Gastrointestinal tract involvement in patients with potential celiac disease beyond the small intestine: An early proof with IgA anti-tissue transglutaminase-2 antibody deposits

Background: IgA anti-tissue transglutaminase-2 antibody (anti-TG2Ab) deposits in intestinal and extraintestinal organs have been used to link the respective pathological changes in these organs with celiac disease (CeD). Aims: To know if parts of intestine other than the duodenum, such as esophagus, stomach, and colon, have any pathology related to potential CeD or have mucosal IgA anti-TG2 Ab deposits. Settings and Design: A prospective case–control study conducted from April 2018 to December 2019. Materials and Methods: Nine patients with potential CeD and 27 age- and gender-matched patients with irritable bowel syndrome were recruited as cases and controls, respectively. Mucosal biopsies were collected from esophagus, stomach, duodenum, and rectosigmoid regions, histological changes were evaluated, and IgA anti-TG2 Ab deposits were analyzed in these regions by two-color immunohistochemical staining. Statistics: Data were analyzed using statistical software Stata 14.0. Results: No distinct difference in mucosal lymphocytosis were identified between biopsies of patients with potential CeD and controls at the following sites: esophagus (11.1% vs 0%, P = 0.079), stomach (14.3% vs 7.7%, P = 0.590), and rectum (20% vs 0%, P = 0.067). Co-localized IgA anti-TG2Ab deposits were observed more in potential CeD than in controls at esophagus 22.2% (2/9) vs 0%, P = 0.012; stomach 66.7% (6/9) vs 11.5% (3/26), P < 0.001; and duodenum 66.7% (6/9) vs 0%, P < 0.001 but not at rectum 0% (0/4) vs 0% (0/25). Conclusion: Although histological changes are not distinct, a subset of subjects with potential CeD has pan-intestinal involvement other than in the duodenum.

Serum Levels of Activin A: Predictor of Insulin Resistance and Atherosclerosis in Prediabetics

Background: Pathological effects of dysglycemia and insulin resistance on atherosclerosis and cardiac remodeling starts as early as in the prediabetic state before the onset of overt diabetes. Activin A is a molecule with multiple functions, including an important part in glucose homeostatic mechanisms as well as inflammatory processes and is therefore being researched as a useful novel biomarker for prompt recognition of the risk of cardiovascular disease (CVD) in prediabetic individuals, thereby helping in disease prognostication and early institution of therapeutic measures. Objective: The study aimed to measure serum levels of activin A in prediabetic patients and evaluate them in comparison to normoglycemic controls. The association of activin A with carotid intima media thickness (CIMT), left ventricular diastolic dysfunction (LVDD), and homeostatic assessment of insulin resistance (HOMA-IR) was also studied. Materials and methods: A total of 60 prediabetic cases and 60 normoglycemic control subjects [matched as per age, gender, and body mass index (BMI)] were recruited. Measurement of serum glucose levels (fasting and postprandial) and fasting insulin levels and glycated hemoglobin (HbA1c) levels were done in all the subjects. The values of HOMA-IR were computed using established formulae. Enzyme-linked immunosorbent assay (ELISA) kits were used for the evaluation of serum levels of activin A in both groups. Parameters for the two groups were compared. In the cases, CIMT (using B-mode ultrasound) and LVDD (using two-dimensional (2D) echocardiography) were measured and correlated with activin A levels. Results: Serum fasting insulin (mIU/L) was considerably higher in cases than in the controls (p < 0.001). HOMA-IR median [interquartile range (IQR)] was 4 (3.25–4.93) in some cases, and that in the control group was 1.2 (0.88–1.5) (p < 0.001). Serum activin A levels in the cases group had a median (IQR) of 263.55 (227.1–279.5) ng/mL, which was substantially greater as compared to the control group 159.9 (150.7–178.7) ng/mL (p < 0.001). A significant positive association of serum activin A levels with HOMA-IR (? = 0.75, p < 0.001) and CIMT (? = 0.50, p < 0.001) was found. In LVDD grade I and II groups, the serum levels of activin A were 257.86 (219.3–271.2) ng/mL and 269 (244.19–291.5) ng/mL, respectively (p = 0.12). Conclusion: A substantial proportion of morbidity and mortality related to dysglycemic states can be attributed to cardiovascular complications. Elevated levels of activin A in prediabetes can act as an indicator of subclinical CVD leading to early diagnosis and intervention.

Prevalence of Obsessive–Compulsive Symptoms and the Level of Fear Due to COVID-19 Pandemic among the Undergraduate Medical Students in a Tertiary Care Unit in Southern India

Background: The emergence of COVID?19 and its consequences is causing widespread fears, anxiety, and worries. To overcome the transmission of COVID?19, people resorted to compulsive behaviors. Objectives: The objectives of this study were to assess the prevalence of obsessive–compulsive symptoms (OCSs) due to COVID?19 pandemic, the prevalence of level of fear due to COVID?19 pandemic, and to assess the factors associated with OCSs due to COVID?19 pandemic among the undergraduate medical students of in tertiary unit in Southern India. Methods: The cross?sectional study was conducted in 250 undergraduate medical students (both MBBS and BDS, from 1st to 4th year) in the institute. Students who had consented in the study were included as study participants. The Yale–Brown Obsessive–Compulsive Scale and Fear of COVID?19 Scale (FCV?19 S) were used in assessing OCSs and the level of fear due to COVID?19. Chi?square test and multiple logistic regression were used to compute the factors associated with OCS. Results: The mean age of the respondents was 21 ± 1.313 years. The prevalence of OCS in undergraduate medical students was 36 (14.4%), and the level of FCV?19 was 107 (42.8%). Male students (17.8%, 44.2%) had higher OCSs and levels of fear as compared to female students (13.6%, 42.4%). Students with FCV?19 were three (adjusted odds ratio?3.418, 95% confidence interval?1.596, 7.319) times more likely to manifest OCSs while factors such as age, gender, and course were not significantly associated with OCS. Conclusion: Psychological counseling for undergraduate students should be pivotal, especially during pandemics and outbreaks.

Doctor-patient relationship: Effectiveness of the “Jigsaw” method of teaching among Phase I MBBS students in a tertiary care teaching hospital

Background: Students learn passively in the lecture format and rely on teachers for knowledge acquisition, making it unsuitable for achieving the higher levels of knowledge. Jigsaw learning encourages collaboration between learners for a deeper understanding of the subject and the facilitator role is relatively limited. Aim and Objectives: The aim of the study was to: 1. Determine the effectiveness of the jigsaw method versus traditional lecture methods for the teaching of Attitude, communication, and ethics (AETCOM) in Phase I MBBS students. 2. To assess the perception of students toward the jigsaw method. Material and Methods: This quasi-experimental study included 104 Phase I MBBS students, who were assigned to the jigsaw group and traditional lecture group. As part of the jigsaw method, 10 parent groups and five expert groups were formed to encourage peer group learning. Validated pre-tests, post-tests, and questionnaires were used in the evaluation. Results: On post-test, both groups scored significantly higher than pre-test, but the scores on pre-test did not differ between them. Post-test scores of the jigsaw group were significantly higher than those of the traditional method group. Jigsaw was rated positively by students for enhancing peer interaction (91%), deeper learning of the subject (90%), and communication skills (89%). Conclusion: The jigsaw method is more effective than the traditional method for the teaching of the AETCOM module to medical undergraduates. It can be used as a helpful tool for teaching communication skills and teamwork by utilizing cooperative learning strategies.

Comparison of blunder lecture with tutorial for small-group discussion among Phase I M.B.B.S. students in a medical college in North India

Background: Small-group discussion (SGD) plays an essential role in physiology to foster active learning by the students. Blunder lecture has been used to stimulate inquiry, reflection, and promote collaborative learning by cognitive conflict strategy. Aims and Objectives: The objectives of the study were as follows: (i) To compare the effectiveness of blunder lecture with tutorial for SGD and (ii) to assess the perception of students toward blunder lecture and tutorial. Material and Methods: An educational interventional study was conducted in the department of physiology among 116 Phase I MBBS students using tutorial and blunder lecture for SGD on two core topics of physiology which were already covered in didactic lectures. Blunder lecture included deliberate mistakes spread over the different levels of Bloom’s taxonomy. Blunders were identified and discussed during the group activity. The evaluation was done by validated pre-post tests and questionnaires. Results: There was a statistically significant gain in the mean score of the students who attended blunder lecture session in comparison to tutorial. Out of 116 students who participated in the study, 89% perceived blunder lecture as a challenging way to recollect prior knowledge. Conclusion: Blunder lecture is an effective reinforcement tool that can be used in SGD to facilitate the learning of the undergraduates.

Conformal radiotherapy plans for palliative bone metastasis - comparison of dosimetric parameters

Background:Palliative radiotherapy offers significant relief in the huge physical distress of patients with bony metastasis. The enormous potential of conformal techniques has not been tested in palliative settings. However,the increasing life span of patients with metastatic disease demands to optimize the radiotherapy techniques to provide maximal durable symptomatic relief. Despitean increase in the utilization of the 3DCRT technique for palliative bony metastasis, the optimal beam arrangement remains unknown. Materials and Methods:Ten patients of vertebral bony metastasis were retrospectively selected and four virtual 3DCRT plans were generated for each patient. The field approaches were a single field, two fields, three fields and five field approaches. For PTV, D90, D50, Dmean, Conformity index (CI) were evaluated.Dmean was evaluated for the esophagus, bowel, kidneys, and combined lungs. Dose-volume histograms were computed for the various treatment plans and compared. Statistical analysis was done by ANOVA test. Results:A total of forty radiotherapy plans were generated. PTV parameters were significantly better with two field plans over one field plans in terms of D90 (p= 0.002), D50 (p= 0.02), Dmean(p=0.0009). Dmeanwassignificantly better with three field approach compared to two field approach (p=0.0006). The Dmeanwas significantly increased for organs at risk in two fields and three field plans.Five field approach did not showan advantage in terms of dosimetry of PTV but there was a significant rise in the dose to Organs at risk (OAR’s). Conclusion:The three field plans showed better dose distribution to the PTV with an acceptable increase in the dose to OAR’s.

Association of different patterns of expression of beta-catenin and cyclin D1 with pathogenesis of breast carcinoma

Background: Beta-catenin and cyclin D1 have attracted considerable attention in recent studies as potential proto-oncogenes in many human cancers especially colonic cancer. Beta-catenin plays multiple roles within the cell such as canonical Wnt signaling where cyclin D1 has been identified as one of its target genes. The role of beta-catenin and cyclin D1 in breast cancer has been evaluated in many studies but not established yet. Materials and Methods: The expression of beta-catenin and cyclin D1 was evaluated in 82 cases of breast carcinoma (BCa) and 32 cases of ductal carcinoma in situ(DCIS) by immunohistochemistry (IHC). Their relationship with clinicopathological features was also investigated. Statistical analysis was done to establish an association. Results: Abnormal expression of beta-catenin (ABE) was seen in 80.2% cases of invasive ductal carcinoma (IDC) and 47% cases of DCIS, while the cyclin D1 positive expression rate was 60.9% and 50%, respectively. In the cases showing ABE, cyclin D1 positivity was 88.1%. ABE showed significant association with high-grade BCa. The most common pattern of ABE was loss of membrane with nuclear positivity which is associated with worst prognosis. In addition, ABE in cases of BCa and DCIS showed concordant patterns. Conclusion: Therefore, an association exists between ABE and cyclin D1 in BCa and its precursor lesions implying that Wnt/beta-catenin oncogenic pathway may have a definite role in breast carcinogenesis and can be used for targeted therapy. Also, different patterns of beta-catenin expression may have prognostic and predictive value.

Dosimetric parameters of heart and left ventricle – comparison of 3D CRT and IMRT in left cancer breast

Background: Conformal Radiotherapy techniques adapting to the ballistics of delineated volumes allowed significant reduction in excess radiation induced mortality however the increasing number of long-term survivors and expanding use of cardiotoxic drug highlight the persistent need for maximal cardiac possible sparing. The low dose volume of left ventricle are better predictor of acute coronary events than mean heart dose. Materials and Methods: 38 post-MRM patients were randomized to treatment by 3Dimensional Conformal Radiotherapy (3D CRT) and Intensity Modulated Radiotherapy (IMRT) technique. Two tangential beams were used in 3D CRT technique while five to seven (mostly tangential beams) were used in inversely planned IMRT technique. The dose volume parameters of planning target volume, heart and left ventricle were compared. Results: The dosimetry of Planning target volume showed significantly better coverage in IMRT technique (D90, D95) however the D50 was comparable in both the techniques. In dosimetry of heart, the high dose volumes (V30, V40) were nearly comparable in both the techniques. The other dose volume parameters (V5, V10, V20, V25, D33, D67, D100) and the mean dose were significantly lesser in 3D CRT technique along with significantly better sparing of left ventricle (Dmean and V5). Conclusion: The dosimetry of target volume was better with IMRT technique, but this was accompanied by a huge increase in dose to whole heart and specifically the left ventricle which has strong potential to translate into an increased cardiotoxicity. A better distribution of the target region may be obtained by multiple segmentation of the two tangential fields in 3D CRT plans with further reduction in dose to heart and left ventricle.

Prevalence of overweight obesity among M.B.B.S. students

Background: Prevalence of overweight-obesity is rising in India. Medical Professionals are vulnerable to overweight-obesity because of the sedentary lifestyle which is frequently adopted due to massive work burden. Aim & Objective: To assess prevalence of overweight-obesity and associated factors among MBBS students in a medical institute in north-Indian state of Uttarakhand. Settings and Design: Descriptive cross-sectional study Methods and Material: This study was conducted among 310 M.B.B.S. students at Himalayan Institute of Medical Sciences, Uttarakhand, between March and May 2019. Socio-demographic details were recorded using a structured pro forma. A pre-validated IPAQ questionnaire was used for assessment of physical activity. Anthropometric and clinical parameters were measured using standard techniques. Statistical analysis used: Independent student’s t test and Chi square test were used to compare the quantitative variables and categorical variables, respectively. Pearson’s correlation test was used to study the correlation of BMI with clinical parameters. Results: Among 310 study subjects, 164 (52.9%) were overweight-obese. The prevalence of abdominal obesity was 30.3 percent. Subjects with overweight-obesity, in comparison to normal BMI group, had higher frequency of smoking, higher systolic blood pressure, higher mean arterial pressure, higher pulse pressure and engaged more in high (category 3) physical activity. Conclusions: There was 52.9% prevalence of overweight-obesity in study cohort. Overweight-obese subjects had higher blood pressure and frequency of smoking, both traditional cardiovascular risk factors. Interestingly, more overweight-obese subjects engaged in high physical activity.

Molecular characterization of hepatitis A virus from children hospitalized at a tertiary care centre in northwest India

Background & objectives: Hepatitis A virus (HAV) infection is a major cause of childhood hepatitis, prevalent worldwide. HAV is classified into seven genotypes I-VII; genotypes III and I are the most common among humans. The present work was carried out to identify the genotypes prevalent in children suspected to have acute viral hepatitis (AVH), hospitalized at a tertiary care centre in northwest India. Methods: A total of 1269 blood samples from children (0-15 yr of age) clinically suspected of viral hepatitis were screened for anti-HAV IgM. Acute phase serum was processed for RNA extraction and amplified by nested polymerase chain reaction (PCR) followed by sequencing of representative samples. Results: Among the 1269 samples tested, 642 (50.59%) were positive for anti-HAV IgM; among the positive samples, 171 patients having a history of less than seven days were tested by PCR, of whom 141 (82.45%) were found to be PCR positive. Nucleotide sequencing of a representative 44 samples showed high homology; all the samples were found to be of genotype IIIA. Interpretation & conclusions: Hepatitis A was prevalent during July to September and in predominantly children less than five years age. Only genotype IIIA was detected in all the samples.

Ocular manifestations in patients attending antiretroviral therapy centre at a tertiary care hospital in Himachal Pradesh, India

Background & objectives: Ocular manifestations in HIV/AIDS patients range from adnexal disorders to the posterior segment disease. This study was aimed to evaluate the ocular manifestations, including vision-threatening manifestations in HIV-positive patients attending an antiretroviral therapy centre (ART) of a tertiary care hospital in north India and its association with the CD4+ cell count. Methods: This cross-sectional study was conducted in the department of Ophthalmology in collaboration with the ART centre. An equal number of patients were selected from each year i.e., 30 patients each from those registered in the year 2010 till 2015. These patients were selected randomly from the register using systematic randomization. Hence, a total of 150 patients were examined for ocular manifestations. All the patients included in this study were on highly active ART. Results: Of the 150 patients examined, 53 per cent were females and 47 per cent were males. Heterosexual transmission was the most common mode of transmission in 126 (84%) patients. Maximum number of patients was in the age group of 31-40 yr. Ocular manifestations were present in 53 [35.3%; 95% confidence interval (CI): 28-43%] patients. Twelve (8%; 95% CI: 4-12%) patients had lid and adnexal manifestations. Anterior-segment manifestations were present in 20 (13.3%; 95% CI: 8-19%) patients. Posterior-segment manifestations were present in 21 (14%; 95% CI: 8-20%) and vision-threatening posterior-segment ocular lesions were present in 14 per cent of the patients. Univariate logistic regression showed a significant (P<0.001) inverse association of CD4+T-cell count with the vision-threatening posterior-segment ocular lesions. Interpretation & conclusions: Routine ocular examination may be done in all the HIV/AIDS patients to detect and treat vision-threatening ocular lesions at the earliest.

Topical 002% Mitomycin C for management of primary corneal-conjunctival intraepithelial neoplasia as primary therapy: A long term follow up

Background: The corneal-conjunctival intraepithelial neoplasia (CCIN) is an ocular surface neoplasia commonly found among populations exposed to strong UV light. Although surgical excision is mainstay treatment, topical Mitomycin-C (MMC) 0.02% has been tried as a sole therapeutic treatment of non- invasive Ocular Surface Squamous Neoplasia (OSSN). Aim: The aim of this study was to report the long term outcome of treatment of non invasive ocular surface squamous neoplasia with topical Mitomycin C (0.02%) as primary therapy. Materials and methods: Total six eyes of six patients with CCIN were treated with topical mitomycin C (0.02%) alone as a sole therapy. All patients received topical MMC (0.02%) four times daily as a cycle therapy of two week ON and two week OFF for 12 weeks. The patients were followed up to two years. Results: All patients showed total cure with no recurrence during 2 years follow up period. Ocular irritation and mild conjunctival hyperemia were observed in 4 eyes during treatment with MMC. There were no serious complications noted at the end of the follow-up period. Conclusion: We concluded that Topical Mitomycin C (0.02%) may be used as a sole therapeutic treatment of non invasive Ocular surface squamous neoplasia with close on going follow-up.

Drug Prescription Pattern in Pregnant Women Attending Antenatal Out Patient Department of a Tertiary Care Hospital.

Aims: Pregnant women requiring medication represent a challenge to healthcare providers to avoid any teratogenic risk to fetus. The purpose of this study was to provide information about the drug use among pregnant women in a tertiary care hospital, Mumbai, India. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics and Gynecology and Department of Pharmacology, Seth GSMC & KEM Hospital, between July 2011 and December 2011. Methodology: A cross sectional study was conducted by reviewing the antenatal care Outpatient department case papers of 760 random pregnant women. Demographic profile, detailed medical history and drug intake in current pregnancy was noted. The prescription pattern was assessed and the drugs were classified based on the US FDA Risk Classification. Results: Out of 760 women, one third (33.18%) women were anemic. Majority drugs were prescribed for the treatment of upper respiratory tract infection, vaginal discharge fever with chills, nausea and vomiting. The average number of drugs per prescription was 2.27. Only 4% drugs were prescribed by their brand name and 96 % by generic name. Iron, folic acid and calcium were prescribed to all pregnant women. Majority of the patients were prescribed Category A and B drugs. No patient was given Category X drugs. Conclusion: Findings of our study showed that all pregnant women were provided with prophylactic iron and folic acid therapy. The occurrence of contraindicated medicines was desirably low, thereby minimizing overall risk to developing fetus. Thus prescribing pattern observed in our study sets a good example, as selection of drugs was rational in most of the cases.

Effect of thyroxine on fibrinolytic system in rat.

Thyroid hormones have many effects on the cardiovascular system. Thyroid dysfunction accelerates atherosclerosis not only through conventional risk factors (dyslipidemia) but they also show a very close relationship with hemodynamic parameters. Thyroxine is determinant of the several components of fibrinolytic system even though the exact relationship is far from clear. Present study was carried out to determine the effect of thyroxine on fibrinolytic parameters such as plasminogen activators (PA) in rat heart, levels of PA and plasminogen activator inhibitor (PAI), glucose in plasma and serum lipid profile. Rats were injected with 50 ug eltroxine/100 gm–1 body weight intraperitoneally for one week. Compared with controls, thyroxine treatment increased PA activity significantly in rat heart. No changes were seen in PA, PAI and glucose in plasma of two groups of rats. A significant decrease in total cholesterol and LDL-cholesterol levels was seen in serum of treated group resulting in the decrease of LDL/HDL and Total cholesterol/HDL-cholesterol ratios. These results suggest that thyroxine treatment may have considerable clinical significance. It raised PA activity in heart as well as reduced cholesterol content in blood. It is possible that thyroxine treatment may confer a beneficial effect on cardiovascular risk.

Cervical mediastinoscopy: Re-evaluation of an old technique in era of new imaging technology.

Context. With the advent of modern anatomical and functional imaging technologies, application of cervical mediastinoscopy has decreased in diagnosis and staging of mediastinal diseases. Aim. To evaluate the usefulness of cervical mediastinoscopy in assessing the mediastinal disease when imaging modalities are non-diagnostic. Settings and Design. Retrospective analysis of records of a tertiary care hospital. Patients and Methods. Thirty-nine patients with mediastinal pathology of varied aetiologies underwent cervical mediastinoscopy. Pre- and post-operative diagnosis was compared. Results. In 34 out of 39 cases (87.5%), cervical mediastinoscopy provided a confirmatory final diagnosis. One case had a major complication in the form of recurrent laryngeal nerve palsy. Conclusion. Cervical mediastinoscopy is useful, minimally invasive modality in a scenario where anatomical and functional imaging tools are non-diagnostic.

Tonsillectomy and adenoidectomy for obstructive sleep apnea in sickle cell anemia.

Objective. To evaluate the effects of Tonsillectomy and Adenoidectomy (T&A) on Obstructive Sleep Apnea (OSA) secondary to Upper Airway Obstruction (UAO) in children with Sickle Cell Disease (SCD). Methods. Twenty eight children with SCD and history of snoring, with or without adeno tonsillar hypertrophy, were evaluated for UAO and OSA. Results. Eight children were confirmed to have OSA by multichannel polysomnography and underwent T&A. Follow up examination showed symptomatic clinical and objective improvement in sleep study parameters in OSA. Conclusions. T&A appears to be a safe, effective option to treat selected patients with OSA due to UAO in SCD children.

Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial.

AIM: To assess the efficacy of internal sphincterotomy compared with application of topical 2% Diltiazem ointment after hemorrhoidectomy for pain relief. SETTINGS AND DESIGN: Prospective randomized study. MATERIALS AND METHODS: In an 18-month period, 108 subjects with uncomplicated Grade 3/ 4 hemorrhoids were enrolled in the study and were randomized into two equal groups: Subjects in Group A underwent internal sphincterotomy at time of primary surgery while those in Group B received 1 g of 2% Diltiazem ointment locally, thrice daily for seven days. Postoperative pain perception was measured using visual analog score (VAS) and on the basis of number of analgesic tablets (Tab tramadol 50 mg) required in each group. Time to discharge, time to return to work and incidence of complications measured and compared. STATISTICAL ANALYSIS USED: Statistical techniques applied were Student T test, Chi-square and Fisher's Exact Test. RESULTS: There were 102 analyzable subjects (Group A: 50 and Group B: 52). The mean VAS score was significantly less in the internal sphincterotomy group from the fourth postoperative day onwards compared to topical Diltiazem (2.23 vs. 3.72; P =0.031). Similarly, the mean requirement of analgesic tablets [10.54 vs. 15.40; P =0.01] was much lower in Group A. There was no significant difference in terms of time to discharge and time to return to work between the two groups. The incidence of complications was more with the internal sphincterotomy group (11.5% vs. 3 %; P =0.488). CONCLUSIONS: In patients undergoing hemorrhoidectomy, addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of Diltiazem.

DNA fingerprinting of Mycobacterium tuberculosis isolates from Agra region by is 6110 probe.

DNA fingerprinting using IS 6110 probe has been used all over the world quite successfully to characterize M. tuberculosis strains. The present study has been carried out to study the polymorphism among isolates of M.tuberculosis from Agra region from patients attending the clinics at SN Medical College and TBDTC, Agra. Sputa were collected in sterilized containers and brought to CJIL, Agra. Samples were processed and cultured on Lowenstein Jensen (LJ) slants. M. tuberculosis isolates were identified by standard biochemical tests. DNA from these isolates were purified by a physicochemical procedure, restricted with Pvu II enzyme and hybridized with PCR amplified and DIG labeled 245 bp IS 6110 probe. With a view to study IS 6110 polymorphism, M. tuberculosis isolates obtained from different geographical areas of Agra region were analyzed. Among the 60 isolates taken in study, 5 had no copy of IS 6110, 8 had 1-4 copies and 47 had multiple copies of IS 6110. DNA fingerprinting using this probe was found to be quite discriminating for typing of most of the strains (80%) which had multiple copies. RFLP profiles did not correlate with geographical areas, contacts or the resistance pattern of the strains. While this data shows the potential of IS 6110 based RFLP for strain characterization of M.tuberculosis in Agra, to understand the molecular epidemiology of tuberculosis in this region, a larger number of isolates from defined geographical areas need to be studied.

Is internal podalic version a lost art? Optimum mode of delivery in transverse lie.

AIM: To study the changing trend in the delivery of transverse lie, and its effect on neonatal outcome, in a developing country. SUBJECTS AND METHOD: This is a retrospective study involving records of 12 years of all patients with transverse lie. Neonatal outcome of births by internal podalic version (IPV) and lower segment caesarean section (LSCS) were compared. RESULTS: In the first six years, 37.3% of transverse lie underwent IPV and 62.7%, LSCS. In the next six years, 15.8% underwent IPV and 84.2%, LSCS. 87.7% and 12.3% of live babies were delivered by LSCS and IPV respectively. 52% of the live born IPV were discharged compared to 95% of LSCS babies. Neonatal outcome was best when IPV was performed on second twin. CONCLUSION: IPV has a role in the delivery of second twin, pre-viable and dead babies.