Vibration upshot of operating mechanical sewing machine: an insight into common peroneal nerve conduction study

BACKGROUND: Most of the people associated with tailoring occupation in Nepal are still using mechanical sewing machine as an alternative of new technology for tailoring. Common peroneal nerves of both right and left legs are exposed to strenuous and chronic stress exerted by vibration and paddling of mechanical sewing machine. METHODS: The study included 30 healthy male tailors and 30 healthy male individuals. Anthropometric variables as well as cardio respiratory variables were determined for each subject. Standard Nerve Conduction Techniques using constant measured distances were applied to evaluate common peroneal nerve (motor) in both legs of each individual. Data were analyzed and compared between study and control groups using Man Whitney U test setting the significance level p ≤ 0.05. RESULTS: Anthropometric and cardio respiratory variables were not significantly altered between the study and control groups. The Compound muscle action potential (CMAP) latency of common peroneal nerves of both right [(11.29 ± 1.25 vs. 10.03 ± 1.37), P < 0.001] and left [(11.28 ± 1.38 vs. 10.05 ± 1.37), P < 0.01] legs was found to be significantly prolonged in study group as compared to control group. The Amp-CMAP of common peroneal nerves of both right [(4.57 ± 1.21 vs. 6.22 ± 1.72), P < 0.001] and left [(4.31 ± 1.55 vs. 6.25 ± 1.70), P < 0.001] legs was found significantly reduced in study group as compared to control group. Similarly, the motor nerve conduction velocity (MNCV) of common peroneal nerves of both right [(43.72 ± 3.25 vs. 47.49 ± 4.17), P < 0.001] and left [(42.51 ± 3.82 vs. 46.76 ± 4.51), P < 0.001] legs was also found to be significantly reduced in study group in comparison to control group. CONCLUSION: Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left common peroneal nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

neonate with aplasia cutis congenita type VI with junctional epidermolysis bullosa: a very rare condition

This study aimed to describe a case of aplasia cutis congenita with epidermolysis bullosa, as only a few reports of Bart's syndrome exist in the medical literature. Aplasia cutis congenita [ACC] is a rare dermatological condition characterized by the absence of skin. It has no proven etiology and hence stills remains a mystery for the dermatologist of the modern world. The most common body part affected is the scalp. ACC with epidermolysis bullosa [Bart's syndrome] is a very rare variant of aplasia cutis

Posterior prostatic urethral diverticulum as a cause of recurrent febrile urinary tract infection in an infant: an infrequently seen condition and literature review

This study aimed to report a case of recurrent urinary tract infection [UTI] with Escherichia coli in an infant, secondary to the prostatic urethral diverticulum. Neonatal UTI is a rare cause of late -onset sepsis with an incidence of 1.1% in term neonates. Recurrent UTI in infancy is often associated with vesicoureteral reflux. A prostatic urethral diverticulum is an extremely rare cause of recurrent UTI in neonatal age group. The infant in the present case was treated with intravenous antibiotics and discharged on oral antibiotics prophylaxis. The infant is in regular follow-up with no readmission for repeat UTI. This was a rare presentation of a prostatic urethral diverticulum in newborns/infants. Treatment involves antibiotic prophylaxis with regular urological follow-up

Unruptured rudimentary horn pregnancy presenting with acute haemoperitoneum with combined intrauterine pregnancy: a case report

The incidence of rudimentary heterotopic uterine horn pregnancy varies from 1:76,000 to 1:140,000. However the incidence of twin pregnancy i.e. intrauterine pregnancy in unicornuate uterus and its associated rudimentary horn pregnancy is estimated to be around 1 in 10 million gestations. Here, we present 19 year old pramigravida women with acute haemoperitoneum with diagnosis of unruptured rudimentary horn pregnancy combined by intrauterine pregnancy. The patient was managed with emergency laparatomy and resuscitation. Rudimentary horn containing foetus was excised and intrauterine pregnancy was left untouched. The intrauterine pregnancy was supported with progesterone and tocolytics and the patient delivered a newborn of 2.8 kg through spontaneous labor at 37 weeks of gestation. Heterotopic pregnancies incidence have increased in comparison to past and there should be high level of suspicion for this rare event as this is often associated with high maternal and fetal morbidity and mortality where diagnosis is difficult and challenging and easily missed. Timely intervention provides survival of intrauterine pregnancy in case of twin pregnancy, even in low resource settings where usually the diagnosis is missed before acute event

newborn with teratogenic effect of imatinib mesylate: a very rare case report

To report a case of teratogenic effect of imatinib mesylate [IM] in a newborn, whose mother was suffering from chronic myelogenous leukemia and was treated with IM for 4 years, including during her pregnancy. Case Presentation and Intervention: The newborn was diagnosed with microtia of the right ear, preauricular tag on the left side, absence of right depressor angular oris muscle, and imperforate anus. Infantogram showed dextrocardia, hemivertebrae in the thoracic region and cervical spina bifida occulta. The newborn was operated on for the imperforate anus and was discharged in good condition. This case revealed that IM is not safe for the fetus and leads to teratogenicity. Hence, we recommend that pregnant women should not be treated with IM

Combating iron deficiency anemia among school going adolescent girls in a hilly state of north India: effectiveness of intermittent versus daily administration of iron folic acid tablets

National surveys in India have documented an increasing number of adolescent girls suffering from anemia. Efforts to build iron stores in adolescent girls will help them improve their prepregnancy hemoglobin level. To assess the effectiveness of school-based supervised weekly, bi-weekly, and daily regimen of iron folic tablets in the treatment of anemia among adolescent girls. This randomized clinical trial included 331 anemic school going adolescent girls of Shimla district of North India. Study subjects were randomized to once weekly, bi-weekly, and daily iron folic acid regimen group. An intent-to-treat approach was used to analyze the change in hemoglobin level and serum ferritin levels at the end of the trial period. The rate of change of hemoglobin and serum ferritin levels from baseline to the end of the intervention was found to be similar in all the three groups [P = 0.64 and 0.98 for change in hemoglobin and serum ferritin]. Bi-weekly treatment regimen results in comparatively more increase in hemoglobin levels [3.1 g/dl] as compared to once weekly [2.4 g/dl] and daily groups [2.3 g/dl] [ANOVA F statistics = 6.08, P = 0.003]. Among the study subjects who reported side effects, more were from daily regimen group [55%] as compared to intermittent regimen group [25% in bi-weekly group; 18% in weekly group; P < 0.001]. In Shimla hills of North India, school-based intermittent iron-folic acid therapy is a feasible and effective intervention for increasing hemoglobin and serum ferritin levels of anemic adolescent girls

Opportunistic infections and complications in human immunodeficiency virus-1-infected children correlation with immune status

The aim of this study was to ascertain the correlation between various opportunistic infections and complications in human immunodeficiency virus [HIV]-l -infected children and the immune status of these patients, evaluated by absolute cluster of differentiation 4 [CD4] count and CD4 percentage. This study was conducted from January 2009 to June 2010 at the Antiretroviral Treatment Centre of the Pt. B.D. Sharma Post Graduate Institute of Medical Sciences, a tertiary care hospital in Rohtak, Haryana, in northern India. A total of 20 HIV-l-infected children aged 4-57 months were studied. Demographic and baseline investigations were performed prior to the start of highly active antiretroviral therapy [HAART]. A fixed-dose combination of HAART was given based on the patient's weight. Baseline investigations were repeated after six months of HAART. Results: There was a significant increase in the patients' haemoglobin, weight, height and CD4 count after six months of HAART. Significant improvements [P <0.05] were also noted in the patients' immune status, graded according to the World Health Organization, Conclusion: This study observed that the severity and frequency of opportunistic complications in paediatric patients with HIV-1 increased with a fall in the CD4 count. The treatment of opportunistic infections, along with antiretroviral therapy, may lead to both clinical and immunological recovery as well as a decreased incidence of future opportunistic infections. The CD4 count may give treating physicians an initial idea about the immune status of each child and could also be used as a biological marker of HAART efficacy. Patient compliance must be ensured during HAART as this is a key factor in improving outcomes

Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine for infraumbilical surgery under subarachnoid block: a prospective study

Subarachnoid blockade can be used in all surgical procedures carried out on the infraumbilical region. This study was aimed to evaluate the clinical efficacy and safety of intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine on onset, duration, intensity, and recovery time of sensory and motor blockade of subarachnoid block for infra umbilical surgery. One hundred sixty adult consented patients of either gender with American Society of Anesthesiologist ASA I and II scheduled for infraumbilical surgery were randomized into two groups of 80 patients each to receive either intrathecal study solution of 4 mL of 0.75% ropivacaine with 0.4 mL of 0.9% sodium chloride [Group I-Ropivacaine Control Group RC] or fentanyl [20 micro g] [Group II-Ropivacaine with Fentanyl RF]. The end points were hemodynamic variability, onset of analgesia at T 10, maximum sensory analgesic level, time to complete motor blockade, duration of sensory and motor blockade and adequacy of surgical anesthesia. The post-spinal nausea and vomiting, shivering, pruritus, respiratory depression or any other side-effects were also assessed. At the end of study, data were systematically complied and analyzed for statistically significance. The intrathecal fentanyl has accelerated the onset time to achieve sensory blockade to T10 dermatome and motor blockade. Small dose of intrathecal fentanyl with ropivacaine has prolonged the duration of analgesia in the early post-operative period when compared with intrathecal ropivacaine alone. The intraoperative hemodynamic variability showed no statistically significant differences between groups. Intrathecal fentanyl as an adjuvant to 0.75% isobaric ropivacaine demonstrated better clinical profile as compared to ropivacaine alone

Oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy: a comparative evaluation

Hemodynamic responses of laryngoscopy and laparoscopy should be attenuated by the appropriate premedication, smooth induction, and rapid intubation. The present study evaluated the clinical efficacy of oral premedication with pregabalin or clonidine for hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy. A total of 180 healthy adult consented patients aged 35 to 52 years with American Society of Anesthesiologist [ASA] physical status I and II of both gender, who met the inclusion criteria for elective laparoscopic cholecystectomy, were randomized to receive placebo Group I, pregabalin [150 mg] Group II, or clonidine [200 microg] Group III, given 75 to 90 minutes before surgery as oral premedication. All groups were compared for preoperative sedation and anxiety level along with changes of heart rate and mean arterial pressure prior to premedication, before induction, after laryngoscopy, pneumoperitoneum, release of carbon dioxide, and extubation. Intraoperative analgesic drug requirement and any postoperative complications were also recorded. Pregabalin and clonidine proved to have sedative and anxiolytic effects as oral premedicants and decreased the need of intraoperative analgesic drug requirement. Clonidine was superior to pregabalin for attenuation of the hemodynamic responses to laryngoscopy and laparoscopy, but it increased the incidence of intra-and postoperative bradycardia. No significant differences in the parameters of recovery were observed between the groups. None of the premedicated patient has suffered from any postoperative side effects. Oral premedication with pregabalin 150 mg or clonidine 200 microg causes sedation and anxiolysis with hemodynamic stability during laryngoscopy and laparoscopic cholecystectomy, without prolongation of recovery time and side effects

Electrolyte changes: an indirect method to assess irrigation fluid absorption complications during transurethral resection of prostate: a prospective study

Fluid absorption is inevitable complication of transuretheral resection of prostate and serum electrolytes changes can indirectly assess the irrigation fluid absorption. To monitor the extent of 1.5% glycineirrigation fluid absorption during transurethral resection of prostate [TURP], by measuring the changes of serum sodium and potassium levels peri-operatively. This is a randomized prospective cohort observational study. The 86 male patients of ASA grades I to III in the age group of 50 to 80 years, scheduled for elective TURP surgery under central neuraxial block, were studied. Their preoperative and post-operative serum sodium, potassium and calcium levels were measured. When duration of surgery exceeds 60 min, serum sodium and potassium levels were done intra-operatively with venous blood samples by using blood gas analyser. The height of irrigation fluid column was kept constant at 60 cm. These changes were correlated with the volume of irrigating fluid used, duration of procedure and the volume of prostate gland resected. The values of pre and postoperative sodium, potassium and calcium serum levels were compared and statistical significance of the difference in values was assessed using Student's paired t test. Statistically significant reduction of serum sodium levels [hyponatremia] and elevation of serum potassium levels [hyperkalemia] were observed post-operatively, which was directly proportional to volume of irrigating fluid used, duration of procedure and volume of prostate gland resected. No significant changes in serum calcium level were observed. To measure serum electrolytes changes during TURP surgery, it is simple and economical method for indirect assessment of fluid absorption for early identification of TURP syndrome