A 3D-Computed Tomography Angiography Study to Help in Surgical Planning for Retrosigmoid Craniotomies

Aims and Objectives: It is impossible to precisely anticipate the course of the transverse and sigmoid sinuses and theirindividual relationship to superficial landmarks such as the asterion during retrosigmoid approaches. This study was done todetermine the position of the asterion and the relationship between asterion and the transverse-sigmoid sinus junction (TSSJ)in making precise burr hole without damaging sinuses during retrosigmoid craniotomies.Materials and Methods: Computed tomography (CT) angiography was performed in 50 patients to obtain 3D-CT volumerendering images of cranial bone and dural sinuses. After delineating the sinuses, by simple restructuring using software andopacity modulation, bone image is reinforced. Asterion type, distance from the tip of mastoid process to asterion and root ofzygoma (ROZ) to asterion, and location of asterion in relation to TSSJ and distance between asterion and TSSJ were analyzedand measured.Results: The incidence of type 1 (presence of sutural bones) in our study was 24% and type 2 (absence of sutural bones) was76%. There was no statistically significance in the side and gender differences. The distance between the asterion and fromthe ROZ was 54.70 ± 3.68 on the right side and 54.32 ± 3.41 on the left side (P-0.612). The distance between asterion and tipof mastoid was 50.51 ± 2.67 on the right side and 50.12 ± 3.06 on the left side (P-0.716). The asterion was located on the T-Ssinus complex in 36 (72%) cases. The asterion was below the T-S sinus complex in 13 (26%) cases, and above the T-S sinuscomplex in only 1 (2%) cases.Conclusion: 3D-CT volume rendering imaging is capable of accurately visualizing the bony landmark and dural sinuses. Aneasy and simple restructured image provides precision and safety for the patient by ready and easy localization of asterionand TSSJ. This study was done to show that the previous cadaver-based anatomical studies can be done now in a moresophisticated and accurate manner with the latest technological advancements. This offers new options for anatomic researchand morphometric investigations.

Change in awareness levels of cervical cancer among rural women after intervention by health education: a community-based study

Background: Cervical cancer is the fourth most common cancer among women worldwide. The prevention and control of cervical cancer depends on awareness about the disease, screening procedures, and preventive measures. Objectives of this study was to assess the awareness levels on various aspects of cervical cancer among women aged 25-65 years, and to assess the impact of health education intervention among them.Methods: This community-based interventional study was conducted for a period of 15 months among 250 women aged 25-65 years by cluster sampling method in a rural population. Data on all aspects of awareness about cervical cancer, i.e., risk factors, signs and symptoms, diagnosis and treatment and prevention were collected using a pre-tested semi-structured proforma. This was followed by a post-test 2 months after health education.Results: Overall awareness for cervical cancer was found to be very poor among the study subjects in the pre-test. Awareness on risk factors, signs and symptoms, diagnosis and treatment, and prevention of cervical cancer was found to be 6%, 3.6%, 1.2%, and 1.6% respectively. A significant increase in the knowledge level was found after health education.Conclusions: As the awareness levels regarding the cervical cancer was poor among the study population, health education programme and campaigns, along with periodic screening is need of the hour to effectively prevent cervical cancer.

Validation of track and act online developmental screening tool: a pilot study

Background: The global prevalence of developmental delay in children is reported as 1-3% according to WHO. Early diagnosis and intervention improve the quality of life in disabled children. There is need for screening tool. So, study was started to evaluate the ability of the online screening tool in detecting the developmental delay in the Indian children.Methods: After IRB approval, around 30 children after parental consent of either gender aged 4 months to 5 years attending the immunization outpatient department were involved in the study After a detailed history, children were screened with online screening tool 'Track and Act'. Due to the logistic reasons among them 30 were assessed in detail using Developmental Assessment Scale for Indian Infants (DASII) which is used as gold standard in this study.Results: Study showed high sensitivity and specificity for all the four domains of the tool. It showed sensitivity and specificity in physical of 83.3% and 91.6%, in language 66.6% and 87.5%, in cognitive 66.6% and 91.6% and in socio-emotional domain 83.3% and 91.6 % respectively.Conclusions: Track and Act screening tool has good test characteristics for detecting developmental delay among Indian children and it can be used for office practice for screening children.

Leprosy in Females: A Retrospective Study in the Urban Leprosy Center of a Tertiary Care Center from Kerala, South India

Leprosy in females has got special epidemiological significance as they are more likely to transmit the infection to their children with whom they are often in close contact. The primary aim of the present study was to determine the proportion of leprosy in females and the secondary aim was to study the clinical profile of these cases. This is a 19 year (1997-2015) retrospective descriptive study done in a Tertiary Care Centre at Thiruvanthapuram, Kerala. Females constituted 258 new leprosy cases (n=258) in this study, thus accounting for a proportion of 27.83%. The female/male ratio was 1: 3.59. The age group 41-50 constituted the maximum number of cases, 50 (19.38%). The mean age was 37.60 years. Indeterminate leprosy (I) was the commonest type of leprosy seen in this study accounting for 47 cases (18.22%) followed by patients in borderline spectrum (BT followed by BB and BL), then Lepromatous (LL). Smear positive cases accounted for 38 cases (14.73%). There were 19 cases of leprosy (7.36%) in the childhood age (1-12 years), with BT being the commonest type, 8/15 (53.33%) followed by Indeterminate (I) and TT. Lepra reactions were present in 45 cases (17.44%). Grade 2 disability was present in 33 cases (12.79%). Patients who were defaulters and on irregular treatment accounted for 2 cases (0.78%). The proportion of leprosy in females in this study was similar to other studies. Indeterminate leprosy was the commonest type, not seen in other studies. The proportion of irregular treatment/defaulters was very low and there were no serious adverse drug reactions to anti-Hansen therapy in this study. As this study was done in a Tertiary Care Centre over a long period of two decades, the figures may not be a true indicater of today's status and general trend in the community which should be analysed by well designed population based epidemiological studies. Data from this study will be useful in planning such studies and necessary interventions.

Lower limb weakness and paresthesia after combined spinal epidural anesthesia for abdominal hysterectomy: a report of three cases

Neurological deficits are the rare but unacceptable complications of neuraxial blockade. We report three cases of vaginal hysterectomy performed under combined spinal epidural anesthesia [CSE] using 3 mlof 0.5% hyperbaric bupivacaine [15 mg] in subarachnoid space followed by epidural analgesia top up after wearing off of spinal anesthesia. One patient complained of unilateral paresthesia and numbness on left thigh with no motor involvement in the evening postoperatively, two patients developed bilateral paresthesia and numbness over anterior thigh and knees and motor weakness in both lower limbs on next day morning. Epidural catheter was removed immediately and treated with oral tab prednisolone and tab methylcobalamin. All patients had complete recovery and were discharged after a week. Unrecognised mechanical irritation of the nerve roots by epidural catheter is thought to be the cause. We conclude that patients with epidural catheter should be monitored and on appearance of any neurological symptoms the catheter be removed to prevent permanent neurological sequelae

Cardiac arrest after simultaneous release of bilateral tourniquets in lower limb orthopaedic surgery: a case report

Surgical tourniquets are commonly used in orthopaedic and trauma surgery, but these have their complications. Reperfusion injury following simultaneous release of bilateral tourniquets is the most likely explanation of cardiac arrest in this case. We describe an unusual complication experienced by a 40 year old, 65 kg healthy male who underwent surgery for trauma to the lower extremity [bilateral fracture tibia]. Bilateral mid-thigh tourniquets [Esmarch bandage] were applied, which were simultaneously released after 90 min. After 5 min of tourniquet release sudden severe hypotension occurred followed by cardiac arrest. Patient was immediately intubated and cardio pulmonary cerebral resuscitation [CPCR] was started. We conclude that bilateral tourniquet application can be hazardous within the safe limit of tourniquet time [<2 hours] and their simultaneous release should be avoided. Moreover, Esmarch tourniquet may generate very high uncontrolled pressures and should be avoided

Diagnostic value of C-reactive protein in suspected acute appendicitis - A prospective case control study.

Aim: To find out the Sensitivity, Specificity and Predictive value of C-reactive protein in the diagnosis of acute appendicitis. Materials and Methods: Hundred patients undergoing emergency appendicectomy were cases and thirty patients undergoing interval appendicectomy during the same period were controls. Creactive protein was measured pre-operatively. Results: CRP was reactive in 89% of cases and 3 of 30 controls (P = 0). Among the thirteen complicated cases, two had a CRP reactivity of 1.2 mg/dl, eight had 2.4 mg/dl and three had 3.6 mg/dl. In the uncomplicated cases, forty nine were reactive at 1.2 mg/dl, twenty six at 2.4 mg/dl and one at 3.6 mg/dl ( P = 0.0009). In histopathologically inflamed appendix, reactivity was 94.4% and in normal appendix reactivity was 40% ( P = 0.00007). CRP positivity had a sensitivity of 94.4% (CI 89.9-98.9) and a positive predictive value of 95.5% (CI 91.4-99.6). CRP reactivity and leucocytosis if combined, the sensitivity, specificity, PPV and NPV were 85%, 100%, 100% and 81% respectively. Threshold for CRP reactivity if raised to 2.4 mg/dl, the sensitivity, specificity, PPV and NPV are 42%, 100%, 100% and 16% respectively. Conclusion: CRP estimation is a good 'rule-in' test and not-so-good 'rule-out' test to diagnose acute appendicitis.

Evaluation of adefovir & lamivudine in chronic hepatitis B: correlation with HBV viral kinetic, hepatic-necro inflammation & fibrosis.

Background & objectives: Chronic hepatitis B is an important cause of morbidity and mortality. We conducted a study comparing the efficacy of adefovir and lamivudine with respect to their impact on serum and hepatic viral DNA clearance, and improvement in hepatic necro-inflammatory score, in naive patients of chronic hepatitis B. Methods: This prospective randomized pilot study was conducted in Lok Nayak Hospital, New Delhi, involving 30 patients of chronic hepatitis B (both e antigen positive and negative); 15 were randomly selected to receive either adefovir or lamivudine for a period of 6 months. Quantification of serum and hepatic HBV DNA levels was done by real time PCR and liver biopsy was done at the beginning and end of 6 months. Results: Serum ALT was elevated to 2 or more times normalized in both the groups. In the adefovir group, two patients became HBeAg negative. In the lamivudine group, one patient became HBeAg negative. After therapy HBV DNA was negative in 26.7 per cent patients from adefovir group and 13.3 per cent patients from lamivudine group. Serum HBV DNA levels were correlated with the hepatic levels before therapy (r=0.843; P<0.001) and after therapy (r=0.713, P<0.001) showing strong correlation. There was a median reduction of 1.92 and 2.06 log copies per ml in serum HBV DNA load after adefovir and lamivudine therapy, respectively. The mean reduction in the histotogy activity index (HAI) score was 2 and 1.53, fibrosis score was 2.33 and 3.06 after adefovir and lamivudine therapy respectively. Interpretation & conclusions: Adefovir and lamivudine treatment caused biochemical and serological improvement when administered for about 6 months with significant reduction in HBV DNA, serum and hepatic viral load without completely clearing the virus from either serum or liver. It also helped in reduction of the necro-inflammatory and fibrosis score of patients with chronic hepatitis B. Our study also showed significant correlation between serum and hepatic HBV DNA levels both before and after therapy. There was not enough evidence to show therapeutic advantage of one drug over the other in any of the parameters measured.