Clinical Profile of Blunt Trauma Chest: A Hospital based Study

Introduction: Blunt trauma to the chest is a very commonoccurrence in setting of traumatic incidents occurring withhighest frequency in young adults between 15-35 years ofage. Traumatic chest injuries lead to significant burden ofmortality and morbidity in the young population. The mostcommon modes of injury in such patients is motor vehicleaccidents followed by other high energy traumatic scenarioslike falls from height, contact sports, violence etc. This studywas aimed at the evaluation and management of BCT with ribfractures and associated injuries.Material and Methods: The present study was a retrospectivecum prospective hospital based study done in SKIMS MedicalCollege Hospital, Srinagar, J & K, India. Sixty four patientswho attended the Emergency Department with history of bluntchest injury were included in the study. Patients of all gendersbetween 18 and 65 years of age were included in the study.The data regarding age, gender, mode of injury, presence ofthoracic injuries, abdominal injuries, skeletal injuries wasgathered and tabulated.Results: We observed a strong male preponderance with45 out of 64 patients being male. Most common mode ofinjury was traffic accidents followed by falls from height,fall of heavy objects, hit by animals, violence and contactsports. Associated injuries were seen in both thoracic andextra-thoracic organs. Musculoskeletal injuries were alsocommonly seen. Patients were managed according to ATLSprotocol; fifteen patients were managed with intercostal tubedrainage four of which required thoracotomy, four patientsrequired laparotomy for visceral injuries, four patientsrequired fixation of vertebral fractures and musculoskeletalinjuries were managed according to the orthopaedic protocols.In the present study four (6.25%) died as a result of massivethoracic injuries.Conclusion: Blunt chest injury is a serious injury whichcan result in life threatening complications which need to beanticipated, identified and adequately managed to reduce therates of poor outcome. Integrated management employingthe general surgeon, anesthetist, orthopaedician, internistand relevant paramedics is essential. Strict adherence toATLS protocol is imperative. Adequate fluid resuscitation,ventilatory support, O2 inhalation, pulmonary physical therapyand efficient analgesia can lead to quick recovery and reducedrates of surgical intervention

Clinical profile of stroke in Kashmir

Stroke is a major health problem in the world ranking among the top three causes of death, after heart disease and cancer in developed countries. We prospectively studied one hundred patients of acute cerebrovascular accident who presented to accident and emergency department. Definite diagnosis was done by cranial imaging. This was conducted last year in our hospital which is a tertiary care hospital in Kashmir valley catering a population of 7 million. We documented hemorrhagic stroke in 79 patients (79%) while 21 patients (21%) had occlusive stroke which is in contrast with most of the studies done earlier (most western studies). Risk factors viz., hypertension, smoking were contributing to the high incidence of stroke. Majority of the patients presented in the 5th to 7th decade, consistent with other studies. Majority of the patients presented during awake phase and presented with maximum neurodeficit at onset. Majority of the patients had hemiplegia (paresis) 71%. Basal ganglia was the major site of bleed 49.4%. Dietary habits, extremes of climate and decreased physical activity predispose to high incidence of strokes.

Multi-parametric 3-Tesla MRI evaluation of prostate in cases with negative prostatic biopsy with raised PSA levels – A tertiary care hospital study

The incidence of prostate cancer has been gradually increasing in the world. Checking the serum prostate-specific antigen (PSA) level and a digital rectal examination (DRE) are the gold standards for prostate cancer screening. Prostate gland is divided into four zones, the peripheral zone (PZ), transitional zone and central zone and anterior nonglandular fibromuscular stroma. Prostate is divided into minimum 16 and optionally 27 regions of interest as per European consensus meeting. Until recently, most professionals have been skeptical that magnetic resonance imaging (MRI) could be used on a widespread basis to diagnose or stage prostate cancer with any degree of reliability, and therefore help with making treatment decisions. The aim of the present study was to study diagnostic value of mpMRI of prostate in cases of raised PSA but with negative biopsy. The present study was carried out in the post graduate department of Radiodiagnosis and imaging Govt. Medical College Srinagar over a period of one year from May 2016 to April 2017. All patients with negative prostatic biopsy were evaluated on Siemens 3 tesla MRI scanner. All patients underwent initial T1W scanning to look for any evidence of hemorrhage and patients having hemorrhage due to previous biopsy were also excluded from study or their study was deferred until hemorrhagic artifacts disappear. After proper case selection patients were subjected to detail Multiparametric MRI (mpMRI) for prostate 6-8 weeks period was given from previous biopsy time to MRI study and cases with hemorrhage on T1 weighted sequence were either excluded from study or their study was deferred till resolution of Aijaz Ahmad Hakeem, Irshad Mohiuddin, Tanvir Iqbal. Multi-parametric 3-Tesla MRI evaluation of prostate in cases with negative prostatic biopsy with raised PSA levels - A tertiary care hospital study. IAIM, 2018; 5(6): 5-13. Page 6 haemorrhage. The conclusion of the present study was that Mp-MRI prior to repeat biopsies can improve the detection rate of clinically significant PCa and allow for a more accuracy in prostate disease diagnosis.

MRI in Cerebellopontine angle and internal auditory canal lesions

Background: A large variety of inflammatory and neoplastic lesions are known to occur within internal auditory canal and cerebellopontine angle Imaging techniques are now available to guide the search for the underlying cause of most patient complaints The advent of MRI has revolutionized the medical diagnostic imaging because it allowed tissue characterization of many lesions High resolution MRI scan is highly sensitive in detecting lesions of internal auditory canal and cerebellopontine angle More recently, diffusion imaging is playing a substantial role in evaluation of CPA masses High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue in tumor matrix) This study was undertaken with purpose to present MRI findings in cases of CPA and IAC lesions and to assess the impact of MRI on the diagnosis management and follow up, after treatment, of these lesions with an attempt to compare MRI findings with operative and H/P findings in the cases where surgery was done Materials and methods: The present study was conducted in Post Graduate Department of Radiodiagnosis, Government Medical College, Srinagar on patients presenting with otoneurological signs and symptoms suggestive of CP angle and IAC lesions referred for MR imaging by various departments of GMC Hospital Srinagar during the one year period of study Results: Majority of lesions found in this study were tumors (33 lesions), next common in our series were inflammatory lesions and vascular lesions (4 each case) Among all lesions and tumors most common MR diagnosis in our study was acoustic neuroma 20 of 41 lesions (4878%) and 20of 33 tumors (6060%) respectively Next common among tumors was meningiomas 3 out of 33 cases (909%) Conclusion: The results of the present study concluded that, MRI has particular advantages over CT for study of internal auditory canal and cerebellopontine lesions because it is non-ionizing Aijaz Ahmad Hakeem, Irshad Mohiuddin MRI in Cerebellopontine angle and internal auditory canal lesions IAIM, 2018; 5(12): 40-50 Page 41 investigation, better soft tissue contrast and resolution, multiplanar capability permits more reliable distinction of lesions, better identification of structures involved by lesions, tissue characterization of lesions and absence of beam hardening artifacts makes MR imaging superior ion evaluating the lesions in CP angle and IAC The radiological features of various lesions are often sufficiently distinctive to permit a specific diagnosis to be made MR imaging due to its multiplanar capability helps in knowing the exact site and extent of these lesions MRI shows inflammatory and vascular lesions with exquisite detail and is better for detection of such lesions as compared to CT MRI allows a confident perspective pathologic diagnosis to be made (Using FSE T2 weighted images, diffusion imaging, SE images, thin section post gadolinium scans) and this predictive value far exceeded the CT

DNA barcoding of a new record of epi-endophytic green algae Ulvella leptochaete (Ulvellaceae, Chlorophyta) in India.

Epi-endophytic green algae comprise one of the most diverse and phylogenetically primitive groups of green algae and are considered to be ubiquitous in the world’s oceans; however, no reports of these algae exist from India. Here we report the serendipitous discovery of Ulvella growing on intertidal green algae Cladophora glomerata and benthic red algae Laurencia obtusa collected from India. DNA barcodes at nuclear ribosomal DNA Internal Transcriber Spacer (nrDNA ITS) 1 and 2 regions for Indian isolates from the west and east coasts have been generated for the first time. Based on morphology and DNA barcoding, isolates were identified as Ulvella leptochaete. Phylogenetic reconstruction of concatenated dataset using Maximum Likelihood method differentiated Indian isolates from other accessions of this alga available in Genbank, albeit with low bootstrap support. Monophyly of Ulvella leptochaete was obvious in both of our phylogenetic analyses. With this first report of epi-endophytic algae from Indian territorial waters, the dire need to catalogue its cryptic diversity is highlighted and avenues of future research are discussed.

A study to evaluate antioxidant and hepatoprotective activity of aqueous extract of roots of Valeriana wallichii in CCl4 induced hepatotoxicity in rats.

Background: Drugs for liver ailments have been important in research, but still the number of drugs acting on various hepatic diseases is very limited. This study, for the fi rst time, evaluates the hepatoprotective activity of aqueous extract of the roots of Valeriana Wallichii in albino rats. Methods: The hepatotoxicity was induced by CCl4. Animals were divided into 5 groups of 6 animals each. Group I (Normal control) was given only distilled water. Group II (Negative control)was administered CCl4 for 7 days while Group III (Positive control) was given silymarin and CCl4 for 7 days. The test groups (Group IV & V) were given an aqueous extract of roots of V. Wallichii in a dose of 300 mg and 500 mg/kg, respectively. The animals were sacrifi ced on 8 days and blood was collected for biochemical analysis (aspartate aminotransferase [AST], alanine transaminase (ALT) and alkaline phosphatase). Liver tissue was extracted for histopathological examination and in vivo antioxidant tests Catalase [CAT], glutathione and malondialdehyde. The extract was also subjected to in vitro antioxidant tests (Total reducing power and total phenolic content). Results: The test extracts in the dose of 500 mg/kg were shown a signifi cant decrease in the levels of AST and ALT (p>0.05) and CAT activity. 300 mg/kg dose of extract showed minimal hepatoprotection. The fi ndings were confi rmatory to histopathology. Conclusion: The aqueous extract of roots of V. Wallichii in a dose of 500 mg/kg offers partial protection against hepatotoxicity produced by CCl4 in albino rats.

Ropivacaine is a better alternative to lidocaine in intra-venous regional anesthesia

This study was conducted to study the analgesic efficacy of ropivacaine and compare it with that of Lidocaine in intravenous regional anesthesia. Fifty patients of physical status ASA I and II, aged 20-50 years undergoing ambulatory hand surgery were randomly allocated to two equal groups of 25 each. Patients in either group received either 40 ml of 0.5% lidocaine or 40 ml of 0.2% ropivacaine. The onset, duration and recovery times of sensory and motor block,time to the request for first analgesic, incidence of rescue medication and total analgesic consumption in first 24 hours were recorded. The recovery time of sensory block was significantly prolonged but the onset of sensory block was delayed in Ropivacaine Group as compared to patients in Lidocaine Group. Time to the request for first analgesic was significantly prolonged while the incidence of rescue medication and total analgesic consumption was significantly low in patients receiving ropivacaine. No statistically significant difference was found in onset and duration of motor block between the two groups. It was concluded that ropivacaine is a better alternative to Lidocaine for intravenous regional anesthesia and provides a prolonged post-torniquet release pain relief as compared to Lidocaine

Health seeking behavior of the people; knowledge, attitudes and practices [KAP] study of the people of urban slum areas of Karachi

The aims and objectives were, to know about the approach of people towards seeking medical advice with different options of healers, to observe thinking, feeling and various actions of people including level of self medication, and to know perception of people regarding various practices done by the healers. People living in urban slum areas of Karachi. Cross sectional Karachi. July to October 2008. Subjects and It was Knowledge, attitudes and practices [KAP] study carried out on a sample of 300 permanent household members aged>/=16 years of middle and poor class living in urban slum areas of Karachi. The mean age of the study participants was 38.27 with standard deviation of 17.57. 182 [61%] were male while 118[39%] were female. Out of 300 study participants [n=300] 260 [86.6%] consult allopathic healers including 169 [56.33%] MBBS general practitioners and 91 [30.3%] non qualified or quacks,25 [8.3%] consult homeopaths, 11 [3.6%] Hakims, and only 4 [1.33%]consult faith healers [P<0.05].148 [49.33%], participants belong to middle class group, while 152 [50.66%] were from poor class. 50% study participants do self medication at home prior to consultation for heath. Health seeking behavior is a complex phenomenon in developing countries like Pakistan where poverty overrides all other factors in decision of selecting a healer. It is recommended that people should be educated in choosing a healer which should be a qualified one

Evaluation of vitamin B12 and folic acid deficiencies in selective middle aged and elderly male and female patients

Significant prevalence of vitamin B12 and folate deficiencies supported by biochemical evidence has been reported in the world. It was indicated that these biochemical evidences are associated with prevalence of anaemia in elderly. The major reasons of vitamin deficiencies, especially that of B-12, was reported to be inadequate dietary intake and, in the elderly, malabsorption of the vitamin from food. Vitamin deficiencies especially that of B-12 are usually diagnosed on the basis of serum or plasma vitamin concentrations. Due to dilemma of management and diagnoses of mal-nutrition and vitamin deficiencies in elderly population, the present study was undertaken to ascertain vitamin B12, folate and RBC folate status in selected middle aged and elderly male and female patients. A total of 132 patients [period March 2004 to November 2007], were selected according to gender and age. For males [n = 72]; age groups were 50-60, 61-70, 71-80 yrs and greater than 80 yrs and for females [n = 60]; age groups were 52-61, 62-69, 70-79 and greater than 80 yrs. The results clearly depicts that elderly patients in both gender between the age groups of 71 and greater than 80 had significantly low vitamin concentrations [p < 0.001] than the middle age groups of 61 to 70 [P < 0.01]. Correspondingly, their hemoglobin levels were also relates to the overall picture of either normal or low concentrations of vitamins in all groups. In males the lowest concentration of 3.5 ng/ml for folate, Vitamin B12 of 228 pg/ml and 168 ng/ml for RBC folate were observed in > 80 years group preceded by 6.2 ng/ml, 278 pg/ml and 170 ng/ml respectively, in 71 to 80 years group, whereas in females, the observations were 2.5 ng/ml for folate, 220 pg/ml for B12 and 110 ng/ml for RBC folate concentrations in > 80 years age group of patients. In conclusion few management strategies were suggested for therapy of vitamin deficient older patients

Assessment of hyperlactatemia and acidosis in patients with cardiac dysfunctions

Background: It has been postulated that hyperlactatemia is not the only cause of acidosis in cardiac dysfunction and there are other factors such as un-measured anions also that significantly participate in its development

Aim: The present study is designed to determine different components of metabolic acidosis in cardiac dysfunctions and cardiac arrest patients in order to assess the degree to which lactate is responsible for the acidosis

Methods and Materials: Forty two patients with out-of-hospital cardiac dysfunctions and cardiac arrest, admitted to the hospital were included in present study. All arterial blood gases and plasma biochemical parameters were estimated by standard methods on automated analyzers. Modified [by Figge and colleagues] form of Stewart's quantitative biophysical methods including formula for apparent strong ion difference AEurooeSIDaAEuro and strong ionic gap AEurooeSIGAEuro were used to evaluate un-measured and measured ions

Results: The mean age of patients were 57.2 years and included 33 [78.6%] males and 9 [21.4%] females. Except for sodium, ionized calcium and SIDa, all variables were significantly different between the two groups. Patients with cardiac dysfunctions and arrest were also hyperkalemic, hypochloremic and hyperlactatemic. The anion gap and SIG were also higher in patients with cardiac arrest. Lactate was the strongest determinant of academia

Conclusion: It was concluded that lactate accounts for only less than 50% of the metabolic acidosis and consequent acidemia seen in such patients and that an increase in unmeasured anions and phosphate also accounts for major portion of acidemia