Pott’s paraplegia-satisfactory outcome in spite of poor prognostic factors, treated by a novel surgical technique of posterior spinal stabilization and anterolateral decompression with bone graft fusion: a case report

A case of Pott’s paraplegia of sudden onset and of more than two months duration in an aged female, treated by a novel surgical technique of anterior decompression and local kyphotic angle correction by spinal pedicular fixation is presented here. A 52 year female with Pott’s paraplegia, ASIA-A with sphincters involvement and with flexor spasm, was treated by surgical intervention, in a single operation of two stages, the first by provisional posterior pedicular fixation and the second stage by anterolateral decompression and correcting the local kyphotic angle by cyclic changing the rods in increments of 5 degrees in compressive mode. The paravertebral abscess of opposite side was sucked out and at the end a tricortical bone graft harvested from iliac crest was impacted in between the space created by pedicular fixation maneuver in course of correcting kyphosis. There was steady dramatic improvement of clinical and neurological status within three weeks. Kyphotic correction was maintained with anterior tricortical interbody bone graft impacted in position. The novel surgical technique that is adopted for decompression, drainage including paravertebral abscess of opposite side, debridement and local kyphotic angle correction along with interbody bone graft fusion, in this case, offered a satisfactory outcome in spite of poor prognostic factors.

Suicidal ideation, suicide attempts and sexual harassment among transgender people in Puducherry, South India: a cross sectional analytical study

Background: Transgender people are stigmatized, victimized and often driven towards attempting suicide due to institutionalized discrimination. We aimed, to determine the proportion and factors associated with suicidal ideation in last one year and suicide attempts in their lifetime and the proportion of transgender people who have faced sexual harassment in Puducherry. Methods: It was a cross sectional analytical study. All consenting adult transgender residing in Puducherry and registered with SCOHD (NGO) were included in the study. Pre-tested semi structured questionnaire was used as study tools (C-SSRS and TGISS). Suicidal ideation, suicide attempts and sexual harassment were expressed in proportion and multivariate analysis was done to find the independent association of variables with the outcomes using adjusted prevalence ratios. Results: Of the 119 transgender people who participated in this study, 50% were unemployed and 28.6% were involved in sex work. Overall prevalence of suicidal ideation, suicide attempts and sexual harassment was found to be 31.1% (95%CI 23.3%-39.8%), 46.2% (95%CI 37.4%-55.2%) and 84.87% (95%CI 77.5%-90.4%) respectively. In multivariate analyses, suicidal ideation was significantly associated with higher income; suicide attempts were associated with being employed. Conclusions: Lack of support from the family and friends and the stigmatizing behaviour of the society were the causes of their fear of living in the society. Extreme forms of stigma ultimately leads to their suicidal behaviour.

Mismatch repair protein deficiency assessed by immunohistochemistry in sporadic colorectal carcinoma

Context: Globally, colorectal carcinoma (CRC) ranks the third most commonly diagnosed malignant disease, one of the leading causes of cancer deaths. Aims: To study the spectrum of clinicopathological characteristics of sporadic colorectal carcinoma and to assess mismatch repair gene deficiency by the expression pattern of the proteins assessed by immunohistochemistry. Setting and Design: Observational study conducted in a tertiary care hospital in West Bengal. Materials and Methods: Fifty-two surgically resected specimens of CRC received from January 2018 to May 2019 were studied for clinical, morphological, MSI status. Statistical Analysis Used: IBM SPSS 23. Results: A total of 50% of the cases belonged to younger and 50% to the older population, with male predominance being 53.8%. The most common histologic type was adenocarcinoma (88.5%). The majority was found to be well-differentiated carcinoma (50%). The majority cases were of the T3 stage accounting to 38.5%. A total of 24 out of 52 cases (46.15%) had an absent expression of at least one mismatch repair (MMR) protein. A significant correlation was found between the young age group and microsatellite instability (MSI) with a P value of 0.001. A significant association was found between MSI and tumor differentiation with P value of 0.018. A significant association was found between MSH6 and histological type with P value of 0.012. A significant association was found between MSI and tumor stage with P value of 0.032. Conclusions: This study shows a significantly higher number of sporadic colon cancers involving the young age group, and younger cases showed significant association with MSI. This alarming trend needs validation by studies involving larger populations and can be helpful prognostically as well as in formulating chemotherapeutic regimens.

A study on management of hemorrhoids: Comparison between conservative management and injection sclerotherapy

Background: Hemorrhoidal disease is one of the most common anorectal conditions encountered in daily practice for centuries. Conservative management of hemorrhoids (with oral diosmin, calcium dobesilate cream local application) and injection sclerotherapy with 3% polidocanol-both are very commonly practiced, cost effective, and outpatient department-based management of hemorrhoids which bear rare adverse effects. Comparative efficacy of injection sclerotherapy and conservative management in cases of hemorrhoids is still confusing and contradictory to each other according to different studies. Aims and Objectives: This study was conducted to compare the effectiveness between conservative management of hemorrhoids and injection sclerotherapy. Materials and Methods: This institution-based experimental study done over 74 patients of first- and second-degree internal hemorrhoids. Thirty-seven patients were randomly selected and managed with conservative management, and the rest with injection sclerotherapy. Treatment responses were assessed after 3 weeks and in unsatisfactory responses, treatment was repeated for another 3 weeks. Reassessment was done after 6 weeks and 6 months. Results: This study demonstrated that both injection sclerotherapy and conservative management had improved per rectal bleeding after 3 and 6 weeks of treatment, but the former had a significant edge over the counterpart after 6 months of treatment (56.8% vs. 35.1%, P = 0.002). In case of reduction of hemorrhoidal mass – injection sclerotherapy had significantly better outcome in all the follow-up visits, that is, 3 weeks (54.1% vs. 13.5%, P = 0.001), 6 weeks (70.3% vs. 35.1%, P = 0.008) and 6 months (59.5% vs. 27.0%, P = 0.003). Injection sclerotherapy had superior overall treatment outcome after 6 weeks of treatment (73% vs. 45.9%, P = 0.04) and long-term periods (56.85% vs. 27%, P < 0.01). Conclusion: Injection sclerotherapy shows significantly better and long-lasting improvement in symptomatic hemorrhoids in comparison to conservative management which is mainly able to limit per rectal bleeding only for a short period of time.

The association between different types of cooking fuels and common health problems: north India region

Background: The fuel used for cooking is a major source of indoor air pollution because of inefficient combustion and inadequate ventilation. This study was conducted to see if there is any association between the type of cooking fuel and common health problems in light of inadequate ventilation. Methods: This was a cross-sectional study; 688 subjects were selected randomly from various sectors and the outlying areas of Surajkund. The impact of indoor air pollution on health was assessed by questionnaires, general physical examination, and pulmonary function testing. Results: One of the key findings of the study has been the implication of LPG, touted as a safe, non-polluting fuel with a definite negative impact on health. There was significantly more breathlessness experienced by LPG users as opposed to the users of wood and cow dung. Though the prevalence of fever in both groups was similar, chest pain, burning of eyes, and fatigue were reported by wood and cow dung users much more frequently. The pulmonary function test showed restrictive pathology in cow dung and wood users, whereas obstructive pathology in LPG users. Conclusions: LPG is considered “clean” fuel because it does not produce visible emissions. However, improper burner design, blocking and clogging of the flue vent, and insufficient combustion air result in improper combustion and the emission of aldehydes, CO, hydrocarbons, and other organics. It would be folly to believe that LPG is harmless. Even a harmless material may become harmful if used inappropriately.

Outcome of Emergency Obstetric Cases in Relation to the Referral Pattern at a Tertiary Hospital in Puducherry: A Cross-Sectional Descriptive Study

Background: Referral is a crucial aspect of emergency obstetric care in India. Adequate and timely referrals help to improve the quality of health‑care services and maternal and child well‑being. Objectives: Studies are needed to assess the outcome of obstetric mothers’ emergency admissions in relation to referral patterns. Materials and Methods: A hospital‑based cross‑sectional descriptive study was done among obstetric patients admitted to a tertiary care hospital’s emergency department (emergency medical service [EMS]). Aretrospective cohort was analyzed. The data were entered in Epicollect5 and imported to STATA software version 16 for analysis. Results: A total of 685 mothers admitted to EMS were selected for the study, with a mean (standard deviation) age of 26.5 years (4.2). Among the study participants, 181 (26.4%) were referred from other institutions, 382 (55.8%) were nonreferral who received antenatal checkups in the tertiary hospital, and 122 (17.8%) were self‑referral who had not received any antenatal checkup in the tertiary hospital. The adverse fetal outcome was 1.88 (1.21–2.95) times higher in the referred mothers compared to the self‑referral. Conclusion: We observed that a higher percentage of referrals were from the primary health centers. This kind of direct referral to tertiary care hospitals can be avoided by availing the emergency obstetric services at secondary hospitals to prevent adverse fetal outcomes and unnecessary referrals to the tertiary hospital.

Mucormycosis - The black menace in COVID-19

The current outbreak of second wave of COVID-19 in India has seen the rise of opportunistic infections, a deadly one being mucormycosis or “black fungus.” As of now, there are over 9000 cases of this deadly disease which have been reported from several states in India. Nine states in India including Punjab, Uttar Pradesh, Rajasthan, and Bihar have declared mucormycosis as an epidemic. There are five types of mucormycosis – rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, and disseminated. Out of these, rhino-orbital-cerebral and pulmonary mucormycoses are most common in post-COVID patients. The clinical presentation of such patients include cough, fever, breathlessness, chest pain, sinusitis, pain on one side of the face with lack of sensation and proptosis of eye. Diagnosis could be done through analysis of clinical findings, direct microscopy, serum antigen tests, culture, histopathology, radio imaging, and polymerase chain reaction/ matrix?assisted laser desorption ionization time?of?flight. Treatment will include preventive measures taken at home or at hospital for post?COVID patients. Medical treatment of mucormycosis mainly includes installing a central catheter (line), maintaining adequate systemic hydration, and infusion of normal intravenous saline before antifungal amphotericin B infusion. Since amphotericin is nephrotoxic, alternative drugs, such as posaconazole or isavuconazole, can be suggested. Adjuvant therapy with caspofungin, deferasirox, statins, aspirin, and hyperbaric oxygen may have to be considered as well. Extensive surgical debridement can also be suggested to remove all necrotic tissues. This review emphasizes the different aspects of mucormycosis such as epidemiology, etiopathogenesis, risk factors, diagnosis, preventive measures, and treatment strategies that can be adopted to tackle this fungal menace in COVID-19.

Prevalence of Vitamin D3 insufficiency among rural ethnic population of Tripura and its association with type-2 diabetes mellitus

Background: Different studies suggest that Vitamin D3 has a role in regulation of insulin and its deficiency leads to the development of type 2 diabetes mellitus (DM). In a study by ICMR-INDIAB (NE), it was shown that the prevalence of type 2 DM is about 9% in Tripura. However, little is known regarding the blood level of Vitamin D3 among the rural ethnic population. Objectives: The objectives of this study were to assess the blood level of Vitamin D3 and its association with type 2 DM in rural ethnic population. Materials and Methods: This cross-sectional study was undertaken from February 2018 to January 2019 at Multidisciplinary Research Unit of Agartala Government Medical College to assess the blood Vitamin D3 level in the rural ethnic population and its association with Type 2 DM. Two hundred and eight subjects were recruited from 10 different health camps. Blood samples were collected for detecting different blood glycemic parameters. The data were statistically analyzed using the Statistical Package for the Social Sciences. Pearson’s correlation coefficient was used to evaluate the association of blood Vitamin D3 with glycemic parameters. Results: Of 208 ethnic subjects, 136 had insufficient while 72 had sufficient blood Vitamin D3 level. Overall, 65% prevalence of Vitamin D3 insufficiency has been observed in the study population. About 98.3% and 52.3% of insufficiency (<30 ng/ml) have been observed in diabetic and non-diabetic subjects, respectively. Conclusion: About 65% prevalence of Vitamin D3 insufficiency irrespective of diabetic status was found in this study. However, Vitamin D3 level and its inverse association with glycemic parameters in type 2 DM could not be established.

YnfA , a SMR family efflux pump is abundant in Escherichia coli isolates from urinary infection.

A quantitative study was undertaken to determine the expression level of different effl ux pumps in multi-drug-resistant (MDR) Escherichia coli isolates from urinary infection. We have determined the presence of different effl ux pumps and measured the expression level of tolC, mdfA, norE and ynfA genes among 48 isolates by quantitative real-time PCR. The expression level of tolC and ynfA was constantly high and observed among 75-80% of isolates, whereas mdfA and norE were expressed occasionally. Our fi ndings suggest that ynfA, a new SMR effl ux pump gene family member increases the antibiotics’ resistance in E. coli.

Tumour necrosis factor-alpha promoter polymorphism and its association with viral dilated cardiomyopathy in Indian population: A pilot study.

Purpose: Tumour necrosis factor-α (TNF-α), a pro-infl ammatory cytokine has been implicated in the pathophysiology of several viral infections. TNF-α promoter gene polymorphism is thus believed to play the modulating role in this disease pathogenesis. Several studies have shown the increased level of TNF-α in dilated cardiomyopathy (DCM). However, the role of the TNF-α promoter polymorphism is yet to be delineated in this regard. The present study for the fi rst time tried to explore the association of TNF-α gene polymorphism with DCM of viral aetiology. Materials and Methods: Eighteen histopathologically proven DCM cases with viral genome positivity and 17 healthy controls were genotyped using polymerase chain reaction of TNF-α promoter gene followed by restriction fragment length polymorphism to determine the SNPs of -238G/A, -308G/A, -857C/T and -863C/A. Results: Of the 18 DCM cases 4 (22.2%) were positive for adenovirus (AdV), 2 (11.1%) for enterovirus (EV) and 12 (66.7%) had co-infection. Six of the 18 DCM cases (35.3%) had -238G/A polymorphism, and 10 (55.5%) had -863 homozygous AA genotype. The association of these polymorphisms was statistically signifi cant as compared to controls (P < 0.05). Conclusions: The present pilot study suggests the possible association of TNFα -238G/A and -863C/A polymorphism with DCM of viral aetiology.

A comparative study between Antioxidant vitamin and Kellgren–Lawrence grading scale in knee osteoarthritis patients.

Osteoarthritis (OA) is a strongly age-related joint disorder that is defined as a gradual loss of articular cartilage. Current concepts of the pathogenic mechanisms of OA suggest that there isa shift in the homeostatic balance between the destruction and synthesis of bone and cartilage,with a net progressive destruction of these tissues. Recent studies of the biology of chondrocytes show that these cells actively produce reactive oxygen species (ROS). ROS are capable of inducing apoptotic cell death in chondrocytes, but more important, they can result in the degradation of aggrecan and collagen. Micronutrient antioxidants such as alpha- Tocopherol (Vitamin E) and Vitamin C also act to reduce the effects of ROS. A hospital based case control study was conducted in Burdwan Medical College, West Bengal, India on 76 postmenopausal women aged 45–70 years suffering from Osteoarthritis (OA) of the knee joint, which was diagnosed from symptoms, clinical examinations and radiographic findings. The 151 controls were selected from the healthy persons .plasma vitamin C and serum vitamin E ware measured.. Knee joint radiographs were evaluated with the Kellgren–Lawrence grading scale .Furthermore both were correlated with Kellgren–Lawrence grading scale to find out possible association between the antioxidant vitamins and the disease progression. Results showed that there was a significant decrease in antioxidant vitamin levels in patients with knee joint osteoarthritis as compared to the controls suggests that treatment with antioxidants in the initial stages of the disease may be useful as secondary therapy. Both antioxidant vitamins showed negative correlation with Kellgren–Lawrence grading. Both vitamins decreased with increasing Kellgren–Lawrence grade. So antioxidant vitamin can be use to assess the disease severity.

Primary Tubercular ulcer in Glans Penis mimicking neoplastic lesion.

Tuberculosis is a very common disease especially in developing countries but primary tuberculosis of penis is extremely rare. Here we are presenting a case of Primary tuberculosis of glans penis of 82 years male.

Acute fulminating viral myocarditis: clinically mimicking ARDS.

Viral myocarditis usually presented with influenza like manifestations, cardiac symptoms and signs related to myocarditis. We are presenting a case which was clinically mimicking acute respiratory distress syndrome but careful history taking with chest x-ray examination saves life of the patient.

Assessment of Nutritional Status of Rural Tribal Children in Tripura.

This cross-sectional study evaluated the nutritional status of 608 rural tribal children (age 6 to 15 years) from Jampuijala block of West Tripura district, India. Prevalence of stunting, thinness and overweight were 23.7%, 33.4% and 0.8%, respectively. The prevalence of stunting and thinness was found to be higher in boys than in girls.

Pattern Of Different Eczema Among Outdoor Patients Attended Faridpur Medical College Hospital, Faridpur, Bangladesh.

Eczematous dermatitis is very common in our country and all over the world. The aim of current study was to assess the burden, frequency and pattern of different eczema at outpatient department of Faridpur Medical College Hospital in the year 2009. Retrospective data were collected from medical records of patient. Patients of all ages & both sexes attending at the dermatology outpatient department of Faridpur Medical College Hospital in the year 2009 suffering from different eczema were included in this study. The frequency of eczema among patients attending at outpatient department of Faridpur Medical College Hospital was 12.8%, and the male to female ratio was almost 1:1. The most affected age group among patients was 0-5 years. Of all cases of eczema, 77.05% were endogenous and 22.52% were exogenous. The most common type of eczema was seborrhoeic dermatitis (27.17% of all cases), followed by contact dermatitis (20.00%) and Hand eczema (14.18%). Seborrhoeic dermatitis is commonest in young adult (21- 45 yrs), whereas atopic dermatitis is common in infant and children (0-10 yrs). Eczema is a public health problem in Faridpur, Bangladesh, and this necessitates prospective studies to determine its incidence and prevalence.

Pattern Of Skin Diseases In Patients Attending OPD Of Dermatology Department At Faridpur Medical College Hospital, Bangladesh.

It is generally agreed that the pattern of skin diseases differs in different countries, and within various regions of a country depending on social, economic, racial and environmental factors. Many workers have reported various patterns of skin diseases in different countries. So far, no such report is available in our country for Faridpur region. To fill the lacunae we decided to undertake a retrospective study of the skin disease pattern in this tertiary hospital of Faridpur, Bangladesh. All the newly diagnosed cases attending the OPD of Dermatology and Venereology, Faridpur Medical College Hospital, during the period of one year starting from 1st July 2007 to 30th June, 2008 were included in the study. Diagnosi s was done on clinical grounds and laboratory investigations were done whenever required. Eczema (19.2%), fungal infections (17.26%), scabies (15.16%) and pyodermas (7.59%) were the major skin diseases. STD's accounted for (0.73%) of the cases. Genodermatoses (0.01%) formed the minimal number of cases. Eczema was the commonest group of disorders. Out of the infective skin disorders fungal infections were the commonest group. Genodermatoses formed the least number of cases.

Deep-sea palaeoceanography of the Maldives Islands (ODP Hole 716A), equatorial Indian Ocean during MIS 12–6.

Deep-sea benthic foraminifera, planktic foraminifer Globigerina bulloides and pteropods have been quantitatively analysed in 451 samples from Ocean Drilling Program (ODP) Hole 716A, to understand both surface and deep-sea palaeoceanographic changes in the equatorial Indian Ocean basin during the late Quaternary (~444–151 Kyrs). Benthic foraminifera were analysed from >125 μm size fraction whereas Globigerina bulloides and pteropods were analysed from >150 μm size fraction. Factor analysis of most dominant benthic foraminiferal species over the studied time span made it possible to identify three biofacies characterizing distinct deep-sea environmental settings at Hole 716A. The environmental interpretation of each species is based on the ecology of recent deep-sea benthic foraminifera. The faunal record indicates fl uctuating deep-sea conditions including changes in surface productivity, organic food supply and deep-sea oxygenation linked to changing wind intensities. These changes are pronounced on glacial-interglacial time scales driven by summer monsoon winds.

Prevalence of diabetes and impaired fasting glucose in a selected population with special reference to influence of family history and anthropometric measurements--the Kolkata policeman study.

AIMS AND OBJECTIVES: The aim of this study was to estimate the prevalence of diabetes as well as IFG in a population of policemen and to evaluate the possible influence of some risk factors. MATERIAL AND METHODS: It was an epidemiological study on a group of policemen in Kolkata. Diagnosis of diabetes was based on history and fasting plasma glucose. The study population was divided in three categories: normoglycaemic, IFG and diabetes. BMI, waist circumference, WHR and waist-to-height ratio were estimated. RESULTS: Out of 2160 subjects with a mean age of 36.4 yrs (between 20 and 60 yrs), diabetes was found in 11.5% (10.4% known and 1.1% newly diagnosed) and 6.2% had IFG. Prevalence of diabetes was found to be increasing with age (p < 0.001). There was no statistically significant difference in BMI when compared between groups (normoglycaemic, IFG and diabetes). Waist circumference, waist-to-height ratio and WHR of normoglycaemic group were significantly less than those with IFG and diabetes; however there was no statistically significant difference between the diabetes and IFG groups. Parental history had significant influence on the prevalence of diabetes; a 37.5% prevalence was found in persons with history of biparental diabetes and 20.8% with uniparental diabetes, whereas it was only 9.9% without any family history (p < 0.01 and p < 0.05, respectively.). CONCLUSION: The prevalence of diabetes in the study population was high and was strongly influenced by family history, age and abdominal adiposity, without having any appreciable impact of BMI.

Pott's disease in a young child.

A 16-month-old emaciated, immunized child presented with low-grade fever and progressive kyphosis with a right sided para-vertebral abscess for 9 months. During this period of illness the child had marked loss of appetite and progressive weight loss. There was history of contact with sputum smear positive father. A gibbus was present at thoraco-lumbar region with a cold abscess at the right side of the gibbus and signs of upper motor neuron lesion were found on lower limb examination. Diagnosis was supported by relevant investigations including MRI of dorsolumbar spine and treatment was started beforehand with anti-tubercular drugs. The paravertebral abscess was drained several times and antibiotics were used depending upon the results of microbiological study. At the same time the patient was advised to wear a modified chest brace for immobilization and the management for severe malnutrition was also started accordingly. There was significant clinical improvement observed within one month of starting treatment.