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   2015| May-August  | Volume 29 | Issue 2  
    Online since August 20, 2015

 
 
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ORIGINAL ARTICLES
Spectrum of unnatural female deaths in Manipur: A postmortem study
Thounaojam Meera, Pabitramala Nandeibam, L Fimate, Saka Koko Maring, Mitul Sangma
May-August 2015, 29(2):88-91
DOI:10.4103/0972-4958.163197  
Background: Unnatural deaths may be caused by unintentional or intentional injuries. Unintentional injuries are mainly accidental, while intentional injuries may be suicidal or homicidal. Female deaths due to unnatural causes, especially in the first few years of their married life, have been observed in Indian society for the last few decades. Materials and Methods: This retrospective study was conducted in a tertiary care teaching hospital during the period of 10 years from January 2004 to December 2013, to assess the pattern of unnatural female deaths in the state of Manipur. A thorough analysis of the history and postmortem findings was carried out, and the findings were statistically analyzed. Results: Out of the total of 4313 cases brought for autopsy, 320 cases (7.42%) were of unnatural female deaths. The year 2004 recorded the highest number of female deaths, and the number of cases declined in the following years. The maximum number of victims was observed in the age group of 21-40 years (36.3%); the majority of the victims were married (70.3%). Road traffic accident victims constituted 68.4% of the cases, while 13.1% were victims of firearm injuries and bomb blasts. Most of the cases were accidental deaths (72.5%), while 23.75% were homicidal in nature. Conclusion: The scenario of unnatural deaths among females in Manipur is different from those of the other parts of the country. Female deaths because of unnatural causes are mostly due to road traffic accidents.
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CASE REPORTS
Recurrent cerebral/cerebellar infarcts and hemorrhages in a patient with oral anticoagulants for prosthetic valve
Chirra Bhakthavatsala Reddy, Kishor V Hegde, Umamaheswara Reddy Venati, Suneetha Pentyala, Amit Agrawal
May-August 2015, 29(2):106-108
DOI:10.4103/0972-4958.163201  
Patients on long-term oral anticoagulant therapy (OAT) for prosthetic valves require close monitoring of their international normalized ratio (INR) levels to prevent deleterious effects. We present a case of a 35-year-old male with a known case of rheumatic heart disease who underwent mitral valve replacement and aortic valve replacement. In our patient, there was an undulation of coagulation parameters between low (INR-2.1) and high (INR-6.0) target levels, which eventually lead to ischemic strokes and fatal intracranial hemorrhage (ICH). Repeat INR was 6.0, which was much beyond the therapeutic range. Attempts to correct the coagulation abnormalities did not succeed and the patient succumbed to ICHs. All patients with valve replacement require chronic OAT. Judicious monitoring of the INR levels with dose adjustments can reduce morbidity and mortality from OAT-related complications like hemorrhage and infarction.
  - 1,307 400
A case of late sequela of infantile hip infection treated by Ilizarov hip reconstruction using monolateral fixator
Srikanth Mudiganty, Arun Kumar Sipani, Satyendra Kumar Das
May-August 2015, 29(2):109-112
DOI:10.4103/0972-4958.163203  
A 13-year-old female presented with chronic instability of her left hip due to late sequela of infantile hip infection. Instability of hip causes significant problems due to pain, limp, and shortening. Such a case is rare and difficult to treat. We performed a subtrochanteric valgus extension pelvic support osteotomy, along with distal varization and lengthening osteotomy utilizing a monolateral fixator. The patient was clinically and radiologically followed up for 24 months after her operation. The fixator was removed after 12 months once radiological union and adequate lengthening was achieved. Pre- and postoperative assessments were done using the Harris Hip Score, which showed a significant improvement. Long duration of usage of the fixator, knee stiffness, and pin tract infections are a few of the limitations observed.
  - 1,644 185
Lateral intermuscular approach to cervical rib - Is it safe?
Amit Chauhan, Madan Mohan Ray, Animesh Kumar, Kanchan Kumar Sabui
May-August 2015, 29(2):113-115
DOI:10.4103/0972-4958.163205  
Thoracic outlet syndrome is a well known identity, caused due to constriction of the space through which the brachial plexus and the subclavian artery pass from the neck into the axilla, with resultant abnormal pressure upon the plexus and the artery. This can be caused by a cervical rib or pressure due to scalenus anterior muscle. Out of two approaches described-anterior and lateral, when authors encountered two such cases of thoracic outlet syndrome due to cervical rib, lateral intermuscular approach was employed and was found to be safe, adequate and effective.
  - 2,191 90
Sympathetic ophthalmia in a case of penetrating ocular injury associated with brain injury: A case report
Thokchom Gojendra Singh, Keisham Sorojini Devi, Laithangbam Pradipkumar, Nongthombam Ratan Singh
May-August 2015, 29(2):116-118
DOI:10.4103/0972-4958.163207  
Sympathetic ophthalmia is a rare bilateral granulomatous inflammation that follows accidental or surgical insult to the uvea of one eye. The diagnosis may be confounded by the associated traumatic brain injury. Here, we report a case of sympathetic opthalmia in a patient who sustained perforating injury of the right eye and traumatic brain injury in the left frontal area following a road traffic accident. Timely diagnosis and surgical intervention was the key to a successful outcome.
  - 1,398 107
EDITORIAL
What's positive about triple negative breast cancers?
Rajesh Singh Laishram, Nepram Sanjib Singh
May-August 2015, 29(2):61-63
DOI:10.4103/0972-4958.163184  
  - 1,744 223
ORIGINAL ARTICLES
A comparative study of lignocaine and nitrous oxide for rocuronium injection pain
Segaran Sivakumar, Nongthombam Ratan Singh, Lairenlakpam Deban Singh, Gojendra Rajkumar, Rupendra Singh Thokchom, Longjam Eshori Devi
May-August 2015, 29(2):64-68
DOI:10.4103/0972-4958.163186  
Background: Pain is a common side effect of rocuronium bromide and this study has been undertaken to compare the effect of nitrous oxide and lignocaine in reducing the rocuronium injection pain in adult patients. Materials and Methods: After ethical committee approval, 80 adult patients of age 18-65 years and ASA I and II who underwent elective surgery from October 2011 and September 2013 in the Regional Institute of Medical Sciences, Imphal were randomly assigned into one of the two groups: Group O (n = 40) received 100% oxygen for 2 min as preoxygenation; Group N (n = 40) received 50% nitrous oxide and 50% oxygen mixture for 2 min as preoxygenation. After 2 min., 2 ml of 2% lignocaine was given with the forearm occluded and then released after 1 min. followed by the injection of subparalyzing dose of rocuronium (0.06 mg/kg) and the patients were enquired about the degree of pain. Anaesthesia was then induced with injection thiopentone sodium (2.5%) 5 mg/kg and then a paralyzing dose of rocuronium (0.6 mg/kg) was given to facilitate intubation. The airway was secured and any withdrawal movements were noted. Results: It was observed that the combination of nitrous oxide and lignocaine (Group N) reduced rocuronium injection pain more than lignocaine alone (Group O) (5% vs. 25%; P < 0.05). Moreover, withdrawal movements were also less in group N compared to group O (5% vs. 22.5%; P < 0.05). Conclusion: It may be concluded that two different analgesic modalities nitrous and lignocaine effectively prevent pain and withdrawal movements associated with rocuronium injection.
  - 1,971 211
Chronoscopic reading in whole body reaction times can be a tool in detecting cognitive dysfunction in type 2 diabetics: A case control study
Vitthal Khode, Jayaraj Sindhur, Santosh Ramdurg, Komal Ruikar, Shobha Nallulwar
May-August 2015, 29(2):69-73
DOI:10.4103/0972-4958.163188  
Background: Type 2 diabetes mellitus investigated as a risk factor for cognitive decline. It is known that the difference between simple and choice reaction time implies time required for cognition. Though delayed reaction times indicate involvement of cognition, they cannot quantify how much time is required for cognition. In whole body choice reaction time (WBCRT), reaction time is split into two chronoscopic readings: Chronoscopic reading-1 (C1) and chronoscopic reading-2 (C2). C1 measures time required for central processing that requires cognition and C2 measures the total reaction time. C2 - C1 measures time required for peripheral motor response. We hypothesized that WBCRT C1 will be delayed in diabetes and will have predictive value in detecting cognitive dysfunction. Settings and Design: Hospital-based case control study. Materials and Methods: Study was conducted on 120 subjects using visual and whole body reaction times having criteria of age (40-60 years) and diabetes, compared with equal number of age- and sex-matched controls. Statistical analysis was done by independent t-test and duration of diabetes was correlated with cognition times (WBCRT C1) using Pearson's correlation. Predictive value of WBCRT C1 was calculated by using the receiver operating characteristic (ROC) curve. Results: WBCRT C1 (564 ± 107 ms) among diabetes patients was more delayed than WBCRT C1 (513 ± 86 ms) among controls indicating a cognitive dysfunction in patients with diabetes. There was no significant correlation between hemoglobin A1c (HbA1c) levels in patients with diabetes and diabetic duration with WBCRT C1. The best cutoff value for WBCRT C1, when predicting cognitive dysfunction in patients with diabetes, was 517 ms (sensitivity 50%, specificity 40%). Conclusions: WBCRT C1 can be used as a tool to detect cognitive dysfunction in patients with type 2 diabetes mellitus.
  - 1,649 148
Intestinal protozoal and helminthic infections in immunocompromised patients attending RIMS Hospital, Imphal
Yompe Kamki, Rebachandra H Singh, Nabakumar Th Singh, Phangreichon Lungram, Brajachand Ng Singh
May-August 2015, 29(2):74-78
DOI:10.4103/0972-4958.163192  
Background: Intestinal parasites continue to be a significant health problem among immunocompromised patients in both developed and developing countries. With the increasing numbers of immunocompromised individuals throughout the world, closer examination and detection of intestinal protozoal and helminthic infections in these individuals is highly needed. Objectives: To find out the prevalence of various intestinal protozoal and helminthic infections in immunocompromised individuals and to compare the pattern of their infection depending on sociodemographic characteristics. Materials and Methods: One hundred seventy stool samples of immunocompromised patients were examined by direct wet mount, formol-ether concentration, Modified Kinyoun's acid-fast stain, and Kato-Katz technique. Data analysis was performed by using SPSS version 17 software. Results: Thirty-two intestinal parasites were detected, of which Ascaris lumbricoides was the most frequently detected parasite (5.90%) and the least frequent was Trichuris trichiura (1.18%). Twenty-one parasites were detected in the immunocompromised patients from rural areas. Conclusion: Immunocompromised patients, especially human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients from rural areas, were found to have more intestinal protozoal and helminthic infections compared to urban patients due to low socioeconomic status and poor hygiene conditions.
  - 2,962 339
Study on role of obstetrical Doppler in pregnancies with hypertensive disorders of pregnancy
Chhakchhuak Lalthantluanga, Ningthoukhongjam Romita Devi, Ningombam Jitendra Singh, Ningthoukhongjam D Shugeta, Victor Khuman, Shangchungla Keishing
May-August 2015, 29(2):79-82
DOI:10.4103/0972-4958.163195  
Objectives: To study Doppler velocimetry of umbilical artery (UA) and middle cerebral artery (MCA) in hypertensive disorders of pregnancy (HDP) and analysis of association of abnormal Doppler waveform with perinatal outcome. Materials and Methods: Doppler velocimetry of fetal UA and MCA were studied in 100 pregnant women with hypertensive disorders of pregnancy. The results were analysed to find out perinatal outcome in those with abnormal Doppler studies. Results: The result of this study showed that fetuses with UA Systolic/Diastolic (SD) ratio >3 were associated with poor perinatal outcome in 89.65% with sensitivity and specificity of 80.00% and 82.86% respectively. Fetuses with cerebro-placental index (CPI) ≤1 have poor perinatal outcome in 95.74% with higher specificity (93.94%) and positive predictive value (95.74%). Conclusion: Fetuses with abnormal Doppler velocimetry had a significantly higher incidence of low birth weight babies, low apgar score, meconium stained liquor, intrauterine growth restriction (IUGR), admission to neonatal intensive care unit (NICU), intrauterine death (IUD)/still birth and shorter period of gestation at delivery.
  - 1,802 224
Factor analysis of metabolic syndrome components in North Indian adult population of Kashmir
Riyaz Ahmad Bhat
May-August 2015, 29(2):83-87
DOI:10.4103/0972-4958.163196  
Aim: The Kashmiri population is ethnically distinct, culturally unique, and has distinct lifestyle and dietary habits. There is high prevalence of obesity in the Kashmiri population. With this background, we designed this study to evaluate important metabolic parameters contributing to the prevalence of metabolic syndrome (MS). Materials and Methods: In this prospective study, a total of 500 subjects were recruited over a period of 1 year. Informed consent was taken from all the subjects before selection. Proper permission was sought from the hospital's Ethical Committee. The subjects were selected from among the attendants who accompanied patients at the inpatient and outpatient departments of Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir. A stratified random sampling procedure was adopted for the study. All subjects underwent anthropometric assessments, blood pressure measurements, and biochemical analysis. Subjects were screened for the components of MS according to criteria given by the Adult Treatment Panel (ATP) III. Statistical Analysis: Analysis was made and inferences were drawn using the student's test, chi-square test, and Mann-Whitney U test. Data were analyzed by SPSS version 11.5. Results: The mean age of both the men and women was 37 years. The overall prevalence of MS was 8.6% (n = 43), with males constituting 7.4% and females constituting 9.9%. The prevalence of hypertension was 24.9% for males and 12.3% for females. The prevalence of hyperglycemia was 9.3% for males and 7.8% for females; 9.7% males and 25.9% females had low high-density lipoprotein (HDL) cholesterol; and 17.1% males and 13.2% females had elevated triglyceride levels. The prevalence of obesity in males was 1.9% and in females it was 8.6%. Hypertension was the commonest factor affecting the estimates of MS in men, whereas central obesity and low HDL cholesterol were the common contributing factors in women. Conclusion: Prevalence of component factors such as diabetes, hypertension, and dyslipidemia is high, which needs attention.
  - 1,443 141
Priming effects of propofol during induction of anesthesia
Rilin Karlo, Nongthonbam Ratan Singh, Khullem Maniram Singh, Takhelmayum Hemjit Singh, Ningthoujam Anita Devi, Maharambam Binarani Devi
May-August 2015, 29(2):92-95
DOI:10.4103/0972-4958.163198  
Background: The "priming principle" is a method to reduce the total dose requirements of a drug. This study was carried out to evaluate whether the priming technique reduces the total induction dose requirements of propofol. Materials and Methods: Fifty (50) patients with American Society of Anesthesiologists (ASA) I and ASA II grades, of both sexes, aged 18-65 years, and undergoing elective surgical procedures under general anesthesia were randomly allocated into two equal groups with 25 patients each. Group I (control) received 3 mL of normal saline (placebo) intravenously (IV) as priming 2 min prior to the calculated dose of injection (inj.) propofol. Group II (study) received 0.5 mg/kg of inj. propofol as the priming dose 2 min prior to receiving a titrated dose of propofol. The titrated dose of propofol was given till loss of the eyelash reflex or loss of verbal command. Baseline hemodynamic variables were recorded at 2 min after priming and immediately after the titrated dose of propofol. Results: The hemodynamic changes in the heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) at different time intervals were similar in both groups (P > 0.05). The control group consumed a higher dose of inj. propofol (119.84 ± 12.28 mg) as compared with the study group (107.58 ± 14.73 mg), i.e., there was 10.23% reduction of the total dose in the study group. Most of the patients (80%) in both the groups were without any associated side effects and the incidence was similar (P = 1.00). Conclusion: The priming technique effectively reduced the total induction dose requirements of propofol and minimized periintubation hemodynamic alterations with minimal adverse effects.
  - 2,123 240
Effect of intravenous dexmedetomidine on bupivacaine spinal analgesia
Stevie JN Sangma, Lourembam Kameshwar Singh, Nongthombam Ratan Singh, Langpoklakpam Chaoba Singh, Alem W Pongener, Dikila Bhutia
May-August 2015, 29(2):96-100
DOI:10.4103/0972-4958.163199  
Background: Dexmedetomidine, a new α2 agonist, has been proven to prolong spinal anesthesia when administered through intrathecal route. This study was conducted to evaluate the effects of intravenous (IV) dexmedetomidine on spinal bupivacaine anesthesia. Materials and Methods: A prospective, randomized, double-blind, and placebo-controlled study was conducted on 80 female patients with the American Society of Anesthesiologists (ASA) grades I and II, aged 18-65 years undergoing abdominal hysterectomy under spinal anesthesia. After spinal anesthesia, patients in group D received a loading dose of 1 μg/kg IV dexmedetomidine over 10 min and followed by a dose of 0.2 μg/kg/h till the end of operative procedure, while patients in group C received the same calculated volume of normal saline. The time to reach peak sensory block level, time taken for two segment regression and maximum motor block, Ramsay sedation score, modified Bromage score, and visual analogue scale were recorded and were statistically analyzed using Statistical Package for Social Sciences (SPSS Inc. Chicago, IL, USA) Windows-based version 16.0. Results: Sensory regression to S1 was prolonged in the dexmedetomidine group compared to the control group (294 ± 18.2 min vs. 288 ± 24.3 min, P < 0.05). The time taken for motor block regression to modified Bromage score 6 in groups D and C were 263.73± 38.4 min and 251.7529.6 min, respectively (P = 0.008). Conclusion: IV infusion of dexmedetomidine significantly prolonged the duration of sensory and motor block of hyperbaric spinal bupivacaine with significant side effects.
  - 1,892 282
Management of extrahepatic portal vein obstruction in children: Experience in a tertiary care center in Northeast India
Hemonta Kr Dutta, Mauchumi Baruah
May-August 2015, 29(2):101-105
DOI:10.4103/0972-4958.163200  
Background: Variceal bleeding in children is often a life-threatening condition for which timely and appropriate management is mandatory. It is a great challenge, especially in resource-constrained centers, to offer the best possible treatment by optimizing the available resources. Aim: To share the experience of management of extrahepatic portal vein obstruction (EHPVO) in children in a resource-constrained setup during the last one decade. Mode of presentation of the children, treatment options available, and outcomes were analyzed. Settings and Design: The study is a hospital-based prospective study conducted between August 2000 and December 2013. Materials and Methods: Seventy six children with EHPVO who bled at least once were included in the study. Common presentations were hematemesis and/or melena, splenomegaly, pain in abdomen, and ascites. In group A, 30 patients residing within the city area were managed conservatively with variceal banding [endoscopic variceal ligation (EVL)] alone. Group B consisted of 48 patients who hailed from outside the city area and had fundal varices and were offered shunt surgery. Fisher's exact test and Chi-square tests were employed for statistical analysis. Results: The average number of EVL sessions for group A was 3.2. Variceal obliteration was achieved in 18 children and rebleeding was noted in 6. One patients from group A died and one had mild dysphagia. Fifty two shunt procedures were performed in group B patients. Mean operating time, blood loss, and hospital stay were 4.23 h, 690 mL, and 12 days, respectively. There was no operative mortality. Other complications were intestinal obstruction, ascites, rebleeding, and blocked shunt. Spleen size regressed appreciably following surgery and ascites resolved spontaneously. Two patients needed a second shunt surgery for the treatment of blocked shunt. The rates of rebleeding differed significantly between the two groups. Patients were blinded and independently evaluated in the pediatric gastroenterology clinic. Growth and development of the patients in both the groups were within normal limits. Mean follow-ups were 52.5 months for group A and 48.2 months for group B. Conclusion: Children presenting with variceal bleeding can be effectively managed with either EVL or shunt surgery depending on the available resources. However, children from far-off places are better managed with onetime shunt surgery.
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