Histological risk score and its role in predicting recurrence in early-stage oral squamous cell carcinomas

Context: Oral squamous cell carcinoma (OSCC) comprises more than 90% of oral cancers and is the most common carcinoma affecting the oral cavity. Early stage T1/T2 OSCC have a heterogeneous prognosis and a significant number of patients develop loco regional recurrence (LRR) and have reduced disease free survival (DFS) with increased disease related mortality. Aims and Objectives: To assess the impact of the three parameters used in Brandwein-Gensler risk model along with lympho-vascular invasion (LVI), depth of invasion (DOI) and lymph node metastases in predicting LRR in early stage OSCC. Materials and Methods: This was a retrospective study on early stage T1/2 OSCC patients over a period of 2 years who received treatment by surgical resection and had follow-up data. LRR was assessed based on recurrence of OSCC at the initial site or in regional lymph nodes. Results: Out of 1135 OSCC cases during our study period a total of 207 cases befitted our inclusion criteria. Recurrence was noted in 113 (54.6%) cases. Univariate analysis identified LVI (P < 0.00001), DOI (P < 0.00001), nodal involvement (P < 0.00001), worst pattern of invasion (WPOI) (P < 0.00001), lymphocytic host response (LHR) (P = 0.004), perineural invasion (PNI) (P = 0.012) as strong statistically significant risk factors for LRR. Conclusion: Adequate assessment of simple parameters on routine H and E by incorporating Brandwein-Gensler histological risk scoring model at the initial presentation can help prognosticate and predict LRR and select patients for post-surgical adjuvant therapy.

Type 1 diabetes in DKA with hypogonadotropic hypogonadism and pituitary apoplexy � A diagnostic dilemma

A 17-year-old underweight boy came with a classical emergency of diabetic ketoacidosis associated with two additional clinical features; persistently low blood pressure despite adequate fluid resuscitation and hypogonadal features with Tanner stage 3 pubic hair, absent facial, and axillary hair along with a high-pitched voice. These findings triggered an endocrine workup which revealed hypogonadotropic hypogonadism. Suspecting primary pituitary pathology, an magnetic resonance imaging brain, was done which showed a well-defined hyperintense lesion in the pituitary suggestive of pituitary apoplexy. In the absence of headache, diplopia, and visual field defects, this incidental finding posed a dilemma regarding the diagnosis and management of diabetic ketoacidosis in the presence of apoplexy.

Retinal nerve fiber layer thickness in amblyopia

Purpose: To report retinal nerve fiber layer thickness (RNFLT) in eyes with amblyopia compared with contralateral healthy eyes. Methods: In this cross-sectional study, we included patients with anisometropic amblyopia, strabismic amblyopia, and mixed amblyopia. All subjects underwent complete ophthalmic examination, including RNFLT measurement with time-domain OCT (Stratus OCT) and scanning laser polarimeter (GDX VCC). A paired “t” test was used to compare average and quadrant-wise RNFL thickness between the amblyopic and contralateral normal eyes. In addition, an analysis of variance test was used to compare various RNFL thickness parameters between the three groups. Results: A total of 33 eyes of 33 subjects with anisometropic amblyopia, 20 eyes of 20 subjects with strabismic amblyopia, and 38 eyes of 38 subjects with mixed amblyopia were included. In the anisometropic amblyopia group, the average RNFLT in the amblyopic eye was 98.2 ?m and 99.8 ?m in the fellow normal eye (P = 0.5), the total foveal thickness was 152.82 ?m (26.78) in the anisometropic eye and 150.42 ?m (23.84) in the fellow eye (P = 0.38). The difference between amblyopic and contralateral normal eye for RNFL and macular parameters was statistically insignificant in all three groups. The RNFL thickness in four quadrants was similar in the amblyopic and non-amblyopic eye between all three groups and statistically non-significant. Conclusion: Our study showed that RNFL thickness was similar in amblyopic and non-amblyopic eyes between all three amblyopia groups

Metabolic risk factors in first acute coronary syndrome (MERIFACS) Study

Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective caseecontrol observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n ¼ 2153) were compared with matched controls (n ¼ 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p ¼ 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p ¼ 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p ¼ 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF

Subscription of various health insurance schemes and factors influencing them in rural area of central Karnataka: a cross sectional study

Background: In a health insurance program, people who have the risk of a certain event contribute a small amount (premium) toward a health insurance fund. This fund is then used to treat patients who experience that particular event (e.g., hospitalization). It is a form of risk management which is used primarily to hedge against the risk of a contingent, uncertain loss. Health is wealth. Therefore, the concept of health insurance (HI) has evolved which finances health care. Objectives of the study was to assess subscription of various health insurance schemes and factors influencing them in the rural field practice area of SSIMS and RC, Davanagere.Methods: The cross sectional study was conducted in the rural field practice area of SSIMS and RC, Davangere from May to July 2016. A sample of 600 families were visited by systematic random sampling and data was collected from the head of the family with informed consent using a predesigned, pretested questionnaire by house to house interview. Analysis was done by using SPSS v10 and were results presented as percentages and proportions.Results: The total subscription in the study was 69.3%, Yeshasvini co-operative farmers’ health scheme coverage was 84% followed by others. The factors determining the subscription were the amount of premium, lack of funds, lack of awareness, lack of comprehensive coverage, etc.Conclusions: The premium has to be customized so that all the patients are benefited irrespective of the type of HI.

Screening Ethanolic Extract Of Aerva Lanata For Α-Amylase Inhibition And In Vitro Uptake Of Glucose In Adipose Tissue And Psoas Muscle Of Male Sprague Dawley Rats

The study was intended to investigate anti-diabetic efficacy of Aerva lanata by determining its α-amylase inhibition activity and in vitro uptake of glucose in adipose tissue and psoas muscle isolated from male Sprague Dawley (SD) rats. Aerva lanata is reported to have many traditional and Ayurvedic uses. Male SD rats (n=3) of 150 g were sacrificed and 250 mg of respective tissues were isolated for the study. Aerva lanata ethanolic extract (ALE) (5-20 mg/mL) showed 13.30 to 54.08% α-amylase inhibition activity. Glucose uptake studies in in vitro conditions were carried out in both adipose tissue and psoas muscle in different sets - tissue alone, tissue along with (Aerva lanata extract: 50µg, 100µg, 150µg, insulin: 25 mU/L, insulin: 50 mU/L and Aerva lanata extract: 50µg + insulin: 25 mU/L, Aerva lanata extract: 100µg + insulin: 25 mU/L, Aerva lanata extract: 150µg + insulin: 25 mU/L, Aerva lanata extract: 50µg + insulin: 50 mU/L, Aerva lanata extract: 100µg + insulin: 50 mU/L, Aerva lanata extract: 150µg + insulin: 50 mU/L). The rate of glucose uptake by insulin action in these tissues was stabilized by ethanolic extract of Aerva lanata and this shows synergetic activity of insulin and Aerva lanata.

Takotsubo cardiomyopathy complicating a twin pregnancy at partum

Takotsubo cardiomyopathy is a rare syndrome characterized by acute left ventricular dysfunction with regional left ventricular ballooning, mimicking myocardial infarction. This condition is often described in post-menopausal women. Authors present a case in an elderly primi with twin gestation immediately after Cesarean surgery. We discussed her presentation, investigations, diagnosis, management and outcome. 35 year female, a primi with twin pregnancy developed chest pain and shortness of breath immediately after Cesarean surgery. Her Electrocardiograph was abnormal, and Echocardiogram demonstrated abnormal apical ballooning of the left ventricle and severe dysfunction. Cardiac enzymes were elevated and chest skiagram showed pulmonary edema. She was managed in the intensive care unit with oxygen supplementation, diuretics and inotropes. She made an excellent recovery with normalization of left ventricular ejection fraction within 8 days. During the six months follow up, she was asymptomatic and left ventricular function remained normal.

Is 075% Ropivacaine More Efficient than 05% Bupivacaine for Prolonged Sensory Blockade in Epidural Anaesthesia for Orthopaedic Hip Surgeries?

The efficiency of 0.75% Ropivacaine as a single shot epidural anaesthetic in comparison to 0.5% Bupivacaine is less studied. Our study focuses on comparing the efficiency of sensory block between 0.75% ropivacaine and 0.5% bupivacaine for epidural anaesthesia. Methods: The study was done with 0.75% Ropivacaine and 0.5% Bupivacaine in epidural anaesthesia in orthopedic hip surgeries given as a single shot technique for which 60 patients of ASA I/II each were chosen and 15ml of the drug was given. Onset of the sensory sensations at T12 and regression at the same level were measured with the aid of response to pin prick and thus duration of epidural anaesthesia was calculated individually in group B and group R respectively. Results: Onset of sensory block was faster in group R than in group B and regression was slower in group R than in group B. Conclusion: It can be concluded that duration of epidural anaesthesia was prolonged and longer with 0.75% Ropivacaine than 0.5% Bupivacaine.

A comparative study of prevalence of overweight and obesity among urban, and rural population of South India

Background: Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have a negative effect on health.1 People are generally considered obese when their body mass index (BMI), a measurement obtained by dividing a person's weight by the square of the person's height, is over 30 kg/m2, with the range 25–30 kg/m2 defined as overweight.Aims and objectives were to estimate the prevalence of overweight and obesity among the study population and to compare the study results between urban and rural area population.Methods: A community based cross-sectional study from April 2008 to May 2009 (1 year) conducted at urban health centre, Harazpenta and rural health centre, Patancheruvu. Total of 1409 persons in the age group of above 15 years were involved in this study. Data collection by using pre-designed, pretested questionnaire. Data analysis by using MS office 2016. Epi info2016, rates, ratios, proportions and Chi-square tests were used.Results: Among urban population prevalence of obesity was 12.7% compared to 5.4% in rural area. The prevalence of pre obesity was more among males (26.2%) in urban area than rural area (16.72%). In the study population 42.9% of the individual who had BMI>25 were from upper middle class in urban area, when compared to 43.3% with BMI>25 belongs to upper class in rural area.Conclusions: All over weight and obese subjects should be educated to know about the occurrence of various health problems due to overweight.

A cross sectional study on proper use of iodized salt in communities of rural areas and its relevant factors in Prakasam district, Andhra Pradesh, India

Background: The coverage of adequately iodized salt in old Andhra Pradesh was 63.6%, which is below the national average. Despite of high coverage rural households were less likely to consume adequately iodized salt. Objectives were (1) to find out the use of iodized salt and practices among community and knowledge regarding iodine deficiency diseases (2) to test salt at the household level to assess level of iodine.Methods: Community based cross-sectional study conducted from July to December 2016 in RHTC, Maddipadu, Prakasam district. Proportionate households from four villages of this area were interviewed for the purpose of study. Factors related to use of iodized salt in the communities like type of salt using in houses, storage practices, practices during cooking, knowledge regarding iodine deficiency disorders were assessed. The salt was tested for iodine using iodine rapid test MBI kits. The data was collected using pre-tested questionnaire and analyzed by using SPSS 22.0 version.Results: Most of households (68.5%) were between 25-50 years age, 68% wives were illiterate and 48.5% wives involved in labor work. Majority (83.6%) of the families were using iodized packed salt, 75% had adequately iodized salt with ≥15 ppm and 25% with inadequate iodized salt <15ppm. Association between illiterate wives and poor knowledge regarding iodized salt found to be significant (p<0.005).Conclusions: Specific education regarding proper storage, handling, duration and the importance of iodized salt needs to be implemented to increase community awareness and to focus on behavior change communication to bring positive attitude toward utilization of iodized salt.

Management of electrical storm of unstable ventricular tachycardia in post myocardial infarction patients: A single centre experience

Objective This is a case series of consecutive patients with past myocardial infarction presenting with Electrical Storm (ES) of unstable ventricular tachycardia (VT) treated by a protocol directed algorithm. Methods Management protocol involved treatment of reversible causes, ventilatory & hemodynamic support, administration of antiarrhythmic drugs (AAD) & maximally tolerated doses of beta-blockers, stellate ganglionectomy and Radiofrequency ablation (RFA) guided by Electro Anatomic Mapping (EAM). Patients were followed up periodically with review of device data logs. Results There were 12 patients (mean age = 61.38 ± 6.48 years & mean LVEF = 31.92 ± 4.23%). Presentation was recurrent ICD shocks (n = 5) or VT (n = 7). All were mechanically ventilated. Reversible causes were identified in 4 patients and appropriately addressed. Totally 8 patients underwent endocardial substrate modification by EAM & RFA. Endocardial LV Voltage mapping demonstrated a mean scar area of 70.04 ± 17.63 sq.cm (27.04 ± 6.20% of mapped area). The electrograms targeted for ablation included late potentials, fractionated electrograms, double potentials and channels within the scar. Two patients had stellate ganglionectomy in addition. Ten patients (83.3%) survived to discharge, all of whom are alive at a follow up of 30.12 ± 19 months free of ES. VT free survival at end of follow up was 80%. No patient had hospitalization related to VT. Single episode of VT recurrence was seen in 2 patients at 7 months and 1 year of follow up respectively. Conclusion In post myocardial infarction patients presenting with ES and unstable VT, a protocol driven approach involving substrate modification targeting abnormal electrograms improves outcomes.

Incidence of Significant Bacteriuria among Pregnant Women in a Teaching Hospital of Rural Setup

Aim This study was carried out to determine the prevalence of asymptomatic bacteriuria in pregnant women attending a teaching hospital in rural setup. Materials and Methods A total of 600 women were recruited for this study. A total of 200 antenatal women were clinically identified to have no signs and symptoms of UTI, 200 antenatal women were having signs and symptoms of UTI, and 200 were non-pregnant women that were studied as controls. Clean catch midstream urine samples were collected from each patient into a sterile universal container from Gynecology and obstetrics department and general medicine department. The urine samples were examined microscopically and by the cultural method. Identification of isolates was carried out by a standard microbiological technique. Result A total of 272 (45.3%) were positive for significant bacteriuria. There was a significant difference in the prevalence of asymptomatic bacteriuria with respect to age (P< 0.0001). Trimester did not show any significant difference (P = 0.2006) in the prevalence of asymptomatic bacteriuria. Escherichia coli was the most predominant organism followed closely by Klebsiella species. Nitrofurantoin, ampicillin, and levofloxacin were mostly used antibiotics. Conclusion Asymptomatic bacteriuria is not uncommon among antenatal patients in the population studied. Routine urine cultural test should be carried out on all antenatal patients in order to identify any unsuspecting infection. This measure will go a long way in reducing maternal and obstetric complications associated with pregnancy.

Intussusception Due to Inflammatory Fibroid Polyp.

Since 1976 to 2011, a sum of 89 cases of infl ammatory fi broid polyp (IFP) of the gastrointestinal tract is recorded in the literature. Th e lesion is always benign, may occur at any age but is most common in the sixth and seventh decades, and involves the stomach most frequently. Abdominal pain, often related to obstruction, is the principal symptom. Th e lesions are sessile or polypoidal, originate in the gut submucosa, vary greatly in cellularity, and have a wide range of tissue eosinophilia. We are presenting a rare case of ileoileal intussusception caused by IFP in a 32-year-old female. Resection and end-to-end anastomosis was done after reducing the intussusceptum.

Ectopic Spleen Presenting as Abdominal Mass: A Case Report.

Ectopic spleens are rare findings though spelenincule are common. It is due to failure of fusion of mesogastrium and the lining body wall epithelium, resulting in supports of the spleen become lax, and spleen position will be abnormally located. Hypermobile colon and prune belly syndrome are associated with the ectopic spleen. This is more common in children. In adults, it is more common in woman; especially in multipara. A rare case of mass per abdomen in right iliac fossa, turned out to be functional spleen with aneurysm of splenic artery is presented. There were no features of infarction, torsion or portal hypertension or splenic vein thrombosis. Splenectomy was done. The patient had uneventful recovery.

Retroperitoneal Fibrosarcoma: A Rare Case Report.

Retroperitoneal sarcomas are rare tumors ranging from only 1% to 2% of all solid malignancies. Among all sarcomas, most of these occur outside the retroperitoneum. Only 10-20% of sarcomas are retroperitoneal sarcomas, and the overall incidence is 0.3-0.4% per 100,000 of the population. The diagnosis and treatment of retroperitoneal sarcomas are challenging because the tumors are quite rare and usually present in latter stages of the disease in an anatomically complex location. A rare case of recurrent retroperitoneal fibrosarcoma in a 23-year-old male presented as a mass per abdomen. Retroperitoneal sarcomas are malignant tumors arising from mesenchymal cells, which are usually located in muscle, fat, and connective tissues.

Poorly Differentiated Synovial Sarcoma over Tendo Achilles: A Rare Case.

Synovial sarcomas of Tendo Achilles are rare tumors. The name “synovial sarcoma” is a misnomer, as it does not arise from synovial membrane. These tumors occur usually in the upper and lower limbs, more often in lower limbs in the distal parts. Distal extremities are more commonly associated with this tumor. It is seen to affect mostly tendon sheath, bursa, and joint capsule; knee being the commonly affected large joint. The common age group is 15-40 years. In our case, the initial pathology report came as hemanioma to us, but the immunohistochemistry report revealed it to be poorly differentiated synovial sarcoma.

Radiomodulatory Role of Psidium guajava Leaf Extracts against X-ray Induced Genotoxicity, Oxidative stress and Apoptosis in albino Wistar Rat Model.

In the present study we investigated the radioprotective activity of hydroalcoholic leaf extracts of Psidium guajava (P.G) against rats exposed to X rays. Exposure to ionizing radiation like X rays induces oxidative damage in normal tissues leading to their death or transforming them into cancerous tissues. To study the optimum dose of radioprotection, rats were administered with different doses (50,100,200,400 mg/kg body weight) of Psidium guajava leaf extracts daily for five consecutive days. One hour after last administration of leaf extracts the rats were treated with 6.6 Gy of x rays.200 mg/kg body weight was selected as an optimum dose for radioprotection based on survival analysis. Pretreatment of 200 mg/kg body weight of P.G leaf extract increased the levels of antioxidant enzymes such as superoxide dismutase, catalase, reduced glutathione and lowered the levels of lipid peroxidation, protein carbonyls and nitric oxide when compared to irradiated group in liver tissue homogenates. DNA damage indicators analyzed through comet assay showed a reduction in Olive tail movement and percentage DNA in tail significantly in P.G pretreated group when compared to irradiated group alone. Pretreatment of P.G leaf extract at a dose of 200mg/kg body weight protected cells from apoptosis which was analyzed microscopically by Ethidium bromide /Acridine orange staining. Our findings demonstrate the role of P.G leaf extract as a radio modulator in vivo, consequent to its powerful antioxidant activity in vitro and could be beneficial in combating radiation induced damage in living systems.

Clinical profile of patients with scabies.

Background: Scabies is a neglected parasitic disease that is a major public health problem in many resource-poor regions. Scabies is found primarily in poor and overcrowded conditions but can affect individuals of all ages and socioeconomic status without regard to level of hygiene. It causes substantial morbidity from secondary infections and postinfective complications such as acute post-streptococcal glomerulonephritis. Methods: This study was conducted out in the department of DVL, Mahatma Gandhi Memorial Hospital, Warangal. 200 patients were included in the study among those attending DVL outpatient department of this hospital, during the period from 1st January 2013 to 31st December 2013. Results: Scabies accounted for 1722 of total dermatology out patients (51266) during study period. In the present study, most of the patients belonged to the age group of 11 – 20 years i.e., 39.5%. Males constituted to the majority of patients (Male: Female::3:2). More number of patients belonged to the middle income group is 140 (70%). Nocturnal itching was present in 163 patients (81.5%). Majority of the patients were students who constituted to 57.5%. Family history of scabies was positive in 86% of patients. 191 (95.5%) had lesions over the inter digital (web) space and wrist of the hand. Conclusion: From this study we conclude that proper vigilance and awareness is required while observing/examining a suspected case of Scabies.

Clinical profile of plasmodium falciparum case presenting to a tertiary care teaching institution in south India: An observational study

Introduction: Malaria has been a major public health problem plaguing India for centuries and about 95% of Indian population is residing in malaria endemic regions. The proportion of the Pf % has gradually increased from 39% in 1995 to 65% in 2014. Periodic clinical profiling studies may help us in understanding of the changing pattern of the disease, complication rate and emerging drug resistance patterns, which can help the clinicians in making better and informed clinical decisions. Objective: To analyze the socio demographic and clinical profile of falciparum malaria cases and to study the incidence and profile of complications of falciparum malaria and their impact on hospital in falciparum malaria. Materials and methods: A prospective observational study was conducted in department of General Medicine of tertiary care hospital from November 2011 to November 2013 among patients diagnosed with falciparum malaria by smear. Patients aged above 18 years, both genders were included in the study. Results: Among 50 study participants, 42% belonged to 26 to 40 years of age and 76% of them were males. Fever was the most common clinical symptom reported by all the patients, followed by chills and rigors (90%), headache (74%), nausea and vomiting (46%). A total of 37 (74%) of the patients had complicated malaria, out of the 37, 17 (45.95%) had single complication and remaining 54.05% T. Murali Venkateswara Rao, B. Bhaskara Rao, Raghuram Chikkala. Clinical profile of plasmodium falciparum case presenting to a tertiary care teaching institution in south India: An observational study. IAIM, 2016; 3(5): 159-165. Page 160 had multiple complications. Liver involvement manifested by jaundice was the most common complication seen 51.4% of the subjects, followed by cerebral malaria (48.6%) and anemia (45.9%). None of the patients reported mortality. Conclusions: Males in the age group of 26 to 40 years is the most common population group affected by plasmodium falciparum malaria. The proportion of complicated cases is very high (73%) in the study population and the most common complications include liver dysfunction and cerebral malaria. No mortality was reported in the study probably attributed to early diagnosis and effective management.