Knowledge, Awareness, and Practices Among Patients with Thyroid Swelling Attending Cytology Clinic in a Medical College, Meerut.

Background: Thyroid disorders are believed to be a common health issue in India, as it is worldwide. However, there is a paucity of data on the knowledge, awareness, and practices (KAP) among these patients. Materials and methods: A crosssectional study was conducted in a medical college of Meerut, Uttar Pradesh. Total 200 patients were evaluated during the period from 2011 to 2012. Results: Total 200 patients with thyroid swelling were evaluated. Sixty percent patients did not know that thyroid is a normal gland in body while 50% did not knew about hyper/hypothyroidism. There are many misconceptions regarding thyroid disorders, such as 79.5% patients thought that hypothyroidism causes excessive weight gain. Conclusion: This study shows that patients with thyroid disorders lack knowledge. Education should take place at all levels and should include doctors and decision makers, health workers, and citizen groups. The results of this study will help the physician to concentrate on these specific issues during their interaction with the patients.

Osteogenesis imperfecta.

Osteogenesis imperfecta is an inherited disorder of the connective tissue. The extreme bone fragility seen in patients suffering from osteogenesis imperfecta pose a series of problems with regard to behavior management and rendering of quality dental treatment. Presented here a case of a four year old child suffering from osteogenesis imperfecta.

Odontogenic myxoma in a child: diagnostic and treatment dilemmas.

A rare case of odontogenic myxoma of the mandible in a 10 year old child has been reported and an attempt has been made to critically analyze the case as well as the diagnostic dilemmas related to myxomatous tumours to improve our knowledge and skills in their management.

Conformational study of peptides containing dehydrophenylalanine: helical structures without hydrogen bond.

The conformational behaviour of deltaZPhe has been investigated in the model dipeptide Ac-deltaZPhe-NHMe and in the model tripeptides Ac-X-deltaZPhe-NHMe with X=Gly,Ala,Val,Leu,Abu,Aib and Phe and is found to be quite different. In the model tripeptides with X=Ala,Val,Leu,Abu,Phe the most stable structure corresponds to phi1=-30 degrees, psi1=120 degrees and phi2=psi2=30 degrees. This structure is stabilized by the hydrogen bond formation between C=O of acetyl group and the NH of the amide group, resulting in the formation of a 10-membered ring but not a 3(10) helical structure. In the peptides Ac-Aib-deltaZPhe-NHMe and Ac-(Aib-deltaZPhe)3-NHMe, the helical conformers with phi = +/-30 degrees, psi = +/-60 degrees for Aib residue and phi=psi= +/-30 degrees for deltaZPhe are predicted to be most stable. The computational studies for the positional preferences of deltaZPhe residue in the peptide containing one deltaZPhe and nine Ala residues reveal the formation of a 3(10) helical structure in all the cases with terminal preferences for deltaZPhe. The conformational behaviour of Ac-(deltaZPhe)n-NHMe with n< or =4 is predicted to be very labile. With n > 4, degenerate conformational states with phi,psi values of 0 degrees +/- 90 degrees adopt helical structures which are stabilized by carbonyl-carbonyl interactions and the N-H-pi interactions between the amino group of every deltaZPhe residue with one C-C edge of its own phenyl ring. The results are in agreement with the experimental finding that screw sense of helix for peptides containing deltaZPhe residues is ambiguous in solution. The helical structures stabilized by hydrogen bond formation are found to be at least 3kCalmol(-1) less stable. Conformational studies have also been carried out for the peptide Ac-(deltaEPhe)6-NHMe and the peptide Ac-deltaAla-(deltaZPhe)6-NHMe containing deltaAla residue at the N-terminal. The N-H-pi interactions are absent in peptide Ac-(deltaEPhe)6-NHMe.

Designing of peptides with left handed helical structure by incorporating the unusual amino acids.

The conformational behaviour of delta Ala has been investigated by quantum mechanical method PCILO in the model dipeptide Ac-delta Ala-NHMe and in the model tripeptides Ac-X-delta Ala-NHMe with X = Gly, Ala, Val, Leu, Abu and Phe and is found to be quite different. The computational results suggest that in the model tripeptides the most stable conformation corresponds to phi 1 = -30 degrees, psi 1 = 120 degrees and phi 2 = psi 2 = 30 degrees in which the > C = 0 of the acetyl group is involved in hydrogen bond formation with N-H of the amide group. Similar results were obtained for the conformational behaviour of D-Ala in Ac-D-Ala-NHMe and Ac-Ala-D-Ala-NHMe. The conformational behaviour of the amino acids delta Ala, D-Ala, Val and Aib in model tripeptides have been utilized in the designing of left handed helical peptides. It is shown that the peptide HCO-(Ala-D-Ala)3-NHMe can adopt both left and right handed helix whereas in the peptide Ac-(Ala-delta Ala)3-NHMe the lowest energy conformer is beta-bend ribbon structure. Left handed helical structure with phi = 30 degrees, psi = 60 degrees for D-Ala residues and phi = psi = 30 degrees for delta Ala is found to be more stable by 4 kcal mole-1 than the corresponding right handed helical structure for the peptide Ac-(D-Ala-delta Ala)3-NHMe. In both the peptides Ac-(Val-delta Ala)3-NHMe and Ac-(D-Val-delta Ala)3-NHMe the most stable conformer is the left handed helix. Comparisons of results for Ac-(Ala-delta Ala)3-NHMe and Ac(Val-delta Ala)3-NHMe and Ac-(D-Ala-delta Ala)3-NHMe and Ac-(D-Val-delta Ala)3-NHMe also reveal that the Val residues facilitate the population of 3(10) left handed helix over the other conformers. It is also shown that the conformational behaviour of Aib residue depends on the chirality of neighbouring amino acids, i.e. Ac-(Aib-Ala)3-NHMe adopts right handed helical structure whereas Ac-(Aib-D-Ala)3-NHMe is found to be in left handed helical structure.

Quantitative enzymuria following aorto-renal angiography.

Quantitative estimation of urinary enzymes has been advocated as a more sensitive marker than conventional renal function tests to assess radio-contrast media induced nephrotoxicity. We studied 27 subjects with normal renal functions who underwent abdominal aortography for varied indications. Among these, 8 also required selective renal arteriography and 3 underwent arch aortography in addition. Sodium iothalamate was used as a radio-contrast medium and the average amount injected was 73 ml (45 to 120 ml) per subject. Standard renal function assessment including urinalysis, 24 hour urinary protein excretion, creatinine clearance done both before and after aortography did not show any significant alteration. Urinary excretion of tubular enzymes including leucine aminopeptidase (LAP), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT) and maltase (MAL) was estimated before and 2, 24 and 48 hours after aortography. All enzymes showed a significant rise at 2 hours. Urinary excretion of LAP, ALP and GGT peaked at 24 hours after aortography without a further change in MAL levels. Enzymuria returned to baseline values 48 hours following the procedure. It is concluded that an increase in the urinary excretion of the brush-border enzymes within 24 hours of contrast media administration may suggest an early nephrotoxicity.

Polyarteritis nodosa--a few unusual findings.

OBJECTIVE: To report the clinical spectrum of polyarteritis nodosa (PAN) from North India and highlight some unusual findings. DESIGN: Retrospective study. SETTING: Hospital based. SUBJECTS: Eight children with PAN. INTERVENTION: Treatment with prednisolone and cyclophosphamide. RESULTS: One child had spontaneous remission while another started deteriorating rapidly in spite of treatment and died within 2 weeks. Six children went into remission-of these one died, two were lost to follow-up and the remaining three are on regular follow-up for periods ranging from 3-5 years. CONCLUSIONS: Prednisolone and cyclophosphamide can significantly improve the outcome in childhood PAN.

Carcinoid tumor presenting as acute abdomen due to hemoperitoneum.

A patient presenting with massive hemoperitoneum due to a large retroperitoneal carcinoid tumor is reported.

Ultrasonographic localization for renal biopsy.

One hundred and fifty consecutive percutaneous renal biopsies were performed using ultrasonography to localise the site and depth of the lower pole of the left kidney. Renal tissue was obtained in 95% of cases and an accurate histopathological diagnosis was reached in 89% of patients. Gross haematuria following the procedure occurred in 6%, but was usually transient. No other complications were encountered. Ultrasonographic marking of the biopsy site and depth is a quick, simple, accurate and safe method of localizing the kidney for the purpose of a biopsy.

Ultrasound in obstructive jaundice.

One hundred and twenty-five consecutive patients with obstructive jaundice were prospectively studied by ultrasonography to determine the level and cause of obstruction. These were diagnosed precisely in 80 (72%) and 52 patients (41.6%) respectively. The results were compared with cholangiography. The final diagnosis was established at surgery (97 cases) and fine needle aspiration cytology (28 cases). While US is an excellent screening modality in distinguishing obstructive and non-obstructive jaundice, cholangiography is still the gold standard for determining the precise anatomic level and cause of obstruction.

Choledocho-duodenal fistula due to tuberculosis.

An unusual case of caseating nodal tuberculosis causing a choledocho-duodenal fistula is reported. Anti-tubercular treatment led to closure of the fistula.

Cholangiographically guided aspiration cytology in the management of malignant biliary obstruction.

Fifteen patients with malignant biliary obstruction were subjected to fine needle aspiration cytology (FNAC) under fluoroscopic guidance. Fourteen (93%) of them were correctly diagnosed to have a malignancy at FNAC. Simultaneous with FNAC or at a later date, all the patients underwent percutaneous biliary drainage with a drop in serum bilirubin from a mean of 23.2 mg/dl to 8.5 mg/dl. Ten patients were subjected to exploratory laparotomy and biopsy at which the diagnosis of FNAC was confirmed in nine of them. The tenth patient with a negative yield at FNAC had a 1.0 cm cholangiocarcinoma. The usefulness of FNAC combined with biliary drainage as an alternative to surgery is highlighted.