Primary orbital yolk sac tumor in an infant: A rare entity

We report a case of pure orbital yolk sac tumor (YST) in an 11-month-old infant, which is a rare entity. The child presented with progressive painless swelling of the right eye and on examination had proptosis, chemosis, and lid edema. Systemic examination was within normal limits. Magnetic resonance imaging (MRI) orbit revealed a lobulated heterogeneously enhancing right retroocular mass extending up to the orbital apex, displacing the optic nerve and eroding the medial orbital wall. Biopsy of the lesion revealed pure YST histology. Serum alpha-fetoprotein (AFP) was markedly raised at 76900 ng/mL. She was started on infant bleomycin etoposide cisplatin (BEP) chemotherapy protocol. There was a good clinical and radiological response. A high index of malignancy is required in young children presenting with orbital proptosis. A multidisciplinary approach and early intervention are essential to save both vision and life.

Treadmill test as a screening tool for detecting silent myocardial ischemia in type 2 diabetes patients: a case control study from Raipur, Chhattisgarh, India

Background: The incidence of diabetes mellitus (DM) is increasing substantially worldwide. CAD silently progresses over years in the diabetics. Diabetic individual appears to be less able to perceive some of the symptoms and signs of ischemia or may have asymptomatic ‘classic silent ischemia’. Thus, screening for early detection of asymptomatic CAD in type 2 diabetes may be helpful to prevent these catastrophic cardiac events and consequent deaths. Objectives of the study was to assess utility of TMT in Type 2 diabetic mellitus subjects to detect silent myocardial infarction.Methods: Hospital based observational analytical case control study was conducted in Department of Medicine in Dr BRAM Hospital Raipur during August 2016 to September 2018. Cases were 45 subjects of Type 2 Diabetes mellitus with normal ECG and controls were 45 subjects of Type 2 Diabetes Mellitus with abnormal resting ECG. Data analyzed using SPSS 17 version.Results: Majority i.e. 40% were found to be in fifth decade of their life. 71 (78.9%) male subjects and 19 (21.1%) female subjects. TMT was found positive in 8(17.8%) subjects with positive ECG changes whereas in 12(26.7%) subjects with no ECG changes. No significant difference was noted between distribution of any parameters except for hypertension which was found to be significantly higher in TMT positive subjects compared to TMT negative subjects.Conclusions: No significant difference was observed regarding TMT findings between T2DM subjects with and without ECG changes. Type 2 diabetes mellitus subjects with dyslipidemia, and hypertension are at higher risk of Positive TMT.

Confusion, blood urea, respiration and blood pressure 65, pneumonia severity index and shock index and hypoxemia scores in community acquired pneumonia and outcome prediction: a descriptive study from Dr B R Ambedkar Memorial Hospital Raipur, India

Background: According to WHO, pneumonia is the third important cause of death worldwide despite various advances in medical science. Incidence of Community acquired pneumonia is about 20% to 30% in developing countries compared to 3% to 4 % in developed countries. Incidence of CAP is much higher in the very young and the elderly individuals. Objectives of the study was to compare CURB 65, PSI (Pneumonia severity index) and SIPF (shock index and hypoxemia) scores with respect to outcome prediction in community acquired pneumonia (CAP).Methods: The present hospital based descriptive observational study was conducted in the Dept of medicine, Pt. J.N.M. Medical College and Dr B. R. A. M. Hospital, Raipur, during 2016-2018 involving a total of 98 patients of community acquired pneumonia.Results: Majority of them i.e. 22 (22.4%) subjects belonged to age group 41-50 years. 34 (34.7%) subjects were found to have CURB65 score 1. 28(28.6%) subjects PSI score was noted to be class I. 89 (90.8%) subjects were discharged while, there was death of 9 (9.2%) subjects. The difference in the mean score was statistically significant (p<0.001). PSI score was found to have diagnostic sensitivity of 94.4% and specificity of 100% while CURB 65 score having 83.1% sensitivity and 100 % specificity. SIPF score had least AUC 0.88.Conclusions: Maximum diagnostic ability was noted with PSI score followed by CURB 65 and SIPF score.

Role of environmental factors & oxidative stress with respect to in vitro fertilization outcome

Background & objectives: Oxidative stress, lifestyle factors as also exposure to certain environmental factors are known to affect the fertility status in human beings. The aim of this study was to evaluate the role of OS and lifestyle and environmental factors affecting IVF outcome. Methods: A total of 253 couples were included, and biological samples such as blood, follicular fluid (FF), cumulus cells and semen were collected. Relevant biochemical parameters and metals namely lead (Pb), cadmium (Cd), copper (Cu) and zinc (Zn) were determined in the biological samples. ?-human chorionic gonadotropin levels ?100 IU/l were considered to predict viable pregnancy on the 15th day of embryo transfer (ET). Results: The mean body mass index (BMI) was significantly lower in females with positive IVF outcome compared to those with negative outcome. Couples residing in the residential area showed more percentage of positive IVF outcomes as compared to couples residing in industrial/agricultural area. FF Zn level was significantly higher (P<0.001) among the females' participants who have undergone ET as compared to those who have not undergone ET. FF MDA and serum Cu levels were significantly higher (P<0.05) in the female participants with negative IVF outcome as compared to positive IVF outcome. Logistic regression revealed that maternal BMI (P=0.034) and FF MDA level (P=0.047) were significantly associated with the IVF outcome. Interpretation & conclusions: The success rate of IVF was about 31.8 per cent, and BMI was significantly lower in females with positive outcome. The higher levels of MDA in FF and SP might have a negative impact on IVF outcome, higher Zn level in SP, FF and serum might have a positive role in embryo transfer as well as IVF outcome. The role of stress management and nutrition supplementation during the IVF treatment may be explored.

Study of serum cobalamin level in vegetarian v/s nonvegetarian geriatric individuals.

Background: Vegetarianism is found in all geographic areas, they may have lower B-12 levels than nonvegetarian; problem could be graver in elderly. This study intended to recognise geriatric individuals with B-12 deficiency so as to save them from anaemia, dementia & neuropsychiatric disturbances by timely recommendations for supplementation. Methods: Current study was conducted on 200 healthy attendants divided in to two groups- A comprised of 100 vegetarian and B of 100 nonvegetarian geriatric individuals (> 60yrs.), they had no previous chronic disease and an attempt was made to exclude diabetes mellitus, hypertension, chronic gastritis, hypoplastic & aplastic anaemia. Those with history of alcohol intake, PPI therapy & regular vitamin supplementation were excluded. Complete clinical examination and routine blood tests were done. Serum cobalamin level was determined by ACCU-BIND ELISA Microwells method. Results: Total of 58 vegetarians were found to be B-12 deficient compared to 42 normal (>350pg/ml) this was statistically significant. Out of 100 nonvegetarian 48 were deficient while 52 had normal levels this too was statistically significant. On comparing the vegetarians and non vegetarian groups significant result was obtained (p <0.01). When different age groups were statistically compared insignificant result was obtained, same was true for gender distribution. Statistically significant result was obtained on comparing vegetarian Vs nonvegetarian group. Conclusions: Irrespective of the dietary habit B-12 deficiency is prevalent in elderly, as 58% of vegetarian & 48% of nonvegetarian were found B-12 deficient, detailed dietary analysis revealed that majority of them consumed nonvegetarian food only occasionally. No significant effect of increasing age & gender was found on B-12 levels in either group. Every elderly vegetarian or non vegetarian irrespective of gender should get their B-12 levels checked & if found low should receive B-12 supplemennt.

Environmental & lifestyle factors in deterioration of male reproductive health.

Background & objectives: Male reproductive function in the general population has been receiving attention in recent years due to reports of various reproductive and developmental defects, which might be associated with various lifestyle and environmental factors. This study was carried out to determine the role of various lifestyle and environmental factors in male reproduction and their possible association with declining semen quality, increased oxidative stress as well as sperm DNA damage. Methods: Semen samples were obtained from 240 male partners of the couples consulting for infertility problem. Semen analysis was carried out using WHO criteria and subjects were categorized on the basis of self reported history of lifestyle as well as environmental exposure. The oxidative and antioxidant markers; lipid peroxidation (LPO), superoxide dismutase (SOD) and catalase (CAT) as well as DNA damage by acridine orange test (AO) were determined. Results: The presence of abnormal semen parameters was significantly higher among the lifestyle and/or environmental exposed subjects as compared to the non-exposed population. Further, the levels of antioxidants were reduced and sperm DNA damage was more among the lifestyle and/or environmental exposed subjects, though the changes were not significant. Interpretation & conclusions: These findings indicated that various lifestyle factors such as tobacco smoking, chewing and alcohol use as well as exposure to toxic agents might be attributed to the risk of declining semen quality and increase in oxidative stress and sperm DNA damage.

Evaluations of soil Fertility Status of Available Major Nutrients (N,P & K) and Micro Nutrients (Fe, Mn, Cu & Zn) in Vertisol of Kabeerdham District of Chhattisgarh, India.

Grid based (GPS) surface (0-15 cm) soil samples by systematic survey were collected from 4 blocks, 84 selected villages in Kabeerdham district were 297samples identified from Vertisol. These soil samples were analyzed for N,P and K and Fe, Mn, Cu and Zn andcategorized as low medium and high as per criteria fallowed in the soil testing laboratory. Based upon the coefficient of correlation between macronutrients& micronutrient and soil properties, a significant and positive correlations observed was between soil pH and available N, P and K. Electrical conductivity exhibited significant and positive relationship with available N, P, K and organic C showed significant and positive correlation with available N and K.

Combination therapy in hemiballismus-hemichorea syndromes – a report of two cases.

Hemiballismus-hemichorea is an uncommon disorder. In the past, patients developing hemiballismus and hemichorea were considered to have poor prognosis with high morbidity and even mortality at times. While majority of patients of hemiballismus go into spontaneous remission, some severe cases require prolonged treatment. We here describe two such cases of which one presented to us with post stroke hemiballismus, unresponsive to monotherapy and the other was an HIV positive patient with unresponsive hemichorea secondary to CNS toxoplasmosis. Both these patients responded well when combination therapy was instituted and had normal recovery.

Comparison of internal sphincterotomy with topical diltiazem for post-hemorrhoidectomy pain relief: a prospective randomized trial.

AIM: To assess the efficacy of internal sphincterotomy compared with application of topical 2% Diltiazem ointment after hemorrhoidectomy for pain relief. SETTINGS AND DESIGN: Prospective randomized study. MATERIALS AND METHODS: In an 18-month period, 108 subjects with uncomplicated Grade 3/ 4 hemorrhoids were enrolled in the study and were randomized into two equal groups: Subjects in Group A underwent internal sphincterotomy at time of primary surgery while those in Group B received 1 g of 2% Diltiazem ointment locally, thrice daily for seven days. Postoperative pain perception was measured using visual analog score (VAS) and on the basis of number of analgesic tablets (Tab tramadol 50 mg) required in each group. Time to discharge, time to return to work and incidence of complications measured and compared. STATISTICAL ANALYSIS USED: Statistical techniques applied were Student T test, Chi-square and Fisher's Exact Test. RESULTS: There were 102 analyzable subjects (Group A: 50 and Group B: 52). The mean VAS score was significantly less in the internal sphincterotomy group from the fourth postoperative day onwards compared to topical Diltiazem (2.23 vs. 3.72; P =0.031). Similarly, the mean requirement of analgesic tablets [10.54 vs. 15.40; P =0.01] was much lower in Group A. There was no significant difference in terms of time to discharge and time to return to work between the two groups. The incidence of complications was more with the internal sphincterotomy group (11.5% vs. 3 %; P =0.488). CONCLUSIONS: In patients undergoing hemorrhoidectomy, addition of surgical internal sphincterotomy results in lesser pain in the postoperative period as compared to those receiving topical application of Diltiazem.

Deaths due to rapid high altitude climbing (ASCEND).

High altitude pulmonary edema develops in people who make a rapid ascend to a high altitude and the body is not able to acclimatize itself. We came across two such cases in the department of Forensic Medicine at I.G.M.C, Shimla.

Pitfalls in diagnosis of epilepsy of Janz and its implications.

84 patients of juvenile myoclonic epilepsy (JME) of Janz were studied. Diagnosis was confirmed using clinical and electro-encephalographic (EEG) criterias. 58 (78%) patients of JME were referred as 'refractory or uncontrolled seizures'. Ignoring myoclonic episodes and non-use of activation procedures in EEG were important reasons for diagnostic delay. Sodium valproate (VPA) or clonazepam are the drugs of choice while phenobarbitone (PB), carbamazepine (CZ), and phenytoin (PHT) are ineffective. Clinical spectrum of JME is slightly different in India. Family history of epilepsy or JME is not forthcoming and there is gross delay in the diagnosis. Other differences include age of presentation and mild cognitive impairment. All juvenile patients of generalized epilepsy, not responding to more commonly used CZ, PB and PHT should be strongly suspected for JME by carefully searching for myoclonus.

Effect of common anti-epileptic drugs on cognition in schoolchildren with epilepsy.

This study was conducted to observe the effect of some commonly used anti-epileptic drugs (AEDs), on cognition, in 118 school going children with epilepsy, in an age range of 9-12 yrs., (Mean 10.4 +/- 1.7 yrs.). For comparison, 28 healthy, age and sex matched schoolchildren served as controls. After a clinical, electrophysiological and radiological evaluation, the cognitive functions were assessed in both groups, using a modified Wechsler's Intelligence Scale. It was observed that cognition was impaired in only 2.5% of children with epilepsy, there being no relationship between cognitive performance and the type of AED used. It is concluded that cognitive functions are impaired in only a limited number of children with epilepsy and effect of phenobarbitone and phenytoin on cognitive functions is comparable to carbamazepine and sodium valproate, particularly when demand of task is not very high.

Need for bringing in a change in biochemistry curriculum to make it clinically oriented?

OBJECTIVES: This study was conducted to (a) assess the views of medical students and doctors regarding relevance of biochemistry training, (b) explore if they have any suggestion to bring in any improvement in contents of biochemistry curriculum and mode of teaching. METHODS: In 1997-98, a structured questionnaire was filled up by 114 medical students and 118 doctors. RESULTS: As many as 62/114 (55%) medical students and 40/118 (34%) doctors believed that it is not important to remember minute details of biochemical reactions (p value < 0.0001). Among medical students, 108/110 (98.2%) agree that a clinician should be invited to seminars for developing skills of interpretation of laboratory investigations; whilst 110/118 (93.2%) doctors expressed similar view, p value ns. Approximately 92% responders favored that departments biochemistry and physiology should co-ordinate on the topics of common interest in order to save time and effort. What is the most informative and effective way of teaching biochemistry?' in response to this question only 0.9% responders opted lecture as the best option. Seminars with active participation of medical students was preferred by 93.2% responders. About 6.9% responders reckoned that symposium prepared by a more than one teacher. In response to the question whether it is possible to cover pre-clinical subjects in 12 months so as to allow spiral mode of curriculum, 73% of all the responders agreed that it would be good idea, there was no difference of opinion among the doctors and medical students. On the other hand, 27% were strongly opposed to this suggestion. CONCLUSIONS: We suggest that there is a need to modify the contents, methods of teaching, and curriculum organization of training in clinical biochemistry. How best the curriculum can be made problem oriented needs to be debated among medical educationists.

Testicular toxicity in rat to repeated oral administration of tetramethylthiuram disulfide (Thiram).

Thiram was administered to male rats through gavage at doses 5, 10 and 25 mg/kg/day for 180 and 360 days. Thiram has caused marginal increase in the relative weight of testes and epididymis and decrease in the weight of seminal vesicle and prostate. Marked degenerative changes were observed in seminiferous tubules together with alterations in testicular enzyme profile. The activity of testicular enzymes such as ACP, SDH and ATPase (Na+ + K+ dependent) was decreased whereas activity of LDH, G-6-PDH and ALP increased. The levels of serum cholesterol and testicular free sialic acid were enhanced, while the level of testicular protein was lowered. It is evident from the present study that long term treatment of thiram at tested dose levels has resulted in dose and time dependent morphological and biochemical changes in testes of rat.

Necrotizing enteritis simulating Pig-Bel disease in northern India.

OBJECTIVE: A clinicopathological study of patients presenting with necrotizing enteritis, similar to the Pig-Bel disease of Papua New Guinea. METHODS: A clinicopathological study of 95 patients presenting in last ten years with acute abdominal pain with diarrhea and/or bleeding per rectum and vomiting and found to have lesions similar to Pig-Bel disease. RESULTS: 89% of the patients were young adult vegetarians from lower socio-economic strata. 94% of cases presented between May and August every year showing a marked seasonal variation. Jejunum was the most common site (95%) involved. Gross examination showed blackish brown 'skip' lesions with gangrene and perforations. Histology showed marked necrosis and congestion of all the layers with mucosal ulcerations. CONCLUSION: A disease simulating Pig-Bel disease occurs in India. It is more common in young adult vegetarians and may have a different etiology from that proposed in endemic regions.

99m Tc DTPA scan as a diagnostic marker of acute rejection in renal transplantation.

Forty renal transplant recipients were subjected to 99m Technicium Diethylene triamine pentacetic acid (DTPA)scans at regular intervals & whenever there was suspection of rejection. Serial scans of a group of 15 recipients from immediate post transplant period till withdrawal of cyclosporine were analysed separately & the results compared to with single scan analysis. The sensitivity & specificity of DTPA scan in the absence of acute tubular necrosis (ATN) was 94.1% & 87.5%, while the positive & negative predictive values were 88.8 & 93.3% respectively. Sensitivity & specificity of serial scan analysis (88.8% and 75%) in early post transplant period was higher than that of interpretation of single scan (75% & 66%). Serial scan changes predated clinical rejection during cyclosporine withdrawal period. We conclude that DTPA scan is both a sensitive & specific non-invasive diagnostic marker of acute rejection in absence of ATN & serial scans during early post transplant period & at the time of cyclosporine withdrawal are helpful in detecting the rejection accurately & at the earliest.

Neonatal mortality in Meerut district.

A study of neonatal mortality in Meerut district revealed an infant mortality rate of 50.1 per 1000 live births. Neonatal mortality accounted for 37.8% of infant mortality with a neonatal mortality rate of 19.0 per 1000 live births. 90.5% of these neonates were delivered at home largely by untrained personnel (57.2%). Only 28.6% of these neonates were treated by qualified doctors and only 30.9% of their mothers were fully immunized against tetanus. At least 2/3rd of neonatal mortality was due to exogenous factors with tetanus neonatorum and septicaemia being the principal causes of mortality each accounting for a mortality rate of 4.7 per 1000 live births.