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Background: Oral cancer is one of the sixth most common cancers in the world. Oral exfoliative cytology is one of the popular screening tool for oral cancer. Use of tobacco in any form are documented as the most common cause as initiators for dysplastic changes in oral mucosa. The purpose of the study was to detect the cytological changes in buccal mucosa, tongue and palate among non-smokers & smokers. Material & Methods: Smears sample were collected according to site (buccal mucosa, tongue & palate) from 100 subjects among smokers & non-smokers. Smears were then stained using Papanicolaou staining technique. Results: Among the smokers and non-smokers the results were statistically significant. Conclusion: Recent advances in the clinical visualization and detection of the oral mucosa have made the viability of cytological procedures more specific and sensitive. Contact endoscopy and use of autofluorescence devices are the forerunners in this group. The fluorescence characteristics of tissues depend upon their biochemical composition and histomorphological architecture, both of which undergo a change during malignant transformation. These changes are detectable as an alteration in the fluorescence spectral profile of the tissues21. Due to low feasibilities of such devices the benchmark of diagnosis will be microscopic tissue examination. Hence cytological smears will always be highly specific, sensitive, easy to use and reproducible procedures in routine screening of population for potentially and malignant conditions of the oral cavity.
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Our case report is regarding a patient who is a k/c/o citrullinemia type 1 which is a defect in urea cycle posted for facture patella reduction surgery (tension band wiring). He was intellectual disabled because of persistent hyperammonaemia before diagnosis that was controlled with benzoate and L- arginine. Patient preoperative fasting was kept to the minimum and taken as 1st case in the operation theatre. Drugs taken orally on routine basis were continued along with serum ammonia monitoring. Clonidine with midazolam along with propofol infusion to decrease protein hypercatabolism due to stress and to get co-operation of the patient for femoral sciatic block. Postoperative ammonia levels were normal. Sedation is considered useful for preventing hyper ammonemia. Preoperative endocrinology consultation, perioperative serum ammonia level monitoring and coordination between various health departments (nephrologist and endocrinologist) for appropriate care in case of hyper ammonemia and hyperglycaemia perioperatively.
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Background: Hypertension is common medical problem encountered during pregnancy, complicating up to 10% pregnancies. Hypertension is defined as the systolic blood pressure ≤140 mmHg and a diastolic blood pressure ≥90 mmHg on two separate measurements at least 4-6 hours apart. During pregnancy thyroid demand changes with increased iodine uptake and synthesis of thyroid hormone. Serum from pre-eclamptic women had both a higher ratio of free fatty acid to albumin and increase up take of free fatty acids, which are further esterified to triglyceride. The aim of the present study was to evaluate thyroid hormone, lipid profile and urine albumin in hypertensive pregnant women and its comparison with normotensive pregnant womenMethods: Total 90 samples were collected from Beri Maternity Hospital and Civil Hospital, Amritsar. Blood samples were analysed for biochemical parameters viz. lipid profile and thyroid profile. Urine samples were also analysed for presence of albumin.Results: From the study it has been revealed that thyroid stimulating hormone (TSH) levels increased in hypertensive pregnant women mean (4.26±1.1µ/ml). The total cholesterol (234.56±14.2mg/dl), triglyceride (138±16.96mg/dl), HDL (50.7±7.4mg/dl), LDL (156.2±17.11mg/dl) and VLDL (27.7±3mg/dl) was found altered in hypertensive pregnancy as compared to normotensive pregnancy. The albumin excretion was seen in 13.3% hypertensive pregnancies.Conclusions: TSH were elevated in hypertensive pregnant women due to the effects of estrogen. Among all the parameters of lipid profile, total cholesterol, TG, LDL and VLDL has been increased significantly in hypertensive pregnant women as compared to normotensive pregnant women due endothelial dysfunction.
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Spinal anaesthesia related hypotension and bradycardia is not rare. One of the causes for post spinal hypotension is thought to be bezold-jarisch reflex (BJR) which is mediated by serotonergic 5-HT3 receptors. Ondansetron, one of the reliable drugs for nausea and vomiting, is 5-HT3 antagonist. Effect of ondansetron to attenuate hypotension has been studied in caesarean section but there is paucity of literature for general population. Aim and Objectives: In this study we aimed at evaluating the efficacy of ondansetron on haemodynamics of patients undergoing spinal anaesthesia. Methods: This prospective study enrolled 200 ASA I and II patients assigned into 2 groups: Group O (Ondansetron group, n=100) received injection ondansetron 0.1mg/kg intravenous, diluting the drug to make volume 10 ml 5 minutes prior to spinal anaesthesia(SA). Group P (Placebo group, n=100) received injection normal saline 10 ml intravenous 5 minutes prior to spinal anaesthesia. Results: Demographic data were comparable in both the groups. There was no significant difference in MAP (mean arterial pressure), HR(heart rate) & SpO2 (oxygen saturation) values in group O whereas in group P statistically significant variations in MAP, HR & SpO2 values were observed. Fewer interventions using intravenous atropine & ephedrine were required in group O as compared to group P. Conclusion: In conclusion, intravenous administration of ondansetron 5 minutes before spinal anaesthesia attenuates the decrease in mean arterial pressure.
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Prescription auditing is a quality improvement process that seeks to improve patient care. Medical Audit may be defined as a process with the aim of making improvements in patient care and proper use of resources. The most important part of healthcare system is to deliver the right medicine to the right people. Prescription auditing is one of the important tools to avoid misuse of drugs and improve rational use of drugs. The performance of the health care providers related to the appropriate use of drugs can be accessed by analysing different prescribing indicators. The parameters which have to be analysed in the process of prescription auditing are Patient demographics, Clinical diagnosis, Department, Prescribing standards, Doctor’s name and signature. A total of 25 national and international articles were collected to see the prescribing pattern of drugs. Various studies showed that majority of practitioners do not follow the guidelines while writing prescriptions and usage of drugs. There is a need to standardize the prescribing patterns in India so that all essential information is included and will be helpful for the better patient care. Irrational prescribing and improper dispensing leads to unnecessary expenditure for the patient. The present study could serve as a frame work upon which further studies can be launched in prescription auditing to investigate the scope for educational intervention and improvement in prescribing patterns.
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Background: The purpose of the study is to investigate the general well-being in students who playsports at a competitive level and students who don't play sports at a competitive level of the age group 16–22 years.Methods: The sample consisted of 160 participants. 80 participants played sports at a competitive level(out of which 40 were males and 40 were females) and 80 participants did not play sports at a competitivelevel (out of which 40 were males and 40 were females). Method of purposive sampling and conveniencesampling was used for inclusion of participants.Results: The difference of general well-being between internal and external locus of control was significantat F= 11.58, p< 0.000852 and the difference of general well-being between male and female was significantat F=9.46, p<0.002491.Conclusion: Sport in the researcher’s sample, did not have major impact on the general well-being ofstudents. The researcher’s study, was in line with previous researches, saying that gender has a majorimpact on general well-being of an individual, this is because of several psycho-social factors.
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Scrub typhus is a rare rickettsial disease which is endemic in the state of Himachal Pradesh. It is caused by bacteria called Orentia tsutsugumasi and transmitted by larvae of Trombiculid mites. Though rarely seen in the plains, it should be kept as differential for a patient presenting as fever with seizure. Eschar may or may not be seen in all cases. We report a case of scrub typhus in a patient who presented with fever and seizures but no eschar.
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Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an ?-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine.Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50?g of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded.Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups.Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.
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Lipomas are the most common type of soft tissue tumors. Intramuscular lipoma is a rare type of deep-seated lipomas, which arise within the skeletal muscle fibres. It can arise in the background of history of trauma, obesity, chronic irritation, metabolic disorders, etc. Lipomas are usually benign, but sometimes clinically and grossly, they simulate malignancy. Intramuscular lipomas also need separation from muscular dystrophies. Histopathology is must to differentiate. Prognosis of intramuscular lipoma is very good and marginal excision is the treatment of choice. We report a case of 32 years old female, who presented with a painless swelling shoulder since six months. She had history of trauma eight years back. Grossly, the received mass was yellow-tan coloured, well circumscribed swelling of soft tissue along with muscle. Histopathologically, features are consistent with intramuscular lipoma. We report this case because of its rarity.
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Background: Adverse drug reaction (ADR) has a severe morbidity and mortality associated with it. The safe use of medicines is a critical issue for all healthcare professionals, including physicians, pharmacists, and nurses as well as the public. The main objective of this study was to evaluate the knowledge, attitude, and practice (KAP) of healthcare professionals about ADRs in a tertiary care teaching hospital. Methods: A cross-sectional survey was carried out among the health care professionals in India using a pre-tested questionnaire with 30 questions (18 questions on knowledge, 6 on attitude, 5 on practice, and 1 on training about reporting of ADR). The study was conducted, over a period of 6 months. Results: The questionnaire was distributed to the respondents (n=200). The response rate of 85% was recorded. Among these, only 82 questionnaires were filled in pre-test and 88 questionnaires were filled in post-test after improving awareness through pamphlets. Of the total completed questionnaire (88), 34.88% were filled by physicians, 8.53% by pharmacists, 27.9% by nurses, and 31.3% by medical and paramedical interns. Conclusions: The health care professionals have little KAP toward ADR reporting. Healthcare professionals with higher experience such as (>10 years experience) have better KAP. With additional training on pharmacovigilance, the Indian healthcare professionals working in different sectors can become part of ADR reporting system.
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Aim: Insomnia is subjective perception of dissatisfaction with sleep quality and/or duration. The present study aimed to determine the effects of sleep deprivation on cardiovascular risk factors and health. Design, Place and Duration of Study: A cross-sectional study was conducted at Exservicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, Punjab, India from July, 2013 to Nov, 2013. Methodology: All the retired defence personnel and their family members (N=351) were assessed to study physical activity, body mass index (BMI), dietary habits, alcohol, hypertension, hyperglycemia, hyperlipidemia, stress, age, gender, employment, and education as determinants of sleep deprivation. The results were analyzed by Chi Square test with statistically significance of P value<.05. Results: The total prevalence of insomnia was 27.64% with higher frequency in females (52.57%) than males (47.42%). The prevalence increased with advancing age >50 years (81.43%), unemployment (75.25%), illiteracy (69.06%) and upper socioeconomic status (39.17%). A significant association of insomnia with hypertension (59.80%; P<.05) and stress (28.86%; P<.001) was found. Alcohol (24.40%) and active lifestyle (38.58%) had shown protective role in sleep adequacy. However, sleep deprivation had no significant relation with obesity, metabolic syndrome, dietary practices, blood glucose, and lipids levels. Conclusion: Insomnia and its significant relation with hypertension and stress increases cardiovascular risk which requires appropriate interventions by identifying those at the risk of chronic insomnia and its associations with females, advancing age, physical inactivity, low education level and unemployment.
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Background: There are limitations of currently recommended stepwise treatment for Type 2 diabetes, especially failure with monotherapies to achieve the strict glycemic control. This has prompted the intensification of therapy with such combinations which have additive efficacy and complimentary mechanisms of action. Vildagliptin is one such agent with the above potential which does not increase the risk of hypoglycemia and does not promote weight gain. Methods: It was a prospective, open-label, randomized, and parallel group study involving 90 patients, divided into three Groups A, B, and C. Group A given vildagliptin/metformin (50/500 mg), Group B vildagliptin/pioglitazone (50/15 mg)and Group C metformin/pioglitazone (500/15 mg) combinations twice daily for 12 weeks. Fasting blood glucose (FBG) was estimated biweekly while hemoglobin A1c (HbA1c), lipid profile, insulin, and C-peptide levels at 0 and 12th week. Statistical analysis was done using ANOVA and Student’s t-test. Results: At the end, mean percentage of age fall in HbA1c and FBG from baseline was maximum in Group B, which was found out to be more efficacious than Group A and C (p<0.001) on glycemic parameters. Mean percentage of age decrease in triglyceride from baseline was maximum in Group C, which was found out to be more efficacious than Group A and B (p<0.001) on lipid parameters. The adverse effects were low in all the groups. However, the incidence of peripheral edema and weight gain was more with the use of Group C while nausea, vomiting, and nasopharyngitis was more with the use of Group A. Conclusion: Vildagliptin/pioglitazone combination is of choice in patients with uncontrolled hyperglycemia but normal lipid profile while metformin/pioglitazone combination in diabetic patients with dyslipidemia.
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Recent exciting discoveries isolated dental stem cells from the pulp of the primary and permanent teeth, from the periodontal ligament, and from associated healthy tissues. Dental pulp stem cells (DPSCs) represent a kind of adult cell colony which has the potent capacity of self-renewing and multilineage differentiation. Stem cell-based tooth engineering is deemed as a promising approach to the making of a biological tooth (bio-tooth) or engineering of functional tooth structures. Dental professionals have the opportunity to make their patients aware of these new sources of stem cells that can be stored for future use as new therapies are developed for a range of diseases and injuries. The aim of this article is to review and understand how dental stem cells are being used for regeneration of oral and conversely nonoral tissues. A brief review on banking is also done for storing of these valuable stem cells for future use.
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Apolipoprotein E is a major constituent of chylomicrons and HDL fractions of the normal blood plasma involved in lipid transfer systems. The three common alleles apoE2, apoE3 and apoE4 with six possible phenotypes have been identified at this locus in all the populations of the world studied so far, with apoE3 being the most common. The present study employed PCR restriction isotyping techniques to estimate allele frequency distribution amongst Ramgharias an artisan caste group of Punjab in North India. The methodology was developed to visualise the isotypes on PAGE using silver staining. The major genotypes observed were E2/3, E3/3 and E3/4 with allele frequencies APO E2=0.107, APOE3=0.714 AND APO E4=0.179.