To evaluate the serum magnesium levels in fresh myocardial infraction patients and to compare them with normal healthy individuals – A comparative study

Background: Now-a-days, myocardial infarction (MI) is one of the most prevalent disorders. Lack of blood supply causes MI/heart attacks. Ischemia or a lack of oxygen causes heart tissue damage and is ultimately fatal. Several studies demonstrated the association of magnesium deficiency with MI. Aim and Objectives: The aim of the study was to evaluate the levels of serum magnesium in MI patients and to compare them with normal healthy individuals. Materials and Methods: The present study assessed magnesium levels in 50 MI and another 50 without MI, healthy participants serve as a control. All the study participants were recruited from Government Medical College, Amritsar. Results: In normal individuals (n = 50), the Mean ± standard deviation (SD) of serum magnesium was 1.994 ± 0.28 mg/dl and SE. of 0.04, while in MI patients Mean ± SD was 1.13 ± 0.49 mg/dl and SE of 0.07. The mean of magnesium was significant (t = 10.8, P < 0.001) high in MI patients as compared to the control. Conclusion: Thus, it concludes that magnesium can be used as a diagnostic investigation tool for assessing patients suffering from MI.

A study of serum magnesium levels in acute myocardial infarction and its association with clinical outcome

Background: Cardiovascular disease is one of the leading causes of mortality, morbidity, and increased health-care cost. Magnesium has been implicated in the pathogenesis of acute myocardial infarction (AMI) and its complications. Magnesium ions are considered essential for the maintenance of functional integrity of myocardium. The serum magnesium concentration was found to have great significance in AMI. The present study was undertaken to evaluate the prognostic value of serum magnesium in AMI. Aim and Objectives: The aim of the study was (1) to evaluate serum magnesium levels in patients of AMI on 1st and 7th day post-myocardial infarction and (2) to evaluate validity of serum magnesium as prognostic indicator of Ami. Materials and Methods: This observational cross-sectional study was conducted in the Medicine Department, Guru Nanak Dev Hospital attached to Govt. Medical College, Amritsar. A total of 40 patients of AMI were enrolled in this study. Serum magnesium levels were done for all the patients and its correlation with clinical outcome was observed. Results: On day 1, mean serum magnesium levels in patients with ST-segment elevation myocardial infarction were 1.638 ± 0.19 whereas mean serum magnesium levels in patients with Non-ST-segment elevation myocardial infarction were 2.315 ± 0.321. Mean serum magnesium levels in patients with arrhythmias were 1.73 ± 0.35 on day 1 and 2.14 ± 0.25 on day 7 (P < 0.05). Mean serum magnesium levels at day 1 in patients having mortality are 1.452 ± 0.078 as compared to 2.105 ± 0.399 in rest of surviving patients. It was inferred from this study that patients with AMI with low serum magnesium levels are more prone to develop complications such as arrhythmias and death as compared to patients of AMI with normal serum magnesium levels. Conclusion: Magnesium is an underestimated cation and has been implicated in the pathogenesis of AMI and its complications. Patients of AMI with low serum magnesium levels are found to be more prone to develop arrhythmias as compared to those with normal serum magnesium levels. Hence, it can be concluded that measurement of serum magnesium level is of prognostic significance in AMI.

How trainee doctors and nurses react to simulated scenarios of violence against healthcare workers: A cross-sectional study

Medical and nursing students may have to face healthcare-related violence, especially now as they may be doing clinical duty during the Covid-19 pandemic. This study was conducted to analyse the perceptions and attitudes of medical and nursing students towards violence against healthcare workers (HCWs), when presented with audio-visual depiction of simulated scenarios. This cross-sectional study was conducted over a period of six months (April to September 2019) among the undergraduate medical and nursing students of first, second, pre-final and final years making it a total of 800 students. Video clips were shown to the students pertaining to HCWs’ interactions with patients and relatives, and their responses were noted. Among 615 participants who completed the proforma, 248 (40%) students reported having observed or experienced violence in their clinical postings. Overall, 70.7% of medical and 68.5% of nursing students said that they would report incidents of violence to the authority. The questionnaire based on video-based simulated scenarios brought forth the perception that in triggering an act of violence, both the healthcare worker and the attendant could be at fault and full disclosure of complications was a necessary step in preventing such an act of violence. Sensitisation about the same should be incorporated into the teaching curriculum by using simulated scenarios to prepare them to manage such incidents.

Developing a hybrid antimicrobial resistance surveillance system in India: Needs & challenges

Growing resistance to antimicrobials has become one of the most important problems of the 21st century. The development of new antibiotics is a time-consuming process involving huge financial resources. An alternate approach is proper utilization of the existing antibiotics through the surveillance of resistance. An important component of surveillance is the informatics tool for collection, management and analysis of antimicrobial resistance susceptibility testing data. Based on the scope, antimicrobial resistance surveillance resistance tools can be broadly classified as collectors and integrators. Individually, both the integrators and collectors have limitations which restrict their use in India. There is a strong requirement to develop a hybrid AMR surveillance tool that captures standardized data from small laboratories and integrates data from multiple sources to present a complete picture of the country. Here we describe a tooli-AMRSS developed by the Indian Council of Medical Research for collection, storage and management of AMR data from collaborating institutes/laboratories and to generate real-time analytics and reports.

Regulation of toxic contents of smokeless tobacco products

Effective regulation of contents of tobacco products is one of the primary milestones to reduce negative health effects associated with the use of smokeless tobacco (SLT) products. As per the available sources, testing of some SLT products has been done on ad hoc basis, but there is a lack of comprehensive and periodic analysis of these products. In addition, the available results indicate huge variations among the levels of pH, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone, N-nitrosonornicotine, benzo[a]pyrene, heavy metals and nicotine within different products as well as within different brands of the same product. This review was aimed to throw light on the variations and gaps in testing of SLT products and emphasize the need for strong policy regulation for monitoring the chemical constituents of these products.

Morphometric Study of Axis Vertebra in Subjects of Indian Origin

Background: The axis vertebra, exhibits complex and extensive variability in the morphology and there are vital neurovascular structures in its proximity. Knowledge of this variability is important for neurosurgeons, orthopaedicians, otorhynologists and other physicians who in everyday practice are in contact with disorders of the spine and their consequences. Objective: The aim was to evaluate various morphometric dimensions of axis vertebrae and to compare with the available data. Material and Methods: 50 dried human axis vertebrae of Indian origin, available in the Department of Anatomy, Dayanand Medical College and Hospital, Ludhiana were studied. Various dimensions were taken with vernier calipers, metric scale and graph paper. The dimensions were measured in millimetres and statistically analysed with paired t-test. Results: The mean of maximum anteroposterior diameter (max.APD) and maximum transverse diameter (max.TD) of Superior Articular Facet (SAF) was measured as 17.42mm±1.73 and 15.31mm±1.44 on the right side, 17.64mm±1.51 and 15.17mm±1.48 on left side. The mean Distance from Lateral most edge of SAF to Midline was measured as 22.56mm ± 2.37 and 22.40mm ± 2.16 on the right and left sides, respectively. The mean Distance from Tip of Transverse Process to Midline was 26.45mm ± 2.85 on the right and 26.03mm ± 2.64 on the left side. The mean Height of Dens was measured as 13.83mm ± 1.52, mean Width of Dens as 9.57mm ± 0.85. Width of Pedicle was measured as 10.52mm ± 1.99 and 10.61mm ± 1.67on right and left sides, respectively. Conclusion: The knowledge of these dimensions can provide useful information for safe planning of osseous fixation.

Giant Cranial Vault Frontal Haemangioma – A Case Report.

Cranial vault haemangiomas are benign vascular lesions having capillaries, venous and cavernous channels. Histopathologically, these are almost like soft tissue haemangiomas. These are slow growing tumors and very rarely bleed. Cranial vault is uncommon site for the occurrence as compared to the vertebral. Cross sectional imaging like Computerized Tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in delineation of the vault pathologies. We present a 38-years old male who presented with slow growing swelling over the frontal bone without any neurological symptoms. CT and MRI imaging clinched the diagnosis which was confirmed subsequently by histopathological examination.

Ectopic Nasal Tooth as a source of Epistaxis –A Case Report.

Nasal teeth are ectopic location of teeth which can present with variety of symptomatology and remains undiagnosed for many years. This can be diagnosed radiologically when patient undergoes Computerized Tomography (CT) for the nasal sinuses for some of the complaints related to this etiology. We report such case of 40-years old lady who attended outpatient department with complaint of epistaxis. Plain CT of Para Nasal Sinuses (PNS) clinched the diagnosis.

Morphological variations of nutrient foramina in lower limb long bones.

Background: The major blood supply to long bone is from the nutrient arteries, which enter through nutrient foramina. Nutrient foramen is an opening into the bone shaft which give passage to the blood vessels of the medullary cavity of a bone The direction of the nutrient foramen of all bones is away from growing end and has a particular position for each bone. Objective: The aim of the present study was to study the topographic anatomy and morphology of the nutrient foramina in human adult lower limb long bones. Material and Method: The study was performed on 150 lower limb long bones which included 50 femora, 50 tibiae and 50 fibulae. The bones were obtained from department of anatomy, Punjab Institute of Medical Sciences, Jalandhar. Results: The variations were found in number and location of nutrient foramen in different lower limb long bones. In femur double and triple foramina were observed. Absence of nutrient foramen was observed in femur and fibula. Conclusion: The topographical knowledge of these foramina is useful in certain operative procedures, in orthopedics as well as in plastic and reconstructive surgery, to avoid damage to the nutrient vessels.

Macrodystrophia lipomatosis : a rare congenital anomaly.

Macrodystrophia Lipomatosis is rare congenital hamartomatous enlargement of soft tissue components leading to gigantism of single, multiple digits or entire limb. Clinical findings are recognised as early as in neonatal period to late adulthood. Patients usually present for either cosmetic corrections or mechanical problems. We report a case of 8 year old female with progressive increase in size of left 2nd and 3rd toes. X-ray findings show congenital focal enlargement of soft tissues and bones of 2nd and 3rd toes and adjacent metatarsals. Clinical and radiological features of our patient points out towards this uncommon condition.

Bilateral variation in the Origin of Sternocleidomastoid muscle.

Morphological variations of sternocleidomastoid are not uncommon. During our routine dissection, in the department of anatomy PIMS Jalandhar, we encountered a rare case of presence of third head of sternocleidomastoid, bilaterally. This anomalous head is arising from clavicle lateral to the clavicular head of sternocleidomastoid muscle. This report not only adds to the knowledge of anatomists but will hold good to surgeons, anaesthetists and radiologists as well.

Allogeneic haematopoietic stem cell transplantation: The Army hospital experience.

Background. We analysed the results of allogeneic haematopoietic stem cell transplantation (HSCT) in various genetic disorders, bone marrow failures and haematological malignancies done from 2002 to 2010 at the Army Hospital, Research and Referral, Delhi. Methods. A total of 119 matched-related allogeneic- HSCTs (allo-HSCTs) were done in 114 patients (men 76, women 38) aged between 2 and 60 years. Peripheral blood stem cells (n=75) and bone marrow (n=43) were used as the source of stem cells. Results. The overall survival was 62.3% (71/114) at a median follow-up of 34 months. Graft versus host disease (GVHD) was seen in 42 (36.8%) patients; grade III/IV acute GVHD in 17 (15%) and chronic GVHD in 24 (21%) patients. There were 4 (3.5%) graft rejections and one nonengraftment. The overall mortality was 37.7% (n=43) and the main causes of death were GVHD (32%), infections (26%), relapse (23%) and regimen-related toxicity (11%). Conclusion. Our results are comparable to published data in most disease conditions. With improvements in GVHD prophylaxis and better supportive care, we need to further reduce our mortality and morbidity.

Primary cutaneous zygomycosis from a tertiary care centre in north-west India.

Background & objectives: Zygomycosis is highly invasive fungal infection, with high mortality rate. In most of patients, diabetes mellitus is an underlying factor but in primary cutaneous zygomycosis, presentation may be different. Here we present the description of clinical presentation, fungi isolated and management of cases with cutaneous zygomycosis seen in a tertiary care hospital in north India during 2001-2007. Methods: All patients diagnosed with primary cutaneous zygomycosis between November 2001 and September 2007 presenting with clinical diagnosis of necrotizing fasciitis were included. Detailed history of each patient was taken, clinical presentation, site of involvement, underlying illness and risk factor, if any were noted. The diagnosis was established by direct microscopic evidence of broad, aseptate or sparsely septate ribbon-like hyphae with right angle branching in KOH wet mount and histopathological examination of stained sections. Cultures were put up for fungal isolation and species identification. Outcome of the therapy was analysed. Results: Of the nine patients reviewed, only one had diabetes mellitus. Commonest risk factor was injection abscess (33.3%). Apophysomyces elegans was isolated in four cases, Saksenaea vasiformis and Absidia corymbifera in one each. The fungal culture was sterile in three cases. Mortality rate was high with only four patients responded well to surgical and/or medical therapy. Interpretation & conclusion: Primary cutaneous zygomycosis appears to be on rise in India that calls for high index of clinical suspicion and an early biopsy of the affected area for timely diagnosis. The standard treatment is a combination of amphotericin B therapy, surgical debridement, and reversal of the underlying disease or immunosuppression.

A study of the risk factor profile of cardiovascular diseases in rural Punjabi male patients.

One hundred rural Punjabi males (40-60 years old) admitted to Hero DMC Heart Institute, Ludhiana with first cardiac attack were studied to identify major determinants of cardiovascular diseases (CVD) among this group. The results revealed that 20% and 56% of the subjects were smokers and alcohol takers, respectively. Smoking had a significant (p< or =0.01) correlation with serum LDL-C, triglycerides and systolic blood pressure. 84% had sedentary life style. 36% and 7% of the subjects were overweight and obese. The body mass index was positively and significantly (p< or =0.01) correlated with serum triglycerides. 32% and 20% of the subjects had systolic and diastolic blood pressure above normal. 22% were diagnosed for hyperglycemia. 6% suffered from hypercholesterolemia and 28% had borderline high values of serum cholesterol. 22% and 6% had high triglyceride and LDL-C levels, respectively. The study concluded that the etiology of CVD is multifactorial and no single factor is an absolute cause among the rural Punjabi male patients. Therefore, desirable modification in diet and life style can significantly reduce the risk of CVD among rural males of Punjab.

An outbreak of dengue fever in periurban slums of Chandigarh, India, with special reference to entomological and climatic factors.

BACKGROUNDS: Dengue viral infection is one of the most important public health problem in tropical countries. AIM: An outbreak of dengue fever was investigated in a periurban slum area of Chandigarh, India, during September to December, 2002. MATERIALS AND METHODS: Blood samples from 218 patients and 30 apparently healthy contacts were tested for dengue-specific immunoglobulin M (IgM) and IgG antibodies including 80 acute samples collected within 5 days of illness were subjected for virus isolation in newborn mice. The average temperature, rainfall, and humidity of the epidemic year were compared with the number of dengue cases. STATISTICAL ANALYSIS: statistical significance was found out using c2-test. RESULTS: A total of 76 cases were positive by either dengue IgM capture assay (n = 57) or virus isolation (n = 17) or both (n = 2). Fifteen of nineteen viral isolates subjected for typing by type-specific multiplex reverse transcription-polymerase chain reaction were found to be of dengue virus. High rainfall and humidity with the temperature range from 21 degrees C to 33 degrees C during the months of August and September might have favored the breeding of mosquitoes, thus leading to an increase in the number of dengue cases in October and November, 2002. CONCLUSION: The present outbreak thus emphasizes the need for continuous sero epidemiological and entomological surveillance for the timely implementation of effective dengue control programme.

Dapsone-induced eosinophilic pneumonitis in a leprosy patient.

A leprosy patient with no prior history of respiratory complaints, developed symptoms of dry cough, fever and dyspnea after six weeks of therapy. Peripheral eosinophilia and radiological evidence of pulmonary interstitial infiltrates pointed towards the possibility of drug-induced eosinophilic pneumonitis. The results of relevant tests for other possible pathologies were normal. The resolution of symptoms without any intervention other than withdrawal of the drug and subsequent re-challenge proved dapsone to be the cause.

Evaluation of the pesticidal potential of the congress grass, Parthenium hysterophorus Linn. on the mustard aphid, Lipaphis erysimi (Kalt.).

Petroleum ether extracts of leaves, stem and inflorescence of Parthenium hysterophorus Linn. at 500, 1000, 2000 and 5000 ppm concentrations were tested in the laboratory for their toxic effects on the mean life span and progeny production of adults of the mustard aphid, Lipaphis erysimi (Kalt.). The investigations revealed a significant decrease in life span and progeny production with treatment. Among the three plant parts tested for their efficacy, the leaf extract showed the most significant effect in causing a dose dependent decline in both the life span and progeny production.