Profile of epileptic patients at a tertiary care centre

Background: The present study was done in a tertiary care centre of North India to know the profile of epilepsy.Methods: Total of 210 patients were selected during the period August, 2017 to July 2018 who attended outpatient clinic of the Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh. Detailed clinical history was taken, general physical examination, and routine blood examination were carried out.Results: Of all the cases, sex ratio (male:female) was 2.39:1. A high proportion of cases (43.3%) were from lower-middle socio-economic group. 76.7% patients had generalized seizures. For 38.6% patients, frequency of seizures was more than 8 in the past 6 months. 71.9% of the patients were using only one anti-epileptic drug.Conclusions: Patients with seizures comprise a significant burden in inpatient department of developing countries.

Study of clinical profile of patients of bipolar mood disorder with and without substance abuse and clinical course variables in the substance abusing bipolar group in one of the tertiary care centre of North India

Background: Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3% in general population. In patients with bipolar disorder there was 58 % lifetime prevalence of co-occurring alcohol abuse and a 38 % lifetime prevalence of co-occurring other substance abuse. Substance abuse interferes with treatment and management approaches of the bipolar disorder.Methods: A cross sectional observational study of 120 male patients divided in substance abusing (60) and non-substance abusing groups (60) with bipolar disorder according to DSM-V, who met the Inclusion criteria . A written informed consent was obtained from the patients and/ or their family members. Patient’s information was recorded on the socio-demographic and clinical profile sheet .Thereafter, YMRS or HAM-D scales were applied as per the phase of the illness.Results: Most of the patients were between 15-25 years in SAB group and 35-50 years in NSAB group, educated, semiskilled and married. Tobacco abuse was the commonest followed by cannabis and alcohol abuse. The mean duration of hospital stay in SAB group was 41.40 days and in NSAB group was 43.20 days. Dysphoric mania, aggressive behavior and suicidal attempts were more in SAB group. Mean total YMRS score of SAB group was greater than NSAB group.Conclusions: Maximum patients had onset of substance abuse before the onset of affective symptoms. Manic symptomatology was more severe in substance abusing group.

Effects of Noise Stress on Body Weight and Adrenal Gland Weight of Male Wistar Rats

The present study was designed to investigate the effects of varying intensities of noise stress onto the body and adrenal gland weight (absolute) of 17 weeks old (291–296) gram (g) Wistar rat. Animals were exposed to varying intensity of noise, i.e., 60 dB (Decibel), 80 dB, 100 dB, 120 dB, and 140 dB for 1 h (h)/day for 30 days. The dose of different noise intensities was delivered through a special fabricated noise chamber which had provided all daily needs of animal-like oxygen, food, and water. Food and water consumption behavior was recorded on 1st, 14th, and 29th days and body weight change recorded on 1st, 15th, and 30th days after the exposure of noise stress. Absolute adrenal glands weight was recorded on the 30th day. The results of the present study showed that the food, water consumption behavior, and body weight (g) of the experimental group EG1 (60 dB), EG2 (80 dB), EG3 (100 dB), EG4 (120 dB), and EG5(140 dB) were found to be significantly (P < 0.001) decreased during 1st–14th days and during 15th–30thdays a recovery which were observed in food, water consumption, and in body weight of the EG1 (60 dB), EG2 (80 dB), and EG3 (100 dB). A percentage (%) decrease was found, i.e., 0.76, 0.37, 3.87, 25.89, and 30.06% in body weight of EG1 (60 dB), EG2 (80 dB), EG3 (100 dB), EG4 (120 dB), and EG5 (140 dB) experimental groups, respectively.

Gastrointestinal Helminthic Challenges in Sheep and Goats in Afro-Asian Region: A Review

Sheep and goats, being hardy and prolific in their growth, play a crucial role in cultural and socioeconomic life of rural poor under privileged people in Afro-Asian countries by providing meat, milk, wool and hide to them. Gastrointestinal helminthic infections are worldwide problem in ruminants. They results considerable loss in them causing mortality and poor production. Various helminthes types like trematodes, cestodes and nematodes are prevalent in different climates and geographical regions depending on rearing systems, intermediate host’s availability and management practices. Epidemiology of helminthic diseases, though variable at times, is determined by various factors like treatment, climate and poverty (socio-economic and traditional practices). The study oversees gastrointestinal helminthic challenges in goats and sheep faced in Afro-Asian region in last decade. Methodology involves exhaustive exercise of screening and massive literature hunt which included published research, both abstracts and full length papers on the subject in last 10 years in addition to authors own observations. The diseases like Fasciolosis, Dicrocoelosis, Amphistomosis in trematodes, Monieziosis, Avitellinosis in cestodes and Haemonchosis, Trichostronglylosis, Oesophagostomosis, Trichuriosis, Strongyloidosis in nematodes were still serious challenges in the region threatening the small ruminant production. Frequent reports on Marshallgia, Ostertagia, Nematodirus, Stilesia, Thysaniezia spp. from this region showed emerging threats. Infections like Camelostrongylus, Graphidiops, Parabronema and Skrjabinema spp. were scarcely distributed. The paper reviews scientific work and developments of last 10 years on occurrence, distribution and epidemiology of common gastrointestinal helminthic infections of sheep and goats in Afro-Asian region with future research prospective in light of newer scientific approaches

Myelomatous pleural effusion as an initial presenting sign in a case of multiple myeloma

Multiple Myeloma (MM) is a neoplastic disease which mainly affects bone marrow but rarely may infiltrate extramedullary tissues as well. Myelomatous pleural effusions (MPE) develop due to extension of plasmacytoid cell lesions of thoracic bones into pleural tissue and directly presenting as an initial sign in a case of MM is exceedingly rare. It indicates poor prognosis, resistance to treatment and more chance of relapse in spite of aggressive chemo-radiotherapy. The effusions of serous cavities in MM generally develop as a late complication of the disease like heart failure, renal failure, pneumonia and amyloidosis. We are reporting a rare case of IgG subtype myelomatous pleural effusion demonstrating abundance of plasmacytoid cells in pleural fluid. Bone marrow smear examination favoured the diagnosis of multiple myeloma with the presence of predominant population of plasma cells with high cellularity. There were also presence of a heterogenous myelomatous mass lesion in the right infratemporal fossae, multiple erosive lesions in ribs, vertebral bodies, skull and pelvic bones. Pleural fluid and serum protein electrophoresis demonstrated the presence of gamma monoclonal protein peaks confirming the diagnosis.

Microfilarae in malignant mesothelioma associated pleural effusion with blood microfilaremia: a rare association

Filariasis has a wide spectrum of presentation and usually involves the lung in the form of tropical pulmonary eosinophilia with pulmonary infiltrates and peripheral eosinophilia. Filariasis presenting with pleural effusion is an unusual presentation. Malignancy in association with filarial pleural effusion is extremely rare. In this context, we hereby report a case of 45 year old male who presented with right sided chest pain, cough, fever and generalized weakness. Pleural fluid cytology revealed microfilaria and pleural biopsies from pleural nodules confirmed malignant mesothelioma. Peripheral blood smears taken at night exhibited microfilaria with normal eosinophil counts, which is further uncommon. Role of filariasis in tumorigenesis is controversial.

Description of clinical factors for suicide attempts in a tertiary care hospital of northern part of India

Background: Suicide is the result of an act deliberately initiated and performed by a person in the full knowledge or expectation of its fatal outcome. Suicide attempts are a significant public health problem. The present study aimed to explore the variousclinical characteristics of suicideattempters in a tertiary care hospital of Shimla, Himachal Pradesh, a northern state of India.Methods: We conducted a descriptive study among patients with attempted suicide to the department of Psychiatry, Indira Gandhi Medical College (IGMC) Shimla. A structured, self-designed interview schedule and short-form revised Eyseneck personality questionnaire-Hindi (EPQRS-H) was used for data collection. Data was analyzed using Epi info software v 7.2.0.Results: There were total 77 participants in the study out of which 44 (57.1%) were females. Mean age (Standard deviation) of participants was 30.8 years (9.9 years). Relationship problems were the most common (48.1%) recent life event followed by health events (28.6%). Depression was found to be the most common diagnosis (62.3%). Pesticide consumption was the method of attempting suicide in 72.7% of females compared to 66.7% of males.Conclusions: Recent major life events especially relationship problems may lead to majority of suicide attempts. There is urgent need to focus on patients suffering from depression by health personnel as well as family members. The sale of the pesticides should be regulated to keep in check the misuse of the same.

Electric Burn Injury: Experience of 218 Cases from a Tertiary Care Center of Western Rajasthan

Background: The aim of the study is to know the pattern and profile of injury in relation to setting of electric burn and effect of voltage of their presentation. Methods: A total of 1328 patients were admitted to the burn unit during study duration amongst them 218 were meeting our selection criteria and taken for final analysis.We restrict ourselves to the duration of the patients till admission and didn’t analyze follow up visits. Our protocol is the discharge the patients once, one is able to take self-care and not having open infected wound. Results: Majority of patients were of young age and the mean age was 27.8. 96.7% of our patients were male. More than 60% of admitted patients were inflicted with high voltage electric burn. Majority of patients affected on during work. 88 % of the patients were from rural background, and 96.7% of the patients were male, while only 3.3 % were female. Upper limb was most frequently affected site of injury (66%) of the cases. Conclusion: Workers exposed to electric current and electrical equipment should be fully trained/certified and properly dressed. The education/certification will lessen the burden of having electrical burns, which affects the person, the family as well as the workplace

Predictors of atypical femoral fractures during long term bisphosphonate therapy: A case series & review of literature.

Background & objectives: Bisphosphonates (BPs) are the most widely prescribed medicines for the treatment of osteoporosis because of their efficacy and favourable safety profile. There have been, several reports on an increased incidence of atypical femoral fractures after long term treatment with BPs. The objective of this study was to evaluate the clinical presentation including prodromal symptoms, skeletal radiograph findings, type and duration of BPs received and treatment outcome of patients who developed atypical femoral fractures during bisphosphonate therapy. Methods: In this retrospective study, eight patients with atypical femoral fractures were analysed based on clinical features, biochemical and radiological investigations. Results: Of the eight patients, who sustained atypical femoral fractures, six were on alendronate and two were on zoledronate therapy before the fractures. In addition to BPs, two patients were on long term corticosteroid therapy for rheumatoid arthritis and Addison’s disease. Three patients had bilateral atypical femoral fractures. Except one, all of them had prodromal symptoms prior to fracture. Skeletal radiograph showed cortical thickening, pointed (beaking of) cortical margin and transverse fracture in meta-diaphyseal location. Serum calcium, phosphate, alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) concentrations were within the reference range in all patients. Interpretation & conclusions: Long term bisphosphonate therapy may increase the risk of atypical femoral fractures. Presence of prodromal pain, thickened cortex with cortical beaking may be an early clue for predicting the atypical fractures. High risk patients need periodical skeletal survey and a close follow up for early detection of cases.

A probable association of acute dystonia with gemifloxacin administration.

Gemifloxacin is a recently introduced fluoroquinolone antibiotic frequently used for its broad spectrum and once-daily dosing. Fluoroquinolones are associated with various neuropsychiatric side effects, such as seizures, insomnia, confusion, lightheadedness, psychosis, paranoia and hallucinations. We report a case of a 36-year-old woman given gemifloxacin for an upper respiratory tract infection who developed acute dystonia on the third day following therapy initiation. The clinical implications are discussed.

Studies on the sorption of As(III) on the synthetic gel sodium potassium fluorophlogopite.

Sorption of As(III) has been studied on the synthesized gel close to Sodium potassium fluorophlogopite [Na0.5K0.5Mg3 (Si3 AlO10) F2] as a function of initial solution concentration at pH 2,4 and 7. The effect of parameters like equilibration time (0.5 - 24.0 hr), weight of the exchanger (30-150 mg) and temperature (25 degrees - 45 degrees c) has been investigated. The uptake of metal ion, As(III) has been expressed in terms of distribution coefficient i.e. (kd) values.

Evaluation of the Alvarado score in the diagnosis of acute appendicitis.

Acute appendicitis may simulate many other acute abdominal illnesses and the exact diagnosis is important for the proper management. The present study was undertaken to evaluate the role of the Alvarado score in the diagnosis of a patient with suspected appendicitis. The study was carried out on 100 patients operated with a presumptive diagnosis of acute appendicitis on the basis of clinical grounds. Alvarado scoring was done in all these patients preoperatively by different personnel. Discriminant analysis of the Alvarado score of all the patients was done to determine the cut-off value in an Indian set-up. The positive and negative predictive values of the Alvarado score were 77.6% and 52.4%, respectively. It is more effective in men and children, with a predictive value of 84% and 92.8%, respectively. Discriminant analysis revealed a cut-off value of > or = 6 rather than the original value of > or = 7. The sensitivity of the Alvarado score increased from 69.2% to 92% with the new cut-off value of > or =6. The Alvarado scoring system can be used in surgical emergency departments to diagnose acute appendicitis. In women, additional investigations may be required to confirm the diagnosis. The original cut-off value given by Alvarado may be changed in the Indian set-up to increase sensitivity.