Consumer Protection Act – Awareness.

Background: With the inclusion of health care services under Consumer Protection Act, a spurt in litigations arising out of breach in medical/dental profession is seen. Thus, it becomes imperative for health professionals today to be aware of such laws. Objective: To assess and compare the awareness about Consumer Protection Act among dentists (dentists in teaching institutions and dentists in private practice.) Material and Methods: A questionnaire survey was carried out on a total of 224 dentists [112 dentists in teaching institutions (DTI)] from Manipal and Mangalore and 112 dentists in private practice (DPP) from Udupi and Mangalore, Karnataka, India]. Statistical Analysis was done using SPSS version 10. Chi- square test was used to compare between the categorical variables (P<0.05). Results: A total of 69.6% of DTI and 76.8% of DPP reported to be aware of Consumer Protection Act but subsequent analysis of responses did not reveal the same. Awareness (> 75%) about rules and regulations of Consumer Protection Act was found to be low in both the dentist group. No difference was seen in awareness based on gender, degree and type of practice (P>0.05). Significantly higher percentage of DPP as compared to DTI (90.7% Vs 69.2% ; P< 0.05) were observed to rely upon regular consent. Conclusion: There is a need to raise the awareness of health professionals about such laws so that their increased professional concern and practice conforms to welfare of patients.

Effect of various antihypertensive drugs on plasma fibrinogen levels in patients with essential hypertension.

In recent years, substantial evidence has accumulated to unambiguously implicate high plasma fibrinogen levels as a major cardiovascular risk factor. An open prospective and randomised pilot study was therefore undertaken in mild to moderate hypertensives to evaluate the effect of various antihypertensive drugs viz enalapril, felodipine and prazosin on the blood pressure and plasma fibrinogen levels. The systolic and diastolic blood pressures were determined at 0, 4 and 8 weeks whereas plasma fibrinogen assays were done at baseline and at the end of the 8th week of treatment in all the drug-treated groups. It was observed that although all the three drugs effectively controlled blood pressure, only enalapril significantly reduced plasma fibrinogen levels. Due to this additional effect, enalapril has potential to control two major cardiovascular risk factors--hypertension and high plasma fibrinogen levels--simultaneously.

Interobserver agreement of the Nottingham histologic grading scheme for infiltrating duct carcinoma breast.

Interobserver agreement of the histologic grading scheme for infiltrating duct carcinoma (IDC) of breast was assessed. Three pathologists independently evaluated histologic grade using the modified Bloom and Richardson histological grading system on 40 cases of IDC breast. Pairwise K value for agreement ranged from 0.68-0.83 (median 0.68) for histological grade suggesting substantial agreement. Generalized K values were 0.54, 0.34 and 0.36 for tubule formation, nuclear pleomorphism and mitotic count respectively indicating moderate and fair agreement. Similar levels of agreement were obtained specially in the final histologic grade between pathologists routinely reporting histopathology material and one pathologist who was not. This was achieved by use of precise guidelines. The ease with which this grading system could be applied by pathologists on histopathology material will greatly help its acceptability in routine histopathology.

Diagnostic distinction between unusual malignant tumors of gall bladder by histochemistry and antigenic phenotype.

In a review of 79 cases of gall bladder malignancy, nineteen cases were labelled as unusual tumors while sixty were diagnosed as adenocarcinoma. Alcian blue, PAS, Grimelius' and Masson trichrome stains were done. Expression of EMA, CEA and desmin was assessed (PAP). Histological subtype was revised, in eleven cases out of 19. Five tumors initially diagnosed as squamous cell carcinoma were found to be positive for mucin and CEA and hence were reclassified as adenosquamous carcinoma. Three undifferentiated carcinomas and two malignant carcinoids were labelled as adenocarcinoma and composite tumor respectively. Positive reactivity with CEA and alcian blue PAS and absence of AFP helped in differentiating one giant cell carcinoma from hepatocellular carcinoma. No definite marker could be identified in one case of malignant mesenchymal tumor. Histochemistry and immunohistochemistry also helped in confirming the diagnosis of three cases of carcinoma in situ, one of malignant carcinoid and three of clear cell carcinoma.

Red cell indices and discriminant functions in the detection of beta-thalassaemia trait in a population with high prevalence of iron deficiency anaemia.

Red cell indices and discriminant functions were studied in 463 heterozygous beta-thalassaemics (337 without iron deficiency, 126 with iron deficiency) and 195 patients of iron deficiency anaemia (IDA) to ascertain their utility in the detection of betathalassaemia trait (BTT). Majority of traits in both groups had an elevated RBC count (> or = 5.0 x 10(12)/L). The counts were significantly higher than of patients with IDA, only 4.6% of whom had this degree of erythrocytosis. Mean Hb concentration was significantly higher in traits as compared to iron deficient subjects (p < 0.0001). Mean MCV and MCH were significantly (p < 0.0001) lower in traits more so in those with ID as compared to patients of IDA. MCV < 80 fl and MCH < 27 pg were found to be sensitive markers in the detection of traits even in the presence of ID. Of the four discriminant functions studied MCSQ was found to be most sensitive in detection of BTT and it identified 97.9% traits. DF of England and Fraser was most specific for BTT being < 8.4 in only 6.2% patients with IDA. Detection of erythrocytosis especially in the presence of mild anaemia and calculation of discriminant functions derived from red cell indices were found to play an important role in screening for BTT even in the presence of ID and helped identify those patients who required further laboratory evaluation.

Haematological parameters and HbA2 levels in beta-thalassaemia trait with coincident iron deficiency.

Iron status was estimated in 463 heterozygous beta-thalassaemics to delineate the effect of iron deficiency (ID) on the haematological parameters and expression of HbA2 in these patients. One hundred and twenty six (27.2%) traits had coincident ID. These iron deficient traits had a significantly (p < 0.0002), higher prevalence of anaemia (90.5%) as compared to iron replete traits (71.5%). Mean haemoglobin concentration was significantly lower (p < 0.0001) in beta-thalassaemics with ID (10.7 +/- 1.5) g/al as compared to those without ID (11.6 +/- 1.6 g/dl). Mean MCV and MCH were significantly lowered (p < 0.0001) in patients of beta-thalassaemia trait (BTT) with ID than in these without ID. Mean HbA2 was not significantly different in the two groups of traits and was elevated (> or = 3.5%) in all except one patient. However, mean HbA2/cell was significantly (p < 0.05) lower in traits with ID. The effect of ID in BTT was apparent with significant lowering of haemoglobin concentration and increased prevalence of anaemia. Iron therapy is warranted in iron deficient traits and would help in significantly raising their haemoglobin concentration. Elevation in HbA2 values was striking and could be used with reliability for diagnosis of BTT even in the presence of ID.

Haemostatic function in coronary artery disease (CAD).

Tests to evaluate haemostatic function bleeding time (BT), prothrombin time (PT) partial thromboplastin time with kaolin (PTTK), thrombin time (TT), platelet count, platelet function tests (platelet adhesiveness and microthrombus index) and plasma fibrinogen levels were performed in 30 patients of coronary artery disease (14 myocardial infarction, 16 angina pectoris) and 20 age and sex matched controls. There was no statistically significant difference in platelet adhesiveness and mean microthrombus index in patients and controls. The BT, PT, PTTK and TT were normal in all patients and controls. Stepwise logistic regression analysis showed that plasma fibrinogen was an independent risk factor in the production of CAD.

Congenital deficiency of factor VII.

A case of congenital factor VII deficiency in a five-year-old child is reported. The patient, born of a non-consanguineous marriage, presented with repeated bouts of epistaxis since childhood. The prothrombin time (PT) was markedly prolonged with a normal bleeding time (BT), partial thromboplastin time with Kaolin (PTTK) and platelet count. The patient has been on follow up for the last four years and is doing apparently well.

Effect of maternal iron deficiency anaemia on foetal outcome.

One hundred and two pregnant women and their neonates were examined to evaluate the effect of maternal haemoglobin concentration (Hb. conc) and iron deficiency anaemia on the placental weight and the foetal outcome. Haematological and serum ferritin values were determined. It was observed that 34.3% of the pregnant women were anaemic. Maternal Hb conc. and serum ferritin showed a highly significant correlation (r = 0.40, p < 0.001) indicating that iron deficiency was the most important cause of anaemia amongst them. The maternal Hb conc. showed a significant correlation with placental weight (p < 0.05), birth weight (p < 0.01), Apgar score (p < 0.001) and birth asphyxia. Maternal serum ferritin also correlated positively with cord ferritin (p < 0.001). The study did not reveal any association between high Hb and adverse foetal outcome.

Significance of mucin stain in uterine cervical cancers.

Histopathological examination of 140 cases of cervical cancer was supplemented with staining for the presence of mucin. Secretion of mucin was detected in 27 cases. Fourteen cases of large cell non-keratinizing (LCNK) squamous cell carcinoma were reclassified, 12 as squamous cell carcinoma with mucin secretion and two as adeno-squamous carcinoma. One case of undifferentiated carcinoma was labelled as adenocarcinoma on the basis of mucin stain. None of the keratinizing squamous cell carcinomas were positive for mucin. The results indicate that mucin expression should be looked for even in those carcinomas where no obvious gland formation is seen.

Bilateral testicular biopsy--is it necessary?

Bilateral testicular biopsies from 202 infertile males were examined to ascertain the differences in the degree of damage to the germinal epithelium on both sides. Depending on the histologic changes, the biopsies were divided into six groups. A significant difference in the morphology on both sides was seen only in 3% cases. The left and the right testes were equally damaged in cases with similar morphology.