Central retinal artery occlusion: an unusual complication of snakebite

Snakebites are endemic in some parts of India, being associated with a number of complications. Ocular disturbances are rare, except for injury to the cornea or conjunctiva when the eye is directly exposed to the venom. In this work, we present a case of central retinal artery occlusion caused by snakebite.(AU)

Attitude of teachers towards teaching.

INTRODUCTION: Teaching is an art and the quality of teaching depends on the love, dedication and devotion of the teacher towards the subject of the knowledge. The quality of any teaching programme cannot rise above the quality of its teachers. In medical colleges it is the teacher who is responsible for influencing a student's learning of the subject. METHODS: We assessed the attitude of 31 teachers working at MGIMS. Twenty one of them were of the rank of Reader and above and had more than five years teaching experience. Ten were of the rank of lecturers with three years of teaching experience. The assessment was done by a likert type scale containing 20 items on various aspects of teaching. All the participants were given the scale and requested to mark the agreement or otherwise on a scale i.e. strongly disagree, disagree, cannot say, disagree, strongly agree. OBSERVATION AND CONCLUSION: The mean score was 3.808, which indicates a positive attitude. There was not much difference in attitude of teachers in different group. Thus indicating that our study group has predominantly positive attitude for most of the items. This positive attitude helps the teachers to be role model for the future generation of students.

Seasonal variations in incidence of severe and complicated malaria in central India.

The geographical position and climate of India is favorable for the transmission of malarial infection. The maximum prevalence of malaria in most parts of India is from July to November months. Rainfall provides mosquitoes, a breeding ground giving rise to epidemics. We studied the seasonal variation in cases of severe and complicated malaria presenting at MGIMS, Sevagram, Wardha (Vidarbha region in Maharashtra) over a period of three years. The findings of peak of malaria observed during September-November during three years period points to the fact that the increase in vector breeding after rainy season is responsible for the upsurge in the malarial cases during these months. This also indicates that this area (Vidarbha) has an unstable transmission of malaria.

Role of oxygen free radicals in causing endothelial damage in acute myocardial infarction.

OBJECTIVES: This work was done in order to study the oxidant and anti-oxidant status in a disease resulting from endothelial injury. The disease selected for study was acute myocardial infarction. METHODS: Sixty patients of acute myocardial infarction were selected after being diagnosed in accordance to the guidelines laid down by the WHO. Thirty subjects were included as controls. Plasma levels of certain markers of oxidative stress and anti oxidant activity were measured in all the subjects. Malonaldehyde (MDA) and nitrite (NO2) were measured as markers of free radical mediated endothelial injury, and superoxide dismutase (SOD) enzyme as an indicator of antioxidant activity. RESULTS: It was found that the plasma levels of MDA and nitrite were significantly elevated in the patients of acute myocardial infarction compared to the control group (7.29 +/- 3.28 v/s 4.57 +/- 0.63 nmol/ml and 12.85 +/- 8.71 v/s 0.97 +/- 0.25 microM respectively), thereby indicating that oxygen free radicals cause endothelial damage in them. The superoxide dismutase levels were also found to be elevated in these patients (5.57 +/- 1.47 v/s 3.91 +/- 0.66 U/ml). CONCLUSION: These results indicate that acute myocardial infarction is a state of enhanced free radical activity, which causes endothelial damage. The elevated SOD levels may imply that the body attempts to combat this oxidative stress by raising it's level of anti-oxidants.

Spontaneous bacterial peritonitis in liver cirrhosis with ascites.

OBJECTIVE: The study was designed to elucidate the correlation of spontaneous bacterial peritonitis (SBP) with aetiology of liver cirrhosis, overall mortality, ascitic fluid and systemic microbial infections. METHODS: Sixty three patients with cirrhosis of the liver were included in this study. These patients were diagnosed on the basis of clinical evaluation, biochemical investigation, ultrasonography, ascitic fluid examination for protein, cells, pH, and bacterial culture. RESULTS: SBP developed in 22 (34.92%) patients of cirrhosis. Culture positive SBP was present in 18 (81.81%) and culture negative neutrocytic ascitis (CNNA) in 4 (18.18%). In the culture positive group, 14 (77.7%) patients had monomicrobial bacterascites (MNB), the commonest organism being coagulase positive Staphylococcus aureus eight (44.44%) followed by E. coli (22.22%). Only 4 (22.22%) had infection by more than one organism. Direct bed side inoculation of ascitic fluid into blood culture bottle was a better method for bacterial yield than the conventional method of ascitic fluid culture (81.8% vs. 18.2%). Only 22.8% patients with SBP had ascitic fluid protein less than 1 gm%, ascitic fluid pH < 7.3 and polymorphonuclear cell count > 250/cmm. CONCLUSION: Spontaneous bacterial peritonitis is common complication in Child Pugh class C cirrhosis. Alcoholic cirrhosis with SBP carries high mortality than their non-alcoholic group. The most common organisms isolated were coagulase positive Staphylococcus aureus followed by E. coli.

Interobserver variations in clinical signs for diagnosis of pleuritis.

A study was conducted on 150 patients admitted in a teaching hospital to find out reliable clinical signs for diagnosing pleuritis. Cases were selected based on suspicion of pleural involvement by history and examination. Final diagnosis was made by correlations with radiographic and ultrasonographic reports. Reliability of the signs was determined on the basis of high concordance of independently observed variations between two medical consultants. Inflammatory involvement of pleura was seen in 69.3% cases and 30.7% were due to oedema disorders. Concordance between observers was high for crepitations (95.5%) and pleural rub (93.8%) followed by vocal resonance (87.6%), dull percussion note (76.9%) and mediastinal shift (76.9%).

The prevalence of hypertension in rural population around Sevagram.

To detect the prevalence of hypertension in an asymptomatic rural community from Central India, we screened 4045 subjects (2247 men and 1798 women) aged 20 and beyond. The prevalence of hypertension was 34.12 per thousand population, being higher in women (40.60 per thousand) than in men (28.92 per thousand). Level of physical activity, economic status, smoking and body mass index showed real association with hypertension.

False positive ECG and coronary heart disease.

In 1983, we carried out a cross-sectional, rural community based study and highlighted an abysmally low prevalence of probable coronary heart disease in resting electrocardiogram. A seven year follow-up (1983-1990) of 179 suspects showed no morbidity or mortality from coronary heart disease. Eighty one out of 98 suspects tested negative on a symptom limited maximal exercise test. Though seventeen suspects had an asymptomatic exercise-induced ST depression (> 1.0 mm) their haemodynamic response to exercise and effort tolerance was excellent. Of the twelve subjects who took a repeat exercise test six months later, eleven failed to show ST depression on exercise. We attribute the false positivity of exercise test and its poor reproducibility to labile electrocardiographic changes unmasked by exercise.

M-mode echocardiographic diagnosis of left ventricular hypertrophy.

To assess the utility of various primary and derived M-Mode Echocardiographic parameters for the purpose of defining left ventricular hypertrophy (LVH), 74 subjects with LVH were subjected to M-mode echocardiographic examination. It was concluded that except for cross sectional area, the other echocardiographic parameters performed too poorly to be of any clinical utility for defining LVH by echocardiography.

Evaluation of clinical variables as predicators of left ventricular function in acute myocardial infarction.

In 43 rural patients, all survivors of acute Myocardial infarction, left ventricular function was studied by 2-D echocardiography and evaluated in relation to 18 clinical predictors of left ventricular function. The mean left ventricular ejection fraction (LVEF) was 41.53 +/- 12.92% as compared to 70.02 +/- 7.02% in 506 healthy controls. LVEF was dichotomised at < 40% (n = 24) and > 40% (n = 19). Out of various clinical variables analysed following were found to be strong predictors of low LVEF. S3 gallop (p < 0.001) pulmonary rates (p < 0.001); Creatine phosphokinase > 200 I.U. (p < 0.001); Cardiomegaly on X-ray (p < 0.001); pulmonary congestion on chest X-ray (p < 0.001); and proportional pulse pressure (p < 0.001). There was a stepwise decline in the LVEF for each additional clinical variable. The over all predictive accuracy was 90%. It is concluded that readily obtainable clinical variables provide a useful bedside method of estimating LVEF after acute myocardial infarction.

Left ventricular M-mode echocardiographic measurements of Indian population.

The left ventricular dimensions of 506 normal healthy subjects (men = 317, women = 189) in the age group of 17 to 80 years were measured echocardiographically. The measurements were found to differ significantly from the western data. A separate limit for left ventricular echocardiographic parameter for the normal Indian population was established.

Left ventricular mass by M-mode echocardiography.

A comparison of various M-mode echocardiographic methods for assessment of left ventricular mass (LVM) was done in 21 subjects. The anatomical LVM was taken as Standard; it varied from 64.55 to 341.82 g. Of the six different M-mode echo methods compared, the method of Devereux and Reichek (1977) was found to correlate best with anatomical LVM (r = 0.99; SD = 49.54). By this method LVM = 1.4 [(LVIDd + LVPWTd + IVSTd)3 - (LVIDd)3] - 14 g.

Left ventricular muscle mass by echocardiography: methodology.

The limitations of electrocardiography for diagnosing left ventricular hypertrophy (LVH), due to unacceptable accuracy and lack of serial quantifications, are well known. The use of angiocardiography for LVH assessment is invasive, hazardous and costly. Echocardiography provides an excellent method of estimation of left ventricular muscle mass, which is simple, non-hazardous, accurate and reproducible.

Haemorheological treatment of painful sickle cell crises. Use of pentoxifylline.

A variety of drugs have been tried, with little or no benefit, to prevent and treat painful crises in patients with sickle cell anaemia. The new drug pentoxifylline, which has the ability to alter red cell flexibility, was tried in nine patients with painful vaso-occlusive crises. Another nine matched patients served as control. While no patient in the control group improved, five patients in the pentoxifylline group responded favourably within 48 hours. We conclude that pentoxifylline may be useful in patients with acute painful vasoocclusive crises due to sickle cell anaemia.

Clinical profile of irritable bowel syndrome at a rural based teaching hospital in central India.

In a study of 52 patients with irritable bowel syndrome preponderance of males (4.2:1) and young adult age group (20-29 years) was observed. Distinct spastic colon and functional diarrhoea constituted 60%, whereas 40% had mixed presentation. Abdominal pain commonly in the umbilical and splenic flexure region, relieved after defaecation, and rectal dissatisfaction were the common symptoms. Upper gastrointestinal symptoms were present in 25% of patients.

Left ventricular mass in normal Indian population.

A prospective study was conducted to ascertain the distribution of the left ventricular mass in normal adult Indian population and to establish the upper limit of the same. Four hundred and eighty normal subjects (men = 310; women = 170), in the age group of 18 to 60 years were screened echocardiographically, to estimate the left ventricular mass. The left ventricular mass in men was found to be 124 +/- 32 gm whereas in women it was 93 +/- 37 gm. The upper limit of the left ventricular mass (mean +/- 2 SD) was found to be 189 gm and 167 gm, for men and women respectively. The left ventricular mass in both men and women correlated with the body weight (r = 0.51, p less than 0.001; r = 0.22, p less than 0.001), height (r = 0.27, p less than 0.001; r = 0.22, p less than 0.01), and the body surface area (r = 0.49, p less than 0.001; r = 0.27, p less than 0.001), whereas it was found to be independent of age (r = 0.01, p = NS; r = 0.10, p = NS). In men alone the diastolic blood pressure influenced the left ventricular mass (r = 0.27, p less than 0.001), otherwise the left ventricular mass was independent of systemic blood pressure variations within the normal range. The left ventricular mass in the present study differs significantly from the Western population.