Prevalence of normal weight obesity in young adults of Western Uttar Pradesh – A community-based study

Background: Obesity is described as a build-up of abnormal or excessive fat that risks life. A body mass index (BMI) is a screening tool for overweight and obesity. For a long time, BMI has been used as a marker to measure obesity. However, a significant limitation of using BMI is its failure to differentiate between a high body fat content and preserved or increased lean mass, especially in patients or subjects with a BMI <30 kg/m2. Normal weight obese (NWO) is such individuals who have high fat content but a normal BMI. To identify such individuals and to save them from morbidity associated with obesity, this study was carried out. Aims and Objectives: The objective of the study was to estimate the prevalence of NWO in healthy young adults (aged between 18 and 30 years) and to suggest the methods of primary prevention for obesity. Materials and Methods: In this observational cross-sectional study, the 324 subjects were selected randomly from the residents, students, and employees of Swami Vivekananda Subharti University. Subjects were chosen according to the study’s inclusion and exclusion criteria and also, based on the self-structure questionnaire. A general and systemic examination was carried out. The body composition of these subjects was done by bioelectric impedance analyzer BODY STAT QUAD SCAN 4000. Data were analysis using R-software (1.25 version), and unpaired t-test was applied. P < 0.05 was taken as significant in this study. Results: The prevalence of NWO in males was found to be 24.6% and females to be 13.4%. The body composition parameters of NWO and NWNO differed significantly. Conclusion: The increase rate of NWO is reason for concern and routine screening of body composition parameters should be done at health setups to identify that these NWO individuals and timely interventions can be made.

Giant Eyelid Eccrine Hidrocystoma: A Case Report

Aims: To report a case of a rare giant eyelid eccrine hidrocystoma confirmed on histopathological examination and successful surgical excision with no recurrence.Presentation of Case: A young male presented with a mass over his eyelid which was gradually increasing in size, leading to drooping of the upper eyelid with no other associated symptoms. The mass 20x15x10 mm was present over the upper lid, non-mobile, non-tender, and firm. On the CT scan, a well-defined round to oval hypodense cystic mass was seen to be originating from the left upper eyelid. The cyst was excised and sent for histopathological analysis. The histological appearance of cystic spaces lined by cuboidal epithelium and containing mucinous fluid was suggestive of eccrine hidrocystoma. There was no recurrence till 2 months of follow-up.Conclusion: Eccrine hidrocystomas are 1-6 mm in size, generally 4 mm, and cysts larger than 10 mm are rare. Larger cysts have been described as “giant eccrine hidrocystoma.” Giant eyelid eccrine hidrocystoma is an unusual condition of the eyelid that must be considered in the differential diagnosis of eyelid tumours. They can be managed by complete surgical excision although recurrences are found to be common.

Awareness and outlook of health-care professionals regarding materiovigilance in a tertiary care teaching hospital in South Rajasthan

Background: Post-marketing surveillance regulates the safety, quality, and performance of medical devices (MDs). Medical professionals play a key role in the monitoring and reporting of MD Adverse Events (AEs). Since the launch of Materiovigilance (MV) Programme of India, very few published studies were found regarding reporting of MDAE. Aim and Objective: This study aims to know about awareness and outlook of medical professionals regarding MV. Materials and Methods: A cross-sectional study done among medical professionals of various specialties in a tertiary care teaching hospital in South Rajasthan. A pre-validated questionnaire was circulated to 200 doctors containing questions related to knowledge, attitude and practice of MV. Results: About 58.6% of the doctors came to know about the term MV during this study. About 76.7% of participants knew that MD could lead to an AE, but only 11.2% of the participants had the correct knowledge of how to report an AE related to MD. About 66.8% of participants had positive attitude regarding reporting of AE, 23.7% reported the event and 66.6% did not report as they found them mild. Conclusion: Majority of doctors had the knowledge about reporting of AEs, but they were largely unaware of the term MV. Knowledge regarding where to report is very limited. Despite adequate level of knowledge, reporting practices are very limited. Hence, there is a need for regular sensitization and training programs to foster the habit of reporting AE related to MD even if they are mild.

Impact of an educational intervention on knowledge and attitude regarding pharmacovigilance and adverse drug reaction reporting among postgraduate students of a tertiary care teaching hospital

Background: Doctors doing postgraduation (PG) are backbone of any teaching-hospital and are in close contact with patients. It is important they have adequate knowledge and attitude towards adverse drug reaction (ADR)-reporting and Pharmacovigilance Programme of India (PvPI). Aim and Objectives: To study the impact of an educational intervention on knowledge and attitude of 1st year PG residents toward ADR reporting and Pharmacovigilance. Materials and Methods: An educational intervention was conducted among 1st-year postgraduate students, including a lecture on importance and need of pharmacovigilance, hands-on-training on how to fill Suspected ADR Reporting Form and group based interactive discussion. Knowledge and attitude of participants were recorded in pre-post intervention questionnaire and analyzed. Results: Sixty-three postgraduate students from clinical (82.5%), paraclinical (12.7%), and preclinical (4.7%) departments participated. Mean test-score improved from 7.27 to 11.65 (P < 0.005). Need for pharmacovigilance, ADR-reporting related terminologies, PvPI, who can report and where to report ADR, signal generation, types of ADR-forms, and legal implications of reporting were the major areas with significant improvement. About 87% agreed post-intervention that ADRs are a major cause of morbidity, 96% agreed there should be an ADR-Reporting Centre in every institute and 92% agreed they will try to find whether some drug might be responsible for any unusual symptom in patient. Conclusion: Educational intervention could improve knowledge as well as attitude toward ADR reporting among postgraduate doctors, long-term impact needs further assessment.

Study Of Visual And Refractive Outcomes In Patients Undergoing Limbal Relaxing Incision During Clear Corneal Phacoemulsification Surgery With Foldable Intra Ocular Lens

Background:Phacoemulsification requires a smaller incision, few or no stitches are needed and the patient's recovery time is usually shorter when using a foldable IOL.Limbal Relaxing Incisions, or LRIs, are partial thickness corneal incisions strategically placed to reduce or eliminate pre-existing astigmatism duringcataractsurgeryorrefractivelensexchangesurgery. Present study was aimed to evaluate the visual and refractive outcome in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens.Material And Methods:Present study was single-center, prospective, observational study, conducted in patients of age more than 18-75 years, with clear cornea and regular astigmatism on keratometry, with preoperative astigmatism more than or equal to 0.5D on keratometry, fit for phacoemulsification cataract surgery with foldable IOL.Result:A total of 44 eyes of 44 patients who for cataract phacoemulsification surgery, mean age of the patient was 56.98 ± 05.98 years. Refractive acceptance preoperatively was 0.50 D to 2.0 D.Onslit lamp examination showed most common Cataract Nucleus grade is NS 3 with PSC preoperatively. We observed improved diopteric difference by automated keratometry on postoperative 90th day as compared to preoperative values. Majority of patients had Preop Keratometric Difference (K1-K2) of 1.5 D, all required LRI Incisions length of 4 clock hours (60°).The difference between the visual acuity preoperatively and post operatively was found to be statistically significant with a p<0.01 by employing the statistical test Analysis of Variance (ANOVA). Visual outcome a change after limb relaxing incisions statistically significant. Keratometry changes preop and postop is statistically significant with p value <0.001.Conclusion:Visual and refractive outcome changes as improved best corrected visual acuity (BCVA), decrease in Corneal Astigmatism was noted in patients undergoing limbal relaxing incision during clear corneal phacoemulsification surgery with foldable intra ocular lens

Haplotype analysis of ADAM33 polymorphisms in asthma: A pilot study

Background & objectives: ADAM33 is implicated as a potentially strong candidate gene for asthma and bronchial hyper-responsiveness. Many polymorphisms of ADAM33 have been studied along with ADAM33 expression in various cells of the lungs. Haplotype analysis also showed association with asthma in different populations across the world. Therefore, the aim of this study was to perform a comprehensive screening of ADAM33 polymorphisms in adult patients with asthma. Methods: Thirty five polymorphisms of ADAM33 were genotyped in 55 patients with asthma and 53 controls. The association of single nucleotide polymorphisms (SNPs) and haplotypes with phenotypes of asthma was analysed. Results: The genotype, minor allele frequency, odds ratio and Hardy–Weinberg equilibrium did not show any significant difference among cases and controls. No association was found between SNPs of ADAM33 with the severity of asthma. Correlation analysis of ADAM33 SNPs to the phenotypes, based on clinical variables and allergen sensitization, did not show significant difference. Haplotype analysis showed that rs2280090 and rs2280091 were associated with asthma in the patient group. Interpretation & conclusions: Haplotype analysis showed an association of the two SNP variations with asthma. These SNPs lead to amino acid change and are prone to phosphorylation, which may affect expression levels and protein function of ADAM33 and asthma susceptibility.

Rapidly reversing bilateral macular edema associated with fluid overload in a young type 1 diabetic

We report a case of sudden onset bilateral diminution of vision in a young lady with type 1 diabetes. She was administered intravenous fluids for correction of diabetic ketoacidosis (DKA) prior to onset of her ocular symptoms. Dramatic resolution of macular edema was noted within a very short period after correction of fluid input–output ratio. Visual acuity was restored to baseline after 3 days without any active ocular intervention.

Clinical spectrum of AKI in chronic liver diseases

Introduction: Acute kidney injury (AKI) is a heterogeneous syndrome of different aetiologies, and often multifactorial. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer. Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used. Result: 87% are males and 13 % are females. The most common cause of cirrhosis is alcoholic 77% followed by hepatitis Bvirus related 10%, unknown etiology 7%, hepatitis C 3%, NASH 2%, Wilson 1. The most common sign of decompensation of liver is jaundice 78% followedby ascites 70%, hepatic encephalopathy 37% and upper GI bleed 30%. Distribution of child class as a prognostic indicator showed the maximum no. ofpatients found in class C 56% followed by class B 34% and class A 10%. Conclusion: Acute kidney injury is very common in chronic liver disease patient in our hospital and majority of them have intrinsic cause of AKI

A Comparison of the Intrathecal Isobaric 0.5% Levobupivacaine with Fentanyl and Isobaric 0.5% Ropivacaine with Fentanyl for Lower Abdominal and Lower Limb Surgeries: A Prospective Randomised Double Blind Controlled Study

Background: Spinal anaesthesia is an accepted and most convenient anaesthetic technique for lower abdominal and lower limb surgeries. Opioids have been used intrathecally as adjuvant for improvement in quality and extending the duration of spinal block. We conducted this prospective randomised double blind study to compare effects of intrathecal isobaric 0.5% levobupivacaine with fentanyl and isobaric 0.5% ropivacaine with fentanyl in spinal anaesthesia. Methods: After taking approval from institutional ethical committee,80 patients of ASA grade I or II were randomly allocated into two groups.Group I received 3ml of 0.5% isobaric levobupivacaine with 25μg fentanyl and group II received 3 ml of 0.5% isobaric ropivacaine with 25μg fentanyl intrathecally .The level of sensory blockade and motor blockade was assessed. Results: The onset of sensory and motor blockade was earlier in group I as compared to group II . In group I sensory and motor blockade lasted significantly longer than group II. The duration of analgesia and time for rescue analgesia was prolonged in Group I as compared to Group II. Conclusion:Intrathecal 0.5 % isobaric ropivacaine-fentanyl combination provides satisfactory anaesthesia with shorter duration of motor blockade which is a desirable feature for early ambulation favouring day care ambulatory surgeries as compared to intrathecal 0.5% isobaric levobupivacaine-fentanyl combination which can be used in surgeries of longer duration.

Applicability of 2008 World Health Organization classification system of hematolymphoid neoplasms: Learning experiences

Background: 2008 World Health Organization (WHO) classification of hematolymphoid neoplasms (HLN) has classified them based on morphology, results of various ancillary techniques, and clinical features.[1] There are no studies looking at the applicability of WHO classification. Aims: The aim of the study was to calculate proportions of all HLN subtypes seen during 1-year period based on 2008 WHO classification of HLN and study applicability and also shortcomings of practices in a tertiary care center in India. Materials and Methods: This was a 1-year retrospective study (January 1st, to December 31st, 2010) where cases were identified using hospital/laboratory electronic records. Old follow-up and referral cases were excluded from the study. Only newly diagnosed cases classified into categories laid down by 2008 WHO classification of HLN included. Results: Out of 2118 newly diagnosed classifiable cases, 1602 (75.6%) cases were of lymphoid neoplasms, 489 (23.1%) cases of myeloid neoplasms, 16 (0.8%) cases of histiocytic and dendritic cell neoplasms, and 11 (0.5%) cases of acute leukemias of ambiguous lineage. Overall, most common HLN subtype was diffuse large B-cell lymphoma (n = 361, 17.0%). Precursor B-lymphoblastic leukaemia/lymphoma (n = 177, 48.2%) was the most common subtype within pediatric age group. Conclusions: All major subtypes of HLN were seen at our center and showed trends almost similar to those seen in other Indian studies. Molecular/cytogenetic studies could not be performed on a significant number of cases owing to logistic reasons (unavailability of complete panels and also cost-related issues) and such cases could not be classified as per the WHO classification system.

Bilateral medial rectus palsy due to midbrain infarction following concussion head injury

Here, we report a rare case of bilateral medial rectus palsy following closed head injury. An adult male had an accidental fall which rendered him unconscious. This was followed by diplopia and restricted ocular motility. He received supportive medical therapy. He was examined for systemic medical and ophthalmic findings. Routine laboratory tests and imaging techniques were employed as per the symptoms. Diffusion-weighted imaging on magnetic resonance imaging proved it to be a rare presentation of small bilateral midbrain infarct. He recovered fully after 8 months.

Thymic epithelial tumors: Can fluorodeoxyglucose positron emission tomography help in predicting histologic type and stage.

OBJECTIVES: To study the utility of fluorodeoxyglucose (FDG) positron emission tomography (PET) in predicting (1) the World Health Organization (WHO) histologic type and differentiating low‑risk from high‑risk types. (2) Tumor stage and differentiate early from advanced stage disease. MATERIALS AND METHODS: Patients with thymic epithelial neoplasia who underwent a pretreatment FDG‑PET study were included. Tumor maximum standardized uptake value (SUVmax) was correlated with the WHO histologic type and also with the Masaoka‑Koga (MK) staging system. Patients with WHO Type A, AB, and B1 were classified as low risk and those with B2 and B3 as high risk. Thymic carcinomas belonged to Type C. Patients with MK Stage I and II disease were grouped as early stage and those with Stage III and IV as an advanced stage. Differences in SUVmax between the various groups were calculated. RESULTS: The SUVmax of thymic carcinomas was significantly higher as compared to low‑risk (P = 0.001) and high‑risk groups (P = 0.007). The SUVmax of high‑risk group was also significantly higher than the low‑risk group (P = 0.002). SUVmax cutoff of 6.5 was able to differentiate thymic carcinomas from thymomas with 100% sensitivity and 87.2% specificity. The SUVmax in patients with advanced stage disease showed a higher trend compared to those with early stage, but the difference was not significant (P = 0.167). CONCLUSION: PET can differentiate thymic carcinomas from rest of the thymoma subtypes by the virtue of their higher FDG uptake. It can also provide valuable information in differentiating high‑risk from low‑risk thymomas and in predicting disease stage.

Diagnosis of Malaria by Detection of Parasite Lactate Dehydrogenase with Advantage Mal Card Test.

Background : Malaria is a global problem. Rapid diagnosis is essential for effective treatment and reducing mortality and morbidity of malaria. Diagnosis of malariaby peripheral smear is labor-intensive and requires considerable expertise for its interpretation. A rapid test , Advantage MAL card test is based on detection of parasite lactate dehydrogenase (pLDH) and has the ability to differentiate the four major Plasmodium species in 20 minutes. Objectives: 1) To evaluate utility of parasite lactate dehydrogenase for diagnosis of malaria with Advantage Mal card test.2) To compare the results of Advantage Mal card test with peripheral smear findings. Materials and Methods: In this retrospective study, total 5242 patients with malaria like symptoms attending OPD and admitted in wards at Acharya Vinoba Bhave Rural Hospital (AVBRH) from January 2008 to August 2011 were studied. Result: The age of patients ranged from < 1 year- >80 years. The commonest age group affected was 21-30 years. Male to female ratio was 1.04: 1. Prevalence rate of malaria was 101/1000 population in AVBRH. Malarial parasites were detected in PS in10.11% patients (P.falciparum 27.73% , P.vivax 71.32% , mixed infection 0.94%) and in 10.07% patients with Advantage Mal test (P. falciparum 28.03%, P.vivax 71.02%, mixed infection 0.95%). 3 cases of P.vivax and 1case of P.falciparum detected by PS were not detected by Advantage Mal test. 2 cases of P.falciparum detected by Advantage Mal and not by PS. Compared to PS, the Advantage Mal had sensitivity 99.24%, specificity 100%, positive predictive value 100%, negative predictive value was 89.92%. Conclusion: Diagnosis of malaria by detection of pLDH with Advantage Mal card test is simple ,rapid, reliable and cheap method. Results are comparable to blood films. It can detect P.flciparum infection when parasites are sequestered.

Cervical spine clearance: a review and understanding of the concepts.

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt trauma who undergo imaging studies. However, timely and accurate recognition of cervical spine injury is essential for the optimal management of patients with blunt trauma as subsequent morbidity includes prolonged immobilization. Evaluation of cervical spine injuries should begin in the emergency department and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons for definitive management. Knowing which patients are at highest risk for injuries will undoubtedly influence decisions on how aggressively to pursue a potential cervical spine injury and can be achieved by establishing a multidisciplinary team approach that provides cervical spine immobilization, assessment, and clearance. Implementation of such guidelines will decrease time for cervical spine clearance and incidence of missed injuries. In this article different aspects of cervical spine injuries and cervical spine clearance protocols are reviewed.

Intracranial ricocheting of bullet from anterior clinoid process.

Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.

Cushing's Syndrome : an overview.

Cushing's syndrome is the collection of symptoms and signs caused by chronic elevation of circulating free cortisol. Since the first description of the syndrome, results from long-term exposure to glucocorticoids has not been improved upon, but our understanding of its pathophysiologic features and our ability to diagnose and treat the disorder have increased dramatically. In this article we review the current literature about Cushing's syndrome.

Symmetric peripheral gangrene with mixed malaria.

Symmetric peripheral gangrene (SPG) in a case of mixed malaria (P. falciparum and P. vivax) is a rare and relatively unknown complication of malaria. We report a case of 10-yr-old female with mixed malaria infection and SPG (Symmetric Peripheral Gangrene) of foot, which is most likely due to interaction between parasite factors (P. Falciparum and P. viavx) and host factors.