A Study of Anatomical Variations in Transverse Foramen of Cervical Vertebrae for Morphological and Clinical Importance

Introduction: Cervical vertebrae constitute the skeletal framework of vertebral column in the region. The most important feature to identify the cervical vertebra is the presence of foramen transversarium. Vertebral artery, vertebral vein and sympathetic chain run through this foramen as a single unit. Compartmentalization or absence of the foramen may alter the course of these structures. Material and methods: The study was performed on 240 dry human cervical vertebrae of both sexes, which were collected from Anatomy department of MSYMCH, Meerut and HIMS, Varanasi. The variations in number and shape were observed, recorded and analyzed. The intact cervical vertebrae without any degenerative or traumatic disorders were included in this study. Result: Out of 240 cervical vertebrae, 63 vertebrae were found to have variations in the transverse foramina. Complete double transverse foramina were observed in 48 vertebrae (20%), out of which unilateral double foramina were found in 29 vertebrae (12%) and bilateral double foramina were found in 19 vertebrae (8%). Similarly, incomplete double transverse foramina were observed in 15 vertebrae (6%), of which the foramina were unilateral in 8 vertebrae (4%) and bilateral in 5 vertebrae (2%). Conclusion: In our study, we observed the double foramen transversarium in 26.25% of the cases. These variations may alter the course of vertebral artery. Presence of compartmentalization suggests the chances of compression of neurovascular bundle. Spicules of incomplete septation between the two foramina may pierce the vascular or neural structures resulting into vascular insufficiency or persisting pain. These findings may suggest a cue to the spinal surgeons in planning preoperative procedures for surgeries related to this region

Determination of Age of Epiphyseal Union of Bones Around Knee Joint by Radiological Approach in the Varanasi Region

Background: Age is an important parameter for medico-legal cases. Age of epiphyseal union is an important objective method of age determination. But these ages vary with racial, geographic and various other factors. These variations have suggested need of separate standards of ossification for separate regions. Methods: After approval from institutional ethical committee, present work was undertaken to work out ages of epiphyseal union around knee joint for Kolhapur region. Study was carried out in total 200 healthy subjects aging from 13 to 21 years.  Results: The chronological age was determined & A-P view of right knee joint was taken in each case. These radiographs were studied to determine the age of union of epiphyses of lower end of femur, upper end of tibia & upper end of fibula. Conclusions: These ages were compared with those reported from various states of India & abroad.

Comparative study of preloading with ringer lactate v/s 6% hexa starch solutions to prevent hypotension following spinal anaesthesia in elective surgery.

Background: Hemodynamic variations are commonly encountered following subarchnoid block and can attribute to significant mortality and morbidity. To counteract the hypotension, fluid adminstration before spinal anaesthesia is recommended (preloading). Crystalloids and colloids are recommended as preloading fluids but both have their own merits and demerits. Objective: This comparative study was done to compare the effectiveness of ringer lactate versus 6% hydroxyl ethyl starch for preventing spinal anesthesia induced hypotension. Material and Methods: In this prospective study, we compare the effectiveness of ringer lactate versus 6% hydroxy ethyl starch at 10ml/kg over a period of 20 minutes before spinal anaesthesia in preventing hypotension. After administration of spinal anaestheisa mean arterial pressure were recorded at 1, 5, 10, 15, 30, 45, 60, 90 minutes and 3 hours after spinal anaesthesia. Number of patient, recieving injection Mephentermine sulphate for persistent hypotension was also recorded. Results: We found that hydroxy ethyl starch is more effective than ringer lactate solution as a preloading fluid in prevention of hypotension following spinal anaesthesia. Conclusion: Hydroxy ethyl starch is superior to ringer lactate in preventing hypotension in patients undergoing elective lower abdominal surgeries under spinal anaesthesia but the incidence of hypotension is not completely eliminated.

In-vitro antidermatophytic activity of essential oil of Psidium guajava (Linn.).

Dermatophyte with the ability to digest keratine invade and therve on keratinized of human and animals. In the present study, the activity of essential oil of Psidium guajava (Linn.) was evaluated against four selected dermatophytes, namely Microsporiumcanis, Trichophytomruburum, T. verrucossum, T. tonsurans. Dermatophyteswere isolated with the infected skin, scalp, nail and genital organs of patients from districts hospital, Bareilly. Griseofulvin was used as a standard antifungal drug against the test dermatophytes. Oil was extracted through clevenger’s apparatus. Maximum inhibition zone was reported 69 mm against T. verrucossum followed by 60 mm Trichophytomruburum, 48 mm Trichophytomruburum and 45mm Microsporiumcanis. All five concentrations of oil showed excellent inhibitory effect against all test dermatophytes as compared to standard antifungal used.

Role of arbuscular mycorrhiza fungi on tolerance to salinity of the tree legume Albizia lebbeck (L.) inoculated by Rhizobium.

Myrica esculenta (Myricaceae) and Syzygium cumini(Myrtaceae), the Indian traditional fruits The effect of different level of salinity on growth, nodulation and Nitrogen fixation of single and dual inoculated tree legumes which help arbascular mycorrhizal fungi (AMF) Acaulospora laevis Gerd. and Trappe with Rhizobium bacteria in the presence of different levels of salinity (concentration of NaCl) conducted in earthen pots in a completely randomized block design with three replications resulted in effective plant growth, shoot and root biomasses, nodulation and N2 fixation. The effect of different levels of salinity (concentration of NaCl) on growth, nodulation and N2 fixation of single (Rhizobium or AMF alone) and dual inoculated (Rhizobium + AMF ) tree legume has a pot culture experiment using The parameter growth , nodulation, nitrogen fixation and % AMF colonization of roots were considerable influenced with the increase in salt concentration from 0.5 % to 4.0 % NaCl. It was observed that the mycorrhizal tree legume (inoculated with the most preferred AMF Acaulospora laevis) performed better in the increasing levels of salinity in comparison to non-mycorrhozal ones. These investigations suggested a protective role play by AMF in providing resistance to the tree legume against injurious effects of salinity. Inoculation of efficient strain of AMF (Acaulospora laevis) during the course of study, prevented the injurious effects of salinity in the test plants due to enhanced water and sustainable nutrient uptake thereby promoting growth, nodulation and biogeochemical N2 cycle (fixation of nitrogen) of the tree legume under investigation.

Gallbladder disease in type-2 Diabetes mellitus patients.

Background: Diabetes mellitus is a modern epidemic which leads to various complications over a period of time. Autonomic neuropathy is one such complication which may lead on to gallbladder dysmotility and gallbladder stones. Objectives: To determine the incidence of gallbladder disorders in patients of type 2 diabetes mellitus and to find out the incidence of autonomic dysfunction in type 2 diabetes mellitus and correlate it with presence of gall bladder disorders. Material and Methods: The present study was conducted in 50 cases of type 2 diabetes mellitus and 25 healthy age and sex matched normal individuals were taken as controls. The cases as well as the controls underwent ultrasonographic examination for gall bladder volume, wall thickness, intraluminal mass and contraction in response to fatty meal. Data thus collected was compared and analysed statistically by using students ‘t’ test and chi- square test. Results: Mean postprandial gallbladder volume was 20.56±8.87 cm3 in diabetics with ANP with gallstones, 26.16±1.24 cm3 in diabetics with ANP with dysmotility 13.0±6.26 cm3 in diabetics with gallstones without ANP, 12.14±4.88 cm3 in normal diabetics and 13.60±5.95 cm3 in controls. The percentage contraction post fatty meal was calculated from these values and found to be 24.73±14.64% in diabetics with ANP with dysmotility, 26.38±17 .04% in diabetics with ANP with dysmotility, 43.48±8.45% in diabetics with gallstones without ANP, 56.84±9.02% in normal diabetics and 57 .64±9.92% in controls. Conclusion: Incidence of gallbladder disease is much higher in type 2 diabetics (40%) as compared to normal healthy adults (4%). It was concluded that diabetics with ANP had significantly impaired gallbladder emptying. Poor control of diabetes, hypercholesterolemia and diabetic autonomic neuropathy are important risk factors for the development of gallbladder disease.

New synthetic precocenoids as potential insect control agents.

Ageratochromes or precocenes are known for their insect growth regulating (IGR) activity. The present investigation was taken up with an objective to look for the lead structure in these compounds which can be elaborated synthetically to obtain useful growth regulators for practical purposes. With this in mind, some variants of precocenes were synthesized in the laboratory and tested for their toxicity and growth regulating activity using red cotton bug Dysdercus koenigii as the test insect. Most of the precocenoids showed toxicity of various degree and metamorphic derangements to different extents. Adults emerging from treated nymphs could not complete the normal life span. Among the compounds tested 8-acetyl-7-hydroxy-5-methoxy-dimethylchromene (alloevodinol) was more toxic and also showed developmental defects at very low dose such as 0.5 mg l(-1)/nymph. Precocene II (6, 7-dimethoxy-2, 2-dimethylchromene) was used as the standard compound. It was the least toxic and showed effects at 30 mg l(-1)/nymph.

Greenstick fracture of the mandible: a case report.

This case report is an insight in to pediatric traumatology whereby bilateral greenstick fracture of condyle is used as a means to discuss the incidence and anatomic considerations for the management of the same, highlighting the fact that dental surgeons require a unique understanding of the anatomy, growth considerations, healing pattern and operative management involving minimal manipulation while managing pediatric facial fractures.

Cognitive functions in stable schizophrenia & euthymic state of bipolar disorder.

BACKGROUND & OBJECTIVE: Some cognitive deficits in schizophrenia and bipolar disorders persist after the subsidence of active symptoms. We carried out this study to assess and compare the cognitive functioning of patients with stable schizophrenia and bipolar disorder. METHODS: Fifteen each of stable maintained schizophrenic patients and euthymic bipolar-I patients attending outpatient clinic in a tertiary care psychiatric hospital in north India were included in the study as also equal number of age and education matched control subjects. Cognitive assessments were done using Wisconsin's Card Sorting Test (WCST), Spatial Working Memory Test (SWMT) and Continuous Performance Test (CPT). RESULTS: Stable schizophrenia patients performed poorly on all the neurocognitive parameters as compared to both controls and bipolar euthymic patients. Euthymic bipolar patients showed significant difference on executive functions with normal controls. Patterns of cognitive disturbances in tasks of executive function are similar in both groups but are quantitatively more marked in schizophrenia. INTERPRETATION & CONCLUSION: Our results showed that stable schizophrenia patients performed significantly worse on cognitive measures than patients of euthymic bipolar disorder which was consistent with their poorer functional outcome. The results further indicated that stable schizophrenia and euthymic bipolar disorders may be distinguished qualitatively in neuropsychological terms with different profiles of cognitive impairment.

Chikungunya epidemic: global and Indian scenario.

Chikungunya is a disease of zoonotic importance affecting man with non-human primates as a main reservoir. Recently the world has seen its outbreaks in Asia and Africa affecting large population. The disease has re-emerged after 2 long decades. Other part of the world reported it as a disease which is introduced through travelers. The known vectors of Chikungunya are Aedes mosquitoes, notably Aedes aegypti and A. albopiticus. Although, the people of rural areas are among more risk groups, the disease spread very rapidly among urban population. The disease shows epidemic pattern with severe arthralgia and usually without any mortality but in the recent outbreak it has shown mortality also. Thus it is the major cause of public health concern. Understanding the public health significance of disease, there is a need of continuous monitoring and surveillance of the virus in both human and animal population.

Distal spinal muscular atrophy.

Spinal muscular atrophies (SMA) are clinically heterogenous group of motor system disorders characterised by progressive pure lower motor neuron involvement. The distal form of SMA is an extremely rare disorder, which presents in the adults and has a relatively slow progression with almost no effect on the patients' life-span. Differential diagnosis of this syndrome include other forms of neuromuscular disorders with peroneal muscular atrophy like hereditary motor sensory neuropathy (HMSN) and distal myopathies, which need exclusion before confirming this rare entity. We present a young male with this disorder and briefly discuss the theoretical aspects.

Granulomatous angiitis of the central nervous system associated with herpes zoster.

Granulomatous angiitis of central nervous system (CNS) is a rare inflammatory disease of blood vessels mostly confined to CNS. We describe a case which presented with right sided hemiplegia with aphasia, after herpes zoster ophthalmicus. CT scan and MRI brain showed a large left sided infarct in the left middle cerebral artery (MCA) territory. MRI angiography revealed narrowing and thinning of left internal carotid artery (ICA) and to a lesser extent, left MCA suggestive of granulomatous vasculitis. Herpes zoster is often associated with major CNS involvement and a vascular etiology was previously postulated. Recent pathological reports suggest that cerebral angiitis secondary to herpes virus infection may be more common than realised.

Extramedullary astrocytoma of conus region : a short report.

A 55 year old man presented with features of cauda equina syndrome. Magnetic resonance imaging (MRI) showed a well demarcated intradural extramedullary tumour at L2 vertebra. At surgery it was found to be well encapsulated and had no attachment to spinal cord or root. Histopathology including immunohistochemistry confirmed it to be a low grade astrocytoma.

Paraganglioma of cauda equina: a case report.

Histopathologically and immunologically confirmed case of paraganglioma of cauda equina region is described.

Seizures in patients with human immunodeficiency virus infection.

OBJECTIVE: To study the significance of new onset seizure in patient with human immunodeficiency virus (HIV) infection. METHODS: Patients infected with HIV with the new onset seizure were enrolled in the study. Seizure type was classified. Adequate work up was done to search for a cause of their initial seizure. All patients were administered antiepileptic drugs in addition those detected to have treatable opportunistic infection were treated for the same. RESULTS: A total of 455 patients of HIV infection were admitted to this centre during study period, of these twenty three patients had new onset seizures. Seizures were generalized tonic-clonic in fifteen patients (65.21%), partial motor in six patients (26.08%) and partial motor with secondary generalization in two patients (8.69%). Recurrence of seizures was observed in 69.56% patients. Identified causes included cerebral toxoplasmosis in seven patients (30.43%), cryptococcal meningitis in four (17.39%), tuberculoma in three (13.04%), AIDS dementia complex in one (4.34%) and progressive multifocal leucoencephalopathy in one (4.34%). In seven patients (30.43%) seizures were not associated with any identifiable cause. Phenytoin was used for control of seizures and no side effects to the drug were noted during the brief period of follow up. CONCLUSION: Majority of patients with HIV infection and new onset seizures have secondary brain lesion as the cause of seizure. High rate of seizure recurrence mandates therapy of solitary seizure in patients with HIV infection.

Cryptococcal meningitis in acquired immunodeficiency syndrome.

OBJECTIVE: To study the clinical course and outcome of cryptococcal meningitis (CM) in patients with acquired immunodeficiency syndrome (AIDS). METHOD: Patients infected with human immunodeficiency virus (HIV) and symptoms suggestive of meningitis were evaluated with detailed history, clinical examination and investigations. Diagnosis of CM was based on positive India ink preparation or positive fungal culture of CSF. All patients were treated with amphotericin those showing response were put on oral fluconazole. RESULT: A total of 431 patients with HIV infection were admitted to this centre during the study period, of these 15 were diagnosed to have CM. Majority of the patients had a subacute presentation with signs of meningeal irritation seen in only seven patients. India ink preparation and positive fungal culture on cerebrospinal fluid (CSF) established diagnosis in all cases. All patients were treated with amphotericin B and fluconazole. Complete response was noticed in seven patients, two patients were lost to follow-up and six patients died during the course of therapy. Raised intracranial tension (ICT) and disseminated disease were associated with poor prognosis. CONCLUSION: CM is a common opportunistic fungal infection in patients with AIDS. A high index of clinical suspicion and routine mycological surveillance is required to diagnose this infection. Majority of patients respond to therapy except those who have disseminated infection, altered sensorium and features of raised ICT at presentation.