Catheter induced hypospadias, urethral trauma and penile abscess in completely recoverable neurological afflictions: preventable entities

Background: Catheter associated complications are very common in the emergency departments of medicine, general surgery, orthopaedics and in community. They mostly occur in patients with neurological afflictions because of inexperience of the first handlers as they lack the insight of altered physiology and anatomy in the lower urinary tract because of neurological lesions and also because of an inadequate advice at the time of discharge regarding the catheter care. Objectives of this study were to find the prevalence of per-urethral catheter associated injuries in patients with neurological lesions in a tertiary care centre of south-eastern Punjab and their prevention in completely recoverable neurological afflictions.Methods: This is a cross-sectional observational study conducted in urology department from 1st August 2017-31st August 2018. The data was taken from medicine, general surgery and orthopedic emergency departments. A total of 82 patients were taken from 19-78 years and 49 patients had per-urethral catheter placement. Analysis was done using Statistical Program of Special Sciences, version 20.Results: It was observed that overall neurological lesions are more common in males (80.48%) as compared to females (19.51%) and distributed over an age range of 19-84 years in both sexes. Out of total patients, 59.75% required per urethral catheterization. The prevalence of per-urethral catheter associated complications was 20.40%.Conclusions: Insertion of per-urethral catheter is a simple procedure but an error of omission on the part of health professionals’ results in a serious complication in a neurological patient. Proper insertion technique and catheter care are to be followed to prevent avoidable complications in this subset of patients.

Mitochondrial Reactive Oxygen Species and Nephrolithiasis

Mitochondrial redox/oxidative balance are vital for cellular life and death. Mitochondria are considered as the most important sub cellular site of reactive oxygen species production in mammalian organs. Reactive oxygen species produced by mitochondria can cause damage to mitochondrial components and initiate degradative processes. The kidney requires ample amount of mitochondria to remove waste from the blood and regulate fluid and electrolyte balance. Adverse conditions of organelle stress such as decreased altered energy metabolism in mitochondria contribute in the progression and development of kidney diseases. Nephrolithiasis is a kidney disease in which solid urinary components form crystals, precipitated out of the urine and shaped into stones. Studies have suggested that oxidative stress and associated renal injury paved the way for crystal deposition in the renal tissue. Mitochondria are anticipated as the foremost source of intracellular reactive oxygen species under oxalate induced nephrolithiasis. Persistent mitochondrial dysfunction results in the progression of nephrolithiasis. Although different approaches to minimize mitochondrial dysfunction through regulation of mitochondrial ROS production using antioxidants have been accomplished yet mitochondria specific antioxidants are the prerequisite. This review offers a glimpse into the role of mitochondrial reactive oxygen species in nephrolithiasis and the future perspective of potential antioxidant therapies.

Study of ABO Blood Groups and Subgroups A1, A2, A1B and A2B in Blood Donors and Recipients

Blood transfusion in modern era is possible only due to the knowledge of exact blood groups and sub blood groups. Over 700 erythrocyte antigens have been reported and are organized into 35 blood group systems by International Society of Blood Transfusion. These antigens may be proteins, glycoproteins or glycolipids and are controlled by single or more gene locus. Some antigens are specific to red cells; whereas, others are found on other cells throughout the body. The ABO blood group was the first human blood group to be discovered by Landsteiner in 1900 and it served the beginning of Blood Banking and Transfusion Medicine. Numerous mutations are found in A, B and O genes, but the most common mutation is A2. The A2 gene has two nucleotides different from the A1 gene which results in diminished enzymatic activity and consequently, weakened antigen expression. Distinction between A1 & A2 made by testing red cells with the lectin from Dolichos biflorus. Prospective study on 2000 cases to find the frequency of ABO and sub blood groups to reduce the blood transfusion related reactions. Methods: The present study included 2000 blood sample collected in the Department of Blood Banking, Govt. Medical College and Hospital, Amritsar and in voluntary blood donation camps organized by the department. 4 ml of venous blood sample collected. 2ml of blood put into ethylene diamine tetra acetic acid (EDTA) vial and remaining 2ml transferred to test tube and allowed to clot. The EDTA sample used for forward grouping and serum used for reverse grouping. Results: In our study the frequency of blood group B was the highest 37.8%, blood group O was 31.8%, blood group A was 21.2% and group AB was the least common with 9.2%age. In case of sub groups, A1 was 20.10% (highest in sub groups) and A2B was 0.85% (Lowest). The Rh +ve blood group was 94.1% and Rh –ve was 5.9%. Conclusion: The study is concluded with the suggestion that, as already being carried out, ABO, Rh blood grouping and sub grouping should be done in each and every case to reduce the blood transfusion related complications. More work should be carried out in different parts of state to know the distribution pattern of ABO, Rh blood groups and sub groups. This will also help the Blood Banks to estimate the requirement of different blood groups and sub groups.

Patient Satisfaction in Dentures Among Edentulous Patients

Background: Several researchers have pointed out that one of the most important correlated factors for the success of dentures is understanding the patient and his/her psychology. Patients’ background may influence his/her psychology and thereby his/own satisfaction over the denture. Aims: The present study was aimed to assess the patients’ overall satisfaction in using complete dentures compared to normal teeth by various socio-demographic variables. Methods: Edentulous patients who received complete dentures at least two months back in the JN Institute of Dental Sciences, Imphal, during the period Jan 2016- Dec 2017 were selected in this cross-sectional study. After obtaining informed verbal consent, by using a pre-tested semi-structured questionnaire their socio-demographic details were collected. Further, a set of 38 questions was designed to evaluate the quality of satisfaction (related to mastication, appearance and speech). Results: Patients aged above 65 years felt satisfied with the dentures compared to younger patients and widowed/divorced patients.The quality of satisfaction in terms of mastication, appearance and speech when analysed by socio-demographic variables did not show any statistically significant difference. Literacy was the only factor directly associated with satisfaction in mastication (p<0.01) whereas both literacy and income had a direct association with satisfaction in appearance (p value of <0.001 and 0.016 respectively). No socio-demographic variable was found to have significant association with satisfaction in speech. Conclusion: While giving prosthodontic treatment in edentulous patients, it is important to ascertain the socio-demographic background of patients which might influence the psychological state of the patients.

A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.

Pregnancy outcome of sickle cell disease women

Objective: To evaluate the maternal and fetal outcome in pregnant women with sickle cell disease [SCD] compared with healthy women

Setting: Department of Gynecology and Obstetrics, Salmaniya Medical Complex, Bahrain

Design: Retrospective Case-Control Study

Method: Patients with SCD who delivered from 1 January 2011 to 31 December 2012 were reviewed. The matched controls had neither SCD nor sickle cell trait

Result: Patients with sickle cell disease required significantly more admissions during their pregnancy, 135 [78.4%] compared to the control, 74 [37.4%]. One hundred thirteen [65.6%] SCD patients were admitted with vaso-occlusive crises and 18 [10.4%] with hemolytic crises. SCD patients had a significant decrease in parity, gestational age and birth weight compared with the control group. SCD patients had a significant rise in the incidence of urinary tract infection, but there was no difference between both groups in the incidence of hypertensive disorders, mode of delivery and perinatal outcome. Four [2.3%] patients with SCD died; two [1.2%] patients died due to pulmonary embolism, one [0.6%] due to acute chest syndrome and one due sepsis and disseminated intravascular coagulopathy

Conclusion: Sickle cell disease is hazardous both to the mother and the fetus and is associated with high maternal morbidity and mortality

Guided Tissue Regeneration Based Treatment of Root Coverage using Placental Membrane Allograft: A Case Report.

Gingival recession is defi ned as the apical migration of gingival margin to the cementoenamel junction. It results in root exposure which leads to clinical problems such as root surface hypersensitivity, root caries, cervical root abrasions, diffi cult plaque control, and diminished aesthetic/cosmetic appeal. Guided tissue regeneration based root coverage has emerged as a promising treatment modality. A variety of non-resorbable and bioresorbable membranes have been successfully used. Among resorbable membranes, collagen has been extensively studied. Recently, amnion membrane, the third generation membrane which is a placental derived tissue has been introduced. On the basis of the fi ndings of the present case report, it can be concluded that recently introduced amnion membrane (third generation membrane) are equally effi cacious in the treatment of gingival recession and use of this resorbable membranes with coronally advanced fl ap is a versatile treatment modality for root coverage of isolated buccal gingival recessions. Th e more gingival tissue thickness (gingival biotype) enhancement was observed with this membrane. Amnion membrane has certain additive advantages over the collagen membrane such as better handling properties and a thin diameter enabling it to mold according to the defect anatomy and root surfaces easily.

Biological activity of Dolichos biflorus L. trypsin inhibitor against lepidopteran insect pests.

Protease inhibitors confer resistance in plants against insect pests by inhibiting larval gut proteases. Cultivars of Dolichos biflorus were screened for their inhibitory activity against midgut proteases of Pieris brassicae larvae. Seed extracts of developing and germinating seeds of HPK4 cultivar inhibited larval gut proteases of Spodoptera littoralis efficiently. Neonate larvae of P. brassicae fed on cabbage leaf discs coated with 0.025-2.50 mg protein (seed extract) resulted in 10-80% larval mortality and significantly reduced leaf area eaten and faecal matter as compared to control. The treated larvae had 40% less soluble proteins per mg faecal matter and there was similar decline in midgut proteases of treated larvae (@ 2.5 mg protein) compared to untreated ones after 5 days. The LC50 and LT50 value was calculated to be 1.05 mg/leaf disc and 4.8 days (2.5 mg protein), respectively for neonate larvae of P. brassicae. Significant reduction in egg hatching (75%) was observed in egg mass treated with 5.3 mg of crude inhibitor protein of mature seeds. This could be due to the inhibition of proteases involved in the hydrolysis of egg chorion proteins. The studies demonstrated the insecticidal activity of D. biflorus seed extracts.

Characteristics of rheumatoid arthritis patients at first presentation to a specialized rheumatology department.

Background: Rheumatoid arthritis (RA) is a chronic, progressive, debilitating, systemic, autoimmune disease that mainly affects the diarthrodial joints. It is the most common form of inflammatory arthritis that occurs in approximately 1% of adults. The main objective is to study the characteristics of patients with Rheumatoid Arthritis (RA) at first presentation to a specialized rheumatology department. Methods: The study included 122 consecutive patients with RA, fulfilling 1987 American College of Rheumatology (ACR) criteria for RA at ‘Joint Disease Clinic’ of rheumatology department, at ISIC, New Delhi. Results: The mean age was 45.3 ± 12.4 years, F:M ratio, 8.4:1; maximum patients (31.1%) belonging to age group 30-40 years. Mean age at onset of symptoms was 38.1 ± 12.9 years and disease duration mode 5 years. 88% patients were literate and 59% referred by other patients. 14.8% patients had family history of RA, 7.38% (all males) were smokers. 16.4% female patients developed symptoms of arthritis within one year after delivery. 44.3% patients had severe, 50.8% moderate, 3.3% mild and 1.6% inactive disease (DAS 28[ESR] scoring system). 28.7% patients were taking treatment from alternative systems, 25.4% from orthopaedicians, 15.6% from internists and 8.2% from rheumatologists. Methotrexate and glucocorticoids were the most prescribed drugs (50.8% each) but in inappropriate doses. 23.8% patients had co-morbidities, hypothyroidism (9%) being the commonest. Conclusions: RA affects middle aged women. Hypothyroidism is the mostly associated autoimmune disease. The majority receive suboptimal / inappropriate treatment before visiting a rheumatologist. Most patients consult a rheumatologist at late stage in the disease often with deformities. Hence, increased awareness is needed about this disease among patients and doctors so that patients get timely referral to a rheumatologist for the proper management of this disease.

Acute transfusion reactions encountered in patients at a tertiary care centre in Punjab.

Background. Blood transfusion is a life-saving procedure, which can occasionally be unsafe and result in a spectrum of adverse events. We aimed to determine the characteristics and type of acute transfusion reactions occurring in patients at a tertiary care centre. Methods. A retrospective study was conducted at the Department of Immunohaematology and Blood Transfusion, Dayanand Medical College and Hospital, Ludhiana, Punjab. All acute transfusion reactions reported to the department from 1 Jan 2012 to 31 March 2013 were evaluated. All the adverse reactions were recorded, analysed and classified on the basis of their clinical features and laboratory tests. Results. During the study period, 45 092 blood components were issued from the department and 190 transfusion reactions (0.42%) were reported. The most frequent were febrile non-haemolytic transfusion reactions (54.2%) followed by allergic reactions (36.3%), haemolytic reactions (1%) and non-specific reactions (8.5%). Conclusion. Each transfusion has to be monitored carefully with prompt recognition and treatment of acute transfusion reactions to decrease transfusion-related morbidity and mortality. Data from a well-functioning haemovigilance system can be used as a quality indicator for monitoring blood transfusion safety and contribute to evidence-based transfusion medicine.

Development and in vitro characterization of mebendazole delayed release tablet for colonic drug delivery

The main objective behind this study was to formulate delayed release colon targeted tablet of Mebendazole by using different polymers. The precompressional parameters of powder blend were studied. The wet granulation method was used for the preparation of tablets. The tablets of all formulation were subjected for different physicochemical evaluation. The drug-excipient interaction study was carried out by using Fourier transforms Infrared spectroscopy [FTIR]. The in vitro evaluation was carried out at different pH ranges [0.1M HCl, 6.8 and 7.4 Phosphate buffer] for the prepared tablets. From the stability, Fourier transform infra-red spectroscopy studies Mebendazole tablet does not show any interaction between drug and polymer. The prepared tablets were complied all the physicochemical test as per official limit. The formulated [M3] batch shows better sustained release 99.89% over a period of 12 hours and the data was fitted into Korsemeyer-Peppas kinetic equation. The result indicates that Mebendazole colon targeted matrix tablet remain stable in the stomach and shows better release into the colon with the help of pH dependent synthetic polymers

Maternal mortality in women with sickle cell disease

Sickle cell disease [SCD] is a major health problem encountered in the Kingdom of Bahrain; it is associated with high maternal morbidity and mortality. To determine the immediate cause/s of maternal mortality. A Retrospective Study. Health Information Directory, Ministry of Health. All reported maternal deaths in Bahrain from 1977 to 2012 were included in the study. Personal characteristics, pregnancy outcome and the main cause of death were compared between women with and without SCD. Hundred twenty-two maternal deaths were reported in Bahrain between 1977 to 2012; 37 [30%] had SCD. The study showed a significant decline in overall Maternal Mortality Rate [MMR]. The OR of maternal mortality by SCD was 117. The most important causes of maternal mortality in SCD were embolism 13 [35%], sepsis 9 [24%], hemorrhage 6 [16%] and acute chest syndrome 5 [13.5%]. In the non-SCD group, the leading cause of death was embolism 18 [21%], hypertensive disorders 18 [21%], followed by infection 14 [16.5%], hemorrhage 14 [16.5%] and heart disease 10 [11.8%]. Sickle cell disease is the leading cause of maternal death in Bahrain. A significant decline in MMR in Bahrain over the years has been revealed, but unfortunately there was no substantial reduction amongst SCD mothers

Effect of Aegle marmelos (L.) Correa on alloxan induced early stage diabetic nephropathy in rats.

Diabetic nephropathy (DN) has a complex pathogenesis and poor prognosis due to the lack of therapeutic interventions. The present study investigates the effect of A. marmelos leaf extract (AME) on early alloxan induced DN. The treatment with AME was found to significantly decrease the fasting blood sugar, total cholesterol, blood urea, creatinine and renal TBARS and increased the levels of renal reduced glutathione and catalase significantly as compared to the diabetic control group. The maximum dose-dependent protection was observed at a dose of 200 mg kg-1. Histological examination revealed marked reversal of the morphological derangements with AME treatment as indicated by a decrease in glomerular expansion, tubular dilatation and inflammatory cells. The present results conclude that AME treatment has a significant ameliorative effect on early changes induced in the kidneys by alloxan and improves the outcome of DN.

Prevalence and risk factors for vitamin D deficiency among mothers in labor and their newborns

Vitamin D deficiency is recognized as a global public health problem. Studies of vitamin D levels in mothers in labor and their newborns in Bahrain are lacking. The aim of this study is to identify the prevalence of vitamin D [25[OH]D] deficiency among mothers in labor and their newborns in Bahrain. A cross-sectional multicenter study. Four Public and Four Private Maternity Hospitals in Bahrain. The study was conducted in April 2012. It included mothers in labor and their newborns. Differences between the subgroups were analyzed using Chi-Square or Student's t-test as appropriate. Linear regression analysis was used to evaluate independent predictors of 25[OH]D level. The study included 403 mothers and 403 newborns. Overall prevalence of 25[OH]D deficiency [<50 nmol] was 358 [88.8%] of the mothers and 364 [90.3%] of the newborns. The mean maternal alkaline phosphatase level was significantly higher than the neonatal level and the maternal mean calcium was significantly lower than the neonatal level. Significant association with vitamin D deficiency was found among Bahraini and non-Bahraini Arab mothers, delivering in public rather than private hospital, living in flats, low education, the use of veil, gravida >/= 4, not using multivitamins, vitamin D or calcium supplements. Vitamin D deficiency among mothers and their newborns is high. This mandates increasing awareness, vitamin D supplementation among mothers in labor and their infants; in addition to the introduction of vitamin D fortification of dairy products and flour at the national level

Karyotypic findings in chronic myeloid leukemia cases undergoing treatment.

BACKGROUND: Chronic myeloid leukemia (CML) is a clonal myeloproliferative expansion of primitive hematopoietic progenitor cells. MATERIALS AND METHODS: In the present study, CML samples were collected from various hospitals in Amritsar, Jalandhar and Ludhiana. RESULTS: Chromosomal alterations seen in peripheral blood lymphocytes of these treated and untreated cases of CML were satellite associations, double minutes, random loss, gain of C group chromosomes and presence of marker chromosome. No aberrations were observed in control samples. Karyotypic abnormalities have also been noted in the Ph-negative cells of some patients in disease remission. CONCLUSION: This is a novel phenomenon whose prognostic implications require thorough and systematic evaluation.

Evaluation of the relative efficacy of an alloplast used alone and in conjunction with an osteoclast inhibitor in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Mucoperiosteal flap surgery stimulates varying amounts of alveolar bone loss due to accelerated osteoclastic activity [Regional Accelerated Phenomenon (RAP)]. Alendronate sodium inhibits osteoclastic activity and is thought to result in a net increase in osteoblastic activity. We undertook a preliminary study evaluating the effect of adjunctive use of topically delivered bisphosphonate alendronate (ALN) along with regenerative bone graft material in the treatment of periodontal infrabony defects. Materials and Methods: Fifteen patients with two-walled or three-walled infrabony defects were selected. In each patient, the infrabony defect of one side of arch was designated as group A (control site) and received hydroxyapatite (HA) bone graft material, while the infrabony defect on the contralateral side of same arch was designated as group B (test site) and received HA + 200 μg drug solution of ALN. Results: Both the groups exhibited a highly significant reduction in probing depth and gain in clinical attachment level and linear bone fill at the end of 24 weeks. Comparative evaluation between the study groups revealed a statistically nonsignificant reduction in probing depth (P=0.128 NS ) and mean gain in attachment level (P=0.218 NS ). However, there was a statistically significant gain in linear bone fill (P=0.040*) in group B as compared to group A. Conclusions: The results suggest that use of ALN along with graft material led to enhanced linear bone fill at the surgical site. This research provides a clue that bone-targeting properties of bisphosphonates can be harnessed along with regenerative materials to potentiate osseous regeneration.

Evaluation of the relative efficacy of copolymerized polylactic-polyglycolic acids alone and in conjunction with polyglactin 910 membrane in the treatment of human periodontal infrabony defects: A clinical and radiological study.

Background: Absorbable synthetic biopolymers have been used as bone filler in Periodontology, proving effective stimulants to bone regeneration. Aim: Copolymerized polylactic and polyglycolic acid is used as a bone filler and polyglactin 910 as a guided tissue regeneration (GTR) membrane to achieve regeneration in periodontal infrabony defects. Materials and Methods: Forty patients with two- or three-walled infrabony defects were selected and randomly divided into two groups. Group A included patients treated with polylactic-polyglycolic acids 50:50 (Fisiograft® ,Ghimsa SPA,Via Fucini, Italy) alone and Group B included patients treated with polylactic-polyglycolic acids (PLA-PGA)50:50 in conjunction with polyglactin acid 910 (Vicryl Mesh® Johnson&Johnson , U.S.A ). Evaluation of clinical parameters probing depth and attachment level and radiographs was done preoperatively and 12 and 24 weeks postoperatively. Results: Both the groups showed statistically significant mean reduction in probing depth and gain in clinical attachment level and linear bone fill. Conclusions: Within the limit of this study, both the treatment modalities are beneficial for the treatment of infrabony defects.

Anesthetic considerations and difficult airway management in a case of Noonan syndrome

Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Anesthetic management in such cases poses a multitude of challenges, especially related to the airway management and maintenance of cardiovascular stability. We report a case of a 9-year-old male child weighing 24 kg, who was diagnosed as a case of Noonan syndrome and had undergone ligation of patent ductus arteriosus during early childhood. The child was operated on for release of bilateral neck bands under general anesthesia. The case report pertains to the successful airway and anesthetic management in the background of difficult airway and existence of various cardiac lesions

Management of primitive neuro-ectodermal tumor of the vagina in a sickle cell disease patient

A twenty-five years old female, a known case of sickle cell disease, presented with frequent and heavy periods of six months duration. Pelvic ultrasound and MRI showed a vaginal mass pushing the bladder anteriorly; the diagnosis of cervical fibroid was considered. Histopatholgical examination of the mass revealed a very rare entity of primitive neuro-ectodermal tumor of the vagina. This is the first recorded patient of sickle cell disease with primitive neuro-ectodermal tumor of the vagina. The management was challenging in dealing with her disease and preserving her fertility