Lymphangioma circumscriptum of scrotum: a rare case

Lymphangioma circumscriptum (LC) is a form of lymphatic hamartoma, which mainly involves the skin and subcutaneous tissues. The mucosa of the mouth, tongue, groin, trunk, and axilla are the most common locations of LC, and the scrotum is a rare site of occurrence. Here we report a case of LC of scrotum occurring in a 58-year-old man without any history of surgery and radiation. The man was presented with multiple small vesicles containing clear fluid in the scrotum and subsequent histopathology confirmed the diagnosis. We are presenting this case for its rare presentation.

Double Whammy the Great Switch and a Complex Endgame

In 1988 the world health assembly resolved to eradicate poliomyelitis.The Live attenuated oral polio vaccine was the captain against the fight to eradicate poliomyelitis.It had indeed many advantages in the fight to eradicate polio.But despite its many advantages it has a risk for occurrence of rare cases of paralytic poliomyelitis among immunologically normal OPV recipients and additional risk of emergence of Vaccine derived polio virus(VDPVs).Poliovirus being an RNA virus are notorious for mutation.India is a polio free country since 2011 however endemicity of its neighbours are a detterent against dropping guard.This article reviews the introduction of Bivalent oral polio vaccine instead of trivalent oral polio vaccine and rationale of addition of Inactivated Polio vaccine on the road to the—Endgame Strategy

Nitric Oxide Metabolite Concentration in Cerebrospinal Fluid: Useful as a Prognostic Marker?

STUDY DESIGN: Prospective study. PURPOSE: To establish the significance of cerebrospinal fluid (CSF) nitric oxide metabolite (NOx) concentration in acute spinal cord injury (SCI) patients to assess the neurological severity and prognosis. OVERVIEW OF LITERATURE: Quantitative analysis of specific biomarkers in CSF will assess neurological severity more accurately and permit the formulation of a more precise management plan. METHODS: Forty SCI patients represented the cases and 20 lower limb injury patients were the controls. NOx concentration in CSF was measured at week 1, 2, and 4 by Griess method. Magnetic resonance imaging (MRI, T2-weighted) done in each case to measure cord edema and neurological severity was assessed using the Frankel classification. RESULTS: CSF NOx concentration peaked at week 2 and declined to normal by week 4. The concentration remained normal in controls. Mean NOx concentration was directly proportional to the severity of acute SCI as correlated with cord edema seen in MRI and neurological severity assessed. CONCLUSIONS: CSF NOx concentration can be considered a specific quantitative biomarker in acute stage of SCI to predict the severity and prognosis of SCI patients.

The prevalence of low birth weight infants amongst hospital deliveries in Lucknow.

Background: Low birth weight has been defined by the WHO as weight at birth less than 2500gms. More common in developing than developed countries, LBW contributes to a range of poor health outcomes. Objectives: To know the prevalence of low birth weight neonates and the effect of maternal age and parity on birth weight. Methods: It was a hospital based cross sectional study conducted in Era’s Lucknow Medical College and Hospital over a period of six months i.e from July 2014 to December 2014. A total of 356 women who had their deliveries conducted at Era’s Lucknow Medical College and Hospital were included in the study. Data was collected, compiled and tabulated using Microsoft Excel and analysed using SPSS 17.0 version for calculation of percentages. Results: The prevalence of LBW neonates was found to be 29.65%. 40.19% of the LBW neonates were preterm. Majority of the LBW neonate’s i.e 72.54% weigh between 2.0 to 2.5 kg. Percentage of LBW neonates was found to be highest among women aged between 36 to 40 years (50%) and in primi para (46%). Conclusions: The prevalence of LBW was found to be slightly higher than that for the state of Uttar Pradesh (25.1%). It is closely associated with foetal and neonatal mortality and morbidity. The prevalence can be lowered if women start pregnancy healthy and well nourished, which can be assured by educating the mother about proper nutrition, birth spacing and antenatal care.

Intake of vitamin A & its association with nutrition status of pre-school children.

Background: Vitamin A is an essential micronutrient for the immune system. Its deficiency is one of the most important causes of preventable childhood blindness and is a major contributor to morbidity and mortality from infections. Studies have linked vitamin A deficiency to a greater risk of malnutrition. Therefore the present study was planned to assess the intake of Vitamin A in pre- school children and to find out its association with nutritional status of Pre- School children. Methods: A cross-sectional study was conducted in urban and rural Lucknow, Uttar Pradesh, India. Children (n=400) of 12-59 months were randomly selected and mothers were interviewed after taking informed consent on pretested predesigned questionnaire on socio-demographic and Dietary intake. Anthropometry was performed using standard procedures. Results: The mean age of children was 31.9 months and mean intake of Vitamin A was 344.8 μg. Underweight, stunting and wasting was seen in 43.7%, 51.3 % and 21.8% of children respectively. Stunting was associated significantly with mean Vitamin A intake (p<0.005). 54% children had been administered Vitamin A in past six months. Signs of Vitamin A deficiency were seen in only 6.2 % children. On Multivariate analysis Height / Age Z score was significantly associated with Vitamin A intake (OR-2.8, 2.5-14.0). Conclusions: The prevalence of malnutrition for pre-school children is worrying. There is low intake of Vitamin A. There is need to find innovative and effective ways of reaching the community for educating them on balanced diet particularly rich in vitamin A.

A comparative study on effects of intrathecal ropivacaine plus dexmedetomidine versus ropivacaine plus clonidine.

Background: Subarachnoid block is a safe and effective alternative to general anaesthesia when surgical site is located on the lower extremities, perineum or lower body wall. Spinal anaesthesia produces intense sensory and motor blockade as well as sympathetic blockade. Intrathecal α-2-agonists are used as adjuvant drugs to local anaesthetics successfully over the last decade .They potentiate the effect of local anaesthetic and decrease the required doses. Clonidine is a partial α-2-adrenorecptor agonist used intrathecally, with a well- established record of efficacy and safety. Its addition to local anaesthetics prolongs the duration of both motor and sensory spinal blockade. Dexmedetomidine is an α-2-adrenorecptor agonist. It has α-2/α1 selectivity ratio which is eight times higher than that of Clonidine. With this background, this study was conducted to compare the effects of intrathecal Ropivacaine plus Dexmedetomidine versus Ropivacaine plus Clonidine during procedures. Methods: The present prospective study was carried out in the Department of Anaesthesiology, M.G.M. Medical College and M.Y. Hospital, Indore (M.P.), India. Study period was from June 2011 to July 2012. Patient were randomly allocated to one of the following three group in a double blinded fashion based on computer generated code: Ropivacaine (R), Ropivacaine + Dexmedetomidine (D); Ropivacaine + Clonidine (C). Nominal categorical data between study groups were compared using the Chi – squared test or Fisher’s exact test as appropriate. p<0.05 was considered to be significant. Results: In all age groups patients were equally distributed in three Groups. Mean time taken for the onset of sensory and motor block was quite low in group D patients. Thereby showing statistically highly significant difference in onset of sensory and motor blocks (P<0.001). Whereas mean duration of sensory and motor block was also quite prolonged in group D patients. (p<0.001) There is significant difference between all the three groups. Conclusion: In conclusion our study shows that intrathecal Dexmedetomidine or Clonidine added with isobaric Ropivacaine produces rapid and prolonged sensory and motor block as compared to plain Ropivacaine.

A study to assess the iodine deficiency disorder and salt consumption pattern in Lucknow.

Background: Iodine is an essential element for thyroid function, necessary for the normal growth, development and functioning of the brain and body. In India, about 200 million people are already affected with IDD. In India, about 200 million people live at risk of IDD, whereas more than 71 million people are suffering from goiter and other IDDs. Aims and objectives: 1) To estimate the prevalence of goiter in Lucknow district. 2) To study the level of urinary iodine excretion of the study population. 3) To study the salt consumption pattern in Lucknow district. Methods: A descriptive cross sectional study was carried out amongst School children in the age group of 6 to 12 years in urban and rural areas of Lucknow district over a period of one year. A sample size of 400 was estimated. A pre structured & pre tested questionnaire was used to interview. Data was Tabulated on Microsoft excel and, analysis was carried out using Chi square test & other necessary statistical test as appropriate, using software SPSS 17.0 version. Results: A total No. of 400 children were studied. In urban areas 54% were males and 46% were females. Mean age of children were found to be 9.22 years with standard deviation of 2.28. By history, majority (79.8%) of the families were using iodized salt and only 20.3% were using non-iodized salt. Over all prevalence of goiter was 12.7%. Prevalence of goiter was more in rural areas (18%) than in urban areas (7.5%). Prevalence of goiter was more among females (19.9%) than in males (6.8%). Conclusions: To conclude, findings of the present study demonstrates that prevalence of goitre was high (12.7%) among children in Lucknow district and therefore it constitutes a public health problem in this region. Strict implementation of salt iodization and marketing in hard to reach areas is recommended as a measure to control the situation.

The external quality assessment scheme in coagulation: five years’ experience as a participating laboratory.

Background: The attainment of quality services in a laboratory requires a comprehensive quality assurance programme which includes both internal and external quality control. External Quality Assessment Scheme (EQAS) programmes are accepted around the world as invaluable tools by laboratories to assess the performance of their testing systems. Results are objectively compared to other laboratories, using the same methodologies for every parameter. The goal of this study was to review EQAS results from time to time in an effort to improve the performance of the laboratory. Methods: Observational study done at Pramukhswami medical college, Shree Krishna hospital, Karamsad from January 2009 to December 2013. In the present study we have evaluated our EQAS test result of the past five years, from 2009 to 2013. We receive two samples in duplicate in lyophilised form, which are stored at 2-8°C in the refrigerator. The samples are reconstituted with 1 ml of distilled water at the time of procedure. The samples are received quarterly in a year. The test results of all the samples are analysed and documented. Results: Satisfactory results were obtained in all the cycles except four times. Discrepancy was observed in Prothrombin time INR (International Standardized Ratio). Root cause analysis was performed and necessary action taken. Conclusion: This participation in EQAS over the last five years has helped us significantly to improve our laboratory services in terms of performance evaluation, patient care and overall quality of laboratory practices.