other groups at 48h. Analysis of the AUC showed significant differences among all the groups (P<0.01). There were no significant differences in the AUC between control groups, the acute group, and the sub-acute group (P>0.05); however, the AUC of the chronic group was significantly lower than other groups (P<0.05). Conclusions: The CSF absorption ability of arachnoid villi is significantly damaged in a long-term state of hydrocephalus. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/371/65601 en Copyright 2017 Neurology India.
oai:medknow.com:65686 2010-05-01 all journal:Neurol_India
Magnetic resonance imaging evaluation of subarachnoid hemorrhage in rats and the effects of intracisternal injection of papaverine and nitroglycerine in the management of cerebral vasospasm Ramdurg, SR Suri, A Gupta, D Mewar, S Sharma, U Jagannathan, NR Sharma, BS Background : Cerebral vasospasm is a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). It usually occurs about 3-9 days after SAH. The pathogenesis involves the release of endogenous spasmogens. Though various treatment modalities are available, none are really effective. Aims and Objectives : The aim of the study was to develop an effective animal model for the study of SAH and vasospasm as well as to study the efficacy of vasodilators, namely nitroglycerine and papaverine, on SAH-induced vasospasm using magnetic resonance angiography. Materials and Methods : Fifteen Wistar albino rats, weighing around 150-200 gm were used for the study. Five rats served as controls of SAH-induced vasospasm, while five rats each were used to study the efficacy of intracisternal injection of papaverine or nitroglycerine. Results : Rats demonstrate vasospasm in a manner similar to humans. The maximal vasospasm is seen in the basilar artery. Statistical analysis demonstrates an improvement in vasospasm after instillation of intracisternal papaverine at the end of 2 hours in basilar and left internal cerebral artery. However, nitroglycerine does not produce any significant amelioration of vasospasm. Thus, it can be deduced that the pathogenesis of the vasospasm is more due to the action of cGMPase enzyme rather than inhibition of nitric oxide (NO) synthetase by the spasmogens. The present study is the first study in the English literature to compare the effects of single bolus doses of nitroglycerine and papaverine using magnetic resonance angiography. Conclusion : Rats can be used to create an effective model for SAH-induced vasospasm as the pattern resembles human SAH. Papaverine is an effective drug for ameliorating SAH-induced vasospasm. Short-acting NO donors are not as effective in ameliorating vasospasm. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/377/65686 en Copyright 2017 Neurology India.
oai:medknow.com:65810 2010-05-01 all journal:Neurol_India
Evaluation of PRGD/FK506/NGF conduits for peripheral nerve regeneration in rats Jifeng, H Dezhong, L Qiongjiao, Y Huayong, Z Shipu, L Context : Both tacrolimus (FK506) and nerve growth factor (NGF) enhance peripheral nerve regeneration, and in vitro experimental results demonstrate that the combination of FK506 and NGF increased neurite outgrowth compared with either treatment alone. Aim : To determine if the combination of FK506 and NGF benefits peripheral nerve regeneration compared with either treatment alone in vivo. Settings and Design : Rat sciatic nerves were cut off to form a 10 mm defect and repaired with the nerve conduits. All of the 32 Wistar rats were randomly divided into 4 groups: Group A: RGD peptide modification of poly{(lactic acid)-co-[(glycolic acid)-alt-(L-lysine)]} (PRGD)/FK506/NGF; Group B: PRGD/FK506; Group C: PRGD/NGF; and Group D: autologous nerves. Materials and Methods : At 3 months after surgery, the regenerated rat sciatic nerve was evaluated by electrophysiology, calf triceps wet weight recovery rate, and histologic assessment. Statistical Analysis Used : The SPSS 10.0 software (Bizinsight, Beijing China) was used for statistical analysis. Results : The compound muscle action potentials (CMAPs) of groups A and D were significantly stronger than those of groups B and C. The calf triceps wet weight recovery rate of groups A and D were higher than those of groups B and C. The regenerated nerves of groups A and D were more mature than those of groups B and C. There was no significant difference between groups A and D. Conclusions : PRGD/FK506/NGF sustained-release nerve conduits are more effective in regenerating nerves than both PRGD/FK506 sustained-release nerve conduits and PRGD/NGF sustained-release nerve conduits. The effect is as good as that of an autograft. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/384/65810 en Copyright 2017 Neurology India.
oai:medknow.com:65923 2010-05-01 all journal:Neurol_India
Decompressive surgery for severe cerebral venous sinus thrombosis Lath, R Kumar, S Reddy, R Boola, GR Ray, A Prabhakar, S Ranjan, A Background : Cerebral venous sinus thrombosis (CVST) is one of the common causes of stroke in young people. Mortality in CVST, in addition to progressive thrombosis, is related to elevated intracranial pressure causing transtentorial herniation. The role of decompressive surgery in CVST is not well established. Aims : We report our experience with decompressive surgery in CVST and review the literature. Settings and Design : This is a retrospective study carried out in the Stroke Unit of a multispeciality tertiary care hospital in south India. Materials and Methods : The medical records of patients admitted with the diagnosis of CVST between December 2003 and July 2009 were reviewed. The clinical presentation, etiology, medical management, indications for surgery and outcomes were assessed for patients undergoing decompressive surgery. The sensorium was assessed using the Glasgow Coma Scale (GCS), while the outcome was assessed using the modified Rankin scale (mRS). Descriptive statistics were used as appropriate. Results : One hundred and six patients were admitted with the diagnosis of CVST during the study period. Eleven patients (10%) underwent decompressive surgical procedure. Indications for surgery included a low GCS at admission with large infarct on the computed tomography scan, mass effect and midline shift, clinical and radiological signs of transtentorial herniation, deterioration in the sensorium in spite of anti-edema measures and postthrombolysis hematoma. Eight patients (73%) had a good outcome while three patients (27%) died. Of the patients who died, two had a low GCS and bilaterally nonreactive pupils before the surgery while one had thrombosis of the deep venous system. Conclusion : Decompressive surgery for patients with large cerebral venous infarcts is a life-saving procedure. Patients with CVST who develop clinical and radiological features of transtentorial herniation either at presentation or during the course of medical management may benefit from decompressive surgery. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/392/65923 en Copyright 2017 Neurology India.
oai:medknow.com:65926 2010-05-01 all journal:Neurol_India
Selective autonomic screening in Guillain-Barré syndrome Yerdelen, D Erol, T Karatas, M Background : Autonomic dysfunction is a common and important complication in Guillain-Barre syndrome (GBS) and may be the cause of significant morbidity or death. Objectives : To show the possible autonomic involvement in patients with GBS. Materials and Methods : The sympathetic skin response (SSR) and the parameters of heart rate variability gathered from a 24-h electrocardiogram recording were studied in 14 patients with GBS [13 with acute inflammatory demyelinating polyneuropathy (AIDP) and one with acute motor axonal neuropathy (AMAN)]. Results : In two of the patients, SSR couldn't be elicited. In the rest of the patients, amplitude of SSR was found to be decreased when compared with the control subjects. In the time domain analysis of the 24-h electrocardiogram, SDNN (the standard deviation of all R-R intervals), SDANN (the standard deviation of the averages of R-R intervals during all 5-min periods that constitute the 24-h day), SDNN index (mean of the standard deviations of all R-R intervals for all 5-min segments of the 24-h recording); in the frequency domain analysis HF(high frequency), LF(low frequency), VLF (very low frequency) and total power were found decreased in patients when compared with the control subjects. When the mean values with standard deviations of controls were compared with the patients' values one by one, the pregnant patient with AMAN had increased heart rate variability parameters. The remaining 13 patients had decreased values. Conclusions : These findings reflect an involvement of both the parasympathetic and sympathetic systems in GBS. Our results suggest that SSR and heart rate variability parameters may be used for early detection of any autonomic dysfunction in patients with GBS. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/398/65926 en Copyright 2017 Neurology India.
oai:medknow.com:66085 2010-05-01 all journal:Neurol_India
Predictors of major neurological improvement after intravenous thrombolysis in acute ischemic stroke: A hospital-based study from south India Boddu, DB Srinivasarao, BV Reddy, PG Madhusudan, M Rukmini, MK Suryaprabha, T Jabeen, SA Suvarna, A Jayalakshmi, SS Meena, AK Borgohain, R Kaul, S Background : Despite the increasing use of recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke, uncertainty persists about the short- and long-term outcome of the thrombolysed patients. Objective : To identify predictors of major neurological improvement at 24 h after intravenous rt-PA administration in patients of acute ischemic stroke and their relationship with outcome at 12 months. Materials and Methods : We analyzed the data of the patients with acute ischemic stroke treated as per the National Institute of Neurological Disorders and Stroke (NINDS) criteria with intravenous rt-PA between January 2000 and June 2009 at a tertiary care center in south India. Major neurological improvement was defined by an 8-point improvement in National Institute of Health Stroke Scale (NIHSS) score or an NIHSS score of 0 or 1 at 24 h. Good outcome was defined as a 12-month modified Rankin Scale (mRS) of 0 to 1. Results : Of the 72 patients with acute ischemic stroke treated with intravenous rt-PA, 23 (32%) patients had major neurological improvement at 24 h. Age <60 years (OR 1.9, 95% CI 1.7 to3.2), admission glucose levels <8 mmol/L (OR 3.87, 95% CI 1.9 to 9.2) and mild to moderate baseline stroke severity (NIHSS median score 10+ 6) were associated with major neurological improvement after adjusting for co variables. Major neurological improvement at 24 h was an independent predictor of good outcome (mRS=1) at 12 months (OR 13.9, 95% CI 6.84 to 40.2). Conclusions : Age <60 years, glucose levels <8 mmol/L and mild to moderate stroke severity (NIHSS median score 10±6) was associated with major neurological improvement after intravenous rt-PA. Major neurological improvement at 24 h after the administration of intravenous thrombolysis independently predicted good outcome at 12 months. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/403/66085 en Copyright 2017 Neurology India.
oai:medknow.com:66110 2010-05-01 all journal:Neurol_India
Xe-CT and transcranial doppler in symptomatic vasospasm subarachnoid hemorrhage patients under euvolemic treatment without sedation Xu, Y Wang, Y Bao, Y Zhang, H Ling, F Background : Delayed cerebral ischemia from cerebral arterial vasospasm following aneurysmal subarachnoid hemorrhage (aSAH) is associated with significant morbidity and mortality. Early recognition of the cerebral arterial vasospasm and institution of appropriate treatment can reduce the consequences. Aim : We investigated the association of transcranial Doppler (TCD) and Xe-CT with the characteristics of symptomatic vasospasm secondary to aneurysmal subarachnoid hemorrhage (SAH) in patients who underwent euvolemic treatment without sedation. Materials and Methods : Data collected prospectively in patients with aSAH admitted to a neurocritical care unit in a regional hospital were retrospectively analyzed. Out of the 98 consecutive patients with aSAH, 30 patients underwent paired Xe-CT (not sedated) and TCD studies. Correlation between cortical cerebral blood flow (CBF) and mean blood flow velocity in middle cerebral artery (MCA) territories was analyzed. The lowest cortical regional CBF and MCA velocity were compared between patients with and without symptomatic vasospasm. Results : Symptomatic vasospasm occurred in 12 patients. No correlation was found between CBF and mean blood flow velocity of the MCA territory. The differences between MCA velocity and lowest cortical CBF in patients with symptomatic vasospasm were significantly different from patients without symptoms. Conclusion : TCD does not help to predict regional CBF in the MCA territory in patients with aSAH on euvolemic treatment. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/407/66110 en Copyright 2017 Neurology India.
oai:medknow.com:66222 2010-05-01 all journal:Neurol_India
Endoscopic management of third ventricular colloid cysts: Eight years' institutional experience and description of a new technique Mishra, S Chandra, PS Suri, A Rajender, K Sharma, BS Mahapatra, AK Background : The operative approaches for colloid cyst excision are varied with open microsurgical excision still being considered as the "gold standard". Endoscopic removal of these cysts is gaining in popularity. Aims : To document the efficacy and safety of the endoscope for colloid cyst excision. Materials and Methods : Retrospective study of all the patients who underwent endoscopic colloid cyst excision between January 2000 and March 2009. Patient records, radiological images and operative notes were assessed. Follow-up data including clinical and radiological details were retrieved. Results : Fifty-nine cases underwent endoscopic surgery during the study period. Gross total excision of cyst (with small residual nubbin) could be achieved in 46 (78%) patients. Others patients underwent: near-total excision (seven); partial excision (five); and cyst aspiration (one). A two-port technique for achieving excision was used in 18 patients. There was one death due to fulminant meningitis. No patients had recurrence, follow-up till 99 months. Two patients required ventriculo peritonealshunt for persistent hydrocephalus. Conclusions : Endoscopic excision is a safe and effective, minimally invasive method for colloid cyst removal. Even a subtotal excision of these slow-growing cysts may be acceptable when experience with the endoscope is limited. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/412/66222 en Copyright 2017 Neurology India.
oai:medknow.com:66336 2010-05-01 all journal:Neurol_India
A clinicopathological and immunohistochemical study of clinically non-functioning pituitary adenomas: A single institutional experience Rishi, A Sharma, MC Sarkar, C Jain, D Singh, M Mahapatra, AK Mehta, VS Das, TK Background : Non-functioning pituitary adenomas (NFPA) are characterized by the lack of clinical syndrome as compared to functioning adenomas (FA) but not all functioning adenomas have clinical effects. Their exact incidence varies in different series. Materials and Methods : This study was undertaken to analyze the hormonal profile of NFPA at the immunohistochemical level in the Indian population and to see if any differences exist from the earlier studies. Their biological aggressiveness was also studied by MIB-1 labeling index (MIB-! LI) and Epidermal Growth Factor Receptor (EGFR) expression. These parameters along with their clinical behavior were correlated with radiological features of invasiveness and size. Results : Of the 151 pituitary adenomas diagnosed during a period of one and half years, 77 (51%) were NFPA with a male predominance. There was increase in the incidence of NFPA with increase in age. Immunopositivity for various hormones was observed in 64 (83%) cases, either singly or in various combinations. On the basis of immunohistochemistry, NFPA were classified into three subtypes; gonadotroph adenomas, silent adenomas, and null cell adenomas. Gonadotroph adenomas were the commonest subtype. In general, NFPA showed low MIB-1LI but invasive NFPA had LI on the higher side, however, this difference was not significant. We observed EGFR positivity in two cases only; therefore the tumorigenesis mechanism may be different in NFPA. Conclusion : Although non-functional at the clinical level immunohistochemistry showed reactivity for various hormones. If a battery of immunostains including seven hormones is studied, a significant number of cases are shifted to the functional group. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/418/66336 en Copyright 2017 Neurology India.
oai:medknow.com:66454 2010-05-01 all journal:Neurol_India
Significance and cost-effectiveness of somatosensory evoked potential monitoring in cervical spine surgery Ayoub, C Zreik, T Sawaya, R Domloj, N Sabbagh, A Skaf, G Background : Intraoperative somatosensory evoked potential (SSEP) monitoring during cervical spine surgery is not a universally accepted standard of care. Our retrospective study evaluated the efficacy and cost-effectiveness of intraoperative SSEP in a single surgeon's practice. Materials and Methods : Intraoperative SSEP monitoring was performed on 210 consecutive patients who had cervical spine surgery: anterior cervical approach 140 and posterior approach 70. They were screened for degradation or loss of SSEP data. A cost analysis included annual medical costs for health and human services, durable goods and expendable commodities. Results : Temporary loss of the electrical wave during cauterization resolved upon discontinuation of the cautery. We had no loss of cortical wave with preservation of the popliteal potential. A drop in the amplitude of the cortical wave was observed in three patients. This drop was resolved after hemodynamic stabilization in the first patient, readjusting the bone graft in the second patient, and interrupting the surgery in the third patient. The additional cost for SSEP monitoring was $835 per case and the total cost of the surgery was $13,835 per case. By spending $31,546 per year on SSEP, our institution is saving a total cost ranging from $64,074 to $102,192 per patient injured per year. Conclusion : Intraoperative SSEP monitoring is a reliable and cost-effective method for preventing postoperative neurological deficit by the early detection of vascular or mechanical compromise, and the immediate alteration of the anesthetic or surgical technique. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/424/66454 en Copyright 2017 Neurology India.
oai:medknow.com:66455 2010-05-01 all journal:Neurol_India
Choroid plexus tumors: An institutional series of 25 patients Menon, G Nair, SN Baldawa, SS Rao, RB Krishnakumar, KP Gopalakrishnan, CV Purpose : Choroid plexus tumors (CPT) are rare neoplasms that pose considerable treatment challenges. This study reviews a single institute's experience with 25 patients of CPT and attempts to contribute to the general body of knowledge on CPT. Materials and Methods : A retrospective analysis of the case records of 25 patients operated for CPT since January 1998 and having a minimum of 1 year follow-up. Results : The study group included 12 (48%) cases of choroid plexus papilloma (CPP), 09 (36%) cases of choroid plexus carcinoma (CPC) and 4 cases of atypical CPP. The mean age at presentation was 18.6 years (range, 6 months to 54 years; SD, 18.7) and a male preponderance was noted (17:8). Raised intracranial pressure was the commonest presenting symptom (72%). The tumors were distributed as follows: lateral ventricle (16; 64%), fourth ventricle (5; 20%), fourth ventricle with cerebellopontine angle extension (3; 12%), and third ventricle (1; 4%). A complete surgical excision was achieved in 11 cases of CPP and 8 cases of CPC. Operative complications include pneumocephalus (40%), focal deficits (36%), subdural effusion (32%), and persistent hydrocephalus requiring shunt (24%). All patients with CPP had a good outcome at the end of a mean follow-up of 5.4 years, whereas the median survival for patients with CPCs who underwent a subtotal resection with adjuvant therapy was 36 months. Conclusion : CPTs include a spectra ranging from CPP to CPC. Radiologic and histologic characterization of these tumors is difficult and newer immunohistochemical and genetic studies should be done to differentiate them from each other. Total excision offers a good prognosis and should be attempted for all forms of CPTs. CPPs carry a good prognosis, and adjuvant therapy is not indicated even after partial excision. CPCs and atypical CPCs carry a poor prognosis, and adjuvant therapy improves survival marginally after total excision. Spinal drop metastases are common for CPC and screening of the spine for possible metastasis should be part of the routine preoperative and postoperative investigation protocol. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/429/66455 en Copyright 2017 Neurology India.
oai:medknow.com:66456 2010-05-01 all journal:Neurol_India
Clinical profile and molecular diagnosis in patients of facioscapulohumeral dystrophy from Indian subcontinent Tamhankar, PM Phadke, SR Facioscapulohumeral dystrophy (FSHD) is an autosomal dominant muscular dystrophy. We retrospectively studied three families (two Indian, one Nepalese) with 12 affected members (male:female-7:5). Mean age at onset of weakness was 17.63 + 5.48 years. Patients were classified according to muscle groups affected (F-face, S-scapula, H-humeral, PG-pelvic girdle, P-peroneal, A-loss of independent ambulation): FSH-A (2), four FSH (4), SH (3), FSH-PG (2) and one: F (1). Progression of weakness was classified as F>S>P>PG in eight cases, S> F>P in one, static in three. Eleven patients had electromyographic findings suggestive of myopathy and one had features of neurogenic involvement. Molecular diagnosis was done by southern blotting using probe p13E-11 after digestion of genomic DNA with EcoRI and/or EcoRI/BlnI for twelve patients and three unaffected relatives. No EcoRI fragment smaller than 35 Kb was seen in unaffected subjects. Size of EcoRI fragment varied between 17 kb to 27 kb in affected subjects and was constant for affected members of the same family. Molecular diagnosis by southern blotting has helped to provide genetic counseling for the families. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/436/66456 en Copyright 2017 Neurology India.
oai:medknow.com:65529 2010-05-01 all journal:Neurol_India
Treatment of acute ischemic stroke: Awareness among general practitioners Aaron, S Alexander, M Maya, T Mathew, V Goyal, M For promptly referral of a patient with acute ischemic stroke (AIS) for possible thrombolysis, general practitioners (GPs) need to equipped with the advanced knowledge of AIS treatment. We assessed the knowledge regarding treatment of AIS among GPs practicing in and around a quaternary care teaching hospital in south India. A total of 109 GPs who attend to medical emergencies were interviewed using a standard questionnaire. Of the 109 GPs interviewed, 54% felt that tissue plasminogen activator (tPA) can be used in the treating AIS, but only 24% had chosen tPA as the best treatment option and 22% opted for other agents like citicholine or edavarone. Only 17% were aware that tPA should be given within 3 h. and 35% felt that intra-arterial thrombolysis as a treatment option.. Only 30% felt the need for good sugar control and 37% wanted aggressive lowering of blood pressure. Majority of GPs are not clear about beneficial effects of thrombolysis and are not updated regarding BP and sugar control in the setting of AIS. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/441/65529 en Copyright 2017 Neurology India.
oai:medknow.com:65533 2010-05-01 all journal:Neurol_India
Apolipoprotein-E genotypes and myasthenia gravis Suhail, H Soundararajan, CC Vivekanandhan, S Singh, S Behari, M Autoimmune myasthenia gravis (MG) is a disorder of neuromuscular junction. Possible role of multiple genes in the development of the MG has been documented. This case-control study, studied the association of apolipoprotein E (Apo-E) alleles with MG. Anti-AChR antibody was measured using radio receptor immunoassay. Apo-E genotypes were analyzed in 120 MG patients and 120 healthy subjects. Comparison between patients with MG and controls showed no significant association with Apo-E allelic variants. However, a significant association of Apo-E4 allele with AChR-antibody positive patients was observed (P = 0.007). Also, among seropositive patients, a significant association was seen between female gender and Apo-E4 allele (P = 0.023). Our results suggest that the presence of Apo-E4 allele might influence seropositive status in patients with MG and seems an associated susceptible factor in female patients. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/443/65533 en Copyright 2017 Neurology India.
oai:medknow.com:65538 2010-05-01 all journal:Neurol_India
Endovascular treatment of A1 segment aneurysms of the anterior cerebral artery Yu, B Wu, Z Lv, X Liu, Y Sang, M Aneurysms of the A1 segment of the anterior cerebral artery (ACA) are rare and challenging to treat. We evaluated our experience of endovascular treatment in 11 patients with A1 segment aneurysms of ACA. Seven aneurysms were treated with coiling; three were treated with stent-assisted coiling and one was treated with balloon-assited coiling. Endovascular treatments were technically successful and without complication. Follow-up examinations showed complete cure in all 11 patients. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/446/65538 en Copyright 2017 Neurology India.
oai:medknow.com:65704 2010-05-01 all journal:Neurol_India
Glutamic acid decarboxylase antibody-positive paraneoplastic stiff limb syndrome associated with carcinoma of the breast Agarwal, PA Ichaporia, NR Stiff limb syndrome (SLS) is a rare "focal" variant of stiff person syndrome which presents with rigidity and painful spasms of a distal limb, and abnormal fixed foot or hand postures. Anti-glutamic acid decarboxylase antibodies (GAD-Ab) are variably present in most cases. Most reported cases of SLS are unassociated with cancer. We describe a patient with SLS as a paraneoplastic manifestation of breast carcinoma, in whom GAD-Ab was present. The patient responded very well to oral diazepam, baclofen and steroids.This is the third reported case of SLS as a paraneoplastic accompaniment to cancer. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/449/65704 en Copyright 2017 Neurology India.
oai:medknow.com:65751 2010-05-01 all journal:Neurol_India
Inflammatory demyelinating disorders of childhood: Experience with six children Srinivasan, A Sankar, J Ganapathi, K Demyelinating disorders of the central nervous system (CNS) in children pose diagnostic and prognostic difficulties in clinical practice. In this report, we describe our experience with inflammatory demyelinating disorders of CNS in six children, classified as per the proposed criteria by the Pediatric Multiple Sclersois Study Group. We emphasize the importance of appropriate diagnosis and follow-up to distinguish transient inflammatory demyelinating diseases from chronic inflammatory demyelinating diseases. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/452/65751 en Copyright 2017 Neurology India.
oai:medknow.com:65840 2010-05-01 all journal:Neurol_India
Cerebral miliary micro aneurysms in polyarteritis nodosa : Report of two cases Sharma, S Kumar, S Mishra, NK Gaikwad, SB Cerebral involvement is rare in polyarteritis nodosa (PAN) and is mostly characterized by ischemic events and intracranial hemorrhages secondary to cerebral aneurysms is extremely rare. We report two patients of PAN with multiple intracranial aneurysms. One patient presented with intracerebral hemorrhage and in the other patient multiple intracranial aneurysms were incidental findings and were asymptomatic. Both our cases suggest that multiple intracranial aneurysms are not very uncommon in PAN and cerebral angiography should be considered while doing abdominal angiogram in these patients. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/457/65840 en Copyright 2017 Neurology India.
oai:medknow.com:65925 2010-05-01 all journal:Neurol_India
Pattern recognition on brain magnetic resonance imaging in alpha dystroglycanopathies Bindu, PS Gayathri, N Bharath, RD Mahadevan, A Sinha, S Taly, AB Alpha dystroglycanopathies are heterogeneous group of disorders both phenotypically and genetically. A subgroup of these patients has characteristic brain imaging findings. Four patients with typical imaging findings of alpha dystroglycanopathy are reported. Phenotypic features included: global developmental delay, contractures, hypotonia and oculomotor abnormalities in all. Other manifestations were consanguinity (3), seizures (3), macrocephaly (1), microcephaly (3), retinal changes (2) and hypogenitalism (2). Magnetic resonance imaging (MRI) of the brain revealed polymicrogyria, white matter changes, pontine hypoplasia, and subcortical cerebellar cysts in all the patients, ventriculomegaly, callosal abnormalities, and absent septum pellucidum in two and Dandy -Walker variant malformation in three. Magnetic resonace imaging of the first cousin of one the patient had the same characteristic imaging features. Brain imaging findings were almost identical despite heterogeneity in clinical presentation and histopathological features. Pattern recognition of MR imaging features may serve as a clue to the diagnosis of alpha dystroglycanopathy. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/460/65925 en Copyright 2017 Neurology India.
oai:medknow.com:66086 2010-05-01 all journal:Neurol_India
Spontaneous subarachnoid pleural fistula: A rare complication of lateral thoracic meningocele Kumar, V Bundela, YS Gupta, V Dua, S Singh, AK A case of spontaneous subarachnoid pleural fistula following rupture of a thoracic meningocele into the pleural cavity is described in this article. The patient had symptoms of low-pressure headache and difficulty in breathing. The fistulous opening was closed near the foramina by rotating a vascularized muscle flap. After showing initial improvement the patient had a recurrence of symptoms after 6 weeks, with a small leak at the closure site. A lumbar thecoperitoneal shunt led to permanent cure. In this article we discuss the course of the disease, the symptoms, the diagnostic methods, and the various treatment modalities for subarachnoid pleural fistula. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/466/66086 en Copyright 2017 Neurology India.
oai:medknow.com:66335 2010-05-01 all journal:Neurol_India
Changing signal intensity of a craniopharyngioma Chatterjee, S Kesavadas, C Menon, G Nair, S Radhakrishnan, VV Craniopharyngiomas can present as suprasellar cystic lesion with varied imaging appearance. In magnetic resonance imaging using T1-weighted sequence, the cyst can show hypointense, isointense or hyper intense signals depending on the cyst content. We report a case where the T1 signal intensity of a craniopharyngioma changed over time. The hypointense lesion had become hyper intense in the follow-up scan after six months. Such change in signal intensity is described with Rathke's cleft cyst but has not been reported with craniopharyngioma. The possible reason for this change in signal intensity is discussed. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/468/66335 en Copyright 2017 Neurology India.
oai:medknow.com:66051 2010-05-01 all journal:Neurol_India
Papillary tumor of pineal region: Prolonged control rate after gamma knife radiosurgery - A case report and review of literature Cardenas, R Javalkar, V Haydel, J Wadhwa, R Fowler, M Scheithauer, B Nanda, A Papillary tumors of the pineal region (PTPR) are very rare. We describe the first report of a PTPR empirically managed with gamma knife radiosurgery. The patient was initially shunted and referred for empirical gamma knife radiosurgery. After initially showing some improvement, he had recurrence of tumor after 7 years. For recurrence he underwent a gross total resection and the biopsy established the diagnosis of PTPR. Further research needs to be done as to the efficacy of gamma knife surgery for PTPR. In addition, the role of stereotactic biopsy for eligible patients should be considered as the initial step to direct the treatment of choice. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/471/66051 en Copyright 2017 Neurology India.
oai:medknow.com:65924 2010-05-01 all journal:Neurol_India
Intraventricular ganglioglioma with bleed: A rare case report Bhat, DI Mahadevan, A Manish, R Sampath, S Chandramouli, BA Shankar, SK Gangliogliomas are benign lesions that are predominantly temporal in location and present with chronic epilepsy. Intraventricular gangliogliomas are extremely rare and still rarer is intratumoral hemorrhage. Till date only 9 cases of lateral ventricular gangliogliomas have been reported. To the best of our knowledge only 1 case of intratumoral hemorrhage has been reported. We report a rare case of lateral ventricular ganglioglioma with intratumoral hemorrhage in a 27-year-old man. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/477/65924 en Copyright 2017 Neurology India.
oai:medknow.com:65894 2010-05-01 all journal:Neurol_India
Endoscopic management of large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro Yadav, YR Basoor, A Todorov, M Parihar, V The treatment options for symptomatic arachnoid cysts are shunting, open craniotomy, and endoscopic fenestration. Endoscopic fenestration of large arachnoid cyst is safe and effective. Postoperative subdural hematoma and intraparenchymal hemorrhage can be avoided by endoscopic fenestration. This technique has the additional advantage of identifying and treating ventricular abnormalities, such as foramen of Monro stenosis and cerebral aqueduct occlusion. This report describes endoscopic dual fenestration in a child with large multicompartmental intraventricular arachnoid cyst extending from foramen magnum to foramen of Monro. The child presented with difficulty to hold the neck in upright position, irritability, vomiting, and large head. Follow-up postoperative magnetic resonance imaging at 3 months showed a significant reduction in size of the cyst. Clinically, the patient showed a gradual improvement at 10 months follow-up. Probably this is the first report of this nature. Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/481/65894 en Copyright 2017 Neurology India.
oai:medknow.com:65515 2010-05-01 all journal:Neurol_India
Hyperacute disseminated intravascular coagulation following surgery for a choroid plexus carcinoma in a child Moiyadi, AV Jalali, R Menon, S Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/485/65515 en Copyright 2017 Neurology India.
oai:medknow.com:65517 2010-05-01 all journal:Neurol_India
Intra-arterial thrombolysis after full-dose intravenous recombinant tissue plasminogen activator for patients older than 80 years with acute ischemic stroke: What is the safety limit? Pieri, A Spitz, M Kihara, EN Gabbai, AA Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/487/65517 en Copyright 2017 Neurology India.
oai:medknow.com:65518 2010-05-01 all journal:Neurol_India
Bumps on the head: Brown tumors of hyperparathyroidism Brar, R Prasad, A Chawla, R Sharma, T Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/487/65518 en Copyright 2017 Neurology India.
oai:medknow.com:65519 2010-05-01 all journal:Neurol_India
Respiratory syncytial virus encephalitis with symmetrical bilateral hemispheric lesions in an adult Cheng, FB Li, YH Jin, GH Liu, KD Sun, YB Wu, W Feng, JC Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/489/65519 en Copyright 2017 Neurology India.
oai:medknow.com:65521 2010-05-01 all journal:Neurol_India
Anteverted odontoid: A rare congenital bony anomaly of craniovertebral junction Vijayasaradhi, M Phaniraj, GL Kumar, B Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/490/65521 en Copyright 2017 Neurology India.
oai:medknow.com:65522 2010-05-01 all journal:Neurol_India
Intracranial gossypiboma: An under-reported entity Moiyadi, AV Pai, P Chaturvedi, P D'Cruz, A Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/492/65522 en Copyright 2017 Neurology India.
oai:medknow.com:65524 2010-05-01 all journal:Neurol_India
Corticoventriculostomy for the treatment of intracerebral arachnoid cyst Hou, Z Yan, P Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/493/65524 en Copyright 2017 Neurology India.
oai:medknow.com:65525 2010-05-01 all journal:Neurol_India
Traumatic bilateral orbital subperiosteal hematoma with vision loss Kataria, R Kumar, V Mehta, VS Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/495/65525 en Copyright 2017 Neurology India.
oai:medknow.com:65526 2010-05-01 all journal:Neurol_India
Fixed dilatation of pupils at the end of posterior fossa surgery due to bupivacaine scalp infiltration Gadhinglajkar, S Sreedhar, R Gopalkrishnan, CV Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/497/65526 en Copyright 2017 Neurology India.
oai:medknow.com:65530 2010-05-01 all journal:Neurol_India
Does Paget's disease affect a single vertebra? Avadhanam, PK Ankathi, P Kumar, PA Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/499/65530 en Copyright 2017 Neurology India.
oai:medknow.com:65532 2010-05-01 all journal:Neurol_India
Florid leptomeningeal dissemination in a case of glioblastoma multiforme Shetty, PM Moiyadi, AV Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/501/65532 en Copyright 2017 Neurology India.
oai:medknow.com:65536 2010-05-01 all journal:Neurol_India
The need for more evidence-based reporting in deep brain stimulation Saleh, C Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/503/65536 en Copyright 2017 Neurology India.
oai:medknow.com:65537 2010-05-01 all journal:Neurol_India
Citation rates of pediatric oncology publications from India Arora, RS Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/503/65537 en Copyright 2017 Neurology India.
oai:medknow.com:65544 2010-05-01 all journal:Neurol_India
Intra-arterial thrombolysis in acute ischemic stroke Aaron, S Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/504/65544 en Copyright 2017 Neurology India.
oai:medknow.com:65600 2010-05-01 all journal:Neurol_India
Dr. S. Janaki Singh, D Medknow Publications 2010-05-01 http://www.neurologyindia.com/text.asp?2010/58/3/506/65600 en Copyright 2017 Neurology India.
oai:medknow.com:86716 2010-05-01 all journal:North_Am_J_Med_Sci
Acute pancreatitis Fan, B Andrén-Sandberg, & Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/211/86716 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86717 2010-05-01 all journal:North_Am_J_Med_Sci
Histological effects of chronic consumption of soda pop drinks on kidney of adult Wister rats Adjene, JO Ezeoke, JC Nwose, EU Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/215/86717 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86719 2010-05-01 all journal:North_Am_J_Med_Sci
The severity of coronary artery disease evaluated by central systolic pressure and fractional diastolic pressure An, S QI, Y Wang, L Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/218/86719 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86721 2010-05-01 all journal:North_Am_J_Med_Sci
The changing faces of diabetes, hypertension and arthritis in a Caribbean population Bourne, PA McDaniel, S Williams, MS Francis, C Kerr-Campbell, MD Beckford, OW Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/221/86721 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86723 2010-05-01 all journal:North_Am_J_Med_Sci
Hepatotoxicity and nephrotoxicity evaluation in Wistar albino rats exposed to Morinda lucida leaf extract Oduola, T Bello, I Adeosun, G Ademosun, A Raheem, G Avwioro, G Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/230/86723 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86726 2010-05-01 all journal:North_Am_J_Med_Sci
Histopathological changes in Wistar albino rats exposed to aqueous extract of unripe Carica papaya Oduola, T Bello, I Idowu, T Avwioro, G Adeosun, G Olatubosun, L Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/234/86726 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86728 2010-05-01 all journal:North_Am_J_Med_Sci
Intraperitoneal rupture of renal cyst in autosomal dominant polycystic kidney disease Hammami, M Guirat, A Ksibi, H Azzaza, M Rekik, N Beyrouti, MI Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/238/86728 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:86729 2010-05-01 all journal:North_Am_J_Med_Sci
Double staining immunohistochemistry Chen, X Cho, D Yang, P Medknow Publications 2010-05-01 http://www.najms.org/text.asp?2010/2/5/241/86729 en Copyright 2017 North American Journal of Medical Sciences.
oai:medknow.com:64242 2010-05-01 all journal:Oman_J_Ophthalmol
Kajal (Kohl) - A dangerous cosmetic Mohta, A Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/100/64242 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64243 2010-05-01 all journal:Oman_J_Ophthalmol
Dealing of mass casualty in ophthalmology - A challenge Pandey, K Singh, P Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/101/64243 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64244 2010-05-01 all journal:Oman_J_Ophthalmol
Selected Abstracts Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/103/64244 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64226 2010-05-01 all journal:Oman_J_Ophthalmol
Do I have an ethical dilemma? Levin, AV Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/49/64226 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64227 2010-05-01 all journal:Oman_J_Ophthalmol
Gene therapy in glaucoma-part 2: Genetic etiology and gene mapping Glaucoma diagnosis, identification of people at risk, initiation of treatment and timing of surgical intervention remains a problem. Despite new and improving diagnostic and therapeutic options for glaucoma, blindness from glaucoma is increasing and glaucoma remains a major public health problem. The role of heredity in ocular disease is attracting greater attention as the knowledge and recent advances of Human Genome Project and the HapMap Project have made genetic analysis of many human disorders possible. Glaucoma offers a variety of potential targets for gene therapy. All risk factors for glaucoma and their underlying causes are potentially susceptible to modulation by gene transfer. The discovery of genes responsible for glaucoma has led to the development of new methods of Deoxyribonucleic acid (DNA)-based diagnosis and treatment. As genetic defects responsible for glaucoma are identified and the biochemical mechanisms underlying the disease are recognized, new methods of therapy can be developed. It is of utmost importance for the ophthalmologists and glaucoma specialists to be familiar with and understand the basic molecular mechanisms, genes responsible for glaucoma and the ways of genetic treatment. Method of Literature Search The literature was searched on the Medline database, using the PubMed interface. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/51/64227 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64228 2010-05-01 all journal:Oman_J_Ophthalmol
Knowledge, attitude and practice regarding eye complications and care among Omani persons with diabetes - A cross sectional study Khandekar, R Al, HS Al, HH Al, LJ Purpose : We present the level of Knowledge, Attitude and Practice (KAP) among diabetic patients regarding eye complications and their care. Materials and Methods : A cross sectional study was conducted in 2008 at seven regions of Oman. Arabic speaking nurses interviewed diabetics at clinics. They used a closed ended questionnaire with 15 questions. The responses were analyzed and the KAP were grouped into excellent (>80%), good (60 to 79%), average (40 to 59%), poor (20 to 39%) and very poor (<20%). They were also compared among epidemiologic variants. Result : Of the 750 participants, 'Excellent', grade of knowledge about diagnosis and eye care was present in 547 (72.9%) and 135 (18%) persons respectively. The 'excellent' grade of attitude about eye involvement and eye care was found in 135 (18%) and 224 (29.9%) participants. The practice for undergoing eye check up and accepting treatment was of 'excellent' grade in 390 (52%) and 594 (79.2%) respectively. Age (OR = 0.98), Sharqiya region (OR = 25) and '5 to 9' duration of DM (OR = 2.1) were associated with the knowledge. '<1 year' duration (OR = 0.3) and Dhakhiliya region (OR = 39) were associated with the attitude while '5 to 9 year' duration (OR = 3.4) was associated with better practices. Conclusions : Knowledge about eye complications and care is satisfactory among persons with diabetes. However, levels of attitude and practice were less than desired and should be improved. This could strengthen program approach for early detection and care of eye complications of diabetes in Oman. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/60/64228 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64229 2010-05-01 all journal:Oman_J_Ophthalmol
Indirect evaluation of corneal apoptosis in contact lens wearers by estimation of nitric oxide and antioxidant enzymes in tears Bhatia, RP Dhawan, S Khanna, HD Dash, A Background : Contact lens induced trauma to the corneal epithelium results in increased release of inflammatory mediators. The keratocyte apoptosis is directly related to epithelial injury and has been correlated with increased production of nitric oxide. Potent antioxidant enzymes protect cells from oxidative damage by inactivating reactive oxygen species and thus inhibiting apoptosis. This study aims at determination of total nitric oxide and antioxidant enzymes in tears which will be an indirect criteria for assessing apoptosis. Materials and Methods : Nitric oxide and antioxidant enzymes were estimated in tears of 25 soft contact lens wearers and compared with 25 age and sex matched controls. Results : Statistically significant increase of nitric oxide (P<0.001), superoxide dismutase (P<0.001) and glutathione peroxidase (P<0.001) levels was seen in tears of contact lens wearers as compared to controls. There was also statistically significant increase in the levels of antioxidant enzymes, superoxide dismutase (P<0.05) and glutathione peroxidase (P<0.01), with increase in the total duration of contact lens wear in years. Conclusions : Increase in the level of nitric oxide and antioxidant enzymes in tears of contact lens wearers suggested that contact lens wear suppresses the process of apoptosis. However, it was also postulated that the increased levels of nitric oxide balances the anti-apoptotic activities of increased levels of antioxidant enzymes by its pro-apoptotic activity leading to protective outcomes in contact lens wearers. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/66/64229 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64230 2010-05-01 all journal:Oman_J_Ophthalmol
Congenital fibrosis of the extraocular muscles Cooymans, P Al-Zuhaibi, S Al-Senawi, R Ganesh, A Background : Congenital fibrosis of the extraocular muscles (CFEOM) describes a group of rare congenital eye movement disorders that result from the dysfunction of all or part of the oculomotor (CN 3) and the trochlear (CN 4) nerves, and/or the muscles these nerves innervate. Aim : To describe the clinical and neuro-radiological findings in three patients with CFEOM and review literature with respect to clinical features, genetics and management of this condition. Materials and Methods : A retrospective chart review was performed of three Omani patients who had been diagnosed with CFEOM in our institution. All patients had undergone standardized orthoptic and ocular evaluations and magnetic resonance imaging (MRI) of the orbits and brain. Results : The three patients (age range nine months - 10 years) presented a history of congenital strabismus. All patients had severe bilateral ptosis and mild to moderate visual impairment secondary to the ptosis and astigmatism. Two of three patients demonstrated a positive jaw-winking phenomenon. A moderate to large angle exotropia with varying amount of hypotropia and limitations of almost all the extra ocular muscles was noted. Patient 3 was also developmentally delayed. MRI brain and orbit showed abnormalities of the extraocular muscles in two patients and brain malformation in one patient. Conclusions : CFEOM is a rare, congenital, and non-progressive disorder with multiple extra ocular muscle restrictions. CFEOM can be associated with neuro-radiological abnormalities; its diagnosis and classification is defined by clinical characteristics and genetics. Options for treatment are limited and difficult. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/70/64230 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64231 2010-05-01 all journal:Oman_J_Ophthalmol
Correlation of central corneal thickness and optic nerve head topography in patients with primary open-angle glaucoma Mokbel, TH Ghanem, AA Purpose : To evaluate whether changes in optic nerve head topography and visual field in patients with primary open-angle (POAG) are related to central corneal thickness (CCT). Materials and Methods : Eighty eyes of 50 patients with POAG underwent ophthalmic examination; optic nerve head imaging with the Heidelberg Retina Tomography II (HRT II), ultrasound corneal pachymetry, and visual field evaluation with the Humphrey visual field analyser (program 24-2). Correlation between CCT, age, gender, family history of glaucoma, visual acuity, intraocular pressure (IOP), optic disc surface area, vertical and horizontal cup: disc ratios, neuroretinal rim area, mean deviation of visual field, and number of glaucoma medications was analyzed. Patients were divided into a thin CCT group <540 μm or a thick CCT group >540 μm. Pearson correlation was used for correlation coefficient and a P value of <0.05 was considered statistically significant. Results : Thin CCT was significantly correlated with vertical and horizontal cup: disc ratios, neuroretinal rim area loss, and smaller optic disc surface area (r=0.043, r=0.021, r=0.036, and 0.031 respectively). Thin CCT was also significantly associated with worsened mean deviation of visual field, and increased number of glaucoma medications (r=0.065 and r=0.423). Patients with positive family history correlated with with greater vertical cup: disc ratio, and more glaucoma medications but this was not statistically significant. Conclusions : In patients with POAG those with thinner CCT are likely to develop greater glaucomatous optic nerve and visual field damages than those with a thicker CCT. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/75/64231 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64232 2010-05-01 all journal:Oman_J_Ophthalmol
Retinal vasculitis in a patient with abdominal tuberculosis Kannan, B Govindarajan, K Kummararaj, S Balaji, V Natarajapillai, V Tuberculosis (TB) is one of the most common systemic diseases in India. Intraocular TB is however, rare. Retinal vasculitis is a relatively rare manifestion of intraocular TB. We report a case of bilateral retinal vasculitis in a 19-year-old girl with abdominal tuberculosis. The patient responded well to anti-TB treatment along with a short course of low dose oral steroids. Vision in her right eye however remained compromised due to residual maculopathy. This is the first report of bilateral retinal vasculitis due to colonic TB. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/81/64232 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64233 2010-05-01 all journal:Oman_J_Ophthalmol
Bilateral anophthalmia with septo-optic dysplasia Jana, M Sharma, S Bilateral anophthalmia is a rare entity and association with septo-optic dysplasia is an even rare condition. The condition is characterized by absent eyeballs in the presence of eyelids, conjunctiva or lacrimal apparatus. Though anophthalmia can be diagnosed clinically, imaging plays a crucial role in delineating the associated anomalies. In addition, often clinical anophthalmia may prove to be severe microphthalmia on imaging. We describe the imaging findings in an infant with bilateral anophthalmia and septo-optic dysplasia. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/86/64233 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64234 2010-05-01 all journal:Oman_J_Ophthalmol
An unusual case of penetrating ocular trauma with a pressure cooker Chattopadhyay, SS Mukhopadhyay, U Saurabh, K Ocular trauma is a major cause of vision loss. The circumstances and agents implicated in such injuries are diverse. We present an unusual case of penetrating ocular trauma with the nozzle of a pressure cooker lid in a 32-year-old housewife causing deep laceration of the upper eye lid and sclera. The impacted metallic nozzle was removed on an emergency basis. Autoevisceration of ocular contents due the high velocity impact resulted in the final decision to surgically complete the evisceration and implant a glass ball implant. This case highlights the propensity of grievous ocular trauma in a domestic environment. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/89/64234 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64235 2010-05-01 all journal:Oman_J_Ophthalmol
Primary orbital rhabdomyosarcoma with skeletal muscle metastasis Das, JK Tiwary, BK Paul, SB Bhattacharjee, H Cida, B Das, D We report a case of embryonal orbital rhabdomyosarcoma (RMS) in a five year old boy. Immuno-histochemistry of incisional specimen confirmed diagnosis. Eight cycles of chemotherapy along with radiotherapy resulted in over 50% reduction in size of the mass. However, increase in size was noted subsequent to completion of therapy and exenteration was deemed prudent. Margins of the excised specimen were free from tumor cells, but after five months, the patient developed multiple metastases, including skeletal muscle involvement, and died nine months after exenteration, despite repeat chemotherapy along with radiotherapy. Orbital RMS with metastasis to skeletal muscle is a rare entity. Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/91/64235 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64236 2010-05-01 all journal:Oman_J_Ophthalmol
Anterior ischemic optic neuropathy in a case of Takayasu's arteritis Nithyanandam, S Mohan, A Sheth, U Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/94/64236 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64237 2010-05-01 all journal:Oman_J_Ophthalmol
Proliferative diabetic retinopathy in acromegaly Malhotra, C Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/96/64237 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64239 2010-05-01 all journal:Oman_J_Ophthalmol
Six-year-old girl with decreased vision Haider, AS Al-Hinai, A Ganesh, A Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/98/64239 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:64241 2010-05-01 all journal:Oman_J_Ophthalmol
Combined photodynamic therapy and intravitreal ranibizumab as treatment for extrafoveal choroidal neovascularization associated with age-related macular degeneration Chhablani, JK Medknow Publications 2010-05-01 http://www.ojoonline.org/text.asp?2010/3/2/99/64241 en Copyright 2017 Oman Journal of Ophthalmology.
oai:medknow.com:65503 2010-05-01 all journal:Phcog_Res
Looking backward to find the path forward Furey, A Kingston, R Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/121/65503 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65504 2010-05-01 all journal:Phcog_Res
Chromatographic evaluation and anthelmintic activity of Eucalyptus globulus oil Taur, DJ Kulkarni, VB Patil, RY In world Helminthes infections are the most widespread of all the infections in humans. The morbidity due to parasitic diseases has been increasing in our population. The gastrointestinal helminthes become resistant to the currently available anthelmintic drugs. Anthelmintic substances having considerable toxicity to human beings are present in foods derived from livestock, posing a serious threat to human health. Due to this, there is a need to derive new chemical substances from natural sources, for helminthes control. In this study, volatile oil isolated from Eucalyptus globulus Labill was evaluated for its anthelmintic activity on adult Indian earthworms, Pheretima posthuma, which have anatomical and physiological resemblance with the intestinal roundworm parasites of human beings. In concentrations of 0.05, 0.01 and 0.15 ml/ml, respectively, all the oil samples showed potent anthelmintic activity as compared to that of the standard drug albendazole at a concentration of 10 mg/ml. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/125/65504 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65505 2010-05-01 all journal:Phcog_Res
Analysis of antimicrobial, antifungal and antioxidant activities of Juniperus excelsa M. B subsp. Polycarpos (K. Koch) Takhtajan essential oil Moein, MR Ghasemi, Y Moein, S Nejati, M Juniperus excelsa M.B subsp. Polycarpos (K.Koch), collected from south of Iran, was subjected to hydrodistillation using clevenger apparatus to obtain essential oil. The essential was analyzed by gas chromatography/mass spectrometry (GC/MS) and studied for antimicrobial, antifungal and antioxidant activities. The results indicated α-pinene (67.71%) as the major compound and α-cedral (11.5%), δ3-carene (5.19%) and limonene (4.41%) in moderate amounts. Antimicrobial tests were carried out using disk diffusion method, followed by the measurement of minimum inhibitory concentration (MIC). All the Gram positive and Gram negative bacteria were susceptible to essential oil. The oil showed radical scavenging and antioxidant effects. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/128/65505 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65506 2010-05-01 all journal:Phcog_Res
Effect of ethanolic extract of Cassia occidentalis Linn. for the management of alloxan-induced diabetic rats Verma, L Singour, PK Chaurasiya, PK Rajak, H Pawar, RS Patil, UK Aim: As per traditional claims, root, bark, leaf and flower of the plant Cassia occidentalis Linn. (Caesalpiniaceae) have been reported to possess antidiabetic activity. Based on this traditional indication, the aim of this study was to evaluate the antidiabetic activity of ethanolic extract of C. occidentalis in normal and alloxan induced diabetic rats. Materials and Methods: Ethanolic extract of the whole plant of C. occidentalis was orally tested at doses of 100 and 200 mg/kg for evaluating the hypoglycemic effect in normal and alloxan-induced diabetic rats. In addition, changes in body weight, serum cholesterol, triglyceride and total protein levels, assessed in the ethanol extract treated diabetic rats were compared with diabetic control and normal animals. Histopathologic observations during 21 days of treatment were also evaluated. Results: Ethanolic extract of C. occidentalis produced a significant reduction in fasting blood glucose levels in the normal and alloxan-induced diabetic rats at doses of 100 and 200 mg/kg body weight. Treatment with ethanolic extract of C. occidentalis in normal and alloxan-induced diabetic rats led to a dose-dependent fall in blood sugar levels. Significant differences were observed in serum lipid profiles (cholesterol and triglyceride), serum protein and changes in body weight in ethanolic extract treated diabetic animals, when compared with the diabetic control and normal animals. Concurrent histopathologic studies of the pancreas of these animals showed comparable regeneration by ethanolic extract, which were earlier necrosed by alloxan. Conclusion: Ethanolic extract of C. occidentalis exhibited significant antidiabetic activity in normal and alloxan-induced diabetic rats. The rats also showed improvement in parameters like body weight and lipid profiles and also, histopathologic studies showed regeneration of β-cells of pancreas and so it might be of value in the treatment of diabetes. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/132/65506 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65507 2010-05-01 all journal:Phcog_Res
Estrogenic activity of friedelin rich fraction (IND-HE) separated from Cissus quadrangularis and its effect on female sexual function Aswar, UM Bhaskaran, S Mohan, V Bodhankar, SL Women experience menopause differently across the world, in terms of their symptomology. Many experience symptoms of menopause like hot flashes, joint pain and loss of libido. Estrogen replacement is the prescribed therapy for most of the sexual dysfunction observed in menopausal women. Many women are reluctant to use exogenous hormone therapy for treatment of menopausal symptoms and are turning to botanical and dietary supplements for relief. In the present study IND-HE (friedelin rich fraction) was studied for estrogenic activity as well as its effect on sexual behavior in overiectomized female Wistar rats. The rats were divided into 4 groups of six rats each. The Group 1 received distilled water, Group II - IND-HE (75 mg/kg p. o.), Group III - IND-HE (100 mg/kg p. o.) and Group IV received estrogen (estradiol) (1 mg/kg in olive oil suspension, s.c. bi-weekly). The treatment period was 8 weeks. On 1 day, one month and two month of treatment the sexual behavior was studied. At the end of the treatment the blood was withdrawn from retro-orbital plexus. The animals were sacrificed and uterus was removed, weighed and histology was studied. In different group of rats estrous cycle was studied which indicate estrogenic activity and for progestogenic activity of deciduoma formation was studied. The result indicated that IND-HE (75 and 100 mg/kg p.o.) improved sexual behavior parameters. IND-HE (75 and 100) significantly (P<0.01) decreased darting and hopping latency. The darting frequency and hopping frequency was significantly (P<0.01) improved in IND-HE (75 and100 mg/kg p.o.) as well as estrogen group. Lordosis interval (LI) was increased significantly in estrogen group after 1<sup> st</sup> month (P<0.05), and after 2<sup> nd</sup> month (P<0.01). IND-HE (100) treatment showed increase in LI after 1<sup> st</sup> month (P<0.05) remained during 2<sup> nd</sup> month (P<0.01). While IND-HE (75) treatment increased LI only after 2<sup> nd</sup> month (P<0.05).IND-HE (75 and 100 mg/kg p.o.) showed estrogenic activity as indicated by vaginal cornification, increase in uterine weight and rise in serum estrogen. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/138/65507 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65508 2010-05-01 all journal:Phcog_Res
Comparative measurement of hydration effects of herbal moisturizers Saraf, S Sahu, S Kaur, CD Saraf, S Improvements of skin hydration properties by the use of polyherbal moisturizers are the recent advances in cosmetic preparations to avoid the harmful effects of chemical moisturizers. The main aim of the study was to establish selection preference of different available marketed herbal moisturizers on the basis of the efficiency of constituents for their hydration effects. The criteria for the selection of formulations were presence of herbal constituents, wheat germ oil and Aloe vera extract. Initially, physiochemical and psychometric studies were performed to visualize the compliance of moisturizers with the skin. The clinical study was carried out in six groups of six healthy human volunteers (aged 20-25 years) each applying moisturizers twice daily over a period of 3 weeks in their forearm. The skin properties measured were conductance, glow and appearance. The results indicated that all the moisturizers show moisturizing effect in a time-dependent pattern and the maximum increase in skin conductance was 168.125 and 165.24% for A2 and A1, respectively. Ranking of moisturizers based on conductance as well as physicochemical analysis is A2 > A1 > A4 > A3 > A5 > A6. It was found that the formulation A2 having wheat germ oil, Aloe vera extract and turmeric extract in combination showed best results due to their synergistic effect and wheat germ oil or Aloe extract, when present separately produced skin hydration to lesser extent. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/146/65508 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65509 2010-05-01 all journal:Phcog_Res
Determination of polyphenols and free radical scavenging activity of Tephrosia purpurea linn leaves (Leguminosae) Patel, A Patel, A Patel, A Patel, NM Background: Leaves of Tephrosia purpurea Linn. (sarpankh), belonging to the family Leguminaceae, are used for the treatment of jaundice and are also claimed to be effective in many other diseases. This research work was undertaken to investigate the in vitro antioxidant activity of aqueous and ethanolic extracts of the leaves. Method: The therapeutic effects of tannins and flavonoids can be largely attributed to their antioxidant properties. So, the quantitative determinations were undertaken. All the methods are based on UV-spectrophotometric determination. Result: The total phenolic content of aqueous and ethanolic extracts showed the content values of 9.44 ± 0.22% w/w and 18.44 ± 0.13% w/w, respectively, and total flavonoid estimation of aqueous and ethanolic extracts showed the content values of 0.91 ± 0.08% w/w and 1.56 ± 0.12%w/w, respectively, for quercetin and 1.85 ± 0.08% w/w and 2.54 ± 0.12% w/w, respectively, for rutin. Further investigations were carried out for in vitro antioxidant activity and radical scavenging activity by calculating its percentage inhibition by means of IC<sub> 50</sub> values, all the extracts' concentrations were adjusted to fall under the linearity range and here many reference standards like tannic acid, gallic acid, quercetin, ascorbic acid were taken for the method suitability. Conclusion: The results revealed that leaves of this plant have antioxidant potential. The results also show the ethanolic extract to be more potent than the aqueous decoction which is claimed traditionally. In conclusion, T. purpurea Linn. (Leguminosae) leaves possess the antioxidant substance which may be responsible for the treatment of jaundice and other oxidative stress-related diseases. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/152/65509 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65510 2010-05-01 all journal:Phcog_Res
Triterpenes from Euphorbia rigida Gherraf, N Zellagui, A Mohamed, NS Hussien, TA Mohamed, TA Hegazy, MF Rhouati, S El-Sayed, MA Phytochemical studies of the aerial parts of Euphorbia rigida afforded three triterpenes: betulin (1), cycloart-23Z-ene-3, 25-diol (2) and cycloartan-3, 24, 25-triol (3), firstly isolated from this plant. The structures and relative stereochemistry were determined on the basis of extensive spectroscopic analyses, including 1D and 2D NMR experiments (1H NMR, 13C NMR, COSY, NOESY, HMQC and HMBC). Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/159/65510 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65511 2010-05-01 all journal:Phcog_Res
Antifungal, antibacterial and antimycobacterial activity of Entada abysinnica Steudel ex A. Rich (Fabaceae) methanol extract Mariita, RM Orodho, JA Okemo, PO Mbugua, PK The purpose of the study was to investigate the antifungal, antibacterial and antimycobacterial properties of methanol extract of Entada abysinnica steudel ex. A. Rich (Fabaceae) leaves used by herbalists from the Lake Victoria region, Kenya. The extract was tested against four strains of mycobacteria (Mycobacterium tuberculosis, Mycobacterium kansasii, Mycobacterium fortuitum, and Mycobacterium smegmatis) using BACTEC Mycobacteria Growth Indicator Tube (MGIT) 960 system and the proportional method. Standard procedures were used to determine the zones of inhibition, minimum inhibitory concentrations (MICs) and minimum bactericidal/fungicidal concentrations (MBCs/MFCs) for Candida albicans, Salmonella typhi, Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumoniae. The extract showed activity against some mycobacteria strains, especially M. tuberculosis. It also showed strong antimicrobial activity (zones of inhibition were between 9.00 and 14.10 mm) against C. albicans, Sa. typhi, and St. aureus. The extract gave a better zone of inhibition against C. albicans than fluconazole whose zone of inhibition was 13.00 mm. The MICs and MBCs for C. albicans and Sa. typhi were good. The crude extracts were also analyzed for the presence of phytochemicals. Phytochemical screening indicated that the extract most abundantly contained tannins, saponins, and flavonoids. The data suggest that the methanolic leaves extract of E. abysinnica could be a rich source of antimicrobial agents, especially antifungals. The results further show that there is some merit in the use of the plant in alternative medical practices. However, bioassays of isolated compounds are underway and will be reported during subsequent communications. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/163/65511 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65512 2010-05-01 all journal:Phcog_Res
Effect of Celastrus paniculatus seed oil (Jyothismati oil) on acute and chronic immobilization stress induced in swiss albino mice Lekha, G Mohan, K Samy, IA Stress alters the homeostasis and is produced by several factors. Immobilization stress induced due to reduced floor area provided for the mobility results in the imbalance of oxidant and antioxidant status. The modern computer savvy world decreases human mobility in the working environment, leading to the formation of oxygen free radicals and if left untreated might result in severe health problems like hypertension, cardiovascular disease, premature aging and brain dysfunction. Hence, modern medicines rely upon the medicinal plants for some drugs with zero side effects. In this context, Jyothismati oil (JO), extracted from Celastrus paniculatus seeds, was used to treat acute and chronic immobilization induced experimentally. C. paniculatus plant is considered to be rich in antioxidant content and so the seed oil extract's efficacy was tested against immobilization stress in albino mice. The animals were kept in a restrainer for short and long durations, grouped separately and fed with the drug. Animals were sacrificed and the samples were analyzed. The antioxidant enzyme levels of the animals regained and markedly increased in the acute and chronic immobilized groups, respectively. The results suggested that the extract of C. paniculatus seed was highly efficacious in reducing the stress induced by least mobility for hours. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/169/65512 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65513 2010-05-01 all journal:Phcog_Res
Senna occidentalis leaf extract possesses antitrypanosomal activity and ameliorates the trypanosome-induced anemia and organ damage Ibrahim, MA Aliyu, AB Sallau, AB Bashir, M Yunusa, I Umar, TS The in vitro and in vivo antitrypanosomal effects of the ethanol extract of Senna occidentalis leaf were investigated. The crude extract exhibited an in vitro activity against Trypanosoma brucei brucei as it completely eliminated parasites' motility within 10 minutes postincubation with 6.66 mg/ml of effective extract concentration. The extract was further used to treat experimentally T. brucei brucei infected rats at concentrations of 100 and 200 mg/kg body weight, beginning on day 5 post infections (p.i.). At the termination of the experiment on Day 11 p.i., the extract significantly (P < 0.05) kept the parasitemia lower than was recorded in the infected untreated rats. All the infected animals developed anemia, the severity of which was significantly (P < 0.05) ameliorated by the extract treatment. The infection caused significant (P < 0.05) increases in serum alanine and aspartate aminotransferases as well as serum urea and creatinine levels. However, treatment of infected animals with the extract significantly (P < 0.05) prevented the trypanosome-induced increase in these biochemical indices. Furthermore, the T. brucei infection caused hepatomegaly and splenomegaly that were significantly (P < 0.05) ameliorated by the extract administration. It was concluded that orally administered ethanol extract of S. occidentalis leaf possessed anti-T. brucei brucei activity and could ameliorate the disease-induced anemia and organ damage. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/175/65513 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65514 2010-05-01 all journal:Phcog_Res
The evaluation of antinociceptive activity of alkaloid, methanolic, and aqueous extracts of Malaysian Mitragyna speciosa Korth leaves in rats Sabetghadam, A Ramanathan, S Mansor, SM Mitragyna speciosa Korth is a medicinal plant indigenous to Thailand and Malaysia and has been known for its narcotic and coca-like effects. Many studies have been performed on the antinociceptive effect of the plant extracts of Thai origin; however, limited studies have been reported till date on M. speciosa extracts of Malaysian origin. Various concentrations of alkaloid (5-20 mg/kg), methanolic (50-200 mg/kg), and aqueous (100-400 mg/kg) extracts of Malaysian M. speciosa leaves were prepared and orally administered to nine groups of rats. Morphine (5 mg/kg, s.c.) and aspirin (300 mg/kg, p.o.) were used as control. Antagonism of the antinociceptive activity was evaluated by pretreatment with naloxone at a dose of 2 mg/kg (i.p.). Results showed that oral administration of the alkaloid (20 mg/kg), methanolic (200 mg/kg), and aqueous (400 mg/kg) extracts significantly prolonged the latency of nociceptive response compared with control groups in both hot plate and tail flick tests (P < 0.05). Antinociceptive action of the alkaloid (20 mg/kg), methanolic (200 mg/kg), and aqueous (400 mg/kg) extracts was significantly blocked by naloxone. In conclusion, these results suggest the presence of antinociceptive effect in various extracts of Malaysian M. speciosa leaves. In addition, the antinociceptive effective doses vary depending on the type of solvents used for extraction. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/181/65514 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65516 2010-05-01 all journal:Phcog_Res
A new alkaloid isolated from Abies webbiana leaf Ghosh, AK Sen, D Bhattacharya, S A new alkaloid namely 1-(4'-methoxyphenyl)-aziridine was isolated from the leaf of Abies webbiana Lindl. (Pinaceae), grown in Sikkim Himalayan region of India. Its chemical structure was elucidated on the basis of elemental and spectral analyses. This is the first experimental report of the isolation of any alkaloid from A. webbiana. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/186/65516 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65520 2010-05-01 all journal:Phcog_Res
The antihyperglycemic effect of aerial parts of Salvia splendens (scarlet sage) in streptozotocin-induced diabetic-rats Kumar, PM Sasmal, D Mazumder, PM Salvia splendens (Labiatae) is widely used in Indian traditional medicine for the control of diabetes mellitus. In this study, the hypoglycemic effects produced by the acute and subacute administration of various extracts of S. splendens were investigated. Both the aqueous extract (SSAE) and the methanolic extract (SSME) from the aerial parts resulted in significant reductions of glycemia in streptozotocin (STZ)-induced diabetic rats after oral administration at a dose of 100 and 200 mg/kg, respectively. On oral administration, aqueous and methanolic extracts showed statistically significant (P < 0.001) effect by reducing the effect of glycemia in STZ-induced diabetic rats. These findings suggest the significant antihyperglycemic potential of the S. splendens extracts in ameliorating the diabetic conditions in diabetic rats. No significant effects were found in the normal rats. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/190/65520 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65523 2010-05-01 all journal:Phcog_Res
Antihyperglycemic activity of Catharanthus roseus leaf powder in streptozotocin-induced diabetic rats Rasineni, K Bellamkonda, R Singareddy, SR Desireddy, S Catharanthus roseus Linn (Apocynaceae), is a traditional medicinal plant used to control diabetes, in various regions of the world. In this study we evaluated the possible antidiabetic and hypolipidemic effect of C. roseus (Catharanthus roseus) leaf powder in diabetic rats. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ, 55 mg/kg body wt) to male Wistar rats. The animals were divided into four groups: Control, control-treated, diabetic, and diabetic-treated group. Diabetic-treated and control-treated rats were treated with C. roseus leaf powder suspension in 2 ml distilled water, orally (100 mg/kg body weight/day/60 days). In diabetic rats (D-group) the plasma glucose was increased and the plasma insulin was decreased gradually. In the diabetic-treated group lowering of plasma glucose and an increase in plasma insulin were observed after 15 days and by the end of the experimental period the plasma glucose had almost reached the normal level, but insulin had not. The significant enhancement in plasma total cholesterol, triglycerides, LDL and VLDL-cholesterol, and the atherogenic index of diabetic rats were normalized in diabetic-treated rats. Decreased hepatic and muscle glycogen content and alterations in the activities of enzymes of glucose metabolism (glycogen phosphorylase, hexokinase, phosphofructokinase, pyruvate kinase, and glucose-6-phosphate dehydrogenase), as observed in the diabetic control rats, were prevented with C. roseus administration. Our results demonstrated that C. roseus with its antidiabetic and hypolipidemic properties could be a potential herbal medicine in treating diabetes. Medknow Publications 2010-05-01 http://www.phcogres.com/text.asp?2010/2/3/195/65523 en Copyright 2017 Pharmacognosy Research.
oai:medknow.com:65120 2010-05-01 all journal:Saudi_J_Anaesth
Severe lingual tonsillar hypertrophy and the rationale supporting early use of wire-guided retrograde intubation Schroeder, K Becker, A Guite, C Arndt, G An expanding body of literature exists which describes the airway challenges and management options for lingual tonsillar hypertrophy (LTH). The use of retrograde intubation to secure a patient's airway in the setting of LTH has been previously unreported and should be considered early in the event of a cannot intubate, cannot ventilate scenario. A 55-year-old man, who had previously been described as an easy intubation, presented an unexpected cannot intubate, cannot ventilate scenario secondary to LTH. Various noninvasive airway maneuvers were attempted to restore ventilation without success. We describe the advantages of early use of wire-guided retrograde intubation as an alternative to a surgical airway for obtaining a secure airway in a patient with LTH, in whom noninvasive airway management maneuvers have failed. Multiple different noninvasive approaches to management of LTH have been previously described including the laryngeal tube, laryngeal mask airway, and fiberoptic bronchoscopy. Unfortunately, none of these noninvasive airway maneuvers successfully ventilated this patient and an invasive airway became necessary. Retrograde intubation is a less invasive alternative to the surgical airway with potentially less risk for complications. Retrograde intubation may be particularly effective in the setting of LTH as it may stent open an otherwise occluded airway and allow passage of an endotracheal tube. Skillful use of this technique should be considered early as a viable option in any case of unexpected difficult intubation due to LTH. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/102/65120 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65121 2010-05-01 all journal:Saudi_J_Anaesth
Difficult intubation management in a child with I-cell disease George, G Al-Bahlani, SS I-cell disease (mucolipidosis II) is a rare metabolic disorder resulting from the deficiency of a specific lysosomal enzyme, N-acetylglucosamine-1-phosphotransferease. Developmental delay and growth failure are common presentations of I-cell disease. Psychomotor deterioration is rapid and progressive. Some physical signs such as hip dislocations, inguinal hernia, hepatomegaly, joint limitation, and skin changes may be present at birth. Coarse facial features and skeletal abnormalities become more conspicuous with time. The life expectancy of children with this condition is poor, with death usually occurring around the fifth year. A case report of the anesthetic management of gingivectomy with multiple dental extractions in a 5-year-old Omani female with I-cell disease is presented. The problems faced and their management during anesthesia are described. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/105/65121 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65123 2010-05-01 all journal:Saudi_J_Anaesth
Endotracheal tube defects: Hidden causes of airway obstruction Sofi, K El-Gammal, K Manufacturing defects of endotracheal tube (ETT) are still encountered in anesthesia practice. Many such defects go unnoticed during routine inspection prior to their use. Such defects in ETT may lead to partial or complete airway obstruction in an intubated patient. We report a case of partial airway obstruction with a prepacked, single use, uncuffed ETT due to a manufacturing defect in the form of a plastic meniscus at the distal end of the tube. This case report highlights the significance of standard monitoring of ventilation and the role of a vigilant clinician in detecting such defects in avoiding critical events as can arise from the use of such defective ETTs. It also emphasizes the need for double checking ETTs prior to their use. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/108/65123 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65124 2010-05-01 all journal:Saudi_J_Anaesth
Ventricular tachycardia during microdebrider-assisted turbinectomy: An electrocardiographic artifact Sofi, K Khalid, AS Interference of monitored electrocardiogram is common during different surgical procedures using electrical equipment. The electrical devices used induce artifacts in the electrocardiographic tracing, which may resemble serious arrhythmia. We describe a case of electrocardiographic artifact resembling ventricular tachycardia with the use of a Storz unidrive microdebrider during inferior turbinectomy under general anesthesia. This case report highlights the importance of knowledge of various equipment-related electrocardiographic artifacts in avoiding unnecessary and harmful therapeutic interventions. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/111/65124 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65125 2010-05-01 all journal:Saudi_J_Anaesth
Pulmonary artery catheter entrapment in cardiac surgery Alsatli, R A pulmonary artery catheter (PAC) is an important tool in the preoperative cardiac management, and it provides measurements which helps in the patient management During open heart surgery the catheter tends to rest against the anterior lateral wall of the right atrium where the catheter may be caught by a suture in the cannulation for cardiopulmonary bypass. We describe a very rare complication which is inadvertent surgical suturing of the PAC to the inferior vena cava that necessitated reopening the chest, cutting, the suture and removing the catheter. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/114/65125 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65126 2010-05-01 all journal:Saudi_J_Anaesth
Pseudo loss of resistance in epidural space localization Gupta, B Sharma, S D'souza, N Kaur, M Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/117/65126 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65127 2010-05-01 all journal:Saudi_J_Anaesth
Ultrasound guided femoral nerve block: An essential pain management modality in emergency settings for femur fractures Kapoor, D Palta, S Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/118/65127 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65116 2010-05-01 all journal:Saudi_J_Anaesth
SJA is now on PubMed Al-Saeed, A Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/45/65116 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65117 2010-05-01 all journal:Saudi_J_Anaesth
Personalized intravenous regional anesthesia Flood, P Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/46/65117 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65119 2010-05-01 all journal:Saudi_J_Anaesth
Comparison of epidural ropivacaine and ropivacaine clonidine combination for elective cesarean sections Bajwa, SK Jasbir, K Background and Aim: Neuraxial adjuvants augment the action of local anesthetics. The aim is to determine the qualitative and quantitative aspects of epidural block of ropivacaine 0.75% versus ropivacaine 0.75% with clonidine for elective cesarean section . Settings and Design: A randomized double-blind study was conducted among 51 healthy parturients, scheduled for elective cesarean section, at Gian Sagar Medical College and Hospital, Banur, Punjab, India. Materials and Methods: Epidural block was administered with 20 ml of ropivacaine 0.75% (group R) and ropivacaine 0.75% and clonidine 75 μg (group RC) and anesthetic level was achieved minimum until T6-T7 dermatome. Onset time of analgesia, sensory and motor block levels, maternal heart rate and blood pressure, neonatal Apgar scores, postoperative analgesic dose and adverse events were recorded. Results: Fifty one patients were enrolled in this study and were subjected to statistical analysis. Groups were comparable with regard to demographic data, neonatal Apgar scores and incidences of side effects except for the higher incidence of dry mouth in patients of RC group. Onset of analgesia was much shorter in RC group along with prolonged duration of analgesia. The incidence of bradycardia and hypotension was more in RC group as compared to R group which was statistically significant. The dose requirement for postoperative pain relief was significantly lesser in RC group. Conclusions: The addition of 75 μg clonidine to isobaric epidural ropivacaine results in longer, complete and effective analgesia with similar block properties and helped to reduce the effective dose of ropivacaine when compared with plain ropivacaine for cesarean delivery. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/47/65119 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65122 2010-05-01 all journal:Saudi_J_Anaesth
Does the use of ketamine or nitroglycerin as an adjuvant to lidocaine improve the quality of intravenous regional anesthesia? Elmetwaly, KF Hegazy, NA Aboelseoud, AA Alshaer, AA Aims: To compare and evaluate the effect of adding ketamine or nitroglycerin (NTG) as adjuncts to lidocaine for intravenous regional anesthesia (IVRA) on intraoperative and postoperative analgesia, sensorial and motor block onset times, and tourniquet pain. Settings and Design: A prospective, randomized, double-blind study was carried out. Materials and Methods: Seventy-five patients undergoing hand surgery were divided into three groups as follows: control group receiving lidocaine 2%, LK group receiving lidocaine 2% with ketamine, and LN group administered lidocaine 2% with NTG. Sensory and motor blocks' onset and recovery times were recorded. Visual analog scale (VAS) for tourniquet pain was measured after tourniquet application and it was also used to measure postoperative pain. Analgesic consumption for tourniquet pain and postoperatively were recorded. Results: Sensory block onset times were shorter in the LK (4.4 ± 1.2 minutes) and LN (3.5 ± 0.9 minutes) groups compared with the control group (6.5 ± 1.1 minute) (P <0.0001) and motor block onset times were shorter in the LK (7.3 ± 1.6 minutes) and LN (3.6 ± 1.2 minutes) groups compared with the control group (10.2 ± 1.5 minutes) (P<0.0001). Sensory recovery time prolonged in the LK (6.7 ± 1.3 minutes) and LN (6.9 ± 1.1 minutes) groups compared with the control group (5.3 ± 1.4 minutes) (P = 0.0006 and <0.0001, respectively). Motor recovery time prolonged in the LK (8.4 ± 1.4 minutes) and LN (7.9 ± 1.1 minutes) groups compared with the control group (7.1 ± 1.3 minutes) (P = 0.0014 and 0.023, respectively). The sensory and motor block onset times were also shorter in LN group than in the LK group (3.5 ± 0.9 versus 4.4 ± 1.2 minutes, P=0.004; and 3.6 ± 1.2 versus 7.3 ± 1.6 minutes, P < 0.0001, respectively). The amount of fentanyl required for tourniquet pain was less in adjuvant groups when compared with control group. It was 13.6 ± 27.9 and 27.6 ± 34.9 μg in LK group and LN groups, respectively, versus 54.8 ± 28 μg in the control group. VAS scores of tourniquet pain were higher at 10, 20, 30, 40 minutes in the control group compared with the other study groups (P < 0.0001). It was also higher in LN group compared with LK group at 30 and 40 minutes (P < 0.001). Postoperative VAS scores were higher for the first 4 h in control group compared with the other study groups (P< 0.0001). Conclusions: The adjuvant drugs (ketamine or NTG) when added to lidocaine in IVRA were effective in improving the overall quality of anesthesia, reducing tourniquet pain, increasing tourniquet tolerance and improving the postoperative analgesia in comparison to the control group. Ketamine as an adjuvant produced better tolerance to tourniquet than the other groups. NTG as an adjuvant produced faster onset of sensory and motor blockades in comparison to other groups . Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/55/65122 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65129 2010-05-01 all journal:Saudi_J_Anaesth
Mixed venous versus central venous oxygen saturation in patients undergoing on pump beating coronary artery bypass grafting Alshaer, A Abdel-Meguid, ME Ibraheim, O Fawzi, K AbdulSalam, I Sheta, S Abdullah, KM El-Demerdash, A Al-Satli, R AbdelAll, M Bakir, BM AlNahal, N Abdulrahman, Y AlHamoud, H Objective: To examine the validity of central venous oxygen saturation (ScvO<sub> 2</sub> ) as a numerical substitution of mixed venous oxygen saturation (SvO<sub> 2</sub> ) in adult patients undergoing normothermic on pump beating coronary artery bypass grafting (CABG). Materials and Methods: Prospective clinical observational study was done at King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. Thirty four adult patients scheduled for coronary artery surgery were included. Patients were monitored by a pulmonary artery catheter (PAC) as a part of our routine intraoperative monitoring. SvO<sub> 2</sub> and ScvO<sub> 2 </sub> were simultaneously measured 15 minutes (T1) and 30 minutes (T2) after induction of anesthesia, 15 and 30 minutes after initiation of cardiopulmonary bypass (T3 and T4), and 15 and 30 minutes after admission to intensive care unit (T5 and T6). Results: ScvO<sub> 2</sub> showed higher reading than SvO<sub> 2</sub> all through our study. Our results showed perfect positive statistically significant correlation between SvO<sub> 2 </sub> and ScvO<sub> 2</sub> at all data points. Individual mean of difference (MOD) between both the readings at study time showed MOD of 1.34 and 1.44 at T1 and T2 simultaneously. This MOD was statistically insignificant, but after on pump beating normothermic bypass was initiated; MOD was 5.2 and 4.4 at T3 and T4 with high statistical significance. In ICU, MOD continues to have high statistical significance, MOD was 6.3 at T5 and at T6 it was 4.6. Conclusions: In on pump beating CABG patients; ScvO<sub> 2</sub> and SvO<sub> 2</sub> are not interchangeable numerically. ScvO<sub> 2</sub> is useful in the meaning of trend; our data suggest that ScvO<sub> 2</sub> is equivalent to SvO<sub> 2</sub> , only in the course of clinical decisions as long as absolute values are not required. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/63/65129 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65131 2010-05-01 all journal:Saudi_J_Anaesth
Survival after in-hospital cardiopulmonary resuscitation in a major referral center Saghafinia, M Piryaie, M Rafati, H Saghafi, A Jalali, A Madani, SJ Kolahdehi, RB Aim: This study was undertaken to assess the demographics, clinical parameters and outcomes of patients undergoing cardiopulmonary resuscitation (CPR), by the code blue team at our center to compare with other centers. Materials and Methods: Data were collected retrospectively from all adult patients who underwent CPR at our hospital from 2007 to 2008. CPR was performed on 290 patients and it was given 313 times. Clinical outcomes of interest were survival at the end of CPR and survival at discharge from the hospital. Factors associated with survival were evaluated via binomial and chi square-tests. Results: Of the 290 patients included, 95 patients (30.4%) had successful CPR. However, only 35 patients (12%) were alive at discharge. The majority requiring CPR were above 60 years of age (61.7%). Males required CPR more than females. There were 125 women (43.1%) and 165 males (56.9%) aged 3 to 78 (average 59.6) years. Majority (179) of the cases (61.7%) were above 60 years of age. Regarding the various wards, 54 cases (17.3%) were in the internal medicine ward, 63 cases (20.1%) in the surgery ward, 1 case (0.3%) in the clinic, 11 cases (3.5%) in the paraclinic, 116 cases (37.1%) in the emergency (ER), 55 cases (17.5%) in the Intensive Care Unit (ICU) and Coronary Care Unit (CCU), and 13 cases (4.2%) were in other wards. Cardiac massage was done in 133 cases (42.5%), defibrillation only via electroshock 3 cases (1%), and both were used in177 cases (56.5%). The ER had the most cases of CPR. Both cardiac massage and electroshock defibrillation were needed in most cases. Conclusion: In-hospital CPR for cardiopulmonary arrest was associated with 30.4% success at our center at the end of CPR but only 12% were alive at discharge. Duration of CPR >10 minutes was predictive of significantly decreased survival to discharge. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/68/65131 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65132 2010-05-01 all journal:Saudi_J_Anaesth
Comparison of two drug combinations in total intravenous anesthesia: Propofol-ketamine and propofol-fentanyl Bajwa, SK Kaur, J Background and Aims: Keeping in consideration the merits of total intravenous anesthesia (TIVA), a genuine attempt was made to find the ideal drug combinations which can be used in general anesthesia. This study was conducted to evaluate and compare two drug combinations of TIVA using propofol-ketamine and propofol-fentanyl and to study the induction, maintenance and recovery characteristics following anesthesia with these techniques. Settings and Design: A case control study was conducted, which included 100 patients, in the department of Anaesthesiology and Intensive care, Government Medical College and Hospital, Patiala. Patients and Methods: A hundred patients between the ages of 20 and 50 years of either gender were divided into two groups of 50 each, and they underwent elective surgery of approximately 1 h duration. Group I received propofol-ketamine while group II received propofol-fentanyl for induction and maintenance of anesthesia. All the results were tabulated and analyzed statistically with student's unpaired t-test and chi-square test. Results : Propofol-fentanyl combination produced a significantly greater fall in pulse rate (PR; 9.28% versus 0.23%) and in both systolic (7.94% versus 0.12%) and diastolic blood pressures (BP; 8.10% versus 0.35%) as compared to propofol-ketamine during induction of anesthesia. Propofol-ketamine combination produced stable hemodynamics during maintenance phase while on the other hand propofol-fentanyl was associated with a slight increase in both PR and BP. During recovery, ventilation score was better in group I while movement and wakefulness score was better in group II. Mean time to protrusion of tongue and lifting of head was shorter in group I. Conclusions : Both propofol-ketamine and propofol-fentanyl combinations produce rapid, pleasant and safe anesthesia with only a few untoward side effects and only minor hemodynamic effects. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/72/65132 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65130 2010-05-01 all journal:Saudi_J_Anaesth
Comparison of classic peribulbar anesthesia and new entry point (single percutaneous injection technique) in vitroretinal surgery Kabeel, MM Purpose: To describe the method that seeks to improve the administration of regional anesthesia for vitroretinal surgery avoiding the risk of potential complications associated with other techniques through comparison of safety and efficacy of classic peribulbar anesthesia versus single percutaneous technique using a prospective, randomized clinical trial. Materials and Methods: One hundred patients were randomized to classic peribulbar and single percutaneous peribulbar technique after informed consent. Pain during administration of anesthesia, during surgery was graded on a visual analogue pain scale and compared for both techniques. Globe akinesia, analgesia and IOP measurements before and after administration of anesthesia, detection of distribution of local anesthetic agent by ultrasound scanning and complications related were also compared. Results: Twenty out of 50 (40%) patients of group 1(classic pirebulbar) and 36/50 (72%) of group II (single percutaneous technique) experience no pain during administration of anesthesia. Scores for globe akinesia and anesthesia were less satisfactory in group 1 and supplemental blocks required in 8% of the patients while in group II all of the patients (100%) showed proper globe akinesia and anesthesia. There were significant elevation in mean IOP following injection in both groups and the incidence of subconjunctival haemorrhage, chemosis and echymosis were more frequent in group 1. Conclusion: Single percutaneous peribulbar technique proved to be a safe and efficient technique that offers excellent anesthesia and akinesia with less complication for various ophthalmic procedures Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/80/65130 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65128 2010-05-01 all journal:Saudi_J_Anaesth
Conventional mechanical ventilation Tobias, JD The provision of mechanical ventilation for the support of infants and children with respiratory failure or insufficiency is one of the most common techniques that are performed in the Pediatric Intensive Care Unit (PICU). Despite its widespread application in the PICUs of the 21st century, before the 1930s, respiratory failure was uniformly fatal due to the lack of equipment and techniques for airway management and ventilatory support. The operating rooms of the 1950s and 1960s provided the arena for the development of the manual skills and the refinement of the equipment needed for airway management, which subsequently led to the more widespread use of endotracheal intubation thereby ushering in the era of positive pressure ventilation. Although there seems to be an ever increasing complexity in the techniques of mechanical ventilation, its successful use in the PICU should be guided by the basic principles of gas exchange and the physiology of respiratory function. With an understanding of these key concepts and the use of basic concepts of mechanical ventilation, this technique can be successfully applied in both the PICU and the operating room. This article reviews the basic physiology of gas exchange, principles of pulmonary physiology, and the concepts of mechanical ventilation to provide an overview of the knowledge required for the provision of conventional mechanical ventilation in various clinical arenas. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/86/65128 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:65118 2010-05-01 all journal:Saudi_J_Anaesth
Dynamic left ventricular outflow tract obstruction complicating aortic valve replacement: A hidden malefactor revisited Panduranga, P Maddali, MM Mukhaini, MK Valliattu, J It is known that a dynamic left ventricular outflow tract (LVOT) obstruction exists in patients, following aortic valve replacement (AVR) and is usually considered to be benign. We present a patient with dynamic LVOT obstruction following AVR, who developed refractory cardiogenic shock and expired inspite of various treatment strategies. This phenomenon must be diagnosed early and should be considered as a serious and potentially fatal complication following AVR. The possible mechanisms and treatment options are reviewed. Medknow Publications 2010-05-01 http://www.saudija.org/text.asp?2010/4/2/99/65118 en Copyright 2017 Saudi Journal of Anaesthesia.
oai:medknow.com:62689 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Renal thrombotic microangiopathy revisited: When a lesion is not a clinical finding Isenring, P Despite advances in the field of thrombotic microangiopathy (TMA) and associated syndromes such as thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS), they still leave several issues unresolved. For instance, actual diagnostic criteria on which therapeutic decisions rely are relatively narrow and focused on TTP-HUS, with the consequence that non-idiopathic and atypically-presenting TMA are overlooked. In addition, nosologic classifi-cations of TMA disorders have varied substantially over the years, but are still devised from historical rather than mechanistic data. As such, it is perhaps not surprising that even today TMA is erroneously used as an interchangeable term with TTP-HUS, and missed or inappropriately diagnosed on various occasions. Yet, recognizing TMA is of crucial importance given that this lesion often manifests with potentially reversible renal failure. In this editorial, which is presented from a Nephrologist's perspective, we propose that TMA disorders need to be reclassified to include most types of presentations and confirmed or excluded through more elaborate diagnostic approaches. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/411/62689 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62693 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Ramadan fasting and transplantation: Current knowledge and what we still need to know Khedmat, H Taheri, S Ramadan fasting is one of the most appreciated Islamic rituals in Islamic culture. Although non-healthy as well as weak people are allowed not to fast in this month, some trans-plant recipient patients are willing to fast but are concerned about adverse effects on their health. Due to answering this question, a number of studies have been conducted. In this literature review we review the existing data on this issue and attempt to reach to a conclusion on what we know and what we still need to know. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/417/62693 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62697 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Laparoscopic right donor nephrectomy: Endo TA stapler is safe and effective Devra, AK Patel, S Shah, SA Although laparoscopic donor nephrectomy is now a well-accepted alternative to traditional open donor nephrectomy at many transplantation centers, there are always concerns regarding quality of graft and vessels after laparoscopic harvest, especially with right donor nephrectomy. Several methods of graft retrieval have been explored to achieve acceptable graft outcome. We share our initial experience at the Institute of Kidney Diseases and Research Center, Amedabad, India of laparoscopic right donor nephrectomy performed by subcostal open, and pure laparoscopic approach with the use of Endo TA stapler. Nine laparoscopic right donor nephrec-tomies were performed by the trans-peritoneal approach at our centre from January 2006 to March 2007. In the first five cases, the grafts were retrieved through subcostal incision (Group A) and the last four cases were performed purely laparoscopically by using Endo TA stapler device (Group B). None of the patients needed open conversion. The mean operative time and hospital stay were comparable in each group. The warm ischemia time was longer in pure laparoscopic group (415 seconds) than the subcostal open approach group (176 seconds). The serum creatinine of the recipients on day seven was comparable in both the groups. The recipient surgery was effectively performed with graft retrieved using Endo TA stapler device (Group B) without any compromise to the renal vein length. Our study suggests that the Endo TA stapler device is safe and provides all the benefits of minimally invasive surgery to the donor. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/421/62697 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62705 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Safe conversion to cicloral, a generic cylosporine, in both stable and De Novo renal transplant recipients Kahn, D Muller, E Pascoe, M Several generic cyclosporine (CsA) formulations have been developed over the last decade and are now widely available. In 2003 our local Health Department replaced Neoral with CicloHexal for the cost benefits, and we were compelled to convert all our renal transplant reci-pients to the generic CsA formulation. All renal transplant recipients were converted from Neoral to CicloHexal on a 1:1 dose basis in August/September 2003. Study 1 constitutes the retrospective review of all stable renal transplant patients and the CsA dose, CsA level and serum creatinine were noted. Study 2 constitutes the review of the records of de novo transplant patients inititated on CicloHexal compared to matched patients transplanted on Neoral before the conversion and the CsA dose, CsA level and serum creatinine noted (Study 2). There was no difference in the mean CsA dose, CsA level or serum creatinine at one month before conversion (on Neoral) com-pared to one month after conversion (on CicloHexal) in the 117 stable renal transplant recipients. Similarly, the mean CsA dose, CsA level and serum creatinine in de novo renal transplant reci-pients on Neoral (n= 26) were similar to those on CicloHexal (n= 23) at about seven and ten days postoperatively. In conclusion both stable and de novo renal transplant patients can be safely converted from Neoral to CicloHexal on a 1:1 dose basis. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/426/62705 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62712 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Assessment of sleep disturbance in renal transplant recipients and associated risk factors Pourfarziani, V Taheri, S Sharifi-Bonab, MM Mohammadzadeh, M Sleep disturbances are highly prevalent in ESRD patients. In this study we sought to evaluate the associations of poor sleep with several genetic, laboratory, treatment and de-mographic factors in renal allograft recipients using a validated sleep quality questionnaire. A cross-sectional study was conducted on renal transplant patients over 18 years of age with stable current stable graft function. All patients completed PSQI and Ifudu questionnaires for assessment of sleep quality and morbidity measures. Kolmogorov-Smirnov test was used for evaluation of distributions besides Student's t-test, and Fisher's exact test for analyses. Mean total PSQI score for the whole patients was 6.5 ± 2.6. Overall 26 (67%) of patients were diagnosed as "poor sleepers" (PSQI total score ≥ 5) and the reminding 13 (33%) were "good sleepers". Compared to "good sleepers", "poor sleepers" significantly had higher serum phosphate levels and ESRD duration (P= 0.05). Hematological disorders were more seen in "poor sleepers" and musculo-skeletal disorders had a significant worsening impact on PSQI total score (β= 0.28, P= 0.05). In conclusion our study showed that sleep disturbance is common in renal transplant patients is sur-prisingly common, and ESRD duration prior to transplant was significantly associate with sleep quality. Future studies with larger sample sizes are necessary for confirming our results. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/433/62712 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62717 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Impact of cardiovascular risk factors on the outcome of renal transplantation Moghimi, M Falaknazi, K Bagheri, N Cardiovascular diseases are common in renal transplant recipients and renal insuf-ficiency has been shown to be a risk factor for cardiovascular disease. Some studies have reported that cardiovascular risk factors may contribute to the outcome of renal transplantation. This study was performed to determine the impact of cardiovascular risk factors on the outcome of renal transplantation in Iranian subjects. This is a retrospective, observational study including patients of 20-85 years of age who had undergone renal transplantation. Parameters documented and analyzed included demographics, cardiovascular risk factors, past medical history, date of last transplan-tation, the outcome of transplant, last measured serum creatinine, cause of graft failure, rejection, and death. A total of 192 patients were analyzed including 152 in the case group (with identifiable cardiovascular risk factors) and 40 controls (transplant recipients without identifiable risk factors). The mean serum creatinine in the case and control groups were 1.33 ± 0.13 and 1.29 ± 0.36 mg/dL respectively (P= 0.493). Response to transplantation was categorized based on a report from the World Health Organization. Complete response to grafting occurred in the control group more than the case group (P= 0.009), while frequency of partial response to grafting was higher in the case group (0.008). A history of chronic obstructive pulmonary diseases (COPD) could significantly predict the outcome of grafting (P= 0.008) as could the occurrence of renal failure (P= 0.022). Results were consistently reproduced using multivariate cumulative log it model. Our study indicates that the measured cardiovascular risk factors do not significantly influence the outcome of renal transplantation. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/438/62717 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62720 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Holy month of Ramadan and increase in organ donation willingness Najafizadeh, K Ghorbani, F Hamidinia, S Emamhadi, MA Moinfar, MA Ghobadi, O Assari, S Organ shortage is the most significant factor in restricting the activities of trans-plantation systems. We herein report the positive impact of Muslims' holy month of Ramadan on willingness to donate organs in Iran. Data were derived from the database of Donation Willing-ness Registries, affiliated to the organ procurement unit of Masih Daneshvari Hospital during March 2007 till March 2008. The number of applications for organ donation was compared bet-ween Ramadan and its previous month, and the socio-economic characteristics of the applicants were compared between those who applied in Ramadan and those who did so in the previous month. In addition, the mean number of daily applications was compared between Ramadan and the other months of the same year. A total of 11528 applications for organ donation cards were registered for the Ramadan of 2007 as opposed to 4538 applications in the previous month, sho-wing an increasing rate of 154%. The mean number of daily applications was significantly higher in Ramadan than that of the other months of the same year (P< 0.001). There was also a significant difference in terms of the socio-economic characteristics between the applicants in Ramadan and those in the previous month. The increase in organ donation willingness in Ramadan may be the result of the propagation of altruism by the mass media and religious organizations. Ramadan seems to provide a great opportunity to promote organ donation across the Muslim world. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/443/62720 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62723 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Factors associated with decision-making about end-of-life care by hemodialysis patients Baharoon, SA Al-Jahdali, HH Al-Sayyari, AA Tamim, H Babgi, Y Al-Ghamdi, SM The current cross sectional study is based on a questionnaire database on patients with end-stage renal disease (ESRD) to determine their preferences about end-of-life care and differences of certainty regarding the application of cardiopulmonary resuscitation and life sus-taining measures in case of cardiac arrest. The study was performed on 100 patients on hemo-dialysis for at least 2 years and not on the transplant list in two tertiary hospitals in Saudi Arabia; King Fahad National Guard in Riyadh and King Faisal Specialist Hospital in Jeddah in March 2007. More than two thirds of the surveyed patients were willing to make decisive decisions. Ha-ving more than 5 children was the only factor significantly associated with the ability to make de-cisive decisions; there was an insignificant association with factors such as marital status or non-Saudi nationality. Factors such as self-perception or disease curability, previous admissions to hospital or intensive care units, prior knowledge of mechanical ventilation, or cardiopulmonary resuscitation did not have any influence on making certain decisions on end-of-life care. There was a significant lack of knowledge in our study patients of cardiopulmonary resuscitation, me-chanical ventilation, and disease outcome. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/447/62723 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62725 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
The role of oral L-Carnitine therapy in chronic hemodialysis patients Sabry, AA To evaluate the effects of L-carnitine oral supplementation on anemia and cardiac function in patients on maintenance hemodialysis (HD), we studied 55 adult chronic HD patients at our center during the period from January 2006 to June 2006 and divided them into two groups; a group of 20 patients who received 1,500 mg/day oral L-carnitine and a control group of 35 patients. Both groups were on erythropoietin therapy. Echogardiographic studies were performed before and at the end of the study. The mean hemoglobin levels were comparable in the L--carnitine group and the control group at the start and after 6 months of therapy (8.63 ± 1.77 and 9.39 ± 2.02 gm/dL, P= 0.18; 10.49 ± 1.65 and 10.92 ± 2.48 gm/dL, P= 0.76, respectively). The mean weekly maintenance dose of erythropoietin was not statistically significantly different in L-carnitine group (80.16 ± 35.61 units/kg) and the control group (91.9 ± 38.21 units/kg, P= 0.20). In addition no significant improvement could be observed in the echogardiographic findings in the L-carnitine group after therapy. We conclude that our study revealed no significant improvement in hemoglobin, erythropoietin dose and echocardiographic findings after six months of therapy. Long-term studies including larger number of patients are required to clarify the questionable role of L-carnitine in the HD patients. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/454/62725 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62727 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Changes in QT intervals in patients with end-stage renal disease before and after hemodialysis Malhis, M Al-Bitar, S Farhood, S Zaiat, KA Increased dispersion of QT intervals is known to predispose to ventricular arrhyth-mias and sudden cardiac death. To assess the effect of hemodialysis (HD) on QT and corrected QT (QTc) intervals and their dispersions in chronic hemodialyzed patients we studied 85 patients (male/female = 48/37; mean age 44 ± 17 year) on chronic hemodialysis. Simultaneous 12-lead ECG was recorded before and after HD in a standard setting. The QT intervals for each lead were measured manually by one observer using calipers. Each QT interval was corrected for heart rate: QTc= QT √ R-R/ (in milliseconds [ms]). ECG parameters, body weight, blood pressure, heart rate, electrolytes (Na<sup> +</sup> , K<sup> +</sup> , Ca<sup> ++</sup> , phosphate), urea, and creatinine were measured before and after HD. The mean of pre and post dialysis cycle intervals was 828 ± 132 ms and 798 ± 122 ms respec-tively; the difference was not significant. The mean of QT<sub> max </sub> intervals changed significantly from 446 ± 47 to 465 ± 72 ms (P< 0.05). The mean of corrected QT<sub> cmax </sub> intervals increased significantly from 472 ± 38 to 492 ± 58 ms (P< 0.05). The mean of QT dispersions and the corrected QT interval dispersions changed from 60 ± 29 to 76 ± 32 ms (P< 0.05) from 72 ± 46 to 98 ± 56 ms (P< 0.05), respectively. During HD, the serum potassium and phosphate levels decreased whereas the calcium levels increased. We conclude that QT and QTc interval and dispersion increase in HD patients. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/460/62727 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62729 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Effect of vitamin E coated dialyzers on anticoagulation requirement in hemodialyzed children Aoun, B Janssen-Lozinska, Y Ulinski, T As hemodialysis (HD) requires extra corporal blood flow and the need for anti-coagulation, we evaluated the effect of vitamin E coated membranes (VIE) on the requirement of low molecular weight heparin (LMWH) in pediatric HD patients. Patients and methods: seven children and adolescents on regular hemodialysis were started on VIE and their LMWH dose was decreased every week. In order to monitor the requirement of LMWH we used a coagulation score to evaluate coagulation in the dialyzer, air trap and blood line. Other classical parameters (hemoglobin, erythropoietin dose, inflammatory markers) were monitored weekly while the pa-tients were on VIE dialyzers. LMWH dose during the 1st week was 110 IU/kg ± 18 (defined as 100%), in the 2nd week the dose was 77 IU/kg ± 12 (70%), in the 3<sup> rd </sup> week the dose was 33 IU/kg ± 5 (30%), and in the 4<sup> th </sup> week anticoagulation could be stopped in one patient, in the other six pa-tients further decrease was impossible given the increase of the clotting score. There was no in-crease in clotting score during week one and two. During week three (while on 30% of the initial LMWH dose) six patients showed mild to moderate clotting phenomena: mild coagulation phe-nomena in three patients and moderate clotting phenomena in three others. One patient did not show any clotting phenomena in week three and LMWH was totally stopped. In conclusion, use of VIE dialyzers may help to reduce the requirement of anticoagulation in pediatric HD patients reducing bleeding problems and simplify hemostasis after HD sessions. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/466/62729 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62732 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Electrocardiographic manifestations of hyperkalemia in hemodialysis patients Nemati, E Taheri, S This study was performed to evaluate whether any electrocardiogram (ECG) para-meter can predict the presence of hyperkalemia in patients on maintenance hemodialysis (HD). In January 2006, we conducted a cross-sectional study of 80 stable patients with end-stage renal disease from four university-based HD units of Tehran, Iran, receiving conventional thrice-weekly HD. Pre-HD serum electrolyte values and conventional 12-lead ECG were obtained from each pa-tient. Bivariate linear regression was used for assessing relationship of the study variables with hyperkalemia (K<sup> +</sup> > 5.2 mg/dL). Multivariable logistic regression was used for evaluating inde-pendent relationship between decreased T wave duration (≤ 170 ms) and other variables. Bivariate correlation analysis showed a significant inverse correlation between serum potassium concentra-tion and T wave duration (P<0.05). None of the patients with serum potassium of ≥ 5.6 mg/dL had T wave duration > 200 ms. Multivariate logistic analysis, after adjustment for other factors, also showed a significant relationship between decreased T wave duration (≤ 170 ms) and hyper-kalemia. We conclude that although hyperkalemia does not induce the usual ECG changes in HD patients, decreased T wave duration was found to be a good indicator of this lethal condition. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/471/62732 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62737 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Comparative study of anticoagulation versus saline flushes in continuous renal replacement therapy Nagarik, AP Soni, SS Adikey, GK Raman, A Systemic heparinization during continuous renal replacement therapy (CRRT) is associated with disadvantage of risk of bleeding. This study analyses the efficacy of frequent saline flushes compared with heparin anticoagulation to maintain filter life. From January 2004 to November 2007, 65 critically ill patients with acute renal failure underwent CRRT. Continuous venovenous hemodialfiltration (CVVHDF) was performed using Diapact Braun CRRT machine. 1.7% P.D. fluid was used as dialysate. 0.9% NS with addition of 10% Ca Gluconate, Magnesium Sulphate, Soda bicarbonate and Potassium Chloride added sequentially in separate units were used for replacement, carefully monitoring their levels. Anticoagulation of extracorporeal circuit was achieved with unfractionated heparin (250-500 units alternate hour) in 35 patients targeting aPTT of 45-55 seconds. No anticoagulation was used in 30 patients with baseline APTT > 55 seconds and extracorporeal circuit was maintained with saline flushes at 30 min interval. 65 pa-tients including 42 males. Co-morbidities were comparable in both groups. HMARF was signifi-cantly more common in heparin group while Sepsis was comparable in both the groups. CRRT parameters were similar in both groups. Average filter life in heparin group was 26 ± 6.4 hours while it was 24.5 ± 6.36 hours in heparin free group ( P=NS). Patients receiving heparin had 16 bleeding episodes (0.45/patient) while only four bleeding episodes occurred in heparin free group (0.13/patient, P< 0.05). Mortality was 71% in heparin group and 67% in heparin free group. Frequent saline flushes is an effective mode of maintainance of extracorporeal circuit in CRRT when aPTT is already on the higher side, with significantly decreased bleeding episodes. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/478/62737 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62738 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Treatment of steroid resistant nephrotic syndrome in children Kari, JA Halawani, M Achieving remission in children with Steroid-Resistant Nephrotic Syndrome (SRNS) could be difficult. Many immunosuppressive drugs are used with variable success rates. We have studied the response of children with SRNS who presented to our pediatric's renal unit between 2002 and 2007 to various modalities of therapy. We included patients with no response to pred-nisolone (60 mg/M<sup> 2</sup> /day) after four weeks of therapy; all the patients had renal biopsy and follow-up duration for at least one year. We excluded patients with congenital nephrotic syndrome, lupus, or sickle cell disease. There were 31 (23 girls and 8 boys with F: M= 2.9:1; the mean age at presentation was 4.2 ± 3.2) children who fulfilled the inclusion criteria. The mean duration of follow up was 3.1 ± 1.6 years. Twenty children (65%) achieved partial (6 children) or complete (14 children) remission. There were 16 children treated with cyclophosphamide either oral or intra-venous, and only 4 of them (25%) achieved remission. Seven children received oral chlorambucil, and only2 of them (28.5%) achieved remission; none of the children experienced side effects. Fifteen children received cyclosporine, and only eight of them (53%) achieved remission. Six children developed gum hypertrophy and one had renal impairment, which was reversible after discontinuing the drug. Mycophonelate mofetil (MMF) was used as the last option in 5 children, and 2 of them achieved complete remission. One child developed a systemic cytomegalovirus (CMV) infection which indicated discontinuing the drug. Fourteen (45%) children needed more than one immunosuppressive therapy. Three children progressed to end stage renal failure and required dialysis. We conclude that SRNS in children is a difficult disease with significant morbidity. However, remission is achievable with cyclosporine and other immunosuppressive agents. Treatment should be individualized according to the underlying histopathology, and clinical and social conditions of the children. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/484/62738 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62740 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
The role of B-Mode ultrasonography in the detection of urolithiasis in patients with acute renal colic Haroun, AA Hadidy, AM Mithqal, AM Mahafza, WS Al-Riyalat, NT Sheikh-Ali, RF This study was conducted to assess the diagnostic yield of B-Mode Ultrasonogra-phy compared to unenhanced helical CT scan in detecting urinary stones in patients with acute renal colic. This retrospective study comprised of 156 patients who underwent unenhanced uri-nary tract CT scan and ultrasonography for suspicion of urolithiasis. Both techniques were used to determine the presence or absence, site, size, and number of urinary stones, as well as presence of any other intra-abdominal pathology. For statistical analysis, the sensitivity, specificity, predictive values, and diagnostic accuracy of ultrasonography were measured considering unenhanced CT scan as a gold standard. Unpaired two-tailed student's t-test was used for comparison between mean size of true positive, false positive, and false negative stones. There were 68 patients having 115 urinary stones. Ultrasound identified 54 stones, missed 43, and falsely diagnosed 18 stones. The mean size of true positive, false positive, and false negative stones were 4.8 ± 3.3 mm, 6 ± 1.8 mm and 4.18 ± 3 mm, respectively. There were 23 patients with other intra-abdominal patho-logies, equally detected by both techniques. Ultrasound helped in identifying the cause of acute flank pain in 62% of cases. The overall sensitivity, specificity, positive and negative predictive values, and accuracy of ultrasonography in the diagnosis of renal stone disease were 58%, 91%, 79%, 78%, and 78% , respectively. Our study suggests that, despite its limited value in detecting urinary stones, ultrasonography should be performed as an initial assessment in patients with acute flank pain. Unenhanced helical CT should be reserved for patients in whom ultrasonography is inconclusive. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/488/62740 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62739 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
The effect of low serum bicarbonate values on the onset of action of local anesthesia with vertical infraclavicular brachial plexus block in patients with End-stage renal failure Al-mustafa, MM Massad, I Alsmady, M Al-qudah, A Alghanem, S Vertical infraclavicular brachial plexus block is utilized in patients with chronic renal failure at the time of creation of an arterio-venous fistula (AVF). The aim of this study is to test the effect of impaired renal function, with the resulting deranged serum electrolytes and blood gases, on the success rate and the onset of action of the local anesthetics used. In this prospective clinical study, we investigated the effect of the serum levels of sodium, potassium, urea, crea-tinine, pH, and bicarbonate on the onset of action of a mixture of lidocaine and bupivacaine administered to create infraclavicular brachial plexus block. A total of 31 patients were studied. The success rate of the block was 93.5 % (29 patients). The mean onset time for impaired or re-duced sensation was found to be 8.9 ± 4.7 mins and for complete loss of sensation, was 21.2 ± 6.7 mins. There was no significant association with serum sodium, potassium, urea, creatinine or the blood pH level (P> 0.05). The bivariate correlation between serum bicarbonate level and the partial and complete sensory loss was -0.714 and -0.433 respectively, with significant correlation (P= 0.00, 0.019). Our study suggests that infraclavicular block in patients with chronic renal failure carries a high success rate; the onset of the block is delayed in patients with low serum bicarbonate levels. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/494/62739 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62687 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Relapsing peritonitis in a malnourished female with rheumatoid arthritis on continuous ambulatory peritoneal dialysis Sundaram, V Abraham, G Mohanraj, SK Reddy, YN Sathiah, V Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/501/62687 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62688 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Post transplant ureteric stenosis causing allograft hydronephrosis and calyceal rupture: Salvage side to side ureteroneocystostomy Baig, MA Khan, T Mousa, D A 26 years old lady with End Stage Renal Disease who received a cadaveric renal trans-plant, presented with ureteral stenosis as well as calyceal rupture due to hydronephrosis that was unresponsive to balloon dilation and the allograft was salvaged by a side to side ureteroneo-cystostomy. The symptoms and renal function improved and patency of the side to side uretroneo-cystostomy was confirmed post operatively and also at seventeen month follow-up. It may be rea-sonable to treat post-transplant ureteral stenosis resistant to balloon dilation with this technique. However, long-term follow-up is required to evaluate the efficacy of this treatment. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/504/62688 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62690 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Conservative treatment of processus vaginalis hernia in two peritoneal dialysis patients Al-Wadani, H Alqahtani, AA Al-Dossari, N Alsawad, A Al-Atiqu, M Saad, I Al-Hwiesh, AK Dialysate leakage represents one of the major noninfectious complications of peri-toneal dialysis (PD). In some instances, dialysate leakage may lead to discontinuation of the technique. Despite its importance, the incidence, risk factors, management, and outcome of dia-lysate leakage are poorly characterized in the literature. Here, we report two PD patients who pre-sented with painless scrotal swelling. Computerized peritoneography confirmed the diagnosis of processus vaginalis hernia that was treated conservatively. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/507/62690 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62692 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Congenital vitamin D deficiency: A rare etiology of an acute life threatening event in early infancy Mosalli, R Yasser, E Ali, AM Harbi, SA Infants born to mothers with deficiency of vitamin D and/or calcium due to cultural modifications in their diets, life style and clothing habits, are at risk of developing early and fatal sequelae of hypocalcemic vitamin D deficiency. We present a 44-day-old infant with hypocal-cemia secondary to congenital vitamin D deficiency, who presented as a recurrent Acute Life Threatening Event (ALTE) resulting in an unexpectedly prolonged intensive care course. This report suggests that evaluation of vitamin D status should be included as part of the workup of ALTE and we describe evidence-based preventive measures for both mothers and infants who are at risk for vitamin D deficiency. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/511/62692 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62696 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Xanthogranulomatous pyelonephritis in a Horse-Shoe kidney Mongha, R Dutta, A Vijay, M Chatterjee, U Chakraborty, SC Xanthogranulomatous pyelonephritis (XGPN) represents an unusual suppurative gra-nulomatous reaction to chronic infection, often in the presence of chronic obstruction from a calculus. We present a case of XGPN in a horse shoe kidney in an adult. Hemi-nephrectomy of the involved side was followed by clinical improvement. The case highlights the importance of early hemi-nephrectomy in XPGN with horse shoe kidney. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/515/62696 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62699 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Cystic nephroma: A diagnostic dilemma Mohanty, D Jain, BK Agrawal, V Gupta, A Cystic nephroma (CN) is a rare benign neoplasm of kidney with excellent prog-nosis. An accurate pre-operative diagnosis differentiating CN from other cystic renal malignan-cies may be impossible by clinical and radiological examination, and histopathological exami-nation provides the final diagnosis. This report describes two adult patients with large multi-locular cystic renal masses on imaging and the diagnosis of CN was clinched post-operatively by the ho-neycomb appearance of the cut specimen and the finding of multiple, non-communicating fluid filled cysts lined by cuboidal or flattened epithelial cells and absence of blastemal cells on mic-roscopy. Tumor diameter on cross sectional imaging remains the key parameter for treatment de-cisions in renal neoplasms, with nephrectomy being preferred for larger lesions. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/518/62699 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62702 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Transient IgA nephropathy with acute kidney injury in a patient with dengue fever Upadhaya, BK Sharma, A Khaira, A Dinda, AK Agarwal, SK Tiwari, SC Dengue virus infection can clinically manifest as dengue fever, dengue shock syn-drome and dengue hemorrhagic fever. Acute kidney injury as a result of dengue virus infection can occur due to various reasons including hypotension, rhabdomyolysis, sepsis and rarely immune complex mediated glomerular injury. However, glomerulonephritis associated with IgA Nephropathy in dengue virus infection has not been reported previously. We report a case of 15-year-old boy who was admitted with dengue fever and dialysis dependant acute kidney injury. Urine examination showed microscopic glomerular hematuria and proteinuria. Kidney biopsy showed mesangial proliferation with mesangial IgA dominant immune complex deposits and acute tubular necrosis. A repeated kidney biopsy 6 weeks after clinical recovery showed reversal of glomerular changes as well as resolution of mesangial IgA deposits. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/521/62702 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62704 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
ANCA-Positive Pauci-Immune rapidly progressive glomerulonephritis and the nephrotic syndrome Jabur, WL Saeed, HM We herewith report a case of biopsy proven crescentic glomerulonephritis (GN) due to vasculitis, whose sole presentation was the nephrotic syndrome. Our case raises the possibility of whether the disease initially was a primary GN, upon which crescentic GN was superimposed, or was it vasculitis from initial stages with an atypical presentation. The various points for both these possibilities are discussed. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/526/62704 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62707 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Delayed presentation of traumatic renal AV fistula managed by coil embolization Banerji, JS Aswathaman, K Mani, SE Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/531/62707 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62710 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Regional citrate anticoagulation for hemodialysis: A safe and efficient method Jarraya, F Mkawar, K Kammoun, K Hdiji, A Yaich, S Kharrat, M Charfeddine, K Hmida, MB Mahfoudh, H Ayedi, F Hachicha, J Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/533/62710 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62714 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Computerization of hemodialysis records: A new era explored Alam, A Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/535/62714 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62716 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
An unusual cause for Post-Renal transplant hematuria and proteinuria: A retained Double-J catheter Amini, M Naderi, GH Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/538/62716 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62718 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Panniculitis associated with steroid use Bagga, A Sethi, SK Sharma, A Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/539/62718 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62719 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Retroperitoneal mass and burned out testicular tumor Jaber, S Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/542/62719 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62721 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Primary renal lymphoma: A differential diagnosis of renal mass in a young male Gupta, A Bhatt, A Khaira, A Gupta, A Ran, DS Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/544/62721 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62722 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Renal artery embolization in a patient with severe nephrotic syndrome Solak, Y Atalay, H Polat, I Turkmen, K Koc, O Turk, S Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/546/62722 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62724 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Prevention of hepatitis C virus in hemodialysis patients: Five years experience from a single center Mohamed, WZ Hepatitis C virus (HCV) has been a significant problem in hemodialysis (HD) pa-tients. In general, it carries significant morbidity including liver cirrhosis, liver cell failure and hepa-toma. The study was conducted on 36 seronegative HD patients. All patients were managed with strict application of infection control guidelines as well as isolation of HCV-positive patients. None of the patients received any blood transfusions and were managed with iron and erythro-poietin. After five years of follow-up, we found that the incidence of HCV seroconversion was zero. Our study further suggests that following infection control guidelines, isolation of sero-positive patients and minimizing blood transfusions can help in prevention of HCV transmission among HD patients. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/548/62724 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62726 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Isolated non diabetic renal disease in diabetic patients: A moroccan report Haddiya, I Hamzaoui, H Hamany, ZA Radoui, A Rhou, H Benamar, L Bayahia, R Ouzeddoun, N The occurrence of non-diabetic renal disease (NDRD) in diabetic patients is well established, with different frequencies from all around the world. We report 13 cases of isolated NDRD in diabetic patients diagnosed in our unit and present our biopsy criteria in these patients. From January 2000 to December 2008, 13 diabetic patients with suspected NDRD underwent renal biopsy. The case records of these patients were retrospectively analysed. Nine were males and the mean age was 51 years (10-75). Two had a type I diabetes and 11 had a type II diabetes. The mean duration of diabetes was 36 and 30 months in type I and II respectively. Indications for renal biopsy included: absent retinopathy in 11 cases (84%), heavy proteinuria in four cases (30%), acute renal failure (ARF) in three cases (23%), rapidly progressive renal failure (RPRF) in one case (7%), hematuria in five cases (38%), extra-renal signs in four cases (30,7%), short duration of diabetes in all cases. In conclusion, NDRD was observed in our study in patients with a short duration of diabetes and atypical clinical or biological findings. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/555/62726 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62728 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Renal transplantation in Nepal: The first year's experience Chalise, PR Shah, DS Sharma, UK Gyawali, PR Shrestha, GK Joshi, BR Kafle, MP Sigdel, M Raut, KB Francis, DM A successful renal transplantation service was started in Nepal at the Tribhuvan Univer-sity Teaching Hospital in August 2008, and a continuing regular service is being provided currently to needy people. We report here our experience in thirty five end stage renal disease patients who re-ceived kidneys from close relatives during a one year period. The mean age of donors was 46.7 years. Seventeen (49%) donations were from parents, 13 (37%) from spouses, four (11%) between siblings and one (3%) between mother and daughter in law. Although the left kidney was given preference, right sided donor nephrectomy was needed in five (14%) cases. Six (17%) donors had minor post-operative problems. The mean age of recipients was 33.2 years, four (11%) of whom had pre-emptive renal transplantation. Recipients were immunosuppressed with dacluzimab, prednisolone, mycophena-late, and cyclosporine or tacrolimus. The average time taken for graft implantation was 137 minutes. The mean cold ischemia time and second warm ischemia time were 133 and 36 minutes respectively. Four (11%) patients developed urinary tract infection, three (9%) had significant hematuria, one (3%) developed a peri-transplant abscess, and one (3%) had ureteric ischemia and urine leak which required re-exploration in the early post-operative period. Four patients (11%) developed acute rejection of which three were cell- mediated rejection and one was antibody-mediated. There were two (6%) deaths, one due to transplant-related sepsis and the other due to subarachnoid hemorrhage following rupture of a posterior communicating artery aneurysm. No kidney has been lost otherwise. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/559/62728 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62730 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Pattern of lipid profile in patients on maintenance hemodialysis Maheshwari, N Ansari, MR Laghari, MS Darshana Lal, K Ahmed, K This hospital-based cross-sectional comparative observational study was performed to determine the pattern of lipid profile in patients on maintenance hemodialysis. The study was performed at the Department of Nephro-Urology, Liaquat University Hospital, Hyderabad, Pakistan from April 2008 to June 2008. Fifty patients with end-stage renal disease on maintenance hemo-dialysis (MHD) were studied. They comprised of 31 males and 19 females, the mean duration on HD was 7.58 ± 2.05 yrs, with frequency of two to three sessions per week and each session las-ting for four hours. Additionally, 25 healthy volunteers (16 male, 9 female) were also studied. Af-ter obtaining informed, written consent, general information of each patient was recorded on the proforma. After 12-hours fasting, blood samples were drawn from the arterio-venous fistula before starting dialysis. The total cholesterol, triglyceride (TG) or low density lipoprotein (LDL) levels more than 95<sup> th</sup> percentile for age and gender or high density lipoprotein (HDL) less then 35 mg/dL was defined as dyslipidemia. Descriptive and inferential statistical analysis were performed using SPSS version 16.0. The age among MHD and control groups was 47.88 ± 13.92 and 54.56 ± 11.16 years respectively. Serum TG and lipoprotein-a (LPa) were significantly increased (P= < 0.001 for each) while HDL-c was significantly lower (P= < 0.001) in MHD patients than in the control group. The serum cholesterol, LDL-c, VLDL-c and chylomicron levels were not signi-ficantly different in the two groups. Our study suggests that patients on MHD show abnor-malities of lipid metabolism like hypertriglyceridemia, elevated lipoprotein-a and low HDL-c, which could contribute to atherosclerosis and cardiovascular disease that may increase the mor-bidity and mortality in these patients. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/565/62730 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62731 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Outcome of Iranian children with mild post streptococcal glomerulonephritis Gheissari, A Adjodani, TS Hashemi, M Mokhtarian, A Sirous, M We studied the long-term outcome of children with mild acute post streptococcal glomerulonephritis (APSGN) APSGN hospitalized at St Al Zahra hospital, Isfahan, Iran from 1993-1998. The patients were subdivided into two groups according to the duration of follow-up. Group A consisted of 15 patients and group B consisted of 12 patients, followed up for 4 and 8 years, respectively. The male to female ratio was 1.45/1. The mean GFR in group A and B was 127.7 ± 26 mL/min/1.73 m<sup>2</sup>; and 128.57 ± 7 mL/min/1.73 m<sup>2</sup>, respectively. There was no statis-tically significant difference between GFRs in two groups. Comparing the mean systolic blood pressure in two groups did not demonstrate a significant difference; 95.33 ± 7.1 mmHg in group A and 102.5 ± 14.06 mmHg in group B. However the mean diastolic blood pressure in group B was significantly higher than group A; 65.4 ± 11.71 mmHg vs 61.33 ± 3.51 mmHg. Our study found that even mild APSGN may lead to some degree of renal impairment, and rising diastolic blood pressure maybe an early clinical sign of renal impairment in APSGN. Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/571/62731 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:62736 2010-05-01 all journal:Saudi_J_Kidney_Dis_Transpl
Hospital activities in organ donation program in Saudi Arabia Medknow Publications 2010-05-01 http://www.sjkdt.org/text.asp?2010/21/3/575/62736 en Copyright 2017 Saudi Journal of Kidney Diseases and Transplantation.
oai:medknow.com:90417 2010-05-01 all journal:Thyroid_Res_Pract
Glaucoma and thyroid disease: An interesting association Bhat, S Unnikrishnan, AG Jeyapathy, P Kumar, H Jayakumar, RV Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/35/90417 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:90418 2010-05-01 all journal:Thyroid_Res_Pract
Myxedema coma Khandelwal, D Jyotsna, VP Myxedema coma is a decompensated state of severe untreated hypothyroidism. It is an endocrine emergency. This article will focus on its definition, clinical features diagnosis and management. Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/37/90418 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:90420 2010-05-01 all journal:Thyroid_Res_Pract
Thyroid status in metabolic syndrome - A clinical study Jayakumar, RV Nisha, B Unnikrishnan, AG Nair, V Kumar, H Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/47/90420 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:90421 2010-05-01 all journal:Thyroid_Res_Pract
Thyroid stimulating hormone (TSH) -secreting pituitary adenoma presenting as hyperthyroidism Chaubey, SK Yarker, J Sinha, AK Graves ' disease was diagnosed in a patient in the community . Clinical and biochemical thyrotoxicosis persisted on anti thyroid drug (ATD) Carbimazole treatment and thyroid function tests showed inappropriately normal TSH with raised free T' and free T . After methodological interferences were ruled out, TSH-secreting pituitary adenoma or thyroid hormone resistance was suspected. After further biochemical and radiological investigations including free alpha glycoprotein subunit (SL-GSU) measurement and MB! scan of brain a diagnosis TSH secreting macro adenoma was suggested. She underwent debulking surgery and immunohistochemical staining confirmed a benign pituitary tumor with positive staining for TSH and Luteinizing hormone (LH). She received pre and post operative octreotide injections. Post operatively pituitary radiation treatment was given with which her disease had stabilized and she had marked clinical and investigational improvement. Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/52/90421 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:90422 2010-05-01 all journal:Thyroid_Res_Pract
Thyroid images Shrivastava, S Unnikrishnan, AG Sundaram, S Sundaram, PS Vijay, H Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/58/90422 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:90423 2010-05-01 all journal:Thyroid_Res_Pract
Thyroid Watch Unnikrishnan, AG Medknow Publications 2010-05-01 http://www.thetrp.net/text.asp?2010/7/2/60/90423 en Copyright 2017 Thyroid Research and Practice.
oai:medknow.com:65104 2010-05-01 all journal:Urol_Ann
Transperineal bulboprostatic anastomotic repair of pelvic fracture urethral distraction defect and role of ancillary maneuver: A retrospective study in 172 patients Singh, SK Pawar, DS Khandelwal, AK Jagmohan Objective: We present our experience with transperineal bulboprostatic anastomosis procedure and compare the results with age of patients, length of urethral stricture, effect of previous treatment and need for ancillary procedures. Materials and Methods: We retrospectively reviewed the outcome of 172 patients who underwent perineal urethroplasty procedure for traumatic stricture in our institute. Simple perineal anastomosis was done in 92 patients. Perineal anastomosis and corporal separation were done in 52 patients. Perineal anastomosis with inferior pubectomy was done in 25 patients. Perineal anastomosis with rerouting was done in three patients. Age, prior treatment, length of stricture, and ancillary techniques required during reconstruction were compiled. The clinical outcome was considered as failure when any postoperative instrumentation was needed. Results: Out of 172 cases that underwent transperineal urethroplasty procedure, 157 (91.28%) were successful. Simple perineal urethroplasty procedure showed a success rate of 93.4%, perineal anastomosis with separation of corporal bodies had a success rate of 90.4%, perineal anastomosis with inferior pubectomy had a success rate of 88% and perineal anastomosis with rerouting of urethra around the corpora had a success rate of 66.7%. Conclusion: The success rate of delayed progressive perineal urethroplasty procedure for post-traumatic stricture urethra is excellent and majority of the failures occurs in prepubescent boys and in those undergoing secondary repair. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/53/65104 en Copyright 2017 Urology Annals.
oai:medknow.com:65107 2010-05-01 all journal:Urol_Ann
Does nerve-sparing radical prostatectomy increase the risk of positive surgical margins and biochemical progression? Alkhateeb, SS Alibhai, SM Finelli, A Fleshner, NE Jewett, MA Zlotta, AR Trachtenberg, J Background: Since the introduction of nerve-sparing radical prostatectomy (NSRP), there have been concerns about the increased risks of positive surgical margins (PSM) and biochemical progression (BP). We examined the relationship of NSRP with PSM and BP using a large, mature dataset. Materials and Methods: Patients who underwent RP for clinically localized prostate cancer at our center between 1997 and 2008 were identified. Patients who received neoadjuvant therapy were excluded. We examined the relation of NSRP to the rate of PSM and BP in univariate and multivariate analyses adjusting for clinical and pathological variables including age, pretreatment prostate-specific antigen (PSA) levels and doubling time, and pathological stage and grade. Results: In total, 856 patients were included, 70.9% underwent NSRP and 29.1% had non-NSRP. PSM rates were 13.5% in the NSRP group compared to 17.7% in non-NSRP (P=0.11). In a multivariate analysis, non-NSRP was preformed in patients with a higher pathological stage (HR 1.95, 95% CI 1.25-3.04, P=0.003) and a higher baseline PSA level (HR 1.04, 95% CI 1.01-1.08, P=0.005). With a median follow-up of 41 months, BP-free survival was 88% for non-NSRP compared to 92% for the NSRP group (log rank P=0.018); this difference was not significant in a multivariate Cox regression analysis (HR 0.54, 95% CI 0.28-1.06, P=0.09). Conclusion: When used in properly selected patients, NSRP does not seem to increase the risk of PSM and disease progression. The most effective way of resolving this issue is through a randomized clinical trial; however, such a trial is not feasible. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/58/65107 en Copyright 2017 Urology Annals.
oai:medknow.com:65110 2010-05-01 all journal:Urol_Ann
The efficacy of tamsulosin in lower ureteral calculi Griwan, MS Singh, SK Paul, H Pawar, DS Verma, M Context: There has been a paradigm shift in the management of ureteral calculi in the last decade with the introduction of new less invasive methods, such as ureterorenoscopy and extracorporeal shock wave lithotripsy (ESWL). Aims: Recent studies have reported excellent results with medical expulsive therapy (MET) for distal ureteral calculi, both in terms of stone expulsion and control of ureteral colic pain. Settings and Design: We conducted a comparative study in between watchful waiting and MET with tamsulosin. Materials and Methods: We conducted a comparative study in between watchful waiting (Group I) and MET with tamsulosin (Group II) in 60 patients, with a follow up of 28 days. Statistical Analysis: Independent 't' test and chi-square test. Results: Group II showed a statistically significant advantage in terms of the stone expulsion rate. The mean number of episodes of pain, mean days to stone expulsion and mean amount of analgesic dosage used were statistically significantly lower in Group II (P value is 0.007, 0.01 and 0.007, respectively) as compared to Group I. Conclusions: It is concluded that MET should be considered for uncomplicated distal ureteral calculi before ureteroscopy or extracorporeal lithotripsy. Tamsulosin has been found to increase and hasten stone expulsion rates, decrease acute attacks by acting as a spasmolytic, reduces mean days to stone expulsion and decreases analgesic dose usage. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/63/65110 en Copyright 2017 Urology Annals.
oai:medknow.com:65114 2010-05-01 all journal:Urol_Ann
Urogenital fistulae: A prospective study of 50 cases at a tertiary care hospital Mathur, R Joshi, N Aggarwal, G Raikwar, R Shrivastava, V Mathur, P Raikwar, P Joshi, R Introduction: The misfortunate incident of formation of a urogenital fistula remains a major challenge for surgical urologists worldwide. Such fistulae may not be a life-threatening problem, but surely the women face demoralization, social boycott and even divorce and separation. The fistula may be vaginal, recto-vaginal or a combination of the two. The World Health Organization (WHO) has estimated that in the developing nations, nearly 5 million women annually suffer severe morbidity with obstetric fistulae being the foremost on the list. The objective of our study was to enunciate the patient demography, patient profile, incidence, type of surgery, as well as the long-term outcomes encountered in the management of all types of genital fistulae at a tertiary care centre. Materials and Methods: 50 consecutive patients, attending the outpatient department with urogenital fistulae, were studied during the period of 5 years from July 2005 to July 2009. All female patients with complaints of urinary incontinence and fecal incontinence and dribbling, patients having a history of obstructed labor, radiotherapy, instrumental delivery, foreign body or trauma and with a history of hysterectomy (abdominal/ vaginal) and lower segment caesarean section (LSCS) were included. A thorough urological examination included a dye study using methylene blue, Renal function tests, X-ray KUB and intravenous urography (IVU). Cystoscopy along with examination under anaesthesia (EUA) were done to assess the actual extent of injury. All patients were subjected to appropriate surgical interventions via the same combination of surgeons . Post operatively, prophylactic antibiotics were administered to all patients and patients were managed till discharge and followed thereafter via regular outpatient visits for a period of 3 years. Results: Age of patients ranged from 21 to 40 years. 64% patients hailed from rural areas, 76% were from the lower socio-economic strata, 40% illiterate and 69% were short Statured. Vesico vaginal fistulae (VVF) was seen in 64% cases of which 50% were due to obstructed labor, 19% cases post LSCS and 31% cases post total abdominal hysterectomy (TAH). 68% of urogenital fistulae were between 1 to 3 cms. We obtained a 75% cure rate in UVF, 87.5% cure rate in RVF while a 93.75% cure rate was observed in patients with VVF. 76% of all patients were cured while 8% had a recurrence, probably due to the large size of fistula. Conclusion : Genital fistula is preventable, yet it remains a significant cause of morbidity among females of reproductive age group. Despite facilities available, certain conditions like physical, social, economic, illiteracy, and a very casual attitude towards maternal health and children birth practices limit utilization of services for women. It is important that the modern health care providers should be aware of these aspects, so that they can recognize services that are appropriate and acceptable to the people. Thus, one must agree that in cases of urogenital fistulae, "prevention is better than cure". Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/67/65114 en Copyright 2017 Urology Annals.
oai:medknow.com:65115 2010-05-01 all journal:Urol_Ann
Biopsies of the normal-appearing urothelium in primary bladder cancer Librenjak, D Novakovic, ZS Situm, M Milostic, K Duvnjak, M Aim: The aim of the study was to determine the incidence of "positive" findings in biopsies of the normal-appearing urothelium near primary cancer and their influence on therapeutic decisions. Materials and Methods: Between January 2001 and October 2008, in 230 patients with primary bladder cancer during initial resection of tumor, we also performed random biopsy of surrounding normal-appearing urothelium. We analyzed retrospectively the number and type of positive biopsy findings and their impact on further treatment. Results: There were 40% of patients (92/230) whose normal-appearing urothelium biopsy revealed pathological findings such as tumor tissue, Tis, and dysplasia. In 24.4% of patients, the stage of the primary tumor was Ta (32/131), in 50% it was T1 stage (30/61), and in 79% T2 stage (30/38). When we assessed the grade of malignancy, we found 18% of biopsies with G1 tumors (16/88), 33% with G2 tumors (19/59), and 69% with G3 tumors (57/83). Tumor tissue that was found in the normal-appearing urothelium in biopsy specimens in 13% of patients was in stage Ta (17/131), in 16% it was T1 stage (10/61), and in 39% of patients, the tumor was in T2 stage (15/38). Pathological findings of random biopsies were crucial in changing therapeutical decisions in 4.6% (9/192) of patients. Conclusion: Biopsy of the normal-appearing urothelial tissue is easy to perform and may help in identifying patients with high risk of disease progression and recurrence. Based on our results and results from the literature we recommend this simple tool as part of the routine management during transurethral resection of primary bladder cancer. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/71/65115 en Copyright 2017 Urology Annals.
oai:medknow.com:65105 2010-05-01 all journal:Urol_Ann
Primary malignant melanoma of prostate Doublali, M Chouaib, A Khallouk, A Tazi, MF Farih, MH Elfatmi, H Bendahou, M Benlemlih, A Lamarti, O Primary genitourinary melanoma accounts for less than one per cent of all cases of melanoma. Most cases attributed to the prostate actually originate from the prostatic urethra. Due to its infrequency, primary malignant melanoma of the genitourinary tract presents a difficult diagnostic and management challenge. We report a case of primary malignant melanoma of the prostate found during transurethral resection of the prostate. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/76/65105 en Copyright 2017 Urology Annals.
oai:medknow.com:65106 2010-05-01 all journal:Urol_Ann
Inflammatory myofibroblastic tumor of the urinary bladder Yagnik, V Chadha, A Chaudhari, S Patel, K Inflammatory myofibroblastic tumor (IMT) of bladder is an uncommon benign tumor of bladder, which is of unknown neoplastic potential, characterized by spindle cell proliferation with characteristic fibroinflammatory and pseudosarcomatous appearance. Essential criteria for the diagnosis of IMT are: spindle myoepithelial cell proliferation and lymphocytic infiltrate. Complete surgical resection is the treatment of choice. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/78/65106 en Copyright 2017 Urology Annals.
oai:medknow.com:65108 2010-05-01 all journal:Urol_Ann
A knotted ureteral stent: A case report and review of the literature Picozzi, S Carmignani, L The indications for ureteral stent placement have expanded significantly with the progress of surgical procedures and techniques. Although such stents are now an integral part of contemporary urological practice, their use is not free of complications and consequences. There are very rare descriptions of knot formation in a ureteral stent and the consequences of this occurrence, with only 12 cases previously reported. Here, we report an additional case and review all the literature concerning this urological complication with emphasis on its predisposing factors and conservative and surgical management. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/80/65108 en Copyright 2017 Urology Annals.
oai:medknow.com:65109 2010-05-01 all journal:Urol_Ann
A case of infective endocarditis after transurethral prostatic resection Kawahara, T Taguchi, H Yamagishi, T Udagawa, K Ouchi, H Misaki, H We report a case of infective endocarditis (IE) after transurethral prostatic resection (TUR-P). A 63-year-old man who had underwent TUR-P for benign prostatic hyperplasia. After 40 days of surgery, he developed a fever. A diagnosis of IE was established by cardiography which detected large vegetation at mitral valve. After intravenous antibiotics therapy, he underwent mitral valve replacement surgery. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/83/65109 en Copyright 2017 Urology Annals.
oai:medknow.com:65111 2010-05-01 all journal:Urol_Ann
Penile abscess and necrotizing fasciitis secondary to neglected false penile fracture Al-Reshaid, RA Madbouly, K Al-Jasser, A Penile infection and abscess formation have been described in association with priapism, cavernosography, intracavernosal injection therapy, trauma and penile prosthesis. We report a case of penile abscess and necrotizing fasciitis of penile skin in a 37-year-old male, presented 3 weeks after neglected false penile fracture. Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/86/65111 en Copyright 2017 Urology Annals.
oai:medknow.com:65112 2010-05-01 all journal:Urol_Ann
Primary hydatid of psoas muscle Wani, I Wani, RA Wani, KA Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/89/65112 en Copyright 2017 Urology Annals.
oai:medknow.com:65113 2010-05-01 all journal:Urol_Ann
Prostatic abscess Baishya, RK Vyas, J Sabnis, RB Desai, MR Medknow Publications 2010-05-01 http://www.urologyannals.com/text.asp?2010/2/2/89/65113 en Copyright 2017 Urology Annals.