Topical Heparin: A Better Sanative For Burns Patient than Conventional Treatment.

Background: Burns trauma represents a major cause ofmorbidity and mortality. Tackling the pain andproviding a better healing with conventional therapieshave been compared to that by using topical heparinapplication in < 40% burns. Aim and Objectives: Tocompare pain score, healing, duration of hospital stayafter applying topical heparin and conventionaltreatment for burns < 40%. Material and Methods: Atotal of 80 patients were included in the study anddivided into 2 groups Heparin (H) and Control (C)group with 40 patients in each group. H group receivedunfractioned Heparin 25,000 IU / 5ml and C groupreceived silver based antimicrobial cream and paraffingauze. Results: Maximum number of patients belongedto the age group (15-35years = 65.5%). The maximumnumber of patients who sustained thermal injuries wasfrom 11-20% (23 patients) and 31-40% (22 patients).The patients in H group had a significant decrease intheir pain score (p <0.001) when compared to C group.The days of hospitalization was reduced significantlyin patients receiving topical Heparin therapy whencompared with the C group. Majority of the patients inH group (36 patients, 90%) had only 1-2 doses/day ofanalgesic medication administered to them. Patients inC group (26 patients, 65%) had to be given 3-4 divideddoses/day of analgesia. Conclusions: From this study itwas concluded that topical application of Heparinreduces pain, duration of hospital stay, rates of woundinfection, cost and time required for dressing

Determinants of maternal near miss events: a facility based case-control study

Background: Worldwide, approximately 830 women died every single day due to complications during pregnancy or childbirth in 2015. Many researchers revealed that the quality of health care delivery in a system can be identified by studies on maternal deaths. In recent years, women who survived the critical events during pregnancy and childbirth, called as maternal near miss cases, are explored as an adjunct to maternal death inquiries, as these cases occur more frequently than maternal deaths and can identify problems that had to be overcome for the provision of better healthcare services. This study aims at evaluating determinants of such maternal near miss events among postnatal women admitted in KIMS Hospital, Hubli. Methods: A case-control study was done on postnatal women admitted in the KIMS Hospital. A structured pre-tested questionnaire was administered to 82 participants (27 cases and 55 controls). Information about biodata, sociodemographic characteristics, medical illnesses, previous pregnancies and the current pregnancy with its outcomes and complications was collected. Results: Most women were satisfying the criterion for admission to ICU followed by hypertensive complications and severe anemia, to be considered as cases. The study showed height, type of family, religion, presence of danger signs during pregnancy as significant determinants of maternal near miss events. Conclusions: The factors showing significance in our study are non-modifiable risk factors of maternal near miss events. With early identification of such cases and appropriate antenatal care, such events can be prevented and reduced.

Pseudodactylitis : A unique Manifestation of Lepromatous Leprosy

Leprosy has many unique manifestations, sometimes delaying the actual diagnosis. Arthitis in leprosy is a common rheumatologic manifestation seen in lepra reactions. Diffuse fusiform digital swelling termed as dactylitis may occur secondary to leprosy arthritis and enthesitis. These presentations are common in other rheumatologic disorders and may cause diagnostic dialemma till neurologic manifestations of leprosy are evident. We present a case of lepromatous leprosy in an Indian patient manifesting as pseudodactylitis and nodular lesions over forehead. On examination he had enlarged peripheral nerves and sensory loss over distal limbs. Slit skin smear was positive for lepra bacilli and patient was treated with WHO - MDT multibacillary regimen. This report highlights the unique manifestation of lepromatous leprosy which requires a high index of suspicion for diagnosis.

A cross sectional study to assess prevalence and pattern of ocular morbidity among pre-school children attending anganwadi centres of Hubballi taluk in South India

Background: About 30% of blind population of India loses their eyesight before the age of 20 years and many of them are under 5 when they become blind. Childhood blindness will have serious impact on development, education and quality of life. Therefore it is essential that ocular morbidity is detected and treated at an early stage.Methods: A cross-sectional study was conducted among 120 children aged 3-5 years attending 6 anganwadi centres of Hubballi taluk which were selected by stratified random sampling. Data was collected using pretested semi-structured questionnaire. Ocular examination was conducted to identify ocular morbidity. Test for visual acuity, colour blindness and refractive status was done using lea chart, ischihara charts and plusoptix mobile vision screener respectively. Nutrition status was assessed by clinical examination and anthropometry. Statistical analysis was done using SPSS package.Results: Out of 120 children 51.7% were male. Majority, 63.3% were residing in urban area and 40% belonged to class IV of modified B G Prasad classification of socio-economic status scale. The prevalence of ocular morbidity was found to be 20%. 15.8% of children had refractive error, 2.5% had vitamin A deficiency and 1.7% had squint. No statistically significant association was found between ocular morbidity and any risk factors.Conclusions: Refractive error was found to be the most common ocular morbidity among pre-school children. This if detected early can be corrected. Therefore it is important to screen for refractive error at the preschool age itself and to create awareness among parents and anganwadi teachers regarding common ocular symptoms.

The Perception Of MBBS Interns Towards Biochemistry Curriculum In A South Indian Medical College.

Introduction: The concepts taught in pre-clinical sciences serve as a backbone to understand the clinical sciences. The system of teaching basic science subjects through didactic lectures followed in most of the medical colleges is more of a teacher centered. The medical educators are concerned about the learning outcomes of the traditional programs of teaching. Usually feedback on curriculum is obtained by subject experts from other universities. There is an unmet need to obtain the perceptions of graduates as they represent one of the important stakeholders of curriculum. Objective: To collect the interns perception about the content, need and application of biochemistry knowledge during their internship using a pre-designed and pre validated questionnaire. Materials and Methods: It was a cross sectional study done on interns who were asked to give feedback on biochemistry curriculum using the questionnaire. All the opinions were rated using 5- point Likert scale, ranging from strongly disagree to strongly agree. Results: 72.9% of interns were in favor of integrating basic science subjects with clinical sciences . Around 74.5 % (2/3rd) expressed that adopting interactive teaching strategies and problem based learning helped them in better understanding of the subject. Conclusion: The final goal of teaching in a medical sector includes attainment of knowledge, skills, attitudes and morals required to perform professional tasks safely and competently. In order to achieve this interactive, practical/case oriented and integrated teaching should be promoted.

A comparative study of efficacy and safety of flupirtine versus piroxicamin patients with low back pain.

Background: Low back pain is a common musculoskeletal symptom caused by a variety of disorders that affect the lumbar spine. The most frustrating aspect in the treatment of low back pain is that there is “no magic bullets”. The objective of the study was to compare the efficacy and safety of flupirtine versus piroxicam in patients with back pain. Methods: This was prospective, open labeled, randomized, comparative clinical study conducted by the Departments Orthopedics and Pharmacology, BMC&H, Chitradurga. Study was conducted on 60 patients of either sex, aged above 18 years with low back pain. Assessments were done for Finger-to-Floor Distance (FFD), lumbar pain, Lasegue’s sign, tenderness of vertebral muscles, pain & sensory disturbance in lower limbs and response to therapy for efficacy. Parametric data was analyzed by t-test and proportions were compared using Chi-square test. Results: 74 patients were randomized to 2 groups of 37 each. Group I patients received flupirtine maleate 100 mg twice daily and Group II patients received piroxicam 20 mg twice daily for 14 days. 30 patients in each group completed the study and were analysed. On intergroup comparison, there was no statistical difference (p>0.05) in the efficacy parameters of finger-to-floor distance (FFD), lumbar pain, Lasegue’s sign, tenderness of vertebral muscles, sensory disturbance in lower limbs, VAS scores & global assessment of response to therapy. 13.3% in flupirtine group and 16.6% in piroxicam group reported adverse events. Conclusions: Both flupiritine and piroxicam were equally effective but flupirtine was better tolerated than piroxicam.

A study on the evaluation of medical students perception and feedback of teaching-learning of pharmacology in a medical college.

Background: Pharmacology, like any other branch of medicine, is progressing by leaps and bounds. Consequently, reforms in undergraduate teaching are the need of the hour. Objectives: To determine the medical students’ perception and receive feedback on teaching and learning of pharmacology in our institution. Material and Methods: This was a cross-sectional study based on the questionnaire. A pre-validated, predesigned questionnaire containing 23 points was administered to fifth term medical students. Results: 73.43% wanted the faculty members to make more use of Audio-Visual aids for effective learning. 98.43% students wanted to include case based learning in the curriculum and 90.62% students wanted more of the clinical pharmacology to be introduced in the curriculum. 70% participants wished recent advances to be included in the curriculum and almost 80% were in favour of MCQs to be included in assessment of their academic performance. Only 26% participants felt rabbit eye experiments was appropriate and relevant to the present days of practical pharmacology reflecting a need for reforms. Only 10.93% students were willing to consider pharmacology as one of the subject for post-graduation. About 25% students felt the ideal teaching method for learning pharmacology was didactic lectures and group discussions and 81% thought the ideal teaching/learning media for pharmacology was the combination of LCD projector and blackboard. The most difficult system to understand was Autonomic Nervous System (53%). Conclusion: The study revealed the perception and feedback of the students regarding learning pharmacology were positive and constructive. It also revealed the priority areas for improvement.

A cross-sectional study on the extent of Pharmacovigilance awareness among fifth term medical students.

Background: Adverse effects due to medicines are common cause of morbidity and mortality and have a major impact on public health. Aim: To assess the awareness of Pharmacovigilance among fifth term medical students. Material and methods: This was an observational, cross-sectional study based on the questionnaire The study was conducted on fifth term medical students in the Department of Pharmacology of BMCH, Chitradurga. A questionnaire containing 15 questions with 2-5 options were given to each student and they were asked to mark one best suitable option. We analyzed data of 66 participants The results were evaluated graphically using Microsoft excel sheet. Results: 89.93% of students were aware of all the activities involved in Pharmacovigilance. 48.48% of the students had an idea that all the health care professionals (i.e. doctors, pharmacists, nurses) are responsible for reporting adverse drug reaction (ADR). 34.84% of students had wrong perception that WHO online database for reporting ADRs was Medsafe and 31.81% thought Vigibase as the WHO online database. 48.48% had the correct understanding that CDSCO is the regulatory body for monitoring ADRs in India. 66.66% students thought that, all the types of ADRs (mild, moderate and severe) irrespective of their severity have to be reported. 61% of students thought that ADR reporting is a Professional obligation. 91% of the students were aware that all the measures (stop the drug,report ADR and treat the condition) have to be taken when an ADR is suspected. Other finding included like, 68% students knew drugs banned because of ADR. Majority of students wrote Thalidomide and Nimesulide as an example for a drug banned because of ADR. Conclusion: The current study revealed that medical students had good awareness about Pharmacovigilance and ADR reporting. Better understanding of subject will help in improving the quality of health care and safety of the patients.

Ameliorating Effect of Black Tea Extract on Cadmium Chloride-induced Alteration of Serum Lipid Profile and Liver Histopathology in Rats.

Cadmium is one among the most environmental pollutants that affects many organs like kidney, liver and testis. The present study was aimed to assess the simultaneous effects of black tea extracts (BTE) on cadmium chloride induced alterations in lipid profile and liver histology. Adult rats were divided into four groups (n=6/group), group I (normal saline), group II (CdCl2, 1.0 mg/kg, b.wt; i.p), group III (black tea extract, 2.5 gm tea leaf/dl of water that is 2.5% of aqueous BTE) and group IV (cadmium chloride + BTE). Cadmium chloride intoxicated rats showed significant increase in serum total cholesterol, triglycerides, and low density lipoprotein-cholesterol and there is a significant decrease in the serum high density lipoproteincholesterol. In the liver, cadmium chloride showed changes in normal architecture, swollen hepatocytes, kupffer cells hyperplasia, dilation and congestion of central vein. Oral administration of black tea extracts with cadmium chloride significantly improves lipid profile and liver architecture as compared to the cadmium chloride group. The results indicate that BTE is beneficial in preventing cadmium-induced lipid alterations and hepatocellular damage.

Langer’s muscular axillary arch, features and importance.

Anatomical variations are common in axilla. These are usually encountered during axillary explorations for breast cancer and other surgical procedures. The most common being the presence of a muscular slip known as the axillary arch. This muscle, usually arises from the latissimus dorsi to be attached to the pectoralis major (which is more common) or to the coracobrachialis or to the fascia over the biceps brachii. This may be single or present as multiple bands and may or may not be clinically apparent. The axillary arch may cause thoracic outlet syndrome like symptoms, may pose difficulty in axillary explorations for various surgical procedures, reconstruction techniques and axillary bypass operations. The current case report is to discuss the features of this variation, with an emphasis on its surgical implications.

Oxyphilic Adenoma Involving Floor of The Mouth : A Case Report.

Oxyphilic adenomas are unusual neoplasm of the head and neck region affecting the glandular epithelial tissue. They were first called as oncocytoma, which is composed of oncocytes and were first described by Schaffer and Hamperl. Oncocytes are polyhedral cells and contain abundant cytoplasm filled with eosinophilic granules. Oxyphilic adenomas are benign neoplasm and represent approximately less than 1% of all salivary gland tumors. They are found generally in the parotid gland, affecting parotid gland region extraorally and rarely encountered in various other sites. Involvement of floor of the mouth is very rare. Presented in this article is a case report of patient suffering from neoplasm, which was histopathologically diagnosed as oxyphilic adenoma.

Multiple impactions in non-syndromic patient: a case report

Man is blessed with twenty primary teeth that are replaced by thirty two numbers of permanent teeth for his whole life. Teeth which exceed the normal number are termed as supernumerary teeth. Multiple supernumerary teeth are rarely seen. Retention of teeth or impaction is one of the most common developmental dental defects seen among the eruption disorders. However, impaction of multiple teeth is an uncommon finding unless associated with some syndromes or systemic disorders. The present article reports a case of non-syndromic patient having 15 erupted permanent teeth, 10 retained primary teeth, 13 impacted permanent and 11 impacted supernumerary teeth.

Prospective comparative study of polypharmacy and patient’s knowledge regarding antihypertensive drugs in obstetrics and gynaecology department at two tertiary care hospitals.

Objectives: To assess polypharmacy and patient’s knowledge regarding antihypertensives in Gynaecology and obstetrics department. Materials and Methods: This is a prospective comparative study carried out in Gynecology and Obstetrics department in two tertiary care hospitals. A interaction was done with consultants, post graduate students patients and patient’s attendants and the readings were taken. Results: A total of 200 prescription were studied and the average number of per prescription was 2.47%, poly pharmacy in 122/200, adequate knowledge was in 139/200 patients. Conclusion: The incidence of poly Pharmacy was more in our set of studies, patients compliance/adequate knowledge was good only among educated patients. The concerned health care can be improved by prescribing rational and required prescription and by motivating patients and patient’s attender, regarding the intake of drugs.

Drug utilization study of antihypertensives in obstetric practice in a tertiary care hospital.

Objectives: To evaluate the drug utilization of antihypertensive in obstetric practice two tertiary care hospitals in Gulbarga city. Material & Methods: A prospective cross-sectional study was conducted for 2 years in obstetric departments of Government General Hospital and Sangameshwar Teaching Hospital, Gulbarga. W.H.O. basic drug indicators were used for studying the prescribing trends and interviewing the patients. Results: A total of 200 prescriptions were studied and the average number of drugs per prescription was 2.47. 1.89% of generics and 49.59% of essential drugs were prescribed. 98.15% were non generic names used. The average consulting time given per patient was 9 mins 8 secs. 69.5% of the patients knew their dosage schedule and this was related to their education status. 13% were irrational prescription. The frequency of use of Nifedipine was highest followed by Benzathiazide + Triamterene, Amlodipine, Furosemide, Methyldopa and Spiranolactone etc. The use of the safest drug, Methyldopa was among only 4% of patients. 66.28% of prescribes drugs were available in hospital pharmacy. Conclusion : The incidence of poly pharmacy was high. Patient compliance is good only among educated patients. Irrational prescriptions were few. The availability of drugs in the hospitals was not satisfactory. The present healthcare can be improved by advocating rational drug prescribing patient education and improving the facilities in the hospitals.

Maxillary paramolar: report of a case and literature review

Supernumerary teeth are the teeth which are more in number in addition to the normal number found in either primary or permanent dentition. Paramolar is a supernumerary structure occurring buccally or lingually near the molars and it may be caused by combination of genetic and environmental factors. Reports of this unique entity are rarely found in the literature. The present article reports a case of paramolar in the maxillary molar region in an 11-year-old female patient and also reviews the literature about paramolar.

Can anti-Helicobacter pylori and anti-CagA antibodies be used to select patients with dyspepsia for gastroscopy?

BACKGROUND: agA IgG antibody in sera may indicate presence of peptic ulcer disease among dyspeptic patients and therefore may be used as a serological marker to identify high risk patients for peptic ulcer who can be subjected to endoscopy. Present study was performed to identify association of CagA IgG antibody in patients with peptic ulcer. METHODS: Consecutive patients with dyspepsia were subjected to endoscopy and sera was collected from each. Rapid urease test in antral tissue collected from each patient by endoscopic biopsy was performed. Antral tissue was also examined histologically. IgG Antibody against H. Pylori and CagA IgG antibody was tested in each patients sera. RESULTS: Out of 82 patients with dyspepsia included in the study 28 had peptic ulcer. Of whom 26 were positive for anti IgG H. Pylori antibody. More than 80% patients with peptic ulcer patients had detectable anti Cag A antibody in contrast to 33% patients with non ulcer dyspepsia (P < 0.001). CONCLUSION: Anti-Cag A antibody may be used as a screening test in patients with dyspepsia to select high risk patients for peptic ulcer for upper gastrointestinal endoscopy.

Abdominal wall abscess secondary to subcapsular tubercular liver abscess.

We report a 22-year-old woman who presented with an abdominal wall lump in the right upper quadrant 15 days after starting antitubercular treatment for right pleural effusion. CT scan revealed a right liver lobe subcapsular abscess communicating vith subcutaneous tissue. Aspiration of pus revealed acid-fast bacilli. She responded to 9 months of antitubercular treatment.

Diagnostic dilemma in coinfection.

A Fifteen years girl belonging to a low socioeconomic status was admitted with peritonsillar abscess caused by methicillin resistant Staphylococcus aureus (MRSA), high fever, diarrhoea and septicaemic shock. Initial blood cultures and widal test, stool cultures and routine stool examination were non-contributory to the diagnosis. A bone marrow culture in the second week confirmed the diagnosis of Salmonella typhi infection. Examination of a fresh stool sample showed cysts of Entamoeba histolytica. She was treated with ciprofloxacin, metronidazole, augmentin and ceftriaxone. She had no clinical evidence of immunosuppression prior to this episode and her HIV test was negative. This case report highlights the presence of community acquired MRSA infection causing perititonsillar abscess, and the diagnostic dilemma of fever and diarrhoea due to coinfection with Salmonella typhi and Entamobea histolytica.