Cephalic Tetanus Presenting as Ptosis

A 7-year-old unimmunized boy developed cephalic tetanusfollowing chronic suppurative otitis media. We wish to emphasizethat possibility of cephalic tetanus should be considered in anunimmunized child presenting with ptosis.

Nodal metastasis of cervix carcinoma- As a probable cause of bone erosion

Introduction: Carcinoma of cervix is a common gynaecological malignancy and remains the third most common cancer in developing countries. While nodal metastases are common in cervical cancer, major sites of the less common haematogenous metastases include lung, liver and bones. Bone involvement in cases of carcinoma of cervix is low and the estimates range from 0.8-16 % according to various series.Several patterns of bone involvement are observed in cases of carcinoma of cervix including, (1) direct extension into bone, either from the parametrial extensions of the primary or recurrent pelvic tumor, (2) direct extension into adjacent bone from the pelvic or distant lymph node metastasis (3) regional or systemic haematogenous metastasis to bones. Aims: To evaluate the pattern of metastases in patients of carcinoma of uterine cervix, with particular emphasis on the pattern of bone involvement on contrast enhanced CT. Settings and Design: Retrospective study. Materials and Methods: This was a retrospective study, where we reviewed the hospital records and data of patients of cervical cancer who underwent contrast enhanced CT (CECT) of the chest and abdomen over a period of one year between January and December 2016. A total of 100 patients of carcinoma cervix were included. CT images were reviewed by two experienced radiologists. The bony erosion due to pelvic mass or lymphadenopathy was classified as subtle or gross. Results: Bone involvement was seen in 11 out of 100 cases (11% cases). Among 13 cases direct bone involvement by the pelvic mass/recurrence and metastatic lymph nodes (8/11; 72.7%) was slightly more common than thehematogenous bone metastasis (5/11; 45.4% cases). Among the direct bone involvement direct erosion of the underlying bone by the nodal metastasis (6/8; 75%) was twice more common than the direct bone involvement by the pelvic mass/recurrence(2/8; 25%). Conclusions: Direct bone involvement by erosion of adjacent bone by nodal metastasis is the most common mechanism of bone involvement in cases of carcinoma of cervix signifying the high propensity of lymph nodal deposits to erode the underlying bone. This finding of direct bone erosion is not seen in any other gynaecological malignancy and should be promptly looked for in all cases of carcinoma of cervix

Prevalence of overweight, obesity and hypertension among school going children in District Kanpur, Uttar Pradesh, India: a longitudinal study

Background: India is undergoing a rapid epidemiological transition with increased urbanization and socio-economic development which has resulted in a dramatic change in lifestyle, consisting of physical inactivity, diet rich in fat, sugar and salt coupled with a high level of mental stress. Obesity is one of the most common diseases worldwide and the prevalence in school aged children appears to be increasing. Thus, the present study was planned to establish an association between body mass index (BMI) with hypertension among 10-16 years children.Methods: Present longitudinal study was conducted on 350 children in private schools of District Kanpur and children 12-16yrs of age have included in the study. BMI for age charts was used to assess the obesity and blood pressure was measured by sphygmomanometer and Blood pressure values were compared to the values given by the update of 1987 task force report of the National high blood pressure Education Programme Co-ordinating Committee and children who were found prehypertensive or hypertensive were followed up after 4 weeks duration.Results: In present study the prevalence of overweight and obesity was found 4%,2% respectively. Prevalence of Pre-hypertension and hypertension was found 1.14%, 2.57% respectively and pre-hypertension and hypertension were found more in overweight and obese participants.Conclusions: Prevalence of pre-hypertension and hypertension is more among overweight and obese children. Overweight and obesity are not only risk factor for hypertension but also other diseases, so health education should regularly give about the obesity and its deleterious effects in later part of life.

In vitro evaluation of antimicrobial activities and antibiotic susceptibility profiling of culturable actinobacteria from fresh water streams

Actinobacteria are major producers of antibiotics, industrially significant enzymes and many pharmaceutically important biologically active compounds. Twenty two actinobacterial strains were isolated from fresh water stream sediment samples of Murlen National Park, Mizoram, India. The actinobacterial strains were screened against antifungal pathogens (Fusarium oxysporum, Fusarium udum, Fusarium proliferatum, Fusarium oxysporum ciceri and Fusarium graminearum), and antibacterial activities against five bacterial pathogens (Staphylococcus aureus, Pseudomonas aeruginosa, Micrococcus luteus, Bacillus subtilis and Escherichia coli) and a yeast pathogen Candida albicans. All strains showed antibacterial activity against E. coli and F. proliferatum. Based on the results of antagonistic, antibacterial and anti-yeast, two most potent strains Kocuria sp. and Streptomyces intermidus were further evaluated for their antibiotics susceptibility activity against 21 different antibiotics. Kocuria sp. showed resistance to 10 antibiotics whereas Streptomyces intermidus was resistance to 15 antibiotics. Modular genes Polyketide Synthase (PKS II) and Nonribosomal Peptide Synthetase (NRPS) were also detected in these two strains, which might be responsible for the production of secondary metabolites. Two volatile compounds, Di-N-octyl phthalate and 1-Bromo-3, 7-Dimethyloctane were identified from the extract of Streptomyces intermidus BPSWAC29 strain using Gas chromatography Mass spectrometry (GC-MS). This study highlights the promise of discovering novel actinobacteria with antimicrobial activity from underexplored niche biotopes such as fresh water stream sediments.

A Nexus model of cellular transition in cancer

The exact cause of cancer is one of the most immutable medical questions of the century. Cancer as an evolutionary disease must have a purpose and understanding the purpose is more important than decoding the cause. The model of cancer proposed herein, provides a link between the cellular biochemistry and cellular genetics of cancer evolution. We thus call this model as the "Nexus model" of cancer. The Nexus model is an effort to identify the most apparent route to the disease. We have tried to utilize existing cancer literature to identify the most plausible causes of cellular transition in cancer, where the primary cancer-causing agents (physical, chemical or biological) act as inducing factors to produce cellular impeders. These cellular impeders are further linked to the Nexus. The Nexus then generates codes for epigenetics and genetics in cancer development.

Chromosomal context and replication properties of ARS plasmids in Schizosaccharomyces pombe.

Short, specific DNA sequences called as Autonomously Replicating Sequence (ARS) elements function as plasmid as well as chromosomal replication origins in yeasts. As compared to ARSs, different chromosomal origins vary greatly in their efficiency and timing of replication probably due to their wider chromosomal context. The two Schizosaccharomyces pombe ARS elements, ars727 and ars2004, represent two extremities in their chromosomal origin activity – ars727 is inactive and late replicating, while ars2004 is a highly active, early-firing origin. To determine the effect of chromosomal context on the activity of these ARS elements, we have cloned them with their extended chromosomal context as well as in the context of each other in both orientations and analysed their replication efficiency by ARS and plasmid stability assays. We found that these ARS elements retain their origin activity in their extended/altered context. However, deletion of a 133-bp region of the previously reported ars727- associated late replication enforcing element (LRE) caused advancement in replication timing of the resulting plasmid. These results confirm the role of LRE in directing plasmid replication timing and suggest that the plasmid origin efficiency of ars2004 or ars727 remains unaltered by the extended chromosomal context.

Package of local interventions for reducing in-hospital neonatal mortality using quality improvement methodology at a major hospital in India.

Background: Short birth interval adversely affects the maternal and neonatal health. The use of contraceptive methods is still one of the biggest challenges in developing countries despite various programs. Janani Suraksha Yojana was started with aims to achieve national targets for contraception. Methods: The present study was a cross sectional study conducted in Lucknow district amongst the women admitted in three blocks of rural area health centers. The blocks were selected by simple random sampling method. A total of 400 women who delivered in the labor wards of the health centers were interviewed and enrolled. Results: In the present study, out of 400 mothers, 39(9.8%) mothers had their first delivery below the age of 18 yrs. According to modified Udai Pareek Scale, 56.3% of the mothers belonged to 5th socio-economic status. Birth spacing was the purpose to use family planning (FP) methods among 121(55.5%) of the mothers. The use of FP method was significantly associated with occupation of mothers and their husband and education of mothers. It was also found that the use of FP method was significantly (p=0.001) higher among those beneficiaries who had birth interval > 3 years (72.1%) in contrast to 2-3yrs (68.8%), 1-2yrs (60.2%) and < 1yr (36.4%). Conclusions: JSY is a promising program for promotion of contraception. Knowledge about the family planning methods should be provided to the beneficiaries during their ANC visits as during this period they are more receptive to family planning methods.

Package of local interventions for reducing in-hospital neonatal mortality using quality improvement methodology at a major hospital in India.

Background: Reducing neonatal mortality has always been a challenge for the world and India. Here we provide a brief account of a pilot done at Sanjay Gandhi Memorial Hospital, New Delhi for reducing neonatal mortality. Methods: Rotation of labour room nurses to In-hospital Neonatal ICU for a specified period of 4 months for providing hands-on training on neonatal emergencies. In exchange, equal number of Nurses from NICU was posted in labour room, thus making each delivery managed by an obstetric nurse and a paediatric nurse. Ensuring breastfeeding within one hour within the labour room itself was also mandated by NICU Nurse. Results: It was observed that there was 30.2% decrease in In-hospital neonatal mortality. Conclusions: Using these interventions, there has been a dramatic decrease of neonatal mortality to 30.2% and 4.53% due to sepsis. There has also been 1% decrease in Median Referral Percentage to In-hospital Neonatal ICU due to morbidities associated with inborn neonates.

Patient Safety due to Administrative Negligence: Neglected Area in India.

Background: Patient safety and security extends beyond due to medical error alone i.e. due to administrative carelessness. This aspect has been neglected or low priority area in India. Many instances if overlooked can be source of potential litigations for which court can award compensation against the hospital. Courts in India have recognized civil rights of right to safety of the patients and awarded compensation. Methods: A descriptive study has been conducted. This paper deals with administrative aspect on patient safety. A critical review of court cases in India and abroad along with review of relevant literature to make the situation understandable and clear for the safety and security of patients in India scenario. Results: Further study (KAP) needed to draw impact on the Health Administrators. Conclusion: An attempt has been made to sensitize the healthcare administrators/managers in both private and public sector hospitals.

Sex determination from sternal end of 4th rib in Western U.P. population: An autopsy study.

There have been several studies on the human skull, long bones, pelvis, sacrum and manubrium to establish the sex of skeletal remains. If small segment of the bone or small bone is found then it will be very difficult to identify the sex. The present study showed the sternal extremity of the fourth rib can be used in determining the sex by direct metrical analysis of an isolated 4th rib. The samples (55 males, 39 females) were obtained from individual of known age and sex and three measurements (SI, APW and PD) were taken from each rib. The sample was divided into five groups from less than 15 years to more than 60 years and was analysed by stepwise discriminant function analysis. It was found the specificity of sex determination varied from 50 % to 88.89 % and overall correct classification varied from 60% to 94%. SI was the most reliable followed by APW and APW measurement is most useful criteria for more than 60 year of age. It was therefore concluded that sexual dimorphism can be detected by direct measurement of fourth rib and this dimorphism increases with age.

Analysis of bite mark evidence.

Bite mark analysis casework strives to connect a biter to the teeth pattern present on an object linked in some way to a crime or event. The general public and some law enforcement may consider any “bite mark” case they develop to be a certainty in the quest to identify the biter. The ability of skin to register sufficient detail of a biter’s teeth is highly variable. Bite mark casework indicates that many bite marks are not well defined in detail and posses distortion due to the physical nature of skin itself. The current opinion is that bite mark can be useful in including or excluding possible suspects and ability to identify only one person as the biter. In mortal combat situations, such as the violence associated with life and death struggles between assailants and victims, the teeth are often used as a weapon. It is well known that assailants in sexual attacks, including sexual homicide, rape and child sexual abuse, often bite their victims as an expression of dominance, rage and animalistic behaviour. The teeth are a significant component of our natural arsenal.

DNA profiling in forensic dentistry.

In last few years, DNA analysis methods are applied to forensic cases. Forensic dental record comparison has been used for human identification in cases where destruction of bodily tissues or prolonged exposure to the environment has made other means of identification impractical, i.e., after fire exposure or mass disaster.Teeth play an important role in identification and criminology, due to their unique characteristics and relatively high degree of physical and chemical resistance. The use of DNA profile test in forensic dentistry offers a new perspective in human identification.DNA is responsible for storing all the genetic material and is unique to each individual. The currently available DNA tests have high reliability and are accepted as legal proofs in courts. This article gives an overview of the evolution of DNA technology in the last few years, highlighting its importance in cases of forensic investigation.

Need for enhanced punishment for outraging the modesty of woman U/S 354 IPC.

Crime against women are rising in India especially in State of Uttar Pradesh, Madhya Pradesh and Delhi and there is a need felt in every corner of India to enhance punishment to deter these crimes. India is signatories to various International treaties including related to protection of human rights of woman and children. Hon’ble Supreme Court of India and various High Courts has taken cognizance of situation on many occasions and recommended to Union of India and state Governments to amend the law to protect the faith of common man especially vulnerable groups like woman and children. A Critical review of decisions of courts has been done for highlighting the legal situation on the issue of meaning and scope of applicability of section 354 IPC. Data base collected and compiled from the National Crime Record Bureau website to understand the rising trend of crime. This paper discusses various reasons for less punishment for molestation and need for enhanced punishment and making it non-bailable to make sense in preventing rising crimes against woman.

Right to emergency care: Consumer court.

Indifference towards victims of accidents and those in emergency medical conditions and even women under labour who are about to deliver is not peculiar to India but is prevalent in other countries also. The SC of India as long back as 1989 observed in Parmanand Katara v. Union of India that when accidents occur and the victims are taken to hospitals or to a medical practitioner, they are not taken care of for giving emergency medical treatment on the ground that the case is a medico-legal case and the injured person should go to a Government Hospital. The SC emphasized the need for making it obligatory for hospitals and medical practitioners to provide emergency medical care. Delhi State Consumer Court first taken up for consideration the question of maintainability of award against the hospital in case of brought dead patient: This paper deals with critical review of recent judgment of State Consumer Court of Delhi on the issue of right to emergency care of common man and deficiency of service in Indian context.