Prospective study of ovarian function in hysterectomised females

Background: Hysterectomy is one of the most common operations performed in the world. The aim of this study was to determine prospectively the influence of hysterectomy on ovarian function by measuring gonadotrophin levels and studying ovarian doppler over a two-year period.Methods: Authors conducted a prospective cohort study at the department of obstetrics and gynecology in study tertiary care center. The study was carried out over a period of two years November 2012-November 2014. Serum FSH, ovarian PI and questionnaire data were obtained at baseline and at 6 and 12 months postoperatively.Results: There was significant difference in the mean FSH and mean PI at follow-up visits of 6 and 12 months. Patient characteristics did not contribute to the changes that were observed during the follow-up.Conclusions: Authors conclude that hysterectomy affects ovarian function by affecting blood supply (reducing blood supply). This is reflected by increased FSH levels and increased PI values on ovarian Doppler.

Role of speech-language pathologist in tracheostomy care – A case study

A “tracheotomy” refers to the surgical procedure that creates an opening between the trachea and the midline skin surface of the neck. Indicators for a tracheostomy tube include airway protection, removal of tracheal secretions, and wean from long-term mechanical ventilation. Assessment and management will be overseen by a multidisciplinary team which includes a speech-language pathologist whose involvement in tracheostomy include assisting the patient to tolerate successful periods of cuff deflation and saliva management, re-establishing verbal communication, conducting swallow assessments to re-establish oral intake, providing dysphagia rehabilitation, and providing input into the decannulation decision. This case study is focusing on the 42-year-old male who had the right cerebellopontine angle meningioma for which he underwent retrosigmoid, suboccipital craniotomy, and excision of lesion. Tracheostomy was done following stridor and wheezing, and he is under nasogastric tube for feeding. Assessment and management for swallowing and speech were focussed and results were documented.

Determinants of Voluntary Smoke- Free Home Among Non- Smoking Women in Alor Gajah, Melaka

Abstract@#Introduction: Second hand smoke exposure to cigarette smoke leads to many medical conditions including asthma and lung cancer. Women are the most vulnerable adults of passive smoking at home. Even though Malaysia had its own smoke- free policy, the smoke- free home is voluntary in nature. Thus, this study was aimed to explore the practice of voluntary smoke- free- home among women in Alor Gajah and its determinants. Methods: A cross-sectional study based on multistage sampling was conducted among 180 non- smoking women in areas implemented Community Intervention Program (KOSPEN), which emphasized on healthy lifestyle, in Alor Gajah, Melaka from April 2018 to May 2018. Data on sociodemographic characteristic, characteristic of second hand smoke (SHS) exposure at home, knowledge, attitude and avoidance behaviour from SHS were collected using questionnaires. The data were then analysed using IBM Statistical Package for Social Science (SPSS) version 24.0 involving descriptive and inferential statistics. Results: Majority of the respondents practised smoke- free home (72.8%). The predictors of smoke- free home were those who attained higher education (AOR= 11.939, 95% CI 1.175- 121.277), did not live with any children (AOR= 3.546, 95% CI 0.985- 12.765) and lived with smokers other than their husband (AOR= 3.793, 95% CI 1.192- 12.076). Conclusion: Education level and household factors were significant predictors of smoke- free home. Thus, few measures were suggested to increase tobacco bans at home among women including periodic health programs, community empowerment programs and creating smoke- free housing.

Probing the mechanism of the anti-diabetic potential of a terpenoid from Elephantopus scaber L., an Indian ethnomedicinal plant in STZ diabetic rats- In vivo and in silico analysis

Plants have always been an exemplary source of drugs and many of the currently available drugs have been derived directly or indirectly from them. Since ancient times, traditional medicines all over the world have advocated the use of plants to treat diabetes. Elephantopus scaber L. assumes significance because it has shown by us to possess high hypoglycemic effect and justifies the traditional claims of being anti-diabetic drug candidate. The terpenoid isolated from Elephantopus scaber L. demonstrated promising antihyperglycemic property with an increase in insulin levels but the mode of action had not been investigated. Since increased insulin levels are associated with β-cells of the pancreas, histological studies were undertaken to evaluate the effect of the compound on β-cells protection in streptozotocin induced diabetic rats. Streptozotocin is known to cause damage to β-cells and hence the protective and curative role of terpenoid was evaluated on the restoration of β-cells. The regeneration of damaged β-cells on the administration of the terpenoid is evident from histological and ultra-structural investigations. In histological observations, islets of extract-treated diabetic rats are seen to have numerous cells with normal histoarchitecture. Ultrastructural studies revealed β-cells of compound-treated diabetic rats to contain granulated secretory vesicles. The plant may act independently or synergistically to regenerate the damaged endocrine pancreas and thereby stimulation of insulin secretion in β-cells as revealed by LM and TEM. To further confirm the mode of action of the compound, in silico docking with target proteins like PPARγ, which plays a role in protecting β-cells from damage was undertaken. The docking analysis in the active sites of 2PRG was performed by Schrodinger program. The docking results showed good binding interactions of the ligand with the target at the very low energy level. In our in silico analysis, terpenoid isolated from E. scaber clearly demonstrated that it could improve the diabetic condition by increasing insulin secretion from remnant or regenerated pancreatic β-cells and could promote insulin sensitization and glucose uptake activities, which was a supporting evidence to the histological studies. Thus the terpenoid from E. scaber can be considered for developing into a potent antidiabetic drug.

Role of serum interleukin-6 in heart failure

Background: A growing body of evidence suggests that inflammation plays the key role in different cardiovascular diseases. But very study has been done so far in relation to serum interleukin-6 in heart failure patients. The aim of the study was to measure serum interleukin-6 in heart failure patients.Methods: Total 22 heart failure patients and 22 age and sex matched controls were included in this study from August 2015 to June 2016 for serum analysis of interleukin-6.Results: serum interleukin-6 was significantly [median(IQR) 14.3(26.2) pg/mL] increased in heart failure patients compared to age and sex matched controls [median(IQR) 0(2.4) pg/mL].Conclusions: Even though little is known about function of interleukin-6 in heart failure patients, this study shows that increased level of IL-6 in heart failure patients plays an important role as a pro-inflammatory marker in development of cardiovascular disease i.e. heart failure.

Sensitizing undergraduate medical students to consultation skills: A pilot study.

Background. Good consultation skills help physicians to diagnose the problems of the patient more accurately, and foster a therapeutic relationship. We describe a pilot study that used role-play with peers as a method to sensitize first clinical year medical students to consultation skills. Methods. Students were divided into groups of three where one acted as a doctor, the second as a patient and the third as an observer. Students were asked to perform a role-play of a prepared clinical scenario where the patient had a hidden fear of malignancy. Observations were recorded in a simplified Calgary– Cambridge consultation checklist. Students’ feedback and their emotions written after the role-play were analysed and discussed. Assessment of their learning was done with an objective structured clinical examination. Results. Students’ feedback revealed that they were sensitized to the importance of starting the consultation with an open question, listening to the opening statement, non-verbal

Symposium on bioethics: empowerment of research participants/patients.

YRG CARE conducted The YRG CARE Bioethics Symposium (TYBS) in collaboration with the National Institute of Epidemiology (NIE), the Indian Council of Medical Research (ICMR), Chennai, through the National Institutes of Health Project “Centrally Coordinated Bioethics Education for India” and the National Institute for Research in Tuberculosis (NIRT), ICMR, Chennai on January 6, 2013.

Olfactory bulb serotonin level modulates olfactory recognition in neonate rat.

Role of serotonin in olfactory recognition was tested by depleting the olfactory bulb serotonin during postnatal day (PND)1- 4 following administration of 5,7-dihydroxytryptamine. Significant difference in the olfactory recognition test was observed during PND5-7; control pups successfully recognized and oriented towards their mother; whereas treated pups failed to recognize their mother odour. Later on, during PND12-14, both group of pups responded equally in the recognition test. Levels of olfactory bulb serotonin were depleted (53.3%) in the treated pups on PND-8, which was restored on PND-14 with only 15% variation. Further analysis demonstrated that depletion of serotonin in olfactory bulb did not affect the normal suckling and weight gain, it only modulates olfactory recognition.

An effective integrated learning programme in the first year of the medical course.

BACKGROUND: An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course. METHODS: The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members. RESULTS: Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum. CONCLUSION: An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.

Retinopathy of prematurity in VLBW and extreme LBW babies.

OBJECTIVE: This is a hospital-based, prospective clinical study to determine the incidence, risk factors, and outcome of extreme low birth weight and very low birth weight pre-term babies with retinopathy of prematurity (ROP) at the Sultan Qaboos University Hospital, Oman. METHODS: All babies with a birth weight =/< 1500 g and gestational age =/< 32 weeks admitted in the Neonatal Unit, were screened for ROP between 4 to 6 weeks of age and staged according to the international classification and were followed up until complete vascularization of the retina. Fifty nine babies formed the study group. RESULTS: The overall incidence of ROP was 25.4% (15 out of 59), of which 6 babies had severe ROP and underwent cryotherapy/laser. All babies with ROP had a birth weight < 1250 g and were born before 31 weeks of gestation. CONCLUSION: ROP is a multifactorial disease, the immature retina of the pre-term baby being the primary factor. Incidence and severity was inversely proportional to birth weight and gestational age. Multiple logistic regression analysis showed that sepsis and total parenteral nutrition to be highly significant risk factors. Repeated blood transfusions, hypotension and congenital heart disease with left to right shunt were seen to be considerably associated with the development of ROP. A decrease in overall incidence and severity of ROP was observed in this study.

Scleral suspension pars-plana lensectomy for ectopia lentis followed by suture fixation of intraocular lens.

PURPOSE: To describe a simple technique of scleral suspension-pars plana lensectomy (SS-PPL) in acquired and congenital ectopia lentis and scleral fixation of intraocular lens (IOL). MATERIALS AND METHODS: Twenty eyes of 16 patients (12 unilateral and 4 bilateral cases of "essential familial lens subluxation") aged 10-40 years (mean 25 years) underwent SS-PPL with implantation of scleral fixated IOL. Indications for surgery were best-corrected visual acuity < 6/18, bisection of pupil by the lens, and lens-induced glaucoma. Prerequisites for SS-PPL were, visibility of part of the lens in the pupillary area and soft lens. RESULTS: Postoperative visual acuity ranged from 6/6 - 6/36. Lens tilt in 3 cases(15%) and small decentration in 2 cases(10%) were seen; however these did not seriously compromise the visual result. Scant vitreous bleeding on the first postoperative day was seen in 3 cases (15%). CONCLUSION: The advantages of the scleral suspension of subluxated lens prior to lensectomy include stabilization; it allows proper viewing of the lens, avoids injury to the iris and ciliary body during lensectomy and reduces the possibility of dislocation of the lens.

Transcatheter fenestration of a total cavopulmonary connection baffle.

Transcatheter creation of a de novo fenestration of a total cavopulmonary connection baffle has not been previously reported from India. We present our experience with such a procedure in a 4-year-old child with recurrent pleural effusions in the early postoperative period.

Mycobacterium fortuitum endocarditis and meningitis after balloon mitral valvotomy.

Mycobacteria rarely cause endocardial infections. We describe the clinical course of a patient who developed endocarditis, and meningitis with Mycobacterium fortuitum following balloon mitral valvotomy. The patient was treated with amikacin and clarithromycin but did not respond. She developed haemolytic anaemia as the terminal event.

Acinetobacter meningitis following head trauma.

A case of acinetobacter meningitis following head injury in a patient who developed cerebrospinal fluid otorrhea, and did not have any neurosurgical procedure, is presented. Previously reported cases are cited, with a review of the literature. Pefloxacin monotherapy is associated with a poor clinical response.

Systemic lupus erythematosus in Indian patients: prognosis, survival and life expectancy.

BACKGROUND: There have been several studies on survival patterns in Indian patients with systemic lupus erythematosus but it is still not clear as to which factors at diagnosis predict survival outcome. The impact of specific organ involvement, and of disease activity itself, needs to be studied further. METHODS: We conducted a non-concurrent prospective study of 98 lupus patients between 1981 and 1993. The clinical symptoms, signs and investigation results at onset, and at subsequent visits, were abstracted from the case notes. A systemic lupus erythematosus disease activity index (SLEDAI) was constructed at the initial presentation and for each subsequent visit. Patients not attending for at least 6 months were traced by post. The quantitative data from the SLEDAI was used to construct a Markov chain mathematical expression designed to predict life expectancy. RESULTS: The cumulative percentage survival at 1, 5 and 10 years was found to be 89%, 77% and 60%, respectively. The Markov chain predicted a life expectancy of 13.9 years. Central nervous system and renal involvement were poor prognostic factors. Proteinuria (> 0.5 g/day) caused a 50% reduction in life expectancy but increased disease activity at onset did not predispose to a poor outcome. CONCLUSION: The survival of patients with systemic lupus erythematosus continues to be poor. Central nervous system and renal disease indicate a poor outcome. Hence, new treatment strategies must be evolved to improve the survival of such patients.

Epidemiological features of acquired immunodeficiency syndrome in southern India.

AIDS was diagnosed in 187 men and 24 women (M:F = 8:1) from April 1987 till December 1994 at the Christian Medical College Hospital, Vellore. The doubling time of the occurrence of AIDS cases was 14 months; during 1987-90 there were an average of 5.7 cases per year; in 1991-93 there were 28 per year; in 1994 there were 104 cases. The mean age of patients was 33 yr for men and 31 for women. Among men, the primary mode of infection was heterosexual contact with female commercial sex workers. Among women, the most common source of infection was their husbands. There were 4 bisexuals and one homosexual subject who might have acquired infection by having sex with other men. There were 135 subjects from urban and 76 from rural communities. Most subjects belonged to the lower socio-economic classes. These data show that HIV infection had been very widespread in this region, both urban and rural.