Morphometric Aspects of the Jugular Foramen and Jugular Fossa in Dry Skulls of Central India

Jugular foramen is a large irregular hiatus at the base of the skull which transmits a large number of important structures. Any abnormality of jugular foramen and associated jugular fossa may impart damage to these structures. Aim of the present study was to analyse the shape, size, presence of septa, presence of a domed bony roof and bilateral symmetry of the Jugular foramen in dry adult skulls of males and females in the central Indian population. METHODSA total of 120 skull jugular foramina and jugular fossae were examined, by two different researchers to avoid observer errors. Parameters studied were anteroposterior and transverse diameters of jugular foramen, width and depth of jugular fossa, presence of bony septum etc. Data was collected and analysed using statistical software. RESULTSAntero-posterior and transverse diameters of right jugular foramen were found to be more than left one. Complete septation of jugular foramen was observed in 1.67 % and 2.5 % skulls on right and left side respectively. Bony roof or dome of jugular fossa was observed in 30 %, 17.5 % and 16.67 % on the right side, the left side, and bilaterally respectively. In 10.83 % skulls, we found an accessory foramen connecting jugular foramen to anterior condylar canal. CONCLUSIONSDetailed knowledge of various anomalies of jugular fossa and jugular foramen should be kept in mind while doing surgery by neurosurgeons and ENT surgeons. Radiologists also should keep these points in the mind while interpreting CT and MRI scans.

Cognitive Impairment in Renal Transplant Recipient: A Prospective Study

Introduction: Kidney transplant recipients, like patients on dialysis, have several risk factors for developing cognitive impairmentsuch as comorbid illness, depression, and lower level of physical activity.Materials and Methods: A total of 25 patients were included to analyze the cognitive status in chronic kidney disease patientbefore and after renal transplant (RT) (6–9 months after renal transplant). Demographic and clinical variables associated withcognitive impairment were also examined.Results: The mean hemoglobin (Hb) before RT was 8.44 g, significant increase after RT 11.56 mgs. The mean blood ureadecreased from 115.60 mgs to 31.60 mgs after RT. Serum creatinine significantly decreased after RT from 8.10 mgs to 1.30 mgs.Blood pressure (BP) after RT decreased to 123.6/80.40 mmHg. Statistically significant changes in attention, anterogradememory, verbal fluency, and word recognition after renal transplant, but there is no statistically significant in language domain.Conclusion: There is a statistically significant increase in Hb level, decrease in serum creatinine and blood urea, and BPcontrol after the renal transplant. Statistically significant changes in attention, anterograde memory, verbal fluency, and wordrecognition after renal transplant, but there is no statistically significant in language domain

Comparative Analysis of Conventional Flap Surgery vs Laser Assisted Periodontal Flap Surgery: A Report of Two Cases.

The objective of periodontal surgery is to restore periodontal health and to prevent further relapse. Traditionally scalpels were used in periodontal surgery. Recent advancements in laser have set a milestone in the field of periodontal surgery. So considering the above facts, the objective of this case series is to analyze the pre and post–operative results obtained between conventional periodontal flap surgery and diode laser assisted periodontal flap surgery. Two chronic periodontitis patients with generalized probing pocket depth of more than 7mm was selected for this clinical study. Both the patients had angular bone loss in the upper quadrant and generalized horizontal bone loss in the lower quadrant. So scalpel periodontal surgery was planned for the upper quadrant and diode- laser assisted flap surgery in the lower quadrant. Post-operative results based on clinical parameters and patient perspective were recorded. Clinically significant improvement in probing pocket depth and clinical attachment levels were observed in both the surgical sites. Patient acceptance and comfort were more in laser treated sites compared to conventional surgical sites.

Clinical Profile of Patients with Scorpion Sting.

Introduction: Scorpion sting is a major public health problem in developing countries, especially in villagers. Manifestations include vomiting, profuse sweating, piloerection, diarrhoea, loss of appetite, loss of sphincter control and priapism. Stimulation of Alpha receptor results in hypertension, tachycardia, myocardial dysfunction, pulmonary edema and cool extremities. Aims: The study is undertaken to know the clinical profile of the patients with scorpion sting. Methods and Materials: prospective study was conducted from October 2011 to September 2013 at Mamata General Hospital, khammam in adult patients 18yrs and above with history of scorpion sting. Detailed physical examination and grading of envenomation was done. Results: Eighty two patients fulfilled the inclusion criteria for the time period studied. Fifty two patients (62.25%) were male and thirty (37.50%) were female. Mean age of patients with scorpion sting was 31.23±7.23 years. Pain (87.50%),Sweating (81.25%) tingling & numbness (77.50%) were the most common presenting symptoms Conclusion: The present study shows that scorpion bite is more common in males. Local pain and signs of sympathetic over activity were the commonest features.

Paracetamol induced fi xed drug eruption: a case report.

Fixed drug eruption (FDE) is a type of drug-induced skin reaction pattern that characteristically recurs at the same skin or mucosal site. Paracetamol is one of the common drugs prescribed as analgesic–antipyretic agent in all age group of patients. FDE is a well-reported, but uncommon side-effect of paracetamol, usually the classic, pigmenting type most commonly found in children and adolescents. We present a case of 52 years old male patient who developed FDE over the glans penis following paracetamol use.

Fatal Stevens-Johnson syndrome induced by phenytoin: a case report.

Toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare (one to two per 10,00,00 population per year) but life threatening adverse drug reactions. Drugs commonly implicated are anti-epileptics, anti-microbials and non-steroidal anti-inflammatory drugs (NSAIDS). Amongst anti-epileptics, carbamazepine and phenytoin are the major culprits. We report here a fatal case of SJS due to phenytoin.

Acute muscle dystonia resulting from medication error: a case report.

Acute Muscle Dystonia (AMD) due to medication error is rarely reported in the literature. We are reporting a case of adverse drug reaction due to a single dose of haloperidol. Patient was free from any psychiatric illness and still he developed AMD with use of haloperidol because of medication error. The patient recovered completely from AMD symptoms in one hour after receiving the treatment. This case report intends to improve the awareness among clinicians to be cautious while writing the prescriptions.

The irrational fixed dose combinations in the Indian drug market: an evaluation of prescribing pattern using WHO guidelines.

Background: Evaluation of the pattern of fixed dose combinations (FDCs) prescribing amongst the practitioners in a tertiary care hospital in Central India. Methods: Nine hundred and ninety four prescriptions, containing 639 FDCs were scrutinized in the tertiary care hospital. After excluding the total and the interdepartmental repetitions, the numbers of FDCs were 278, which were considered for final analysis. Inclusion criteria were FDCs from the major out-patient department (OPD) of the tertiary care hospital from January 2011 to December 2011. FDCs from the wards, casualty, infectious disease unit, intensive cardiac care unit (ICCU), tuberculosis and chest and HIV unit were excluded from the study. FDCs were analysed for the different pattern of prescribing and rationalism. Results were expressed as percentages. Results: Out of 639 FDCs, the most commonly prescribed FDCs were B complex (12.20%), pantoprazole plus domperidone (9.55%) and amoxicillin plus clavulanic acid (7.35%). Seventy percent of the FDCs were prescribed to the age group of 21-60 years. The FDCs were maximum from the department of medicine (25.59%), followed by surgery (15.47%) and ENT 13.69%. Out of 278 FDCs, only 5.4% were rational, and rest of the FDCs were irrational. Ninety five percent of all FDCs were brand names. The physicians were unaware of the active pharmacological ingredients (APIs) of 20.86% FDCs. Ninety two percent FDCs were available as over the counter (OTCs). Forty eight percent FDCs were costing from Rs. 0-50. There were 2.87% FDCs whose price was above Rs. 500. Conclusions: Irrational FDCs are prescribed by all the departments. Physicians were ignorant about the essential drugs and FDCs. Patients didn’t have access to rational medicines. Therefore, physicians and regulators should be alerted in time. Regulatory actions or government laws should be made mandatory. Availability and access to 348 essential medicines for basic health care should be the priority of the government. Implementation of central drug standard control organisations (CDSCO) guidelines on industries for manufacture of FDCs must be made compulsory.

Comparison of Indian package inserts in public and private sector: an urgent need for self regulation.

Background: Package inserts are the authentic source of information for the new molecules in the market. Incomplete and incorrect product information may promote irrational prescribing and may have serious consequences. Hence, our aim was to analyse and compare the information supplied in the package insert according to the section 6.2 and section 6.3 of schedule D of Drugs and Cosmetic Act, 1940 in public (government) and private (non-government) sector. Methods: Package inserts of allopathic drugs which were supplied by government from drug store of tertiary care centre and hospital and from pharmacies on request were collected. A total of 270 package inserts in English were collected that is 38 from government hospital and 232 from the pharmacies nearby the hospital. The package inserts were analysed for the presentation of completeness of the information as per section 6.2 and 6.3. Results: The presentation of information on analysing 233 package inserts (28 government and 205 non government) was not uniform and it was difficult to locate and retrieve information easily due to lack of common layout and heading. Moreover, the package inserts were of variable shape and size with different font size which made it inconvenient for analysing as well as for reference. Posology and method of administration was incomplete in 3% package insert in non- government cases whereas in government supply it was 7%. Use of drug in pregnancy and lactation was deficient in 11% and 14% packages inserts of non-government sources and government sources respectively. Instructions for use were lacking in 25% and 29% package inserts of government and non-government sources respectively. Conclusions: The need of the hour is to further refine contents of the circulated package inserts to make them complete, reliable and up to date. This can be a step forward for ethical and effective dissemination of healthcare services in our growing society.

Acute and sub-acute toxicity studies of Passiflora nepalensis in rats

This study was designed to elucidate the toxicity of widely used plant Passiflora nepalensis Walp. (Passifloraceae) in rats. We have taken methanolic extract isolated from whole plant of Passiflora nepalensis and studied their toxic effects. Acute, sub-acute toxicities and LD50 values were determined in experimental rats. The external appearance of the dead animals, the appearance of the viscera, heart, lungs, stomach, intestine, liver, kidney, spleen and brain were carefully noted and any apparent and significant features or differences from the normal were recorded after acute treatment with methanolic extract of whole plant of Passiflora nepalensis (MPN). Following the sub-acute administration of MPN for fourteen days, the vital organ such as liver, kidney and heart were carefully evaluated by histopathological and biochemical studies and any apparent and significant changes or differences from the normal were recorded. Pathologically, neither gross abnormalities nor histopathological changes were observed. Oral administration of MPN at the doses of 40, 80, 160 and 320 mg/kg body wt for fourteen consecutive days to male and female rats did not induce any short term toxicity. Collectively, these data demonstrate that the methanolic extract of Passiflora nepalensis have a high margin of safety.