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Background: Central Venous Catheterizations (CVC) is a standard method of intravenous access in resuscitation of acute severe burn patients, with the subclavian and internal jugular veins being preferred over the femoral vein. However the ease of placement and the decreased chance of life threatening complications make it an attractive and safe option for the burns physician. Aims: To study the efficacy femoral CVC in acute burns resuscitation. Methods: This is a prospective observational study conducted over a period of 2 years. Patients with acute severe burns were admitted, and landmark based femoral central venous catheter was placed for resuscitation. Results: A total of 300 femoral central lines were placed in 300 patients. In 84.66% patients the right femoral vein was used and 15.3% patients, left femoral vein was catheterized. In 65% patients catheterisation was done in one attempt while 34.33% patients required 2- 3 attempts. No use of ultrasound was required in any of our patients. The risk of catheter related blood stream infections due to femoral CVC was not higher when compared with CVC placement in other sites (subclavian/internal jugular). Conclusion: Landmark based femoral central venous catheterisation is a quick, reliable and safe method to attain venous access in acute severe burn patients with lesser chances of immediate life threatening complications when compared to other sites of placement.
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Background: Necrotising fasciitis is a progressive, fulminant, inflammatory infection of deep fascia with secondary necrosis of subcutaneous tissue. The present study was carried out to evaluate the usefulness of LRINEC score to differentiate Necrotising fasciitis (NF) from other soft tissue infections (STI). Methods: Ours was a prospective observational study carried out in a tertiary care setting over a period of one year from November 2013 to November 2014. 150 patients of soft tissue infections were included. Clinical evaluation was done based on the signs and symptoms which included a rapidly progressive oedema, bullae, blue-grey cyanotic lesions, erythema and necrotic patches. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score including Haemoglobin count, Total leucocyte count, C - reactive protein, Platelet count, Fasting blood sugar and Serum sodium, was calculated for all the patients. Results: Among 150 patients with soft tissue infection, 108 (72%) patients were clinically proven to be NF, rest 42(28%) were soft tissue infections. Based on LRINEC score out of 42 STI, 15 % had moderate to high risk of NF while out of the 108 confirmed NF cases 55 % had low to moderate risk of NF. Conclusion: The low sensitivity and low positive predictive value achieved in this study as well as other studies makes the LRINEC score unsuitable to be used solely to distinguish NF with other soft tissue infections
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Background: Drug resistant tuberculosis has frequently been encountered in India. The prevalence of extrapulmonary multi drug resistant tuberculosis in this country is found to be 3% in new cases and 12-17% in treated cases, which needs to be evaluated. Settings and Design: A retrospective analysis of processed extrapulmonary tubercular samples in Intermediate Reference Laboratory of Department of Microbiology, Goa Medical College, was carried out over a period of one year, from November 2013 to October 2014. Methods: Lowenstein Jensen Media was used for culture processing of 202 samples from clinically suspected cases of extra-pulmonary tuberculosis patients. Drug susceptibility testing was done on the isolated strains using the economic variant of proportion method. Results: Out of 202 samples, 30 (14.85%) were observed to be culture positive for Mycobacterium tuberculosis of which six (21.43%) were found to be resistant to both Isoniazid and Rifampicin. Conclusion: With the advent of immunocompromised states, one has to be aware of multi drug resistant extra-pulmonary tuberculosis as a double edged sword. The early detection in such cases is a need of the hour to initiate prompt treatment.
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Background: Calcium, zinc and copper are essential minerals for growth. Methods: Twenty five human foetuses were divided into five groups i.e. group I (<17 wks), group II (17-20 wks), group III (21-25 wks), group IV (26-30 wks), group V (> 30 wks) having 5 foetuses each. Results: Fifty clavicles obtained after dissection were used to determine concentration of aforementioned minerals in each clavicle separately. Except a significant rise of calcium level in group II clavicles compared to group I ones, its deposition kept pace with matrix formation in clavicles of rest of the groups. Conclusion: Uniform concentration of zinc and copper and their constant ratio throughout in developing clavicles were unique observations.
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Background: Detailed histopathological and histomorphometric analysis of gastric mucosa after long term treatment or ingestion of esomeprazole specifically is lacking in literature. Methods: 24 male and female rats, 12 each were divided into control and experimental groups (6 each for both sexes). Rats of experimental group got 15 mg/kg body weight of esomeprazole by oral intubation for 130 days. After perfusion fixation by Karnovsky’s solution, two pieces of gastric wall were procured from anterior aspect, 1 each from distal part of body and pyloric region respectively. Sections of 8 μm thickness, obtained by using wax embedding technique, were stained with haematoxylin and eosin. Results: In both the regions of stomach in two sexes of control rats, the mucosa showed 1/5th superficial layer of absorptive epithelial cells,3/5th parietal and deepest 1/5th layer of pepsin secreting glands. Parietal and pepsin gland layers were involved in body of male and pyloric region of female. Marked oedema, hypertrophy and hyperplasia were uniformly observed in experimental animals. Conclusion: Atrophic gastritis observed in female pyloric region is an alarming observation because it is the precursor of gastric carcinoma.
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Background: Aminoglycoside antibiotics are still the drug of choice in variable conditions like resistant tuberculosis and septicaemia. Toxic effects are the greatest hurdle in their liberal use. Their central neuro-toxicities specially in terms of affinity are yet to be explored. Methods: Experimental rats received streptomycin, kanamycin and gentamycin in a dose of 30mg/kg, 400mg/kg and 135 mg/kg respectively, IMI, daily for 21 days. Total lipids, phospholipids, cholesterol and gangliosides were estimated in auditory cortex, medial geniculate body, inferior colliculus, cerebellum and spinal cord in both control and experimental rats. Results: On the basis of statistically significant alterations in aforementioned biochemical parameters, affinity of drugs was quantified by scoring. Streptomycin and kanamycin showed maximum toxicity in terms of scoring of 4 with preferential targets i.e. medial geniculate body and inferior colliculus respectively. Gentamycin showed affinity for higher centres only with equal scoring of 3 for toxicity at three locations i.e. auditory cortex, medial geniculate body and inferior colliculus. Conclusion: Such preferential toxicities might reflect some aspects of mechanism of toxicity of different drugs.
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Background: Comparative histology not only provides information regarding tissues of different mammals but also gives insight to understand human features in the background of informations on tissue of lower mammals. Methods: Splenic tissues from five mammals i.e., human, buffalo, goat, rabbit and rat were processed for histomorphometric study on capsule, trabeculae, lymphoid follicle and central arteriole. Result: Buffalo was one mammal having highest values for all the parameters while rat having lowest. Values in human splenic tissues are in between aforementioned maximum and minimum readings. Conclusion: Teaching materials are available in histology labs from lower mammals in medical colleges might give an insight for understanding human tissues if literature on comparative histology is made available.
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Background: Methotrexate is an anti-cancer drug but carries toxic effects on genital system and the study was conducted to find out the exact mechanism involved and to search for remedy. Methods: Twelve female albino rats 6 experimental and 6 control received methotrexate. [in former] and normal saline. [in latter], 1 mg/kg, intraperitoneally for 6 weeks. Results: H/E stained sections from ovary of experimental rat showed poorly developed Graafian follicles with loss of ova. There were follicular spaces in these rats with albuminous fluid and inflammatory cells. Granulosa lutein cells also showed degeneration due to inflammation. Cells were found to be smaller, shrunken, and irregular with vacuolated lighter colour cytoplasm. Conclusion: The drug is safer to be used in those patients who have completed their family.
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Background: Methotrexate was often used for prolonged period for satisfactory therapeutic results enhancing the chance of toxicity. Methotrexate was known for its toxic effects involving most of the organs of body including testis. Attempts were made earlier to find out changes in testicular structure of methotrexate toxicity, but details of histopathological reports were not available in literature. The aim of the present study was to see the histopathological changes on testis after giving methotrexate. Materials and methods: Twelve male albino rats were divided into experimental and control groups of equal animals. Former received methotrexate, 1mg per Kg, intraperitoneally, weekly for 6 weeks. Testicular tissue after perfusion fixation, were processed for wax embedding technique and the sections thus obtained were stained with H/E stains. Result: Marked histopathological alterations in seminiferous tubules, cells in its wall undergoing spermatogenesis and Leydig cells were observed. Conclusion: In younger patients the risk of infertility should be kept in mind while using it for prolonged period.
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Background: Prolonged use of methotrexate in juvenile arthritis and multisystem involvement due to its toxicity prompted us to find out detailed histo-morphometric study after exposure to drug. The concern became alarming because of reported gonadal damage due its direct effect on fertility. Methods: Methotrexate was injected in both male and female rats (1mg/kg, intraperitoneally), weekly for 6 weeks. Thin sections of testis and ovary of both control and experimental groups were stained with H/E stains for light microscopic examination. Results: Histomorphometric observations on seminiferous tubules included, external diameter, thickness of the wall and the diameter of the lumen. Such observations for ovarian tissue included diameters of ovarian follicles and their ova. Highly significant changes in both testicular and ovarian microscopic parameters confirmed the damage of tissue in experimental groups. Conclusion: The study suggests that utmost precaution should be taken while using methotrexate in younger patients.
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Background: Density of bone is directly affected by mineralization, which makes visualization by ultrasonography possible to follow foetal growth from early gestation to term. Clavicle being the first bone to ossify and the only bone to transmit upper limb weight to the axial skeleton, receives special attention by the scientists. Methods: Forty-nine foetal clavicles were divided into five groups. Statistically densities of the clavicles were measured and values between groups were compared. Results: Density was constant in all the groups and both in males and females. Conclusion: It was concluded that matrix formation in clavicles keeps pace with their mineralization during 2nd and 3rd trimesters.
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Introduction: Supraorbital foramen is an important site for various surgical and anesthetic procedures. Accurate localization of the foramen holds the key to success, although racial variations exist in various population groups. Th e study included the morphometry of supraorbital foramen and its location with respect to nearby anatomical landmarks. Methods: A total of 100 dry skulls (60 male and 40 female) were collected and observed for the study. Various parameters in the sagittal and transverse planes were noted from supraorbital foramen on both sides, together with its vertical and horizontal dimensions. In addition, the location of supraorbital foramen with respect to midline and frontozygomatic suture were noted. Results: Th e study of 100 adult skulls revealed that the SON (71% on right and 70% on left) was found more frequently than the SOF (29% on right and 30% on left).Th e distance between centre of SOF/SON and midline was found to be statistically signifi cant on right and left sides. Conclusions: Th is study makes possible the identifi cation of exact position of supraorbital foramen and also discuss its racial variation.
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Adult , Female , Frontal Bone/abnormalities , Frontal Bone/anatomy & histology , Humans , Male , Nerve Block , Orbit/abnormalities , Orbit/anatomy & histology , SkullABSTRACT
Serum IgG, IgA and IgM were estimated in 42 cases of carcinoma and 12 cases of fibroadenoma of breast. The results were compared with 20 healthy female controls. Results showed increased levels of serum IgA in carcinoma breast cases. This increase was statistically significant (p = 0.001) when compared with healthy controls while IgG and IgM values were found to be insignificant. Values of IgG, IgA and IgM in cases of fibroadenoma breast when compared with the controls were found to be insignificant. Statistically significant increased value of IgA was also observed in medullary carcinoma and non-metastasizing tumours when viewed separately, suggestive of good prognostic index of serum IgA level estimation in the case of carcinoma breast.