Hepatitis D virus seroprevalence in HBsAg positive patients attending a tertiary care hospital in Northeast India

Background:Hepatitis D virus (HDV) infection is present worldwide. Around 18 million people are estimated to be infected with HDV and can infect individuals with active HBV infection and cause severe liver disease. There is lack of data on the prevalence of HDV infection in the state and also in the region. The aim of the study was to determine the seroprevalence of HDV in HBsAg positive patients attending Regional Institute of Medical Sciences Hospital, Imphal, Manipur, India.Methods:This study was carried out in a tertiary care hospital (Regional Institute of Medical Sciences, Imphal).The study was done for a period of 2 years from September 2016 to August 2018. A total of 119 HBsAg ELISA positive cases were included in the study.Results:Out of 119 HBsAg positive cases, 5 cases were positive for hepatitis D antibodies, of which 3 were positive for anti-Hepatitis D virus IgM and 2 were positive for anti-Hepatitis D virus IgG.Seroprevalence of HDV infection was found to be 4.2%.Conclusions:Seroprevalence of HDV infection was found to be 4.2% which is higher than the finding in some of the recent studies in the country.

Factors Influencing Non-utilization of Antenatal Care Services from Government Sector among Rural Pregnant Women — A Hospitalbased, Cross-sectional Study in Vijayapura District of North Karnataka

Background : Pregnancy is one of the most important events in the life of Indian women. Maternal care includes care, during pregnancy and should begin from the early stages of pregnancy.Maternal mortality and morbidity remain high even though National Programs exist for improving Maternal and Child Health in India. Among several factors related to it one is less or non-utilization of free maternal healthcare services, especially amongst rural women. Objectives : To measure the utilization of free Maternal Healthcare services & to study the factors determining the utilization of free Maternal Healthcare services by Rural Women during pregnancy. Methods : The study was conducted on the women admitted in postnatal ward after delivery, by using structured proforma containing questionnaire which included socio-demographic variables, details of present pregnancy, delivery & details of utilization and non-utilization of Antenatal Care Services given by their local Government Health Facility. Also, questions were asked about the reasons regarding their preference to the Private Hospital for delivery in spite of free delivery service at Government Hospitals. Results : The early identification of risk factors during pregnancy will be possible by Ultrasonography and other investigations, which is the main reason for a greater number of visits to private hospitals during pregnancy compared to Government Health Facility. Conclusion : Strengthening of Government Health Facility in terms of specialist Manpower and Material like Laboratory/Equipment’s/Drugs to handle the complications effectively during pregnancy or delivery by the specialist is need of the hour.

Cutaneous Lesions Among South Indian Children With Beta Thalassaemia Major

Objective: To study the cutaneous lesions among south Indian children with Beta thalassaemia major . Design: Observational, hospital based study. Method & Material: 67 children between age 1 year to 14 years with diagnosis of beta thalassaemia major were followed up at Paediatric hematology clinic over 4 years for cutaneous lesions. Results: The common skin lesions were pruritus(49.2%),xerosis (40%) and hyper pigmentations (37.3%).

A Rare Case of Scrotal Basal Cell Carcinoma in the Presence of Metastatic Squamous Cell Carcinoma of the External Auditory Meatus and its Management Strategy

Basal cell carcinoma (BCC) of the scrotum is uncommon and its pathogenesis is not well understood. The clinical behaviour of scrotal BCC is thought to be more aggressive and has a higher metastatic potential than BCC of other regions. The mainstay of treatment for localized scrotal BCC is wide local excision, while metastatic disease may need systemic chemotherapy for palliative control. A rare clinical scenario of scrotal BCC presenting concurrently with another metastatic cancer has never been reported. The present case illustrates the diagnostic challenge and management dilemma due to simultaneous presentation of scrotal BCC and metastatic squamous cell carcinoma (SCC). A 70-year-old man complained of a non-healing scrotal ulcer while he was being investigated for metastatic squamous cell carcinoma (SCC) of the external auditory meatus. The scrotal lesion was initially thought to be metastatic SCC. It was later confirmed to be BCC with biopsy and histopathological examination. He underwent surgical resection of the scrotal BCC for local control followed by palliative chemotherapy with cisplatin and radiotherapy for lymph node metastases. He remained well and did not have any local recurrence following 6 months after palliative treatment. Surgery coupled with palliative chemoradiation can offer good quality of life for patients with scrotal BCC and concurrent metastatic SCC.

Heterogeneous Occlusal Traits among Monozygotic Twins from the Village of Twins – A Report of 3 Cases.

Research involving twins contributes much to the scientific world as they enable one to understand the complex morphological variations and the phenotypic expressions of various genes. Twin research study design illustrates and explains the relative contribution and interactions of genes and the environmental factors responsible for the development of a particular trait. Quantification of the genetic and environmental contributing factors enables researchers to explore the variations to various physical, behavioural disorders and dental diseases like dental caries, periodontal diseases and malocclusion. Research with monozygotic twins who share the same genetic pool and similar environmental factors estimates the expression of a particular trait by disentangling the shared genetic coding and environmental contributing features. Monozygotic twin pairs may not always be a look alike in resemblance or other features given that fact that the original zygotic genome might be altered due to epigenetic and environmental factors. This case report elaborates three monozygotic twins from a unique village of twins who differ in their occlusal characteristics.

Bilateral Acute Anterior Uveitis and Optic Disc Edema Following a Snake Bite

The authors wish to report a case of bilateral acute anterior uveitis and optic disc edema following a hemotoxic snake bite, in order to highlight the concomitant occurrence of these conditions and the potential adverse effects of anti-snake venom (ASV). A 35-year-old male was bitten by a viper at seventeen thirty hours, and was started on ASV. Two days following treatment he experienced sudden onset redness and painful diminution of vision in both eyes (OU). On examination, the patient's visual acuity (VA) in OU was 20/200. Examination revealed fresh keratic precipitates, cells, and flare in the anterior chamber (AC), posterior synechiae, sluggish and ill-sustained pupillary reaction, and hyperemic, edematous disc with blurred margins in OU. He was started on topical steroids, cycloplegics and intravenous methylprednisolone. Following treatment, the patient showed improvement and was continued on topical medications and oral prednisolone tapered over 3 weeks, after which VA OU improved, the AC showed no cells and flare and disc edema resolved. Uveitis and optic disc edema in snake bite can either be due to the direct toxic effects of the venom or the effect of ASV. Steroids have a beneficial role in the management of these symptoms.

Simultaneous Estimation of Ramipril and Amlodipine in Bulk and tablet Dosage form by RP-HPLC Method.

A Simple and precise HPLC method was developed for the simultaneous estimation of Ramipril and Amlodipine in pure drug and pharmaceutical dosage forms. The separation was carried out using C18 Column (250 × 4.6 mm i.d. 5 μm particle size), with mobile phase compressing of Acetonitrile, Sodium phosphate buffer and Methanol in the ratio of 50: 20:25 v/v/v, pH= 6.8 (pH adjusted with OPA). The flow rate was 0.8 ml/min and the detection was carried out using PDA detector at 210 nm. The retention times were 2.64 and 7.45 mins for Ramipril and Amlodipine respectively. Calibration curves were linear with correlation coefficient 0.998 and 0.996 over concentration range of 1 - 16 μg/ml for Ramipril and 0.2 – 3.2 μg/ml for Amlodipine respectively. Recovery was found in between 100.21% and 100.82% for Ramipril and Amlodipine respectively. Method was found to be reproducible with relative standard deviation (R.S.D) for intra and inter day precision less than 2%. The method was validated by evaluation of different parameters such as accuracy, linearity, precision, LOD and LOQ.

Inflamatory Pseudotumor of the Bladder: A Histopathological Diagnostic Challenge from Its Malignant Variant

Inflammatory Pseudotumor (IP) of bladder is one of a variety of lesions which may arise from spindle cell lesions in the bladder. It is benign in nature compared to the other end of the spectrum of spindle cell lesions, such as sarcoma, sarcomatoid carcinoma and leiomyosarcoma. The diagnosis of IP and its differentiation from a malignant pathology is a diagnostic dilemma for Urologist and Pathologist as both entities share certain similar morphological and histo-pathological appearance as well as immuno-histo chemistry staining. It is however crucial to avoid misdiagnosis as the treatment option varies significantly between a radical or partial cystectomy with future surveillance cystoscopes. Hereby, we highlight a case of a benign variant of spindle cell tumour of bladder which needed second pathology review for confirmation and thus avoiding a radical cystectomy. We also review the literature on its presentation and emphasis characteristics differentiating a benign from a malignant pathology.

Gastro-Retentive Floating Matrix Tablets of Cefpodoxime Proxetil.

The present work aims at the development and evaluation of Floating matrix tablets of Cefpodoxime Proxetil were undertaken to prolong gastric residence time. A visible Spectrophotometric method has been employed for the estimation of Cefpodoxime Proxetil at 263 nm and Beer’s law is obeyed in the concentration range of 5-40 μg/ml. Total 7 formulations (B1-B7) were prepared using guargum with carbopol 934P was used in different concentrations. Fourier transform Infrared spectroscopy confirmed the absence of any drug/polymers/excipients interactions. The tablets were prepared by direct compression technique, using polymer such as hydroxy propyl methyl cellulose (HPMC K4M), guargum and carbopol 934P in different combinations with other standard excipients like sodium bicarbonate and lactose. Tablets were evaluated for physical characterization viz. hardness, friability, swelling index, floating capacity, thickness and weight variation. Further tablets were evaluated in-vitro drug release for 12 hr. The effect of polymer concentrations on buoyancy and drug release pattern was also studied. In-vitro drug release mechanism was evaluated by PCP V-3 software. Carbopol 934P had a negative effect on the floating properties also decreased the drug release. A lesser FLT and a prolonged floating duration could be achieved by varying the amount of effervescent and using different polymer concentrations. The entire matrix tablets showed significantly greater swelling index, exhibited controlled and prolonged drug release profiles and some floated over the dissolution medium for more than12 hr. The paddle speed affected the floating lag time and floating duration it had a negative effect on the floating properties. The optimized formulation followed the higuchi release model and showed non-fickian diffusion mechanism. It also showed no significant change in physical appearance, drug content, floatability or in-vitro dissolution pattern after storage at 45 oC at 75 % RH for three months.

Female infanticide.

Killing infant girls is something most of us cannot imagine. As shocking and disturbing as this behavior is, however, we must look at in within its cultural context. In some Indian communities there is a preference for male children. This attitude is rooted in a complex set of social, cultural and economic factors. Daughters will require a sizable financial dowry in order to marry. This dowry system, lack of economic independence, social customs and traditions has relegated the female to a secondary status. Because daughters leave their families of origin, they are often regarded as temporary members of their families and a drain on its wealth. There is an expression in India that ―bringing up a daughter is like watering a neighbor‘s plant‖. In most of such cases of female infanticide the perpetrator is the mother of the infant. Here we are highlighting a case where a new born female was suspected to have been brutally killed by her parent.

Periprostatic Lidocaine Infiltration Versus Transrectal Lidocaine Gel For Local Anaesthesia In Transrectal Ultrasound Guided Prostate Biopsy

Management of pain plays an important role during prostate biopsy. Various types of management of pain plays an important role during prostate biopsy. Various types of anaesthetic methods have been used. The present study aimed to compare the efficacy and complication rate between periprostatic lidocaine infiltration and transrectal lidocaine gel in transrectal ultrasound guided prostate biopsy. All prostate biopsy patients were included except those with lidocaine, allergy, haemorrhagic diathesis, anticoagulation therapy, the inability to rate a visual analogue scale and inability to obtain consent. They were randomized into two groups. Group 1 received 20ml 2% transrectal lidocaine gel. Group 2 received 5ml 1% lidocaine infiltration for each periprostatic nerve block with 23-gauge spinal needle. After three minutes, prostate biopsy was performed with an 18 gauge 7-inch spring-loaded biopsy gun. Six biopsies were taken for each lobe. Pain during probe insertion, biopsy and immediately after the procedure was assessed using the Visual Analogue Scale. Any complication immediately after procedure, one day or after one week, was recorded. Mean pain score was lower after periprostatic lidocaine infiltration compared to transrectal lidocaine gel (3.1 + 1.9 versus 4.9 + 2.4, p = 0.027). There was no statistically significant difference in the complication rate. Transrectal ultrasound prostate biopsy using periprostatic lidocaine infiltration provides better anaesthesia as compared to the transrectal lidocaine gel application with no significant difference in complication. Thus, the use of periprostatic lidocaine infiltration in TRUS guided prostate biopsy is recommended.

Extra-gonadal Germ Cell Tumour – What About the Testis!

Extra-gonadal germ cell tumours (EGGCT) are rare. Therefore further investigations of the testis is aimed at sourcing a possible primary origin of gonadal tumour. Over the years, various case series on EGGCT have been reported questioning its true nature as in a majority of them, a primary source is found in the testis, thus representing a metastatic gonadal tumour. The testis pathology could be either a true germ cell foci, an intra-tubular epithelial neoplasia or an area of fibrosis, indicating a ‘burnt out tumour’. We report a 39-year-old male who underwent laparotomy and excision of a retroperitoneal tumour. Histopathological examination revealed retroperitoneal lymph node of mixed germ cell tumour origin. Clinical and ultrasound examination of bilateral testis was normal. The patient refused orchidectomy or a testicular biopsy. He underwent four cycles of bleomycin, cisplatin, and etoposide with no evidence of tumour recurrence on follow up and remains disease free after 12 months of diagnosis. A literature review of EGGCT, its relation and factors relating with future testicular tumour is presented.

Nephrectomy for a Case of Intrarenal Dermoid Cyst: Was it an Appropriate Decision?

Dermoid cyst in a kidney is rarely seen. We report a case of intrarenal dermoid cyst which mimics malignant renal tumour and discuss the dilemma in managing this disease.

Prevalence and Awareness of Lower Urinary Tract Symptoms among Males in the Outpatient Clinics of Universiti Kebangsaan Malaysia Medical Centre

This study aims to determine the prevalence of lower urinary tract symptoms (LUTS) and level of awareness among male outpatients in Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A questionnaire consisting of demographic data, questions related to knowledge, attitude and practice on BPH and the International Prostate Symptom Score (IPSS) was used for this study. Uroflowmetry and bladder scan were used to evaluate the function of the urinary tract and severity of BPH. Urine dipstick was done for glycosuria, proteinuria and haematuria. A total of 220 respondents were surveyed. The prevalence of moderately and severely symptomatic LUTS was 42.7%. The most commonly reported LUTS were nocturia (78.2%), frequency (58.2%) and incomplete emptying (44.6%). The prevalence of glycosuria, proteinuria and haematuria were 23.6%, 11.4% and 1.8% respectively. There was a significant association between increasing age with the severity of LUTS (p=0.005). Out of 102 respondents with voided urine volume greater than 150 mL, there was a significant decrease in maximum (Qmax) (p=0.039) and average (Qave) urine flow rates with every 10 years increase of age (p=0.001). The majority of respondents (59.5%) have heard of BPH before. Over 78.2% of the respondents would seek medical attention if they have LUTS with 15.9% saying they would seek traditional treatment. In conclusion, the prevalence of LUTS was high and the level of awareness was satisfactory.

Death due to isolated mesenteric vascular injury following blunt abdominal trauma: A case report.

Death due to isolated injury to small bowel mesentery following abdominal trauma is rare. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. Focal mesenteric infiltration associated with haemoperitoneum, particularly in the absence of solid organ injury, is highly suggestive of a mesenteric tear. In this report one such seat belt abdominal injury with subsequent mesenteric tear and bowel infarction with significant haemoperitoneum leading to death on the Operation table is being discussed. The main significance of this injury is delay and difficulty in diagnosis, especially when there is minimal signs and symptoms to warrant an exploratory laparotomy. Early detection and emergency surgical intervention when necessary are critical in improving the outcome of treatment.

Synchronous adenocarcinoma and gastrointestinal stromal tumor in the stomach

In recent years, the synchronous occurrence of tumors of different histotypes arising in the same organ has been reported more frequently in the literature. In the stomach, adenocarcinoma has been described with coexisting primary rhabdomyosarcoma, carcinoid, and low-grade B-cell lymphoma of mucosa-associated lymphoid tissue. The simultaneous development of adenocarcinoma and gastric mesenchymal tumor has been documented rarely. We report one such case. A 65-year-old male was diagnosed with a proximal gastric adenocarcinoma and underwent subtotal gastrectomy. Subsequent histopathological examination revealed the presence of another tumor at the gastric antrum. This was a gastrointestinal stromal tumor of low risk category [GIST]. The literature has only a few previous reports of this very rare association. It is not known whether this synchronicity is incidental or there is a causative factor inducing the development of tumors of different histotypes in the same organ. Pathologists, oncologists and surgeons should be aware of this interesting condition

Auxin regulated poly(A)polymerase activity in Cicer arietinum epicotyls.

There was a linear increase in poly (A+) polymerase activity in the C. arietinum epicotyls during germination. Six-day-old auxin treated seedlings showed about 3-4 fold stimulation in enzyme activity, accompanied with 3- fold rise in the relative abundance of poly (A+) RNA levels. Actinomycin D, cycloheximide, cordycepin and amino acid analogues caused dramatic decline in poly (A+) polymerase as well as poly (A+) RNA levels. It seems that auxin induced a de novo synthesis of this enzyme.