Oral health-related quality of life among male subjects with oral submucous fibrosis in a tertiary care hospital

Background: Oral submucous fibrosis is very common in Asia. It has many deleterious effects on individual's oral functions. Thus, there is a need to assess the effect of oral submucous fibrosis on quality of life. Objective: To assess the oral health-related quality of life (OHRQoL) in male subjects with oral submucous fibrosis. Methods: Two hundred and thirty male subjects in the age range of 20–40 years were recruited in the cross-sectional, two-group comparative study. Of 230 male subjects, 115 were oral submucous fibrosis subjects who were included in the study group and 115 healthy subjects formed the control group. English version of the oral health impact profile-14 (OHIP-14) was used to assess the OHRQoL. Wilcoxon signed-rank, Kruskal–Wallis, and Bonferroni tests were applied, and the P = 0.05 was considered as level of significance. Results: The mean and median OHIP-14 scores were 19.10 ± 0.66 and 18.00 in the study group and 3.98 ± 3.80 and 3.00 in the control group subjects, respectively (P < 0.001). Mean score of all the seven domains of OHIP-14 was significantly more in oral submucous fibrosis subjects (P < 0.001). All the oral submucous fibrosis subjects had one or more negative effects on OHRQoL compared to 64.34% of healthy subjects. Stage-4 of the oral submucous fibrosis had maximum effect on quality of life compared to other stages (P < 0.001). Conclusions: The quality of life among males is severely affected by oral submucous fibrosis, and Stage-4 of oral submucous fibrosis has maximum effect on the quality of life.

Prospective study of opportunistic infections among HIV infected patients in VSS Institute of Medical Science and Research, Burla, Sambalpur, Odisha, India

Background: HIV destroys the CD4+T cells progressively thus making the HIV infected persons susceptible to a number of opportunistic infections (OIs).Methods: The study was conducted in the Medicine Department and ART Centre, VIMSAR. It is a prospective study from July 2016 to September 2017.Results: 86 patients register, detail history, clinical examination and investigation were done and then the data is complying in detail. Most of the patients were male (72%) male female ratio is 2.6:1. The majority of patients presented with fever, weight loss and anorexia seen in more than 73% of the study population.Conclusions: (42%) cases belonged to the CD4+T cell count range of 101-200/µl with aCD4+T cell count of 183/µl, so there is increased chance of hospitalization in patients having CD4+T cell count below 200/µl. The most common OI was tuberculosis (51%) with pleural effusion as its commonest manifestation. The second most common OI was candidiasis (43%) with most cases suffering from oral candidiasis was seen to occur at higher CD4+T cell counts than tuberculosis.

Quantitative reckoning of embelin from fruits of Embelia tsjeriam- cottam using water bath process as an alternate method of extraction.

The world is culturally endowed with various forms of healing practices having rich medical wisdom of immense importance. One of such pharmacognostically indispensable medicinal plant is Embelia tsjeriam-cottam A. DC. The active principle of E. tsjeriam-cottam is embelin, possessing a range of pharmacognostic activities including anti-cancer, antioxidant, antiinflammation, antibacterial and analgesic effects. Embelin in fruits of E tsjeriam-cottam was extracted using water bath method. For extraction of embelin from fruits of E. tsjeriamcottam, methanol and chloroform were used as solvents. Fruits were collected from five different agro-climatic zones of Odisha. Comparative estimation of embelin was done through spectrophotometer and High Performance Liquid Chromatographic (HPLC) methods. Samples extracted with chloroform and methanol showed embelin content in a range of 2.13- 0.29% dry wt., and 0.95-0.28% dry wt. respectively using spectrophotometer. In case of HPLC analysis, samples extracted in chloroform and methanol showed embelin content in a range of 1.86-0.27% dry wt., and 0.875-0.26% dry wt. respectively. However the water bath method, used as alternative method for extraction, proved to be less time consuming, costeffective in extracting a pretty good amount of embelin as compared to the conventional (soxhlet) methods of extraction.

Evaluation of clinico: Pathologic findings of breast carcinoma in a general hospital in Southern India.

Background and Objectives: Breast cancer is the second most common cancer in the Indian female population. As per our hospital data, breast cancer is also found to be the second leading malignancy in women. Hence, we undertook this study to evaluate the clinical profile, histopathologic types, grade, stage and the prognosis of the disease in our patients. Majority of our patients are from rural areas. Materials and Methods: This study was undertaken over a period of three years comprising of 178 patients who underwent modified radical mastectomy following preliminary diagnosis of carcinoma on fine needle aspiration cytology or histopathological examination of the lumpectomy or trucut biopsy specimens. Clinico-pathological evaluation was done in all of these cases following standard protocols. Result: The study comprised of 175 female patients and 3 male patients in the age range of 28 to 76 years. Majority (111/62.3%) of the cases were within the age range of 31-50 years of age with mean age of 48.7 years. Two females had bilateral breast cancer and one female had synchronous papillary serous cystadenocarcinoma of the ovary. Invasive ductal carcinoma no special type was the most common histopathologic pattern, and was seen in 172 (95.5%) cases. Most tumors were Scarff Bloom Richardson grade II and American Joint Committee on Cancer pathologic stage II. Prognostically, majority of tumors (49.5%) was assessed as 'good' as per the Nottingham prognostic index score. Conclusions: This study gave an insight to the clinico-pathological profile of breast cancer in our area. Long term study with follow up of the patient is needed for better understanding of the case.

Manifestation and outcome of concurrent malaria and dengue infection.

Objective: Studies on concurrent infection of dengue and malaria are uncommon in India. Therefore, in this study, we compared the clinical features and outcome of concurrent infection with mono-infection of dengue and malaria. Methods: All the patients of fever within 7 days duration were investigated for dengue, malaria and other causes of fever. Patients of concurrent dengue and malaria (Group A) were compared with dengue mono-infection (Group B) and malaria mono-infection (Group C). Biochemical and haematological investigations were done and compared. Results: During the study period 367 patients of dengue were admitted. Concurrent infection of dengue and malaria was found in 27 (7.4%) patients. There were 27 (5.8), 340 (72.5), and 102 (21.7%) patients in Groups A, B, and C respectively. The clinical features of concurrent infection were more like dengue than malaria. Unlike malaria the outcome of concurrent infection is good. Conclusion: Concurrent infection of dengue and malaria is not uncommon. For the diagnosis investigations for both the infections should be carried out routinely.

Delayed gastric emptying time in adult cerebral falciparum malaria.

Objective: We hypothesize that upper gastrointestinal symptoms in cerebral malaria are due to gastric motor dysfunction. But gastric motility studies in cerebral malaria are scarce. Methods: We determined gastric emptying half-time (GET½) of liquid meals quantitatively by radio isotope scintigraphy in 25 patients of cerebral malaria and 10 healthy controls. Results: GET½ was prolonged (46.5 ± 4.8 min) significantly (p <0.001) in patients of cerebral malaria compared to healthy controls (27.6 ± 5.3 min). Conclusion: Cerebral malaria can cause prolongation of gastric emptying time of liquid foods.

The malaria severity score: A method for severity assessment and risk prediction of hospital mortality for falciparum malaria in adults.

Back ground: There is paucity of research to quantify the severity and to predict the mortality risk of severe falciparum malaria even if it affects multiple organ systems during the course of the disease. Therefore, the aim of the present study is to develop a severity score for assessment of disease severity and risk prediction in adult patients of severe falciparum malaria on the first day of hospitalisation. Methods: A cohort of 2598 patients of falciparum malaria were enrolled in this study of which 2089 patients were included as developmental sample and 509 patients as validation sample. Physiological variables were analyzed for defining and assessment of severity of organ dysfunction (OD). The severity level and corresponding severity score for each organ dysfunction were determined by logistic regression analysis that took both the relative severity among the organ systems and the degree of severity within an organ system into account. Risk of mortality has been calculated for each score. Results: Physiological variables defined dysfunction in 7 organ systems with 3 levels of severity (I to III). Neurologic and renal dysfunction had 3 levels of severity. Hematologic, cardiovascular, and respiratory dysfunction had 2 levels of severity where as hepatic and metabolic dysfunction had 1 level of severity. 1,3, and 5 points were assigned to level I,II, and III severity of organ dysfunction respectively. Malaria without any abnormal physiological variables had been considered as no organ failure and assigned 0 score. The cumulative scores in a patient is known as malaria severity score (MSS) that ranged from 0 to 21. Risk of mortality had been calculated for each score. Conclusion: This prospective study provides an objective tool for assessing severity levels for organ dysfunction and prediction of risk of mortality in severe falciparum malaria which can be used for treatment and research. It has been observed that no two patients of falciparum malaria are same in severity. The severity varies over time and malaria can affect single or multiple organs with different levels of severity which can be quantified as level I, II, and III. Neurologic and renal dysfunction were the most severe with level III severity, followed by haematologic, cardiovascular, and respiratory dysfunction with level-II severity, as well as hepatic and metabolic dysfunction the least severe with level-I severity. Patient of malaria can be stratified as low, intermediate, and high risk depending on the MSS. With the help of MSS daily risk estimates and recovery time of OD can be determined. ©

Polycythemia vera presenting with bilateral papilledema: a rare case report.

A 45-year-old male patient presented with gradual onset of headache, vomiting and blurring of vision of 28 days duration. Ophthalmological examination revealed normal anterior segment and pupillary reflex. No abnormality was detected in the vitreous. Optic disc showed features of advanced papilledema with normal macula and retinal periphery in both eyes. Visual acuity was 20/200 in the right eye and counting fingers close range in the left eye. Non-contrast computed tomography of brain was normal and magnetic resonance imaging showed sagittal sinus thrombosis without any evidence of venous infarction or intracranial mass. Routine hematological investigations revealed increased hemoglobin level, packed cell volume and leucocytosis. Further investigation revealed increased Vitamin B12 and decreased serum erythropoietin. A diagnosis of polycythemia vera was made from the above findings. This case is being presented for the rarity of association of polycythemia vera with bilateral advanced papilledema due to sagittal sinus thrombosis.

The natural history of complicated falciparum malaria--a prospective study.

OBJECTIVE: Despite a substantial disease burden, little is known about the natural history of complicated falciparum malaria. Therefore, the present prospective study was undertaken to assess the clinical course, outcome, and resolution time of various complications of falciparum malaria. METHODS: This prospective study has been conducted in a tertiary health care institution with high prevalence of malaria. A cohort of 608 patients of complicated falciparum malaria with single and multiple complications were enrolled. After discharge, all patients were followed up for 1 month except patients with anaemia who were followed up for 3 months. The onset time, interval of progression of one complication to other, resolution time of complications and mortality were determined. RESULTS: At the time of admission there were 288 (46.8%) patients with single complication (SC) and 320 (53.2%) patients with multiple complications (MC). Majority (n=214, 74.3%) of patients with SC had cerebral malaria, followed by jaundice (14.6%), anaemia (6.9%), hypoglycaemia (2.1%), and respiratory distress (2.1%). The multiple complications were found in various combinations and majority (n=136, 42.5%) had constellation of 3 different complications. Cerebral malaria, jaundice, and renal failure (102 of 136, 75.3%) were the most common combination. Regardless of number of complications, cerebral malaria was present in 91.6% (293 of 320) patients with MC. As the population of patients progressed from single to multiple complications, increasing proportions had jaundice, renal failure, and anaemia. 12.8% to 36.2% of patients in any category progressed from one complication to other complication within 72 hrs. There mortality rate was 14.6%, 21.3%, 30.9%, 38.5%, 100%, and 100% among patients with 1, 2 , 3, 4, 5, and 6 complications respectively. CONCLUSION: This is the first prospective study that provides the clinical evidence that complicated malaria represents a hierarchical continuum of abnormalities resulting from malaria infection. All complications developed within 5 days (median 72 hrs, range-2 to l20 hrs.) of onset of fever. Pre-pernicious stage had been recognised in cases of cerebral malaria. Each complication is unique in its onset and recovery time. Not only the number but also the type of complication influences the outcome of complicated malaria.

Type 1 diabetes mellitus in homozygous sickle cell anaemia.

For reasons unknown, the association of diabetes mellitus with sickle cell anaemia is uncommon. A patient of sickle cell anaemia with diabetes mellitus, complicated with ketoacidosis is being reported in view of its rarity.

Pseudobulbar paralysis--a sequelae of cerebral malaria.

Demyelination may be a pathogenic mechanism of post-malarial neurological sequelae. It can cause pseudobulbar palsy, which has not been documented earlier. In the present communication we report two cases of pseudobulbar palsy after cerebral malaria with evidence of demyelination.

A clinico-epidemiological perspective of lymphatic filariasis in Satyabadi block of Puri district, Orissa.

BACKGROUND & OBJECTIVES: Lymphatic filariasis is a major public health problem in the coastal district of Orissa. However, no systematic studies have been done to document the prevalence of microfilaraemia/disease in different regions of the State. Therefore, the present cross sectional study was undertaken during 1996-97 to obtain information on the clinical and epidemiological status of the disease in Satyabadi block area of Puri district, known to be endemic for filariasis. METHODS: Night blood smear survey and clinical examinations were performed on 4646 individuals aged 0-> or = 60 yr from systematically selected households of 17 randomly selected villages of the Block. Microfilaraemia was detected by thick drop technique using 20 microliters of peripheral blood and microfilariae (mf) density by nucleopore filtration technique collected during 1900-2300 h. RESULTS: The prevalence of microfilaraemia was observed to be 14.8 per cent; 13.3 per cent Wuchereria bancrofti, 1.4 per cent Brugia malayi and 0.09 per cent had mixed infections. Geometric mean microfilaraemia density (infected persons only) was found to be 1288 per ml in case of W. bancrofti and 204 per ml in case of B. malayi. The disease rate was observed to be 19.8 per cent; 12.85 per cent had acute manifestations and 6.97 per cent had chronic manifestations. INTERPRETATION & CONCLUSION: The rate of acute disease manifestations was observed to be significantly higher (P < 0.001) than chronic manifestations. There was a male preponderence among the affected individuals (P < 0.001). The interesting observations of the study were the occurrence of occult filarial manifestations viz., tropical pulmonary eosinophilia (TPE) in 0.47 per cent cases and other associated manifestations like asymptomatic microscopic haematuria, monoarticular arthritis and filarial associated respiratory diseases in 0.50, 0.24 and 0.19 per cent of cases respectively. The present study indicates that the area is highly endemic for lymphatic filariasis with active transmission.

Occurrence of asymptomatic microscopic haematuria in a filarial endemic area of Orissa, India.

To determine the frequency of occurrence of asymptomatic microscopic haematuria in filarial endemic area of Orissa, where the mf rate and disease rate were observed to be 14.8% and 37.2% respectively, clinical examination, night blood smear examination, morning midstream urine examination were conducted on 697 persons-randomly selected from all age groups in 8 villages of Puri tehsil. Out of them, 15.6% were found to have asymptomatic haematuria (Grade I-14.7%, Grade II-0.6%, Grade-III 0.3%). The prevalence of asymptomatic microscopic haematuria was observed to have positive statistical correlation with mf status (P < 0.001), filarial antigenaemia (Ag) (P < 0.001), antibody (Ab) (P < 0.001) and circulating immunocomplex antigen (CIC-Ag) (P < 0.001). The prevalence was also found to be increased with the progression of the disease process i.e. from endemic normal to chronic manifestations. None of the cases having Grade-II and III haematuria cases revealed any gross renal pathological lesions, when subjected to special investigations like X-ray, IVP, cystoscopy and urethroscopy.