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Introduction:Anthropometric studies have shown significant variations in the cranium and orbits between races and genders due to various factors such as genetics, race, hormones, nutritional differences, and environmental influences. The present study aims to record cranial and orbital dimensions and indices to classify skulls based on these measurements. MaterialsandMethods: Thirty‑five human adult skulls were obtained from the dissecting laboratory and museum of Hind Institute of Medical Sciences, Safedabad. The orbital height, width, interorbital distance, maximum length, and width of the cranium were measured directly using a digital Vernier caliper. The skulls were then classified based on the orbital and cranial indices calculated. Results: The study found a mean orbital index of 83.42, classifying the skulls as mesoseme, and a cranial index of 73.15, classifying them as dolichocephalic. Conclusion: Basic data and records of morphometry of bones belonging to specific regions can help identify the ethnicity and race of a person. Understanding the correlation of dimensions of the orbital cavity and cranium is crucial in certain conditions, such as interpreting fossils, classification of skulls in forensic medicine, and discovering trends in evolution and racial differences. These findings may also aid in identifying unclaimed bodies in India, which are found in significant numbers yearly
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Nursing is one of the professions which require knowledge along with clinical competence to provide high quality nursing care. Objective Structured Clinical Examination (OSCE) and Objective Strucured Practical Examination (OSPE) methods of evaluation have emerged as an alternative to traditional evaluation methods for the skills assessment. This study was planned to train nursing faculties on OSCE and evaluate its effectiveness. The primary objective of the for nursing faculties on knowledge regarding OSCE. A one group pretest-posttest design with a quantitative research approach was used. Convenient sampling method was used include 27 faculties from all the available colleges of Nursing in NCT of Delhi. A structured 15-item questionnaire with multiple choice questions, each comprising four responses with one correct response was used to evaluate the knowledge of the participants regarding OSCE. The twoday training programme comprised the theory sessions and demonstration of OSCE stations ties. The study suggests that there is a need to develop a structured training programme and conduct training for faculties across the country to bring in uniformity in implementation of OSCE method of evaluation in colleges.
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Background: Epilepsy is a common chronic non-communicable neurological disorder in which the brain function is impaired. Cognitive function is more frequently impaired in people with epilepsy than in the general population. The neurocognitive outcome of epilepsy in children and adults is vital for social prognosis and quality of life assessment. Cognitive changes in epilepsy have multifactorial etiology, including the epilepsy itself, age at onset, duration of epilepsy, treatment of epilepsy, reaction to epilepsy and any associated brain dysfunction and /or damage. This study was conducted to check association of neurocognitive impairment with the socio-demographic factors and disease associated factors in patients with epilepsy. Methodology: This study was a single centre cross-sectional study in which 96 patients were included. Severity of neurocognitive impairment was measured by Addenbrookes’ Cognitive Examination- R (ACE- R) score. Results: Out of 96 patients, neurocognitive impairment was seen in 23 (23.95%) patients. Conclusions: This study shows that neurocognitive impairment was found to be more when the age at onset of epilepsy was less, when the duration of the illness was more and when frequency of seizure was higher. Conclusion: Neurocognitive impairment is noted in patients with epilepsy and must be treated in the long- term management of epilepsy
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Transient ischemic attack (TIA) is a diagnostic challenge for all physicians due to the temporariness of symptoms and the absence of any definitive diagnostic test. There is a very high risk of TIA being followed by an ischemic stroke, hence require urgent investigation and preventive strategies. At the same time, it is also important to distinguish TIA from other close differentials, to avoid wrong diagnoses leading to harmful, misdirected medical management. In this report, we will discuss the case of a middle-aged male patient with stable pre-operative vitals who was posted for total parotidectomy and suddenly developed jerky movement of the upper limb and transient aphasia on the operation theater table along with raised blood pressure. This is a very rare presentation of TIA that needs to be differentiated from other close differentials as this form is mostly associated with severe carotid occlusive disease and, hence, carries a high risk of stroke.
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This study aimed to evaluate whether human chorionic gonadotropin (hCG) therapy is beneficial for improving semen parameters and clinical hypogonadism symptoms in hypogonadic oligozoospermic or severe oligozoospermic men with low or borderline testosterone levels. Methods: A weekly dose of 250 μg (equivalent to approximately 6,500 IU) of hCG was administered subcutaneously for 3–6 months to 56 hypogonadic oligozoospermic or severe oligozoospermic men. Semen, biochemical, and genetic analyses were performed before the start of treatment followed by analyzing semen parameters every 3 months after the start of therapy. We grouped participants into responders and non-responders depending on positive changes in semen parameters. Results: Out of 56 men, 47 (83.93%) responded, while 9 (16.07%) did not. Upon statistical analysis, it was found that age did not affect the overall outcomes (p=0.292); however, men with higher body mass index (BMI; 28.09±3.48 kg/m2 ) showed better outcomes than those with low BMI (25.33±3.06 kg/m2 ) (p=0.042). The duration of therapy (in months) was higher in non-responders than in responders (p=0.020). We found significant improvements in sperm concentration (p=0.006) and count (p=0.005) after 3 months of therapy. Sperm motility and progressive motility were also found to be higher in responders, but did not show statistically significant changes. Conclusion: We conclude that hCG therapy can be beneficial in men with hypogonadic oligozoospermia or severe oligozoospermia.
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Purpose@#Neuroblastoma (NB) is childhood’s most common extracranial solid malignancy. We have compared two imaging modalities, 131I-MIBG and 18F-DOPA PET/CT, to evaluate NB. Also, feasibility of the application of standardised scoring systems, SIOPEN and Curie scoring systems, in 18F-DOPA PET/CT was explored. @*Methods@#Patients with histopathology-proven NB underwent 131I-MIBG (planar and SPECT/CT) and 18F-DOPA PET/CT scans, as per standard imaging protocols. Duration between scans ranged from 1 to 30 days (median = 8 days). Number of lesions in Curie and SIOPEN scoring systems applied on both modalities was compared. @*Results@#Forty-six patients were included (M:F = 29:17) with a median age of 36 months. Both 131I-MIBG and 18F-DOPA scans were positive in 39 patients and negative in four patients. 18F-DOPA PET/CT was positive in additional three patients, in which 131I-MIBG was negative (p = 0.25). Overall, 18F-DOPA identified significantly greater number of lesions than 131I-MIBG, especially metastatic skeletal lesions (p 0.05). CS and SIOPEN scores were significantly higher in bone marrow-positive patients. @*Conclusion@#18F-DOPA PET/CT detected more lesions than 131I-MIBG but had little impact on staging of the disease. For evaluation of NB, both scans can be used interchangeably as per the availability. Furthermore, both SIOPEN and Curie scoring systems, standardised for MIBG, can also be used to semi-quantify disease extent in 18F-DOPA PET/CT.
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Background: Growth and development of dentocraniofacial complex occurs during various stage of development of dentition with TMJ as one of its centres of growth. The condition of temporomandibular joint can be visible from its condylar head form; therefore, it is crucial to recognize the normal morphology of condylar head during different stages of development of dentition. Aims: The aim of the study is to view the morphological appearance of condylar head during primary dentition, mixed dentition and permenant dentition. Subject and Methods: 400 panoramic images of 194 boys and 296 girls were collected and were divided into three groups bases on the stage of dentition. Shape of the condylar head were determined by tracing the print out of the panoramic image on an X ray viewer. Results: The study showed that during primary dentition stage shape of the conylar head was dominated by round shape and as growth and development occurs the condylar head shape changes to convex. Conclusion: The study describes the normal morphology of mandibular condyles in a child population attending The dentition status as well as growth of craniofacial has a significant role in determining condylar morphology.
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Lidocaine is the most commonly used local anesthetic (LA) agent in various dental as well as oral and maxillofacial procedures. Although rare, adverse effects and allergic reactions to lidocaine have been reported. In patients with suspected allergy to LA or a history of such reaction, careful history-taking and allergy testing should be performed to choose an alternative LA agent to avoid any adverse effects. Here, we present two cases of delayed hypersensitivity reaction to lidocaine, wherein the patients presented with erythema, edema, and itching. Intradermal testing confirmed allergic reaction to lidocaine, and the patients underwent successful dental treatment using an alternative LA agent. This report highlights the importance of allergy testing prior to LA use considering the serious consequences of allergy to these agents and describes the management of such patients using an alternative LA agent.
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Wallenburg syndrome occurs due to damage to lateral segment of the medulla. Medial medullarysyndrome occurs due to damage to upper portion of the medulla. I report a case of a 30 years old woman diagnosed with medullary syndrome[both medial & lateral features] in absence of CT scan findings sent to the department of Physiology for electrophysiological tests like nerve conduction studies, blink reflex, brainstem auditory evoked potential (BERA) & visual evoked potential (VEP). She had loss of sensations on the ipsilateral half of face (right), hemisensory loss on contralateral trunk & extremities, headache, contralateral hemiparesis (left), ipsilateral lingual paresis with atrophy, fibrillations with contralateral positive Babinski’s sign. The electrophysiological tests showed decrease in conduction velocity of right facial nerve, left tibial & peroneal nerves with decreased amplitude. The nerve conduction studies of median nerve (both motor & sensory) were normal. In blink reflex, latency of R2 ipsilateral & R2 contralateral of supraorbital nerves were increased on right side. There were increasedlatencies of waves II, III, IV & V of BERA & increased P100 latencies in VEP.The results of the electrophysiological tests of the patient showed that she had features of both medial & lateral medullary syndrome suggesting a lesion of both upper & middle medulla. The CT scan in this case was normal but conduction of MRI & CT guided angiography of posterior cerebral & vertebral arteries could have further localized the lesion causing this mixed symptomology
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Background: Alcohol is the commonest psychoactive substance used by Indians. Stress and self-esteem issues may cause alcohol use as a coping mechanism. The purpose of this study was to analyze the severity of alcohol dependence, gauge levels of perceived stress and self-esteem and study coping skills in patients. It further examined the relations between sociodemographic variables of patients, their perceived stress, self esteem and coping skills as well as duration and severity of alcohol dependence.Methods: Cross-sectional study of 200 patients with alcohol use disorder recruited by complete enumeration technique was undertaken. They were administered a semi-structured questionnaire along with Perceived Stress Scale (PSS-10), Rosenberg’s Self-Esteem Scale (RSES), Coping Inventory for Stressful situations (CISS-21) and Severity of Alcohol Dependence Questionnaire (SADQ). Associations and correlations were examined.Results: Almost half the patients had severe alcohol dependence. Less than one-fourth of the patients had low self esteem. There was a significant negative correlation between self esteem and severity of alcohol dependence as well as duration of alcohol use. Nearly half the patients had high perceived stress. There was a significant positive correlation between severity of alcohol dependence and perceived stress. Majority patients used task oriented coping skills. Patients of alcohol dependence having low self-esteem used predominantly avoidant-oriented coping skills.Conclusions: This study highlights the importance of thorough evaluation and screening in patients having alcohol dependence for self-esteem issues and perceived stress levels. Teaching effective coping skills, supportive psychotherapy and counselling can be effective. Multimodal treatment protocols will effectively lighten the stress caused by alcohol dependence.
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Background: Acute appendicitis is one of the commonest surgical emergencies. Authors undertook this study to evaluate serum bilirubin levels in acute appendicitis and appendiceal perforation.Methods: A retrospective study evaluating the serum bilirubin levels in acute appendicitis and appendiceal perforation was carried out for 6 years at three tertiary care hospitals at India from 2014 to 2019. Patients having acute appendicitis and appendiceal perforation, confirmed on histopathology, with no other medical or surgical comorbidity were included in the study.Results: The total number of our study subjects was 927. 306 patients had appendiceal perforation, amongst these, 226 (74%) had hyperbilirubinemia. Out of the 621 patients having acute appendicitis only 186 (30%) had hyperbilirubinemia. The lowest and the highest serum bilirubin levels of this study group were 0.6 and 3.1 mg/dl, respectively, with an average of 1.6 mg/dl. In patients diagnosed to be having acute appendicitis, the lowest and highest serum bilirubin levels were 0.6 and 2.4 mg/dl, respectively, with an average of 1.3 mg/dl. As for the patients having appendiceal perforation the lowest and highest serum bilirubin levels were 0.8 and 3.1 mg/dl, respectively, with an average of 1.8 mg/dl.Conclusions: Hyperbilirubinemia is seen in acute appendicitis but predominantly in appendiceal perforation, so serum bilirubin estimation may help us in diagnosing appendiceal perforation pre-operatively if and when used in conjunction with other available diagnostic modalities.
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Background: Breast cancer is the most common malignancy in female worldwide. Ultrasound (US) is a safe and easily available modality for evaluation of breasts in females of all age groups. It can detect characteristic features of breast malignancy with high degree of accuracy. This study was undertaken with the aims to evaluate the ultrasonographic features of malignant breast mass, to identify the most commonly encountered gray scale ultrasound findings and to study the role of Doppler ultrasound in those cases.Methods: The study was conducted in Dr B. Borooah Cancer Institute, Guwahati from January 2018 to January 2019. Gray scale ultrasound including Doppler study was done in all the female patients coming with palpable breast lump or with nipple discharge and images were archived. The archived images of a total number of 108 patients with biopsy report positive for malignancy were retrospectively studied and the ultrasound findings were evaluated.Results: Most common gray scale ultrasound features for malignant breast masses were hypoechoic mass, taller than wide, irregular shape, having spiculated margins, neither posterior acoustic enhancement nor shadowing, presence of intralesional microcalcifications and surrounding echogenic halo. Hypervascularity, noticeable difference in waveform pattern between central and peripheral vessels, high resistance flow pattern with absent or reversal of diastolic flow were the common Doppler findings.Conclusions: Combination of Doppler with gray scale ultrasound has emerged as a very important technique in diagnosing malignant breast mass with high accuracy.
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The determination of working length and its maintenance during cleaning and shaping procedures is a key factor for successful endodontic treatment. The aim of this in- vitro study was to evaluate the utility and accuracy of Raypex5 electronic apex locator in determining the working length in comparison to conventional radiography and radiovisiography in posterior teeth. Methods: In this study sixty extracted mandibular first and second molars were used. Diagnostic images were obtained both by conventional radiography and radiovisiography (RVG) and tentative working length was obtained and recorded. After access opening actual root canal length was determined by both conventional radiography and RVG and recorded. Four blinded observers determined the working length in all samples with Raypex5 electronic apex locator. Then at that length file position was checked using RVG. Results: All the data collected was statistically analyzed using one way analysis of variance (ANOVA), Cronbach’s alpha reability analysis and student paired t-test. Conclusion: In this study it was found that Electronic apexlocator Raypex 92 %, RVG 74% and conventional radiograph was 70% accurate in measuring root canal length in posterior teeth.
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The 2x4 appliance consists of bands on the first permanent maxillary molars, bonded brackets on the maxillary incisors, and a continuous archwire inserted into buccal tubes of the molar bands. It provides total control of anterior tooth position, allows precise and rapid positioning of the teeth, does not require any adjustment and is very well accepted by the patient, and. This case report presents correction of anterior crossbite at early mixed dentition stage with the help of 2x4 appliances. The results achieved, satisfied the esthetic demands of the patients as well as parents.
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Background: Significant number of induced pregnancies land in caesarean delivery. Cervical assessment is integral to successful outcome of induction of labour. Objective of this study was to study preinduction transvaginal ultrasonographic cervical length and to compare it with Bishop Score in predicting successful labour.Methods: This prospective study was conducted at the department of obstetrics and gynaecology, MMIMSR, Mullana, Ambala on 150 patients. A total of 150 women were studied from January 2015 to June 2016 after taking an informed consent. The sociodemographic particulars were recorded, detailed history was taken and examination performed. Transvaginal ultrasound was done to assess cervical length after evacuation of bladder. Bishop score was then determined by separate observer. The occurrence of vaginal delivery was considered as primary outcome. All statistics collected were entered in statistical software SPSS-15. ROC curves were constructed for both Bishop Score and TVS.Results: The mean gestational age was 38 week 6 days, majority 134 (89.3%) being less than 40 weeks of gestation. The ROC curve for Bishop Score demonstrated better predictability compared to cervical length by TVS. Optimized cut off for Bishop score in addition to TVS was determined by ROC curve to predict successful vaginal delivery, it was ≥ 6 for Bishop score (sensitivity 90.7%, specificity 68.6%, positive predictive value 91.5% and negative predictive value 66.7%) and ≤ 3.0 cm for cervical length on TVS (sensitivity 74.6%, specificity 51.6%, positive predictive value 74.5% and negative predictive value 51.6%). The relation of both cervical length and Bishop score with successful vaginal delivery was found to be statistically significant with p value of 0.0001.Conclusions: The present study indicates that Bishop Score is a better predictor for successful vaginal delivery as compared to cervical length by transvaginal ultrasonography.
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Background: Carcinoma of the gall bladder (GB) is the commonest malignancy of the biliary tract. Ultrasound (US) guided Fine Needle Aspiration Cytology (FNAC) plays a major role in early detection of malignancy in a suspicious GB lesion. The aim of this study was to evaluate the safety and diagnostic accuracy of US guided FNAC in detection of GB malignancy, to find the association of gall stones with GB malignancy, to study the ultrasound pattern of GB malignant mass and demographic profile of the disease in North eastern India.Methods: The study was conducted retrospectively in Dr. B. Borooah Cancer Institute, Guwahati from January 2016 to December 2017. A total number of 173 patients suspected to have GB malignancy were subjected to US guided FNAC.Results: Total 161 patients were positive for malignancy with significant female majority. There were 124 female (77.02%) and 37 males (22.98%) in the range of 29 to 82 years. Male female ratio was 1:3.5. One was diagnosed as xanthogranulomatous cholecystitis and another was chronic cholecystitis. FNAC remained inconclusive in 2 patients. There was no major procedure related complication. Adenocarcinoma was the most common malignancy found in 146 patients (98.68%). Cholelithiasis was associated in 88.19% of malignant lesions.Conclusions: US-guided FNAC is a safe, highly accurate and reliable procedure for early detection of GB malignancy.
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This study compared hemodynamic changes and occurrence of complications following oxytocin administration with a prior injection of phenylephrine 100 μg or normal saline during elective cesarean section. Sixty-six healthy term parturients with uncomplicated, singleton pregnancy undergoing elective cesarean section under spinal anesthesia were studied. They received either intravenous phenylephrine 100 μg or normal saline before oxytocin 3 IU was administered over 30 seconds. Oxytocin dose was repeated depending on the adequacy of uterine tone. There was no significant change in systolic, diastolic, and mean arterial pressures during the initial 3 minutes following oxytocin administration in the phenylephrine group but a significant fall in mean and diastolic pressures in the saline group. Heart rate did not change significantly, and no significant complications occurred in either of the groups. To conclude, phenylephrine 100 µg administered before oxytocin injection maintained hemodynamic parameters better than normal saline injection during elective cesarean section
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The pregnancy is one of the most fascinating experiences which a woman undergoes in her life and of the whole, the first trimester is a vital time as the pregnancy gets established. The last menstrual period (LMP) is generally used as a landmark for pregnancy dating, and the first trimester of pregnancy is defined as 12 weeks after the LMP. The first recognizable structure inside the gestational sac is the yolk sac, which should be detectable as a regularly rounded extra-amniotic structure when the gestational sac reaches dimensions of 8 to 10 mm. In a normal pregnancy it should be possible to observe the yolk sac between 6-12 weeks of pregnancy or when it reaches 10 mm in size. Ultrasonography shows the yolk sac as a round structure that is made up of an anechoic center bordered by a regular well-defined echogenic rim. The normal shape of yolk sac is circular. The yolk sac appears at 6 weeks, thereafter increases in size, attains its maximum diameter at 10 weeks and then it starts decreasing in size. It disappears at 12 weeks. Aim and Objectives of the present study is to study the shape of yolk sac in pregnant females, in the first trimester of pregnancy and to find it's correlation with spontaneous abortion. We studied 72 pregnant females, who were in their first trimester of pregnancy, referred by Department of Obstetrics and Gynaecology. The shape of yolk sac was observed by transvaginal sonography and its correlation with spontaneous abortion was studied. Yolk sac was present in 70 cases (97.22%) and in two cases (2.78%), it was absent. In 68 (97.14%) cases the shape of yolk sack was circular. It was irregular (1.4%) and oblong (1.4%) in one case each.
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Background: Neonatal seizures are common manifestations of neurologic dysfunction in newborns. The incidence of' seizures in neonatal period is higher than any other period of life. It is one of the common causes of admission to special newborn care unit. Therefore, it has been decided to assess the epidemiological profile of neonatal seizure.Methods: A cross-sectional study was conducted from January2017 to June 2018, in the SNCU of MKCG Medical College and Hospital, Berhampur. A total of 300 neonates admitted to SNCU with clinically apparent seizure were the study population and convenient sampling method was used for selecting them. The approval was taken from IEC MKCG Medical College to carry out the study. The data was collected by using a pretested proforma from parents and hospital records. Verbal informed consent was taken from parents. The data so collected was analysed in the department of Pediatrics.Results: Out of the total 300 babies, 66% were males, 61.34% were early neonates,77% babies were of primi' mothers,76% of babies were outborn . 62.12% of babies were born by vaginal route. HIE was most common (88%) cause of seizure. Out of the all seizure types, subtle seizure was most common (87.67%), followed by clonic seizure (35.67%). Various maternal risk factors were present in 81.81 % of cases. Most common risk factor was anemia (50.57%).18.93% of cases were born with' history of obstructed labor/prolonged labor. Overall mortality was 8%.Conclusions: Neonatal seizures are important causes of morbidity and mortality in newborns. Prevention of HIE and maternal risk factors along with early use of an effective drug with minimum side effects are the ways to overcome this problem.
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Purpose of the study: Nerve-muscle physiology is a very basic and vital module in undergraduate physiologycurriculum. The practical sessions on this system are demonstrated on amphibian (frog) nerve-musclepreparation, which becomes a limiting factor in most of the medical colleges of India. In this study, wepropose an alternative approach by using mammalian (rat) model for nerve-muscle physiology undergraduatepractical experiments.Materials and methods: Rat in-situ sciatic nerve-soleus muscle preparation was used to study neuromusculartransmission. Stimulation of nerve and recording of muscle contraction (force) were done by using digitalrecording system. To demonstrate fatigue, repetitive electrical stimulation was applied to nerve-musclepreparation and muscle twitches were recorded. A reduction in amplitude of contraction to 50% of their basalrecording was considered as onset of fatigue. To demonstrate site of fatigue, the muscle was stimulateddirectly after the fatigue was observed with nerve stimulation and muscle twitch recorded. To observe theeffect of neuromuscular blocking drug Pancuronium bromide, on neuromuscular transmission, in a separateset up the drug was injected in muscle belly at multiple sites and nerve was stimulated to elicit muscletwitch. The response (amplitude of muscle twitch) was compared with control (injection of 0.9% saline).Main findings: On repeated stimulation of nerve muscle preparation, initially there was an increase inamplitude of contraction but progressively amplitude went on decreasing. After development of fatigue ondirect muscle stimulation, amplitude recorded was same as the initial twitch amplitude. This demonstratesthat the site of fatigue is not the muscle. Further, as nerve is also non- fatigable, site of fatigue wasneuromuscular junction.Injection of Pancuronium bromide showed that the twitch amplitude decreased substantially than the control(saline injection) on stimulation of nerve, but on direct muscle stimulation amplitude of contraction remainedsame as initial, confirming the effect of drug on neuromuscular junction.