Outbreak of cholera in a remote village in western India

Background & objectives: Atypical El Tor strains of Vibrio cholerae are frequently implicated in outbreaks of cholera. It is important to understand genetic variations of such strains which impact clinical and epidemiological outcomes. The present study was carried out to characterize an outbreak of cholera which occurred between July 8 and 13, 2018, in a remote settlement in Nashik district, Maharashtra. Methods: A large number of acute diarrhoea cases were reported in Rahude village, Nashik, Maharashtra since July 8, 2018. Molecular characterization of the isolated strains of V. cholerae was done. Results: 195 cases of cholera were detected from a population of 850 (attack rate 22.9%) with two deaths (Case Fatality Ratio of 1.03). A non-haemolytic polymyxin B sensitive strain of V. cholerae O1 Ogawa was isolated from 5/14 fecal samples. Molecular characterization of the isolates indicated that this strain was an altered El Tor (AET) strain. Deletion of the trinucleotide ‘GTA’ in the rstB gene, a unique feature of classical strains, was observed. Interpretation & conclusions: A cholera outbreak caused by a non-haemolytic polymixin B sensitive AET strain, occurred from July 8 to 13, 2018, in a remote settlement in western India. The molecular characterization of the outbreak strains highlighted an assortment of genetic determinants, stressing the need to monitor the genetic attributes of V. cholerae O1 in outbreaks for better understanding and mapping of clinical and epidemiological changes.

Study The Efficacy Of Rohitakmul Churna In The Management Of Shwetapradar W.s.r. To Leucorrheoa

Every woman faces varies physiological and psychological changes during this "change of life" as a part of hormonal derangement. Now a days women's health is of prime importance to get a healthy society. Woman play different roles in her life and these balances the family and keeps them nested together. It is important that she should remain healthy and proper attention should be paid towards her health. But because of their shyness and hesitation they would not discuss freely about their diseases relating to the exposable parts of the body and thus they get the diseases ultimately more and more complicated. Any deviation from natural process leads to complications like irritation in vagina due to excessive discharge which in turn causes divesting effect on marital harmony. This irritation can be caused due to infection or pathological manifestation in the vagina. “Shwetpradar” which is identified as white discharge which is commonest in all gynecological disorder’s like vaginitis. Leucorrhoea is a white discharge from the vagina. Normally, vaginal discharge occurs in regular variations of amount and consistency during the course of the menstrual cycle. A greater than usual amount is normal in pregnancy, and decrease is to be expected after delivery, during lactation, and after menopause. It may be physiological or pathological. Physiological excess of vaginal discharge does not require any treatment. But, the pathological conditions which necessitate treatment are those involving many infections due to Candida, Trichomonas, Gram negative, Gram positive etc. organisms. Whenever women suffer from certain pathological conditions the effective treatment is very essential. It is hoped that the research work in the field of Ayurveda will create much interest in the medical practice and for scientific application and interpretation of Ayurvedic formulations. Rohitakmul Churna is one above them. For this study we have use Rohitakmul Churna for treating Shweatpradar.

Comparative Study Of Efficacy Of Palonosetron With Dexamethasone Versus Granisetron With Dexamethosone In Laproscopic Abdominal Surgeries For Control Of Post Operative Nausea And Vomiting.

Background & Aim: This study was carried out to demonstrate the efficacy and compare a dose of Granisetron with Dexamethasone and Palonosetron with Dexamethasone for prophylaxis against postoperative nausea and vomiting. Aim is to study the effectiveness of palonosetron and granisetron with aims of evaluating the efficacy of palonosetron and granisetron with dexamethasone in prevention of postoperative nausea and vomiting and to study associated adverse effects. The study was carried out in Civil Hospital, Ahmedabad with prior permission of ethical committee of the hospital. Methodology: This study was designed to evaluate the efficacy and compare a dose of study drugs in 60 patients of either sex and age ranging from 18 to 60 years and physical status ASA risk I or II undergoing general anaesthesia for various laparoscopic surgical procedures. Patients were divided into 2 groups(n=30), assigned to receive granisetron 1mg plus dexamethasone 8mg i.v and palonosetron 0.075mg plus dexamethasone 8mg i.v. A standard general anaesthesia technique and post operative analgesia were used throughout our study. The groups were compared with regards to the incidence of complete response, mean PONV score, mean nausea VDS scores and requirement of rescue anti emetics drug at various intervals (0-6,6-24,24-72hrs). Differences in continuous variables (age and duration of anaesthesia) across two dosage groups were compared using analysis of variance (ANOVA) test which is a parametric statistical test. Differences in categorical variables (gender, presence of complete response, use of rescue anti-emetics) across two dosage groups were compared using chi square test. Differences in ordinal variables (PONV scores and 4-point verbal descriptive nausea scores) across two dosage groups were compared using non-parametric Kruskal Wallis one-way analysis of variance. Mann Whitney U test was used to conduct sub-group analyses for comparing PONV scores and 4-point verbal descriptive nausea scale scores between two given groups. McNemar's test was done to compare differences in rates of complete response in a given dosage group across different time periods of assessment. Results: Our study results shows clear superiority of palonosetron with dexamethasone as a prophylactic drug for the prevention of PONV than that of granisetron with dexamethasone. Conclusions: Due to its longer duration of action, a single dose of palonosetron with dexamethasone before induction is effective in preventing PONV for upto 72 hours and hence can be termed as a prophylactic drug for PDNV also. It’s optimal and effective dose is 0.075mg i.v. with minimal side effects.

An anesthetic encounter with an operated case of coarctation of aorta

Coarctation of aorta is a connective tissue disorder, which accounts for a type of acyanotic congenital heart disease. A patient with surgically treated coarctation of aorta may present in adulthood with several cardiovascular and central nervous system problems which could pose considerable challenges in their anesthetic management. We present here our experience of the anesthetic and perioperative management of an operated case of coarctation of aorta taken up for inguinal herniorraphy

Vegetable gum based gel lubrication of endotracheal tube cuffs improves efficacy of alkalinized intracuff lignocaine in preventing postoperative sore throat: a randomized controlled study

Background and aims: In order to reduce endotracheal tube [ETT] induced emergence phenomenon at extubation which involves postoperative sore throat [POST], cough, hoarseness, dysphagia and hemodynamic changes, we evaluated the efficacy of vegetable gum based [VGB] Lubic gel lubrication alone or in combination with 4% intracuff alkalinized lignocaine [IAL]. The vegetable gums in the gel appear to be of special significance

Methodology: 100 patients undergoing surgical procedures under general anesthesia were randomly allocated to 4 groups of 25 each. In Group C [control group] patients, the ETT cuffs were inflated with air and lubricated with normal saline. In Group G, the cuffs were inflated with air, while in Group L and LG, cuffs were filled with IAL. The Group G and LG cuffs were lubricated with VGB lubricant gel while Group L cuffs were lubricated with normal saline. During the post-extubation period POST was studied using Visual Analogue Scale [VAS] at 15 min, 1, 2, 3 and 24 h. Incidence of cough, dysphagia, hoarseness and hemodynamic changes was recorded and compared

Results: The mean VAS scores for POST were found to be the least in Group LG [12.6 +/- 7.08] compared to Groups C [33.8 +/- 9.38], G [32.52 +/- 2.11] and Group L [21.6 +/- 12.30] over 24 h. Incidence of cough, dysphagia, hoarseness and hemodynamic changes was least in Group LG compared to others

Conclusion: VGB gel lubrication combined with IAL enhanced the effect of IAL, than IAL or VGB gel lubrication alone thus proving most effective in preventing emergence phenomenon at extubation

Idiopathic Granulomatous Mastitis-A Case Report.

Idiopathic granulomatous mastitis (IGM) is an uncommon and curious condition of unknown etiology. However, its association with the use of oral contraceptive pills, autoimmune disorders, hyperprolactinaemia and Corynebacterium species has been proposed. It occurs in young parous women and presents as a firm tender lump that may be mistaken for carcinoma. Histopathologically proven IGM initially show breast masses which were suspected of having breast carcinoma. So, detailed histopathological examination of the cases which are suspected as carcinoma is mandatory. We present a case of painless breast lump with radiological suspicion of malignancy and diagnosed as Idiopathic Granulomatous mastitis without any underlying cause. Correct diagnosis requires the exclusion of infectious etiologies, other causes of granulomatous mastitis and malignancy combined with definitive histopathological confirmation.

Perioperative reexpansion pulmonary edema

Reexpansion pulmonary edema is a rare form of acute lung injury following rapid re inflation of collapsed lung parenchyma. It can rarely be associated with anaesthesia and repair of traumatic diaphragmatic hernia.We report a case of reexpansion pulmonary edema [REPE] occurring during repak of traumatic diaphragmatic hernia in an adult male. He was a victim of occupational trauma and presented to casualty with complaints of dyspnoea and left sided chest discomfort soon after the injury. Oxygen supplementation was administered via simple face mask to compensate for his hypoxemia. Chest radiograph revealed left diaphragmatic hernia and he was taken up for surgery. Under general anaesthesia with two lung ventilation and epidural analgesia via a thoraco-abdominal approach reduction of abdominal contents with diaphragmatic repair was undertaken. Intraoperatively within an hour of lung expansion he developed pulmonary edema. In spite of altered ventilation perfiision dynamics in the lateral decubitus position he was successfully treated on table. He recovered after a couple of days of invasive ventilatory support. Prompt diagnosis and treatment can reduce the lethality of this condition

Post-evacuation cardiopulmonary distress in a case of molar pregnancy

Molar pregnancy is a gestational trophoblastic disease wherein the swollen chorionic villi grow in a way that resembles a cluster of grapes. Patients with molar pregnancies very often need anesthesia for suction evacuation. Though molar pregnancy is usually uncomplicated, few cases may be associated with perioperative complications. Various anesthetic techniques have been used for molar evacuation. We present here a case of molar pregnancy with hyperthyroidism, in which general anesthesia [GA] was administered to the patient with laryngeal mask airway. Six hours after evacuation, she went into acute cardiopulmonary distress. She was fortunate enough to be picked up early and was managed successfully

Awake rigid bronchoscopy for post intubation tracheal stenosis

Prolonged tracheal intubation is a common cause of tracheal stenosis. These patients may present with respiratory insufficiency and stridor of insidious onset and progressive nature. Immediate management includes securing the airway which requires anesthesia. We present successful management of a case of post intubation tracheal stenosis using rigid bronchoscopy under a combination of regional and general anesthesia

Glass wool tripod foreign bodies in the eye: first ever reported case series

We present three cases of unusual corneal/conjunctival foreign bodies that were not visible on standard slit lamp examination. All patients presented with complaints of foreign body sensation in the affected eyes. One patient had visited an ophthalmologist prior to presentation to our center and was diagnosed and treated for conjunctivitis. On slit lamp examination minimal congestion was seen hence, all the patients were diagnosed with conjunctivitis with corneal epithelial defects by the residents. However, because the patients complained of foreign body sensation, fluorescein staining of the affected eye was performed. On examination, the corneas had epithelial defects and linear scratch marks. We suspected a foreign body in upper palpebral conjunctiva [UPC]. Examination after eyelid eversion indicated tripod-shaped glassy foreign bodies embedded deep within the UPC. We present cases of an unusual type of glassy tripod-shaped foreign body which may go undetected even on slit lamp examination. Fluorescein staining may aid in the detection of these foreign bodies

Role of automated urine analyser in the diagnosis of urinary tract infection.

Aim: Although urine culture is used as the reference standard to determine presence or absence of urinary tract infection (UTI), culture is an expensive and time-consuming method. The objectives of the study were to compare automated dipstick urinalysis with microscopic urinalysis and form an algorithm to reduce time and labour of the pathologist and faster initiation of treatment to the patient. Method: 500 morning urine samples were analysed by using automated dipstick analyser( Cobas u 411) and those samples showing abnormal results were subjected to microscopy. Leucocyte esterase and nitrite positivity were taken into consideration as predictive indicators of UTI. Result: 34% of the samples showed abnormal results on automated urine analyser. Total 28% samples showed positive results for leucocytes, nitrite, protein and RBC’s were sent for urine culture. 5% samples grossly turbid were sent for culture. Conclusion: Automated urinalysis method can be used for the rapid diagnosis of UTI. The algorithm presented in this study will guide the pathologist to decide when culture should be advised after urinalysis. Urine culture is an expensive test for routine use and should not be applied unless the result of nitrite, leukocyte or RBC’s are positive on automated dipstick/ microscopic examination.

Free Gingival Graft In The Treatment of Isolated Gingival Recessions : A Case Report.

Gingival recession is an intriguing and complex phenomenon. Recession frequently disturbs patients because of sensitivity and esthetics. Many surgical techniques have been introduced to treat gingival recession, including those involving connective tissue grafting, various flap designs, orthodontics, and guided tissue regeneration. This article describes a different clinical approach to treat gingival recession with emphasis on techniques that show promising results and root coverage.

Sarcomatous transformation in a conventional Giant cell tumour of femur.

Although giant cell tumour (GCT) is seen quite frequently, malignant giant cell tumour (MGCT) is a rare entity occurring in less than 1% of patients with GCT. It can develop as a primary (de novo) or a secondary form. Secondary malignant giant cell tumour occurs as a result of previous attempts at local control of a benign GCT i.e. post-surgical or post-irradiation. Malignant transformation has been very rarely reported in patients with GCT who have not received radiation treatment. We report a rare case of sarcomatous transformation in a benign giant cell tumour occurring six years after the primary surgery for GCT and without radiotherapy. This report of malignant spindle cell transformation of a conventional GCT of bone strengths the theory that there is a mesenchymal cell line in GCT which can spontaneously transform into sarcoma. The prognosis of such patients is poor because the malignancies are usually high grade sarcomas. Key Messages: Although giant cell tumour (GCT) is seen quite frequently, malignant giant cell tumour (MGCT) is a rare entity occurring in less than 1% of patients with GCT. It can develop as a primary (de novo) or a secondary form. The prognosis of such patients is poor because the malignancies are usually high grade sarcomas.

Prevalence of gestational diabetes mellitus in South India (Tamil Nadu)--a community based study.

AIM: Women diagnosed to have Gestational Diabetes Mellitus (GDM) are at increased risk of developing diabetes in future. Thus, diagnosis of GDM is an important public health issue. In a random survey 16.2% of pregnant women were found to have GDM in the Chennai urban population. Hence we undertook a planned community based study to ascertain the prevalence of GDM. MATERIALS AND METHODS: We conducted a prospective screening for GDM in the urban, semi urban and rural areas. All pregnant women irrespective of gestational weeks underwent a 75 g glucose challenge test in the fasting state. Diagnosis of GDM was made if the 2 hr plasma glucose was > or = 140 mg/dl (WHO criteria). RESULTS: A total of 4151, 3960 and 3945 pregnant women were screened in urban, semi urban and rural areas, respectively. GDM was detected in 739 (17.8%) women in urban, 548 (13.8%) in semi urban and 392 (9.9%) in rural areas. Out of 1679 GDM women, 1204 (72%) were detected in first visit and the remaining 28% in subsequent visits. A significant increase (P < 0.0001) in the prevalence of GDM was observed with family history of diabetes, increased maternal age and BMI. A trend for increased prevalence of GDM was observed in women with less physical activity, however, not statistically significant. CONCLUSION: In this community based study, the prevalence of GDM varied in the urban, semi urban and rural areas. Age > or = 25 years, BMI > or = 25 and family history of diabetes were found to be risk factors for GDM.

Scope for prevention of diabetes--'focus intrauterine milieu interieur'.

The prevalence of diabetes is increasing globally and India is no exception. The lifestyle modification and drug intervention are likely to delay or postpone the development of overt diabetes in persons diagnosed to have impaired glucose tolerance. This is a post primary prevention strategy. The primary prevention is more important as this effort is likely to reverse or halt the epidemic of disease. Women with Gestational Diabetes Mellitus (GDM) are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly type 2 diabetes, as are their children. Pima Indians have the highest prevalence of diabetes. This is attributed to the children exposed in utero to maternal diabetes. Hence as a policy to identify GDM and its consequences on the infant, a 75 gm Oral Glucose Tolerance Test has been recommended to all Pima Indian women during the 3rd trimester of pregnancy. Ethnically Asian Indian women also have high prevalence of diabetes and the relative risk of developing Gestational Diabetes Mellitus in them is 11.3 times compared to White women. This necessitates universal screening for gestational diabetes during pregnancy in India. Probably the undiagnosed gestational diabetes that has been occurring in the past has resulted in the increased prevalence of diabetes in India. The timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycemia in them and ensuring adequate nutrition may prevent in all possibility, India becoming the diabetes capital of the world.

Glycemic level at the first visit and prediction of GDM.

OBJECTIVE: To evaluate the glycemic level at the first visit that is likely to predict gestational diabetes mellitus (GDM). METHODS: Consecutive pregnant women underwent a 75g oral glucose tolerance Test (OGTT) recommended by WHO and diagnosed GDM if 2hr post plasma glucose (PG) value > or = 140 mg/dl. Women with normal OGTT results at the first visit were screened again with an OGTT at the subsequent visits. RESULTS: A total of 4151 pregnant women from different trimesters underwent OGTT. Of them 739 women (17.8%) had GDM. Among the GDM women, 528 (71.4%) were detected at the first visit. On screening during subsequent visits, GDM was diagnosed in the remaining 211(28.6%) women who had normal OGTT in the first visit. We performed the analysis taking the glycemic level in the first visit of 211 pregnant women who manifested GDM in the subsequent visit. During normal pregnancy, 2hr PG level is < 120 mg/dl. Taking this value into consideration among the 211 women who turned to have GDM in the subsequent visits 119 women (56.4%) had 2hrPG > or = 120 mg/dl and the remaining 92(43.6%) had 2hrPG < 120 mg/dl. CONCLUSION: Pregnant women irrespective of 2 hr PG > or = or < 120 mg/dl at initial visit progressed to GDM in the subsequent visit. No glycemic level in the early weeks of pregnancy predicts GDM and at the same time at no statistically significant glycemic cut-off level could we say that a woman will not develop GDM. Hence rescreening in the subsequent trimester or visits is essential.

Gestational diabetes mellitus in India.

BACKGROUND: Glucose intolerance during pregnancy predisposes the offspring for increased risk of developing glucose intolerance in the future. This vicious cycle is likely to influence and perpetuate the incidence and prevalence of glucose intolerance in any population. AIM: No data is available about the prevalence of glucose intolerance during pregnancy in our country and hence a study was undertaken on this aspect. METHODS: This study was performed in the antenatal clinic of Government Maternity Hospital, Chennai, India. As a pregnant woman in second or third trimester checks into the antenatal clinic, she was given 50 gm oral glucose load and blood sample was collected after one hour. This test was performed on 1251 pregnant women. They were requested to come after 72 hours for the 75 gm OGTT recommended by WHO. Among the 1251 women, 891 responded. The blood sample was taken in the fasting state and at 2 hours after 75 gm of oral glucose. Diagnosis was based on the WHO criteria for gestational diabetes mellitus (GDM). RESULTS: The mean age of these pregnant women was 23+/-4 years. There was a significant increase in the prevalence of GDM in relation to gravida. The effect of BMI did not quite reach statistical significance (chi2 (df=1) = 3.659, P = 0.055), but a model of linear trend was significant. Of the 1251 women who underwent the 50 gm oral glucose challenge test, 670 (53.55%) had one hour plasma glucose > or = 130 mg/dl. Among the 891 pregnant women who had 75 gms OGTT, 168 (18.9%) were diagnosed as GDM, taking both FPG > or = 126 mg/dl and/or 2 hr PPG > or = 140 mg/dl as cut-off values. Taking only 2 hr plasma glucose for analysis, 144 (16.2%) had a value > or = 140 mg/dl. A similar study was conducted in different parts of the country taking only the 2 hr 75 gm post-glucose value of > or = 140 mg/dl as diagnostic criteria for GDM. Of the total number of pregnant women (n = 3674) screened, 16.55% of them found to have GDM. CONCLUSION: Our study has documented the increased prevalence of GDM in our population necessitating universal screening for glucose intolerance in pregnancy. Using 2 hr plasma glucose > or = 140 mg/dl as a one step procedure is simple and economical, particularly for the countries ethnically more prone to high prevalence of diabetes.

Diagnosis and management of diabetes in pregnancy.

Diabetes and pregnancy encompass not only pregestational diabetes mellitus but also any form of abnormal glucose tolerance during gestation. While screening for glucose intolerance is mandatory for high-risk patients in pregnancy, it is not required in others. There are various methods for screening of gestational diabetes mellitus eg, urine glucose detection, O'Sullivan screening test, WHO criteria, etc. Proper management of diabetes in pregnancy can arrest foetal mortality and morbidity. Practical self management skills are essential for attaining good glycaemic control. Management of gestational diabetes mellitus rests on the idea of medical nutrition therapy and insulin therapy.