A Study Of Clinical Profile And MRI Findings Of Patients Admitted In LG Hospital With New Onset Generalized Tonic Clonic Seizures

Background:Seizure is defined as a paroxysmal event due to abnormal, excessive, hyper synchronized discharge from central nervous system neurons. A generalized tonic clonic seizure is involuntary movements of all limbs that have a tonic phase followed by clonic muscle c ontraction. It has various underlying etiologies.It is a major public health concern in terms of burden of disease,nature of illness, and its impact on individual, family, and community.Objective: This study was performed to evaluate clinical profile and MRI findings of patients admitted in LG Hospital with 1st episode of generalized tonic clonic seizures (GTCS).Design: The study was cross sectional study conducted over a period of 1yr in AMC MET medical college, Ahmedabad.Material And Methods:The clinical profile and MRI findings of 50 patients with 1st episode of GTCS admitted in the medicine department of our hospital were analysed. Result:The most common age group affected was 18-30 yrs (56%), more commonly affecting males (54%). The most common presenting symptoms are uprolling of eyes (90%), followed by frothing from mouth (80%) and tongue bite (78%). AmongMRI findings, the majority of patients (78%) had normal MRI followed by infarct (8%) and tuberculoma (4%). Conclusion:The onset of GTCS occurs most commonly in early adulthood and both male and female genders are almost equally affected. The most common presentation is tonic clonic type of convulsion with uprolling of eyes, frothing from mouth and tongue bite. Majority of patients didn't have any co-morbidities and also had normal laboratory parameters and normal MRI findings. In patients with metabolic precipitating factors; most common was alcohol withdrawal, while in those with CNS cause, the most common MRI finding was infarct.

Impact of Migration on Epidemiology and Control of Leprosy

Migration has been a major influencing factor facilitating movement of disease between endemic and nonendemic areas. Both internal migration and global immigration contributes to spread to disease to nonendemic areas. This review discusses the findings of studies carried out all over the world regarding the role of migration in leprosy. It focuses on factors contributing to migration within the country, effect of migration on leprosy control programme, migration related factors adding to stigma and leading to administrative problems in leprosy control programmes. Migration of leprosy patients affects the opportunities to seek timely treatment at other places due lack of leprosy treatment facilities or awareness among the users. This review analyses the published studies available in PubMed and news articles related to migration in Leprosy. Out of total 2506 search results, only 18 were found to be relevant. In these studies migration has been identified as one of the important obstacles in achieving elimination of leprosy as the affected individuals may continue to spread the disease and themselves may suffer from disabilities with social consequences. The review also finds paucity of scientific studies carried out to study the role of migration in leprosy at present. There is clear need to focus on in depth studies on this aspect in the contemporary scenario for achieving the goal of world without leprosy.

Study Of Sex Determination By Presence Of Sex Chromatin In Oral Mucosal Cells

Introduction: In oral smear, a small condensed mass of sex chromatin usually located just inside the nuclearmembrane of the nucleus is called Barr body. The study of Barr bodies is advantageous for sex determination bypresence or absent. Oral mucosal smear of 150 students (79 female students and 71 male students in the agegroup of 17 to 32 years) from P.D.U. Govt. medical college, Rajkot were selected with aim to study oral mucosalcells for presence of sex chromatin in oral mucosal smear and to measure efficacy of oral smear in determinationof sex by presence of sex chromatin during 2012 to 2014.Method: Oral smear was prepared for sex determination by scrapping buccal mucosa with wooden spatula andobtained turbid suspension, these were smeared on a glass slide, fixed by mixture of Methanol and Glacialacetic acid in the ratio of 3:1 for 10 min and stained by Carbol Fuschin for 15-20 min at room temperature, aftertaking informed written consent from students. Smears were examined with Compound light uniocular microscopeunder 100x magnification (Oil immersion), cells and nuclei were easily identified.Observations and Results: One hundred cells were counted in each slide. Mean value of Barr body positive cellsin male was 0.647 and Mean value of Barr body positive cells in female was 35.215 and range of percentage ofBarr body positive cells in male was 0-5% and range of percentage of Barr body positive cells in female was 0-55%. Presence of sex chromatin in oral mucosal cell of female was statistically significant. (P value < 0.05).Conclusion: Mean value of Barr body positive cells in male was 0.647 ± 1.148, Mean value of Barr body positivecells in female was 35.215 ± 10.28, range of percentage of Barr body positive cells in female was 0-55% and rangeof percentage of Barr body positive cells in male was 0-5%. Presence of sex chromatin in oral mucosal cell offemale was statistically significant. (P value<0.05) Mean values of sex chromatin positive oral mucosal cells ofmale was lower than mean value of sex chromatin positive oral mucosal cells in female, that is the supportingfact that sex chromatin is present in female in higher frequency. Sex chromatin can be used as simple and easilyavailable method for sex determination.

Knowledge, attitude and practice (KAP) of general population of Vadodara towards diabetes mellitus

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level.

Dendrimer: a novel approach for drug delivery systems.

Dendrimers are hyper-branched macromolecules having tree like structure, consisting of a core molecule and alternating layers of monomers. So they can be synthesized by divergent and convergent growth methods. During synthesis, properties of dendrimers like dendrimer size, molecular mass, surface group can be controlled and configured to the desired need. Dendrimers have the ability to encapsulate and bind the guest molecule can be used for solubility enhancement, sustained release and various drug delivery applications. The reflections on biomedical and industrial applications of dendrimers given in this report clearly demonstrate the potential the class of polymer architecture and indeed substantiate the high hopes for the future of dendrimers.

Practice of stereotactic body radiotherapy in a developing country: Perception, aspiration, and limitation ‑ A survey.

BACKGROUND: Stereotactic body radiotherapy (SBRT) is an effective and established modern technology now used more commonly. Radiation oncology personnel’s (ROP) opinion toward SBRT in the developing countries like India is unknown. SUBJECTS AND METHODS: A 30 question survey evaluating ROP’s profile, technological details, and SBRT’s perceptive were seeked. Tata Memorial Center – ROP’s email database was used. RESULTS: Survey questionnaire was emailed to 500 ROP’s and 224 ROP’s were contactable. Majority of the responders were from corporate hospitals and half of responders had experience of 5 or more years of experience in radiation oncology. SBRT was practiced by 70% of responders and the majority had adopted SBRT in 2010 or later. Quick turn around time, high dose delivery and competitive market forces were major factors to adopt SBRT. Lung was the most common site practiced followed by prostate, spine, and liver. All SBRT users were keen to increase SBRT in practice and the majority of non‑responders were planning to adapt SBRT in the recent future. Almost half of SBRT users were willing to share data and expertise for training others. Lack of infrastructure was the prime reason for not practicing SBRT. ROP’s perceived physics, radiobiology as the biggest challenge in SBRT. International collaboration may be helpful. CONCLUSION: Use of SBRT is expected to increase in India. Limited experience with lack of infrastructure in public funded centers is a major limitation. Unmet need of infrastructure, training and guidelines is enormous and formulation of Indian SBRT consortium will help reforming at all levels.

Prevalence of anemia in patients with Type 2 Diabetes Mellitus at Gandhinagar, Gujarat, India

Introduction: Anemia is a common finding in diabetes. Number of factors contributes to an increased prevalence of anemia in diabetes. Aim: To determine the prevalence of anemia in our patients with diabetes. Material and methods: The present study was conducted at the Gayatri Hospital, Gandhinagar. The subjects for the study included 200 adult patients with age more than 30 years and having diabetes mellitus type 2, attending the outdoor patient department (OPD) or admitted in ward as indoor patient department (IPD) of Gayatri Hospital. Blood specimens were collected and processed for determination of blood glucose, serum creatinine, and hemoglobin, HbA1C. Results: Anemia was present in 18% patients of diabetes. The prevalence of anemia was almost similar between women (18.60%) and men (17.54%). 74% of anaemic patients had a serum creatinine <110 μmol/l and 72% of anaemic patients had a calculated creatinine clearance of >60 ml/min. Conclusion: Every fifth individual in a population of diabetes mellitus could be anemic. Identifying and treating anemia would make a great impact in managing various complications of diabetes mellitus.

Perceptions of patients towards euthanasia A medico-legal perspective

Background: Euthanasia is a matter of debate since its origin and till now. Few countries have proper legislation for the same while in India, the matter is always remain unnoticed. Present study was aimed to analyze perceptions of patients towards euthanasia. Materials and methods: A cross sectional study was conducted among 107 patients after obtaining their informed written consent for participation in the survey regarding euthanasia and its medicolegal perspectives. All patients were subjected to pre-tested and validated questionnaire (Likert type scale) related to euthanasia after obtaining their socio-demographic details. Results: Out of 107 responses, only 100 responses were considered for analysis and rest of 7 were discarded. Out of 100 patients, maximum (33%) were in between 31 to 40 years of age, 66% were male, 82% were Hindu, and 71% were married. 51% were agreed that person should be kept alive as long s possible regardless of his age, disease, disabilities and personal preferences. 40% believed that supporting death with dignity means supporting active and passive euthanasia. 61% suggested that freedom of choice also applicable to freedom of choice to live or die. 55% disagreed that some patients should be allowed to die instead of making heroic efforts to prolong their lives. 73% believed that demanding or helping in euthanasia is crime. 52% were unsure regarding legalization of euthanasia. 78% believed that legalization of euthanasia may create moral and ethical problems. Conclusion: Perceptions of patients were varied but conclusion can be drawn that many of them believed that legalization of euthanasia may create moral and ethical problems.

Consent in medical practice Perceptions of patients towards legal aspects of informed consent.

Background: Informed consent is way of providing necessary information to the patients and helping them for decision making. All the pros and cons of procedure must be explained to the patients in the language he or she can understand. Just taking signature of patient on consent form without proper explanation and understanding of him is violating entire process of informed consent. Materials and methods: A cross sectional, observational study was conducted over 121 patients aged 18 years and above who came to Gayatri Hospital, Gandhinagar after obtaining their informed written consent for participation in survey regarding informed consent. All participants were subjected to pretested and validated questionnaire (Likert type scale) regarding legal aspects of informed consent. Results: Out of 121 participants, only 100 participants’ responses were included for analysis. Among 100 participants 73 were male and 27 were female. 78% agreed that informed consent is must for any procedure. 61% agreed that signing consent form is just a formality. 91% believed that informed consent is protective shield for doctors. 88% believed that informed consent is legally necessary. Only 52% agree that consent form is meant to protect patients’ rights. 77% felt that signing consent form Parmar P, Rathod GB, Rathod S, Parikh A. Consent in medical practice – Perceptions of patients towards legal aspects of informed consent. IAIM, 2016; 3(4): 105-110. Page 106 eliminate patients’ right to compensation. 82% wanted to know everything but letting decision left on doctor. Conclusion: The study concluded that there is a vide gap between actual concept of informed consent and perceptions of patients for the same. Patient awareness programs must be conducted by appropriate authority with help of media and television to improve their knowledge and preserve their rights.

Thymoma: First large Indian experience.

BACKGROUND: Thymoma is the most common tumor of the anterior mediastinum. Surgery is mainstay of treatment, with adjuvant radiation recommended for invasive thymoma. Because of rarity, prospective randomized trials may not be feasible even in multicentric settings hence the best possible evidence can be large series. Till date Thymoma has not been studied in Indian settings. MATERIALS AND METHODS: All patients presenting to Thoracic disease management group at our Centre during 2006‑2011 were screened. Sixty two patients’ with histo‑pathological confirmation of thymoma medical records could be retrieved and are presented in this study. Mosaoka staging and WHO classification was used. The clinical, therapeutic factors and follow up parameters were recorded and survival was calculated. Effects of prognostic factors were compared. RESULTS: Sixty two patients were identified (36M, 26F; age 22‑84, median 51.5 years) and majorities (57%) of thymoma were stage I‑II. WHO pathological subtype B was most common 30 (49%). Mean tumor size was smaller in patients with myasthenia (5.3cm) than the entire group (7.6cm). Neoadjuvant therapy was offered to five unresectable stages III or IV a patient’s with 40% resectability rates. Median overall survival was 60 months (Inter quartile‑range 3‑44 months) with overall survival rate (OS) at three year being 90%. Resectable tumors had better outcomes (94%) than non resectable (81%) at three years. Mosaoka Stage was the only significant (P = 0.03) prognostic factor on multivariate analysis. CONCLUSION: This is first thymoma series from India with large number of patients where staging is an important prognostic factor and surgery is the mainstay of therapy. In Indian context aggressive multimodality treatment should be offered to advanced stage patients and which yields good survival rates and comparable.

Determination of sex from the anterior border of the human hip bone.

Background: The distinctive biometry of the anterior border of the human skeleton and its clear sexual dimorphism make it of interests from anatomical, forensic, obstetrical, radiological, archaeological and anthropological point of view for examination of skeleton remains. Aims & Objective: To determine the sex of human being from the anterior border of the hip bone. Material and Methods: For the present study total 306 normal dry human hip bones, out of which 202 are of male and 104 are of female, 141 are of Right side, 165 of Left side were studied. Osteometric board with graph paper and Sliding Vernier Calliper are used for all measurement. Results: Statistically highly significant(P ≤ 0.001) differences were detected between means in relation to sex for 6 variables ( The maximal width of the anterior border notch, The distance from the anterior superior iliac spine to the pubic tubercle , The distance from the anterior inferior iliac spine to the iliopubic eminence , The distance from the anterior inferior iliac spine to the pubic tubercle , The length of the notch between the anterior inferior iliac spine and the iliopubic eminence, The depth of the notch between the anterior inferior iliac spine and the iliopubic eminence), Statistically very significant differences(p≤0.005) were detected between means in relation to sex for 2 variables( Index of widening of the anterior interspinous notch, The depth of the anterior interspinous notch), Statistically significant differences(P≤.01) were detected between means in relation to sex for 1 variable (Index of widening of the notch between the anterior inferior iliac spine and the iliopubic eminence). These variables could be used for sex determination from the human hip bone or its fragments. Conclusion: Therefore we consider that these 6 variables are the best of the variables studied for sexing human hip bone (P < 0.001).

The study of total facial index in living subjects in Gujarat region.

Background and objectives: The total facial index exhibits sexual differences and different shapes of face. This information will be highly important for Plastic surgeons, Forensic Scientists, Anatomists, Human Biologists, Criminologists & Physical Anthropologists.Method: The present study was performed on 510 living subjects of Gujarat (243 male and 267 female) of 18 to 30 years in the year of 2011 with the objective to study the sex differences in total facial index. Total facial index was investigated with the help of face height and width with the use of sliding caliper.Result: The study showed that mean face height and width were higher in males than in females, and mean total facial index was also higher in males than in females. Interpretation and conclusion: Predominant face type in males was mesoproscopic while in females was euriproscopic and there was statistically highly significant gender difference.

The study of cephalic index in living subjects in Gujarat Region.

Background and objectives: The cephalic index exhibits sexual differences and different shapes of head. This information will be highly important for Plastic surgeons, Forensic Scientists, Anatomists, Human Biologists, Criminologists & Physical Anthropologists.Method: The present study was performed on 510 living subjects of Gujarat (243 male and 267 female) of 18 to 30 years in the year of 2011 with the objective to study the sex differences in cephalic index. Cephalic index was investigated with the help of head length and width with the use of spreading caliper.Result: The study showed that mean head length and width were higher in males than in females , while mean cephalic index was higher in females than in males. Interpretation and Conclusion: Predominant head type was mesocephalic in both sexes and there was no significant gender difference (p value > o.o1).

Anthropological study of the foot and it’s relationship between different parameters and stature in an adult population of different areas of Gujarat.

Background And Objectives: The study has been done to find out correlation between different parameters of foot. The aim and objective are to develop a model to reconstruct a stature from foot breadth. The study is carried out in 285 asymptomatic healthy adults 149 Males and 136 Females between 18-23 years of age, belongs to different region of Gujarat. Materials And Methods: Foot breadth and foot length were measured with sliding calliper and stature was measured by a standard anthropometer rod in erect anatomical position. Observation And Results: Obtained data was statistically analysed, and a significant correlation of stature was observed with foot breadth and foot length with foot breadth on both Rt. And Lt. side in males and females. Linear regression equations were derived to calculate foot length and stature from foot breadth. Interpretation And Conclusion: A highly significant correlation coefficient (p-value 0.0000) has been found between different parameters of foot on both Rt. and Lt.side in males and females. So stature can be more accurately calculated by foot breadth than long bones. The findings are useful to anatomists, criminologists, human biologist and forensic medicine experts.

A study of palmar dermatoglyphics of pulmonary tuberculosis patients in Bhavnagar District.

Dermatoglyphics, the ridged skin covering our palms and sole, are not only found on human beings. All primates have ridged skin, and it can also be found on the paws of certain mammals and on the tails of some monkey species. Palmar creases develop during the 2nd and 3rd month of intrauterine life and are not influenced by movement of hand in utero. They are of considerable clinical interest because they are affected by certain abnormalities of early development including genetic disorders. In the present study 100 patients of pulmonary tuberculosis (sputum smear positive) were collected from the department of TB & Chest diseases, Government Medical College, Bhavnagar (Gujarat) and from DOT centers of Bhavnagar. Out of 100 cases, (77 males and 23 females) are of pulmonary tuberculosis (sputum smear positive). There was no statistically significant difference observed in finger print pattern in between male & female and total cases and control in this study.

A study of palmar dermatoglyphics in leprosy in Bhavnagar District.

Dermatoglyphics, the ridged skin covering our palms and sole, are not only found on human beings. All primates have ridged skin, and it can also be found on the paws of certain mammals and on the tails of some monkey species. The drag against the ridges when feeling the texture of a surface heightens the intensity of stimulation of the nerve endings. The sample consists of 100 cases of leprosy in the age group of 18 to 60 years. Fingerprints and palm prints were taken, using the Ink and Pad method, described by Harold Cummins and Midlo. The dermatoglyphics of 100 leprosy cases are studied in the age group of 18 to 60 year. All cases are selected from Bhavnagar district & Taluka places of Bhavnagar District. Out of 100 cases 70 Case of Multibacillary type, (40 Male & 30 Female) and 30 case of Paucibacillary type (16 Male & 14 Female) are compared with the control of different age group 18 to 60 years, (74 Male & 26 Female). there was no statistically significant difference observed in finger print pattern and in between male & female in present study in MB, PB and control.

Measurement of ulnar length for estimation of stature in Gujarat.

In this study, an attempt has been made out to formulate a linear regression equation for estimation of stature from the ulnar length. The material consists of 310 subjects between 20-40 years of age in Gujarat. The Ulnar (Rt. & Lt.) length was measured by spreading caliper. The Stature ( Height ) was measured in standing erect, anatomical position with standard height measuring instrument. Data tabulated and statistically analyzed using Microsoft excel. A good correlation of stature was observed with Ulnar length and it was statistically highly significant. The results of present study would be useful for Anthropologist and Forensic Medicine experts.

Multicentric morphometric study of dry human sacrum of Indian population in Gujarat Region.

Sacrum is a large triangular bone. It is formed by fusion of five sacral vertebrae and forms the caudal region of the vertebral column. It forms posterosuperior wall of the pelvic cavity wedged between the two hip bones. The present study is undertaken to test the validity of the parameters by which it may be possible to know detail morphometry of sacrum and sacral hiatus. The material for the present study consists of 150 adult sacrum of unknown sex. The measuring was done on intact parts of normal bones. Bones showing wear and tear, fracture or any pathology were not considered. Each linear recording was taken to the nearest millimeter. shape and length of the sacral hiatus, level of apex and anteroposterior depth at apex, level of base and transverse width at base were measured with the help of vernier calipers, recorded, tabulated and analyzed. Significant findings in the present study are high, 83 (55.33%) bones showed narrowed sacral canal at the apex (0-3mm), where as previous studies reported 15.6%. This should be kept in mind while applying caudal epidural anaesthesia in Gujarati population.

Morphometric study of greater sciatic notch of dry human hip bone in Gujarat region.

The distinctive morphology of human skeleton and its clear sexual dimorphism make it of interests from anatomical, forensic, obstetrical, radiological and anthropological point of view. 100 known sex normal dry human hip bones obtained from Medical College Bhavnagar, 168 known sex normal dry human hip bones from BJ Medical College, Ahmedabad and Smt. NHL Municipal Medical College, Ahmedabad were studied the year of 2005-06. The posterior segment of Greater Sciatic Notch, Genoves’ sciatic notch index and posterior angle are found to be significant by t test (P < 0.001). The posterior angle of greater sciatic notch was found to be highly significant for determination of sex of hip bone.