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According to the World Health Organisation (WHO), a caesarean section is a surgical procedure that can save the life of a woman and her baby when undertaken for medical reasons. Thus, the procedure should only be used in complicated pregnancies.However, C-sections have gradually become common in developing countries, and it is already quite common in the developed countries for a long time. A number of obstetric complications such as dystocia, foetal distress, breech births, post-term pregnancy, multiple pregnancy, and pregnancy-induced hypertension are recognized as reasonable motives behind caesarean section deliveries. Approximately 18.5 million caesarean births have been recorded each year globally, accounting for 19.1% of total births, which is beyond the cut-off recommended by the World Health Organization (WHO). In India, the rate of caesarean section delivery is dramatically increased from 3% in 1992–93 to 17% in 2015–16. In terms of regional variations, south Indian states have recorded substantially higher levels of caesarean deliveries in comparison to north India.Despite several studies that have investigated the factors contributing to caesarean section delivery, systematic evidence is still lacking towards understanding the determining factors and formulating effective policies to address the increasing rate of caesarean section deliveries in India. With this backdrop, this study attempts to observe the major indications and prevalence of caesarean section among pregnant women in a tertiary care hospital in India.
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Background: Atlas is the first cervical vertebra. The vertebral artery lies in the groove on posterior arch of the atlas. The vertebral artery groove may sometimes get converted into a foramen. This is commonly known as ponticulus posterior (ponticulus posticus) or arcuate foramen of the atlas. These foramina may be complete or incomplete. This can lead to compression of the vertebral artery and produce symptoms like headache, syncope, altered consciousness etc. It can also complicate manipulations of the cervical spine by reducing the blood flow during extreme rotations of head and neck. It is also associated with vertebrobasilar artery stroke So, neurosurgeons or orthopaedic surgeons who operate in this area should have a detailed knowledge of variations of groove for the vertebral artery. Materials and Methods: The present study was conducted on 50 dried and fully ossified adult human atlas of unknown age and sex collected from the department of Anatomy, Government Medical college, Nagpur. Each atlas vertebra was carefully observed for the presence or absence of complete or incomplete ponticuli on superior surface of posterior arch of atlas. Results: Out of the 50 vertebra studied 7(14%) showed the presence of Ponticuli. Ponticuli were incomplete in all 7 atlas vertebras. Complete ring was not observed in any of the atlas vertebra .Out of the 7 ponticuli 6(12%) were found to be unilateral and in only 1 (2%) case it was found to be bilateral. Out of the 6 ponticuli 4(8%) were noticed on the Left side and 2(4%) were present on the right side. Conclusion: Presence of incomplete ponticulus posterior might cause cervical pain and even cerebrovascular disorders due to pressure on third part of vertebral artery present in the vertebral artery groove. This anatomical knowledge is important for neurosurgeons, orthopaedic surgeons, radiologists and clinicians while dealing with this region.
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ABSTRACT Toxic leukoencephalopathy (TLE) is a rare neurological debilitating and fatal condition. It has been previously associated with exposure to leukotoxic offenders such as chemotherapy, cranial radiation, certain drugs, and environmental factors. Currently, it is a commoner white matter syndrome resulting from increased substance abuse, classically by inhaled heroin and other opioids. Herein, we report a case of fatal TLE unveiled in an autopsy of a drug abuser. A 24-year-old male was found dead on the roadside. A day before, he was located in a state of delirium. In this case, the autopsy findings and histopathology characteristics of cerebral cortex involvement particularly directed to speculate the heroine as the principal offender.
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Background: Chronic kidney disease is becoming epidemic oftwenty-first century. With increasing burden of diabetes and hypertension, chronic kidney disease is becoming rampant in our country. Adverse outcome of CKD includes kidney failure, complications due to decreased kidney function and cardiovascular disease etc. Increasing morbidity and mortality of coronary artery disease in CKD patients make it necessary to develop further researches in these population. Aim and objectives of current study were to demonstrate the correlation of anemia with left ventricular hypertrophy in a cohort of CKD patients in a tertiary care centre.Methods: This study was done over one year on 100 patients of CKD (stage III to V), aged 15-80 years, who had elevated serum creatinine and reduced glomerular filtration rate, haemoglobin <11gm/dl withultrasonographic evidence of renal parenchymal disease grade >2. The patients were assessed based on clinical history and a number of laboratory parameters including blood urea, serum creatinine, calcium, inorganic phosphorus, serum electrolytes, iPTH level, Hb, Hct, glomerular filtration rate and left ventricular mass index.Results: There is a significant relationship between of anemia and left ventricular hypertrophy among chronic kidney disease patients. In our study, it was observed that left ventricle mass (left ventricular mass index) increases with increasing severity of anemia.Conclusions: Anemia is widely prevalent in our CKD patients. Severity of anemiais correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these group of patients can halt or prevent cardiovascular morbidity and mortality.
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A perforated liver abscess mimics hollow viscus perforations. It may be accompanied by pneumoperitoneum and peritonitis. A hollow viscus perforation appears to be the most common cause of gas under diaphragm. In about 10% of the cases, it can be due to rare abdominal and extra-abdominal causes. One of the causes could be intra-abdominal infection caused by gas-forming organisms. We are reporting a rare case of pneumoperitoneum resulting from an unruptured liver abscess in an old male with no comorbidity. An unruptured pyogenic right lobe liver abscess in a 70-year-old male was accompanied by X-ray flat plate abdomen features suggestive of free gas under the right hemidiaphragm. Culture of the pus drained from liver abscess grew Klebsiella sensitive to piperacillin and tazobactam, and antibiotic treatment was administered.
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This literature review aims to name the influential female pioneers who broke the conservative barriers in place for their gender and set the standards for those who followed in their paths as either dentists or forensic odontologists, with the purpose of increasing the visibility of their identities, feats, and positions of authority, hence, diminishing the states of exclusion that may be still practiced towards the recognition of their contributions to dentistry. It is our expectation that contemporary female forensic dentists can, by accessing this reading, acknowledge and promote the female performance in the forensic field, from its beginning to the present time, and be reassured of the representation and the excellence of women in it. We anticipate that all these professionals' names will not be mentioned due to lack of information from sound resources or unawareness. We also hope to witness similar literature reviews in the future
Esta revisão de literatura tem como objetivo nomear as influentes pioneiras que romperam as barreiras conservadoras de gênero e estabeleceram os padrões para aquelas que seguiram seus caminhos como dentistas forenses ou odontolegistas, com o objetivo de aumentar a visibilidade de suas identidades, feitos e posições de autoridade, diminuindo, assim, os estados de exclusão que ainda podem ser praticados para o reconhecimento de suas contribuições para a Odontologia. É nossa expectativa que as odontolegistas contemporâneas possam, ao acessar essa leitura, reconhecer e promover a atuação feminina no campo forense, desde o seu início até os dias atuais e ter a certeza da representação e da excelência da mulher nela. É possível que outros nomes não foram mencionados por falta de informação segura ou desconhecimento. Também esperamos testemunhar revisões de literatura semelhantes no futuro
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We propose a technique for combined femto laser?assisted cataract surgery (FLACS) and limited vitrectomy from the pars?plana site for optimization of surgical results in subluxated cataracts. FLACS creates a free?floating, customised capsulotomy, minimizes stress on compromised zonules, and prechops the nucleus, effectively reducing the ultrasonic power as well as the forces required to chop the nucleus. The area of zonular dehiscence creates a direct communication between the irrigation fluid and the anterior vitreous, leading to its hydration. Trans?limbal vitrectomy creates a continuum between the liquefied vitreous and the main wound, leading to further vitreous loss, and exaggeration of the zonular weakness, while pars?plana vitrectomy avoids this by cutting the liquefied vitreous, near its attachment, thereby preventing further hydration and causing lesser stress to the zonules. A combination of these procedures, along with a capsule support device, gives favorable surgical outcomes in moderate to severe subluxations.
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Background and Objective: Glossopharyngeal nerve block (GNB) technique has been used as alternative of treatment of cancer and noncancer pain of the oral cavity. The objective of the study is to compare the two approaches (extraoral and intraoral) of GNB in patients of carcinoma of the tongue in terms of efficacy, duration, and complications. Materials and Methods: This was a prospective comparative randomized study over a period of 1 year. Fifty patients of either sex of ASA physical status and 2, between 21 and 70 years of age, suffering from carcinoma of the tongue, were selected. The patients were randomly divided into two groups. Group I received 4 mL of 0.5% bupivacaine combined with 40 mg, of triamcinolonacetonide by extraoral approach of GNB, and Group II received the same amount of drug by intraoral approach of GNB. Hemodynamic parameters, degree of pain relief using visual analog scale (VAS), number of attempts, effect on quality of life (QOL), and complication were noted during the performance of GNB. Results: Demographic profile in both groups was comparable. Rate of complication and number of attempts to complete intervention were higher in Group I, which was found to be statistically significant. However, mean VAS scores in Group I were significantly higher as compared to those in Group II during most of the study period starting from the 1st follow-up at 30 min to the 2nd month postintervention (P < 0.05). No statistically significant difference in mean QOL scores of two groups was observed for the entire study period except at 1 week when mean scores in Group I were higher as compared to those in Group II (P = 0.011). Conclusion: The intraoral approach of GNB was better with respect to pain control and improvement in QOL whereas the rate of complication and number of attempts was lower in extraoral approach of GNB
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Background: Supraglottic airway device results in less hemodynamic responses during laparoscopic surgery but supraglottic airway device to be used should have higher oropharyngeal seal pressure than peak pressure for effective ventilation as laparoscopic surgery also leads to higher airway pressure. In this study the efficiency of the I-gel with SLMA is compared in patients undergoing laparoscopic cholecystectomy surgeries.Methods: Sixty patients were randomized in to two groups, group A where I-gel was considered for airway management and group B where LMA Supreme was the device chosen for airway management.Results: Oropharyngeal seal pressure was significantly lower in group A than group B, 5 minutes after insertion of airway device it was 24.90±3.03 cm H2O and 27.30±3.41 cm H2O in group A and group B, respectively and 5 minutes after creation of pneumoperitoneum it was 25.53±3.17 cm H2O and 27.57±3.36 cm H2O in group A and group B, respectively. There was significant difference in the difference between inspiratory and expiratory tidal volume between the groups at all the time periods being higher in group A than group B. Hemodynamics were comparable between the two groups. Time taken to insert the airway device and Ryle’s tube insertion was significantly lesser in group B in comparison to group A. The percentage of complications was higher in group A than group B with no significant (p>0.05) association.Conclusions: Both the I-gel and SLMA devices can be used safely in laparoscopic cholecystectomy in non-obese patients. But in SLMA group oropharyngeal seal pressure was higher with lesser leak volume in comparison to I-gel group.
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Pancreatic alpha amylase (PAA) inhibitory activity of cinnamon, cumin was evaluated in vitro to search newanti-diabetic agents as alternatives to synthetic medicines. Bark of cinnamon, seeds of cumin, fenugreek,nutmeg, fennel, and buds of clove were extracted with hot water, methanol, chloroform, benzene, and ethylacetate and 30 extracts were tested for the presence of PAA inhibitory activity using qualitative and quantitativemethods and their modes of inhibition were determined. Presence of alpha amylase inhibitors was identified in18 extracts in quantitative assay. Benzene extracts of cinnamon, clove, fenugreek, and nutmeg and chloroformextract of cumin showed highest anti-amylase potential. The IC50 values of these potential extracts rangedbetween 2.09 ± 0.12 mg/ml and 2.89 ± 0.079 mg/ml with lowest IC50 value noted for benzene extract ofcinnamon and highest IC50 value was noted for benzene extract of fenugreek. Based on the values of Vmaxand Km compared to control, it was found that all these extracts display non-competitive mode of inhibition onamylase activity. In conclusion, active constituents of these five extracts possess anti-amylase properties andcan be used in management of diabetes mediated complications.
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Regulatory binder is one of the essential documents that isrequired to be maintained by all clinical sites throughout the conduct of clinical trials and post completion of clinical trials. Managing regulatory binders for multiple studies has been challenging due to large volume of documents that needs to be maintained in a paper form especially when the site has 150-200 open studies. To utilize electronic regulatory binders to replace paper based regulatory binders for improve efficiency while maintaining regulatory compliance. Use of document management system effectively allows sites to store regulatory binders electronically.Electronic regulatory binders provide a new way of managing tons of documents in a simplified fashion that helps in redefining the process, tracking documents, reducing physical storage requirements, retention, preparation for monitoring visits, and in prompt audits.
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Background: One of the important requirements to achieve “Zero Human rabies deaths by 2030” is to build awareness of the PEP and care for exposed victims. So, this study was undertaken with the aim and objective to study knowledge, attitude and practices related to animal bite transmitting rabies, amongst medical officer.Methods: A cross sectional study was done among 95 medical officer. Pretested and structured questionnaire was prepared related to training sessions conducted and their knowledge, attitude and practices (KAP) related to rabies prophylaxis. Data was entered and analysed using Microsoft Excel 16 version. Percentages were calculated and appropriate statistical test were applied.Results: None of them had received training on rabies prophylaxis. Regarding WHO categorization of animal bite, 69.5% participants had sufficient knowledge about category III, 47.4% about category II and 42.10% about Category I. Only 4.21% participants were aware of the preexposure prophylaxis and 29.47% participants had sufficient knowledge about intradermal (ID). schedule. Attitude was poor (47.40%) regarding willingness of administrating equine antirabies serum at their setup. 81% practiced immediate wound toileting and 45.30% of participants administered ARV by intradermal route. All patients were referred to tertiary care centre for administration of ARS and 82.10% of participants referred the patients immediately.Conclusions: There was an apparent lack of awareness seen in rabies prophalaxis and management. Effort should be taken to emphasize the importance PEP management through regular reorientation programs.
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Background: Puerperium is strictly defined as the period of confinement during and just after birth. It is the period following childbirth during which body tissues specially the genital organ reverts back approximately to the pre-pregnant state both anatomically and physiologically. At some stages some of these well-orchestrated changes can go away resulting in complications which can endanger life.Methods: Retrospective c study was conducted in Department of Obstetrics and Gynecology of M.G.M. Medical College and M. Y. Hospitals, Indore. The cases were selected randomly from the patient who were admitted in M.Y. Hospital who had either a vaginal or caesarean delivery (both in our institution as well as outside institution) during the study period, irrespective of age, parity and registration status. Data was recorded in predesigned coded case report forms and statistical analysis was performed.Results: Authors found that puerperal pyrexia was the most common complication, accounting for 38.96% of total cases. The second most common complication was perineal pain affecting 28.15% of cases. The other complication was wound gaping/discharge (11.71%), mastitis and breast abscess (6.81%), secondary postpartum hemorrhage (5.33%), episiotomy gaping and infection (4%), perineal hematoma (0.59%), wound dehiscence (0.3%) and other rare causes accounted for 4.15% of the complication.Conclusions: Puerperal period is as important as antenatal period. Anaemia, suboptimal personal hygiene as well as improper sterilization can resulted in severe health hazards such as septicemia, disseminated intravascular coagulation as well as death. So, risk factor should be treated vigorously.
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The neurons show remodeling in their dendritic arbor and spine/synapsenumber in many brain regions including the hippocampus, amygdala and the prefrontalcortex. The dendritic spine density is reported to be changed due to experiences andstressful conditions. The dendritic spines are the small protrusions arising from thedendritic shaft of the neurons. They have basic shapes as large mushroom spines, shortstubby spines and thin spines. The morphology of spines changes rapidly in response tovarious stimuli that may be internal such as hormones and external such as environmentalchanges. Dendritic spine density plays a major role in classification of principal neuronsi.e. multipolar and pyramidal neurons. The principal neurons may be classified as sparselyspinous, moderately spinous and heavily spinous on the basis of density of spine over thedendritic branches. In response to environment dendritic remodeling takes place in theform of spine shapes, spine turnover and spine density etc. Synaptic plasticity primarilytakes place in dendritic spines and enriched environment have positive effect while socialisolation have negative effect on synapse formation. Exposure of animals to environmentalcomplexity may improve the learning and memory by providing adaptive changes in thedendritic spine density.
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Background: Estrogen therapy in younger postmenopausal women is associated with a decisive reduction in morbidity and mortality, but estrogen use in this population is low because of risk of side effects. Weekly intermittent therapy is a more patient friendly approach with reduced pill burden increasing compliance and adherence as well as reducing side effects. Therefore, authors wanted to study the effect of weekly intermittent fixed dose estrogen and progesterone (ultra-low dose) supplements in hysterectomised surgically menopaused women.Methods: The present study was prospective and retrospective study. For retrospective study authors records of 100 hysterectomised women up to 45years of age with severe post-menopausal symptoms treated in authors Medicine Department of Hospital with once weekly MALA-D tablets were studied. For prospective study, all consecutive hysterectomised patients with severe post-menopausal symptoms attending medicine OPD were given once weekly MALA-D which contains ethinylestradiol 0.03mg and levonorgestrel 0.15mg tablets and followed up monthly with outcomes measured by Modified Kuppermann Index, visual analogue scale, and women’s health questionnaires.Results: Present retrospective study showed moderate degree of postmenopausal symptoms as indicated by Modified Kuppermann index of 19.57. Prospective study showed significant improvement in postmenopausal symptoms with weekly intermittent hormone replacement therapy as indicated by outcomes measured by Modified Kupperman index and Visual analogue scale. Women’s health questionnaire also showed statistically significant improvement in 6 out of 8 dimensions.Conclusions: Authors concluded that weekly estrogen progesterone hormone replacement therapy with mala-D tablet (ultra-low dose therapy) was 100% effective in relieving vasomotor symptoms and it is very effective in improving psychosomatic symptoms, urinary symptoms and quality of life with no obvious side effects and greater adherence.
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Background and objectives: According to the WHO, India is home to 12% of the world‘s smokers. More than 1 million die each year due to tobacco in India. Cigarette smoking is one of the most extensively used potentially hazardous social habits throughout the world. Material and method: The study was conducted on 150 normal asymptomatic healthy males. Out of which 75 were controls and 75 were cigarette smokers with age-group between 17-35 years. The association of cigarette smoking and raised blood cholesterol levels was studied. Results: The study showed, cigarette had raised concentration of serum total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol and had reduced levels of HDL cholesterol. Conclusion: We observed a dose response relationship between the number of cigarettes smoked and cardiovascular morbidity and mortality
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Squamous cell carcinoma of breast is a very aggressive, treatment-refractory tumor, with a poor prognosis. The case is being presented in view of the age of the patient for this extremely rare tumor of which histogenesis is unclear and biologic studies are urgently needed to find out relevant treatment targets. To the best of our knowledge no case of SCC of breast has been reported in 21 years of age.
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Solitary Osteochondroma is the most common benign bone tumor, and occurs most frequently in the proximal humerus, tibia, and distal femur. It rarely affects proximal femur and talus. Therefore, we report two cases of solitary osteochondroma, which were found at these rare sites (one at lesser trochanter and another at talus) with a brief review of literature and discussion of clinical features and management..
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Objective: To measure malondialdehyde in order to determine oxidative stress in rheumatoid arthritis and osteoarthritis subjects and comparing them with healthy individuals
Methodology Malondialdehyde estimation were done by using the UV-VIS spectrophotometer in the department of biochemistry SP medical college, Bikaner. Thiobarbituric acid assay method was used to estimate Malondialdehyde
Results: A statistically significant elevation of MDA level in serum of rheumatoid arthritis [RA]and osteoarthritis [OA] subjects was seen [p<0.0001]. The serum MDA level was also significantly increased in the subjects than in the controls. The serum MDA level was also significantly increased in the subjects than in the controls
Conclusion: Oxidative stress is due to increased free radical production which is the main mechanism in the pathogenesis of of RA and OA