Comparison of single versus double versus triple site band ligation for haemorrhoids in a single visit: a case-controlled double blind randomized study

Background: Rubber band ligation is considered one of the most popular non-surgical procedures available, representing the most reasonable balance between efficacy, pain and potential of complication. The present study was a controlled double blinded randomized study to compare Single versus double versus triple site band ligation for haemorrhoids in single treatment visit with special regards to its safety and efficacy in our patient population.Methods: There were 78 patients equally randomized in three groups by closed enveloped method. The number of patients in each group was 26, In Group A, a single, in Group B, two, and in Group C three major haemorrhoidal groups were rubber band ligated, in a single treatment visit on outpatient basis under topical anaesthesia with lignocaine 2% jelly.Results: Rubber band ligation was effective with significant symptom improvement seen in all patients with 88% patient satisfaction at end of 30 days period. Post ligation pain score and number of analgesic requirement in immediate post band ligation period, at 12 hours, at 1,7,14, 21 and 30 days post band ligation were similar in all three groups with p value >0.05. Multiple site haemorrhoidal bandings was done safely at single session without severe discomfort, pain or bleeding or severe complications requiring hospitalization.Conclusions: The study finding shows that triple site band ligation in a single session is a safe way of treating symptomatic haemorrhoids with similar post-procedure pain and patient satisfaction as conventional single or double site band ligation.

Assessment of Patients Undergoing Therapeutic Dental Extractions for Orthodontic Purposes

ABSTRACTBackground: Since the early days of orthodontics the need fortooth extractions in certain orthodontic situations has beendiscussed. Hence; under the light of above mentioned data, thepresent study was undertaken for assessing the patientsundergoing therapeutic dental extractions for orthodonticpurposes.Materials & Methods: A total of 85 patients who underwentorthodontic treatment were included in the present study.Complete demographic and clinical details of all the patientswere obtained. Clinical examination of all the patients wascarried out. Classification of the patients was also done on thebasis of type of angle’s classification. Frequency of dentalextraction was recorded. All the results were recorded inMicrosoft excel sheet and was analysed by SPSS software.Results: The overall frequency of therapeutic dental extractionwas 49.41 percent. Among these 42 patients, angle’s class I,class II and class III malocclusion was present in 12, 21 and 9patients respectively. Among these 42 patients, 28 werefemales while the remaining 14 were males.Conclusion: Therapeutic dental extractions are a commonfinding among patients undergoing orthodontic treatment withangle class II malocclusion being the most common reason fordental extractions.

Music: an effective anxiolytic during caesarean section under spinal anaesthesia

Background: Parturient undergoing repeat caesarean section (CS) under spinal anaesthesia usually experience anxiety due to unpleasant operative environment. Music therapy has been found to have positive psychological impact to relieve anxiety, improve patient satisfaction and provide stable haemodyanamics.Methods: Sixty patients without any co morbidity having history of previous CS, scheduled for another caesarean under spinal anaesthesia were included in the study. Patients were divided into two groups of 30 each. Group(M) patients were subjected to hearing music of their choice with the help of headphones after administration of spinal anaesthesia till the end of surgery. Group(N) patients were not made to listen to any music but headphones were applied. Haemodyanamic parameters including mean arterial pressure (MAP) and heart rate (HR), visual analogue score for anxiety (VASA) after administering spinal block and at the end of surgery, patient satisfaction score (PSS) and comparison of anxiety with previous CS were observed and recorded.Results: Both MAP and HR in Group M started falling after 10 minutes of spinal anaesthesia as compared to Group N and difference was significant (P <0.005), VASA 2 (2.2±1.8) in Group M was significantly lower than VASA 1 (5.4±1.7). PSS was also in favour of music group (Group M) and difference was highly significant as compared to group N (p=0.018). Patient’s anxiety as compared to anxiety with previous CS was lesser in Group M as compared to Group N(p=0.009).Conclusions: Music is a non-invasive tool to relieve anxiety during intraoperative period along with higher patient satisfaction and stable haemodyanamics.

Pattern of Canine Impaction in Relation to Lateral Incisors: A Reterospective Study

Objective: The aim of this study was to evaluate the pattern of maxillary permanent canine impaction in relation to lateral incisors. Methods: This reterospective study was conducted on a sample of population that had been treated in the Dentistry Department. The study con¬sisted of clinical and radiographic examination of 56 patients coming to the department for treatment. The patients having age between 15-18 years were included in the study. Data was analysed using SPSS version 22. A p-value of <0.05 was accepted as statistically significant. Results: Females had more impaction of maxillary canine than males. Palatal canine impaction were the most common in males while buccal canine impaction were more common in females. Conclusion: Maxillary palatal impaction was more common than buccal impaction and maxillary palatal and buccal impaction occurred more often in female subjects.

Immediate Versus Delayed Loading of Dental Implants: A Comparative Study

For single tooth gaps, implants serve as a valuable replacement option as shown by large number of studies. Various advantages offered by this technique include better cosmetic, functional and psychologic outcome for the patient. The aim of the present study was to compare the bone loss and the soft tissue condition of the conventionally loaded dental implants with those loaded immediately. Methods: The present prospective study was conducted was conducted in department of dentistry, in our hospital. The study included 40 subjects reporting for the replacement of single missing tooth. Stent was prepared for appropriate placement of the implants. Subjects were kept on an antibiotic regimen prior to implant placement and under complete aseptic conditions and using standard surgical procedures implants were placed. After 6 months, IOPA radiographs were taken to estimate the bone level and regarded as Time 1 and same was repeated after 12 months, regarded as time 2. Peri implant soft tissue evaluation was done at 6 months and 12 months. All the data was arranged in a tabulated form and analysed using SPSS software. Results: There were 62.5% (n=25) males and 37.5% (n=15) females in the study. There was 1 case of implant failure amongst both males and females. The mean periodontal index amongst Group B subjects at 6 months and 12 months was 0.52+/-0.65 and 0.71+/-0.42 respectively. Conclusion: The present study compared immediate and delayed loading of the implants. Immediate loading demonstrated a highly successful clinical outcome at the end of 1 year. Keyword

Relationship between Olfactory Dysfunction and Cognitive Impairment in Elderly Patients with Type 2 Diabetes Mellitus.

Background: Olfactory dysfunctions albeit commonly studied in research study are rarely tested in clinical practice and commonly overlooked in elderly. With ageing, rate of decline in olfactory and cognitive functions increases. Diabetic patients are more prone to develop these olfactory and cognitive dysfunctions. Elderly diabetic patients with olfactory dysfunction were found to have increased incidence of cognitive impairment as compared to patients without olfactory dysfunction. So olfactory function testing can be used as screening tool to detect cognitive impairment at earliest and can halt the progression of cognitive impairment by appropriate measures. Methods: A cross-sectional study done on 200 elderly diabetic patients. Olfactory dysfunctions were detected by open essence test and cognitive testing was done with MMSE. Patients with psychosis, apparent dementia, any nasal disease were excluded. Results: Out of 200 patients total number of patients with MMSE <23, 24-26 and >26 were 19, 51 and 150 with average Open Essence (OE) score 6.05±, 6.74±0.92 and 8.5±0.54 respectively indicating that patients with lower OE score were found to have lower MMSE score. Conclusion: With ageing, olfactory as well as cognitive dysfunction increases. Diabetes accelerates these processes substantially. Olfactory dysfunction precedes the development of cognitive impairment. So elderly patients with diabetes should be screened for olfactory functions so that proper measures could be taken to decrease the incidence or severity of cognitive dysfunction.

Study of Cardiac Manifestations in Patients with HIV Infection and Their Correlation with CD4 Count in Indian Population.

Background: HIV continues to be a major global public health issue. In 2014 an estimated 36.9 million people were living with HIV, a global prevalence of 0.8 %. The clinical spectrum of HIV infection encompasses a spectrum ranging from an acute syndrome associated with primary infection to a prolonged symptomatic state to an advanced cardiac disease in HIV affected patients is becoming more prevalent as therapy and longevity improve Infection HIV is one of the causes of acquired heart disease in these patients. With advances in the management of patients living with HIV and AIDS (PLHA), not only survival has increased but manifestations of late stage HIV infection are encountered more often including cardiovascular complications. Aims and Objectives: To determine the prevalence and characteristics of cardiac manifestations in patients with HIV infection and to evaluate their correlation with CD4 count. Methods: During the period of 1 year from July 2015 to September 2016, total 100 cases of HIV/AIDS were included. The occurrence of cardiac involvement in HIV/AIDS cases was determined based on cardiac enzymes, ECG findings & 2D Echocardiography findings. An attempt was made to correlate various cardiac findings with CD4 T cell count. Results: Male to female ratio was 3:1. Common clinical symptoms were fever (68%), cough (44%) & extertional breathlessness (33%) Echocardiographic abnormalities were seen in 54.3% of patients. Reduced ejection fraction (below 50%) and fractional shortening below 30% were the most common cardiac abnormality (46.3%) followed by pericardial effusion (16.66%), pulmonary artery hypertension (11.11%), dilated cardiomyopathy (9.25%), diastolic dysfunction (9.25%), regional wall motion abnormality (1.85%) and valvular regurgitation (5.55%) respectively. Significant statistical positive correlation was observed between low CD4 count and echocardiographic abnormalities (p < 0.001). Pericardial effusion was seen more in patients with CD4 count below 200 (p < 0.05). Maximum number of echocardiographic abnormalities was seen in WHO clinical stage IV. Conclusion: Echocardiographic abnormalities are more prevalent in HIV/AIDS patients and their prevalence increases as the CD4 count falls andoccur more in advanced stage of the disease. So we should aim at starting ART early in HIV infected patients so as to improve the quality of life of people living with HIV/AIDS.

Hepatic Abscess Caused By Salmonella-A Case Report.

Salmonella typhi is a rare cause of liver abscess. Numerous extra-intestinal complications can occur with S.typhi infection, including the involvement of the cardiovascular system, pulmonary system, bone and joints, hepatobiliary system, genitourinary system etc. We describe a 65-year-old diabetic male with liver abscesses due to S. typhi. Ultrasonography revealed the rounded 8x4 cm lesion in the right lobe of liver with low echogenicity. Gram stain, abscess culture (with sensitivity testing) and blood culture provide valuable information to guide successful therapy. The patient did not respond appropriately to amebicidal therapy and culture of the liver aspirate yielded S. typhi. Percutaneous aspiration combined with appropriate antibiotic therapy resulted in a complete recovery. In the present case, we did not have definite evidence such as positive stool culture; however, we thought that gastrointestinal focus would be most likely.

Eosinophilic Gastroenteritis Presenting as Small Bowel Obstruction.

Eosinophilic gastroenteritis is a rare disease of unknown etiology characterized by eosinophilic infiltration of bowel wall to a variable depth. A 38 year old female presented with loose stool and vomiting since 3 days. She gave history of pain abdomen and weight loss since six months. Barium study revealed ascending colon stricture just proximal to the hepatic flexure ? malignant. A colonic biopsy was done, which was reported as edematous colonic mucosa with mild increase in eosinophils. Intra-operatively, a dense long segment stricture was found in the ascending colon extending to the caecum which warranted a right hemicolectomy. Histopathology revealed dense infiltration of eosinophils in the entire thickness of ileal and caecal wall. The diagnosis of eosinophilic gastroenteritis was made. Patient responded well to steroids. The case is being reported to highlight its rarity due to caecal involvement, presentation as intestinal obstruction and missed diagnosis on endoscopic biopsy.

Gangliocytic paraganglioma: A rare presentation as intestinal intussusception.

Gangliocytic paragangliomas are rare benign neoplastic lesions of neuroendocrine origin occurring primarily in peri-ampullary region. Commonly occurring as small submucosal lesions, presentation as a large polyp with acute ileo-ileal intussusception in a 62-year-old woman is rare and is described in this case report.

Methicillin-resistant Staphylococcus pneumonia and underlying asymptomatic sarcoidosis: Are they related? A post-mortem case report.

Staphylococcus aureus is a rare cause of pneumonia, though in recent times methicillin-resistant strains are emerging increasingly as causative pathogens. Methicillin resistant Staphylococcus aureus (MRSA) has been reported to cause rapidly fatal hemorrhagic pneumonia. Most of these strains have been found to produce a lethal exotoxin called Panton-Valentine leukocidin. The finding of an underlying asymptomatic multisystem sarcoidosis was unusual in the case being reported here.

Corneal edema following diode laser cyclophotocoagulation in an eye with secondary glaucoma.

A 70-year-old man had undergone a complicated cataract extraction followed by repair of iris prolapse ending up with secondary glaucoma. Refusing routine filtering surgery, patient underwent contact transconjunctival diode laser cyclophotocoagulation. This report highlights the occurrence of corneal edema restricted to the inferior half of cornea following a diode laser cyclophotocoagulation performed in the inferior 180 degrees. The necessity to perform a routine specular microscopy in all such cases is highlighted, especially in eyes with good visual acuity.

Is seroprevalence of anti-IGM CMV among blood donors relevant in India?

BACKGROUND: Infection with cytomegalovirus (CMV) is more common in developing nations and the people belonging to the lower socioeconomic section of the society. The immunosuppressed population for whom CMV-seronegative blood products are requested is increasing due to advances in medical care. AIM: To study the prevalence of CMV antibodies among the different sexes and age groups in healthy blood donors. MATERIALS AND METHODS: A retrospective study was done on 5600 serum samples stored frozen in a repository for CMV antibodies using the ELISA technique. RESULTS: Five thousand three hundred and fifty (95.5%) were male and 250 (4.5%) were female. Four cases (0.071%) out of 5600 samples were positive for anti-IgM CMV with 95% Confidence Interval (95% C.I) of 0.02 - 0.17. CONCLUSION: In a developing country like India, screening for IgM antibody on a routine basis may not be feasible, given the likely positive yield to be low and the cost being high. It is recommended that in a tertiary care hospital, blood units to be transfused to neonates, organ transplant recipients, those suffering from malignancies and other immunocompromised patients should be screened for anti-IgM CMV or preventive strategies like universal leucodepletion to be implemented to decrease the transmission of CMV in these groups of patients.

Multimeric analysis in diagnosis of vWD variants in Indians.

von Willebrand disease is a common inherited bleeding disorder and the problem is undefined in developing countries due to limitation of its diagnostic facilities. The aim of the study was to diagnose vWD in patients with history of muco - cutaneous bleeding and characterization into its variants by multimeric analysis. 224 patients presenting with history of muco - cutaneous bleeding were selected. In all patients, platelet count, BT, PT, APTT, PF3 availability, clot solubility and factor VIII assay were done. Diagnosis of vWD was confirmed by RIPA, vWF: Ag, and vWF: RCo and its sub-characterization was done by multimeric analysis. 64 patients were diagnosed to have vWD. Of these, 21.9% were of type 1 vWD, 43.7% type 2 vWD, 1.6% acquired vWD and 32.8% type 3 vWD. By multimeric analysis, 2 patients had supranormal HMW multimers and two patients had normal distribution of vWF multimers were diagnosed as type 2M 'Vicenza'; and type 2M vWD respectively. It is concluded, that vWD is not an uncommon condition amongst Indian population.

Is seroprevalence of HTLV-I/II among blood donors in India relevant?

Human T-cell lymphotropic virus type I/II (HTLV-I/II) is associated with certain hematologic and neurologic disorders. Seroprevalence studies demonstrate that the distribution of HTLV-I/II is heterogeneous worldwide and not specific to one region. Because blood is one of the major routes of transmission of the virus, blood banks of several countries routinely screen all blood donations for HTLV-I/II. The aim of the present study was to assess the seroprevalence rate of HTLV-I/II antibodies among Indian blood donors and to confirm the positive rates by polymerase chain reaction (PCR). Between Jan 2004 to May 2005, consecutive blood samples of 10,000 blood donors were collected at the blood bank of Armed Forces Medical College, Pune. The samples were screened for HTLV-I/II by enzyme-linked immunosorbent assay (ELISA) method. Screening resulted in 18 (0.18%) positive samples, of which 14 (77.8%) samples were also positive by PCR. The prevalence of HTLV-I/II carriers in India seems to be negligible and is not a major public health hazard. Hence, routine screening of Indian blood donors for antibody to HTLV-I/II is not warranted due to its low prevalence in India.

Role of gel based technique for Coomb's test.

The direct (DAT) and indirect antiglobulin tests (IAT) are one of the most important diagnostic tools used in the investigation of immune mediated disorders. Recently, transfusion laboratories have seen the introduction of column technology in the form of the gel technology (GT). Aim of this study is to compare the conventional tube tests (CTT) and the GT for Coomb's test and to evaluate their sensitivity and specificity. 1656 samples were included in this study, in which 1054 samples were subjected to IAT and 602 samples were subjected to DAT Of the 602 samples tested for DAT, 587 (97.5%) showed concordant DAT results. DAT by the GT could detect 8.6% positivity as compared to 6.1% by CTT. The sensitivity and specificity of the GT was 100% and 97.3% respectively and its negative predictive value was 100%. Among the 1054 samples for IAT, 1041 (98. 8%) showed concordant results. The IAT by the GT showed 6.6% positivity as compared to 5.4% positivity by CTT The sensitivity, specificity and the positive and negative predictive value were 100%, 97.7%, 81.4% and 100% respectively. In conclusion, the GT is a better alternative to the CTT for both DAT and IAT. The GT is highly recommended to be implemented as a routine method of testing in all zonal / regional blood transfusion centers.

Programme planning and screening strategy in retinopathy of prematurity.

Retinopathy of Prematurity (ROP) is one of the major emerging causes of childhood blindness. A well organised screening strategy and timely intervention can to a large extent prevent blindness due to ROP. This communication proposes a screening strategy and management plan to develop a model for the care of babies with ROP.