Does the morbidity management and disability prevention (MMDP) clinic serve the filarial lymphedema (FLE) patients’ preeminent expectation?

@#Advocacy and training on “Home care” for filarial lymphoedma (FLE) patients are provided through morbidity management and disability prevention (MMDP) clinic commonly known as filariasis clinic and clinical improvement is assessed by follow-up visits. While the physicians aim at reducing the recurrent ADL (coined as ADLA in 1997) episodes, the patients expect reduction in LE volume. The objective of the present study was to know whether the MMDP clinic serves the primary expectation of the FLE patients. LE patients who attended the clinic for at least four follow-up consultations and had LE volume measurements at three points of time during the one year period of observation were considered for analysis. Clinical assessment was done for LE grading and LE volume was measured by water displacement volumetry. Sixty-three patients who fulfilled the follow up criteria were included. It was observed that the median LE volume was 914ml (IQR 269 – 1935) at first visit of the observation period which reduced to 645ml (IQR 2151666) and 752ml (IQR 215 – 1720) at first and second follow-up visits respectively. Over all, in short span of one year, 21 of the 63 patients (33.3%) who visited MMDP clinic at least four times in a year were benefitted through the MMDP advocacy and the National filariasis control programme need to emphasise on the importance of follow up visits to FLE patients.

A Cadaveric Study Of Variations In The Urological System

Introduction: Knowledge of anatomical variations of the urinary system is important for urological surgeriesinvolving renal transplant and radiological interpretations. When urologists and clinicians have a soundknowledge of anatomical variations, it eases management, surgical interventions and helps to reducecomplications.Advanced imaging technology is the boon for the patients requiring minimally invasive approaches for variouskidney disorders. These approaches require precise knowledge of normal and variant anatomy of the kidneys,ureters and vascular structures at the hilum of the kidney. Therefore, the objective of this study was to furnish theclinicians with the major anatomical variations of urological system.Method: Ninety adult human cadavers were examined for number, shape and position of kidneys and the uretersover a period of 5 years. Out of these, 85 were males and 15 were female cadavers.Results: Kidneys were bilaterally present in all the cadavers. Hypoplastic kidneys were seen bilaterally in 3.3%cadavers. Out of 90 cadavers, 3 showed bilateral and 6 showed unilateral lobulated kidneys. 2 cadavers showedunilateral (1 L, 1 R) incomplete double ureter. One showed bilateral and 5 showed unilateral accessory renalartery amongst 90 cadavers. Ectopic kidney was seen in one cadaver.Conclusions: Morphological variations in the kidney are very common and are clinically important for urosurgeons

Problem Based Learning In Anatomy – Our Experience.

Background: Presently Anatomy is taught in a traditional way through lectures, small group teaching and demonstration. All these are teacher-controlled methods for teaching as per Medical Education Technology. So it was decided to introduce a learner-controlled method for teaching of Anatomy i.e. problem-based learning (PBL) with the following. Objectives:To compare the performance of the students undergoing PBL with the performance of the students taught in a traditional way To compare the perception of the students about PBL in comparison to Traditional way Materials and methods: 32 students who volunteered for the study were divided into two groups. The first group was taught cerebellum by PBL method and the second group was taught cerebrum by PBL method. Cross over method was then applied. Thereafter a theory examination was conducted. A feedback questionnaire was given to the students after the examination. Results: The average score of the students in the PBL group was more than that of the students in the lecture group in 60% questions. The score was same in 20% questions. The score was reverse in 20% of questions. PBL was appreciated and accepted by the students. It can be introduced partly in the existing curriculum.

Uncommon Parameters for Hip bone sexing.

Background- It is very difficult to determine sex of skeleton when pieces of skeletal bones are exhumed Objectives- Thus our study aims at: 1. Finding accuracy of the previously set criteria for sexing of hip bone. 2. To find the validity of other criteria in sexing of hip bone by which sex of the skeleton can be determined from small portion of hip bone. Methods- 200 hip bones of known sex (100 male and 100 females) were studied from various medical colleges. Results and Interpretation- Unpaired 't' test was found to be highly significant when values of true pelvic height in males and females were compared. Similarly, 'p' value was found significant in comparing mid-pubic width in males and females. Mean of distance from ischial tuberosity to farthest rim of acetabulum in males was found to be more than that of the females. Very significant differences were observed in the mean of pubic length and acetabular diameter in females. The index mentioned by Maclaughline and Bruce in 1985 was calculated in males and females. The index showed a value of 100.226 in males and 126.944 in female. Conclusion- Apart from the previously mentioned criteria in hip bone sexing, the study helped to prove the importance of following criteria in hip bone sexing : 1.True pelvic height 2.Mid-pubic width 3.Distance from ischial tuberosity to farthest rim of acetabulum 4.Index mentioned by Maclaughline and Bruce 5.Distance from anterior superior iliac spine to pubic tubercle 6.Distance from anterior superior iliac to iliopubic eminence.

Detection of day blood filarial antigens by Og4C3 ELISA test using filter paper samples.

BACKGROUND: The launching of the global filariasis elimination programme has necessitated the use of highly sensitive and specific diagnostic tests. The Og4C3 monoclonal antibody-based ELISA test has been found to be highly specific and sensitive for the diagnosis of filariasis using night blood samples. However, it requires a serum sample which poses problems of transport and storage. Collection of blood samples on filter paper the will greatly circumvent these problems. Therefore, we evaluated the utility of the Og4C3 assay on filter paper samples collected during daytime. METHODS: Blood samples were collected from 63 microfilariae (mf) carriers during different time periods in a day on filter paper discs as well as venous blood for sera. The mf carriers and chronic (hydrocele n = 20; lymphoedema n = 120) and acute filariasis (adenolymphangitis n = 39) patients were from the endemic areas and the non-endemic normals were from Uthagamandalam district of Tamil Nadu, India. The filarial antigens in the samples were determined using the Og4C3 filarial antigen assay as per the manufacturer's instructions (JCU TrapBio, Australia). The sensitivity of the assay on sera and filter paper samples collected during night and also on filter paper samples collected during different time intervals of the day were compared with those of the membrane filtration technique, which was used as a gold standard. RESULTS: The geometric mean titre of the sera samples collected during night was 11 units/ml for non-endemic normals and 601.2 units/ml for mf carriers. The specificity of the assay on sera samples collected during night was 100% and the sensitivity 96.8% and the positive and negative values were 100% and 95.2%, respectively. The antigen positivity of the filter paper samples collected during morning hours was 93.3% while it was 76.6% and 86.7% for afternoon and evening hours. A significant association was observed between antigenaemia levels and mf density in the blood samples collected during the night. CONCLUSION: The samples collected on filter paper during the day can be used as an alternative to sera samples for detection of filarial antigens employing Og4C3 ELISA. Also, samples collected during morning hours yield a higher positivity. The assay when applied to serum samples will be useful especially when quantitative results are required.

Factors influencing response to lymphonodovenous shunt in filarial lymphoedema.

BACKGROUND: Although several studies have been published on lymphonodovenous shunt, there are no objective data either on the outcome of lymphoedema or on various parameters likely to influence the results. METHODS: A trial of lymphonodovenous shunt was carried out in 75 patients with unilateral filarial lymphoedema. The primary aim of the trial was to identify a cohort of responders as against non-responders and to correlate the outcome with various factors such as age, gender, duration and preoperative grade of lymphoedema, number of preoperative attacks of adenolymphangitis, operative impression of the lymph node, effect of venous reflex and type of nodovenous anastomoses. Change in oedema volume was measured objectively by water displacement method using the normal limb as a control. RESULTS: There was no operative mortality. Predominant postoperative complications included wound haematoma (8.5%), wound infection (13.6%) and transient lymphorrhoea (13.6%). In the immediate postoperative period, a reduction of 25%-50% in the oedema volume was recorded in 46.7% of cases and of more than 50% in 17.3% cases. The difference in response with respect to the type of lymphonodovenous shunt was not statistically significant, although the end-to-side type of shunt showed marginally better results. The response was significantly higher in patients with preoperative oedema volume more than 2 L. There was a significant reduction in postoperative attacks of adenolymphangitis, irrespective of the reduction in oedema volume. Of the 75 patients, 22 showed regression of oedema volume to preoperative or higher levels in the postoperative phase. A majority (21/22) could be identified as non-responders within 3 months of surgery. CONCLUSION: The best results of lymphonodovenous shunt were seen in patients with large-volume lymphoedema. The results are better when combined with early excisional surgery. Other factors did not significantly affect the outcome. Non-responders could be identified within 3 months after surgery. Even in patients who did not respond well, a significant decrease in the frequency of adenolymphangitis attacks was observed. Higher initial oedema volume and history of higher frequency (25-50 per year) of adenolymphangitis attacks can be considered as indicators for good response to lymphonodovenous shunt.

Tropical vaginal hydroceles: are they all filarial in origin?

Hydrocele of the tunica vaginalis testis has been conventionally used as an absolute indicator of filarial disease in most clinical surveys. The prevalence of filarial etiology in 100 consecutive hydroceles was studied using clinical, parasitological, histopathological and immunological parameters. Filarial etiology could be proved in 57% of hydrocele cases using major criteria: presence of microfilaria in hydrocele fluid, presence of chyle in hydrocele fluid, demonstration of adult worm in tunica, ratio of fluid antibody titer to serum antibody titer more than 2 and presence of filarial antigen in hydrocele fluid. The results of other tests in these 57 cases were used to define the minor criteria. In the other 43 cases, based on the minor criteria, 12 hydroceles could be classified as likely to be due to filariasis and the rest were probably non-filarial. Thus only 69% of hydroceles were definitely or probably filarial.