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   2016| September-December  | Volume 30 | Issue 3  
    Online since September 28, 2016

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Medicolegal cases: What every doctor should know
Thounaojam Meera
September-December 2016, 30(3):133-134
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Effects of oral prednisolone and fluticasone nasal spray in the management of nasal polypi
Krunichuno Rino, Mohonish N Chettri, Niteshore Singh Moirenthem, Rita Zoramthari, Kalpana Devi Thongam, M Madhumangal Singh
September-December 2016, 30(3):135-140
Background : Nasalpolyp presents a significant challenge in management due to its frequent recurrences. This study focuses on a medical model of combined local and systemic therapy for efficacy. Aims: Evaluation of a combined therapy, oral prednisolone, and fluticasone propionate nasal spray in the management of nasal polypi. Materials and Methods: This study was carried out in a tertiary care hospital in northeast India during a period of 18 months from 2010 to 2011. The recruitment of patients was done for 13 months and follow-up done for 3 months. The diagnosis made on the basis of physical examination, diagnostic nasal endoscopy, and radiological findings. The patients were evaluated for effects of combined treatment with fluticasone propionate nasal spray and oral prednisolone and followed up for 3 months. Descriptive statistics and analysis were carried out wherever applicable and P < 0.05 was considered statistically significant. Results: Altogether 67 patients were enrolled in this study. The most common presentation was observed in males in the fourth decade. With our modality, 98.5% showed a reduction in nasal obstruction score after treatment, and 83.6% showed a reduction in nasal discharge symptom score. Sixty patients (89.6%) showed a reduction in hyposmia symptom score after treatment and 68.7% showed a reduction in facial pain symptom score after treatment. Nasal polyp size was found to be significantly reduced after treatment, and no patients developed any adverse effects during or following the treatment initiation except mild burning sensation with fluticasone nasal spray (three patients) which subsided after a few days. Conclusion: We found that a 3-week course of combined oral prednisolone and fluticasone-propionate nasal spray is effective in decreasing polyp size and improving nasal symptoms for nasal polyposis, without sustained adverse effects.
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Comparative study of the effect of dexmedetomidine and butorphanol as epidural adjuvants in abdominal hysterectomy under intrathecal levobupivacaine anesthesia
Nirmeen Fatima, Nongthombam Ratan Singh, Laithangbam Pradip Kumar Singh, Dhananjaya Bangalore Doddaiah, Takhelmayum Hemjit Singh, Yamini Taloh
September-December 2016, 30(3):166-171
Background: Combined spinal-epidural technique has become increasingly popular in the last few years for abdominal hysterectomies. Opioids or α-2 agonists are being increasingly used as epidural adjuncts. Aims: The aim of this study is to compare the clinical profile of dexmedetomidine and butorphanol when administered epidurally, following intrathecal levobupivacaine (heavy) in combined spinal and epidural anesthesia. Materials and Methods: Sixty adult patients aged 18-60 years, the American Society of Anesthesiologists Physical Status I and II undergoing abdominal hysterectomy were enrolled into the study and randomly divided into two groups: Group LD (n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus dexmedetomidine 1 ΅g/kg in 10 ml saline epidurally and Group LB (n = 30) received 12.5 mg of 0.5% levobupivacaine (heavy) intrathecally plus butorphanol 10 ΅g/kg in 10 ml saline epidurally. The hemodynamics, block characteristics, and side effects were observed; the data were compiled and analyzed using Student's t-test and Chi-square test. P < 0.05 was considered statistically significant. Results: The demographic profiles of the patients were comparable between the two groups. The onset of sensory analgesia at T10 was significantly faster in the Group LD (92.80 ± 31.51 vs. 105.43 ± 42.04 s). The time to two-segmental regression in dexmedetomidine group was 184.23 ± 45.10 min versus 120.40 ± 33.03 min in butorphanol group (P < 0.001). Postoperative analgesia was prolonged in the Group LD (321.43 ± 60.68 vs. 205.03 ± 57.90 min, P < 0.001). Sedation scores were much better in the LD group and highly significant on statistical comparison (P < 0.001). Conclusions: Dexmedetomidine was a better alternative to butorphanol as an epidural adjuvant providing comparable stable hemodynamics, early onset, and establishment of sensory anesthesia, prolonged postoperative analgesia, and much better sedation.
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Correlation between prostate specific antigen levels and various prostatic pathologies
Bedarshi Banerjee, Banyameen Mohamad Iqbal, Harsh Kumar, Tushar Kambale, Rupali Bavikar
September-December 2016, 30(3):172-175
Background: Prostate-specific antigen (PSA) is a protein produced by the cells of the prostate gland. It is generally increased in diseases such as prostatitis, hyperplasia, and malignancy, but the correlation between various pathologies affecting the prostate gland and their corresponding rise in PSA values is not constant, and exceptions may occur. Aims and Objective: The aim of this study was to find out the spectrum and distribution of various prostatic lesions affecting men, with respect to their age and to find out the correlation between serum total PSA and histological findings. Materials and Methods: This study included a total of eighty samples (both transurethral resection of the prostate and prostatic biopsies) received in the histopathology laboratory, in our tertiary care center over a period of 1 year. All representative tissue sections were taken, and paraffin embedded blocks were made, which were finally sliced in a standard 0.3 mm microtome and stained with hematoxylin and eosin stain. They were finally examined under light microscopy for final evaluation and diagnosis. PSA levels were recorded in all the patients before surgical procedure was undertaken. Statistical analysis was done using Graph Pad in Stat 3 software. Analytical tests done included calculated probability (P value), Chi-squared test, tables containing data distribution in various formats and arithmetic mean. Results: About 51% of subjects studied were in the age group of 61-70 years. Maximum no of subjects had PSA ranging from 0 to 7 ng/ml (37.5%). Benign prostatic hyperplasia was the predominant lesion (38.75%) in the population studied. Chi-Squared distribution yielded a value of 11.49 while P < 0.01 indicating that there exists a positive correlation between the increasing PSA levels and chances of adenocarcinoma, the findings were statistically significant. Conclusion: We were able to determine the spectrum of prostatic lesions in different age groups, and the results indicate that the chances of finding malignancy with increasing values of PSA are more, but not a rule. It can only give a clue to the histopathologist to examine the sections more thoroughly.
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Testicular leiomyoma masquerading as lymphoma
P Arul, C Akshatha
September-December 2016, 30(3):176-178
Leiomyomas are benign tumors which arise from smooth muscle cells. They are usually seen in the uterus and other organs. In the genitourinary tract, the renal capsule is most commonly involved; however, leiomyoma involving testis is extremely rare. We describe the case of a 63-year-old male patient presented with painless swelling of the right scrotum for 2 years with gradual increasing in size. Ultrasonography of scrotum revealed well-defined hypoechoic mass in the right testis just beneath the tunica albuginea layer; hence, a diagnosis of testicular lymphoma was made. However, leiomyoma was confirmed by histopathological examination. This case highlights the rare occurrence and also it can mimic as malignancy.
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Isolated extrapontine myelinolysis due to hemodialysis in a normonatremic individual
V Umamaheswara Reddy, P Suneetha, Amit Agrawal
September-December 2016, 30(3):179-181
Osmotic demyelination syndrome primarily occurs due to an imbalance of serum electrolytes and caused by rapid correction of hyponatremia. Isolated extrapontine myelinolysis is extremely rare, etiopathogenesis of which may be related to osmotic stress resulting from electrolyte disequilibrium. Extrapontine sites involved in osmotic demyelination syndrome show abundant oligodendrocytes, which are highly susceptible to osmotic stresses. Myelin vacuolization followed by intramyelinic splitting and disruption of myelin sheaths occur due to rapid osmolar fluctuations. Symmetrical hyperintensities showing restriction, which resolve in subsequent magnetic resonance scans can help in clinching the diagnosis of this condition in a given clinical setting.
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Citrobacter freundii : A rare cause of native valve endocarditis
Maria Koshy, Ravikar Ralph, Kundavaram Paul Prabhakar Abhilash, George M Varghese
September-December 2016, 30(3):182-183
Citrobacter species are usually intestinal tract colonizers and occasionally cause nosocomial infections such as urinary tract, respiratory tract, and wound infections. However, native valve endocarditis due to these organisms is extremely rare. We report a human immunodeficiency virus-infected individual with Citrobacter freundii endocarditis of the native aortic valve.
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Intraspinal synovial cyst presenting with leg radiculopathy
Umesh Takhelmayum, Shankar Acharya, Pravin Gupta, Nagendra Palukuri
September-December 2016, 30(3):184-186
Intraspinal synovial cysts are rare cystic lesion arising from degenerated facet joint affecting most commonly in lumbosacral spine. They usually present with low back pain with leg radicular pain with or without neurodeficit mimicking prolapsed intervertebral disc. Surgical excision is the treatment of choice.
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Safe handling of healthcare waste: A priority public health concern
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-December 2016, 30(3):187-188
  - 1,286 83
Hemoglobin status of children in the age group 0-14 years
Rajkumari Rupabati Devi, Ksh. Chourjit Singh
September-December 2016, 30(3):189-190
  - 24,746 416
The effect of the antioxidant drug "U-74389G" on amylase during ischemia reperfusion injury in rats
Tsompos Constantinos, Panoulis Constantinos, Toutouzas Konstantinos, Triantafyllou Aggeliki, Zografos George, Papalois Apostolos
September-December 2016, 30(3):141-145
Background: This experimental study examined the effect of the antioxidant drug "U-74389G" on a rat model and particularly in an ischemia-reperfusion protocol. Settings and Design: The beneficial effect or noneffectiveness of that molecule was studied biochemically using blood mean amylase (A) levels. Materials and Methods: Forty rats of mean weight 231.875 g were used in the study. The levels were measured at 60 min of reperfusion (Groups A and C) and at 120 min of reperfusion (Groups B and D) with the administration of the drug U-74389G in Groups C and D. Results: U-74389G administration significantly decreased the predicted A levels by 8.40 ± 2.02% (P = 0.0001). Reperfusion time kept nonsignificantly increased the predicted A levels by 1.68 ± 2.44% (P = 0.4103). However, U-74389G administration and reperfusion time together produced a significant combined effect in keeping decreased the predicted A levels by 4.67 ± 1.26% (P = 0.0005). Conclusions: U-74389G administration whether it interacted or not with reperfusion time has a significant decreasing beneficial restoring short-term effect on amylase levels.
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Drug utilization study on antimicrobials use in lower respiratory tract infection in Pediatric Intensive Care Unit of Rural Tertiary Care Hospital
Varsha P Gajbhiye, Ranjana S Kale, Krishnarao Y Vilhekar, Satish E Bahekar
September-December 2016, 30(3):146-148
Background: Antimicrobial agents (AMAs) are the most commonly prescribed drugs for lower respiratory tract infections (LRTIs). This study was conducted to evaluate the pattern of prescription and AMAs use in LRTI. Aims: This study was conducted to evaluate the pattern of prescription and AMAs use in Pediatric Intensive Care Unit (PICU) for LRTIs patients of Rural Tertiary Care Teaching Hospital. Materials and Methods: This is prospective, observational study undertaken in a pediatric patient in PICU in tertiary care hospital. Prescriptions of 65 patients of age group 1-12 years diagnosed with (LRTIs) years admitted in PICU of a Rural Tertiary Care Teaching Hospital were studied. Positive blood samples were studies for common microorganisms, their sensitivity, and resistance to AMAs. Settings and Design: The study was a prospective, observational study carried out by collecting prescriptions of patients admitted in PICU diagnosed as LRTI clinically. Statistical Analysis Used: The obtained data were subjected to descriptive statistical analysis using Microsoft Excel. Results: Of 65 patients admitted in PICU of LRTI, 12 patients were of mild-moderate pneumonia, three patients were of bronchiolitis, ten patients were of croup, three patients were of bronchitis, and 37 patients were of severe pneumonia. The most frequently prescribed AMAs were a combination of cephalosporin and aminoglycosides. The most common organism isolated was streptococcus pneumonia sensitive to meropenem in 84.6%, resistant to ampicillin in 92.3%, amoxicillin in 92.3%, and cloxacillin in 92.3% of cases. Conclusions: This study has given an insight into utilization pattern of AMAs in LRTI prescribing on which future intervention studies may be based to promote rational drug use.
  - 2,387 270
Study of conduction blocks in acute myocardial infarction
Ratan Ram, Konsam Biona Devi, Keisham Jaya Chanu, Th Shanti Devi, Santa Naorem, Dhanaraj Singh Chongtham
September-December 2016, 30(3):149-152
Context: Acute myocardial infarction (AMI) is a global epidemic. As a leading cause of morbidity and mortality, AMI is a major public health problem. Many of these deaths are attributed to the development of arrhythmias during the period of myocardial infarction (MI). Aims: To study various patterns of conduction blocks occurring in AMI and to determine the prognostic implications of conduction blocks in AMI. Settings and Design: Study was conducted at a Tertiary Care Teaching Hospital in Imphal. The study design was longitudinal study. Subjects and Methods: One hundred AMI patients from October 2013 to September 2015 were evaluated by detailed history, clinical examination, routine investigations, and observed for conduction defects. Statistical Analysis Used: Statistical Package for the Social Sciences (SPSS 16.0 version) and t-test, Chi-square test, and Fisher's exact were used for statistical analysis. P < 0.05 was considered statistically significant. Results: Atrioventricular (AV) blocks were more common in inferior wall MI and bundle branch blocks were more common in anterior wall MI (AWMI). AMI patients with conduction block had higher chance of mortality (41.2% vs. 16.8%) as compared to nonconduction block AMI patients. Conclusions: Most of the AMI patients were males. The most common block is being first-degree heart block. AV blocks were more common in inferior wall MI and bundle branch blocks were more in AWMI. Mortality was increased in MI patients with conduction block than that of nonconduction block.
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Determinants of infertility in male partners of infertile couples at a public health facility in Ilorin, Nigeria
Lukman Omotayo Omokanye, Abdulwaheed Olajide Olatinwo, Kabir Adekunle Durowade, Isiak Funsho Abdul, Sikiru Abayomi Biliaminu
September-December 2016, 30(3):153-157
Background: Infertility is the most important reproductive health and social issue confronting married couples in our environment. The contribution of male factor is assuming a tremendous proportion. Seminal fluid analysis (SFA) remains an indispensable tool in the evaluation of the fertility potential of these male partners. Aim and Objectives: This study aimed to determine the pattern of seminal fluid parameters and its impact on infertility among male partners of infertile couple at a public health facility in Ilorin. Materials and Methods: A cross-sectional study of the seminal fluid indices of consecutively consenting male partners of infertile couple seen at the Assisted Reproductive Technology (ART) Unit of the Department of Obstetrics Gynecology, University of Ilorin Teaching Hospital, Ilorin, between January 1, 2012 and December 31, 2014. Results: All male partners of infertile couple who had infertility consultation at the ART unit consented to SFA during the study period. The patients were aged 27-67 years. One hundred and seventy-five (56.1%) patients had normal parameters. There was a high level of leukocytospermia and bacterial infections in both normospermic and oligospermic semen. The predominant organism was Staphylococcus aureus. Of the sociodemographic and reproductive/hormonal variables, only the age was found to have statistically significant association with types of infertility. Conclusion: Male factor is increasingly assuming a significant role in the etiology of infertility in Ilorin. The practitioners should, therefore, endeavor to involve them early in the overall management to reduce stigmatization and ostracizing of women for infertility.
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Frequency and distribution of blood groups in tribal blood donors of Tripura
Pranab Choudhury, Jayanta Sankar Chakrabarti, Partha Sarathi Chowdhury
September-December 2016, 30(3):158-161
Background: There has been a common belief among the people of Tripura that the frequency and distribution of blood groups in tribal people of Tripura are not similar to that of other parts of India. Aims: To find out frequency and distribution of blood groups in tribal people of Tripura. Setting and Design: A data-based study carried out in a tertiary care teaching institute, Agartala. Methodology: After obtaining ethical clearance from the Institutional Ethics Committee, this study was conducted among the blood donors from tribal communities of different areas of Tripura, who donated blood from October 2012 to August 2013. ABO blood grouping was performed by forward (cell grouping) and reverse blood grouping (serum grouping) using test tube agglutination method using antisera A and antisera B. Rh blood grouping was performed by forward blood grouping (cell grouping) method using antisera D. Weak D (Du) testing were done in case of Rh negative cases. Statistical Analysis Used: Percentage and proportion. Results: Out of 508 blood donors, 421 (82.9%) were male and 87 (17.1%) were female. Majority of blood donors came from 21-40 years of age group. B (33.7%) group is in maximum numbers followed by O (30.3%) and A (24.2%) groups; whereas minimum are from AB group (11.8%). Blood donations by females are low as it is in other areas of India. Conclusion: "B" is the most frequent and "O" is the second most common blood group of ABO blood group system among the tribal blood donors of Tripura. Rh-positive donors were 94.5% and Rh negative were 5.5%.
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Epidemiological profile of ocular trauma in a tertiary care facility in Imphal
Usharani Laishram, Chingsuingamba Meitei Yumnam, Anshuman Gahlot, Robi Singh Thoudam, Sorojini Devi Keisham
September-December 2016, 30(3):162-165
Background: Ocular trauma is an important cause of preventable ocular morbidity and blindness. Aims: To analyze the epidemiological profile of patients with ocular trauma requiring tertiary care. Materials and Methods: A descriptive study was carried out of all patients with ocular trauma, presenting to emergency and outpatient departments of a tertiary care facility at Imphal, during a 2 year period. Along with a complete ophthalmic workup, the demographic data and the mode of injury for each were recorded from the hospital records. Results: Males (69%) were found to be more commonly affected by trauma. Individuals below 30 years of age (58.5%) suffered most from ocular trauma followed by those between 30 and 60 years of age (35%). Best-corrected visual acuity was found to be better than 6/60 in 68% of cases. Residents of urban areas were found to suffer more often (62%) as compared to rural residents (38%). Occupation-related injuries were found to be the most common cause (38.46%). Lids and lacrimal system were the most commonly injured structures (23.86%) followed by conjunctiva (16.50%). Adnexal injury was found to be the most common type of injury (46.15%), and blunt trauma was found to be the most common mode of injury (20.31%). Conclusion: Ocular trauma is an important cause of blindness and ocular morbidity. The young age, rural status, and illiteracy are probably the factors responsible for delayed presentation and thus more risk of infection. Eyes with intraocular foreign body are more likely to be associated with endophthalmitis. Most ocular injuries are preventable if protection is worn and care is taken.
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