Gallbladder tuberculosis: A rare case report with review of literature

Gallbladder tuberculosis (TB) is a rare disease, and it might be challenging to distinguish it from gallbladder cancer on clinical history and radiology. It frequently mimics carcinoma in patients who initially appear with a gallbladder mass. Gallbladder TB is only identified after histology of the resected specimen since radiography lacks pathognomic characteristics. Here, we describe a unique case of gallbladder TB that was incidentally identified when a 49-year-old lady was being evaluated for suspected gallbladder cancer. Histology of the gallbladder exhibits necrotizing granulomatous inflammation with the presence of numerous pink-colored, curved, and beaded acid-fast bacilli that were recognized on the Ziehl-Neelsen stain.

Topographic Study Of Supraorbital Margins, And Notches In North Indian Human Dry Skulls And Its Clinical Applications

Introduction: The supraorbital notch (SON) is present at the junction of sharp lateral two-thirds and roundedmedial third of supraorbital margin. The neurovascular bundle exit via this notch/foramen. The morphometricvariations of the supraorbital ridge, notch, or foramen are not uncommon. The knowledge of these parameters isimportant to preserve the neurovascular bundle during surgery in this area.Materials and Methods: This study included seventy skulls obtained from department of Anatomy, Doon governmentmedical college Dehradun and Sri Guru Ram Rai Institute of medical and health sciences Dehradun followingstandard guidelines. All the parameters were observed and measured with the help of vernier caliper andreported in the tabulated form.Results: Out of seventy skulls, bilateral supraorbital notch and supraorbital foramen were found in 37.14% and14.28% respectively. Unilateral notch and contralateral foramen was found in eight skulls i.e. 11.42%. notch orforamen was absent in 5.71% skulls. The distance from SON/F to the midline (nasion) and frontozygomaticsuture were 25.86±3.11 and 29.89±2.19 mm. respectively . The mean distance between supraorbital notch orforamen to infraorbital foramen was 42.33 ±3.11 mm.Conclusion: Topographical anatomy of supraorbital ridge, notch and foramen and its variation is important toprevent the complications after surgical procedure in this area.

Status of trace elements zinc, copper, and selenium in transfusion dependent beta thalassemic Indian children: a cross sectional study

Background: Maintenance of normal levels of copper, selenium, and zinc play an important part in lessening the morbidities associated with thalassemia major. Levels of these elements have been found to be altered in this chronic transfusion dependent disease from all over the world, but with widely variable results.' Besides repeated blood transfusions and use of chelating agents, their levels in thalassemics are affected by genetic and dietary factors also, compelling us to undertake this study in our population. The objectives of this study were assessment of serum levels of zinc, copper and selenium in transfusion dependent beta thalassemics. 'Methods: Cross sectional descriptive study conducted at Thalassemia Day-care Centre of a teaching hospital. Total 64 transfusion dependent thalassemics in the age group 3-18 years were subjected to serum levels of zinc, copper and selenium by inductively coupled plasma mass spectrometry technique.' 'Results: Four (6.25%) had hypozincemia, 15 (23.43%) hypocupremia and one (1.565%) had hypercupremia. Two (3.12%) had higher selenium levels (>190 'gm/l).Conclusions: In contrast to previous studies, hypocupremia has been found to be more prevalent than hypozincemia and hyposelenemia in our population.

Morphometric Evaluation Of Glenoid Cavity And Other Dimensions Of Dry Human Scapulae

Introduction: The scapula (shoulder blade) is a triangular flat bone that lies on the posterolateral aspect of thethorax. The scapula bears various angles namely superior, inferior, lateral, medial, acromial and coracoidangle. The three borders meet strategically to form the referenced three angles (lateral, superior, and inferior. Itslateral angle, truncated and broad, bears the glenoid cavity which articulates with the head of the humerus at theglenohumeral joint. The morphology of the glenoid cavity is highly variable. The glenoid rim presents a notch inits upper and front partMaterials and Methods: This study included thorough observation of 120 dry human scapulae, 67 from left sideand 53 from right side, obtained from department of Anatomy, Sri Guru Ram Rai Institute of medical and healthsciences Dehradun following standard guidelines. All the metric and non metric parameters were observed andrecorded in tabulated form.Results: The mean length of scapula of left side was observed as 127.35±12.35 and right side was 128.10±11.21.Thetotal mean value for length of scapula was noted as 130.21±12.65 . The mean breadth of scapula was recordedas 96.98±7.62mm. The mean value of scapular index was listed as 68.47±3.98 . The mean of infraspinous lengthwas recorded as 99.14±9.54 and the infraspinous index was 99.65±8.32.The mean AP glenoid diameter 1 was24.54±2.65mm, the mean AP glenoid diameter 2 was 16.56±2.45mm and the mean AP glenoid diameter 3 was17.09±2.75 The shape of the glenoid cavity was recorded as type 1(oval) 17.50%, Type2 (pear) 48.14%,Type3(inverted coma) and Type4(other).Conclusion: To summarize, the present study provides a base line data of different scapular dimensions on theleft and right sides. Knowledge of the measurements and indices of various parameters of scapula such aslength, width and various parameters of glenoid cavity can be used for comparative anatomy and also fordefining the race.

Psychosocial Care and its Association with Severe Acute Malnutrition.

This cross-sectional study compared 120 children having severe acute malnutrition with 120 healthy children for exposure to 40 behaviors, by measuring psychosocial care based on Home Observation for Measurement of the Environment (HOME) inventory. The mean (SD) psychosocial care score of cases and controls significantly differed [18.2 (2.2) vs 23.5 (2.1); P<0.001]. A score of less than 14 was significantly associated with severe acute malnutrition (OR 23.2; 95% CI 8.2, 50).

Anatomic variations in the origin of the left circumflex coronary artery with angiography in Northern Indian population.

Introduction: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is definitely a crucial component in the management of heart diseases. Complex cardiac surgical repairs demand enhanced understanding of the basic anatomy to improve the operative Outcomes Material and methods: The present study was planned by Department of Anatomy and was executed in collaboration with Department of Internal Medicine and Cardiology during 2010 to 2014 at a tertiary care teaching hospital located in western Uttar Pradesh. The angiographic data of 5,532 patients who underwent coronary angiography were considered for anomalous origin of the left circumflex coronary artery (LCx). Results: The incidence of anomalous origin of the LCx was found to be 0.36%. The LCx arose from the left coronary sinus of valsalva (there was separate orifice for the LCx and the left anterior descending coronary artery) in 45.0% patients, from the right coronary sinus of valsalva, (there was a separate orifice for the LCx and the right coronary artery) in 25.0% patients, from the proximal part of right coronary artery in 30.0% patients. Conclusion: On the basis of findings of the current study it can be concluded that, the anomalous origin of the LCx may not be benign all the time. In case where ischemia does not resolve accurately after successful treatment of a coronary stenosis, anomalous coronary arteries must be considered.

A rapid appraisal of factors influencing utilization of primary eye health services among the residents in a rural community.

Background: Identification of factors affecting utilization of primary eye health services would help the government and other eye care providers to address inequity issues in their eye care program. Aim: Therefore this study was planned to find out barrier to utilization of eye health services among people living in rural western Uttar Pradesh. Material and methods: The current community based cross-sectional survey which involved both qualitative and quantitative methods, was conducted among the residents. A total of 216 study subjects participated in the study. Factors in the supply side influencing utilization of eye health services by people from the community were sought through Focus Group Discussion (FGD) and Key Informant Interview (KII). Results: Almost 80% of the respondents had agriculture as their major occupation and > 1/4th were from lower caste community. Regarding the seeking of eye care services, 52.4% respondents who gave a positive history of an eye problem in the family told they attended the nearest health facility; CHC, PHC or SC while 19.2% did actually go to the eye health center. Only 4.8% respondent did not seek any service. Among 112 respondents who were aware of one or other eye diseases, 74.6% identified dirty things fallen into the eyes as the cause of an eye problem followed by 50.3% of the respondents who pointed out injury to the eyes as the culprit. For emergency problem in the eyes 79.2% respondents told that they sought services from health facilities without delay, while 15.4% gave priority to starting household treatment. Conclusion: Raising awareness of the community about eye diseases and the services available together with strengthening of primary eye health services available at the local health facilities could help bring eye health services in closer proximity to the rural population.

A study on perceptions about eye health care and promoting factors for eye donation among medical students from a tertiary care teaching hospital.

Background: Voluntary eye donation depends on the awareness levels of various stakeholders in the community. Today’s medical students are tomorrow’s stakeholders of the community. Medical professionals can enhance eye donation rates by educating and motivating the relatives in case of patient's death. Aim: Hence the present study was undertaken with an objective of assessing the promoting factors for eye donation among medical students. Material and methods: The present descriptive cross sectional study was carried out among undergraduate students of a medical college in western Uttar Pradesh in the month of February 2014 using pretested self administered questionnaire. Results: 77% students knew about eye donation. 51% of them were willing to donate their eyes. Only 39% students knew that the ideal time for eye donation is within 6 hours of death. 64% had knowledge about vitamin A’s important role in prevention of childhood blindness. TV, newspaper or other media were the most important channels of getting information for majority (60%) of the students. Regarding perceived promoting factors for eye donation by them, noble cause (57%), pleasure to help the blind (51%) and inspired by advertisement on television (42%) were 3 top most promoting factors. Conclusion: Inclusion of different preventive and promotive aspects of corneal blindness along with basic eye health care into the course curriculum is the need of the hour.

Prevalence and clinical evaluation of Pressure Ulcers using Braden scale from orthopedics wards of a tertiary care teaching hospital.

Background: The need for research into bed sores in orthopedic patients is evident from the increased number of beds they occupy and the considerable morbidity from pressure sores in orthopedic wards. Objective: To analyze and ascertain the prevalence and clinical evaluation of Pressure Ulcers from orthopedics wards of a tertiary care teaching hospital. Material and methods: The present prospective study was conducted by the Department of Orthopedics of a tertiary care teaching hospital from July 2009 to August 2014 among 228 patients seeking care for trauma to proximal femur, hip joint, pelvis and undergone elective surgery or surgery for removal of old implants. Braden scale was used for predicting pressure ulcers in the study subjects. All patients showing the potentiality of developing clinical signs of bed sores were selected and put on the study list. Patients aged ≥ 80 years, sick patients due to terminal illnesses and the worst pressure sores were excluded from the study. Results: Out of total 228 study subjects, 61 subjects developed pressure ulcers giving a prevalence of 26.75%. According to Braden Scale, 16.39% of patients were at high risk for developing the pressure ulcers. 68.85% of ulcer patients were treated for trauma mostly for fracture hips, pelvis or proximal femur or spine. Majority of patients (60.66%) developed pressure ulcers after the second week of admission. The lengths of stay of patients with bed sores exceed the stay of non sores patients on orthopedic wards by several times. Sacrum was the most commonly affected part of body. Conclusion: The findings of the current study highlight the multi-factorial etiology of pressure ulcers and they are preventable. Its prevention would require multidimensional approach including the collaboration of all the nursing and surgical staff. Frequent patient turning, close monitoring and frequent skin checks would delay the onset of pressure ulcers.

Prevalence of microbial infection and strategic pattern of antimicrobial resistance among intensive care unit patients in a tertiary care teaching hospital from rural Northern India.

Background: Better management of patients cannot be ensured and the antibiotic policy cannot be designed till one knows the profile of prevalent strains along with their antimicrobial resistance pattern. Objective: To assess the strategic patterns of the organisms and its resistance patterns that were isolated from the patients admitted in various ICUs in a tertiary care hospital. Material and methods: The present study was undertaken based on reports of bacterial isolates of various clinical specimens from different ICUs of a tertiary care teaching hospital, that were submitted to the Microbiology laboratory for culture and sensitivity during the period of October 2012 to September 2014. All the organisms were identified morphologically and biochemically by standard laboratory procedure and antibiotic susceptibility pattern was determined by disc diffusion methods. Results: Out of the total samples (2920) received; organisms were isolated from 66.57%. One organism was isolated in 71.19% samples whereas 2 or more organisms were obtained in 28.8% were obtained in 28.8% samples. The most frequently isolated bacteria were P. aeruginosa (38.17%). Among P. aeruginosa, tobramycin had the highest susceptibility rate (94.2%) followed by meropenem (93.93%), carbenecillin (79.11%), and levofloxacin (73.45%). Most of the frequently isolated organisms like K. pneumoniae, Acinetobacter anitratus, Enterobacter were highly resistant to ampicillin, cephalexin, cefepime, ciprofloxacin. Conclusion: Appropriate antibiotic utilization in ICU is crucial not only to ensure an optimal outcome, but also to prevent the emergence of multi drug resistance. Antibiotic policies and effective surveillance are needed for better management of ICU infections with resistant organisms, Alteration and rotation in antibiotic prescribing patterns would decline the antibiotic resistance.

A prospective comparative trial of collagenase and metronidazole in the topical management of diabetic foot ulcer.

Objective: To assess the efficacy of metronidazole and collagenase combination in the treatment of diabetic foot ulcers with regard to the reduction of slough formation, enhancement of granulation tissue and re-epithelization. Study design: Prospective, comparative study. Place and duration of study: Surgery department of a tertiary care teaching centre of rural Haryana, from January 2011 to February 2013. Methodology: The patients who were admitted for diabtic foot ulcers at Surgery Department of a tertiary care teaching centre during the study period were screened. 42 patients in the test group were treated with topical dressings of collagenase and metronidazole. The control group of 40 patients was treated with conventional topical dressings and bed side debridement. Ulcer's status was noted using visual score. Results: The number of patients with no necrotic tissue was significantly higher in test group at 3rd, 4th, 5th, 6th and 7th weeks than control group. Granulation tissue was significantly higher in test group at 3rd, 4th, 5th and 6th week. The test group patients had a faster wound bed preparation resulting in faster wound cover using secondary suturing, S.S.G., flap cover at the third week itself. Conclusion: Combination of collagenase and metronidazole topical application enhanced wound healing of diabetic foot ulcer as compared to conventional treatment modalities.