Clinical evaluation of cases of lower genitourinary tract trauma with special reference to primary realignment in cases of posterior urethral distraction defect

Background: The exact management strategy for lower genitourinary tract trauma remains controversial. Primary realignment with/without suprapubic catheterization provides definitive procedure with low complications and avoids the need for further open surgeries.Methods: This was a prospective longitudinal study done on 31 cases with different complaints related to lower tract genitourinary trauma. All patients underwent suprapubic catheterization and/or primary realignment. The outcome was measured in the terms of time for discharge, urinary incontinence, stricture formation, erectile dysfunction and impotence.Results: Maximum proportion of patients with lower genitourinary injuries in the study was in 10-20 years age group (48.4%). Blunt trauma was accounted for 93.6% of lower genitourinary injuries. Road traffic accidents were the most common cause (90.32%) of lower genitourinary injuries. Urinary bladder injuries accounted for 41.9% of all lower genitourinary injuries. Blood at meatus is present in only about half of the significant urethral injuries. Primary realignment of urethral injury results in lesser duration of hospital stay (9.24±2.44 days), shorter length of suprapubic catheterization (11.67±4.78 days) and early spontaneous voiding (40.93±15.79 days). The stricture rate following primary realignment is low (31.25%). Erectile dysfunction was noted only in two patients (16.6%).Conclusions: Management of traumatic urethral disruption by primary realignment serves as ultimate therapy in majority of patients.

Prospective randomised study of cases of pelvic fracture urethral distraction defects managed by early alignment versus initial suprapubic urinary diversion with delayed urethroplasty

Background: In complex pelvic fracture urethral distraction defects (PFUDD), early management prevents incidence of devastating complications such as urinary incontinence, restenosis and urethra cutaneous fistula. The aim of the present study was to study the outcome of patients with PFUDD undergoing early alignment (either by rail roading or endoscopic) compared with initial suprapubic urinary diversion with delayed urethroplasty.Methods: This was a prospective randomized study done at KGMU, Lucknow; having PFUDD during the period from June 2014 to July 2017. Patients with PFUDD were randomized in to two groups. Group A included 22 patients and managed by supra pubic cystostomy followed by delayed urethroplasty. Group B included 23 patients and managed by primary alignment by rail-roading and early endoscopic alignment. Patients were followed up after 6 weeks, 3 months and 6 months for measuring the primary and secondary outcomes during follow up.Results: The most common age group that sustained pelvic fracture urethral distraction defects injury are male of 21-40 years. In group A, stricture was present in all patients at 6 weeks post-surgery. Open urethroplasty was done at 3 months in 60% and 10% patients at 6 months.  In group B, stricture was present in 80% at 6 weeks, 40% at 3 months and 10% at 6 months. The incidence of ED in group A at 6 weeks, 3 months, was 25% patient which reduced to 20% at 6 months. In group B, ED was present in 30% patients 6 weeks, 3 months and which reduced to 25% at 6 months. No incontinence was observed in both groups.Conclusions: Primary realignment has significant benefits compared to SPC as realignment approach is associated with a 50%-55% decrease in stricture formation.

A comparative analysis between Mannheim peritonitis score and acute physiological and chronic health evaluation II score in predicting prognosis of patients of perforation peritonitis

Background: The early assessment and recognition of peritonitis patient is required in surgical emergency. Various scoring system have been designed successfully to assess the prognosis and outcome of peritonitis. The present study was carried out with an aim to evaluate the usefulness and severity of Mannheim peritonitis (MPI) score in comparison to acute physiological and chronic health evaluation II (APACHE II) scoring system for prediction of the outcome in patients with perforation peritonitis and thus decision making in perforation peritonitis.Methods: A prospective observational study was carried out at Department of Surgery, King George’s Medical University (KGMU), Lucknow for a period of one year from July 2018 to June 2019. A total of 100 patients were enrolled in the study.Results: Majority of patients were males compared to females. Maximum number of patients (40%) was aged 51-60 years. Maximum number of patients (42%) had duodenal perforation. A significant association between higher MPI scores and mortality was seen (p<0.001). Statistically, the association between APACHE II scores and mortality was significant (p<0.001).Conclusions: APACHE II had a slightly higher sensitivity as well as specificity as compared to MPI. MPI is easy to calculate but accuracy of APACHE II is more, compared to MPI.

Correlation between glycemic control and dyslipidemia in Type 2 Diabetes Mellitus patient

Background: India is one of the countries with highest number of diabetes patients. Patients of type 2 diabetes mellitus are usually dyslipidemic. The objective of the research was to study the pattern of dyslipidemia and to study the correlation of glycemic control with dyslipidemia in type 2 diabetes mellitus patients.Methods: A cross sectional observational study was performed on patients of type 2 diabetes mellitus over 6 months period. The study included 200 patients and the variables recorded were demographic profile, FBS, PPBS, HbA1C and lipid profile parameters. The patients were divided into 3 groups according to HbA1C level i.e. Group I (Good glycemic control HbA1C 6-7 gm%), group II (Fair glycemic control HbA1C 7.1-8.2 gm%) and group III (poor glycemic control, HbA1C >8.2 gm%).Results: The data showed that TG level was maximum in group III and was minimum in group I. Comparison between the group shows a significant difference between all the groups (P <0.001). A significant positive correlation (Correlation coefficient 0.67, P <0.001) was also observed between level of TG and HbA1C. Similarly, LDL level was also highest in group III with a significant difference with other two groups (P <0.05). Also, a positive correlation (Correlation coefficient 0.64, P <0.05) was observed between LDL and HbA1C. On the other hand, HDL was lowest in group III as compared to groups I and II (P <0.001) and a negative correlation (Correlation coefficient -0.716, P <0.001) was seen between HDL and HbA1C.Conclusions: Dyslipidemia is less prevalent in diabetics who have better glycemic control.

Vedanadhyaya - A Clinical Approach To Pediatric Examination In Kashyapa Samhita

Kashyapa Samhita is a book of pediatrics having main focus on the health and well-being of children and their pathological manifestations. The most revered source book available on Kaumarbhritya, is presented in the form of compilations of the preaching of Acharya Kashyapa by his disciple Vridhha Jivaka. The Kashyapa samhita available today is actually one fourth or even less than what it would have been in its original form. Fortunately we have Vedanadhyaya where in 32 pediatric illnesses are described. The text is divided in various sections (Sthanas) of which Vedanadhyaya is twenty fifth chapters in Sutra Sthana. Acharya Kashyapa has provided us a strong diagnostic tool which is useful in day to day practice of pediatrics. He undoubtedly laid the foundation stone of clinical pediatrics. Vedanadhyaya concerns the symptomalogy of various diseases in children and serves as a great guidance for pediatric examination and diagnosis as children are unable to narrate their symptoms themselves. So the present article reviews the original text of the chapter and critically analyses it in light of contemporary medical science.

A multi-centric open clinical trial to evaluate the usefulness of 13 predefined homeopathic medicines in the management of acute rhinitis in children

Aims: The study aimed to evaluate the effect of a group of homeopathic medicines in children with acute rhinitis. Materials and methods: In this multi-centric open clinical trial, a total of 784 children (408 males; 384 females) aged 6 months to 15 years, presenting symptoms of acute rhinitis were enrolled from 7 Institutes/ Units under the Central Council for Research in Homeopathy (India). Symptoms were assessed using an acute rhinitis symptom score (ARSS). A total of 13 homeopathic medicines were shortlisted after repertorizing the nosological symptoms of acute rhinitis in children and the results were analyzed. The medicines were prescribed in dilution 6c (10-12) and doses were repeated from few minutes to few hours as per the need of the case. Appearance of any change (improvement or worsening) was followed by placebo / change in dilution or change in medicine according to the response of the patient. The follow up period was up to the 7th day of illness. Results: Out of 784 children enrolled, 638 children were followed up and analyzed. A significant change in the score from the baseline (p<0.05) was observed. Twelve medicines were found to be useful in 638 children suffering from acute rhinitis and among them Nux-v (n=109), Merc (n=106) and Bell (n=88) were the most useful. No complications were observed during the treatment. Adverse events in the form of hyperpyrexia were observed in 2 children only. Conclusion: This study indicates the usefulness of homeopathic medicines in the management of acute rhinitis of children; controlled studies are needed to investigate their efficacy and effectiveness.

Objetivos; este estudo objetivou avaliar o efeito de um grupo de medicamentos em crianças com rinite aguda. Materiais e métodos: neste estudo multicêntrico aberto, foram recrutadas 784 crianças (408 masculinas; 384 femininas) com idade entre 6 meses e 15 anos apresentando sintomas de rinite aguda e que consultaram 7 institutos/centros sob o Conselho Central de Pesquisa em Homeopatia (Índia). Os sintomas foram avaliados através de um escore para sintomas de rinite aguda (ARSS). Um total de 13 medicamentos homeopáticos foi estabelecido após repertorização dos sintomas nosológicos da rinite aguda em crianças e os resultados foram analisados. Os medicamentos foram prescritos na diluição 6cH (10-12) e as doses foram repetidas de minutos a horas segundo a necessidade em cada caso. O aparecimento de qualquer mudança (melhora ou piora) foi seguido pela prescrição de placebo ou mudança da diluição ou do medicamento, de acordo com a resposta do paciente. O período de acompanhamento foi até o 7º dia da doença. Resultados: dentre as 784 crianças recrutadas, 638 foram acompanhadas e analisadas. Houve mudança significativa no escore (p<0,05) por comparação ao ingresso. Doze medicamentos foram úteis em 638 crianças com rinite aguda, entre eles Nux-v (n=109), Merc (n=106) e Bell (n=88) foram os mais úteis. Não foram observadas complicações durante o tratamento. Efeitos adversos sob a forma de hiperpirexia foram observados somente em 2 crianças. Conclusão: este estudo indica a utilidade dos medicamentos homeopáticos no manejo da rinite aguda em crianças; são necessários estudos controlados para determinar sua eficácia e efetividade.

Objetivos: este estudio buscó evaluar el efecto de un grupo de medicamentos homeopáticos en niños portadores de rinitis aguda. Materiales y métodos: en este estudio multicéntrico abierto fueron reclutados 784 niños (408 niños; 384 niñas) de edad entre 6 meses y 15 años que consultaron con síntomas de rinitis aguda en 7 institutos/centros dependientes del Consejo Central de Investigación en Homeopatía (India). Los síntomas fueron evaluados mediante un score para síntomas de rinitis aguda (ARSS). Fueron listados 13 medicamentos homeopáticos después de repertorización y análisis de los síntomas de rinitis aguda en niños. Los medicamentos fueron prescritos en la dilución 6cH (10~12) y las dosis fueron repetidas desde minutos a horas según la necesidad en cada caso. La aparición de todo cambio (mejoría o empeoramiento) fue seguida de prescripción de placebo/cambio de la dilución o del medicamento según la respuesta del paciente. Los pacientes fueron acompañados hasta el 7º día de tratamiento. Resultados: De 784 niños reclutados, 638 fueron acompañados y analizados. Fue observado cambio significativo en el score (p<0,05). Doce medicamentos se mostraron útiles en 638 niños portadores de rinitis aguda; entre ellos, Nux-v (n=108), Merc (n=106) y Bell (n=88) fueron los más útiles.

Factor XI deficiency in Indian Bos taurus, Bos indicus, Bos taurus x Bos indicus crossbreds and Bubalus bubalis

We investigated the occurrence of Factor XI (FXI) deficiency syndrome in the following Indian dairy animals: Bos taurus Holstein-Friesian and Jersey cattle, Bos indicus Indian cattle breeds, B. taurus x B. indicus crossbreds and the river buffalo Bubalus bubalis. Factor XI deficiency is an autosomal recessive bleeding disorder known to affect Holstein cattle worldwide. A total of 1001 dairy animals, mainly bulls, were genotyped to detect the mutation within exon 12 of the gene encoding for factor XI. Two Holstein bulls were detected as heterozygous (carrier) for FXI deficiency, giving a carrier frequency of 0.6 percent in Indian Holstein cattle. None of the other cattle or buffalo breeds was found to be a carrier for FXI. Sequence comparison between normal and heterozygous animals revealed that there is a 77 base pair insertion fragment (AT (A)29 TAAAG (A)27 GAATTATTAATTCT) within exon 12 of the FXI gene. Both sequences were submitted to the National Center for Biotechnology Information (NCBI) GenBank and assigned the accession numbers DQ438908 for normal Holstein Friesian animals and DQ438909 for heterozygous Holstein Friesian animals.