Category Archives: October 2014

Treachers collins syndrome_Sarella LK

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Treacher -Collins syndrome

Sarella LK1 Kumar PD,2 Kumari CK3

Professor & Head,1,2 Resident3

Department of Obstetrics & Gynecology,1,3 Department of Orthopedics2

1-3Rangaraya Medical College, Kakinada, Andhra Pradesh, India.

ABSTRACT
INTRODUCTION Treacher Collins syndrome (TCS) is a rare syndrome inherited as autosomal dominant. The affected children may vary in severity ranging from minimal features as slanting of palpebral fissures to major features of craniofacial development such as hypertelorism, micrognathia, maxillary hypoplasia, high arched palate, conductive hearing loss, external ear abnormalities and narrow nostrils. We report a case of Treacher Collins syndrome with term gestation with polyhydramnios and fetus with micrognathia on ultrasound examination with previous two babies and father having the same disorder.

Case Report

A 30year old ,unbooked G3 P2 L1D1, postcesaerean pregnancy, term gestation with polyhydramnios with breech presentation with features of TCS admitted for institutional delivery at Government General Hospital, Kakinada, Andhra Pradesh, India. Her scan on admission revealed single fetus in breech presentation with micrognathia and AFI 25cm. she delivered a live male baby weighing 2.2kg with features of TCS through ceserean section and inspite of airway support the baby died on first postnatal day.

Conclusion

This case report confirms the need to identify the antenatal women with physical malformations and early ultrasound scan in women with previous H/O anomalous children, and polyhydramnios so that termination can be planned early. 

KEY WORDS
Polyhydramnios , Treacher Collins Syndrome, Micrognathia, Anti mongoloid slant of eyes

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TB contact_Kulkarni

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TB contacts in family and high positive smear: Is there a need of sputum culture at the earliest?

Kulkarni PY,1 Kulkarni AD,2 Akarte SV3

Assistant Professor,1,2 Professor & Head3

1Department of Community Medicine, Dr D Y Patil Medical College, Pimpri, Pune, Maharashtra, India

2Department of Community Medicine, Dr D Y Patil Medical College, Nerul, Navi Mumbai, Maharashtra, India

3Department of Community Medicine, Grant Medical College, Byculla, Mumbai, Maharashtra, India

ABSTRACT
AimTo assess the role of TB contacts at various places in severity of PTB.

Background

Tremendous progress has been made in combating TB over the past ten years. But, dramatic changes in TB epidemiology are challenging TB control activities.

Material Methods

An observational study at DOTS centers in E ward of Mumbai Municipal Corporation was carried out during 1st January 2004 to 30th June 2004. A Pre-tested structured interview schedules were fulfilled by interviewing new smear positive pulmonary tuberculosis patients registered during study period. Data regarding sputum smear examination report at the beginning & at the end of intensive phase were collected from respective DOTS centre.

Results

156 patients were interviewed with 67.3% males & 32.7% females. 24.2% were illiterate, 43.3% were unemployed, 52% belonged to socio-economic class IV & V, 53.8% were migrants.52.6% had history of known TB contact. High positive sputum smear was associated with history of known TB contact in family (p= 0.03, OR= 1.773, 95%CI= 1.102- 3.094). Patients with high sputum smear positivity were more likely to show sputum smear non-conversion at the end of intensive phase (OR=  2.347, 95% CI= 0.953- 5.782)..

Conclusion

Contacts in family play important role in causation of severe TB disease & consequently sputum non-conversion which is a risk factor for MDR-TB.  Physicians or facilities can take decision about investigations like sputum culture and sensitivity at the earliest for such patients.

KEY WORDS
Anti tubercular treatment (ATT), DOTS, High Positive Smear (HPS), MDR-TB, RNTCP, Tuberculosis

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SMS based education_Sucharitha

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Mobile Phone SMS-Based Educational Intervention To Medical Undergraduates For Reduction of Stigma and Discrimination Against PLHIV In Healthcare Settings   

Sucharitha ST,1 RajaGopal J,2 Siriki R3

Assistant Professor,1 MBBS Student,2 Data Manager and Analyst Consultant3

1Department of Community Medicine, Tagore Medical College and Hospital, Chennai

2Tagore Medical College and Hospital, Chennai

3SAATHII Bakaram, Hyderabad

ABSTRACT
AimTo provide mLearning intervention to experimental group of 30 medical students using mobile phone based SMS technologyBackground

Medical students universally own mobile phones with a potential to meet their educational needs. mLearning is a type of mHealth for educating and increasing the capacity of health care providers.

Material Methods

A pre-test and post-test, cross-sectional study design was used to assess the levels of knowledge, attitudes of 30 clinical undergraduates regarding stigma and discrimination towards People Living with HIV (PLHIV) in healthcare settings during August to October 2013 in Tagore Medical College Hospital, Chennai. The intervention phase included the design and implementation of mLearning initiative through SMS technology.

Results

Fears of contagion (33%) and poor awareness (23%) among care providers were identified as reasons for stigma. Improved knowledge about definition of stigma 100%, 97% for Quality, Quantity of HIV virus and Route of transmission (QQR) determining the risk of HIV transmission, 97% for identifying scheduling consultancies towards the end and charging high for PLHIV surgeries as stigma, is seen in experimental group.

Conclusion

mLearning opportunities support stigma reduction in health care settings by improving knowledge and attitudes of care providers.

KEY WORDS
HIV/AIDS, mHealth, mLearning, People Living With HIV, Stigma and Discrimination, Short Message system (SMS).

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Percutaneous Needle Tenotomy_Sirsikar

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A Prospective Study of Outcome of Percutaneous Needle Tenotomy for Tendo-achilles Release in Congenital Talipes Equino Varus
Sirsikar A,1 Kiradiya N2

Assistant Professor,1 Senior Resident2

1,2Department of Orthopaedics, Gajra Raja Medical College, Gwalior, MP, India

ABSTRACT
Aim

To study the outcome of percutaneous tenotomy of tendo-achilles using a wide bore needle in Congenital Talipes Equino Varus.

Background

Congenital Talipes Equino Varus is a commonly seen complex congenital foot deformity that can be treated conservative if the Ponseti technique is followed correctly. Percutaneous tenotomy of tendo-achilles forms an integral part of this technique.  

Material Methods

Forty nine feet were prospectively studied in thirty two patients, treated with the Ponseti technique between July 2011 and June 2013, out of which forty feet (81.6%) required percutaneous needle tenotomy of tendo-achilles.

Results

Out of these forty feet, thirty six (90%) feet were managed successfully, without any complication of excessive bleeding, pseudo-aneurysm formation or neuro-vascular compromise, which was reported with the conventional tenotomy by a knife.

Conclusion

Percutaneous tenotomy of tendo-achilles with a needle is a easy to learn, safe and effective method of tenotomy in Ponseti technique.

KEY WORDS
Congenital Talipes Equino Varus, Ponseti, Tendo-achilles, Tenotomy.

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Adenocarcinoma spectrum_Narang S

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Adenocarcinoma: Morphological & Topographical spectrum: a two year analysis
Narang S,1 Prajapati R,Jain R3

Professor,1 Assistant Professor,3 Tutor2

1Department of Pathology, Index Medical College Hospital and Research Centre, Indore, MP, India

2Department of Pathology, R D Gardi Medical College, Ujjain, MP, India

 3Department of Pathology, M.G.M Medical College, Indore, MP, India

ABSTRACT
Aim

To study of adenocarcinoma of various sites and classify them into morphological categories according to International Classification of Diseases for Oncology (ICD-O, Third edition).

Background

The word cancer is enough to strike fear in the heart of any man because it is this one menace that researchers have been unable to curb, It is for this reason that many ideas are thought of and pursued with the hope of unraveling this mystery. In keeping with this a study delineating the morphological and topographical spectrum of adenocarcinoma was carried out in the Department of Pathology MGM Medical College and M Y Hospital Indore, MP, India.

Material Methods

A retrospective study of adenocarcinoma cases diagnosed during last 2 years, from January 2007 to December 2008 was carried out. ICD-O (3rdEd.) was used as reference to categorize the cases according to anatomical site and morphology.

Results

Total 325 cases were included, out of which, the maximum, i.e. 221 cases (68%) of Adenocarcinoma were found between third and fifth decades. The average for males was 48.1 years while for females was 47.8 years. The frequency of Adenocarcinoma was highest among those involving breast (56.50%), followed by those involving digestive system (30.24%). Regarding the topographical distribution of Adenocarcinoma, the maximum number of cases (26.07%) of Adenocarcinoma belonged to ICD-O category C-50 i.e. breast.

Conclusion

As far as the behavior pattern of the Adenocarcinoma was concerned, most of the cases in our study were invasive type. Hence keeping this in mind the topographical spectrum prevalent in the area and having a high index of suspicion can prove to be useful for early detection, treatment, improved survival rate and reduced mortality in such cases.

KEY WORDS
Adenocarcinoma, Glandular epithelium, ICD-O, Morphologic categories, Topographic spectrum.

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Urgent carotid endarterectomy_Bedi HS

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Urgent carotid endarterectomy for acute cerebral ischemia

Bedi HS,1 Pandian JD,2 Gupta A3

Head CTVS,1 Professor & Head Neurology,2 Head Cardiac Anesthesia3

Department of Cardiovascular Endovascular & Thoracic Surgery,1 Department of Neurology,Department of Cardio Vascular Anesthesia3

1-3Christian Medical College & Hospital , Ludhiana, Punjab, India

ABSTRACT
Background

Carotid endarterectomy (CEA) is well established as the elective treatment for severe symptomatic carotid stenosis . In contrast, the merits of CEA performed  as an  emergency procedure in patients with acute stroke or fluctuating neurological deficit remain controversial.

Material Methods

CEA was performed as an emergency procedure on 16 patients within 4 to 48 hours after the onset of symptoms. Patients selected for urgent surgery fulfilled the following criteria: acute onset of fluctuating hemispheric neurological symptoms, significant carotid pathology, absence of cerebral hemorrhage, absence of massive cerebral damage and stable cardiopulmonary conditions. The patients presented with a crescendo-TIA in 7, evolving (stuttering) stroke in 3 and   fluctuating neurological deficits in  6 -  corresponding to a contralateral carotid stenosis.

Results

Following CEA, the neurological deficits improved instantaneously to complete recovery in 10 patients. The symptoms of 4 patients improved to non-disabling deficits, and remained unchanged in two patients. 14/16 patients were discharged within 8 days after admission. The neurologic status after discharge did not deteriorate in any of the patients during follow up – in fact it further improved in 4 of the patients (2 in whom there had been no change and 2 in whom there had been a partial improvement).

Conclusion

Emergency CEA may be beneficial for selected patients with stroke in evolution and fluctuating neurological deficits. Careful adherence to selection criteria, judicious intraoperative shunting, intensive unit care post surgery and an experienced team are recommended.

KEY WORDS
Carotid endarterectomy; Crescendo TIA; stroke in evolution

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Mobile phone_das D

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Mobile phone surveillance and relationship between quantitative cultures and type of mobile device: A pilot study
Das D,1 Khera R,2 Sumit R3

Assistant Professor,1,3  9th Semester M.B.B.S Student2

1-3Sikkim Manipal Institute of Medical Sciences, Sikkim, India

ABSTRACT

Aim

In this study an attempt was made to compare the mobile phone microbiota from health care workers among various departments and individuals from community not exposed to health care and correlate the quantum of bacterial load with the type of mobile phone.

Background

Inanimate object like mobile phones in the hospital environment are contaminated and are known to be considered as sources of Hospital Care Associated Infection (HCAI). It is also important to know the bacterial load on mobile phones and knowledge regarding mobile phone as source of nosocomial infection among health care workers (HCW) compared to people from community.

Material Methods

Study population and size included 100 healthcare workers from various departments of a tertiary care hospital and 50 individuals from a middle class community of East Delhi. Self structured questionnaire were distributed among the study population and quantitative culture from mobile phones were done.

Results

Total thirtee six of 100 mobile hand sets of health care workers (HCW) were colonized of which 6 were polymicrobial colonisation with average bacterial load of 2709. In the community based survey, 19 (38%) of the mobile handsets were colonized having average bacterial load of 2490 CFU per handset.

Conclusion

Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals. There is a threat of spreading infection by mobile phone if not disinfected properly. This is similar to the importance of hand hygiene in preventing spread of infection. If use of mobile phones is imperative, then strict mobile friendly disinfection policies need to be formulated and implemented.

KEY WORDS
Hospital Care Associated Infection (HCAI), Colonisation, Polymicrobial

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Alzheimer’s Disease_Sheikh AS

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ALZHEIMER’S DISEASE
Sheikh AS

Resident

Department of Medicine, King Edward Medical University & Mayo Hospital, Lahore, Pakistan

MEDICAL POEM
-Alzheimer’s, Alzheimer’s, it’s called the Alzheimer’sConfusion, and memory loss, it’s all about Alzheimer’s

 

-Dementia it causes, progressive it is

Without a cure, aggressive it is

 

-Brain scans show a typical picture

Plaques and tangles show up on the picture

 

-With no cause known, elderly are affected

Sometimes however, younger are affected

 

-A genetic causation has been advised

With multiple genes, so called devised

 

-Neuro-degeneration it causes ultimately

Withdrawal from society is seen subsequently

 

-Caregivers are devastated, and health budgets drained

But the poor patient is still left rotten and untamed

KEY WORDS

ALZHEIMER’S DISEASE  

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Kissing Warts_Sheikh AS

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KISSING WARTS
Sheikh AS

Resident 

Department of Medicine, King Edward Medical University & Mayo Hospital, Lahore, Pakistan

ABSTRACT
A 29 year old man developed three skin coloured lesions near his right ring finger. The first lesion was noticed in the teens and had persisted for a number of years before the other two appeared sequentially in late twenties. These warty lesions were painless and non-itchy. There was no relevant history of medical illness or regular medication usage. On palpation, they had a roughened surface. These warts are caused by human papilloma virus, and are prone to develop in proximity to each other, hence named the “kissing warts”. They are particularly stubborn to most forms of treatment including salicylic acid, cryotherapy, electrodessication and curettage. After carefully discussing different treatment options with the patient, he opted to apply De-wart lotion containing podophyllum emodi extract, verrugon and milk acid. Multiple applications were required and the warts decreased in size gradually. After four months of dedicated treatment, the patient was wart-free.
KEY WORDS
Kissing Warts

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Recurrent Infections_Goyal S

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Recurrent infections in a five year old boy

Goyal S,1 Goyal V2

Assistant Professor1,2

1Department of Pediatrics, Chirayu Medical College & Hospital, Bhopal, M P, India

2Department of Medicine, Chirayu Medical College & Hospital, Bhopal, M P, India

ABSTRACT
Children are prone to develop recurrent illness in the form of upper respiratory tract infections, gastroenteritis, pustulosis and otitis media owing to developing immunity and environmental exposures. Majority of such children improve on symptomatic treatment. However, few of them might develop severe life threatening infections affecting vital organs. Primary immunodeficiency is an entity in which children develop recurrent infection due to defect in the development of immune system. This may affect plasma cells, T lymphocytes, natural killer cells or peripherally circulating leucocytes. We present a 5 year old male child with such diagnosis. A five year old boy was admitted with history of repeated infections since one year of age. His serum IgA, IgG and IgM levels were markedly decreased. Flow cytometry showed absence of B cells. He was started on intravenous immunoglobulin 10 gm every four weeks following which there was marked reduction in intercurrent infections. Primary immunodeficiency should always be suspected in differential diagnosis if history of repeated infections exist.
KEY WORDS
Primary immunodeficiency, recurrent infections.

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