Carotid intima-media thickness in patients with non-alcoholic fatty liver disease: a study from eastern part of India

Background: Carotid intima-media thickness (CIMT) is a reliable marker of atherosclerosis and cardiovascular events. Association between CIMT with non-alcoholic fatty liver disease (NAFLD) is well known; however, such data are limited from India. This study aimed to assess CIMT in NAFLD patients compared to the healthy control, its relationship with other metabolic covariates, and predators of increased CIMT. Methods: In an observational study, involving 150 subjects (84 NAFLD and 66 healthy controls), B-mode ultrasound was used for the evaluation of CIMT. Results: The mean CIMT was significantly higher in NAFLD patients compared to the control group: 0.77±0.27 versus 0.57±0.11 mm on left side, p<0.001 and 0.79±0.22 versus 0.54±0.12 mm on right side, p<0.001. The difference was significant even after adjustment of metabolic confounders. Eight NAFLD patients had carotid plaques compared to none in the controls. The mean CIMT did not differ significantly between lean, overweight and obese subjects. A progressive increase in mean CIMT was noted with increasing grades of hepatic steatosis. High CIMT values (>95th percentile value in controls, 0.79 mm) were found in 52.3% of NAFLD. On multivariate regression analysis, age [odds ratio (OR) 1.42, p<0.001], serum HDL cholesterol [OR 0.92), p=0.02] and NAFLD [OR: 3.5, p<0.001] were found to be independently associated with high CIMT. Conclusions: NAFLD was significantly associated with CIMT which increased progressively with increasing grades of hepatic steatosis. Over half of NAFLD had increased CIMT, and NAFLD along with higher age and lower HDL- cholesterol independently predicted high CIMT values.

Readiness of the Interns to work at rural area: a cross-sectional survey in a backward district of West Bengal

Background: The scarcity of qualified doctors in rural areas remains a critical challenge for the health sector in India Aim was to analyze the perception of medical students regarding upcoming compulsory rural posting for 1 year as a part of their rotatory internship Methods: A cross-sectional survey was conducted in a medical college of West Bengal among the interns during March 2019 to February 2020. By doing complete enumeration of the interns present at the end of their Community Medicine posting, the sample size became 125. Predesigned, semi structured questionnaire was used for data collection. At the end of community medicine posting, when the interns came to department for completion, the printed questionnaire were given to them for filled up by their own. Collected data were entered in MS excel spreadsheet and analyzed with the help of SPSS 22.0 version. Results: About 74% interns thought it was difficult to serve the rural areas however 52% felt it will enrich their professional skills and about 65% thought it would be beneficial to the rural community. Only 22.4% were in favour of rural posting during their internship and 46% thought paying bond money is a good way out. Lengthening of MBBS course, inadequate clinical exposure, poor connectivity, no job satisfaction, obstructed career growth, no quality of life, insecure working environment for women, excessive workload, inadequate monetary compensation were the major reasons identified by interns for noncompliance of compulsory rural service during internship. Conclusions: The policymakers and medical educators need to design newer strategies for the improvement of rural healthcare facility keeping in mind the perception of students regarding rural service in the present scenario.

Intestinal metastasis from carcinoma cervix: An (un) common occurrence in a common cancer. A series of five cases from a single institution

Carcinoma cervix usually spreads directly to contiguous structures, such as the vagina, urinary bladder, ureter, and rectum. Intestinal metastasis from cervical cancer is very uncommon and accounts for less than 4% of cases and to date, 24 cases have been reported in Medical literature. These may be asymptomatic or present with features of intestinal obstruction, bowel wall perforation, and mimic acute abdomen. Intestinal metastasis is a late occurrence and carries a poor prognosis, hence a high index of suspicion with prompt diagnosis and management is essential. We report a series of five patients with squamous cell carcinoma (SCC) of the cervix with intestinal metastasis diagnosed in our hospital.

Wiskott Aldrich Syndrome, often Missed: A Case Report and Review.

Wiskott-Aldrich syndrome is an X-linked recessive disorder characterized by thrombocytopenia, eczema and recurrent infections. We report a 15 month old boy who had presented with lower gastrointestinal bleed, recurrent infections and eczema. Blood picture revealed microthrombocytopenia, high IgA and IgE, and low IgM and Normal IgG levels. A diagnosis of Wiskott-Aldrich Syndrome was made, which was missed by many paediatrician even after prolonged hospital stay before admission in our Institute. The recent progress in understanding of the pathophysiology and treatment are discussed.

Prevalence of Shigella species and their antimicrobial resistance patterns in Eastern Nepal.

The study was conducted to determine the prevalence of Shigella species and their antimicrobial resistance patterns in eastern Nepal. Stool samples submitted to the diagnostic laboratory of B.P. Koirala Institute of Health Sciences, Nepal, during August 2000-July 2004, were cultured for Shigella species and were confirmed by biochemical and serological tests. Of 53 Shigella species isolated, Shigella dysenteriae type 1 was the most predominant isolate (73.7%), followed by S. flexneri (23%) and S. boydii (4%). The majority (79%) of Shigella species were isolated from children aged less than five years. An overall high resistance was observed for trimethoprim-sulphamethoxazole, ampicillin, nalidixic acid, mecillinam, and ciprofloxacin. There was a statistically significant (p < 0.001) increasing trend in the prevalence of ciprofloxacin resistance in S. dysenteriae type 1. The results suggest reconsideration of the empiric use of these antimicrobial agents for shigellosis. A further study is required to evaluate additional antimicrobial agents.

Knowledge and practices regarding injury care among stone quartz workers.

The present study designed as cross sectional study was carried out to study the knowledge and practice regarding injury care among stone quartz workers of Chhotaudepur. A total of 137 stone quartz workers were included in the study, which consisted of 54.7% males and 45.3% females. 85.4% of the workers were illiterate and almost all the workers belonged to lower socio-economic strata according to the Modified Kuppuswamy's socio-economic scale. Majority of the subjects (56.2%) responded that they would consult doctor if they get injured while 32.2% responded that they would neglect the wound, as it will heal spontaneously. Thus the present study suggests that the knowledge regarding injury care among stone quartz workers was poor. Even the attitude and practice regarding injury care was also inappropriate.

Transcatheter coil occlusion of hepatic arteriovenous malformation in a neonate.

A 3-day-old neonate was diagnosed to have severe congestive heart failure due to a large shunt through a hepatic arteriovenous malformation. Percutaneous transcatheter delivery of two detachable coils resulted in complete abolition of the shunt. The patient showed dramatic clinical improvement and resolution of the heart failure, which was sustained on follow-up. This case represents a novel use of detachable occluding spring coils designed primarily for occluding patent ductus arteriosus.

Primary squamous cell carcinoma of the breast in a young woman--a case report and review of literature.

A thirty-four years old woman presented with pure squamous cell carcinoma of the breast, a very rare occurrence in the younger age group. A simple mastectomy with axillary clearance was performed, followed by adjuvant radiotherapy & chemotherapy. The patient is doing well, with no evidence of recurrence thirty months (2 1/2 years after the treatment. Primary pure squamous cell carcinoma of the breast is a very rare disease. The exact histogenesis still remains obscure. There seems to be no specific prognostic correlation with the morphological characteristics of squamous cell carcinoma of the breast. The clinical behaviour of this tumor is also uncertain. Thus, further study is required to determine whether primary pure squamous cell carcinoma of the breast is to be treated as a separate entity or as the common type of breast cancer (i.e. adenocarcinoma or adenocarcinoma with squamous metaplasia.)

Detection of S-100 antigen and anti ceramide antibody in sera of leprosy patients with and without reaction.

Levels of anticeramide antibodies and S-100 antigen in leprosy patients with and without reaction are compared in this study. The increase in levels of IgM anti ceramide antibody in the tuberculoid group of patients with reaction, when compared to those without reaction, is significant (P < 0.05). Similarly, significant increase (P < 0.01) was observed in the borderline group with reaction. No significant change in anti ceramide antibody level was observed in the lepromatous group of patients with and without reaction. Mean levels of S-100 were slightly lower in all three groups of patients with reaction, but the differences were not statistically significant.

Bidirectional Glenn shunt: a step in the right direction.

Bidirectional Glenn (BDG) shunt was carried out in 14 patients (age range 1.5-22 years; mean 9.3 years) for a variety of congenital cyanotic heart diseases with decreased pulmonary blood flow. Postoperative cardiac catheterisation was carried out in 10 patients including successful balloon angioplasty of the shunt and LPA in one patient. There was a significant improvement in oxygen saturation and a drop in haematocrit level at follow-up. Doppler echocardiography studies in 13 patients revealed functioning shunts in all cases with low velocity continuous flow. Thus BDG is a useful palliative procedure and could be undertaken as the first stage of total cavopulmonary connection in high-risk Fontan groups where biventricular repair is not feasible.

Disabilities in multibacillary leprosy patients: before, during and after multidrug therapy.

One hundred fifty-one patients (125 males and 26 females) of multibacillary leprosy (LL 88, BL 40, BB 23), registered during 1986-1992 for multidrug therapy (MDT), were analysed with reference to their disabilities before, during and after MDT. At induction 48 (31.7%) had no disability (Gr 0), 59 (39.0%) had only peripheral anaesthesia (Gr 1) and 44 (29.1%) had Gr 2 and 3 deformities with or without anaesthesia. The parallel analysis of the three groups, with nearly equal duration of symptoms, revealed that new deformities developed in only a few cases during and after MDT, least in the Gr 0 group. The crude fresh deformity incidence was 59.2 per 1,000 person years of observation. The rate of recovery from anaesthesia was higher (64%) in Gr 1 group than that (44%) in group with Gr 2, 3 deformities. No significant difference was observed between the incidence of Gr 2 deformities developed before, during and after MDT (incidence of claw-hands 9.2% before and 7.9% during and after MDT, trophic ulcers 13.9% before and 17.8% during and after MDT). Out of 19 cases which developed motor weakness during MDT and follow-up, 10 (52.6%) were instances of quite nerve paralysis. Occupational factors influenced the development of deformities but not the sex and bacterial load. Generally, the lower the Grade of disability at induction of patient for MDT, the lower the chances of new disability development and higher the chances of recovery from sensory impairments.

Quantitative evaluation of muscle relaxation induced by Kundalini yoga with the help of EMG integrator.

The present work is aimed to quantify the degree of relaxation of muscle under the effects of Kundalini Yoga with the help of EMG integrator. The data collected from 8 individuals (4 males 4 females) on the degree of muscle relaxation at the end of meditation revealed a significantly decreased muscle activity amounting to 58% of the basal level in both the sexes.