DELAYED PRESENTATION OF POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME IN POSTPARTUM PERIOD

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological entity which presents with diverse neurological symptoms ranging from headache, seizure, visual symptoms with altered consciousness and focal signs. The hallmark of this condition is its reversibility. The etio- pathogenesis is attributed to vasogenic cerebral oedema seen in occipital and parietal lobes of brain. We hereby present this case of a multiparous lady presenting with altered sensorium postpartum. Characteristic findings on imaging helped us to form the diagnosis of PRES in this patient

ACUTE PANCREATITIS IN PREGNANCY CHALLENGES

We report a case of a 24 years old lady at 32 weeks 5 days of gestation, who was referred to our hospital with severe pain the upper abdomen and radiating to the back , associated with vomiting with history of raised blood pressure. After investigations she was diagnosed with acute pancreatitis with non severe pre eclampsia. She was managed by multidisciplinary team approach and improved.

Informal Healthcare Providers of Abortion Services among Three Scheduled Tribes of Jharkhand

Background: There is a dominant role of informal healthcare providers (IHPs) in the current cultural and sociological context of tribal communities. They outnumber formal health‑care providers, thus bridging the gap between existing and nonexisting public health facilities despite not having formal training or accreditation. Objectives: The study examines the role, relevance, and extent of abortion services provided by IHPs‑ in Jharkhand among three Scheduled Tribe groups. Materials and Methods: Based on in‑depth interviews with 15 IHPs and 42 married women among three Scheduled Tribe groups in three districts of Jharkhand, a qualitative study was conducted. Interview guidelines addressed reasons for preferring IHP services, their scope of practice, dissemination, and quality of services. Results: The majority of women seeking abortions used traditional contraceptives, which often resulted in unwanted pregnancies. The economic, cultural, social, access to services, and confidence factors encouraged women to seek abortion services from IHPs. There were differences in the nature of access to abortion services among tribal groups. The Chero and Korwa tribes continued to rely heavily on simpler life technologies that shaped their beliefs and practices regarding reproduction. The Ho tribe, however, preferred to use the formal health‑care system since they were close to a more complex society. Conclusion: IHP plays a significant role in the social structure of Tribes, demonstrating their marginalization in access to formal health‑care services. Eventually, they replaced traditional healers with their function as physicians.

Reference centile charts of first-trimester aneuploidy screening & Doppler parameters for Indian population

Background & objectives: The risk estimation for foetal aneuploidies in the first trimester of pregnancy uses reference curves based on western data. The objective of this study was to construct the reference curves of first-trimester foetal aneuploidy screening parameters for the Indian women. Methods: Cross-sectional data were obtained from 1204 singleton pregnancies between the crown-rump length (CRL) of 40-84 mm. Linear regression models were constructed; the mean, median and standard deviation were derived as a function of CRL. Results: The mean value of CRL was 61.3 mm. The regression analysis showed a significant correlation between all variables and CRL (P< 0.001). There was a positive correlation of CRL with nuchal translucency (NT) (y=0.010x+0.629, R2=0.116) and pregnancy-associated plasma protein-A (PAPP-A) (y=0.107x?1.079, R2=0.173), whereas inverse correlation was seen with free ?-human chorionic gonadotropin (?-hCG) (y=?0.409x+75.025, R2=0.018) and Doppler parameters pulsatility index (PI) (y=?0.008x+1.924 R2=0.053). The centile charts of NT, PAPP-A, free ?-hCG and uterine artery (Ut A) Doppler PI were constructed. Interpretation & conclusions: The reference centile charts of first trimester aneuploidy screening along with Doppler parameters were derived in Indian pregnant women. These centile charts may be used as a reference for clinical use in Indian population.

Efficacy of moxifloxacin & econazole against multidrug resistant (MDR) Mycobacterium tuberculosis in murine model.

Background & objectives: studies have shown the bactericidal potential of econazole and clotrimazole against Mycobacterium tuberculosis under in vitro and ex vivo conditions along with their synergism with conventional antituberculosis drugs. these molecules were also found to be effective against different multidrug resistant (MDR) M. tuberculosis isolates in vitro. Hence the present study was designed to evaluate the in vivo antimycobacterial potential of moxifloxacin and econazole alone and in combination against multidrug resistant tuberculosis (MDR-TB) in a mice model. Methods: Mice were infected with 2.5×107 bacilli of MDR strain of M. tuberculosis by aerosol route of infection. After four weeks of infection, chemotherapy was started orally by moxifloxacin 8.0 mg/kg body wt and econazole 3.3 mg/kg alone and in combination, as well as with four first line anti-tuberculosis drugs as a positive control. The animals were sacrificed and the lungs and spleen were excised under aspetic conditions. The tissues were homogenized with sterile normal saline, an aliquot of the homogenate was plated on Middlebrook 7H11 agar supplemented with oleate albumin dextrose catalase (OADC) and incubated at 37°C for four weeks. The number of visible and individual colonies were counted. Results: The first line anti-tuberculosis drugs (RIF+INH+EMB+PZA) after eight weeks of therapy had no impact as the bacillary load in lungs and spleens remained unchanged. However, econazole, moxifloxacin alone as well as in combination significantly reduced the bacillary load in lungs as well as in spleens of MDR-TB bacilli infected mice. Interpretation & conclusions: Co-administration of the two drugs (econazole and moxifloxacin) to MDR-TB strain JAL-7782 infected mice exhibited additive effect, the efficacy of the drugs in combination being higher as compared with ECZ or MOX alone. These results were substantiated by histopathological studies. This study suggests the utility of econazole for the treatment of MDR tuberculosis and warrants further work in this direction.

Prediction Equations for Spirometry in Adults from Northern India.

Background. Most of the Indian studies on prediction equations for spirometry in adults are several decades old and may have lost their utility as these were carried out with equipment and standardisation protocols that have since changed. Their validity is further questionable as the lung health of the population is likely to have changed over time. Objective. To develop prediction equations for spirometry in adults of north Indian origin using the 2005 American Thoracic Society/European Respiratory Society (ATS/ERS) recommendations on standardisation. Methods. Normal healthy non-smoker subjects, both males and females, aged 18 years and above underwent spirometry using a non-heated Fleisch Pneumotach spirometer calibrated daily. The dataset was randomly divided into training (70%) and test (30%) sets and the former was used to develop the equations. These were validated on the test data set. Prediction equations were developed separately for males and females for forced vital capacity (FVC), forced expiratory volume in first second (FEV1), FEV1/FVC ratio, and instantaneous expiratory flow rates using multiple linear regression procedure with different transformations of dependent and/or independent variables to achieve the best-fitting models for the data. The equations were compared with the previous ones developed in the same population in the 1960s. Results. In all, 685 (489 males, 196 females) subjects performed spirometry that was technically acceptable and repeatable. All the spirometry parameters were significantly higher among males except the FEV1/FVC ratio that was significantly higher in females. Overall, age had a negative relationship with the spirometry parameters while height was positively correlated with each, except for the FEV1/FVC ratio that was related only to age. Weight was included in the models for FVC, forced expiratory flow (FEF75) and FEV1/FVC ratio in males, but its contribution was very small. Standard errors of estimate were provided to enable calculation of the lower limits of normal and standardised residuals for these parameters. The equations were found to be valid on the test dataset, and therefore, may be extended to general population. Comparison with the 1960s equations revealed lack of good agreement, and substantially higher predicted FVC with the current equations, especially in the forty-years-plus age group, in both males and females. Even in the age group upto 40 years, the level of agreement was clinically not acceptable. Conclusions. Validated prediction equations have been developed for spirometry variables in adults of north Indian origin using the current ATS/ERS spirometry standardisation recommendations. The equations suggest an improvement in the lung health of the population over time in the middle-aged and the elderly. These equations should address a long-felt unmet need and enable a more appropriate evaluation of spirometry data in different chest diseases in Indian subjects.

Epidemiological Study of Male Infertility.

Advanced male age has been associated with signicant reductions in pregnancy rates, increased time-to-pregnancy and increased subfecundity.The present study was aimed at analyzing the male factor causing infertility and epidemiological factors in the rural institute situated in the eastern part of Maharashtra. Aims and Objectives: Study the profile of male infertility in this rural area over a period of 20 years and correlate the various factors responsible for male infertility. Materials and Methods: The present study comprised of retrospective as well as prospective analysis of infertility cases over a period of 20 years. Analysis of the records was done for male factors thoroughly in relation to age, duration and type of infertility, age at marriage, addiction. Statistical Evaluation: Statistical analysis was done in EPI-6 software. Chi square test and variance analysis was used for analyzing the data. Observations:The incidence of primary infertility (62.00%) was higher as compared to secondary infertility (38.00%) in all the five blocks.The semen analysis reports revealed that the most affected age group was 31-40 years. The abnormalities of semen were 35.49%, 86.49% and 53.75% in smokers, alcoholics and in cases having more than one addictions respectively. Cases with no addictions were having the maximum of (82.96%) normozoospermic males. Conclusions:The relationship between smoking and alcoholism was evident. Both of these addictions were found to impair the reproductive functions in male.

Chronic infections & coronary artery disease with special reference to Chalmydia pneumoniae.

Background & objectives: Studies on cardiovascular diseases (CVD) in India have shown about 10-20 per cent of cases with no obvious risk factors, raising a suspicion of infections as a cause. There is a paucity of data on this possible role of infections. This study was, therefore, undertaken to find out the association between infection due to Chlamydia pneumoniae and other organisms and coronary artery disease (CAD). Methods: Patients with CAD were selected in group I (acute myocardial infarction, AMI) and group III (patients undergoing coronary artery bypass graft (CABG) surgery), and normal controls in group II. Routine biochemical, haematological and inflammatory tests [C-reactive protein (CRP), total leucocyte count (TLC), fibrinogen, ESR], serodiagnostic tests for IgA and IgG antibodies to C. pneumoniae, Helicobacter pylori, cytomegalovirus (CMV), Mycoplasma pneumoniae and Parvovirus B-19 by ELISA kits, C. pneumoniae antigen by microimmunofluorescence and PCR from endothelial tissue obtained at CABG were carried out. Aortic punch biopsies were done in patients who underwent CABG. Results: Acute MI patients had a significantly higher association with accepted cardiac risk factors, lipid profile, inflammatory and thrombogenic tests. IgG and IgA antibodies levels against C. pneumoniae were not significantly different in the controls as against the AMI group. However, C. pneumoniae antigen seropositive group had significant association with HDL cholesterol, lipid tetrad index (P<0.001) and with triglycerides. Parvovirus B antigen was detected in 8.3 per cent of tissue specimens by PCR and of 44 patients with AMI (6.8%) were also positive for parvovirus B-19 IgG antibodies. Interpretation & conclusions: There was no direct evidence of the involvement of C. pneumoniae and other infective agents and viruses in CAD. It is possible that such infections produce an indirect adverse effect on the lipid profile.

Mycobacterium indicus pranii as stand-alone or adjunct immunotherapeutic in treatment of experimental animal tuberculosis.

Background & objectives: Mycobacterium w (M.w) is a saprophytic cultivable mycobacterium and shares several antigens with M. tuberculosis. It has shown good immunomodulation in leprosy patients. Hence in the present study, the efficacy of M.w immunotherapy, alone or in combination with multi drug chemotherapeutic regimens was investigated against drug sensitive M. tuberculosis H37Rv and three clinical isolates with variable degree of drug resistance in mice. Methods: BALB/c mice were infected with M. tuberculosis H37Rv (susceptible to all first and second line drugs) and three clinical isolates taken from the epository of the Institute. The dose of 200 bacilli was used for infection via respiratory route in an aerosol chamber. Chemotherapy (5 days/wk) was given one month after infection and the vaccinated group was given a dose of 1×107 bacilli by subcutaneous route. Bacterial load was measured at 4 and 6 wk after initiation of chemotherapy. Results: M.w when given along with chemotherapy (4 and 6 wk) led to a greater reduction in the bacterial load in lungs and other organs of TB infected animals compared to. However, the reduction was significantly (P<0.05) more in terms of colony forming units (cfu) in both organs (lungs and spleen). Conclusion: M.w (as immunomodulator) has beneficial therapeutic effect as an adjunct to chemotherapy.

A Prospective Study on MBBS Student About Different Visual Aids.

Background: To enhance successful communication medical teachers are increasingly using different visual aids. Objective: To determine medical students perception of different visual aids like black board (BB), over head projector transparencies (OHPT) and, LCD and to generate recommendations for their optimal use. Methods: A questionnaire based study was carried out among first year MBBS students of Government Medical College, Kota, India. The survey was undertaken among 84 Medical students of first year MBBS of batch 2008 after exposing them to different visual aids like BB, OHPT and LCD in Physiology lectures. A few lectures were absolutely on BB, and some were on OHPT and on LCD. Few classes were taken with mixed visual aids. Students were exposed for such visual aids for one year and then they were requested to complete a questionnaire. Data were statistically analyzed by One Sample Chi-square test. Results: 55 (65.48%) students rated chalk & black board as best visual aids in understanding the topic better as compared to OHPT and LCD (P<0.01). 47 (55.95%) students have good learning experience with black board teaching and it is best mode to note down important points. 56 (66.66%) students favored LCD as more interesting and interactive visual aids (P<0.01). It also complete the lecture faster which was advantageous for 69(82.17%) students. 77 (91.66%) students wanted mixing of different visual aids (P<0.01). Mostly (75%) do not find any difficulty in switching from one mode to another. No significant gender difference was observed. Conclusion: To improve students learning medical teachers should match the lectures with preferred visual aids. It will maintain interest and enthusiasm among pupil.

Comparative growth pattern of multi drug resistance versus susceptible isolates of Mycobacterium tuberculosis in mice lungs.

Background & objectives: Rise in prevalence of multi-drug resistance (MDR) in tubercle bacilli is a serious cause of concern. As mutations with two house keeping genes rpoB and katG are associated with resistance to two important anti-tubercular drugs rifampicin and isoniazid respectively, there is a need to understand the growth kinetics of organisms with such mutated genes in experimental animals. This study was undertaken to study the growth kinetics of susceptible as well multi-drug resistance Mycobacterium tuberculosis isolates in mice. Methods: Two MDR (having mutations in rpoB and catG) and two drug susceptible isolates of M. tuberculosis along with H37Rv were grown in mice after aerogenic infection. Results: The MDR isolates grew slowly up to 3 wk though the growth was significantly different from sensitive strains. However, after 3 wk, the growth in sensitive as well MDR strains was similar, suggesting that even the mutations in the MDR strains did not have any impact on the growth kinetics. Interpretation & conclusions: The effect of mutations in other parts of these genes need to be studied. Retention of property of MDR strains to establish infection after aerogenic infection has epidemiological significance in terms of the transmission of MDR tuberculosis.

Animal models of tuberculosis for vaccine development.

Animal models for testing different vaccine candidates have been developed since a long time for studying tuberculosis. Mice, guinea pigs and rabbits are animals most frequently used. Each model has its own merits for studying human tuberculosis, and none completely mimics the human disease. Different animal models are being used depending upon the availability of the space, trained manpower as well as other resources. Efforts should continue to develop a vaccine which can replace/outperform the presently available vaccine BCG.

Tuberculosis of the ilium: a case report.

A twenty year old man presented with pain in the upper part of right hip. CT scan showed multiple osteolytic areas in the right ilium, suggesting malignancy. CT guided needle biopsy was done and diagnosis of tuberculosis was made. The patient was cured with medical management only. Isolated tuberculosis of the ilium is an extremely rare condition. It is important to have a high clinical suspicion to diagnose early and manage the patient without surgical intervention.

Simultaneous ethambutol & isoniazid resistance in clinical isolates of Mycobacterium tuberculosis.

BACKGROUND & OBJECTIVE: There is a need to understand the nature of drug resistance patterns and predictors of emergence of drug resistance in Mycobacterium tuberculosis. There could be common factors/mechanisms for resistance to the drugs, isoniazid and ethambutol, both acting on cell wall. The present study was conducted to analyze the antimycobacterial susceptibility patterns of M. tuberculosis isolates to determine the minimum inhibitory concentrations (MICs) of ethambutol for M. tuberculosis; and to find out possible association of ethambutol resistance with isoniazid resistance. METHODS: A total of 380 M. tuberculosis isolates were tested for their susceptibilities to ethambutol at 2, 4, 6 microg/ml, isoniazid at 1 microg/ml and rifampicin at 64 microg/ml using MIC method. RESULTS: 44.21, 24.73 and 14.21 per cent isolates were resistant to ethambutol at concentrations of 2, 4 and 6 microg/ml respectively. At 6 microg/ml of ethambutol concentration, 85.18 per cent ethambutol resistant isolates were resistant to isoniazid also. At the same ethambutol concentration a fraction of 28.75 per cent isoniazid resistant isolates were ethambutol resistant. INTERPRETATION & CONCLUSION: Ethambutol resistance was accompanied with isoniazid resistance in a large percentage of isolates whereas ethambutol resistance was weakly linked with multidrug resistance. On the other hand, association between isoniazid and ethambutol resistance was weak showing one way linkage.

Necrotic erythema nodosum leprosum.

A 30 year-old farmer presented himself with mild degree fever, joint pain and multiple ulcers of 15 days' duration. Ulcers were multiple, well-defined, irregular in shape with necrotic base and elevated, sloppy margins over anus, forearms, wrists, buttocks, lower half of thighs and shins. A few of the ulcers were covered with black-coloured scab. They were tender and with serosanguinous discharge. Black atrophic scars and ill-defined, irregular, brown black-pigmented macules of various sizes were present over thighs and legs. Excision biopsy of the ulcer showed features of erythema nodosum leprosum. The patient was treated with systemic corticosteroids.

Sub-polar lepromatous leprosy presenting as urticarial wheals: a case report.

A 40-year male lepromatous leprosy patient presented with four, slightly erythematous patches, with multiple urticaria-like wheals, distributed over the body symmetrically and with thickened right ulnar and right common peroneal nerves. He was previously diagnosed as a case of chronic idiopathic urticaria. Slit skin smear from the patches and urticarial wheals showed a BI of 3+ and skin biopsy showed some features of borderline lepromatous leprosy (BL).

Dermatoglyphics: a study of finger tip patterns in bronchial asthma and its genetic disposition.

Finger tip patterns of sixty patients of Bronchial Asthma were compared with that of 50 control cases. Higher frequency of whorls was observed in first digit of both generations of bronchial asthma patients in comparison to controls. In all digits the frequency of arches was reduced in both generations of bronchial asthma patients as compared to controls. These findings proved highly significant statistically (P valve:<0.001). There was no significant change in finger tip patterns in II, & III digit, but, IV & V digit showed significant reduction in frequency of loops in both generations of bronchial asthma patients as compared to controls. There is scope of more studies in this field and the significant findings can be included as part of clinical picture of bronchial asthma.

A preliminary report on characterization and identification of non tuberculous mycobacteria (NTM) on the basis of biochemical tests and protein / isoenzyme electrophoretic patterns.

PURPOSE: To assess the usefulness of protein electrophorograms and protein zymodemes in the identification and characterization of non tuberculous mycobacteria (NTM). METHODS: Cell free extracts (CFEs) from 22 mycobacterial isolates belonging to slow growing and other clinically relevant species were included in the study. The strains isolated from the environment were identified on the basis of their standard biochemical tests; pigmentation and growth characters. The CFEs were electrophoresed and stained for proteins and esterases. RESULTS: Most of the isolates identified on the basis of biochemical tests exhibited characteristic protein and esterase pattern for M.scrofulaceum, M.avium and M.xenopi. Others showed variations in their proteins and esterase pattern though they were identified as M.scrofulaceum, M.avium and M.xenopi. CONCLUSIONS: Based on these studies it appears that because of variability in the protein and isoenzyme patterns of NTM, it may be advisable to use them along with biochemical tests and other tests for identifying and characterizing the different mycobacterial species belonging to slow growers.