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   2014| September-December  | Volume 28 | Issue 3  
    Online since January 5, 2015

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Evoked potentials: Visual evoked potentials (VEPs): Clinical uses, origin, and confounding parameters
Jayshree Phurailatpam
September-December 2014, 28(3):140-144
Background: A study of visual evoked potentials (VEPs) is an important diagnostic tool used equally by neurophysiologist, ophthalmologist, neurologists, and neurosurgeons. Many neurological disorders present with visual abnormalities and detection of subclinical lesions affecting the visual system which are poorly visualized by MRI or in unreliable clinical examination or ruling out of psychogenic origin, depends mainly on the VEPs. Its prognostic utility are also under investigations. Objectives: To review the clinical utility, brief history, origin, and generator sites of VEPs. Data Sources: Published, peer-reviewed literature on VEPs available both in print or online. Conclusion: VEPs have emerged as an important diagnostic tool in demyelinating diseases of the CNS in the current era. An awareness of the conditions where it can be utilized along with a sound knowledge of origin and generator sites will help the clinician or the neurologist to identify the possible sites of abnormalities and thereby effectively influence the management and treatment outcome in patients with neurological disorders.
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Neonatal alloimmune thrombocytopenia
Rajesh Singh Laishram
September-December 2014, 28(3):137-139
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Profile of cardiac arrhythmia in acute myocardial infarction patients within 48 hours of admission: A hospital based study at RIMS Imphal
Linda Marangmei, Salam Kenny Singh, Konsam Biona Devi, Sambhaji Shivaji Raut, Dhanaraj Singh Chongtham, Ksh Birendra Singh
September-December 2014, 28(3):175-179
Background: Acute myocardial infarction (AMI) is a major cause of death worldwide with arrhythmia being the most common determinant in the post-infarction period. Objective: To study prevalence of cardiac arrhythmia in AMI patients within 48 hours of admission and to correlate between type of arrhythmia with site of myocardial infarction. Materials and Methods: Descriptive analytic study carried out in Medicine Department, RIMS, Imphal over a period of 2 years. Results and Observations: Hundred AMI patients were studied, of which 76% developed arrhythmia. Most common conduction abnormality was ventricular premature complex (VPC; 23%) followed by sinus tachycardia (21%). Heart block was present in 15%, bundle branch block in 11%, and ventricular tachycardia in 7% of the patients. In inferior wall myocardial infarction (IWMI), sinus bradycardia was more common, so also was heart block more common showing 28.95% against 6.55% in anterior wall myocardial infarction (AWMI). On the other hand, AWMI patients had sinus tachycardia more frequently than IWMI (31% versus 7.8%) and ventricular tachycardia likewise was also more common in them. It was associated with high mortality, six of seven patients who developed ventricular tachycardia died within 48 hours of hospitalization (P-value <0.01). Conclusion: Arrhythmia is common in post-infarction period seen in 76% of AMI patients. It is also a major cause of mortality in them with higher mortality seen in those with later hospital presentation.
  4,226 465 1
The milk anesthesia management of neonatal accessory digits: The 6 year Coventry and Warwickshire experience
Zeeshan Ahmad, Alan J Park
September-December 2014, 28(3):149-153
The authors present their experience of the surgical management of accessory digits in neonates during a 6 year period (2006-2012). During this period a total of 135 cases were operated on using local anesthetic only when neonates were less than 8-10 weeks old. Through close relations with the local pediatricians, this pathway enables prompt and appropriate management, which is safe and obviates the need for general anesthesia. This paper highlights that managing this condition surgically can be performed in an appropriate pediatric setting safely solely under topical and local anesthesia with excellent cosmetic results as pediatric day-case procedures.
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Evaluation of hearing status in pre and post-operative endoscopic type 1 tympanoplasty and its influencing factors
Moirangthem Niteshore Singh, Priyosakhi Devi Hamam, Nicola C Lyngdoh, Oinam S Priyokumar
September-December 2014, 28(3):166-170
Context: The recent change of using endoscope instead of microscope in performing transcanal type 1 tympanoplasty has encouraged us to compare the results of the surgery. Aims: The aim of this study is to evaluate hearing status in the pre- and post-operative state after endoscopic type 1 tympanoplasty and to correlate the improvement with influencing factors like the age of the patient, site and size of perforation, wet/dry ear, status middle ear mucosa, status of mastoid air cells, and function of Eustachian tube. Settings and Design: An interventional study was carried out in the Department of Otorhinolaryngology, RIMS. Materials and Methods: Thirty cases of diagnosed pars tensa central perforations, aged above 18 years, with a small to subtotal perforation associated with a demonstrable conductive deafness not more than 40 dB was included in the study. Statistical analysis used: Chi-square test. Results: The graft uptake rate in our study is 90% and hearing improvement in terms of airbone (AB) gap within 0-15 dB was achieved in 83.3%. Age, sex, size of perforation, site of perforation, wet/dry ear, and status of the mastoid air cell system were not found to have a significant relation with the successful outcome of endoscopic type 1 tympanoplasty. Presence of mucosal hypertrophy and the nonfunctioning of the Eustachian tube were a significant determinant for the failure of type 1 tympanoplasty. Conclusions: The outcome of endoscopic type 1 tympanoplasty is similar to the outcome of the microscope assisted type 1 tympanoplasty with better cosmesis.
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Autopsy review of sudden deaths in a tertiary hospital of northeastern India
Jesu R Pandian, Rajesh Singh Laishram, Laishram Deepak Kumar, Pinky Phuritsabam, Kaushik Debnath
September-December 2014, 28(3):145-148
Background: World Health Organization (WHO) defines sudden death as "deaths within 24 hours from the onset of the symptoms". It is also defined as death which is sudden, unexpected, clinically unexplained, or otherwise obscure even though there needs to be no unnatural element in their causation. This study was taken up to analyze histopathologically the possible cause of sudden deaths. Aims: To study the different histomorphological profile of sudden deaths in the autopsy/postmortem specimens received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS), Imphal. Materials and Methods: A review of all autopsies/postmortem of sudden deaths performed between 1 st January 2000 and 31 st December 2013 at Department of Pathology, RIMS, were done. Results: A total of 120 cases were autopsied for sudden deaths during the study period. The age ranged from 17 to 70 years with male predominance. Maximum deaths occurred in the age group between 31 and 35 years and males were affected more than females. The cause of deaths in 67 cases (55.83%) were attributed to cardiac causes, the most common cause being coronary artery disease and the remaining 53 cases (44.17%) were due to noncardiac causes. Conclusion: It is found that sudden deaths are most commonly found in young adults (31-35 years) and most of them are attributed to a cardiac cause. This study highlights the serious health concern in our society and a necessity to create awareness among the population at risk so that sudden deaths can be averted and life expectancy can be improved.
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Internal fixation of adult diaphyseal both bone forearm fractures using locking compression plate
Raj Kumar Meena, A Mahendra Singh, Roel Langshong, Sanjib Waikhom, Arun Kumar Singh, SN Chishti
September-December 2014, 28(3):171-174
Introduction: Fractures involving the bones of forearm may result in severe loss of function unless adequately treated. The aim of this prospective study was to evaluate the outcomes of locking compression plate (LCP) for the treatment of adult diaphyseal both bone forearm fractures. Materials and Methods: This study conducted in the Department of Orthopedics, Regional Institute of Medical Sciences (RIMS), Imphal from September 2010 to June 2013 included 36 patients with 72 fractures. Operative time, callus formation, functional outcome, and complications were recorded. Results: Mean operative time forthe LCP fixation was 70.25 min. The time for callus formation and mean time to bone union was significant. However, overall functional outcome was good. One patient developed superficial infection. Conclusion: In this prospective study involving fixation of diaphyseal both bone forearm fractures using LCP, the outcomes were good in terms of final functional outcomes, mean operating time, callus formation, and mean time to bone union.
  3,055 297 -
Prevalence of tuberculosis: A study in forensic autopsies
Mitul M Sangma, Thounaojam Meera Devi, Babina Sarangthem, Supriya Keisham, Phurailatpam Madhubala Devi
September-December 2014, 28(3):162-165
Background: Tuberculosis is a major cause of morbidity and mortality in developing countries. There are many cases of tuberculosis which remain undiagnosed and are diagnosed only at autopsy. Materials and Methods: This retrospective study was conducted on cases brought for forensic autopsy in a tertiary care medical centre from the year 2003 to 2012. The history, post-mortem findings, and histopathological findings of the cases were meticulously studied and analyzed. Results: Out of the total 4,415 autopsies, 74 cases had findings of tuberculosis. Males outnumbered females, and the highest number of tuberculosis cases was observed in males in the age-groups of 40 to 50 years (32.43%) followed 50 years and above (25.67%). Tuberculosis as to be the primary cause of death was observed in 28.38% of the cases, of which 22.97% were pulmonary while 5.41% were cases of disseminated/extrapulmonary tuberculosis. In the lung, active tuberculosis was observed in 34.28%, i.e., granulomatous inflammation with caseation necrosis (27.14%) or granulomatous inflammation with caseation necrosis and tubercular pneumonia (7.14%). Suspicious cases of inactive tuberculosis, i.e., fibrosis and calcification was observed in 65.71% of the cases. Conclusion: The chance finding of tuberculosis in forensic autopsy cases in this study highlights that there are undiagnosed cases of active tuberculosis who are not seeking proper medical attention and these cases may pose as a source of transmission to the general public, health-care providers and mortuary staff.
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Comparative evaluation of fentanyl and midazolam with propofol induction on laryngeal mask airway insertion conditions: A study
Sivaramakrishnan Dhamotharan, Nongthombam Ratan Singh, Sanasam Sarat Singh, Maisnam Brajagopal Singh
September-December 2014, 28(3):185-189
Background: Propofol alone for laryngeal mask airway (LMA) insertion is unsatisfactory. To overcome the problems associated with it, a number of co-induction drugs have been introduced. The present study was conducted to compare the insertion conditions using midazolam and fentanyl co administered with propofol during intravenous induction of anesthesia. Materials and Methods: This prospective, double-blinded, randomized study was conducted at a tertiary healthcare teaching hospital at Imphal. Ninety American Society of Anesthesiologists (ASA) I and II patients aged 18-60 years were randomly divided into three equal groups and received intravenous (IV) fentanyl 2 μg/kg (Group I), IV midazolam 0.05 mg/kg (Group II), and control (saline) group (Group III) followed by induction with propofol 2.5 mg/kg. LMA was inserted after 90 s. The insertion conditions and hemodynamic changes were noted. Data were collected and analyzed with Statistical Package for Social Sciences (SPSS) v.20. Results: There were no statistical differences in the demographic profile (P > 0.05). Adequate jaw relaxation was present in 21 (70%) patients in Group II and 14 (46.6%) patients in Group I (P > 0.05). Excellent insertion conditions were present in 80% of the patients in both fentanyl and midazolam groups, respectively. Conclusion: Midazolam and fentanyl provides adequate conditions for LMA insertion, although midazolam provides better jaw relaxation.
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Association body mass index and spirometric lung function in chronic obstructive pulmonary disease (COPD) patients attending RIMS Hospital, Manipur
Awungshi Jannie Shimray, Wangkheimayum Kanan, Wangkheimayum Asoka Singh, Ashem Nandarani Devi, Kanmi Ningshen, Ranjita Laishram
September-December 2014, 28(3):157-161
Background: Weight loss is highly prevalent in chronic obstructive pulmonary disease (COPD) patients and studies have consistently shown significantly greater mortality rates in underweight and normal-weight COPD patients with than in overweight and obese COPD patients. Objective: To study association between mass index (BMI) and severity of COPD as assessed by spirometric lung function tests. Materials and Methods: 50 patients with COPD (25 women and 25 men), ages ranging from 40 to 65 years attending OPD and ward of Department of Respiratory Medicine, RIMS were included in the study. This preliminary study was conducted in the Department of Physiology, RIMS. Lung function was measured with Computerized Spirometer Helios 701 (Recorders and Medicare System, Chandigarh). Body mass index was calculated and related to recently developed reference values. Statistical analysis was performed using SPSS version 16.0 Independent t-tests and Pearson's correlation coefficient was used. Results: Mean body weight values were 59.66 ΁ 13.10 kg and 42.54 ΁ 2 kg, and BMI values were 21.75 ΁ 3.33 and 19.10 ΁ 1.0788 in males and females, respectively.33.3% of the patients had malnutrition and their flow parameters were found to be lower as compared to well-nourished subjects. FVC, FEV 1 and FEV 1 % predicted were all positively correlated to low BMI. Conclusions: Low BMI is prevalent in COPD patients. Inclusion of BMI in assessment of COPD severity in addition to measurement of FEV 1 is supported.
  2,289 233 1
Electro-encephalographic changes of short-term transcendental meditation
Laishram Leimahanbi Chanu, Ksh Gomti Devi
September-December 2014, 28(3):154-156
Objective: We evaluated the effects of short transcendental meditation lasting ten minutes in untrained subjects. The changes in electroencephalogram (EEG), pulse rate (PR) and blood pressure (BP) were evaluated. Materials and Methods : EEG was taken after 10 minutes rest; during meditation with "AUM" chanting; and after 10 minutes of meditation, in 30 medical students. BP and PR were recorded after 10 minutes rest and after meditation. Results: The mean resting EEG was 38 Hz (range 32-48 Hz; SD: 4.3). During meditation, alpha waves were seen in 8 (26%) subjects, the rest had beta waves. The mean EEG during and after meditation were 24 Hz (range 8-35 Hz; SD 10.8) and 25 Hz (range 8-36 Hz; SD 10), respectively. The mean PR before and after meditation were 82/min (range 70-96; SD 6.6) and 74/min (range 68-88; SD 5.2), respectively, and the change was significant (P = 0.03). There was a significant drop in both systolic BP (P = 0.001) and diastolic BP (P = 0.002) following meditation. Mean systolic BP before and after meditation were 118 mm Hg (range 106-130; SD 7.4) and 112 mmHg (range 100-126; SD 7.3), respectively, and the mean diastolic BP before and after meditation were 74 mm Hg (range 60-82; SD 5.2) and 68 mmHg (range 60 - 82; SD 5.2), respectively . Conclusion: A significant reduction in PR and BP can be achieved with short transcendental meditation. Alpha waves consistent with meditative state could be achieved in 26% of the subjects.
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Clinicopathological correlation in primary nephrotic syndrome
Ghanachandra K Singh, Sharatkumar N Singh, Dwarika Niroula, lboton Y Singh, Kaushik Debnath, Romesh L Sharma
September-December 2014, 28(3):180-184
Objective: To study the clinicopathological correlation in patients suffering from primary/idiopathic nephrotic syndrome. Materials and Methods: A total of 34 cases of idiopathic nephrotic syndrome were included in the present study. All patients had undergone renals biopsy for histological diagnosis. Results: The patients were subjected to renal biopsy and on the basis of light microscopic findings they were divided into two broad groups. Group A included 25 patients whose renal biopsy showed histological picture of minimal change disease. Group B included nine patients whose renal biopsy showed features other than those seen in minimal change disease. Most patients presented in the 2 nd and 3 rd decade (range was found from 14 to 80 years). Increased serum creatinine (<1.6 mg%) wasfound in two (8%) in group A and four (44%) in group B. Thus, the number of patients having high serum creatinine was significantly higher in group B. Nine patients (33%) in group A and three (33%) in group B had low glomerular filtration rate (GFR;i.e.,<90m1/min). Low serum protein (i.e.,<6 g%) was seen in 18(72%) in group A and five (55.5%) in group B and low serum albumin (i.e.,< 3.2 g%) was found in 21 (84%) in group A and six (66%) in group B. The mean serum cholesterol was 426.76 ΁ 77.11 mg% and mean triglyceride was 269.80 ΁ 148.11 mg% in group A, while in group B the mean cholesterol was 357.33 ΁ 116.19 mg% and mean serum triglyceride was 231.55 ΁ 73.85 mg%. Conclusion: Most patients of nephrotic syndrome presented in the 2 nd and 3 rd decades. All patients in both the groups had high serum triglycerides. Seventy-three percent of nephrotic syndrome cases had histopathological diagnosis of minimal change disease, 8.8% had membranoproliferative glomerulonephritis. Membranous glomerulonephritis, focal segmented glomerulosclerosis, and diffuse proliferative glomerulonephritis accounted for 6% cases each.
  2,258 178 -
Immediate autotransplantation of immature third molar with regeneration of recipient site using autologous platelet-rich fibrin
Takhellambam Premlata Devi, Wahengbam Tulsidas Singh, Ngairangbam Sanjeeta, Nongthombam Rajesh Singh
September-December 2014, 28(3):196-199
Autotransplantation enabled the usage of natural tooth rather than prosthesis to replace a missing tooth. Autotransplantation of the mature tooth, incompletely formed root or an immature tooth bud can be done with variable success rate. Autotransplantation carried out within short duration in younger patient with immature tooth bud gives higher success rate. Platelet-rich fibrin (PRF) is a wonderful tissue engineering product and has gained much popularity due its promising results in wound healing. This case report illustrates the efficacy of PRF in the treatment of the autotransplantation of tooth bud.
  2,157 199 1
Congenital cystic malformation masquerading as a lung abscess in an adult: A report of a rare case
Sandhya V Poflee, Asha Zutshi, Pradnya S Bhadarge, Alok C Shrivastava
September-December 2014, 28(3):190-192
A 19 year-old male was getting admitted repeatedly, for complaints of cough with expectoration and fever since last 10 years. On the basis of clinical examination and radiological investigations lung abscess of right lower lobe was suspected. Non-functioning right lung lobe of the patient was removed surgically and sent for histopathological examination. Histopathology showed it to be cystic adenomatoid malformation of lung type I, with no evidence of any other specific disease. Congenital cystic adenomatoid malformation (CCAM) is an anomaly of lung development characterized by proliferation of abnormal bronchiolar structures of varying sizes and distribution. It is usually diagnosed in infancy. It is rare in adults. Awareness about this entity help clinicians while making differential diagnosis of recurrent pulmonary infection limited to one lobe. Morphological identification of CCAM is important as Type I CCAM; the most frequent subtype is associated with an increased incidence of malignant transformation.
  2,155 156 2
Surrogacy in India: A lifeline or livelihood
Kalaivani Annadurai, Geetha Mani, Raja Danasekaran, Jegadeesh Ramasamy
September-December 2014, 28(3):200-200
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Sub acute expansion of hypertensive intracerebral hematoma
Amit Agrawal
September-December 2014, 28(3):193-195
Intracerebral hemorrhage (ICH) is usually secondary to systemic arterial hypertension, sudden in onset, rapidly progressive, fulminating disease, with profound neurological deficit and high mortality. In majority of the survivors of ICHclots are usually absorbed with minimal scar formation; however, in uncommon circumstances the clot can liquefy and expand causing delayed deterioration that require urgent hematoma evacuation to hasten the recovery. We discuss a case of a 40-year-old male, where the patient had delayed deterioration in his neurological status and a follow-up computed tomography (CT) scan showed sub-acute expansile intracerebral hematoma.
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