An endoscopic and histopathological assessment and correlation of endoscopic score with clinical activity index (CIBDAI) in the diagnosis of canine idiopathic inflammatory bowel disease.

Background: Inflammatory bowel disease (IBD) in dogs is often characterized by a relapsing and remitting clinical course. Determination of inflammatory activity is important for assessing the disease extent, severity, and tailoring appropriate treatment. Aims: The study was conducted to record the macroscopic and microscopic changes associated with IBD to assess the usefulness of endoscopy in the diagnosis of the disease and to correlate the clinical activity index (CIBDAI) with endoscopic score. Methods: Thirty-three dogs with idiopathic IBD were selected after thorough examination and exclusion. Gastroduodenoscopy and colonoscopy were performed to document the gross macroscopic intestinal lesions. Histopathology of endoscopic aided biopsy samples was used to confirm the disease. Results: Mucosal erythema and increased friability were the most predominant endoscopic findings in the stomach, duodenum, and colon of IBD dogs. Lymphoplasmacytic infiltration was predominant in the mucosal samples on histopathology and diffuse form of IBD is more common in canines. Gastroduodenoscopy and colonoscopy in combination with endoscopically guided biopsy and histopathology are of value in the assessment and diagnosis of IBD. There was no correlation between the clinical inflammatory bowel disease activity index (CIBDAI) with the endoscopic score. Conclusion: A diffuse form of IBD and colitis is more common in dogs in comparison to human IBD where the disease manifests in two distinct forms. Colonoscopy with ileal biopsy could act as a gold standard in the confirmation of diffuse IBD in dogs. CIBDAI can be used as a reliable measure of clinical signs of inflammation and histopathology can be used as a definitive diagnosis of intestinal inflammation.

Antimetabolite in the Management of Odontogenic Keratocyst-A Case Report.

Odontogenic keratocyst (OKC) is an aggressive cystic lesion of the jaw with high growth and recurrence. Patients are usually asymptomatic and detected during routine radiographic examination. Management of OKC varies from conservative procedures like simple Enucleation and peripheral ostectomy to aggressive resection. More attention is given to new treatment protocols to form them simple and successful. 5 fluorouracil is an anti-metabolite used to treat basal cell carcinoma and other malignancies act by inhibiting thymidylate synthase an enzyme required for DNA synthesis causing cell death. This is a case report of a 40-year-old female patient with OKC treated with topical 5 fluorouracil after enucleation, has less morbidity minimal recurrence, and low cost.

Clinical spectrum of community-acquired acute kidney injury: A prospective study from central India.

The aim is to study the epidemiology of acute kidney injury (AKI), since it differs from country to country and varies from center to center within a country. Owing to the absence of a central registry, data on overall epidemiology of AKI are scanty from India. This study was conducted in an urban tertiary care center in central India with the aim to identify the etiology and outcomes as well as the factors associated with in-hospital mortality of community-acquired AKI (CAAKI) patients. A two-year prospective study of all patients with CAAKI admitted to the Nephrology Department from January 2014 to December 2015 was performed. Of the 9800 admitted patients, 286 patients (2.9%), with a mean age of 48 ± 17.1 years, were diagnosed to have CAAKI as per our specified criteria. The most common cause of CAAKI was medical (77.27%), followed by obstetrical (13.98%) and surgical (9%) causes. Among the medical causes, hypoperfusion (57.4%) was the most common, followed by sepsis (26.69%), glomerulonephritis (8.14%), and drugs (7%). Nephrolithiasis was the most common surgical cause. Puerperal sepsis (52.5%), preeclampsia (20%), hemorrhage (17.5%), and thrombotic microangiopathy (10%) were the obstetric causes of CAAKI. The overall in-hospital mortality among patients with CAAKI was 20% and 8% of patients became dialysis dependent. Sepsis had the highest in-hospital mortality (44%). The epidemiological characteristics of CAAKI are changing rapidly. There has been an increase in the overall incidence of AKI with changing etiology in recent years. In contrast to developed nations, CAAKI is more common in developing countries. It often affects younger individuals. For early diagnosis of kidney injury and reducing the risk of poor outcome, patients should be referred to nephrologists early in the course of disease.

Condylar Fractures: Surgical Versus Conservative Management.

BACKGROUND AND OBJECTIVES: Condylar fractures can be treated with one of the two methods, including the conservative (closed reduction and immobilization) and/or surgical (open reduction and internal fixation) methods. Both these modalities of treatment have their indications and contraindications and merits and demerits. The present study was designed with the purpose of comparing the outcomes of surgical versus conservative management of moderately displaced subcondylar and condylar neck fractures. MATERIALS AND METHODS: The present study included a total of 20 patients with moderately displaced condylar fractures in patients > 18 years of age who were randomly divided into nonsurgical and surgical group and were managed accordingly. In the present study, the outcomes of conservative versus surgical management of subcondylar and condylar neck fractures were discussed in terms of seven parameters, including the maximal interincisal mouth opening, protrusive and lateral excursive movements of the mandible, status of occlusion, deviation of mandible during mouth opening, pain (in terms of visual analog scale) and the height of ascending ramus (radiographically) which were measured and evaluated pre- and post-operatively at different intervals of time. The follow-up was done for a period of up to 6 weeks postoperatively. STATISTICAL ANALYSIS USED: Descriptive and analytical statistics were calculated using the Statistical Package for Social Sciences version 19. The Mann-Whitney U-test was used to assess the significance of the difference between the groups, whereas the Wilcoxon signed-rank test was used to assess the significance of the difference between the paired observations in each group. RESULTS: Patients treated surgically showed better improvement in maximal interincisal mouth opening, lateral excursions with minimal deviation, early relief from pain, and restoration of height of the ramus with symmetry in comparison with the patients managed conservatively where prolonged periods of pain apart from obvious deviation and minimal restoration of height of the ramus was observed over a follow-up period of 6 weeks postoperatively. The results were also found to be statistically significant with the value of P < 0.05. INTERPRETATION AND CONCLUSION: Surgery is inarguably preferred over conservative management of moderately displaced condylar fractures as per the results of the present study. The present study provided valuable information and mandated further studies with larger sample sizes to come to definitive conclusions.

Clinical spectrum of hospital acquired acute kidney injury: A prospective study from Central India.

Acute kidney injury (AKI) is a common disorder worldwide that is associated with severe morbidity, mortality and cost. If managed adequately and in a timely manner, the majority of these cases are preventable, treatable and often reversible with simple measures. We conducted a two years prospective study of patients admitted to medical and surgical units of a tertiary care center in Central India to identify the causes of Hospital Acquired AKI (HAAKI) and its impact on patient outcomes. HAAKI occurred in 215 of 9,800 patients (2.1%). Sepsis (75; 34.88%), volume depletion and hypo perfusion (62; 28.83%), drugs (50; 23.25%), multifactorial (18; 8.37%) and radiocontrast agents (9; 4.2%) were the causes of HAAKI. Thirty-nine percent of patients had complete recovery and 9.3% had partial recovery of renal function. The overall inhospital mortality due to HAAKI was 41.86%. On multivariate analysis, oliguria, multi-organ failure, metabolic acidosis, anemia, and sepsis showed significant association with in-hospital mortality. The mortality and morbidity associated with HAAKI mandates the need for active measures to decrease its incidence. Knowledge of incidence and risk factors is crucial because it drives local and international efforts on detection and treatment. To the best of our knowledge, no epidemiological study has been conducted or published on HAAKI from the Central India.

Age- and Sex-related Prevalence and Drug Utilization Pattern in the Management of Type 2 Diabetes Mellitus and its Comorbidity with Cardiovascular Diseases: A Comparative Study.

A cross-sectional study of 250 cases of type 2 diabetes management was conducted in a governmental tertiary care hospital of urban south India to determine the comparative prevalence of type 2 diabetes and its comorbidity with cardiovascular diseases in diabetic population, core drug use indicators and drug utilization pattern in the management of diabetics entirely and with cardiovascular diseases. Highest prevalent age group for type 2 diabetes/cardiovascular diseases (greater incidence in female than male) was 51-60 years. The 62.8% prevalence of cardiovascular diseases in the diabetic population ascertained in the study could provide an evidence-based rationale for the World Health Organization guidelines for the management of hypertension in type 2 diabetics. Incidence of polypharmacy (6.06, the mean number of total drug products prescribed); 59.26% of encounters prescribed antibiotics; 17.6 and 18.5 min of average consultation and dispensing time, respectively; 100% of drugs actually dispensed and adequately labeled; 81.26% of patients having knowledge of correct dosage and average drug cost of Indian Rupees 145.54 per prescription were the core drug use indicators found mainly. Moreover, drugs prescribed from the Essential Drug List were more than 90% and thereby indicated the drug use in this set-up quite rational. Around 71.09% of cardiovascular agents prescribed by generic name revealed the cost effective medical care. Among the agents in type 2 diabetes management, Actrapid(®) (35.43%) was the highest. Among the cardiovascular agents prescribed, lasix (19.37%) was the highest. Cardiovascular agents prescribed orally by 76.48% signified the good prescription habit indicating the improved patients' adherence to the treatment. The present study emphasizes the need of early detection of hypertension as a preliminary diagnostic parameter of cardiovascular diseases in diabetics and appropriate management through concomitant therapy of cardiovascular drugs to minimize the risks of death.

Dicentric assay: inter-laboratory comparison in Indian laboratories for routine and triage applications.

An Inter-Laboratory Comparison (ILC) study on Dicentric Chromosome Assay (DCA) was carried out between two Indian biodosimetry labs. Human peripheral blood samples exposed to 10 different doses of X-rays up to 5Gy were shared between the labs to generate calibration data. Validation of calibration curves was done by dose estimation of coded samples exposed to X- or gamma radiation. Reliability of the DCA data for triage application was evaluated by scoring 20, 50 and 100 metaphases in the dose range of 0.5-3.0Gy. No significant difference was observed between labs regarding the established calibration data as well as the DCA triage dose assessments. Scoring of 20 metaphases (MP) was adequate to detect radiation exposure of >2Gy whereas 50 MP were sufficient to determine exposures of 0.5Gy. Both labs performed the DCA in a reliable manner and made the first step in setting up a biodosimetry network in India.

Delayed mitogenic stimulation decreases DNA damage assessed by micronucleus assay in human peripheral blood lymphocytes after (60)co irradiation.

While contradictory reports are available on the yield of dicentric chromosomes (DC) in blood samples stored at different temperature and stimulated to enter into cell cycle, various times gap followed by exposure, limited information is available on the micronucleus (MN) assay. As scoring the micronuclei frequency from the blood lymphocytes of exposed individuals is an alternative to the gold standard DC assay for triage applications, we examined radiation induced MN yield in delayed mitogenic stimulation after irradiation of in vitro. Peripheral blood lymphocytes (PBL) were exposed to low LET ((60)Co) radiation dose (0.1 to 5Gy) and incubated at 37°C for 2, 6 and 24 hours. The MN frequency obtained in blood samples stimulated 2 hours post-irradiation showed a dose dependent increase and used to construct the dose-response curve. Further, the results also showed that blood samples stimulated twenty four hours of post-irradiation, a significant reduction (p<0.05) in MN frequencies were obtained when compared to that of blood samples stimulated two hours and six hours after post-irradiation (0.5, 1, 3 and 5Gy). The observed result suggests that the prolonged PBL storage without mitogenic stimulation could lead to interphase cell death and a delayed blood sampling could results in underestimation of dose in biological dosimetry.

Dicentric chromosome aberration analysis using giemsa and centromere specific fluorescence in-situ hybridization for biological dosimetry: An inter- and intra-laboratory comparison in Indian laboratories.

To facilitate efficient handling of large samples, an attempt towards networking of laboratories in India for biological dosimetry was carried out. Human peripheral blood samples were exposed to (60)Co γ-radiation for ten different doses (0-5Gy) at a dose rate of 0.7 and 2Gy/min. The chromosomal aberrations (CA) were scored in Giemsa-stained and fluorescence in-situ hybridization with centromere-specific probes. No significant difference (p>0.05) was observed in the CA yield for given doses except 4 and 5Gy, between the laboratories, among the scorers and also staining methods adapted suggest the reliability and validates the inter-lab comparisons exercise for triage applications.

Trends of vulvar cancer.

Vulvar cancer is an uncommon malignancy of the female genital tract in developing countries, accounting for 3% of gynaecological cancers. Here, cervical cancer is an everyday problem; ovarian cancer is the second commonest gynaecological cancer; endometrial is less common and vulvar cancer is rare. It is advanced at admission, though is a visible cancer. Records of women who had histopathologically proven vulvar cancer over 24 years were analysed for epidemiological status and preventive possibilities. During the analysis period, 9,419 total cancer cases were diagnosed; 4,726 (50.17%) were in women. A total of 39.52% (1,868 of 4,726) were gynaecological; 18 cases were vulvar (0.38% of the 4,726 women with cancer) and 0.96% of the 1,868 gynaecological cancer cases. Decreasing trends were 2.25% between 1984 and 1988, down to 0.33% between 2004 and 2008. Leading presenting complaints were: dyspareunia, 88.88% (16 of 18 patients); pruritus 13; ulcers 14; vulvar swelling 12 and urinary problems 13. Dystrophy was present in 8 of 18 cases. Overall, four had stage I, one stage II, three stage III and four stage IV disease at admission; all at labia majora or minora, some too advanced to know origin. Four women with metastasis in the lungs, liver and bones could only be given palliation. While vulvar cancer is uncommon, advanced disease at admission is a concern. Awareness is essential. Research is needed as to why cervical cancer is common and vulvar uncommon, as HPV plays a major aetiological role, so that cervical cancer can be prevented, with early diagnosis, management of vulvar cancer should also be available.

Late postpartum eclampsia.

Studies lack data regarding incidence, risk factors, optimal treatment and outcome of postpartum eclampsia (PPE), convulsions within 7 days (mostly convulsions occur within 24 - 48 h) after delivery of fetus placenta. However, convulsions can occur late, up to 4 weeks. After 48 h, it is late PPE. Late postpartum eclampsia without preceding pre-eclampsia is rare and poses a diagnostic challenge. An observational study was carried out to find the frequency of PPE, late PPE and clinical profile for prediction/prevention of mortality. PPE cases were analysed from retrospective records and prospective cases. Of 39,050 births, 386 were eclampsia (0.98%); PPE 101 (26.1% eclampsia, 0.26% births); 14.85% were late PPE. Of PPE, 52 (51.48%) were diagnosed hypertensive disorders pre-delivery and 49 (48.51%) were de novo. Prior to convulsions, 56 (55.5%) had headaches, six (5.9%) visual disturbances; nine (8.9) dizziness; four (4.0%) epigastric pain; 18 (17.8%) had no complaints. Research needs to continue and quality care is essential.

Cervical cancer in Indian rural women: trends over two decades.

Worldwide, cervical cancer is considered to be the second commonest cancer as far as mortality and incidence is concerned and India contributes to about 20­30% of the global burden. This paper is based on analysis of records of persons suffering from various cancers over 25 years. Cervical cancer constituted 14.4% of all cancers of men and women put together, 28.8% of the cancers in women and 73.3% of all gynaecological cancer. The cases studied were divided into five Blocks: Block A 1983­1987; Block B 1988­1992; Block C 1993­1997; Block D 1998­2002 and Block E 2003­2007. A 2.34 times increase in cancer cases from Block A to Block E was seen; in women, overall cancer increased by 3.21 times; gynaecological cancer by 3.08 times; cervical cancer 2.91 and ovarian cancer 7.1 times. Cervical cancer in outpatients increased from 0.55% among all gynaecological cases in 1983, to 3.5% in 2007. Cervical cancer comprised of 1.05% of the newly registered outpatients and 70.09% of gynaecological cancer cases. Inpatient gynaecological cancer increased from 2.81% in 1983 to 9.81% in 2007. Out of all cervical cancer in women, cervical cancer was 34.7% in Block A (1983­1987) and 28.6 % in Block E (2003­2007). Of the cervical cancer cases, 43.8% belonged to the age group 30­49 years and 37.6% at 50­64 years. Cervical cancer in women with less than three births increased from 13.1% in Block A to 33.1% in Block E. The proportion of illiterate women or those with primary education was seven times more compared with those with secondary education. Our study revealed that cervical cancer still continues to rank first. Also the overall number of cancer cases has been increasing.