Effect of left ventricular geometric remodeling on restrictive filling pattern and survival in ischemic cardiomyopathy

Background: To evaluate the effects of Left ventricular remodeling patterns in patients with left ventricular restrictive filling pattern (RFP; E/A>2) in ischemic cardiomyopathy (ICM) on prognosis. Methods: Patient data was retrospectively analyzed over a period of 4.5 years to determine the effect of LV geometry by Echocardiographic parameterson survival and re-admission for heart failure. All patients with previous history of transmural myocardial infarction were studied and all were on guideline directed medical therapy. None underwent device therapy or surgery. The stored 2D Echocardiograms were studied. Left ventricular dimensions were noted, including the relative wall thickness (RWT). The patients were grouped based on RWT<0.34 and _x0001_ 0.34 and were compared for clinical outcomes of mortality and re-admissions for heart failure, over a period of 54 months. Results: There were 102 ICM patients who had baseline RFP. We identified two sub-groups based on geometric phenotypes of left ventricular eccentric remodeling and dilated remodeling based on the relative wall thickness (RWT >0.34 or <0.34). The patients with preserved RWT had significantly more dilated ventricles (LVIDd and LVIDs), greater pulmonary artery systolic pressures (PASP), greater diatolic dysfunction (E/A) and less left ventricular ejection fraction (LVEF); p < 0.001. The number of deaths was higher in the reduced RWT patients, as were the number of re-admissions, although the time to survival and time to re-admission was not significant. Conclusions: In this pilot study on ICM patients in advanced heart failure with baseline RFP, the presence of preserved RWT indicative of eccentric remodelling demonstrated a better clinical outcome

Clinical and Genetic Spectrum of Inborn Errors of Immunity in a Tertiary Care Center in Southern India

Objectives To study the incidence, clinical manifestations, and genetic spectrum of primary immunodefciency diseases (PID)/inborn errors of immunity (IEI) in a tertiary care hospital in Southern India. Methods A retrospective analysis of all patients with a clinical suspicion of PID/IEI seen at a tertiary care hospital was performed. All patients had at least one or more warning signs of PID. Serum immunoglobulin levels and other targeted investigations were performed as warranted by the clinical presentation. All families with suspected PID were counseled and ofered genetic testing. Results A total of 225 children were evaluated for PID during the study period of 6 y. Fifty-six of them did not meet the European Society of Immunodefciencies (ESID) criteria (working defnition of clinical diagnosis) and were excluded. An IEI was found in 30/49 (61.2%) patients. The most frequent reason for referral was recurrent/unusual or serious infections (28%), or cytopenia (16%). Group IV diseases of immune dysregulation was the most common category (19%), followed by group III predominant antibody defciencies in 23/163 (14%), as per the International Union of Immunological Societies (IUIS) classifcation. Conclusions This study highlights the heterogeneity of the present cohort, the underuse of genetic tests, and eforts to provide optimal care for children with possible IEI in this center.

Evaluation of patients with polycystic ovarian syndrome at a tertiary care center

Background: It has been estimated that prevalence of PCOS ranges from 5-10% in reproductive females. Thus, it becomes most common endocrinopathy in this age group. Lack of ovulation and androgen over activity are key features of PCOS. The objective of this study was to patients with polycystic ovarian syndrome at a tertiary care center.Methods: Present study was following up study with 200 cases of PCOS. Rotterdam criteria were used for the diagnosis of the PCOS. This criterion includes three things. First is woman having in last year <6 periods of menstruation. Second is testosterone value >0.6 ng/ml and third is each ovary having >12 follicles with increased size and volume. Those cases with hypothyroidism, adrenal tumors, congenital adrenal hyperplasia etc were excluded from the present study. Those on steroid therapy were also excluded. Detailed history and clinical examination were carried out for included cases as well as required investigations.Results: Overall incidence of infertility was found as 27.9%. Out of these 200 cases, 44 (22%) had PCOS. Majority cases belonged to 20-24 years of age. Hirsutism was most common findings in clinical hyperandrogenism. Risk of insulin resistance syndrome was 4.79 times higher in obesity compared to not obese. Age, BMI, duration of infertility, ovarian volume, and menstrual pattern had effect on ovulation rate following laparoscopic ovarian drilling. Increasing duration of infertility and BMI had lower ovulation rate. Ovulation rate was highest when treated with clomiphene citrate alone than the combination therapy.Conclusions: Women with obesity have more chances of having PCOS as seen from the present study.

Bilateral suppurative parotitis in a neonate: a case report

Acute suppurative parotitis is a very rare ailment to be encountered in the neonatal period. Here, we report a 13-day old hemodynamically stable neonate, who presented to us with bilateral tender, erythematous parotid swelling and purulent discharge exuding from stensen's duct. He was exclusively breast fed and had no other risk factors. Provisional diagnosis of acute suppurative parotitis was made with clinical examination. On investigating, there was neutrophilic leukocytosis, elevated acute phase reactants, ultrasonogram showed hypoechoic areas and a heavy growth of Staphylococcus aureus was isolated on pus culture. Baby underwent incision and drainage on the day of admission and was started on appropriate parenteral antibiotics along with supportive management. There was a significant clinical response over next 24 hours. He was doing well throughout the hospital stay and antibiotic course was completed based on culture sensitivity pattern. He neither had any immediate complications during hospital stay nor developed any late complications on follow up. Prognosis of the condition is excellent with adequate timely management. Authors would like to report this case for its rarity and to emphasize on fact that though the condition is uncommon, acute neonatal parotitis should be included in the differentials of any unilateral or bilateral neonatal parotid swelling, as early diagnosis and prompt management of this entity is mandated for a favorable outcome and to limit complications drastically.

Image-Based Simulative Training for Myectomy in Hypertrophic Cardiomyopathy: An Emerging Necessity

Surgical myectomy was initially advocated only for patients with symptoms refractory to maximal tolerated medical therapy. These were mainly symptoms of cardiac failure. In recent times, there has been a call for revision of guidelines to include patients earlier. As the disease progression cannot be reversed by most currently used drugs which become ineffective with time, this need for earlier myectomy seems mandatory. Presently, surgical expertise in myectomy is limited to specialized centers. The complexity of surgical myectomy is enhanced by the complex and variable anatomic substrate. With the need for earlier myectomy, a vast population of patients with hypertrophic cardiomyopathy will need surgery, predicating a requirement for more skilled cardiac surgeons. Mentoring programs in specialized centers may not be the solution, as is training surgeons using image-guided simulation techniques. Here, we discuss the existing simulative techniques and novel image-based preoperative planning techniques which may help guide myectomy.

Retrospective Study on Prevalence, Risk Factors, Maternal and Fetal Outcome in Gestational Diabetes Mellitus

Background: Women with gestational diabetes mellitus pose an important health problem because diabetes not only affects maternal and fetal outcome but these women and fetuses are also at an increased risk of developing diabetes and related complications later in their life. Objectives: The study was aimed to find out prevalence, risk factors, maternal and fetal outcome in patients of gestational diabetes mellitus. Materials and methods: Retrospective study was conducted over a period of 6 months in the Department of Obstetrics and Gynecology, King George Hospital, Visakhapatnam, a Tertiary care centre. Detailed information regarding maternal, fetal and labour outcome parameters was recorded. Results: Prevalence of GDM was found to be 3.12%. Of the affected women, 34.5% were in the age group between 26-30 years, 10.9% were having GDM in previous pregnancy, 14.5% were having family history of diabetes, 20% were managed with diet alone, 41% were on insulin treatment, 65.4% underwent C-Section, 43% of babies were of birth weight 3.1-3.5 kg, 25% of cases were associated with other risk factors like pre-eclampsia. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring and intervention is essential to reduce maternal and fetal short and long term adverse effects in high risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients.

Management of lower ureteral stones using Tamsulosin – A prospective study

Introduction: It has been scientifically established that α1-adrenergic antagonists cause inhibition of the basal tone, peristaltic frequency, and contractions in the lower ureter. Earlier studies have shown promising results with Tamsulosin (α1-adrenergic antagonist) helping in spontaneous passage of Ureteral stones. Hence this prospective randomized double-blind placebo-controlled study is taken up to establish the real impact of Tamsulosin a specific alpha blocker (α1-adrenergic receptors) in expelling distal ureteral stones. This study aimed to include 80 patients with ureteral stones of less than 5 mm and more than 5 mm in size located in the distal ureter. Materials and methods: In the Present study, informed consent was obtained from all 80 patients and the study was conducted after institutional ethical committee approval. Patients are randomized to two groups to receive Tamsulosin and placebo along with analgesics whenever required. Patients were followed up for a period of one month to study the stone expulsion rate, drug side effects and pain episodes. Results: All 80 patients complied with prescribed treatment schedules except 4 patients in placebo group and 2 in study group who were lost to follow up. At the end of 4 weeks, stone expulsion was seen in 30 out of 38 (79% patients in study group and 20 patients out of 36 (56%) in placebo group. The stone expulsion time was shorter in the study group (6.2±3.2 days) and in 9.67±5.4 days for placebo group. No significant impact on the expulsion rate was seen in relation with age, gender and ureteric stones present either in right side or left side. The frequency of pain episodes was almost same and mild in both groups. Conclusion: Tamsulosin is safe and effective drug to enhance spontaneous passage of smaller stones present in distal ureter.

Use of coronary hardware in peripheral vascular interventions: Necessity fostered ingenuity-Is it solution enough?

In third world countries like India, where there is a paucity of dedicated interventional radiologists and training fellowships in peripheral interventions, it is the onus of the cardiologist to perform peripheral interventions. This coupled with logistic constraints of unavailability of medical insurance for majority of the population, makes it necessary to modify coronary hardware for use in peripheral interventions. Here, we discuss the modifications and simplifications performed to ensure optimal quality of clinical outcomes.

Metatropic Dysplasia with a Novel Mutation in TRPV4.

Back ground: Metatropic dysplasia is a skeletal dysplasia characterized by rhizomelia, severe kyphoscoliosis and a coccygeal tail. Case characteristics: A 12 day-old male neonate had facial dysmorphism, short limbs and coccygeal tail and showed radiological features of metatropic dysplasia. Observation: A novel heterozygous variant was observed in TRPV4 gene. Message: We report a novel mutation in an Indian neonate with metatropic dysplasia.

A study of comorbidities in attention deficit hyperactivity disorder: a retrospective analysis of case records

Background: ADHD is a heterogeneous disorder with a prevalence ranging from 4- 7%.It is associated with comorbidities like oppositional defiant disorder, conduct disorder, mood disorders, anxiety disorders, learning disability to name a few. The rate of comorbidities has ranged from 60 to 100 % in various studies. The most common comorbid disorder has been found to be oppositional defiant disorder. Combined type of ADHD was found to be the subtype associated with most comorbidity. Studies have differed in their findings regarding the influence of gender on comorbidities in ADHD. Aims: To study the rates of various comorbidities in ADHD and differences in comorbidities according to subtype of ADHD and gender. Methods: Our current study was conducted in an outpatient child psychiatry clinic. The records of children who were diagnosed as ADHD were analyzed to understand whether our data reflected the findings of international and other Indian studies. The data was analyzed with regard to the rates of various comorbidities, the difference in comorbidities according to subtype of ADHD and gender. Results: We found the overall rate of comorbidities to be 52.9%.The most common comorbidity was oppositional defiant disorder followed by anxiety disorders. The overall rate of comorbidities did not differ significantly according to gender and subtype. However when individual comorbidities were analyzed oppositional defiant disorder was significantly more in combined type, Anxiety disorders were more in inattentive type and Depression was significantly more in females. Conclusions: As a child with ADHD and comorbidities suffers from multiple handicaps it is essential to study the comorbidities in detail both crosssectionally and longitudinally to understand and treat the illness better. Considering the multiple comorbidities a child with ADHD can present with clinical management should be individualized.

case of zosteriform verrucous epidermal nevus at an unusual location

Verrucous epidermal nevus is a common type of keratinocyte hamartoma present at birth or occurring later in life. It affects about one in every thousand live births. It is seen at any site, usually found on the lower extremities but is less common on the head and neck. We present a unique case of a female patient aged 12 years affected by zosteriform verrucous epidermal nevus over neck, a rare presentation

A holistic approach to the management of Erb’s palsy.

A 4.5-month-old female baby, presenting with complete paralysis of right upper limb with typical waiter’s tip deformity, diagnosed as Erb’s palsy was brought to Sri Ganapati Sachchidananda Hospital. Patient was treated with an integrated approach of physiotherapy and Ayurvedic treatment with an intention of aiding faster recovery of the patient to lead a near normal life. As per Ayurvedic classics, this condition can be correlated to Ekangavata (Vata effecting any one part of the body), which is Apatarpana in nature (diseases with deprived growth of body tissue). Hence, the choice of treatment is Santarpana Chikitsa (nourishing treatment). Santarpana Bahyopakramas (nourishing external treatment modalities) such as Ashwagandhabalalakshadi Taila (Ayurvedic medicated oil) Abhyanga (oleation therapy) and Shastikashali Anna Lepa (application of processed rice paste) were administered along with electrical stimulation (physiotherapy modality), both galvanic and faradic current in three sessions. Appreciable results were observed in the form of reduction of disparity in length and mid-arm circumference of right upper limb compared to unaffected left upper limb and the muscle power too improved from zero to four, facilitating patient to near normal movement.

A study of cyto-histological correlation of breast lesions.

Aim & Objective: To study the morphological aspects of various breast lesions in patients with an apparent breast lump. To correlate the cytological findings with histopathological examination. To determine the accuracy of aspiration cytology in the diagnosis of the breast lesions. To analyse the causes of the diagnostic error and ways of overcoming them. Materials & Methods: The present study included 65 cases presenting with palpable breast lump in the outpatient department of the Shri Sayaji General Hospital Vadodara. FNA was carried out on all of them and the material studied in the Department of pathology, Medical College, Baroda, from January 2009 to September 2010. All cases were also subjected to surgical biopsy or mastectomy. Results: Out of 65 cases 21 cases were diagnosed as benign breast lesions and 44 cases were diagnosed as malignant breast lesions on cytology. On histological examination out of 21 benign lesions only one shows carcinoma while all malignant lesions were confirmed. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 95.2%, 100%, 100%, 95.2% and 98.4% respectively. Conclusion: In conclusion, the simplicity, rapidity, lack of morbidity, a high sensitivity, a high specificity and cost effectiveness of FNAC makes it the most valuable tool in the evaluation of the breast lesions.

Non catatonic mutism in schizophrenia- a case report and discussion

Background: Mutism is a common accompaniment of catatonic schizophrenia. It responds to treatment with benzodiazepines and electro convulsive therapy. However mutism can also occur in non catatonic schizophrenia. There are very few reports of the same in literature and most show resistance to conventional treatment. The present case report deals with one such case and the challenges it poses. Case description: A young Asian man, with a diagnosis of paranoid schizophrenia presented with long standing mutism in the absence of any other catatonic features. A trial of various antipsychotics and also electroconvulsive therapy failed to show any improvement in mutism. He ultimately responded to amisulpride 800 mg/day. Discussion: Mutism though is most widely reported in catatonic schizophrenia, can also be seen in non catatonic schizophrenia. It shows poor response to conventional treatment. Conclusion: Mutism is a challenging symptom which may persist after the resolution of other psychotic symptoms and continue to hinder the patient’s social, occupational and personal life.

Impact of mealey bug (Maconellicoccus hirsutus) infection on biochemical components of hibiscus rosa sinensis.

Mealey bug (Maconellicoccus hirsutus) causes dreadful infection in Hibiscus rosa sinensis.Infections are highly virulent and alters biochemical components of the species. Therefore an attempt has been made to evaluate the alteration of biochemical components in Hibiscus stem at various stages of infection. The results reveal that partial infected stem had shown 78% decrease in its aminoacids whereas highly infected had shown 64% decrease. The results also show that proteins had increased significantly(72%) in highly infected stem and noticeable increase (63%) in partial infected.

Physicochemical studies in pongamia pinnata galls infected with fungus.

This paper reports physicochemical studies in fungal infected galls of Pongamia pinnata. The parameters assayed were Total ash, acid insolubility and water solubility values and extractive values (Alcohol, water and petroleum ether). Fungal infected galls showed significantly higher value of ash, acid insolubility and low water solubility and high extractive values (petroleum ether and water) when compared to normal galls.

Review of sexual dysfunction due to selective serotonin reuptake inhibitors

Sexual dysfunction due to use of selective serotonin reuptake (SSRI) are reported since the time they have beenintroduced in the 1980's. Studies have shown the prevalence to be in the range of 30-70%. They effect all phases ofsexual functioning and have been found to persist long after the drug has been withdrawn. Persisting sexual dysfunctionleads to non compliance with treatment and has a negative impact on the quality of life. Various methods have beendocumented on how to reduce this effect. Commonly used methods are switching the antidepressants or adding anotherdrug to counter this side effect.

Humanrights of persons with mental illness

The understanding of mental illness has evolved over the years. Right from being thought to be due topossession by evil spirits to the current bio-socio-psychological model of illness, what has remained consistenthowever is the violation of their human rights. Though the efforts to redress this have started from the timesof Pinel, the real focus has been only after the introduction of the various international and regional instrumentsfor protection of human rights. Under these there is a paradigm shift from protecting society from the mentallyill to protecting the mentally ill.

Hepatoprotective properties of Caesalpinia sappan Linn. heartwood on carbon tetrachloride induced toxicity.

Aim of the study was to investigate the methanol and aqueous extracts of heartwood of C. sappan for its hepatoprotective activity against CCl4 induced toxicity in freshly isolated rat hepatocytes and animals. Freshly isolated rat hepatocytes were exposed to CCl4 (1%) along with/without various concentrations of methanolic and aqueous extract of C. sappan (1000-800 µg/ml) and the levels of selected liver enzymes were estimated. Antihepatotoxic effect of methanolic extract was observed in freshly isolated rat hepatocytes at concentrations 1000-800 µg/ml and was found to be similar to that of standard drug silymarin. Wistar strain albino rat model was used for the investigation of in vivo hepatoprotective properties of aqueous and methanolic extract of C. sappan (100 and 200 mg/kg body weight). Liver damage was induced by ip administration of CCl4 (30%) suspended in olive oil (1 ml/kg body weight). Both the tested extracts showed potent hepatoprotective activity at 200 mg/kg body weight test dose which was comparable with that of the standard silymarin used in similar test dose. The methanolic and aqueous extract was able to restore the biochemical levels to normal which were altered due to CCl4 intoxication in freshly isolated rat hepatocytes and also in animals.