Is Follow-up Co-Morbidity Assessment via Laboratory Investigations in Older High Energy Trauma Patients Justified? - A Prospective-Retrospective Study

@#Introduction: The objective of the current study was to test our hypothesis that older patients sustaining high energy trauma need to be evaluated for their comorbidities similar to geriatric patients sustaining low energy trauma. Materials and methods: This study was a retrospectiveprospective analysis of 173 patients of more than 50 years of age enrolled between November 2017 and December 2018. Herewith, we have compared retrospectively collected laboratory investigations of 124 fragility fracture patients with prospectively collected laboratory investigations of 49 patients with high energy trauma. The laboratory investigations, including the liver function tests, renal function tests, indices of calcium metabolism, serum electrolytes, complete blood counts, and bone mineral density (BMD) scores. Results: Both groups were similar to each other as far as baseline demographic characteristics were concerned. The proportion of female patients and patients with nonosteoporotic range BMD (T-score >-2.5) was significantly higher in the high-energy fracture group (P value <0.05). Hypoalbuminemia (<3.4gm/dl) 17.3%, abnormalities sodium (<135mmol/L or >148mmol/L) 23.2%, Anaemia (<10g/dl) 12.7%, Hypercalcemia (>10.4mg/dl) 16.3%, Vitamin D deficiency (<20ng/ml) 17.3% are the common laboratory abnormality found in study population. No statistically significant difference was found among the two groups in terms of laboratory investigation abnormalities. Conclusion: The laboratory investigation abnormality in an older patient with a clinical fracture is independent of the mechanism of injury. The results of the current study emphasise the need for a comprehensive laboratory workup in older patients with either high- energy fractures or fragility fractures.

Impact of Covid-19 Disease on Health Care Services of Leprosy Patients Attending a Tertiary Care Centre, Telangana

Covid - 19 disease was declared as a pandemic by World Health Organization in March 2020. Subsequently, a nationwide lock down for variable intensity and periods was announced in India to contain the disease. Leprosy patients faced difficulties during this pandemic owing to their long-term health care requirements and lack of access to leprosy services during covid time. This resulted in deprivation of multi - drug therapy (MDT), steroids and other drugs to leprosy patients, which is detrimental to the patients as well as to the society. This study was conducted to analyze the impact of covid-19 pandemic induced lock downs and movement restrictions on leprosy patients attending a tertiary care centre. This provides data to assess their impact on leprosy healthcare services. The study observed a marked decrease in the number of leprosy patients attending the leprosy out patient care and also a reduction in the number of new cases registered during the year 2020. Quarterly analysis showed maximum reduction of cases occurring during the lockdown period and peak covid-19 infection periods. As there is a likelihood of this pandemic continuing and similar other disruptions may occur again, there is a need to assure that MDT and health care services reach leprosy patients by various other means. Some of the modifications can be a) supplying a 3 to 6 month course at a time as A-MDT, b) home delivery of drugs by health workers c) promotion of telemedicine services for leprosy patients d) optimal utilization of social media to educate and counsel leprosy patients on both covid-19 and leprosy. It is also important that leprosy clinics and drug delivery services should be continued both in Covid and Non-covid hospitals at par with Revised National TB Control Programe (RNTPC) renamed as National Tuberculosis Elimination Programme (NTEP) and Anti-Retroviral Treatment (ART) services.

C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) Trends following Total Hip and Knee Arthroplasties in an Indian Population – A Prospective Study

@#Introduction: To evaluate the trends of C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) in the first three weeks after uncomplicated total hip (THR) and total knee (TKR) arthroplasty/replacement in the Indian population and to compare it with available literature. Material and methods: A total of 90 patients were enrolled for this prospective study, of which 30 were unilateral THR, 30 were unilateral TKR (U/L TKR) and 30 were simultaneous bilateral TKR (B/L TKR). Serum CRP and ESR were measured on the day before surgery and postoperatively on day 1st, 2nd, 3rd, 7th, 12th, and at the end of 3rd week. Results: CRP showed a peak at day 2nd with normalisation to pre-operative value by the end of 3rd week. While ESR showed a peak on day 3rd and continued to remain elevated even at end of 3rd week post-operatively. Both mean CRP and ESR values were higher in THR patients followed by in B/L TKR and then in U/L TKR patients. Conclusion: CRP persists to be the best acute phase reactant in the early post-operative phase with a relatively typical pattern as compared to ESR. CRP values peak at postoperative day 2nd and then show a gradual decline. However, its normalisation to pre-operative baseline values may vary among different groups of population.

Frequency and Characteristics of Mesiodens in Indian School Children: A Retrospective Radiographic Study

Abstract Objective: To determine the frequency and characteristics of mesiodens in Indian school children. Material and Methods: 1232 radiographs of patients attending the Department of Oral Medicine and Radiology of the age group of 4-15 years studied for the present retrospective study. The intraoral periapical radiographs and occlusal radiographs of the premaxilla were examined to determine the presence of mesiodens. The data regarding the presence of mesiodens, number, position, location on the arch, shape and associated complications were recorded. Results: Eleven patients had 14 mesiodens, with a frequency of 0.8%. The ratio of boys to girls was 1.2:1. Maximum mesiodens observed in the age group of 7-9 years. Most of the mesiodens were conical in shape and found on the palatal side. Fifty percent of the mesiodens were unerupted. The majority of patients (57.1%) had vertically positioned mesiodens. Midline diastema was the most common complication due to mesiodens (66.7%). Conclusion: Routine check-up during the primary dentition and mixed dentition stages helps for early detection of mesiodens and thus preventing complications. Early identification is useful for planning comprehensive management, initiating proper consultation and referral for evaluation and treatment.

Ameliorative Effect of Punica Granatum Ethanolic Extract in Cyclophosphamide Induced Testicular Toxicity in Male Wistar Rats.

Aim: To explore the potential role of Punica granatum ethanolic extract (PGEE) in Cyclophosphamide (CP) induced testicular toxicity. Methods: Healthy male Wistar rats were allotted to 4 groups (N=6, each) Group I: Control, Group II: CP 15mg/kg twice a week, Group III: PGEE 100mg/kg, Group IV: CP and PGEE for 28 days. At the end of the treatment period, organ weight, body weight, epididymal sperm count, motility, morphology, SOD, catalase, GSH, ACP & testosterone level in the testis were evaluated. Results: The CP treated rats showed toxicity evidenced by decreased organ and body weight, decreased sperm quality and testosterone level also increase in MDA and decrease in antioxidants SOD, GSH indicating oxidative stress. In contrast PGEE co-treatment with CP resulted in significant restoration of the above mentioned parameters. Conclusion: These results indicate that PGEE attenuates CP induced testicular toxicity through its ROS scavenging activity.

Effectiveness of electrical stimulation in idiopathic Parkinson’s disease.

Background: Parkinson’s disease is one of the most disabling chronic neurologic diseases and leads to a significant loss of quality of life. Electrical stimulation activate nerves innervating extremities affected by paralysis resulting from Spinal Cord Injury (SCI), head injury, stroke and hence is primarily used to restore function in people with disabilities. Methods: The study was performed after the institutional ethical clearance and informed consent from all the participants. The parameters assessed were time taken to complete 20 M walk with turn round, distance covered in the first 3 minutes of walking, gait dynamics like stride length, step length and cadence and number of falls with the help of video tape recorder, stop watch and measuring tape. Results: We observed a non-significant reduction (P = 0.471) of UPDRS, mean score of PDQ-39 was declined non-significantly (P = 0.36), time taken to complete 20 meters walk with turn was declined significantly (P = 0.017), The distances walked in 3 minutes by the patients were increased significantly (P = 0.000), number of steps during 20 meter walk was recorded and was found to be declined significantly (P = 0.088), stride length of the patients were increased significantly (P = 0.000), step length of the patients was increased significantly (P = 0.000), average number of falls reduced significantly (P = 0.00) during the stimulation period from week 0 to week 8. Conclusion: This study demonstrated the superior efficacy of electrical stimulation over best medical management in patients with advanced Parkinson’s disease.

Ameliorative Effects of Alcohol on Human Diabetic Volunteers – A Prospective Study.

Aims: The purpose of this study is to assess and confirm the ameliorative effects of alcohol consumption on biochemical indices of blood i.e., blood glucose, HbA1c, NO2, NO3, lipid profiles, hs-CRP (high sensitive C–Reactive protein) and membrane lipid peroxidation of diabetics. Study Design: Pre-clinical and Biochemical experimental study. Place and Duration of Study: Department of Biochemistry, Acharya Nagarjuna University and Dept. of Biotechnology, K L University, Guntur, A.P and Dept. of Biochemistry, Katuri Medical College, Katuri Nagar, Guntur, A.P and Dept. of Biochemistry, Sri Krishna Devaraya University, Anantapur, A.P and Dept. of Basic Sciences, Madanapalle Institute of Technology and Science (MITS), Post Box No: 14, Angallu (V), Madanapalle, A. P., India, during 2008– 2013. Methodology: The study is conducted on 4 groups (n= 1200) of people of different ages ranging from 35 to 50 years at community health centers in Prakasam, Warangal, Srikakulam districts of Andhra Pradesh, India. The first group consists of type-II diabetic patients who have been consuming alcohol (arithmetic mean ranging from 14.16 to 31.61ml/day) moderately for the past 3 to 10 years. The second group consists of nondiabetic, moderately alcohol consuming healthy individuals. The third group consists of patients who are type-II diabetics (who do not drink) taking medical treatment for minimum period of 1 year. The fourth group consists of non-drinking, non-diabetic healthy individuals. Relationships of alcohol intake with lipid profile, hs-CRP and HBA1c are compared among the three groups. Results: In lipid profile analysis of moderately drinking diabetic group, the HDL levels are found to be higher while the remaining factors such as total cholesterol, LDL, VLDL (P<0.05), triglycerides (P<0.01) and membrane lipid peroxidation are significantly lower. Fasting serum glucose levels are lowered, while serum nitrites and nitrates are found to be significantly higher. These differences are not found in abstainers group and Diabetic group who do not drink. Conclusion: Moderate consumption of alcohol in diabetic individuals is found to have an inverse association with the risky factors like LDL cholesterol, Triglycerides, etc. that are the etiological factors for some of the sequelae of diabetes mellitus i.e., coronary heart diseases, Retinopathy, etc. and has a direct association with the positive factors such as HDL and nitric oxide production. Experimental results are very significant and indicate that moderate consumption of alcohol has ameliorative effects on diabetics.

Analysis of prenatal and postnatal risk factors of retinopathy of prematurity in a tertiary care hospital in South India.

Context: Recent advances in neonatology have influenced the incidence and severity of ROP in a dichotomous fashion. Aims: To determine the incidence of ROP and to analyse its risk factors. Settings and Design: Prospective clinical case series. Materials and Methods: 282 preterm infants with birthweight < 1500g and/or gestational age ≤ 32 weeks and also those with gestational age > 32 weeks, with birthweight between 1500‑2000 g, who were at risk for ROP were selected. Weight gain proportion was measured as weight at 6 weeks minus birthweight divided by birthweight. Statistical Analysis: Univariate and multivariate logistic regression. Results: Incidence of any ROP was 21.6% while severe ROP was 6.7%. Prenatal factors like multiple gestation (P = 0.510) and antenatal steroids (P = 0.104) were not significantly associated with ROP. On multivariate analysis, postnatal factors like weight at birth < 1250 g (P = 0.01) and gestational age between 31‑32 weeks (P = 0.02) were independent risk factors for any ROP, while intraventricular hemorrhage (P = 0.03) was the only independent risk factor for severe ROP. Mean birthweight of infants with severe ROP was 1056 ± 207 g (P = 0.004), which was significantly low. After logistic regression, the mean weight gain proportion at 6 weeks, of those neonates with severe ROP was 30%. Conclusions: Low birthweight and prematurity were the most important risk factors for developing any ROP, while intraventricular hemorrhage was the independent risk factor for developing severe ROP. The mean postnatal weight gain at 6 weeks was not statistically significant in neonates with severe ROP.

Eye donation – Awareness and willingness among attendants of patients at various clinics in Melaka, Malaysia.

Aim: Corneal blindness accounts for 3.42% of blindness in Malaysia; the rate of eye donation is low. The aim of the study was to assess the awareness about eye donation and willingness to donate eyes among attendants of patients at various clinics in Melaka, Malaysia. Materials and Methods: This observational study was conducted on attendants who accompanied patients (n = 400) visiting various outpatient departments of the General Hospital and two peripheral clinics in Melaka between August and October 2007. The participants answered a questionnaire (Malay and English versions) which included demographic profile, awareness of eye donation, knowledge regarding facts of eye donation, and willingness to donate eyes. Univariate and multivariate logistic regression was performed at 5% level of significance. Results: Awareness of eye donation was observed in 276 (69%) participants. Multivariate analysis showed that awareness was more among females when compared to males (P = 0.009). Of the 276 participants who were aware of eye donation, only 34.42% were willing to donate eyes. Willingness was more among the Indian race (P = 0.02) and males (P = 0.02). Educational status did not influence the willingness to donate eyes. Conclusions: Although majority of participants were aware of eye donation, willingness to donate eyes was poor.

Synthesis, anti-oxidant and anti-bacterial properties of diethyl (4-flouro-3-nitro phenylamino) (substituted phenyl) methyl phosphonates.

A new class of α–aminophosphoantes 4a-j have been synthesized by condensation of imines 3a-j with dialkyl phosphite under catalyst free conditions in dry toluene at reflux conditions via pudovik reaction in high yields. All the title compounds were confirmed by physico-spectral analysis. All the title compounds were screened for antioxidant properties by radical scavenging methods such as 1,1-diphenyl-2-picryl hydrazyl (DPPH), hydroxyl radical scavenging method and lipid peroxidation. They exhibited potent in vitro antioxidant activity dose dependently. Their bioassay showed them to possess significant antibacterial activity.

Descriptive study on ocular survival, visual outcome and prognostic factors in open globe injuries.

A prospective observational study was done to assess ocular survival, visual outcome and prognostic factors of open globe injury. Eighty eyes of penetrating trauma between 2004 and 2006 were categorized according to the ocular trauma classification system. Primary repair was done and outcomes were assessed at one, three and six months. The final vision was categorized as per World Health Organization classification of visual impairment. Factors at presentation were evaluated for prognostic value towards visual outcome. Sixty-nine eyes with minimum one month follow-up were included for analysis. Statistical analysis was done using Univariate and Multivariate analysis. We found Grade IV visual acuity (<5/200) at presentation (64%) as the most important factor contributing to poor visual outcome. Statistically insignificant factors were time since injury, cataract, and presence of intraocular foreign body. Ocular survival was 97%. We concluded that initial visual acuity, hyphema, zone and length of injury, retinal detachment and vitreous hemorrhage are statistically significant factors affecting outcome in open globe injuries.

Bilateral macular hole secondary to remote lightning strike.

We report a case of a 16-year-old girl, who was struck by lightning, and experienced blurred vision in the right eye (RE) immediately following the episode. She reported for ophthalmic evaluation two months later. Examination revealed relative afferent pupillary defect in the RE. Posterior subcapsular cataract was noted in both eyes. Fundus examination revealed macular holes and multiple areas of RPE hyperpigmentation in the periphery in both eyes. Fundus fluorescein angiography showed increased choroidal transmission with early fluorescence and late fading in the foveal region and retinal pigment epithelium (RPE) stippling in the periphery in both eyes. This is the first case report of such nature in India to the best of our knowledge.

Variation in common lipid parameters in malaria infected patients.

The heart is remarkably resilient even in the face of heavy parasite sequestration and other vital organ dysfunction, and deaths from cardiac arrhythmias in severe malaria are rare. Malaria may prove fatal for patients with pre-existing cardiac failure due to valvular stenosis or myocardial disease. High grade fever, parasitaemia, and fluid overload can all contribute to the problem. Cardiac arrhythmias are very rarely observed in severe falciparum malaria. An attempt has been made to evaluate the risk factors for cardiovascular diseases in malaria infected patients. In the present study the levels of total cholesterol, low density lipoproteins, triglycerides were high and the levels of high density lipoproteins were low in malaria infected patients compared to controls. The markers of free radical induced injury i.e. malondialdehyde were high. The study therefore suggests the importance of assessing these markers of oxidative stress along with the other routine investigations in malaria infected patients for initiating therapy in addition to primary and secondary preventive measures to mitigate the devastating consequences hyperlipidemia in malaria infected patients leading to cardiovascular diseases.

Dengue fever presenting with acute colitis.

Gastrointestinal manifestations of dengue fever are mainly in the form of bleeding or liver function abnormalities. Dengue fever presenting as acute colitis-like picture is not reported to date. We report a 50-year-old man with dengue fever presenting with lower gastrointestinal bleeding and colonoscopic features of acute inflammatory colitis.

Histochemical localization of enzymes and lipids in the ovary of a vespertilionid bat, Scotophilus heathi, during the reproductive cycle

O presente estudo descreve as mudanças sazonais na D5 3b hidroxiesteróide desidrogenase (3b-HSD), glicose-6 fosfato desidrogenase (G-6-PD), e lipídios no ovário de um morcego vespertilionidae, Scotophilus heathi. As atividades totais dos lipídios e do 3b-HSD estão restritas às células tecais e intersticiais do ovário. Os lipídios, 3b-HSD e G-6-PD totais, aumentaram significantemente durante a recrudescência, e permaneceram elevados durante a dormência de inverno e o período de acasalamento, quando comparados a outras fases reprodutivas. A alta incidência de atividade de lipídios e enzimas nas células intersticiais durante o período de acasalamento e durante o período de ovulação sugere claramente que estas células estão ativamente envolvidas na esteroidogênese. O declínio da atividade dos lipídios e enzimas durante a dormência de inverno, o qual se correlaciona com os níveis decrescentes da esteroidogênese, podem ser o fator responsável pela longa sobrevivência do folículo de De Graaf no ovário do S. heathi.

Effects of metformin treatment on luteal phase progesterone concentration in polycystic ovary syndrome

The causes of luteal phase progesterone deficiency in polycystic ovary syndrome (PCOS) are not known. To determine the possible involvement of hyperinsulinemia in luteal phase progesterone deficiency in women with PCOS, we examined the relationship between progesterone, luteinizing hormone (LH) and insulin during the luteal phase and studied the effect of metformin on luteal progesterone levels in PCOS. Patients with PCOS (19 women aged 18-35 years) were treated with metformin (500 mg three times daily) for 4 weeks prior to the test cycle and throughout the study period, and submitted to ovulation induction with clomiphene citrate. Blood samples were collected from control (N = 5, same age range as PCOS women) and PCOS women during the late follicular (one sample) and luteal (3 samples) phases and LH, insulin and progesterone concentrations were determined. Results were analyzed by one-way analysis of variance (ANOVA), Duncan's test and Karl Pearson's coefficient of correlation (r). The endocrine study showed low progesterone level (4.9 ng/ml) during luteal phase in the PCOS women as compared with control (21.6 ng/ml). A significant negative correlation was observed between insulin and progesterone (r = -0.60; P < 0.01) and between progesterone and LH (r = -0.56; P < 0.05) concentrations, and a positive correlation (r = 0.83; P < 0.001) was observed between LH and insulin. The study further demonstrated a significant enhancement in luteal progesterone concentration (16.97 ng/ml) in PCOS women treated with metformin. The results suggest that hyperinsulinemia/insulin resistance may be responsible for low progesterone levels during the luteal phase in PCOS. The luteal progesterone level may be enhanced in PCOS by decreasing insulin secretion with metformin.