Post cholecystectomy common bile duct dilatation: a study from upper hills of Himachal Pradesh, India

Background: Relationship between cholecystectomy followed by postoperative dilatation of the common bile duct is uncertain. Various studies have shown variable results regarding the dilatation of common bile duct after cholecystectomy.Methods: This study was a 1-year prospective study conducted at IGMC, Shimla with consent and ethical approval from the committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in Surgical Wards of IGMC Shimla for elective surgery were selected for the present study. Cholecystectomy was done in all cases, after doing all the investigations.Results: The mean preoperative CBD diameter in the study group was 4.2mm, 48 hours postoperatively was 5.58mm and at 1-month interval following cholecystectomy was 6.02mm, so the mean postoperative diameter observed was (6.02+5.58=5.8mm).Conclusions: Significant dilatation does occur in CBD which is purely compensatory as there was no evidence of any pathological dilatation. This dilatation occur only in early post-operative period till the CBD adapts to contain bile equal to the Gall Bladder.

Perinatal outcome in hypertensive disorder of pregnancy in a rural community of Haryana

Background: Pregnancy in hypertension may complicate pregnancies with variable incidence among different settings. Pregnancies complicated with hypertensive disorders are associated with increased risk of adverse fetal, neonatal and maternal outcome including preterm birth, intrauterine growth retardation (IUGR), perinatal death etc. The present study was undertaken to study the perinatal outcome of hypertension in pregnancy in a rural block of Haryana.Methods: This cross-sectional study was carried out in the all the 20 subcenters under Community Health Center (CHC) Chiri, Block Lakhanmajra. All the pregnant women registered at the particular subcenter at a point of time of visit were included in the study. Pregnancy outcome was followed-up by contacting the health worker of respective sub-center or mother. Information regarding stillbirth, abortion, maturity, birth weight, mode of delivery and early neonatal death was collected. Appropriate statistical tests were used for analysis.Results: A total of 931 pregnant women were included in the present study. Prevalence of hypertension in pregnancy was found to be 6.9%. Hypertension in pregnancy is significantly associated with premature births still births (6.7% vs 1.4%; p=0.003), low birth weight (26.7% vs 4.9%; p=0.000) and early neonatal deaths (8.3% vs 2.8%; p=0.017).Conclusions: Perinatal mortality is significantly high in mothers with hypertensive disorders. Early diagnosis and treatment through regular antenatal checkup is a key factor to prevent hypertensive disorders of pregnancy and its complications.

Awareness about tuberculosis among nurses working in a tertiary care hospital in Solan, Himachal Pradesh

Background: Tuberculosis has remained a disease of public health importance since ages and is known to inflict large quantum of socioeconomic cost on the society. Since nurses are in direct contact with both hospitalised and ambulatory patients, they are likely to play a vital role in the effective implementation of the RNTCP. The present study attempts to evaluate the awareness of nurses about TB.Methods: This cross sectional study was conducted in a tertiary care institute, Maharishi Markandeshwar Medical College and Hospital, Kumarhatti, Solan for period of 1 year. Data was collected from 180 staff nurses and appropriate statistical tests were applied for evaluation of the same.Results: Knowledge regarding the predisposing factors causing the disease, first line drugs under DOTS treatment, full form of DOTS, patient wise boxes and about the side effects of the treatment were comparatively low among the subjects.Conclusions: Nurses are directly handling and managing patients but the knowledge and awareness of tuberculosis was not satisfactory among them. Therefore efforts must be made to organize regular workshops and periodic seminars to upgrade their knowledge.

Comparing Refractive Error with Axial Length in the Subjects Having Refractive Error

Introduction: Refractive error has now become the secondmost common cause of blindness across the world. Thereis necessity to explore the various factors having impact onrefractive errors as they will certainly assist in the variousmodes of treatment aspect of the refractive errors. This studywas carried out with the aim of comparing refractive errorwith axial length in the subjects with refractive error.Material and methods: In this study, total of 500 adult caseswere recruited. So total of 1000 eyes were examined upon.This study was carried out, over a total period of 2 years.General examination was carried out in each and every case.Afterwards, local examination was done. Then refractive errorand axial length was measured. The data obtained from thisstudy was analysed statistically.Results: The results of our present study have showed thatthe spherical refractive error has statistically highly significantnegative correlation with axial length, in right eye (r=-0.836,p<0.01) and in left eye (r=-0.859, p<0.01).Conclusion: The observation made from this study says thaton progressing from myopic to hyperopic refractive error, theaxial length of the eye is found to decrease. In the refractiveerror of shortsightedness or myopia, the final image is formedahead of retina

Peripheral Vascular Disease: An Unusual Presentation of Peripartum Cardiomyopathy.

Peripartum cardiomyopathy (PPCM) usually presents with the heart failure in the last month of pregnancy or up to 5 months post-partum period, without any underlying cause of cardiac failure. This is a hypercoagulable state associated with left ventricular (LV) systolic dysfunction, thereby causing thromboembolic complications. We report a case of 2 months post-partum female who presented with left lower limb arterial thrombotic occlusion which turned out to be secondary to embolization from a large LV thrombus resulting from PPCM. The present case is an unusual presentation of PPCM that usually presents with a clinical feature of cardiac failure.

Comparative study of anti-mutated citrullinated vimentin, anti-cyclic citrullinated peptides, and rheumatoid factor predictability in the diagnosis of rheumatoid arthritis.

Background: Rheumatoid arthritis (RA) is characterized by synovial joint inflammation, which often leads to progressive joint destruction and disability. Several other auto-antibodies specific to RA have been found .Among them, antibodies against cyclic citrullinated peptides (CCP) are useful for diagnosing RA. Antibodies to mutated citrullinated vimentin (MCV) were described recently in RA. The aim of this study was to determine the diagnostic values of ACCP compared to anti-MCV and Rheumatoid Factor in rheumatoid arthritis patients. Methods: This study included 92 patients with Rheumatoid arthritis (RA) and 35 matching healthy controls. Blood samples were obtained from patients and controls for Erythrocyte Sedimentation Rate (ESR), C Reactive Protein (CRP), Rheumatoid factor (RF). Anti-CCP2 and anti-MCV were determined using ELISA technique. Results: RA group was significantly higher than control group as regard ESR, CRP, RF, Anti-CCP, and Anti- MCV. Conclusion: It was concluded, compared to ACCP, anti-MCV has approximately the same accuracy for the diagnosis of rheumatoid arthritis but higher than Rheumatoid Factor. Level of Evidence: Level II, prospective study, as per guidelines for authors.

Sternal tuberculous osteomyelitis: a series of four cases.

Tuberculous osteomyelitis of sternum presenting as an acute swelling over chest is a rare entity accounting for less than 7% cases even in countries with endemic tuberculous disease. We herein report four such cases which were diagnosed by CT scan showing lytic lesion of sternum. Tuberculous osteomyelitis of sternum is rare and therefore differential diagnosis of chest wall mass must be considered. A series of four patients suffering from tuberculosis of the sternum with a mean follow-up of 2 yr is presented. All were treated with antituberculous therapy. All showed good healing.

Prevalence and Correlates of Alcohol Intake In a Rural Block of Haryana, India.

Alcohol consumption is today’s major public health concern in our country, which can be largely reduced solely by primordial and primary prevention. According to NFHS III, 31.9% of men and 2.2% of women drink alcohol in India. Aims & objectives: To determine the prevalence and correlates of alcohol intake among the rural community of block Beri, district Jhajjar, Haryana. Methods: This cross-sectional study was carried out during the period of September 2012 to August 2013. Multistage random sampling was used in this study. From each selected PHC, two subcentres were randomly selected and from each subcentre area, two anganwadis were also selected by simple random sampling technique. Hence a total of 6 sub-health centres and 12 anganwadis were included in the study. From each anganwadi, 90 individuals of 15-64 years age group who were further subdivided into 15-24, 25-34, 35-44, 45-54 and 55-64 years age-group were selected and interviewed. Thus, a sample size of 1080 was included in the study Appropriate statistical tests were used for analysis. Results: The overall prevalence of ever alcohol intake was found 25.7% (Males:49.1%; Females: 2.4%). The prevalence of current alcohol intake was found to be 18.8% (Males: 36.9%; Females: 0.7%). Conclusion: Our study confirmed the high burden of alcohol intake in rural areas and reiterated the need to address these issues comprehensively as a part of NCD prevention and control strategy.