EEG microstates in resting condition in young indians

Objectives: The map topography analysis gives an idea of temporal dynamics of electric fields, which is reference independent, making the results unambiguous. These topographic maps remain stable for 80 to 100 milliseconds, abruptly shifting to a new topographic map configuration and remains stable in that state are called the ‘functional microstates’ as described by Lehmann et al (1987). There has been no study done in the resting state eye closed and eye open conditions showing the microstate maps in healthy Indian subjects in resting eyes open and resting eyes closed condition using 128 channel EEG. So our study aim was to assess the microstates in resting eyes closed and eyes open condition. And to compare the microstate parameters such as mean duration, global explained variance (GEV) and time coverage between eyes closed and eyes open condition. Materials and Methods: A cross-sectional and observational study on 20 indian subjects (Mean age- 26.65 and (SD) - 2.78 years) was done on resting eyes closed and eyes open conditions. After EEG acquisition using 128 channel EEG machine, EEG was preprocessed and microstate analysis using CARTOOL software was performed on the EEG data. Results: After microstate analysis four maps topography were obtained. There was statistically non-significant difference observed in microstate maps between resting eyes closed and resting eyes open condition for the all parameters i.e. mean duration, time coverage and GEV. Conclusion: Our findings suggests that, both eyes closed and eyes open conditions were similar to each other in terms of stability and predominance of Maps

Silent Thecoma of Ovary - A Rare Case.

Theca cell tumours are benign ovarian tumours. These tumours are of stromal origin. Most commonly they are seen in premenopausal and postmenopausal women. Usually they are asymptomatic and are found incidentally. Ovarian cancers can be of benign and malignant type. According to WHO classification, they are classified as epithelial, germ cell, sex cord stromal tumours and others.1 Among them epithelial ovarian cancer are most common, and the least common variety is of sex cord stromal tumours. About 1% of ovarian cancers are thecoma.2 These tumours are most commonly found in postmenopausal women however about 2% of stromal tumours occur in young girls.3 Theca cell tumours are also known as hormone producing tumours as they produce oestrogen hormone. Usually the patient presents with complaint of post-menopausal bleeding because of the oestrogen which is secreted by theca cell tumours. Imaging modalities (ultrasonography and CT scan) are of little help in differentiating thecoma from other types of ovarian tumours, because of radiological close resemblance to other tumours.4 Here we enlightened the symptomless presentation of such a huge thecoma which was diagnosed incidentally.

Prospective interventional study of staple line reinforcement and buttressing in laparoscopic sleeve gastrectomy

Background: Laparoscopic sleeve gastrectomy has gained increasing acceptance among bariatric surgeons and patients. The three main options for staple line reinforcement are over-sewing and buttressing with synthetic polymers or biologic tissue. The purpose of this study was to prospectively analyse the relative efficacy of gastric staple line reinforcement (SLR) by using over sewing as the method of reinforcement and comparing it with non-reinforcement laparoscopic sleeve gastrectomy (LSG) in 60 patients who were admitted in IGGMC Nagpur from May 2017 to November 2019.Methods: Obese patients with age 18-65 years, BMI 40 and above with-out co-morbidities and 35 and above with co-morbidities, and BMI below 60, with no malignancy, no hiatus hernia, no previous bariatric procedure were included. All patients underwent LSG after thorough evaluation. 30 patients had reinforced staple line, while 30 had simple staple line.Results: Total 60 patients were studied, 30 in each group. Intraoperative leak was seen in 1 patient each in both study groups. No bleeding was seen in reinforced LSG, while 3 patients had intraop bleeding in simple staple line group. 1 patient each of non-reinforced group had postop leak, postop bleeding and post op morbidity and mortality in 1 patient, while no postop leak or bleeding, morbidity or morality was seen in reinforced group.Conclusions:Reinforcement of staple line by over sewing in LSG resulted in significantly fewer surgical complications, lesser morbidity and no mortality compared to simple stapling of the gastric tube.

A Study of Nutritional Health Problems of Adolescent Girls in Rural Area of Nagpur District: A School Based Cross Sectional Study

Introduction: "Adolescence" literally means "to emerge"or "to attain identity" and is essentially the period of rapidphysical and psychological development. The World HealthOrganization (WHO) defines “adolescent” as an individualbetween 10 to 19 years of age. About 19.7% of Indianpopulation is adolescents. Nutritional health problems areone of the important health problem faced by adolescents.Prevalence of anemia in adolescents (15-19 years) girls is54%. Underweight is seen among 46.4% adolescent girls.Hence this study was conducted to find out nutritional healthproblems of adolescent girls in a rural area of Nagpur district.Menstrual hygiene was also studied.Material and methods: A cross sectional study was carriedout in one of the randomly selected school in a rural area ofNagpur. Calculated sample size was 145, though the studywas carried out on 150 adolescent girls in August 2019 usinga pre-designed and pre- tested questionnaire.Results: Mean age of study participants was 14.87± 2.77years. Prevalence of anemia was found to be 80%. Prevalenceof undernutrition was 36%. None of the student receivedweekly iron and folic acid tablets in last three months. Only28% study subjects received information of menstrual hygieneprior to menarche.Conclusion: Prevalence of anemia and undernutrition wasfound to be high in a school of rural area of Nagpur district.WIFS program should be strengthened through inter-sectoralcollaboration among health and education sectors

Knowledge and attitude about leprosy among medical students and interns at tertiary care centre of central India: a cross-sectional study

Background: Leprosy has been known to the Indians since the Vedic period. Leprosy is synonymous with social stigma due to reasons like mystery around its transmission, lack of knowledge on available treatment, deformities and religious views. Prejudice and lack of knowledge about leprosy exist even among medical practitioners and healthcare professionals around the world. Considering above mentioned facts, this study was conducted to study knowledge and attitude of medical students and interns towards leprosy. Methods: A cross-sectional study was conducted at IGGMC, Nagpur, among Third MBBS part one of 7th semester medical students who were exam going for community medicine and interns of IGGMC between October 2018 to January 2019. Questionnaire comprised of 27 knowledge-based and 22 attitude–oriented questions. In all total 210 subjects, 99 Interns and 111 students were enrolled for the study. Results: Mean age of interns was 23.52±0.66 years and that of students was 21.45±0.85 years. There was no significant difference in knowledge regarding cause and modes of transmission and clinical features of leprosy between interns and student however interns were having significant higher knowledge regarding diagnosis, treatment, prevention of deformity limitation and precaution to be taken against leprosy. Only 13(6.19%) participants were having knowledge regarding targets of NLEP that was to be achieved by year 2017. Though both interns and students both showed good attitude towards leprosy but only 34 interns and 31 students had ever rendered service or donated money for cause of leprosy. Conclusions: Knowledge regarding national program is limited in both groups, curriculum should be strengthen pertaining to National program.

Choroidal thickness in normal Indian eyes using swept-source optical coherence tomography

Purpose: The purpose of this study is to provide normative database for subfoveal choroidal thickness in Indian eyes using swept-source optical coherence tomography. Methods: This is a cross-sectional study based at a tertiary eye care center in Northern India. Two hundred and thirty eight eyes of 119 healthy subjects were examined in terms of axial length, spherical equivalent, and choroidal thickness. Inclusion criteria included age 19� years, no retinal or choroidal disorder, and patients with clear media and good fixation. Patients with high hypermetropia (>4 D) or myopia (>6 D) or any systemic disease likely to affect choroidal thickness were excluded. Twelve radial line scans were obtained centered on the fovea that were used to calculate choroidal and retinal thickness in 9 early treatment diabetic retinopathy study (ETDRS) zones. Results: The mean age of all the subjects was 28.70 � 11.28 years; mean axial length was 23.63 � 1.96 mm, and mean spherical equivalent was ? 0.92 � 3.08 D. The mean subfoveal choroidal thickness was 299.10 � 131.2 ? and mean foveal thickness was 239.92 � 48.16 ?. A negative correlation was found between subfoveal choroidal thickness and age (r = ?0.0961, P = 0.1392) and axial length (r = ?0.3166, P < 0.001). A statistically significant positive correlation was found between subfoveal choroidal thickness and refractive error (r = 0.2393, P = 0.0002). Conclusion: This study provides normative database for subfoveal choroidal thickness and foveal thickness using swept-source optical coherence tomography. The choroidal thickness measured with swept-source platform is slightly higher than that reported with spectral domain platforms.

The Efficacy and Safety of Tetrachlorodecaoxide in Comparison with Super-oxidised Solution in Wound Healing

BACKGROUND: Some of the relatively newer, more efficacious, and potent topical wound dressing solutions include tetrachlorodecaoxide and super-oxidised solution. This study compares the efficacy and safety of these two drugs. METHODS: This is a block-randomised, double blind, parallel-arm, post-marketing study. One hundred fifty patients with ulcers (75 blocks uniform for sex, ulcer aetiology, diabetes mellitus, and wound area score) were randomised into the two treatment arms. Patients were observed for eight weeks with weekly assessments. One hundred and twenty patients completed the study. Wound healing was objectively assessed by measurement of wound area, scoring of wound exudation and tissue type, and using the pressure ulcer scale of healing Tool (validated for multiple wound aetiologies). Subjective improvement in pain was noted using a visual analogue scale. Both groups were compared using Mann–Whitney U test on all indicators. RESULTS: Difference in change in wound tissue type in the two groups was significant (α=0.05) by intention-to-treat (ITT) and per-protocol (PP) analysis at the end of week two (ITT and PP, P0.05). No study-related adverse events were observed. CONCLUSIONS: Both drugs are efficacious. Tetrachlorodecaoxide yields healthy granulation tissue earlier. Both drugs appear to be safe for application.

Pulse cyclophosphamide therapy in the management of patients with macular serpiginous choroidopathy.

Purpose: To evaluate safety and efficacy of intravenous pulse cyclophosphamide (CyP) in acute macular serpiginous choroiditis (SC). Methods: Patients with acute macular SC with lesions threatening and/ or involving fovea were enrolled. All patients received CyP (1 g/m2) for 3 days followed by high‑dose oral steroids (1.5 mg/kg) tapered over 6 months and monitored for visual acuity, response to treatment and systemic side effects. Results: Eight patients (seven unilateral and one bilateral) with median age of 27 years (range: 13-40 years) were recruited. Mean visual acuity at presentation was 0.71 ± 0.35 logarithm of the minimum angle of resolution while postpulse visual acuity was 0.40 ± 0.32. Final mean visual acuity at 1‑year was 0.31 ± 0.23 (P ≤ 0.05). Three eyes had recurrence and 3 patients developed transient hair loss with no other adverse effect. Conclusion: Intravenous CyP provides rapid resolution of lesion activity and thereby helps in maintaining good functional acuity.

Bacteriostatic activity of con a lectin from Canavalia ensiformis.

The aim of this work was to explore the therapeutic applications of Con A lectin from Canavalia ensiformis and to explore its antibacterial activity. Activity of lectin was quantified by their ability to agglutinate erythrocytes using Hemagglutination assay. Characterization and purity of Con A lectin was evaluated by using SDS-PAGE analysis. The reversal of hemagglutination activity of lectin was evaluated by using the sugars namely; mannose, galactose, lactose, fructose, glucose. The antibacterial activity of lectins was tested against Streptococcus mutans, Staphylococcus aureus, Bacillus subtilis, Escherichia coli using pour plate method. Amoxycillin was used as standard. At 250mg/ml concentration Con A lectin showed good bacteriostatic activity.

Sublingual piroxicam in the management of postoperative pain after surgical removal of impacted mandibular third molar.

Introduction: Surgical removal of impacted mandibular third molar is one of the most commonly performed procedures in oral and maxillofacial surgical practice. The role of preoperative and postoperative medications for management of postoperative complications has been extensively evaluated. Aim: To assess the therapeutic effect of a single dose of 40 mg sublingual piroxicam (study group) vs 150 mg oral diclofenac (50 mg thrice a day) (control group) in patients undergoing surgical removal of impacted mandibular third molar. Materials and Methods: A total of 100 patients with asymptomatic impacted mandibular third molars were randomized into two groups. One group received two 20-mg tablets of piroxicam once daily on the first and second postoperative days, followed by one 20-mg tablet on the third post-operative day. The other group received one tablet of diclofenac 50 mg orally thrice daily on the first, second, and third post-operative days. Repeated extraoral examinations were done for continuous assessment of swelling, trismus, and reduction in pain. Ovearall impression of the treating physician and the patient regarding efficacy of study drugs were recorded at the end of the study. Results: In the piroxicam group there was >50% reduction in pain on all three days postoperatively. The incidence of swelling and trismus was found to be higher in the control group as compared to the study group. Adverse events, such as gastrointestinal (GI) disturbances, were significantly higher in the diclofenac group (11%) as compared to the piroxicam group (0%). Conclusion: Two sublingual piroxicam 20 mg tablets once daily has better efficacy and tolerability profile than diclofenac 50 mg one tablet thrice daily in the management of pain after surgical removal of impacted mandibular third molar. Study Title: A Comparative Study to Evaluate Clinical Efficacy and Safety of Sublingual Piroxicam and Diclofenac in the Management of Pain after Surgical Removal of Impacted Mandibular Third Molar.

Cardiopulmonary exercise testing in evaluation of patients of chronic obstructive pulmonary disease.

Background. Objective assessment of severity in patients with chronic obstructive pulmonary disease (COPD) is mainly limited to pulmonary function testing performed at rest. But, accurate assessment of exercise capacity in patients with COPD may be possible with cardiopulmonary exercise testing (CPET). Methods. Forty-three patients with stable COPD were included and were divided into three groups based upon the spirometry data as per the Global Initiative for Obstructive Lung Disease (GOLD) guidelines as follows: Group A: mild COPD, Group B: moderately severe COPD and Group C: severe COPD. Symptom-limited CPET was performed using treadmill on incremental continuous ramp protocol in all of them. Results. Five patients (11.6%) had mild COPD; 16 (37.2%) had moderately severe COPD and the remaining 22 (51.6%) patients had severe COPD. Anaerobic threshold was attained in all the 43 patients. The dominant symptom at peak exercise were dyspnoea (n=19) and both dyspnoea and leg fatigue (n=7). The other causes of exercise limitation included dyspnoea with significant oxygen desaturation (n=6); and dyspnoea with severe oxygen desaturation (n=2). Six patients complained only of leg fatigue at peak exercise. A significant correlation between forced expiratory volume in the first second (FEV1) percent predicted and the predicted maximum oxygen uptake (VO2 max % predicted) was observed in all the three groups (r=0.39, p=0.011) but with marked variability of peak VO2 for a given degree of airflow obstruction. Twenty-three (53.5%) patients with low anaerobic threshold (<30%) were identified as potential group likely to benefit from exercise training for pulmonary rehabilitation. Conclusions. Cardiopulmonary exercise testing is useful to determine the causes of exercise limitation and to assess the maximal exercise capacity of patients with COPD.

Synthesis and spectral study of 1-(1-hydroxycyclohexane-1-yl)-n-substitutedthioamidoformamidinobenzyl

A novel synthesis of series of 1-(1-hydroxycyclohexane-1-yl)-Nsubstitutedthioamidoformamidinobenzyl (3a-e) was synthesized by the reaction of 1-(1- hydroxycyclohexane-1-yl) benzylcyanide (1) with various thiocarbamides (2a-e) and hydrochloric acid in acetone-ethanol (1:1) medium. Firstly the formation of products was justified on the basis of gas chromatography technique. Their separation was carried out by column chromatography. On these two chromatographical technique, reaction conditions were set for the isolation of pure products. The structure of all the synthesized compounds were justified on the basis of usual chemical characteristics, IR, and NMR spectral analysis respectively.

Spirometry and diffusion studies in patients with type-2 diabetes mellitus and their association with microvascular complications.

Background. Diabetes is a systemic disease with-well known complications involving eyes, kidneys and nerves. The presence of an extensive pulmonary microvascular circulation and abundant connective tissue raises the possibility that lung may also be a target organ in diabetes. Methods. A total of 45 subjects were included in the study. All patients were evaluated for diabetic microangiopathies: nephropathy (by 24-hour protein excretion), retinopathy (by direct ophthalmoscopy) and neuropathy (by clinical examination). The patients were divided into following three groups: Group A: patients with type-2 diabetes mellitus (DM) with evidence of microangiopathy (n=15); Group B: patients with type-2 DM without any evidence of microangiopathy (n=15); Group C: non-diabetic subjects (n=15) as controls. Glycosylated haemoglobin (HbA1C) was measured as an indicator of glycemic control. Spirometry and single-breath diffusion capacity for carbon-monoxide (DLCO) were performed on all patients using Elite Series Body Plethysmograph machine. Results. A significant reduction of diffusion capacity corrected for alveolar volume (%DL/VA) was observed in group A (p<0.001), as compared to the other groups. There were no differences among the three groups for other pulmonary functions. There was a significant correlation between DL/VA percent predicted and albuminuria (r= -0.975, p<0.001), and DL/VA percent predicted and the retinopathy (r = -0.550, p< 0.05). Conclusion. This study shows a mild reduction in diffusing capacity in patients with type-2 DM with microangiopathy.

MR Imaging of The Wilson’s Disease.

Wilson’s disease is known to have various hepatic manifestations like acute hepatitis, chronic hepatitis, cirrhosis of liver and acute fulminant hepatic failure can occur in early childhood. However, we report here Wilson’s disease, presented with neurological manifestations without hepatic involvement.

Antenatal Detection of Renal Malformations.

Our aim was to study the incidence and outcome of antenatally detected renal malformations in rural Maharashtra. Among 7365 deliveries conducted during the study period, antenatal screening for renal malformations was done in 6682 (90.7 %) deliveries. Renal malformations were detected in 35 fetuses on antenatal screening. Postnatal investigations confirmed renal malformations in 27 babies (77.1%), giving an incidence of 0.4% among liveborn babies. Seven babies were operated and 2 were awaiting surgery (33.3%). Two patients expired and another two were lost to follow-up. The outcome was satisfactory in other patients. Antenatal screening was a useful tool in diagnosing renal malformations.

Utility of intrapleural streptokinase in management of chronic empyemas.

BACKGROUND: The nonsurgical medical approach with use of fibrinolytic agent is an alternative modality in management of chronic empyemas. With the introduction of purer forms of streptokinase, there has been renewed interest generated in the use of intrapleural thrombolytics with documented successful drainage of difficult to drain chronic empyemas. To evaluate the utility of streptokinase in the management of chronic difficult to drain empyemas in a single blind randomized case control study. MATERIAL AND METHODS: Twenty four cases of chronic/multiloculated empyema were included which had cases preferred having loculations or multiloculations and failure of drainage via thoracostomies for less than 100 ml during last 24 hours. Cases were randomized into two groups as 12 cases of streptokinases group and 12 cases of placebo group. Streptokinase given as 2.5 lac units in 100 ml of normal saline instilled intrapleurally for 6 consecutive days. In control group, 100 ml of normal saline without streptokinase was instilled intrapleurally through intercostal drain for 6 days. They were assessed by amount of drainage through intercostal drain for six days after instillation of streptokinase/placebo, duration of intercostal drainage in situ, and radiological improvement by standard x-ray chest. RESULTS: The study revealed increased drainage through intercostal drain in streptokinase group compared to control group. The mean duration of intercostal drainage in situ was shorter in streptokinase group compared to control group. Radiologically, streptokinase group revealed score 3 improvement in eight out of twelve cases and score 2 improvement in rest of the four cases. In control group, score 1 improvement was seen in two out of twelve cases and no improvement was seen in rest of the 10 cases. The observation difference is found to be highly significant statistically (p <0.001). No major adverse effects were noted in the streptokinase group. CONCLUSION: The study concludes the safety, efficacy, reduced hospital stay and decreased morbidity in patients treated with intrapleural streptokinase as compared to control group.

Study of superior vena cava syndrome--aetiopathology, diagnosis and management.

Thirty two patients of superior vena cava syndrome (SVCS) were studied. Clinical features noted were diffuse neck swelling, breathlessness, chest pain, engorged neck veins, facial swelling and dilated engorged veins over chest wall. Radiography revealed a superior mediastinal mass in 31.2% of patients and right upper lobe mass in 50% patients. FNAC of lung showed aetiology in 34.5% patients and lymph node biopsy in 31.2% patients. Aetiology of SVCS was benign in 12.5% patients and malignant in 87.5% patients. Squamous cell carcinoma was the commonest cause of SVSC. Radiotherapy proved to be the most beneficial form of treatment. The mean survival period in patients due to malignant etiology was 6 months.

Cryptococcosis: involvement of more than one system.

We report a 37-year-old female patient with pulmonary cryptococcosis who presented with a one week old history of cough and fever. Within a week of admission, she developed cryptococcal meningitis and 5 months later cryptococcomas of the brain were detected. She was successfully treated with 2 courses of amphotericin-B at an interval of 5 months. 5-flucytosine was also administered initially along with amphotericin-B. The pulmonary lesions resolved completely whereas the cryptococcomas reduced in number.