Plastic surgery in Ladakh: a novel initiative in trans Himalaya of India

Background: The super speciality care is not available in remote places in India. But the service of the plastic surgery can be taken to the remote district hospital by arranging plastic surgery camps thereby resulting in service to the poor, capacity building of the local doctors and infrastructure development of the remote hospital.Methods: It is a retrospective study, in which the author analysed the feasibility, management, difficulties and achievement of week long, annual plastic surgery camp in remote set up of a district hospital of Ladakh over three year from 2017 to 2019.Results: A total of 341 patients were included in this study of which 108 underwent various surgical interventions. The youngest operated was 5 months old and oldest was 86 years. Wide spectrum of deformity were seen and operated upon. Complication developed in only six patients (5.5%) which were managed successfully at Leh only. The immediate and long term follow-up result show no difference in surgical result as compared to those compared operated outside with negligible financial burden.Conclusions: Keeping in view the positive outcome, it is argued through this paper that such camps should be replicated in other remote locations all over India.

Tubal Endometriosis Presenting As A Mass In Left Iliac Fossa - A Rare Case Report

Endometriosis is common cause of infertility. We report a case of 28 year old female presenting with left iliac fossa lump diagnosed as endometriosis of fallopian tube on histopathological examination.

Diagnosis In A Spit : A Short Review

Salivary diagnostics is a cost effective, minimally invasive procedure. This bio-fluid can be easily collected, transported and stored. There are a variety of conditions where saliva can be used as a diagnostic tool such as measurement of stress, enzyme levels, developmental disease biomarkers and cancer mutations. A number of studies have focused their attention on the assessment and monitoring of oncologic biomarkers in saliva. Modern techniques, chemicals and various equipment have made laboratory investigations of saliva easy and precise. Its clinical applications and analysis has made salivary diagnostics a useful tool in the field of Medicine and Dentistry. The methodology for diagnosis of oral and systemic diseases has been a subject of study by several researchers with the aim of increasing its use as a diagnostic tool.

Lornoxicam versus diclofenac sodium in acute renal colic: a prospective randomized trial.

Background: Acute renal colic is excruciatingly painful event, opioid analgesics and nonsteroidal anti-inflammatory drugs remain the mainstay of treatment for acute renal colic. This study compares diclofenac and lornoxicam in their efficacy to relieve pain of renal origin. Methods: Prospective, randomized, double blind clinical study including eighty patients with renal pain admitted in emergency department of a tertiary care teaching hospital. Parameters were observed at baseline and after 15, 30, 60, 180 minutes and 5hrs of drug treatment. The efficacy of the drug was measured by observing: Pain score, onset & duration of action, rescue drug use, global patient and physician impression. Results: Both drugs are effective in relieving pain of renal origin (p<0.05) and maintaining it over time as well. When decrease in value of pain score compared between two groups at various interval there was statistically significant (p<0.05) decrease in pain score only at 15 minutes in lornoxicam group showing this slightly more effective in early phase compared to diclofenac. In either group there is no statistically significant difference regarding onset of action, duration of action and side effect profile. Conclusions: Both the drugs are equally effective and safe in renal colicky pain with added advantage of lornoxicam being more effective in early period.

Use of polycarbonate plastic products and human health.

As plastic and plastic products are being used in day to day at the cost of environment pollution, the human and wild life health and has become a global concern. Researchers found link between abnormal liver enzymes in the people and Bisphenol-A (BPA). Changes in insulin resistance, reproduction system, cardiovascular and brain function are also reported. BPA is used in the production of epoxy resins, polycarbonate resins, and polyester resins. BPA can leach out of certain plastic products including variety of modern goods, reusable food storage containers, eyeglass lenses, white dental fillings, sealants, medical equipments etc. In the body, BPA behaves as an estrogen receptor agonist and mimics estrogen hormone. Bisphenol-A (BPA) is a widespread endocrine-disrupting chemical (EDC) used as the base compound in the manufacture of polycarbonate plastics. Children and unborn and new born babies are at high risk of unwanted effects of BPA. Children suffer from chronic exposure to bisphenol A with manifestation of gastrointestinal problems, adrenal stress, immune dysfunction, toxic over load and neurological disorders. Some study in Japan has observed that more BPA can leach from polycarbonate products that have been scratched or is more than 4 years old or used bottles that have been subjected to bottle brushing or dishwashing and sterilization. People exposed to higher levels of BPA due to use of plastic food and beverages containers are more likely to develop cardiovascular diseases, diabetes and metabolic disorder. Recent studies have suggested that BPA exposure may have a role in the development of weight gain, insulin resistance, pancreatic endocrine dysfunction, thyroid hormone disruption, and several other mechanisms involved in the development of diabetes. Urinary BPA levels are found to be associated with diabetes mellitus independent of traditional diabetes risk factors. There is a concern of exposure of BPA to pregnant women that can affect the development of offspring in the womb. It is considered that women may be placing their fetuses at the risk by having dental sealants applied during pregnancy. Public should be educated about the use of plastic and plastic products which can prove to be hazardous and risk factor to many health problems of human and wild life.

Treatment of rayon grade pulp drain effluent by upflow anaerobic fixed packed bed reactor (UAFPBR).

The Rayon grade pulp (RGP) drain effluent of pulp and paper mill was studied to find out pollutant loading and its control measures by low cost and efficient treatment method. Upflow anaerobic fixed packed bed reactor (UAFPBR) with brick ballasts as packing material was used for this purpose. This was compared with conventional anaerobic treatment method. The digested slurry was taken as inoculum from the active cow dung biogas plant. After stabilization of the reactors the reduction in pollutant loading was found to be higher in UAFPBR than conventional anaerobic reactor (CAR). Hydraulic retention time (HRT) of 12 hr was optimum for the treatment of effluent when 74.5% COD and 81% BOD reduction was obtained. 30% inoculum concentration was best for the anaerobic treatment of RGP colour drain effluent. The maximum biogas production (1.37 l l-1 of effluent) was when the effluent was inoculated with 30% seeding material. Thus, UAFPBR system was very efficient in terms of BOD, COD, TSS and TDS removal from RGP drain of paper mills in ambient environmental conditions.

In vitro effect of fl uoroquinolones against Mycobacterium tuberculosis isolates from Agra & Kanpur region of north India.

Background & objectives: Fluoroquinolones (FQs) are important drugs used for treatment of drug resistant tuberculosis and are also now being considered as fi rst line drugs to shorten the duration of treatment of tuberculosis (TB). In order to fi nd out useful FQs for treatment of tuberculosis, the comparative effi cacy of fi ve FQs, namely, ofl oxacin (OFL), ciprofl oxacin (CIP), sparfl oxacin (SPX), gatifl oxacin (GAT) and levofl oxacin (LEVX) was studied against Mycobacterium tuberculosis (MTB) isolates obtained from both treated and untreated patients from Agra and Kanpur regions of north India. Methods: A total of 162 MTB isolates [including 110 MTB isolates obtained from untreated patients (Cat-I) and 52 isolates from treated patients (Cat-II)] were tested for their susceptibilities to FQs using standard minimum inhibitory concentration (MIC) method on Löwenstein-Jensen medium. Results: Keeping in view the therapeutically achievable drug levels, it was found that in Cat-I 97.2 per cent (107/110) isolates were sensitive to GAT, 89 per cent (98/110) to LEVX at 1 μg/ml whereas 92.7 per cent (102/110) isolates were inhibited by OFL at 2 μg/ml and 73.6 per cent (81/110) to SPX at 0.5 μg/ml. Only 63.6 per cent (70/110) isolates were found to be sensitive to CIP at 2 μg/ml which increased to 89 per cent (98/110) at 4 μg/ml (higher than achievable peak serum level). On the other hand, among 52 isolates for Cat-II, 37 (71.2%) were found to be sensitive to GAT and 33 (63.5%) to LEVX at 1 μg/ml concentration, 28 (53.8%) to SPX at 0.5 μg/ml whereas 33 (63.5%) and 24 (46.2%) isolates were found to be sensitive to OFL and CIP at 2 μg/ml, respectively. Interpretation & conclusions: It appears that GAT has higher activity against MTB isolates followed by OFL, LEVX and SPX whereas CIP showed the lowest activity. GAT was also found to be the most effective FQ against multi-drug resistant (MDR) isolates both from Cat-I and Cat-II patients. Thus, except CIP, other FQs showed potential to be included in the treatment regimens of tuberculosis including MDR-TB.

Characterization of mycobacteria isolated from bovines by PRA-targetting hsp 65 gene region.

Bovine tuberculosis caused by the bacterium Mycobacterium bovis is a major infectious disease of animals and has zoonotic importance for humans. Even though the incidence is believed to be very low in India, human tuberculosis caused by M. bovis has been increasingly recognized in many other countries of the world. As differentiation of mycobacterial species take long time, a method for the rapid identification of mycobacteria isolated from bovine samples to the species level was used, which is based on polymerase chain reaction (PCR) of the gene encoding for the 65-kD protein followed by restriction analysis. The method involves restriction enzyme analysis of PCR products obtained with primers common to all mycobacteria and generate M. tuberculosis complex specific pattern. PRA was performed on 33 bovine isolates of which 90.9% (30/33) isolates were identified clearly as M. tuberculosis complex, M. fortuitum, M. phlei and M. smegmatis using restriction enzyme Hae III.

Differential modulation of nociceptive responses to mu and kappa opioid receptor directed drugs by blood glucose in experimentally induced diabetes rats.

The study has evaluated the effect of diabetes associated hyperglycaemia on nociception and antinociception induced by morphine, buprenorphine and pentazocine in female albino rats. Rats were allocated into 3 groups of 20 each--group I consisted of control having normal blood glucose levels (BGLs), group II consisted of streptozotocin-induced diabetics (STZ-D) having hyperglycaemia and group III consisted of diabetic rats controlled with insulin treatment. Immediately before and 15, 30 min, 1, 2 and 3 hr after injection with test drugs, rats were subjected to a thermal noxious stimulus using tail withdrawal from hot water and tail-flick latencies (TFL) so generated were recorded. Similarly, before and 30, 45 min and 1 hr after injection with drugs rats were subjected to abdominal writhing with hypertonic saline and number of writhes were counted per 90 sec. In STZ-D animals (BGLs 317.95 +/- 3.8 mg/dl) a decreased TFL with an increase in the number of writhes compared to control and diabetes controlled with insulin treatment was observed. Percent maximum possible effect of morphine (5 mg/kg, s.c.) and buprenorphine (2 mg/kg, s.c.) was significantly lower when compared to control as well as STZ-D controlled with insulin treatment groups. Similarly percent protection from writhing of morphine (0.05 mg/kg, s.c.) and buprenorphine (0.01 mg/kg, s.c.) was significantly less in comparison to control and STZ-D controlled with insulin treatment group. However, percent maximum possible effect of pentazocine (20 mg/kg, s.c.) and percent protection from writhing of pentazocine (1 mg/kg, s.c.) was significantly high in STZ-D rats when compared to control and STZ-D rats controlled with insulin treatment groups. The results suggest that both mu and kappa--opioid receptors may be modulated by blood glucose levels possibly involving cellular energetics mediated change in potassium (KATP) channels in females rats, albeit differentially.

A study of hypoglycaemic effects of Azadirachta indica (Neem) in normaland alloxan diabetic rabbits.

Hypoglycaemic effect was observed with Azadirachta indica when given as a leaf extract and seed oil, in normal as well as diabetic rabbits. The effect, however, was more pronounced in diabetic animals in which administration for 4 weeks after alloxan induced diabetes, significantly reduced blood glucose levels. Hypoglycaemic effect was comparable to that of glibenclamide. Pretreatment with A. indica leaf extract or seed oil administration, started 2 weeks prior to alloxan, partially prevented the rise in blood glucose levels as compared to control diabetic animals. The data suggests that A. indica could be of benefit in diabetes mellitus in controlling the blood sugar or may also be helpful in preventing or delaying the onset of the disease.

Evaluation of haloperidol, a dopamine antagonist, on intraocular pressure in experimental glaucoma.

Haloperidol, a dopaminergic antagonist, was found to be very effective in lowering intraocular pressure in normal and glaucomatous eyes. The potential ocular hypotensive effect of haloperidol can be utilized for the treatment of glaucoma.

Effect of nitrendipine, nimodipine and nisoldipine on experimentally induced myocardial infarction in rats.

Cardiac necrosis was produced in rats by administering isoproterenol sulphate (85 mg/kg, sc for 4 days). The myocardial damage was proved by observing the elevated levels of serum aspartate aminotransferase, ++alanine aminotransferase and lactate dehydrogenase and the changes were confirmed by his topathology. Nitrendipine, nimodipine and nisoldipine (10 mg/kg, ip) significantly reduced the elevated levels of these enzymes. The average degree of cardiac necrosis in these rats when observed microscopically and histologically was also found to be significantly reduced on pretreatment with these drugs. Nisoldipine was more effective in preventing cardiac necrosis as compared to nitrendipine and nimodipine.

Cerebral palsy--an etiological study.

Five hundred and forty four cases of cerebral palsy were studied to find the etiology. Male to female ratio was 1.9:1. Prenatal, natal and postnatal factors were found in 42 (7.72%), 238 (43.75%) and 142 (26.1%) cases respectively. Only 79 (14.52%) cases were found to have more than one factor which could have contributed to brain damage. In 43 (7.9%) cases the prenatal, natal and postnatal history were normal and the cause was not known. Toxemia (1.29%) cases and microcephaly (1.84%) cases were the most common etiological factors in the prenatal category. Among the natal causes, birth anoxia was the most common etiological factor and was observed in 24.45% cases. Infections of the central nervous system comprised the major etiopathogenetic factors of the postnatal causes--11.95% cases had encephalitis, while 5.15% cases had meningitis. In cases where more than one etiology was present, the most frequent causes were a combination of prematurity or birth anoxia in association with toxemia, antepartum hemorrhage, prolonged labour, twins, forceps or caesarean delivery. Anoxia was consistently the most common etiological factor in those cases of monoplegia paraplegia, quadriplegia, diplegia, and ataxia, i.e. in 0.55%, 1.29%, 11.76%, 6.07% and 0.55% cases respectively. The present study reveals that majority of the cases were found to have natal or post natal etiology.

Cerebral palsy.

The clinical pattern and etiology of 544 cases of cerebral palsy were studied retrospectively. Of these cases, 354 (65.1%) were males. Four hundred and ninety seven (91.4%) cases were of spastic type. Hypotonic, ataxic and athetoid cerebral palsy were observed in 5.5, 1.5 and 1.3% cases, respectively. There was one case each of tremor and mixed type. In the spastic group, quadriplegia comprised the maximum number of cases (34.9%). Hemiplegia (28.7%) and diplegia (21.9) were also common. Mental retardation was found in 47.2%, while speech impairment was observed in 37% cases. Other handicaps included visual (9%), seizures (8.8%), and auditory handicap (2.9%). The etiological factors were prenatal in 7.7% cases, natal in 43.8% cases and postnatal in 26.1% cases. More than one etiological factor was observed in 14.5% cases, while in 7.9% cases, no apparent cause could be found.

Subacute toxicity of adsorbed 250 Lf tetanus toxoid in rats.

Since the naturally acquired tetanus antitoxin titre in Indian population is mostly less than protective levels, to minimise the incidence of morbidity, Glaxo Laboratories (India) Ltd., Bombay have prepared a single dose potent tetanus vaccine of 250 Lf as compared to 5 Lf previous tetanus toxoid. Subacute toxicity study revealed that this toxoid (250 Lf) injected at different dose levels (1-2 ml/rat/injection x 4) is non-toxic to rats.

Failure of reversal of cardiovascular responses of clonidine by centrally administered naloxone in anaesthetised rats.

Central effects of naloxone on the cardiovascular responses of centrally administered clonidine were studied in anaesthetised normotensive, renal DOCA-salt hypertensive and morphine dependent rats. Clonidine (5 micrograms/ICV) produced significant decrease in blood pressure and heart rate in all the groups of rats in a dose dependent manner. Naloxone (2 micrograms/ICV) failed to reverse the responses of clonidine in all the rat groups. In morphine dependent normotensive and morphine dependent renal DOCA-salt hypertensive rats, the responses of clonidine were further enhanced in the presence of naloxone. Our observations clearly indicate that clonidine does not influence endogenous opioid system for producing cardiovascular effects.