Reversible cerebral vasoconstriction syndrome a rare cause of post-partum headache: an anesthetic overview / Síndrome de vasoconstrição cerebral reversível, uma causa rara de cefaleia pós-parto: visão da anestesia

Abstract Reversible cerebral vasoconstriction syndrome is a cerebrovascular disorder leading to multifocal arterial constriction and dilation. Reversible cerebral vasoconstriction syndrome is possibly caused by transient deregulation of cerebral vascular tone. We report a rare case of a patient with chief complain of postpartum headache, was later diagnosed as a case of reversible cerebral vasoconstriction syndrome. A young full term primigravida with good uterine contraction admitted to labour room. Later she complained of leaking per vagina and on examination meconium stained liquor was noted. Caesarean delivery under spinal anesthesia was done and intra-operative period was uneventful. Both mother and baby were normal and shifted to postoperative ward and nursery respectively. In postoperative ward, mother complained of severe headache after 1 h and later developed seizure. Midazolam was given intravenously and was intubated and transferred to critical care unit for further investigation and management. Non contrast computerised tomography scan of brain showed right occipital intracerebral as well as subarachnoid bleed. CT angiography showed right vertebral artery narrowing without any other vascular malformation. Patient was managed in critical care unit for 2 days and then extubated and shifted to high dependency ward after a day observation and discharged 3 days later after a full uneventful recovery.

Resumo A síndrome de vasoconstrição cerebral reversível é uma doença cerebrovascular que leva à constrição e dilatação arterial multifocal. A síndrome de vasoconstrição cerebral reversível é possivelmente causada pela desregulação transitória do tônus vascular cerebral. Relatamos um caso raro de uma paciente com queixa principal de cefaleia pós-parto, posteriormente diagnosticada como um caso de síndrome de vasoconstrição cerebral reversível. A jovem primigesta a termo apresentando boa contração uterina foi internada em sala de parto. Mais tarde, a parturiente queixou-se de perda de líquido pela vagina e, ao exame, líquido amniótico manchado foi observado. O parto cesariano sob raquianestesia foi realizado, e não houve intercorrência no período intraoperatório. Tanto a mãe quanto o bebê estavam normais e foram transferidos para a sala de recuperação pós-operatória e berçário, respectivamente. Na sala de recuperação, a mãe queixou-se de forte dor de cabeça após uma hora e depois desenvolveu convulsão. Midazolam foi administrado por via intravenosa, e a paciente foi intubada e transferida para uma unidade de terapia intensiva para posterior investigação e tratamento. A tomografia computadorizada sem contraste do cérebro mostrou hemorragia intracerebral occipital direita e subaracnoide. A angiotomografia mostrou estreitamento da artéria vertebral direita, sem qualquer outra malformação vascular. A paciente foi tratada em unidade de terapia intensiva por dois dias e, em seguida, foi extubada e transferida para a ala de alta dependência onde permaneceu um dia em observação, recebendo alta hospitalar três dias depois, após uma recuperação completa e sem intercorrências.

Vaginal Bacterial Profile in Buffaloes Following Treatment with Progesterone Insert

The objective of this study was to characterize the vaginal bacterial flora and subsequent conception rates after AI in buffaloes subjected to 3 different estrous induction regimes-the use of CIDR and use of two intravaginal sponges (Polyurethane sponges with micronized progesterone and Polyurethane sponges with micronized progesterone with Carboxy methyl cellulose). The estrus induction was 100% in Group I and II followed by 91.67 % in group III. The pregnancy rates were Group I, II and III were 50.00, 66.67 and 54.55% respectively. All the vaginal swabs in all three groups yielded growth of bacteria and the predominance of mixed isolates over single isolates 81.94% vs 18.06% was indicative of dominance of mixed culture over single isolates. E. coli, Staphylococcus, Proteus and Klebsiela spp. were the commonest isolates obtained prior to insertion and after removal of implants in postpartum anestrus buffaloes. The gram positive bacteria were Staphylococcus, Streptococcus and Bacillus spp. while, gram negative bacteria were E. coli, Proteus and Klebsiella spp. These organisms could be considered as a part of the normal bacterial flora of the buffalo

Evaluation of Genetic Analysis of ESCHERICHIA COLI Isolated from Two Different Environmental Sources: Sewage Water Verses Soiled Bedding Materials of Laboratory Rodents

ABSTRACT The present investigation details an assessment of genetic relationship of E. coli isolates collected from two different environmental sources viz. sewage water and soiled bedding materials of laboratory rodents. Five sewage water samples were collected from the industrial area of Lucknow city and 5 samples of soiled bedding materials of laboratory animals were collected from Animal facility at CSIR-IITR, Lucknow. For this study Random amplified polymorphic DNA markers (RAPD) was chosen as the molecular fingerprinting method. In this study, 10 RAPD primers were used to evaluate the genetic similarity of E. coli. isolates. The RAPD-PCR fingerprints were analyzed and data were scored as 1, 0 matrix. The generated data were fed on Popgene software for calculating genetic diversity and creating dendrogram. The genetic similarity of 85% was recorded from soiled bedding materials and only 71% in sewage water samples in E.coli samples. The dendrogram based generation of clustering of E. coli isolates show two major clusters. Within major cluster sub-cluster were also observed which indicating diversity within isolates of E. coli. The RAPD-PCR based fingerprinting provided a rapid means of discriminating E. coli isolates and considered a relevant tool for molecular typing.

Socio-economic & demographic determinants of hypertension & knowledge, practices & risk behaviour of tribals in India.

Background & objectives: An increase in prevalence of hypertension has been observed in all ethnic groups in India. The objective of the present study was to estimate prevalence and determinants of hypertension among tribals and their awareness, treatment practices and risk behaviours in nine States of India. Methods: A community based cross-sectional study adopting multistage random sampling procedure was carried out. About 120 Integrated Tribal Development Authority villages were selected randomly from each State. From each village, 40 households were covered randomly. All men and women ≥ 20 yr of age in the selected households were included for various investigations. Results: A total of 21141 men and 26260 women participated in the study. The prevalence of hypertension after age adjustment was 27.1 and 26.4 per cent among men and women, respectively. it was higher in the states of Odisha (50-54.4%) and Kerala (36.7-45%) and lowest in Gujarat (7-11.5%). The risk of hypertension was 6-8 times higher in elderly people and 2-3 times in 35-59 yr compared with 20-34 yr. Only <10 per cent of men and women were known hypertensives and more than half on treatment (55-68%). Men with general and abdominal obesity were at 1.69 (CI: 1.43-2.01) and 2.42 (CI: 2.01-2.91) times higher risk of hypertension, respectively, while it was 2.03 (CI=1.77-2.33) and 2.35 (CI 2.12-2.60) times higher in women. Those using tobacco and consuming alcohol were at a higher risk of hypertension compared with the non users. Interpretation & conclusions: The study revealed high prevalence of hypertension among tribals in India. Age, literacy, physical activity, consumption of tobacco, alcohol and obesity were significantly associated with hypertension. Awareness and knowledge about hypertension and health seeking behaviour were low. Appropriate intervention strategies need to be adopted to increase awareness and treatment practices of hypertension among tribals.

A study of the geographical clustering of districts in Uttar Pradesh using nutritional anthropometric data of preschool children.

Background & objectives: Worldwide variations in human growth and its genetic and environmental factors have been described. In this study, an attempt was made to assess the morphological differences and similarities among under 5 year children of rural areas of Uttar Pradesh State in India, and to determine differences or similarities of body size among children living in diverse regions. Methods: For this purpose, a cross-sectional district nutrition profile study conducted during 2002-2003 was used. The data on 10,096 children drawn from 1080 villages in 54 districts were part of the district level Diet and Nutrition Assessment survey. The mean values for height and weight for 54 districts were taken as the input data for subsequent analysis. The data were first normalized by means of principal component analysis (PCA) and then K-means clustering was performed. Results: The PCA and cluster analysis yielded four distinguishable clusters or patterns in the anthropometric data of children. These clusters were ordered according to the average body size (weight and height) of children. The mean stature and body weight of these children in cluster I were 3.2 cm and 1.4 kg higher than those of cluster IV indicating differences between clusters. Also, the variations between clusters in their social, demographic, health and nutrition parameters were compared. Interpretation & conclusions: The use of PCA and cluster analysis methods and their merits in studying the Uttar Pradesh preschool children growth variations are discussed. These results helped in identifying the districts with higher prevalence of undernutrition and the contributing factors.

Diet and nutritional status of rural preschool children in Punjab.

OBJECTIVE: To assess diet and nutritional profile of rural preschool children of Punjab. STUDY DESIGN: Multistage random sampling method was adopted by following probability proportion to population size (PPS). SUBJECT: Four hundred households (HH) were covered in each district of Punjab for socio-economic and demographic information. All the available individuals from these HHs were included for anthropometry and clinical examination. Every fourth household was covered for 24-hour recall method of diet survey (individual dietary intake). RESULTS: At the state level, the intake of macro and micronutrient rich foods such as cereals, pulses and green leafy vegetables, milk and milk products and fats and oils were lower than the RDI among preschool children. Except for protein, calcium and thiamine, the mean intake of all the nutrients was lower than the recommended level. About a half of the preschool children (50.3%) were undernourished (> 2SD weight for age); 60% were stunted (> 2SD height for age) and 12% were wasted (> 2SD weight for height). The extent of undernutrition and stunting was lower than that reported for the country. There was significant variation in the prevalence of severe stunting between the districts (p < 0.001), with the highest being observed in the Rupnagar (55%) and the lowest in Hoshiarpur and Sangrur (30% each). CONCLUSION: Despite, the reported high rates of economic growth and food production in the state, a higher proportion of preschool children were consuming diets, which are inadequate with respect to energy, fat, iron, riboflavin, vitamin A and vitamin C. The prevalence of undernutrition was high as was found in other states.

Aspergillosis of the Lung Presenting as Hemoptysis.

Among mycotic diseases of the lung, pulmonary aspergillosis caused by aspergilloma fumigatus is the one encountered most frequently. An unusual case with a cystic lesion in the lung which turned out to be an aspergilloma is presented here.

Benign Hyperplasia of Prostate:A Correlation Between.

We evaluated 50 conscutive patients of benign hyperplasia of prostate admitted for surgery according to a standard protocol noting down specific details of history, physical examination and sonographic findings in each patient. All patients were operated upon via the transvesical route. Ultrasonography proved to be the be the best predictor of actual prostatic weight. Digital rectal examination seems to be a reasonably accurate method of assessment of prostatic size. Clinically the age of the patient, the severity of obstructive or irritative symptoms and the presence or absence of urinary retention do not correlate well with the size of the prostate. The severity of the symptoms of their duration proved to be poor predictors of eventual development of urinary retention. Due the presence of associated medical problems in these patients and with the advent of trans urethral resection of prostate ( TURP) and nonsurgical means of therapy, a proper preoperative assessment of size of prostate clinically and by sonography is recommended so as to assess the need and the type of surgery.

Horse-shoe Kidney-Approach to Treatment.

Horse-shoe kidney is a congenital anomaly which is associated with calculous formation and pelviureteric junction obstruction due to the abnormal lie of the pelvis and ureters. The patient presents as pain in abdomen, recurrent urinary tract infection, lump in abdomen, haematuria and pyuria. Division of the isthmus and simultaneous nephropexy corrects the lie of the pelvis and ureters and is recommended as the surgery for symptomatic horse-shoe kidney. If the pelviureteric junction is dependent and funnel shaped, simple nephropexy in lower polar diversion position will suffice but if there is high insertion of the ureter, some form of pyeloplasty is mandatory. A contralateral nephropexy, at a later stage, is also recommended.