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Neonatal severe hyperparathyroidism is a rare disorder arising from inherited defects in the calcium sensing receptor (CaSR) that presents early in life with severe hypercalcemia, failure to thrive, and developmental retardation. The authors describe an infant with neonatal severe hyperparathyroidism due to homozygous CaSR gene mutation presenting with recurrent episodes of severe hypercalcemia, growth retardation, and developmental delay. Medical management served as an efective bridge therapy to surgery. Total parathyroidectomy with right hemithyroidectomy was performed at 7 mo of age and resulted in successful cure and normalization of growth and developmental milestones. Timely medical and surgical management can help prevent mortality and morbidity in the form of neurodevelopmental sequelae. Life-long monitoring and treatment is mandatory for the resultant hypoparathyroidism.
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Background: Bicaudate index, Bicaudate - temporal index and Huckman number were commonly used radiological indices to accurately evaluate intracranial ventricular volume. Established normal values for these indices were based on study done among western population. Reference values were not established for these indices in Indian population. Hence this study is undertaken to establish the new reference values for Bicaudate index, Bicaudate - temporal index and Huckman number, based on age and sex in Indian population. Methods: The retrospective study was done in Department of Radiology, Karpagam Faculty of Medical Sciences and Research, Coimbatore during the period between 1st June 2016 to 31st July 2016. One hundred subjects, aged between 5 to 90 years, with normal CT brain performed in Siemens SomatomScope multislice CT scanner were analyzed for this study and Bicaudate index, Bicaudate - temporal index, Huckman number were calculated. Results: Mean Bicaudate Index was 0.14 +/- 0.03. The mean Bicaudate - Temporal Index was 0.13 +/- 0.03. The mean Huckman number in male was 5.09 +/- 0.76 and in female was 4.70 +/- 0.57. Conclusion: The new reference values for Bicaudate index, Bicaudate - temporal index and Huckman number in Indian population based on age and gender was established in our study.
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Syringoma is derived from the Greek word syrinx meaning pipe or tube. It is a benign tumour composed of sweat ducts that is usually multiple. They are fairly common tumours that occur most commonly in women. Rarely, the condition can be familial1. Usually, they present as soft, flesh coloured to slightly yellow papules on the lower eyelids of healthy individuals. They can also affect the scalp, forehead, neck, abdomen and extremities. Hereby reporting a case of disseminated syringoma in a female patient
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Background: Pneumothorax is a medical emergency wherethere is an abnormal collection of air in the pleural space. Afterconfirming the diagnosis chest tube is placed into the pleuralspace which allows the air or fluid to escape from the pleuralspace. Newer methods of tube thoracostomy using Seldingerand thoracoport techniques are replacing the conventionalmethod. The TP technique is said to be safer, faster whencompared to the conventional one.Aim: To compare the time required for the tube thoracostomyand whether tube thoracostomy can be performed by a singlemedical person without assistance. As well as complicationrates using both conventional and thoracoport techniques.Materials and Methods: Out of total 80patients, 40 patientsunderwent tube thoracostomy using thoracoport and remaining40 by conventional method randomly for pneumothorax.Results: Mean procedural time by conventional was highwhen compared to thoracoport technique. Need for assistanceand complications were high in conventional to thoracoportmethod.Conclusions: Tube thoracostomy using thoracoport has astatistical advantage over conventional technique in terms ofprocedural duration, need for assistance and complicationsand this method will definitely revolutionise the emergencymanagement of pneumothorax.
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Background: Breast cancer is one of the common malignancies in females. Chemotherapy with Adriamycin and Cyclophosphamide (AC) followed by the Docetaxel (AC-T, Regimen-I), AC followed by Docetaxel and Carboplatin (AC-T+Cr, Regimen-II) and AC followed by Docetaxel and Trastuzumab (AC-T+Tr, Regimen-III) are commonly given for treatment. These cause myelosuppression and febrile neutropenia and need necessary interventions.Methods: This is a prospective open labelled observational comparative study to evaluate the antibiotic usage needed to treat sepsis following febrile neutropenia among breast cancer patients undergoing chemotherapy with regimen I, II and III. All patients received prophylactic Pegfilgrastim / Filgrastim. Antibiotics used and days in intensive care unit (ICU) in all the 8 cycles of chemotherapy were recorded. 38 patients in Regimen I, 40 patients in Regimen II and 46 patients in Regimen III completed the study and were included in the statistical analysis.Results: In regimen II, following cycle 2 of chemotherapy, none of the patients needed antibiotic therapy. Antibiotic use was maximum, following cycle 1of chemotherapy in regimen I and III, maximum number of antibiotics prescribed were 7. Number of days of ICU care needed for regimen II patients following 3rd cycle of chemotherapy was 3.5±3.5 days. No ICU care was needed for regimen III patients, following cycles 2, 3 and for regimen II following cycle 7.Conclusions: Febrile neutropenia produced by chemotherapy were effectively treated with intravenous antibiotics in ICU for an average of 2-3 days. No mortality was associated with febrile neutropenia and all patients were recovered.
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Background: Patella is the largest sesamoid bone in the body situated in the quadriceps tendon1. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. Patellar fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma2.The subcutaneous location of the patella makes it vulnerable to direct trauma.Aims of the study were to evaluate the clinical outcome of Transverse fractures of patella treated with modified tension band wiring. The objectives of the study are to study the advantages of modified tension band wiring fixation in patellar fracture, the complications associated with this method of fixation and to assess the role of early mobilization with this technique. Methods: This prospective study is done in Department of Orthopaedics at R L Jalappa Hospital and Research Center, attached to Sri DevarajUrs Medical College, Kolarduring the period from December 2010 to June 2012. This study consists of 30 cases of displaced transverse fracture patella treated by modified tension band wiring. The cases were selected based on inclusion and exclusion criteria. After pre anaesthetic fitness patient, patient was operated (tension band wiring). Operatedknee was immobilized in extension in an above knee posterior slab, and advised to do straight leg raising test.Weight bearing was started from 3rd post-operative day. Sutures were removed on 12th to 14thpost operative day. The discharged patients were advised to report for follow up every month, during each follow up the patients were examined for both subjective symptoms and objective signs which was recorded. The patients were questioned about subjective complaints like pain, difficulty in walking, squatting, climbing and getting down stairs and ability to perform routine work. The patient’s objective assessment was done for Extensor lag, Range of knee movement, circumference of thigh (wasting) and Efficacy of quadriceps (power).Results: The range of age of fracture of patella in our series was between 19-70 years, the mean age was 42 years and the incidence was high in the age group of 31-40 years. In a total of 30 cases, 24 fractures were in men and 6 fractures were in females.22 fractures were as a result of indirect mechanism and 8 cases were due to direct trauma to the patella as in RTA. 17 patients had fracture on the right side and 13 patients had fracture on the left side.Average duration between injuries to hospital admission was about 1.16 days. The average duration between the days of admission to the day of surgery is about 2.93 days and the average duration of stay in hospital is about 13.2 days (ranging from 11 to 22 days).No intra operative complications like fragmentation at wiring, difficulty in closure were encountered. Results were excellent in 26 cases, good in 3 cases and bad in 1 caseasper west’s criteria. Conclusion: Thus we conclude that anatomical reduction and stable fixation in patellar fracture is necessary for the normal integrity and stability of the joint.Early post-operative physiotherapy plays an important role in final outcome, which helps in reducing complication like stiffness of knee and in providing good functional. Our outcome was not influenced by the associated injuries. Long-term follow up is necessary to assess late complications like osteoarthritis and late functional outcome.
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Background: It has been a great challenge for the physician to predict the prognosis and outcome of the chronic liver disease. Child-Pugh and MELD scores have been a widely used method for the assessment of prognosis in liver cirrhosis. Both used to determine the need for transplantation and also used to determine the effect of treatment on liver function. The combination of Child-Pugh and MELD score can guide patients and surgeons regarding operative risks. Aim and objective: To study and compare the clinical outcomes of patients with liver disease as predicted by Child – Pugh Scoring system, MELD Scoring system, to evaluate the prognostic accuracy of both (Child-Pugh Scoring System and MELD Scoring System). Materials and methods: The study was carried out at Vinayaka Mission’s Medical College and Hospital, Karaikal among the patient population of the medicine ward who were diagnosed as having the chronic liver disease. This included 75 adult patients with the chronic liver disease who were either inpatients or those who reported for follow up as outpatients who were being managed on an ambulatory basis. All the selected patients were subjected to two scoring systems namely Child-Pugh Scoring and MELD Scoring Systems. The two scores derived from applying both the scoring system on each patient were compared and studied for predictive value and prognostic accuracy. S. Arun Kumar, Babu Rajendran, S.R Charu Nagarjun, Sakthivel V. Predicting the prognosis of chronic liver disease: A comparision between Child – Pugh score and Model for end stage liver disease (MELD). IAIM, 2018; 5(3): 71-76. Page 72 Results: In our study, Correlation between Chid-Pugh Score and survival was -0.56 and correlation between MELD score and survival were -0.64. The following diagnostic indices were obtained: Child-Pugh Score: Sensitivity: 42%, Specificity: 78%. MELD Score: Sensitivity: 62%, Specificity: 87.5%. It was well observed that both scoring systems predict clinical outcome well, both scoring systems can be used to prognosticate survival in patients with Chronic Liver disease. However, it appeared that MELD Score is more accurate than the Chid-Pugh score for prognostic purposes. Conclusion: Pearson’s Coefficient of correlation is closer to -1 for MELD Score as compared to Child-Pugh Score. MELD Score has a higher sensitivity and a higher positive predictive value as compared to Child-Pugh score. Hence MELD Score is a better and more accurate clinical scoring system for Chronic liver disease as compared to Child-Pugh score.
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Introduction: The concept of using surface adhesive tapes to close surgical wounds antedates the development of satisfactory suturing techniques. But previously available wound adhesive tapes lacked adequate adhesive properties and led to the occurrence of associated skin irritation or maceration. Methods: A total of 30 patients who presented to Department of Surgery for elective and emergency surgical procedures were randomly selected, after getting informed consent. Wound adhesive tapes were used for skin closure. The patients were followed up in the immediate post-operative, 1 week, 4 weeks, and 3 months post-operative. Any complication such as wound gaping, wound infection, or skin irritation were noted. Cosmetic results were evaluated using modified Hollanders scale. Results: In our study, 90% of patients were male and rest were females. Wound infection occurred in 6.7% of the patients. This is increased compared to reports from older studies which is about 3-4% wound infection in sutured wounds is about 2-11% according to available literature. Wound infection rate in our study is within this rate and is comparable to that of suture closure. There was a significant association between the incidence of wound infection and presence of diabetes mellitus (DM). 2 out of 4 patients with Type 2 DM developed wound infection. There was no association between occurrence of wound infection and age of the patient or type of incision. The relative risk of sub-optimal closure in sutured wounds is 1-8%. In our study, the rate of suboptimal closure is 6.7% which falls within this range. There is a significant association between occurrence of wound infection and final cosmetic outcome. Conclusion: Wound adhesive tapes are effective alternatives for suture closure. Added advantages of reduced time consumption and cost of tapes compared to sutures were observed in our study.
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Introduction: Blunt Abdominal trauma is the most common caused by road traffi c accidents (RTA). It also occurs as a result of fall from a height, assault with blunt objects, industrial mishaps, sports injuries, bomb blast. Investigative modality can only supplement the clinical evaluation and cannot replace it in the diagnosis of blunt abdominal trauma. In spite of the best techniques and advances in diagnostic and supportive care, the morbidity and mortality remain at large. Purpose: To estimate the frequency of various intra-abdominal organ involved, assess the various mode of blunt abdominal trauma and clinical presentation and various available investigation, treatment and complications. Methods: This a prospective study conducted in SRM Medical College among patients presenting to the casualty and general surgery outpatient department with a sample size of 72. Results: Males (91.6%) outnumbered females (8.33%). RTA forms the most common mode of injury. The most common age group affected is 21-30 years. Majority of the population presented with pain abdomen. Focused assessment with sonography for trauma has picked up solid organ injury in 46 cases. Computed tomography abdomen was performed in 100% of the population and forms the core investigation of choice and becomes more important in dealing operative versus conservative management. For splenic injury, the most common surgery performed was splenectomy (26 cases). Multiple intra-abdominal organs were involved accounting for 9.7%. Wound infection is the most common post-operative complication. The study showed a mortality of 19%. Conclusion: Blunt injury abdomen with solid organ injury forms a considerable load of patients in our society and is usually less obvious. Early diagnosis, repeated clinical examination and use of appropriate investigations form the key in the management.
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Aim: This study was conducted to estimate and correlate salivary thiocyanate (SCN) levels in periodontally healthy subjects, smokers, nonsmokers, and gutka‑chewers with chronic periodontitis. Methodology: The study population consisted of 40 systemically healthy subjects in the age group of 18–55 years that was further divided into four groups: Control, smokers, nonsmokers, and gutka‑chewers with chronic periodontitis. Gingival index (GI) (Loe and Silness‑1963), probing depth (PD), clinical attachment loss was assessed. Estimation of SCN was performed by ultraviolet spectrophotometer at 447 nm wavelength. Statistical analysis was performed using the one‑way ANOVAs Welch test and Pearson’s correlation test using SPSS version 17 software. Results: Results showed statistically significant increase in SCN levels in smokers as compared to gutka‑chewers with chronic periodontitis, control, and nonsmokers with chronic periodontitis subjects. Significantly higher PD and loss of attachment were seen in smokers group compared with other groups. A negative correlation observed between the GI and thiocyanate levels. Conclusion: The present study revealed a significant increase in SCN levels in smokers with periodontitis as compared to nonsmokers.
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Femoral hernia accounts for about 3-5% of all groin hernias. Incarceration and strangulation are more common with femoral hernia. Femoral hernia with bladder as content and its incarceration is reported very rarely in literature. Our patient is a 48 year old multiparous female who presented with left sided groin swelling with difficulty in micturition and was diagnosed to have incarcerated femoral cystocele.
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Aims: The objective of the work is to remove Pb2+ by Pleurotus florida and Trichoderma viride in batch studies and to study the kinetics and adsorption isotherm of Pb2+ adsorption by fungal species and to determine the desorption performance by suitable desorbing agents. Study Design: Experimental study. Place and duration of the study: This work was carried out at Department of Biotechnology, Government College of Technology, Coimbatore, Tamil Nadu, and India for a period of five months. Methodology: The polluted sample was collected from Valankulam lake, Coimbatore. The biomass of Pleurotus florida and Trichoderma viride were used as adsorbents. Atomic Absorption Spectrophotometer was used to quantify Pb2+ concentration. The optimum conditions of pH, adsorbent dose and contact time for biosorption were determined. Results: Maximum adsorption of Pb2+ for Trichoderma viride and Pleurotus florida were observed at a pH of 6 and 7 respectively. The optimum quantities of adsorbent required for the removal of Pb2+ were 0.2g for both the organisms. Adsorption of Pb2+ was found to reach equilibrium in 1 h and 1.5 h for Pleurotus florida and Trichoderma viride respectively. Conclusion: Hence, Pleurotus florida and Tricoderma viride are suitable adsorbents for the removal of Pb2+ from effluents. This methodology can be used for the removal of lead from waste water before its disposal.
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Context: Dentinal hypersensitivity (DH) is a commonly encountered problem. Several products are used in management of DH with varying results. Need is felt in dentistry for a material that chemically reacts, physically occludes and adheres intimately to dentinal tubules to reduce the possibility of its recurrence. One such material is calcium sodium phosphosilicate-Novamin ® . Aim: To evaluate an efficacy of a 5% calcium sodium phosphosilicate (Novamin ® SHY NM TM ) containing dentifrice compared to placebo for the relief of DH. Settings and Design: Outpatients visiting Dept of Periodontics, Yenepoya Dental College with DH were deemed eligible for this case-control clinical trial after an informed consent. Materials and Methods: 30 patients having at least 2 sensitive teeth with a VAS (Visual Analogue Scale) of >3 cm after air blast stimulation, qualified to participate in the study. Test (SHY NM TM toothpaste containing 5% calcium sodium phosphosilicate) and control (Pepsodent toothpaste without a desensitizing agent) groups, each containing 15 participants, were subjected to cold water and air blast stimulation for an assessment of DH at baseline, 6 th and 8 th week using VAS. Statistical analysis used: Unpaired t-test and repeated measures ANOVA. Results: 5% Novamin ® containing dentifrice significantly reduced DH within 6 th and 8 th week of usage when compared to a placebo dentifrice. Conclusions: A Novamin ® containing dentifrice significantly reduced DH when compared to a placebo dentifrice.
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Malathion was used in vivo on fresh water fish Labeo rohita to study its toxicity. The acute toxicity tests were conducted during certain intervals in various concentrations [5, 10, 15, 20, 25 and 30 mg/L] of malathion. The physical and chemical analyses of water were carried out by following APHA methods. While treating with malathion, the percentage of fish mortality was assessed during 24, 48, 72 and 96 hours. The lethal and sub-lethal concentration of malathion were found to be LC[100] [25 mg/L] and LC[0] [5 mg/L], respectively. The antioxidant enzyme activity [Catalase 43.1 +/- 2.3, 16.5 +/- 0.57, 23.9 +/- 0.17 micro moles of phenol liberated/min/100mg protein and Glutathion-S-transferase [GST] 270.5 +/- 0.16, 143.2 +/- 1.03, 215.5 +/- 0.72 micro moles of phenol liberated/min/100mg protein], in the liver, muscle and gill, respectively increased during the accumulation of malathion, whereas it decreased [Catalase 17 +/- 1.44, 7.9 +/- 0.23, 10.7 +/- 0.69 micro moles of phenol liberated/min/100mg protein and GST 219.5 +/- 1.12, 108.1 +/- 0.34, 160.2 +/- 0.46 micro moles of phenol liberated/min/100mg protein] during depuration period. The effects of malathion resulted in the gradual decrease of nucleic acids, protein, free amino acids [FAA] and glycogen. During recovery period, the levels of biochemical components progressively increased indicating a probable recovery from the disruption of internal organ. Hence, the pesticide intoxication has made a disturbance in normal functioning of cells with significant alterations in the fundamental biochemical mechanisms of fish. It suggests that the continuous exposure of pesticide leads to abnormal changes causing fish to death