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The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.
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Background: Laghu Sutashekhara Rasa (LSR) is a herbo mineral formulation containing Shuddha Gairika(Fe2O3) and Shunthi (Zingiber officinale Roxb.) with the levigation of Nagawalli Swarasa (fresh juice ofPiper betel Linn.) prepared as per the reference of Rasatarangini Parishistha. This is an importantformulation in Ayurveda therapeutics, but its shelf life is not evaluated till date. The Govt. of India Gazettespecifies the shelf life of various Ayurvedic medicines. However, there is a need to revalidate the shelf lifeof individual formulations by following parameters prevalent in respective scenario.Objectives: To evaluate shelf life of Laghu Sutashekhara Rasa.Materials and methods: Laghu Sutashekhara Rasa was prepared in the Pharmacy, Gujarat Ayurved University, Jamnagar following classical guidelines. The samples were subjected to accelerated stabilitystudy maintaining temperature and humidity 40 ± 2 _x005F_x005F_x0001_C and 75 ± 5% respectively. Relevant analyticalparameters were analyzed at an interval of 0, 1, 3 and 6 months to check the degradation levels in theformulation.Result: Product was free from microbial contamination and heavy metals were within the prescribedlimits. There were insignificant changes in physico-chemical profiles at different intervals of analysis.On extrapolation of the observations, the shelf life of Rasayoga was found to be 2 years and 8 months.Conclusion: The shelf life of Laghu Sutashekhara Rasa was found to be less than the given standards inofficial gazettes of Govt. of India. This decreased shelf life may be because of the predominantly(approximately 70%) herbal component present in the formulation.
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Background: The mitral valve apparatus, consisting of the mitral valve leaflets and commissures and subvalvular apparatus- papillary muscles and chordae tendinae; is one of the most complex and intricately designedstructures present in the human body and therefore the understanding of anatomical variations of papillarymuscles becomes important for surgical interventional procedures, in response to the increasing incidence ofvalvular heart defects. The aim of the cadaveric analysis was to identify the disparity in the morphometry of thepapillary muscles of the mitral valve complex. Therefore this study was taken up with an effort to extend theconcepts previously presented as well as to overcome deficiencies in the knowledge of gross architecture andpositional nomenclature of the papillary muscles.Materials and methods: Fifty formalinized cadaveric hearts were the material for study. Papillary muscles of leftventricle were classified according to a system developed by Berdajs et al., (2005), by precisely measuringshapes lengths and widths.Results: The significant outcome of this study indicates that no two papillary muscles out of the 50 specimenshad the same size, shape or position. All the hearts had two distinct groups of muscles – anterolateral andposteromedial. Specific analysis of each group revealed data regarding the muscles. In the antero-lateral groupof the specimens, the maximum height and width of the muscles was 37.40mm and 17.06mm respectively and inthe postero-lateral group, 33.86 and 26.90mm respectively. Conical shaped muscles were the most commonlyfound muscles owing to the minimum obstruction posed by them to blood flow.Implication: Better understanding of morphological variations can help cardiothoracic surgeons to customizesurgical procedures according to the papillary muscle pattern of the individual patient
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Background: The clinical manifestations of hypothyroidism are variable, depending upon its cause, duration and severity. The spectrum extends from subclinical to overt hypothyroidism to myxedema coma. A high degree of suspicion is thus required in order to appreciate the clinical manifestation of the disorder to reach a diagnosis. Purpose of this study was to correlate serum TSH level with severity of clinical manifestations and evaluate possible cause of delay in the diagnosis.Methods: A cross section observational and descriptive study for the assessment of severity of primary hypothyroidism at presentation and evaluation of the causes of delay in diagnosis in 86 patients was done from December 2012 to November 2013 in the Department of Medicine, MGM Medical College, Indore, MP, India.Results: Illiterate patients had significantly (p value 0.002) higher TSH values at presentation. 34.8% of patients presented as severe hypothyroidism with TSH value >100 mIU/L. Delay of as much as 7 years was noted. Majority of patients had a delay of around 1 to 3 years in diagnosis. Only 4.6% patients were diagnosed without any delay due to high level of suspicion at presentation.Conclusions: Due to non-specific symptomatology of hypothyroidism diagnosis is often delayed. Therefore, high index of suspicion is required at the physician抯 level and test of thyroid function is available at subsided cost therefore it should be offered to all such patients.
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Background: Anti-inflammatory effects of statins have generated maximum interest, as has been demonstrated in a number of studies showing rapid decrease in CRP levels in patients of acute coronary syndromes. This CRP lowering property of statins has also translated into clinical benefits as suggested by reduction in rate of recurrent angina, recurrent myocardial infarction, and mortality.Methods: This prospective, open, and controlled study was conducted on 160 indoor and outdoor patients, for total duration of two years (2005-2006), in GMC Bhopal, MP, India.Results: In all the four groups, baseline serum hs-CRP was statistically significant (p value <0.01) higher than normal hs-CRP level. Mean reduction (%) in hs-CRP after 3 months of statin therapy was 83.6% in group A and 62.4% in group C which is highly significant (p value <0.001). In group B also, 26% hs-CRP reduction was noticed which is statistically significant (p value <0.01). Baseline hs-CRP was statistically significant high (p value <0.01) in hypertensive patients. Percentages reduction in group A (87%) and group C (66%) was statistically significant (p value <0.01). Baseline hs-CRP was statistically significant higher (p value <0.01) than normal population. After 3 months of statin therapy percentage reduction in group A and group C was statistically significant (p value <0.01). Conclusions: Low dose atorvastatin can significantly reduce CRP level in patients with risk factors for cardiovascular disease. Early initiation of low dose atorvastatin can reduce this inflammatory marker in both ACS and high risk for ACS patients and can prevent major adverse cardiac events.
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Introduction: Histogenesis of kidney gives knowledge regarding histological maturity of kidney and its functionalstatus at the given gestational age. Kidney is developed from two parts, metanephrogenic blastema and uretericbud. Metanephrogenic blastema gives origin to secretory part i.e. nephron while ureteric bud forms the collectingpart i.e. collecting tubules and ureter. Both these parts fuse with each other and the development becomescomplete.Materials and Methods: 50 aborted human fetuses between 13-36 weeks of gestational age were used for thisstudy with no obvious congenital anomalies. The 2-3 mm thick cut sections of both kidneys were taken, processedand Paraffin blocks were prepared. 5-7 micron thick sections were taken with rotary microtome, mounted andthen stained with Haematoxylin and Eosin. Microscopic features were observed in low and high power and thendocumented.Results and Discussion: Differentiation between cortex and medulla was seen from 16-18 week onwards. Themedulla with collecting ducts, thick and thin segment of loop of Henle became well differentiated from 16 weekonwards. Vascularity of medulla increased with increase in gestational age while connective tissue decreasedwith increase in gestational age. Renal pelvis was lined by transitional epithelium.
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Background: Brachial plexus piece has reformed the field of regional anaesthesia for upper limb surgeries. Infraclavicular subcoracoid approach gives complete block without significant difficulties. Aim: To compare the additives adenosine and magnesium sulphate with bupivacaine in infraclavicular infusion for upper limb surgeries and postoperative analgesia. Materials & Methods: This Prospective study was done at the Department of Anaesthesiology, Govt. Medical College, Azamgarh. Around 24 patients scheduled for elective unilateral upper limb surgeries involving distal arm/ elbow/ forearm/hand divided into two groups A (n-12) and B (n-12) randomly. Group A - adenosine 6mgs with 28 ml 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 6mgs of adenosine (2ml) at a rate of 5ml/hr. Group B - magnesium sulphate 75 mgs (in 2ml) with 28ml of 0.5% bupivacaine bolus followed by infusion of 0.25% bupivacaine 28ml with 75mgs of magnesium sulphate (in 2ml) at a rate of 5ml/hr in USG guided placement of infraclavicular catheter. Results: Our Study revealed that Group A had a faster Onset time of sensory and motor block and faster recovery when compared to group B. Group A needed more rescue analgesia than group B. Conclusion: The addition of magnesium sulphate as an additive to bupivacaine in brachial plexus block may be a better choice when prolonged postoperative analgesia is required.
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Infertility is defined as failure to conceive within one year or more than one year of regular & unprotected coitus. It is the most sensitive and cumbersome problem which haunts every couple. Total 10-15% of world population affected due to this problem. Among them Female is directly responsible about 40%. The sub factors of female infertility are Ovarian, Endometrial, Tubal and Uterine etc. In Ayurved so many formulation are given for Infertility. Phalakalyana Ghrita (PKG) is a commonly used and prescribed Ayurvedic poly herbal formulation in all types of Infertility. However, till date no published data is available on its analytical profile. The main aims and objectives of this study are to develop the pharmacognostical and phytochemical profile of PKG. The pharmacognostical study reveals the presence of Lignified fibres, Prismatic crystals, Borderpitted vessels, Rhomboidal crystal, Scleroids, Stone cells etc. Pharmaceutical analysis showed that the loss on drying value was 0.47% w/w, Specific gravity was 0.9133, Refractive index was 1.46, Iodine value was 48.56, Saponification value was 227.05, and Acid value was 1.29. HPTLC fingerprinting profile of PKG revealed 10 spots at 254 nm and 5 spots at 366nm.
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Background: Foreign body aspiration is a common life threatening emergency, but, largely a preventable problem. The object aspirated depends on various factors, such as age, sex, occupation, geographical area, socio-cultural factors, economic status, and nutritional habits. In recent years some traditional/social habits and fashion trends of using headscarf/ hijab pins have become a discrete category of foreign body aspiration in young Muslim/Islam girls wearing headscarves. Objective: To highlight the increasing number of cases coming to clinical attention with headscarf pin aspiration. India having a growing population which is young and fashion oriented, the awareness of this problem needs to improve. Discussion: In recent times young adolescent Muslim girls use multiple matching small headscarf pins to fix the hijab as a fashion trend. Adolescent girls and adults tend to hold the headscarf pin between their lips while wearing the headscarves using their two hands to secure the veil. Lack of concentration or activities such as laughter, talking, and coughing predisposes them to aspiration, especially in young teenage groups where they lack experience in such manoeuvres. Conclusion: Accidental foreign body aspiration to a large extent is a preventable problem and more so in the case of headscarf pin. Appropriate interventions need to be planned as more young population is getting involved.
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Background: In the post-operative period, it has always been an important consideration for clinicians, to keep the patient comfortable, calm and pain free. So there is a constant need for an ideal sedative for postoperative patients. Alpha 2 adrenoreceptor agonists such as dexmedetomidine could provide an answer to this problem because they have several relevant physiological properties like sedation, anxiolysis, analgesia and arousability. This prospective, randomized trial was conducted to compare the safety and efficacy of dexmedetomidine and tramadol in the management of postoperative pain. Methods: In the present study 60 patients operated under general anaesthesia with a pain score of 1-3 were randomly allocated into two groups to receive either dexmedetomidine (group D) or tramadol (group T). In both groups, pain score, sedation score, heart rate, blood pressure, SPO2, respiratory rate were monitored for every 5 min for first 30 min, every 10 min for next 1hr, every 15 min for next 1 h, every 30 min for the next 1 h, every 1 h for 3 h and 6th hourly till 24 h. The need for rescue analgesic was also noted. The data were tabulated and analysed using descriptive statistical tool. Mean, standard deviation and comparison between the groups was done by student’s ‘t’ test. A p value less than 0.0001 was considered significant. Results: Mean duration of sedation of dexmedetomidine was 129.6±41.02 and for tramadol was 117.3 ± 47.75 (p=0.14), mean degree of sedation in both group was -1, mean duration of analgesia 139 min in Group D and 280 min in Group T (p<0.0001), rescue analgesia was required at 169th min in Group D and 288th min in Group T (p<0.0001), mean heart rate in Group D was 67.8±5.24 and 69.4±4.79 (p=0.12), mean Mean Arterial Pressure (MAP) in Group D was 78.0±8.97 and in Group T was 89.2±10.63 (p<0.00001), mean respiratory rate in Group D was 15.8±2.33 and in Group T was 15.9±2.09 (p=0.41), mean SPO2 in Group D was 99.5±0.56 and in Group T was 99.4±0.62 (p=0.14). There was no significant difference in degree and duration of sedation, duration of analgesia, vital parameters, and adverse effects in both groups but there was a statistical difference in the duration of analgesia and the need for rescue analgesia in Group D. Conclusion: Though there is no statistical difference in both groups, dexmedetomidine significantly reduced anxiety, agitation and produced calmness in postoperative patients which was not seen with tramadol.