Profile of pulmonary embolism in service personnel posted at high altitude area

Background We evaluated the clinical presentation and risk factors of pulmonary embolism (PE) in soldiers posted at high altitude areas (HAA). Methods We conducted a retrospective analysis of all cases of PE presented to us between March 2011 and Aug 2014. The patients were serving at an altitude between 10,000 and 22,000 ft above sea level and PE was diagnosed using the pulmonary CT angiography. Screening for the deep vein thrombosis (DVT) and procoagulant conditions was done at presentation and after six months of treatment. The patients were managed as per the American College of Cardiology (ACC) guidelines and descriptive statistics were used to present the data. Results The patients (53 males) had a mean age of 33 ± 4.2 year and were serving at a mean altitude of 12,176 ± 448 feet (ranged between 10,000 and 20,500) at the onset of symptoms. Dyspnea (79%) and tachycardia (68%) were the commonest symptom and sign, respectively. D dimer was positive in 96.2% of the cases while nonspecific T inversion in the ECG was seen in 54.7% of the patients. Procoagulant work up revealed a hereditary thrombophilic condition in 9 out of 53 patients. A total of 44 cases were idiopathic and DVT of lower limb veins was seen in 2 patients. There was no mortality in our case series. Conclusion PE is a common complication of HAA and hereditary thrombophilia contributes in a minority of the patients. Further studies are needed to ascertain the risk factors of PE at HAA.

Aripiprazole-induced transient myopia: A rare entity

Aripiprazole is a new drug for the treatment of adults with schizophrenia. Ocular side effects of aripiprazole are very rare. Review of literature revealed few cases of aripiprazole-induced myopia. We report a rare case of aripiprazole-induced transient myopia. A 22-year-old female patient presented to the department of psychiatry with worsening of symptoms of schizophrenia and was started on aripiprazole. She presented with complaints of blurring of vision in both eyes for 1 week which started on the 3rd day following the use of aripiprazole. Anterior segment examination revealed a shallow anterior chamber and narrow angles. Intraocular pressure was normal. A diagnosis of aripiprazole-induced acute myopia was made and the treating psychiatrist was advised to stop the medication. At 2-week follow-up, the unaided visual acuity improved to 20/20 in both the eyes. Ophthalmologists should be aware of the myopic shift that may occur as an ocular side effect with aripiprazole.

Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction.

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2‑year‑old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well‑defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.

"Comparative Evaluation of Microleakage of Composite Restorative Materials".

To evaluate and compare the marginal leakage in class V cavities restored with three different tooth colored restorative materials using dye penetration system. Materials and methods: Thirty extracted premolars were randomly selected for this study. Standardized classV cavities were prepared and then divided into three equal groups. Group I was restored with nano filled composite, Group II was restored with hybrid composite and group III with polyacid modified composite. They were then subjected to thermo cycling, immersed in 2% methylene blue dye, sectioned and examined under stereomicroscope. Dye penetration for each section was recorded and data was analyzed. Results: Lowest micrileakage was recorded in group I and highest leakage recorded in Group III.Conclusion: Nanofilled composite resins provide a better sealing than hybrid and polyacid modified composites.

Publication trends of research articles from infectious diseases specialty in a medical journal from India.

Background: Details about research productivity in the infectious diseases specialty from India are lacking. Objective: To analyse publishing trends and research productivity of articles related to infectious diseases in the Journal of the Association of Physicians of India (JAPI). Materials and Methods : We carried out bibliometric analysis of articles related to infectious diseases specialty from JAPI published between 2000 and 2011. Data were derived from the journal's website and the articles were analysed for type (original article, case reports, etc.), microorganism (bacterial, viral, etc.) place of the research and timelines for publication. Results : Out of 2977 articles published in JAPI over last 12 years, 256 articles belong to infectious diseases subspecialty. Infectious diseases contributed 11-18% of the published articles per year in JAPI during the last decade. Original articles (31%), case reports (38%) and correspondence (22%) constitute the majority of article types, while remaining 9% was made up by images. Bacterial (22%), protozoal and helminthic (20%), HIV (15%) and mycobacterial (16%) diseases lead the type of microorganisms represented in the research articles. Mumbai (16%), Delhi (9%) and Kolkata (7%) are the top three places contributing to the articles, followed by Chandigarh and Chennai. Original articles and case reports took approximately 14 months for publication, as compared to 6 months for an image (P < 0.0001). Conclusion : Infectious diseases specialty contributes about 15% of articles per annum in JAPI. HIV and tuberculosis together account for 30% of published litearture with fair representation from other organisms. Mumbai and Delhi are the leading contributors towards research productivity in this specialty.

Two interesting cases highlighting an oblivious specialty of psychoneuroendocrinology.

Psychoneuroendocrinology deals with the overlap disorders pertaining to three different specialties. Awareness about the somatic manifestations of psychiatric diseases and vice versa is a must for all the clinicians. The knowledge of this interlinked specialty is essential because of the obscure presentation of certain disorders. Our first case was treated as depressive disorder, whereas the diagnosis was hypogonadism with empty sella. Our second patient was managed as schizophrenia and the evaluation revealed bilateral basal ganglia calcification and a diagnosis of Fahr's disease. We report these cases for their unusual presentation and to highlight the importance of this emerging specialty.

Knowledge, attitude and screening practices of general dentists concerning oral cancer in Bangalore city.

Context: Oral cancer presents with high mortality rates, and the likelihood of survival is remarkably better when detected early. The dental profession shares an important responsibility toward early screening, prompt referral and treatment. Aims: The aim of the present study was to assess the oral cancer knowledge, attitude and screening practices among dental practitioners in Bangalore city. Materials and Methods: This descriptive cross-sectional study was conducted using a 24-item self-administered questionnaire involving private dental practitioners of Bangalore city. A total of 1556 private dental practitioners of Bangalore made up the sampling frame of the study, and a sample of 250 dentists was found to be sufficient. Two hundred and fifty dentists were selected by cluster random sampling. The institutional review committee approved the study. Data were entered using SPSS 13.01. Results: A total of 250 practicing dentists were approached, of which 240 participated in the study. Among the various risk factors for causing oral cancer, the use of alcohol was identified as a major risk factor by 238 (99%) dentists. The high-risk age group for oral cancer was identified as the fourth and fifth decades by 143 (59%) dentists. Adequate training for providing oral cancer examinations was acquired by 164 (68%) of the dentists. Two hundred and thirty-seven (98%) dentists strongly agreed that patients should be referred to specialists if they suspected oral cancer in any lesion. No more than 37% of the dentists routinely practiced complete oral cavity examination on all patients who attended their practice. A mere 31% of the dentists educated their patients on the adverse effects of these habits and assisted them in cessation programmes. Conclusions: These findings concerning dentists' knowledge and opinions related to oral and pharyngeal cancer suggest strongly that educational interventions for practitioners and dental students are necessary. We contend that an offering of continuing dental education programs would go a long way to enhance the prevention and early diagnosis of oral cancer.

Publication trends of a biomedical journal from India.

Background: The details about the research productivity of the biomedical journals published from India is lacking. We analyzed the publishing trends and the research productivity of the Journal of the Association of Physicians of India (JAPI). Materials and Methods: This was a bibliometric analysis of a biomedical journal. The data was obtained from the website of JAPI about the publications between 2000 and 2011. The articles were analyzed for the type (original article, case reports, correspondence, pictorial image, reviews, editorials, philately and miscellaneous), subspecialty (endocrinology, cardiology, etc), and place of the research work (Mumbai, Delhi, etc). Descriptive statistics giving data in numbers and percentages were used. Results: JAPI published 2977 articles over last 12 years (12 volumes and 134 issues). Case reports (29.5%), original articles (22.6%), and correspondence (20.5%) constitute 3/4 of the published articles. JAPI showed a gradual declining trend of published articles per issue (29.5 in 2000 to 17 in 2011). The data about 1798 research articles was analyzed further. Most of the articles belong to the Endocrinology, neurology, and infectious diseases. Mumbai is the leader over past 12 years in contributing toward the articles followed by other three metros. Conclusion: JAPI showed a declining trend in the number of published articles over last decade. Metro cities contributed the maximum research articles and the subspecialty coverage skewed in favor of Endocrinology.

Obesity and thyrotropinemia.

Objective. To study the relation between body mass index (BMI) and TSH in euthyroid and subclinical hypothyroid obese children and compared serum TSH level among obese and overweight children. Methods. Fifty consecutive children (aged 2-18 yr) presenting for obesity were studied. All cases with TSH > 10, low T3/T4, organic and syndromic obesity were excluded. Patients were divided into Group 1: Overweight (n=20) (BMI between 85th to 95th centile) and Group 2: Obesity (n=30) (BMI > 95th centile). Fisher’s exact test, Mann-Whitney U test and Pearson’s correlation were used for statistical analysis. P value < 0.05 was considered significant. Results. Elevated TSH level (between 4.5 – 10 mIU/L) with normal T3, T4 was seen in 4/20 overweight and 9/30 of obese children (P=0.5219). The mean TSH was comparable in both the groups (3.22 ± 3.1 mIU/L vs. 3.63 ± 2.2 mIU/L, P=0.3491). Overall TSH showed no correlation with BMI (r= 0.0014, P=0.9924). Conclusion. The preliminary data did not show any relation between severity of obesity and TSH level. Further large scale data from population are required to confirm these findings.

Anaesthetic and intensive care aspects of spinal injury.

Over the last few years, spinal injuries have been classified depending upon their causative mechanism and on the basis of three column concept of the structure of vertebral column. The concept of primary and secondary injury has laid more stress on prevention and treatment of secondary injury. Methyl prednisolone still remains the drug of choice for prevention of secondary injury. Spinal injury involves all organ systems of the body depending on the level of lesion. Immobilisation of injured spine and maintenance of adequate airway after spinal injury need immediate attention. Orotracheal intubation under general anaesthesia, with manual in-line traction, is still considered the best method. Hypotension, hypertension and hyperglycaemia should be avoided during anaesthesia. Care should be taken to avoid effects of autonomic hyper reflexia. Spinal cord functions should be monitored and, if required, induced hypotension can be used with adequate monitoring.

Effect of pentoxifylline on cyclosporine-induced nephrotoxicity in rats.

Effect of unique hemorrheologic agent pentoxifylline (PTX) was investigated on cyclosporine (CsA) induced nephrotoxicity in rats. Compared to saline control, CsA produced significant increase in blood urea and serum creatinine. Pentoxifylline treatment prevented the CsA-induced rise in blood urea and serum creatinine. Creatinine clearance (Ccr) and lithium clearance (Licr) was decreased with CsA. PTX treatment prevented the CsA-induced decrease in Ccr and Licr. Malondialdehyde (MDA) was increased with CsA compared to saline treated animals. PTX prevented the CsA-induced MDA rise. Kidney form CsA treated rat showed marked vacuolar degeneration of tubular epithelium with excess of microcalcification. Severity of the lesions was markedly reduced in rats treated with PTX plus CsA. The results indicate that PTX reduces CsA-induced renal toxicity in rats.

The use of combustion technique of tissue processing for the study of the distribution of 14C-salicylate in rats after oral administration.

The distribution of 14C-salicylate (150 mg/kg, orally) in rat tissues was studied, at different time intervals upto 2 hr. A fairly rapid distribution was noted and a peak level was found to occur at 30 min after administration of the labelled drug in all the tissue studied. The combustion technique was used for tissue processing to determine the radioactivity as compared to the digestion method of tissue processing utilised by Sturman et al. (5) for their studies. The combustion technique was found to be more sensitive, as at a dose of 150 mg/kg (0.5 ml containing 5 uCi) administered orally, there was a greater level of radioactivity in all tissues as compared to the levels found by Sturman et al. (5) for a dose of 200 mg/kg (0.2 ml containing 2 uCi) administered intraperitoneally.