A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI

@#Introduction: An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendontrochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. Materials and Methods:This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. Results: The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. Conclusions:The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.

Effect Of Shirodhara On Isolated Sleep Paralysis- A Case Study

Isolated sleep paralysis (disturbed sleep) is a condition in which a person is in a state of consciousness but is not able to move or speak in the bed even if he wants to. It is a dreadful condition for a person, in which he or she even fears to fall asleep. It can occur with or without being a part of a sleeping disorder named narcolepsy. According to Ayurveda conditions of isolated sleep paralysis occurring during rapid eye movements (REM) phase of sleep can be correlated to Tandra and Manovaha Sroto Dushti in a stressed individual (Alpa Satva Purush). Ayurveda has potential to treat sleep related disorders with the help of Panchkarma procedures namely Shirodhara. In modern medicine treatment of conditions like isolated sleep paralysis mainly depends on use of antidepressant and sedative medicines which has many side effects. In this case an effort has been made to treat a young male of 21 years with symptoms of helplessness or muscle atonia during initiation of his sleep hours with heaviness in chest, difficulty in respiration and choking sensation for past 2 years. Treatment given is Shirodhara for a period of 15 days with Brahmi oil and tablet Sarpangdha as an internal medicine. The result shows positive response by decreased frequency of attacks, time duration and other symptoms along with improvement in quality of life.

Changes in Biochemical Profile of Superovulated Sahiwal Cows through Hormonal Manipulation at Mid Luteal Phase of Estrous Cycle

In the present study, insulin and insulin-like growth factor-I (IGF-I) administered during mid-luteal phase of the estrous cycle and effect on biochemical profiles of Sahiwal donor cows was noted. Altogether eighteen cows (n=18) were selected and divided into 3 groups; control (n=6, untreated), T-I (n=6, Insulin-treated) and T-II (n=6, IGF-I treated). Superovulatory treatment was started on day 9th of the estrous cycle. With the 6th dose of FSH, prostaglandin was injected to induce superovulatory estrus. The superovulated cows were bred and superovulatory response of each animal was recorded. The collections of embryos were done non-surgically on the 7th day of superovulatory estrus. About 15 ml blood without anticoagulant was collected on days 5,7,9,11,13,15,17,19 and 21st or day of embryo recovery where day 0 of estrous cycle was taken as the day of estrus. Serum was separated, centrifuged at 3000 rpm for 15 minutes and transferred into sterilized serum vials. All samples were stored at -20 oC till analysis. Serum glucose, cholesterol, total protein, urea, and creatinine were estimated by Span Diagnostic Kits. The concentration of serum glucose increased significantly in insulin-treated and IGF-1 treated Sahiwal donor cows. It may be concluded that exogenous insulin and IGF-1 administration during mid-luteal phase may be helpful in follicular and embryonic development by increasing the level of serum glucose. The concentration of serum cholesterol, total protein, urea, and creatinine remains unaffected

Prospective Study of 500 Cases of TURP

Introduction: Clinical benign prostatic hyperplasia (BPH)is one of the most common cause of lower urinary tractsymptoms in ageing men. Gold standard for BPH now days,is transurethral resection of the prostate (TURP). Hence; thepresent study was planned to prospectively analyse 500 TURPcases.Material and methods: 500 patients who underwent TURPafter failed medical therapy for BPH or with absoluteindication for TURP were anlayzed. All patients underwentultrasonography for post void residual urine and prostatesize, Serum PSA, DRE and uroflowmetry. Urine routineand culture along with renal function test was done in allpatients. Urodynamic study was done in patients suspectedfor neurogenic bladder. Data in relation to intraoperativeparameters and postoperative follow-up were analysed.Results: In the present study, data of a total of 500 patientswas analysed. Fever, haematuria and clot retention was foundto be present in 20, 25 and 18 patients respectively. Deathoccurred in 1 patient due to cardiac complication. Bloodtransfusion was required in 50 patients. Stricture and bladderneck contracture was seen in 16 and 9 patients respectively asa manifestation of late complication. Incontinence was foundto be present in 1 patients.Conclusion: TURP is one of the best minimally invasivetreatment for BPH. Along with being cost-effective, it isalso associated with significantly shorter hospital stay andminimum morbidity

A Conceptual Review Of Jalaukavacharana

The basic Ayurvedic treatment is based on two principles viz. Shodhan chikitsa (elimination Therapy) and Shaman chikitsa (internal medicine). Shodhan Chikitsa deals with five purificatory procedures popularly known as Panchakarma. Acharya Susruta included Raktamokshana in Panchakarma and described it as the best procedure because it eliminates all three vitiated Doshas viz. Vata, Pitta & Kapha. Jalaukavacharana is a type of Raktamokshana where leeches are used for bloodletting. This is considered as the most effective and most unique method of Raktamokshana as vitiated Doshas are removed from the body without using any cutting instruments, so, Raktamokshana by means of ‘Leech’ comes under Ashastra category. The following paper deals with the basic concepts of Leech therapy and the method of using leech for Raktamokshana.

Medicosocial characteristics as predictors of school achievements in students with intellectual and developmental disabilities: A follow-up study in ujjain and shajapur districts of Madhya Pradesh, India

Background: For a long time, there have been arguments about which factors influence the skill development of students with intellectual disability in rehabilitation centers. Objective: The present follow-up study was thus planned to analyze the effect of the demographic variables related to disabled child, his/her parents and the family; their schooling pattern and types of study settings and the associated comorbidities on improvement in the performance score of students attending these study settings in one academic year. Methods: The study was conducted among children (n = 204) with intellectual disability receiving rehabilitation services in centers run by a nongovernmental organization in two districts of Central India. Results: Application of regression analysis concluded that among various hypothesized factors higher birth order, more time spent by parents for child抯 development at home, high performing classes, absence of epilepsy, psychiatric comorbidities, and associated physically challenged were significantly associated with improvement in overall mean performance score. Conclusions: The study delineates the need to motivate parents, so that they can involve themselves to develop their child抯 full potential. Identification of associated comorbidities is recommended and parents need to be appraised accordingly.

Evaluation of endometrium in peri-menopausal women in case of abnormal uterine bleeding

Introduction: Abnormal uterine bleeding should include all abnormalities of menstruation like hypermenorrhea as well as hypomenorrhea. Abnormal bleeding is synonymous only with excessive menstruation. Abnormal uterine bleeding (AUB) is one of the most common conditions for which women consult their gynaecologists. Material and methods: This was a retrospective study done in Dhiraj Hospital over a period of six month on patients presenting with AUB. Patients were selected based on clinical details. The study material included a total no. of 60 patients which were inclusive of endometrial samples. Patients with isolated endometrial causes of abnormal uterine bleeding were included for this study and those with pregnancy, profusely bleeding per vaginum, anemic patients were excluded. All specimens were transported in 10% formalin to the pathology laboratory. The gross morphology was recorded. Microscopic examination was done by two pathologist so as to reduce inter observer findings. The data collected for this study was statistically analyzed using chi-square test.

A study of changes in homocysteine levels during normal pregnancy and pre-eclampsia.

To find out changes in homocysteine levels that occur during normal pregnancy and pregnancy with pre-eclamptic toxaemia and also to find out correlation between homocysteine concentration and preeclamptic toxaemia a study was carried out among 90 women of which 30 were control which included normotensive non-pregnant women and the study group I comprised 30 pregnant normotensive women and the study group II comprised 30 pregnant women with pre-eclamptic toxaemia. Serum homocysteine was measured in all subjects using fluorescence polarisation immuno-assay. Control group had highest mean homocysteine levels while the study group I had least mean homocysteine levels (p < 0.001). Levels were significantly higher in subjects with BP > 146/100 mm Hg as compared to subjects with BP >140/90 and <146/100 mm Hg (p=0.017). There was significant difference between study group I and II at same gestational age. Hyperhomocysteinaemia was observed in pre-eclamptic females, also it was found that homocysteine levels were directly correlated with severity of pre-eclampsia.

Laevonorgestrel intra-uterine system--a revolutionary intra-uterine device.

Laevonorgestrel intra-uterine system is a new hormone releasing long acting intra-uterine device. Besides being used as long acting contraceptive, it has multiple non-contraceptive benefits. It is the best choice for young women suffering from menorrhagia who want contraception along with preservation of fertility and for premenopausal women who want to avoid surgery. Moreover, it has been reported to be useful in patients with dysmenorrhoea, fibroids, endometriosis and adenomyosis and endometrial hyperplasia.

Mother and child service coverage: reproductive and child health programme in Alwar district, Rajasthan state.

Present study was conducted to assess the child immunization coverage and availability of safe motherhood intervention services for expecting mothers under RCH programme in Alwar district. WHO-30 cluster sampling method was used and 26 rural and 4 urban clusters were surveyed. Fully immunized children were more in urban areas (82.1%) as compared to rural (45.1%) areas. The immunization coverage was more or less similar in both sexes. BCG and Measles coverage was also higher i.e. 89.3% and 85.7% in urban areas than 69.61%, and 52.2% in rural respectively. High drop out rate was found for DPT (25.3%) and OPV (23.2%) in rural areas as compare to urban (7.70/ each). Failure of immunization in rural areas was mainly due to unawareness of need for immunization (35.4%), mother too busy in 16.8%, place and time not known in 9.7%, place for immunization too far 8.8% and 7.1% each for unaware of need to return for subsequent doses, fear of side reactions and vaccinator absent. TT immunization coverage was mainly through Government source and two third of the mothers were immunized in both urban and rural areas. 71.4% of urban and 36.1% of the rural mothers received ANC >=3. However the iron folic acid supplementation was similar in urban and rural areas. Place of delivery was mainly hospital in urban areas (71.4%) and were home (61.7%) in rural areas. Hospital staff (Govt. or pvt.) conducted 82.1% of the deliveries in urban areas as compared to 58.5% in rural.The ANM/ Health staff (56.4%) and family members (27.0%) were main source of information for mother for the need of mother and child immunization.

Congenital hypofibrinogenemia.

Congenital afibrinogenemia/hypofibrinogenemia is an extremely rare coagulation disorder. We describe a case of congenital hypofibrinogenemia in a 6-year female child, who presented with recurrent ecchymotic spots with no frank bleeding.

Evaluation of enzymes in serum and cerebrospinal fluid in cases of stroke.

Levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH) and creatine kinase (CK) were estimated in serum and cerebrospinal fluid of 25 patients of stroke, and were correlated with severity of disease. 21 (84%) patients had ischemic stroke and four (16%) had hemorrhagic stroke. Serum and CSF AST levels were significantly elevated in the study group. The rise in CSF AST was more in the hemorrhagic subtype than in the ischemic subtype. Serum ALT and CSF LDH levels were also significantly elevated in patients with ischemic stroke. None of the enzyme levels were related to the severity of disease as assessed by the Glasgow coma scale.

A study of prevalence of health problems in asymptomatic elderly individuals in Delhi.

A survey was conducted in asymptomatic aged individuals (> or = 60 years) in The National Capital Territory of Delhi for the prevalence of major health problems like hypertension, diabetes mellitus and respiratory diseases. A total of 200 individuals (100 males and 100 females) were studied over a period of three months in 1998-99. Hypertension was defined as BP > or = 140/90 mmHg (JNC VI criteria), while diabetes mellitus was diagnosed if fasting whole blood sugar was 120 mg/dl or more (WHO criteria). Diagnosis of other health problems was based on relevant history and physical examination. Prevalence of hypertension in the study group was 32.5 per cent (more in males). Of these 18 per cent and 4.2 per cent had isolated systolic and diastolic hypertension, respectively. Prevalence of diabetes mellitus in the same population was 13.0 per cent. Both diseases were more prevalent in urban population. A high prevalence of respiratory disorders was observed (pulmonary tuberculosis 16 per cent, COPD 10 per cent, asthma 4.5 per cent). Cataract was present in 7.5 per cent while 1.5 per cent had symptoms of urinary tract infection. History of Jaundice was present in 3.5 per cent. Three per cent each had a history suggestive of IHD and TIA, respectively. Proteinuria and glycosuria was seen in 22.2 and 7.6 percent, respectively. A large percentage of the study group (34.4 per cent) had asymptomatic ECG abnormalities.

Clinicohaematological profile in chronic renal failure.

OBJECTIVE: Aim of the study was to observe the clinicohaematological profile, bone marrow and serum iron indices of patients with chronic renal failure. METHOD: A total of 27 patients of chronic renal failure were selected, irrespective of their age, sex, clinical profile and etiology. These patients were not on dialysis, haematinics or erythropoietin therapy. They underwent series of biochemical and haematological investigation including bone marrow aspiration and also estimation of serum iron indices. RESULTS: The commonest cause of chronic renal failure in study group was diabetes mellitus (20%), glomerulonephritis (8%). Fifty percent of the patients on first presentation were in end-stage renal disease. Most patients presented with features of anaemia (94%), uraemia (63%) and fluid overload (96%). Severity of anaemia was correlating with degree of azotemia. Sixty percent of the patients had microcytic hypochromic anaemia, five percent had macrocytic anaemia while 30% had normocytic normochromic anaemia. The reticulocyte count was high in 46% of the patients. RDW-CV of greater than 14 was observed in 67%. Thrombocytopaenia was found in 52% of the patients. Leucocyte count was within normal range in 75%. In differential leucocyte count and absolute eosinophil count was high in 32% of the subject. In bone marrow examination 61% of the patients had normal bone marrow cellularity, 75% were having erythroid hyperplasia. Fifty seven percent of the cases had bone marrow iron store of zero, 37.8% had normal bone marrow iron store, 6.5% had increased bone marrow iron store. Serum ferritin was low in 62% and serum iron was below normal in 74% of the patients. CONCLUSION: Majority (65%) of patient had microcytic hypochronic anaemia because of iron deficiency and 33% of patient had parasitic infestation.

14C-urea breath test for assessment of gastric Helicobacter pylori colonization and eradication.

BACKGROUND AND OBJECTIVE: Urea breath test (UBT) is a reliable noninvasive technique for detecting gastric Helicobacter pylori colonization. 14C isotope-based test requires simple equipment and is inexpensive. We studied the utility of 14C-UBT in diagnosis of gastric H. pylori infection. METHODS: Presence of H. pylori was studied using antral histology and culture in patients with rapid urease test (RUT)-positive peptic ulcer. 14C-UBT was performed using a 185-kBq dose. Radioactivity in 15-min breath samples was measured using a beta-scintillation counter and result expressed as % dose recovered/mmol CO2. H. pylori was considered positive when any two tests were positive. All tests were repeated one month after completion of H. pylori eradication therapy. RESULTS: Among 41 patients (duodenal ulcer 36, gastric ulcer 5), H. pylori was detected by histology in 23 (56%) and by culture in 27 (66%). Overall, H. pylori was detected in 28 (68%) patients. Follow-up assessment was possible in 28 patients: 26 cleared the infection (all three tests negative). Mean 14C recovery values at 15 minutes associated with H. pylori-positive status were significantly higher (12.3 [SD 6.8] x 10(-3); n=30; p<0.001) than those associated with H. pylori-negative status (2.1 [0.9] x 10(-3); n=26). Using receiver-operating-characteristic analysis of 15-minute 14C recovery values, a cut-off of 6.5x10(-3) gave the best separation of H. pylori-positive and -negative cases. 14C-UBT had 93% sensitivity, 96% specificity and 95% accuracy. CONCLUSION: 14C-UBT appears to be a reliable noninvasive test for diagnosis of H. pylori infection.

Neonatal disorders and obstetricians.

Neonatal disorders mean disturbance of normal state of body, organs and abnormal function of a newborn. Obstetricians play a major role to minimise the number of neonatal disorders. Prematurity, respiratory dysfunction, birth trauma, congenital malformations, neonatal infection and haemolytic disorders of the newborn are some examples of neonatal disorders commonly encountered. Preventive obstetrics is most important in reducing these disorders. Regular antenatal check-up, balanced diet, iron and folic acid tablet, avoiding repeated pregnancies are some measures which can prevent prematurity. Any factors which cause maternal hypoxia during pregnancy are responsible for foetal hypoxia. Proper antenatal care and avoidance of narcotic drugs in pregnancy are the pillars to combat respiratory dysfunction. Obstetricians play an important part to minimise birth trauma which is single handedly an important example of neonatal disorders. Proper antenatal care to detect any obstetrical anomaly reduces birth trauma to a large scale. In case of congenital anomalies, genetic counselling and early abortion in gross congenital anomaly are important aspects which can be looked after by the obstetricians. Neonatal infections can be minimised by the obstetricians themselves if they take care of any suspicious vaginal discharge in antenatal period. Dirty dressings are to be avoided in delivery time. Proper immunisation to the mother and also counselling of HIV transmission are also important. Haemolytic diseases of the newborn can be confronted by proper Rh and ABO blood groupings in antenatal period and proper intervention at the time of delivery.

Hyperfibrinogenemia in patients of diabetes mellitus in relation to glycemic control and urinary albumin excretion rate.

BACKGROUND: Diabetics have higher cardiovascular morbidity and mortality than general population and hyperfibrinogenemia is one of the important risk factors. MATERIAL AND METHODS: In the present study fibrinogen levels (dry clot weight method) were estimated in 50 diabetic subjects and 10 age, sex and body mass index matched controls and its correlation with various parameters like glycosylated hemoglobin (cation exchange resin method), urinary albumin excretion rate (Esbach's albuminometer), age, hypertension, body mass index (Kg/m2), lipid profile, smoking, duration of diabetes was studied. RESULTS: Higher plasma fibrinogen levels were found in diabetics (7.30 +/- 5.87 g/l) as compared to controls (4.06 +/- 2.5 g/l) which was statistically significant (p = 0.022). Fibrinogen levels were associated with age (r = 0.873), hypertension (p = 0.032), body mass index (r = 0.898), triglyceride level (r = 0.9396), cholesterol level (r = 0.99), glycosylated hemoglobin (r = 0.99) and urine albumin excretion rate (r = 0.930) in diabetics, in a significant manner. But, no correlation was found with sex (p > 0.05), family history (p = 0.072), duration of diabetes (r = 0.443) and smoking (p = 0.081). In controls positive correlation was found between fibrinogen level and age (r = 0.5), family history (p = 0.04), smoking (p = 0.051), body mass index (r = 0.898) and lipid profile (r > 0.5). Mean albumin excretion rate was significantly (p = 0.002) higher in diabetics (397.42 +/- 956.51 mg/min) and it was found to be associated with age (r > 0.5) and lipid profile (r > 0.5) in both diabetics and controls. No correlation was found between glycemic control and urine albumin excretion rate. CONCLUSION: Diabetics have higher fibrinogen levels, which is associated with glycemic control and urine albumin excretion rate in a statistically significant manner.