COARCTATION OF AORTA IN A 33 YEARS-OLD UNCONTROLLED HYPERTENSIVE FEMALE PATIENT – A CASE REPORT

We report a 33-year-female patient of hypertension detected at the age of 19 year. Her blood pressure was not well controlled. The case was investigated for secondary hypertension. CT Thoracic and Abdominal aorta Angiogram of the present case showing the narrowing in the thoracic aorta extending at the level of T8 to T10 vertebral body level for the length of 7.5cm. Reconstructed CT of the case showed multiple tortuous collaterals between the branches of internal mammary artery and external iliac artery and between axillary and intercostal artery. Relevant history was reviewed and discussed.

Aceclofenac-Induced Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a rare but severe and potentially life-threatening systemic clinical condition. We report a case of a 44-year-old female, who developed DRESS syndrome after taking two doses of aceclofenac, paracetamol, and thiocolchicoside fixed-dose combination. The patient presented with maculopapular rashes, itching, fever, pedal edema, swelling of the face and lips, difficulty in swallowing, loose stools, and vomiting for 4 days following drug intake. Laboratory and histopathological investigations supported the diagnosis following RegiSCAR criteria. The DRESS syndrome in this patient was definite as per Naranjo’s adverse drug reaction probability scale. The patient was adequately managed using systemic corticosteroids, antibiotics, and intravenous fluids. Aceclofenac is the most likely causative agent of DRESS syndrome in this patient. Early detection and withdrawal of the suspected drug along with adequate supportive treatment are the mainstay of management.

Observer-masked trial comparing efficacy of topical olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) in mild to moderate allergic conjunctivitis

Purpose: With increasing environmental pollution, the incidence of allergic conjunctivitis is increasing. Newer anti-allergic medications with combined anti-histaminic and mast cell stabilization action can help reducing the use of topical steroids for milder form of disease. There is no study directly comparing olopatadine (0.1%), bepotastine (1.5%), and alcaftadine (0.25%) for mild to moderate allergic conjunctivitis cases. Hence, we decided to methodically study the efficacy of three topical medications. Methods: Prospective, observer-masked clinical trial enrolled 45 patients with 15 patients in each of the three groups. Patients with mild to moderate allergic conjunctivitis were sequentially assigned to respective groups, and relief of symptoms and signs were noted upto 1-month follow-up. Results: All three topical medications faired almost equally in resolving symptoms of the patients with mild to moderate allergic conjunctivitis, and most of them reported complete relief after 1 week of use of medication. Few cases with limbal or palpebral papillae reported symptomatic relief after use of medication, but the resolution of these signs was not noted in all three groups. Conclusion: We concluded similar efficacy of three medications in relieving symptoms and inefficacy in regressing palpebral and limbal papillae in cases of allergic conjunctivitis.

Prevalence of left ventricular diastolic dysfunction among patients with asymptomatic diabetes mellitus type 2

Background: Diastolic heart failure occurs due to impaired myocardial relaxation and compliance. Of late, it has been suggested that the changes in the diastolic function occurs before the onset of diabetes, and present in the prediabetic patients. It is also said to be associated with insulin resistance.Methods: This observational study was performed on 50 diabetic patients, with asymptomatic type 2 diabetes. who came in for 2 D echocardiogram with suspected diastolic dysfunction.Results: The mean age among the 50 patients in the study was 54.1±10.99 years and in controls it was 49.56±10.63 years. The fasting sugar among the patients was 179.43±41.57 mg/dl and the post prandial was 236.72±76.24, and it was in the normal range in the controls. The HbA1c was 9.93±1.2 among the patients and 6.09 ± 0.34 in the controls. In the patients, the E/A ratio was 0.83±0.09 compared to 1.22±0.31 of the controls, which was highly significant as the E/e ratio which was 15.1±3.4 and 7.3±0.08 respectively.Conclusions: There was a higher prevalence of diastolic dysfunction among the patients with diabetes in our study. There was no relation of age or gender among the diabetic and the controls, while a strong association and indicators seem to be FBS, PLBS and HbA1c.

Association of hypothyroidism and polycystic ovarian syndrome: a study in a semi urban area

Background: Polycystic ovarian syndrome reported to be one of the most common endocrine disorders in the women of the reproductive age, causing oligoovulatory infertility. In many cases, apparently healthy looking women are being diagnosed with either subclinical or overt hypothyroidism after having the symptoms of PCOS. This study was done to analyse the association of PCOS and hypothyroidism in our geographical area.Methods: 50 women of reproductive ages between 18 to 45 years, who were diagnosed with PCOS, based on Rotterdam’s criteria, 2003 and 50 healthy women as controls, were included into the study. After taking the demographic details from all the patients, they were all subjected to ultrasound for the detection of the cysts. Blood was collected for various biochemical tests including the thyroid profile. Results: The mean age of all the patients in the study group was 23.6±7.2 compared to 27.1±4.6 of the healthy controls. The Body Mass Index amongst both the groups was 29.1±3.1 and 23.4±2.9 kg/m2 respectively. The levels of thyroid profile were significantly high among the study group with 58%, 54%, 68% as the number of patients with elevated T3, T4 and TSH values. The prevalence of subclinical hypothyroidism was 48.3%, while 51.7% of them had overt hypothyroidism. A higher BMI was found among the patients with PCOS and hypothyroidism.Conclusion: The prevalence of hypothyroidism among the PCOS patients is certainly on the rise accentuating its association with this endocrine disorder especially among the young adults.

Synchronous primary cancers: Renal cell carcinoma and rectal cancer

Although cancers of rectum and kidney are common malignancies, the occurrence of primary synchronous neoplasms of these organs has been reported rarely. Very few case reports are available in literature till date. The relationship between these two events remains unclear, probably because of the rarity of the association. In this report, we describe incidentally detected renal cell carcinoma in an elderly man, during staging workup of rectal adenocarcinoma and both malignancies were surgically managed simultaneously with curative intent.

Metastatic thymic epithelial tumors: A regional cancer center experience

BACKGROUND: Thymic epithelial tumors (TET) are the most common tumors of the anterior mediastinum. Patients with advanced/metastatic disease are usually treated with palliative chemotherapy (CT). Unfortunately, even though various palliative CT regimens have been used for long time, there is a real scarcity of published Indian data regarding the experience of palliative CT in metastatic TET (mTET). MATERIALS AND METHODS: This is a retrospective analysis of mTET patients treated between January 2010 and September 2017. Patients who received at least three cycles of first-line palliative CT were included for analysis of response rates, toxicity, and survival and prognostic factors. RESULTS: Of the 49 mTET patients, 27 (55.1%) were males. The median age at diagnosis was 52 years (range: 25–65). Eighteen patients (36.7%) had Masaoka Stage IVa disease, and the rest of the patients had IVb disease. The most common site of metastasis was pleuropericardium (n = 18), followed by lungs (n = 16) and lymph nodes (n = 9). The median progression-free survival and overall survival (OS) were 11.2 months (95% confidence interval [CI], 8.7–13.6) and 20.2 months (95% CI, 17.1–22.8), respectively, for the whole cohort (n = 49). The median OS of patients with Stage IVa disease was significantly better than that of the patients with Stage IVb disease (log-rank P = 0.000). Moreover, the “responders” to first-line CT had a significantly better median OS than the “nonresponders” (log-rank P = 0.000). Various first-line palliative CT regimens were well tolerated in our patients. CONCLUSION: Adriamycin Cisplatin Vincristine Cyclophosphamide (ADOC), Cyclophosphamide Adriamycin Cisplatin, and paclitaxel + carboplatin all are viable first-line palliative CT options for mTET and showed a comparable survival in Indian patients. The present study suggested that “responders” to first-line CT and those with Stage IVa disease might have a better survival than “nonresponders” and those with Stage IVb disease, respectively

Retained Capsule Endoscope.

Background: Capsule endoscopy was invented to visualize the entire small intestine in a non- invasive manner in adults. Case characteristics: 1 y, 9 mo-old boy presented with generalized edema for last 3 months. His routine investigations, including the upper gastrointestinal endoscopy, colonoscopy, and contrast enhanced computed tomography scan (CECT) were normal. In view of clinical suspicion of protein losing enteropathy, we planned capsule endoscopy. Observation: The capsule was not passed even after 3 weeks. Laparoscopy revealed impacted capsule in a dilated intestinal loop proximal to an ileal stricuture. Message: Capsule endoscopy should be used judiciously in children.

Determination of Antimicrobial Efficacy of Calcium hydroxide, Ozonated sesame oil and their combination as intra canal medicament against Enterococcus faecalis A Study in Fathima Institute of Medical Sciences, Kadapa

Background: Among all the microbial organisms Enterococcus faecalis and Candida albicans were the most commonly seen and most resistant organisms in persistent or failing root canals. Even after chemomechanical preparations and treatment 40 to 70% of the microorganisms survive. Aim: This in vitro study was done to evaluate the antimicrobial efficacy of intra canal medicament in root canals charged with Enterococcus faecalis. Materials and methods: Forty eight extracted human single rooted teeth were taken. Biomechanical preparations and access preparations were done. Specimens were sterilized by autoclaving and later contaminated with Enterococcus faecalis and incubated for 24 hours. Confirmation of Enterococcus faecalis was done and then divided into 3 experimental and 2 control groups. Groups (n=12) A) Animireddy Kishore, G. Obulesu, Madhu Babu. Determination of Antimicrobial Efficacy of Calcium hydroxide, Ozonated sesame oil and their combination as intra canal medicament against Enterococcus faecalis – A Study in Fathima Institute of Medical Sciences, Kadapa. IAIM, 2016; 3(8): 219-227. Page 220 Ozonized Sesame Oil, B) Calcium Hydroxide, C) Calcium Hydroxide + Ozonised Sesame Oil. Control groups Group 1:- (n=6) Negative Control, Group 2:- (n=6) Positive Control. Intra canal medicament was placed in each root canal corresponding to the groups and incubated at 370C. First sampling was done after 24 hours and second or final sampling was done after 72 hours of placement of intra canal medicament. Microbial growth was checked by counting CFU (Colony Forming Units). Results: In the first sampling ozononised sesame oil was 100% efficient, next efficient was Calcium Hydroxide group, and combination of Ozonised sesame oil and Calcium Hydroxide also showed almost similar results. But in the second and final sampling after 72 hours Ozonised sesame oil was highly efficient when compared to other two groups. Calcium Hydroxide was moderately efficient whereas combination of both the drugs was least effective as it showed highest CFU/ml. Conclusion: Ozonised sesame oil was most effective for longer duration when compared to other groups and can be used as an alternative intra canal medicament.

Experience of primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction at a referral healthcare centre in India.

Background. India has the highest burden of coronary artery disease in the world. It also has a higher rate of STsegment elevation myocardial infarction than that in developed countries. Primary percutaneous coronary intervention is an effective treatment, yet little is known about its feasibility and outcome in India. We studied the outcomes of primary percutaneous coronary intervention at an Indian tertiary care centre. Methods. We did a prospective observational study of 1000 consecutive patients with ST-segment elevation myocardial infarction, who were treated with primary percutaneous coronary intervention from December 2010 to May 2014 at Sri Venkateswara Institute of Medical Sciences, Tirupati, India. Patient characteristics, procedural details, inhospital and 3-month adverse events were assessed. Results. The mean (SD) age of our patients was 54.5 (11.3) years. Among the study population, 82.9% were men, 32.8% had diabetes mellitus, and 36.3% had hypertension. Only 18.2% of the patients came to hospital in an ambulance, and 6% were in cardiogenic shock. Most frequently, the left anterior descending artery was the infarctrelated artery (57.9%). The mean (SD) time from onset of symptoms to arrival at hospital was 369.6 (204.6) minutes and the mean door-to-balloon time was 58.6 (17.1) minutes. The in-hospital adverse event rate was 5.7% (mortality 3.6%, non-fatal reinfarction 0.9%, stroke 0.3%, major bleeding 0.9%). Patients without cardiogenic shock had an in-hospital survival rate of 99.1%. During 3 months of follow-up, 0.9% of patients died and 0.8% had non-fatal reinfarction. The 3-month survival rate was 95.5%. Conclusion. Primary percutaneous coronary intervention is feasible in India with an acceptable door-to-balloon time and low rates of adverse events despite longer time to presentation. Natl Med J India 2015;28:276–9

Prophylactic combined supplementation of choline and docosahexaenoic acid attenuates vascular cognitive impairment and preserves hippocampal cell viability in rat model of chronic cerebral hypoperfusion ischemic brain injury.

Background: Stroke is the second cause of mortality in the world and third leading cause of disability in surviving victims. Cerebral ischemic cascade involves multiple pathways that can result in motor and cognitive deficits. The current treatment strategy focuses mainly on motor recovery, and the management of post-stroke cognitive impairment is largely neglected. Similarly, very few studies have explored the prophylactic combined synergetic treatment strategies that have the potential to target multiple pathways in the ischemic cascade to alleviate vascular cognitive impairment (VCI) in the event of an ischemic stroke. Choline and docosahexaenoic acid (Cho-DHA) are both essential neuronal membrane phospholipid precursors, known to be important in enhancing cognitive functions. The objective of present study was to explore the prophylactic efficacy of combined Cho-DHA supplementation (Cho-DHA suppl.) in attenuating VCI in a rodent model of ischemic brain injury. Methods: An 10-months-old male Wistar rats were subdivided into four groups (n=8/group); normal control (NC), bilateral common carotid artery occlusion (BCCAO) induced ischemic brain injury group, sham BCCAO (S-BCCAO) group, and prophylactic combined Cho-DHA suppl. BCCAO group. Subsequently, all groups of rats were tested for cognition and neuro-morphological changes in the hippocampus. Results: BCCAO rats showed significant learning and memory deficits (p<0.05) and neuronal injury compared to S-BCCAO and NC rats. These cognitive deficits and neuronal injury were significantly (p<0.01) attenuated in Cho-DHA suppl. BCCAO rats. Conclusion: Prophylactic combined Cho-DHA suppl. may be envisaged as an effective preventive strategy to attenuate VCI and neuronal injury in high-risk individuals susceptible for a future event of an ischemic stroke.

Clinical manifestation and prevalence of peripheral neuropathy and nerve dysfunction in patients with chronic kidney disease.

Background: Chronic Kidney Disease (CKD) is recognized as a major health problem. Prevalence of CKD is rising continuously; mostly CKD is affecting the elderly aged population and/or patients with diabetes and hypertension. Present study was aimed to explore clinical manifestation and evaluate the prevalence of peripheral neuropathy and peripheral nerve dysfunction in CKD patients attending our hospital with reference to the severity and duration of the CKD. Methods: The present cross sectional study was conducted in 74 patients affected with chronic kidney disease, of different age groups at the medical wards of King George Hospital, Visakhapatnam. The presence of peripheral nerve dysfunction was assessed by nerve dysfunction clinically (motor or sensory symptoms and signs) and electrophysiological nerve conduction studies. Results: Out of 74 patients, 65% of study population was suffering from chronic kidney disease with peripheral nerve dysfunction. The peripheral nerves dysfunction was more prevalent in elder age (>65 years) subjects when compared to subjects with age <65 years. Moreover, the results shown that the rate of prevalence of peripheral nerves dysfunction was observed higher in subjects with longer duration of CKD. Male subjects were affected more when creatinine clearance is <15 ml/minute. Both sexes were affected equally when creatinine clearance is between 30-59 ml/minute. Conclusion: This study enlightens the prevalence and clinical presentation of peripheral nerve dysfunction in patients with CKD. The CKD was found to cause peripheral neuropathy including overt and subclinical neuropathy, of which distal symmetrical sensory motor neuropathy was common in CKD. The prevalence of peripheral neuropathy was directly proportional to duration and severity of CKD.

Study of the Relationship between Metabolic Syndrome Score and Angiographic Severity of Coronary Artery Disease According to the Presence of Diabetes.

Background: The relationship between metabolic syndrome score and coronary artery disease severity is unclear in the presence of diabetes. Hypothesis: The hypothesis of this study is to assess whether there is a relationship between metabolic syndrome score and coronary artery disease angiographic severity and whether or not the severity of the relationship differs in the presence of diabetes. Methods: We consecutively enrolled 132 metabolic syndrome patients who underwent their first coronary angiography. We used four angiographic scores and compared the relationship between metabolic syndrome score and angiographic coronary artery disease severity or clinical presentation between diabetic and non-diabetic subjects. Results: Individuals with both metabolic syndrome and diabetes (n=64) had significantly higher metabolic syndrome scores, acute coronary syndromes, double and triple vessel disease, higher coronary score, extent score, severity score, and atherosclerotic score than metabolic syndrome patients without diabetes (n=68). A significant correlation was apparent between metabolic syndrome and coronary atherosclerotic scores in patients without diabetes. In contrast, we did not observe any significant correlation between metabolic syndrome score and coronary atherosclerotic scores in patients with diabetes. Multivariate regression analysis revealed that metabolic syndrome score is an independent predictor of atherosclerotic score in non-diabetics. Conclusion: While the relationship between metabolic syndrome score and angiographic coronary artery disease severity was disguised by the presence of diabetes, the metabolic syndrome score was related to the extent of coronary atherosclerosis in Indian patients without diabetes. Calculating the metabolic syndrome score might provide additional information for predicting the extent of coronary artery disease in patients with angina without diabetes.

Spectrum of congenital malformations in newborns: in a medical college hospital in South India.

The study was carried out with the aim to determine the overall rate of congenital malformations, incidence in live births and stillbirths, as well as incidence affecting various organ systems, at a medical college hospital in Karnataka and compare them to previous studies Methods: All intramural deliveries between June 2012 and March 2014 were included in the study. All the new-borns were examined for congenital malformations soon after birth and every day during routine ward rounds. Relevant radiological, histo-hematological and genetic tests were carried out. Results: During the study period there were 3016 births out of which 2941 were live births and 75 were still born. 93 babies had one or more malformations. The overall incidence of malformations was 3.083%. Incidence of malformations among live births was 2.72% whereas it was 17.33% among still born babies. Musculoskeletal malformations accounted for 27.5% of all the malformations. This was followed by cutaneous 19.16%, genitourinary 15.83%, gastrointestinal 12.5%, neurological 10% and cardiac 5.83%. Conclusion: Congenital anomalies are a major cause of stillbirths and infant mortality. Musculoskeletal malformations were the commonest system involved. Still born babies had a significantly higher incidence of malformations and also had a higher incidence of multiple malformations.

Identification of mistakes and their correction by a small group discussion as a revision exercise at the end of a teaching module in biochemistry.

Background. Graduate medical students often get less opportunity for clarifying their doubts and to reinforce their concepts after lecture classes. The Medical Council of India (MCI) encourages group discussions among students. We evaluated the effect of identifying mistakes in a given set of wrong statements and their correction by a small group discussion by graduate medical students as a revision exercise. Methods. At the end of a module, a pre-test consisting of multiple-choice questions (MCQs) was conducted. Later, a set of incorrect statements related to the topic was given to the students and they were asked to identify the mistakes and correct them in a small group discussion. The effects on low, medium and high achievers were evaluated by a post-test and delayed post-tests with the same set of MCQs. Results. The mean post-test marks were significantly higher among all the three groups compared to the pre-test marks. The gain from the small group discussion was equal among low, medium and high achievers. The gain from the exercise was retained among low, medium and high achievers after 15 days. Conclusion. Identification of mistakes in statements and their correction by a small group discussion is an effective, but unconventional revision exercise in biochemistry.

Changes in Thiol Content, Glutathione and Hydrogen Peroxide Levels as a Measure of Oxidative Stress in Periplaneta Americana Treated with Metarhizium Anisopliae Spp.

Periplaneta americana (American cockroach) treated with conidia of entomopathogenic fugal isolates of Metarhizium anisopliae revealed a decrease in the thiol content and an increment in the levels of oxidized glutathione as well as hydrogen peroxide (H2O2). T-SH levels decreased to 48% and 50% at 24 hours and 48 hours post treatment respectively at LC90 of M20 isolate. Low virulent isolate M48, on the other hand, recorded a decrease of 76% and 78% in the T-SH levels at 24 and 48 hours post treatment respectively with LC30 treatment. Remarkable increase of 200% in the levels of H2O2 recorded at LC90 of M20 and 102% increase at LC30 of M19 was remarkable and focuses on the extent of oxidative stress induced by the fungal infection. Dynamics in the levels of GSH, GSSG, H2O2 and thiols in the insects treated with different fungal isolates in a time and dose dependant manner reveals oxidative stress induced by the fungal infection and the information would facilitate to explore the antioxidant defense system in augmented resistance or susceptibility of cockroach against entomopathogenic fungal conidia.

In-Vitro Evaluation of the Entomopathogenic Fungal Isolates of Metarhizium Anisopliae for Compatibility with Pesticides, Fungicides and Botanicals.

Isolates of the entomopathogenic fungus Metarhizium anisopliae were tested for their compatibility with insecticides, fungicides and botanical pesticides, which are being used in the field, as a prerequisite for developing as mycopesticides and their use in IPM programmes. Three concentrations (0.1X, 0.5X and 1X) of each chemical were evaluated in the laboratory based on the recommended dose for field application by food poison technique. Variation in vegetative growth and sporulation of M. anisopliae appeared to be related to the chemical nature of the formulations, its concentration and the fungal isolates in study. M19 and M48 isolates showed compatibility with imidacloprid at 0.5X and 0.1X and with fungicide sulphur at all the concentrations tested. All the four botanicals tested were found to be compatible to all the four fungal isolates and neem gold displayed maximum tolerance, at all the concentrations. M19 displayed an enhancement in the vegetative growth with imidacloprid (2%) and HIT (2-18%). 2% increase in the spore output was also recorded by M19 with chloropyrifos and sulphur. M19 and M48 isolates demonstrated compatibility with pesticides, fungicides and botanicals as well as with a cockroach management pesticide, HIT. The two isolates of M. anisopliae tested emerged as prospecting candidates for use as mycopesticide component in the combined application with pesticides like imidachloprid and fungicide, sulphur as well as botanicals in the IPM programmes.