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   2012| July-December  | Volume 2 | Issue 2  
    Online since January 22, 2013

 
 
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EDUCATIONAL FORUM
Vaptans: A new option in the management of hyponatremia
Suruchi Aditya, Aditya Rattan
July-December 2012, 2(2):77-83
DOI:10.4103/2229-516X.106347  PMID:23776817
Arginine vasopressin (AVP) plays an important role in water and sodium homeostasis. It acts via three receptor subtypes-V 1 a, V 1 b, and V 2 -distributed widely throughout the body. Vaptans are nonpeptide vasopressin receptor antagonists (VRA). By property of aquaresis, VRAs offer a novel therapy of water retention. Conivaptan is a V 1 a/V 2 nonselective VRA approved for euvolemic and hypervolemic hyponatremia. Tolvaptan is the first oral VRA. Other potential uses of this new class of drugs include congestive heart failure (CHF), cirrhosis of liver, syndrome of inappropriate secretion of antidiuretic hormone, polycystic kidney disease, and so on. These novel drugs score over diuretics as they are not associated with electrolyte abnormalities. Though much remains to be elucidated before the VRAs are applied clinically, the future holds much promise.
  8,243 1,734 15
ORIGINAL ARTICLES
Evaluation of phenotypic with genotypic methods for species identification and detection of methicillin resistant in Staphylococcus aureus
Kunsang O Bhutia, T Shantikumar Singh, Shilpie Biswas, Luna Adhikari
July-December 2012, 2(2):84-91
DOI:10.4103/2229-516X.106348  PMID:23776818
Background : Phenotypic methods for the detection of methicillin resistance are inadequate, due to presence of hetero-resistant population and dependence of environmental factors that may affect the phenotypic expression of resistance. Aims: Present study was conducted, to evaluate the efficacy of phenotypic methods for the identification of species and mec-A mediated resistance in S. aureus with polymerase chain reaction (PCR), and to assess the prevalence of the Panton-Valentine leukocidin (pvl) toxin in methicillin resistant S. aureus (MRSA) and overall S.aureus population. Materials and Methods: A total of 200 clinical isolates of Staphylococci were subjected to phenotypic and genotypic methods for the species identification and detection of MRSA. Results : The specificity and sensitivity of conventional methods in the detection of S.aureus, was found to be 100 and 97.59% respectively. However, the performance of phenotypic methods in the detection of MRSA were: Oxacillin disc diffusion (DD)-sensitivity 70.58%, specificity 75.75%; cefoxitin DD-sensitivity 86.27%, specificity 83.33%; and oxacillin agar dilution-sensitivity 92.15%, specificity 90.90%. PVL gene was detected in all mec-A positive isolates irrespective of their types. Conclusion:Phenotypic methods still preferred for the species identification, but for the reliable detection of MRSA an algorithm should include a combination of tests and apply a genotypic method for confirmation of resistance isolates showing discrepant results. Considering the high prevalence of PVL-MRSA, we recommend PCR as assay, as it has an advantage of simultaneous detection of mec-A and pvl genes by multiplex PCR.
  6,783 692 6
Arthroscopic synovial biopsy in definitive diagnosis of joint diseases: An evaluation of efficacy and precision
Onis Singhal, Viplesh Kaur, Shivani Kalhan, Manish Kumar Singhal, Anshu Gupta, YV Machave
July-December 2012, 2(2):102-106
DOI:10.4103/2229-516X.106351  PMID:23776821
Context: Arthritis is an important cause of morbidity, presenting as monoarticular or polyarticular lesion. Arthroscopic synovial aspiration and biopsy can help in arriving specific etiological diagnosis. Aim and Objectives: To evaluate the efficacy of arthroscopic synovial biopsy as a diagnostic aid and study the characteristics of synovial fluid in various joint diseases. Materials and Methods: Arthroscopic synovial biopsy along with synovial fluid analysis was studied in 30 of the 50 enrolled cases arthritis. The fluid was subjected to physical, biochemical, and cytological analysis. Results: Both rheumatoid ( n = 14, 28%) and tubercular ( n = 13, 26%) arthritis were found to be more common compared to other etiologies. Next common etiology observed was chronic nonspecific synovitis ( n = 10, 20%). Clinicopathological correlation was seen in 34 out of 50 cases. As a diagnostic tool, synovial biopsy had a sensitivity of 85%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 62%. Conclusion : Arthroscopic synovial biopsy is a simple and easy to perform technique and is an important useful investigative adjunct that may give conclusive diagnosis where clinical diagnosis is equivocal.
  6,873 589 1
EDITORIAL
Surgical options in diabetes mellitus: A ray of hope
Rajiv Mahajan
July-December 2012, 2(2):75-76
DOI:10.4103/2229-516X.106346  PMID:23776816
  1,537 4,743 -
ORIGINAL ARTICLES
Evaluation of calabash chalk effect on femur bone morphometry and mineralization in young wistar rats: A pilot study
Moses B Ekong, Theresa B Ekanem, Abraham O Sunday, Aquaisua N Aquaisua, Monday I Akpanabiatu
July-December 2012, 2(2):107-110
DOI:10.4103/2229-516X.106352  PMID:23776822
Background: Calabash chalk, a popularly consumed geophagic material in Nigeria has been reported to contain lead, arsenic, alpha lindane, endrin, and endosulfan 11 among other pollutants. Aim: The continuous exposure of young children to this chalk necessitated this study on the bone morphometry and mineralization in young Wistar rats. Materials and Methods: Fourteen young (weanling) Wistar rats of both sexes weighing 54-72 g were assigned into two groups of seven animals each. Group I served as control, while group II was the test group (TG). 40 mg/ml of C. chalk was administered as suspension to the test animals in group II. Animals in the control group were orally treated with 1ml of distilled water. Administration of the C. chalk in the animals lasted for 28 days, and the animals were sacrificed on day 29, using chloroform anaesthesia. The femur bones were dissected out, cleaned of flesh and sun-dried. The lengths and weights of the femur bones were measured using graphite furnace atomic mass spectrophotometer. Results: Results showed 1.6% decrease in body weight change in the TG, insignificant decreases in the weights and lengths of both the right and left femur bones, and significant decreased (P < 0.0126) organ-somatic index, and femur bones concentrations (mg/l) of zinc, phosphate, carbonate, calcium, sodium, and potassium (P < 0.05). Conclusion: In conclusion, this study showed that C. chalk may alter growth rate, and cause de-mineralization in the femur bone, hence, it may be detrimental to bone growth.
  5,487 273 4
Effect of glare on night time driving in alcoholic versus non-alcoholic professional drivers
Nishit Gupta, Hem Lata, Amandeep Kaur
July-December 2012, 2(2):128-131
DOI:10.4103/2229-516X.106356  PMID:23776826
Context: The use of alcohol during nighttime driving may affect recovery from glare leading to increased traffic accidents. Objective: To compare the glare recovery time in alcoholic versus non-alcoholic drivers. Materials and Methods: Alcoholic ( n = 25) and non-alcoholic drivers ( n = 25) were subjected to glare recovery test and they also filled a questionnaire about the nighttime driving. Results: The glare recovery time got prolonged in alcoholic drivers and they also complained of more problems during nighttime driving as compared to non-alcoholic drivers. Conclusions: The use of alcohol delays recovery from glare during nighttime driving. This can have considerable implications for developing countries in improving regulations for driving licensing.
  5,175 292 1
Histopathologic changes following neoadjuvant chemotherapy in various malignancies
Divya Sethi, Rajeev Sen, Sanjeev Parshad, Sheena Khetarpal, Monika Garg, Jyotsna Sen
July-December 2012, 2(2):111-116
DOI:10.4103/2229-516X.106353  PMID:23776823
Background: Various histopathological changes have been observed following neoadjuvant chemotherapy in individual tumors in the literature. Aims and Objectives: To observe histopathologic changes seen after neoadjuvant chemotherapy in breast malignancies, squamous cell carcinomas, adenocarcinomas, and Wilms' tumor using breast cancer predominantly as the model. Materials and Methods: The present prospective study was carried out on 60 patients including 40 patients with carcinoma breast and 20 patients with other malignancies who received neoadjuvant chemotherapy. Results: Post neoadjuvant chemotherapy, mastectomy specimens revealed nuclear enlargement, nuclear shrinkage, necrosis, vacuolation of nucleus, vacuolation of cytoplasm, dyscohesion, and shrinkage of tumor cells with nuclear changes of nonviability like karyorrhexis, karyolysis, and pyknosis. Stromal reactions manifested as fibrosis, elastosis, collagenization, hyalinization, microcalcification, and neovascularization. Areas of necrosis included both vascular and avascular pattern. The stroma also revealed fibrinoid necrosis and mucinous change. Hyalinization of the blood vessel wall was a common finding. The most common inflammatory host response observed in the present study was lymphocytic; others included mixed inflammation, plasmacytic, prominent histiocytic, and giant cell types. Giant cell reaction was significantly correlated to all types of tumor responses (P < 0.05). Similar changes were also observed in other malignancies. A detailed review of the literature has also been done and presented. Conclusion: The tumor grade decreases and differentiation improves, in addition to the retrogressive changes and increase in stromal component, as a result of chemotherapy in carcinoma breast as well as in other malignancies.
  4,496 557 7
CASE REPORTS
Unusual form of squamous cell carcinoma of the cervix extending in situ into the endometrium: Three case reports and review of literature
Nisha Marwah, Monika Garg, Sunita Singh, Divya Sethi, Rajeev Sen
July-December 2012, 2(2):139-141
DOI:10.4103/2229-516X.106359  PMID:23776829
Squamous cell carcinoma of the cervix is the most common gynecological malignancy in India. Direct extension from a cervical growth can involve the uterine corpus, but a superficial spread, without invasion of the underlying myometrium, is uncommon. We report three cases of squamous cell carcinoma of the cervix, with superficial extension to the whole endometrial cavity, by expansile intraepithelial growth. Clinically, two of our cases presented with pyometra and one with vaginal bleeding and discharge. The tumor had spread superficially into the entire endometrial cavity, up to the fundus, replacing the columnar epithelium totally. This was a rare phenomenon, with fewer than 30 cases reported in literature.
  4,358 325 3
Metastatic or metachronous adamantinoma: An Enigma
AS Ramaswamy, KR Chatura, HR Chandrasekhar
July-December 2012, 2(2):132-135
DOI:10.4103/2229-516X.106357  PMID:23776827
Adamantinoma is an uncommon tumour of low grade malignancy in terms of biologic aggressiveness; metastasis occurring many years after amputation. A young male underwent an above knee amputation of left leg for adamantinoma of tibia. He returned with pain and swelling in his right thigh five years later. Investigations revealed an adamantinoma in the diaphysis of the right femur. The unusual presentation of this adamantinoma at an uncommon site threw up interesting insights into the nature of this lesion. In particular, the metachronous origin of the adamantinoma in the femur is discussed in this report.
  2,909 220 1
ORIGINAL ARTICLES
Fiberoptic bronchoscopy, as a valuable diagnostic option in sputum negative pulmonary tuberculosis: A prospective study
Saif Quaiser, Anil Agarwal, Ruhi Khan, Shahzad F Haque
July-December 2012, 2(2):123-127
DOI:10.4103/2229-516X.106355  PMID:23776825
Context: World Health Organization recommends bacteriological confirmation of pulmonary tuberculosis (PTB) by the detection of acid-fast bacilli (AFB) in respiratory specimens. However about 40-60% of patients with PTB suspected clinically or radiologically may fail to produce sputum, or when it is available, AFB may be negative on repeated smear examination. These sputum smear negative patients and those who fail to produce any sputum can be diagnosed by flexible fiberoptic bronchoscopy. Aims : Our study was an attempt to analyze the role of fiberoptic bronchoscopy in sputum smear negative PTB patients with respect to their association with clinical and radiological profile. Materials and Methods: In this prospective, open label, observational study, 40 cases of sputum smear negative PTB were subjected to bronchoscopic examination after taking informed consent and samples like bronchial aspirate, bronchoalveolar lavage and post bronchoscopy sputum were collected. The data was analysed and the results were given in percentage. Results : Out of the total 40 patients, overall diagnosis was confirmed in 24 (60%) patients. Of these 24 patients, 17 patients were confirmed for PTB whereas 7 had other diagnoses. Conclusion: The study concludes that fiberoptic bronchoscopy is a useful tool in diagnosing sputum smear negative PTB patients with respect to their association with clinical and radiological profile, and also identifies individuals at a higher risk for progression of disease, at an early stage despite not meeting routine bacteriological criteria for confirmation of PTB.
  2,453 421 3
Comparative evaluation of recovery characteristics of fentanyl and butorphanol when used as supplement to propofol anaesthesia
Vikramjeet Arora, Sukhmindar Jit Singh Bajwa, Sarajit Kaur
July-December 2012, 2(2):97-101
DOI:10.4103/2229-516X.106350  PMID:23776820
Background and Aim: Narcotics have been used since long as a component of balanced anaesthesia, thus minimizing the anaesthetic requirement both during induction and maintenance as well as attenuating the pressor response during laryngoscopy and intubation. Equally significant is their role in provision of smoother recovery period by minimizing postoperative pain. Other than pain, the factors like postoperative nausea and vomiting (PONV), shivering, sedation and respiratory depression are equally important in recovery from the effects of anaesthetic drugs. The present study aimed at comparing the postoperative recovery characterstics of fentanyl and butorphanol in patients undergoing open cholecystectomy under general anaesthesia. Materials and Methods : The present study configured one hundred adults patients of American Society of Anaesthesiologists (ASA) grade 1 or 2 of either sex scheduled to undergo elective open cholecystectomy and were randomly assigned to receive fentanyl (group F; n = 50) or butorphanol (group B; n = 50). Both group were premedicated with midazolam 0.04 mg/kg intravenously followed by injection fentanyl 2 mcg/kg or butorphanol 40 mcg/kg. Standard induction was done with propofol 2 mg/kg and vecuronium 0.1 mg/kg was used for intubation. Anaesthesia was maintained with propofol infusion and 67% nitrous oxide in oxygen. Intraoperative hemodynamic parameters were observed and recorded. Postoperatively analgesia, sedation, PONV, shivering, respiratory depression and recovery score were observed. Results: The recovery time was less in group F ( P > 0.05) while post operative analgesia ( P < 0.001) and sedation ( P > 0.05) was more in group B. The incidence of respiratory depression was more in group B ( P > 0.05). PONV was comparable in both the groups. Postoperative shivering was significantly low in group B ( P < 0.05). Conclusion: It is concluded that besides easy availability and lower cost, butorphanol decreased propofol consumption intraoperatively and provided better analgesia and prophylaxis against shivering in postoperative period.
  2,442 364 7
Study of life style habits on risk of type 2 diabetes
Rajiv Pathak, Ashima Pathak
July-December 2012, 2(2):92-96
DOI:10.4103/2229-516X.106349  PMID:23776819
Background: Diabetes mellitus has become one of the great epidemics of our time, Aim: Characterized by derangement of carbohydrate, protein and fat metabolism. Diabetic patients may have some other habits like drinking, smoking, lack of physical activity. Aim: In the present study, we have tried to study the effect of all these habits on lipid profile and antioxidative enzymes, i.e., catalase and superoxide dismutase. Materials and Methods: Different kits and standard biochemical methods were used to estimate all these parameters. Results: Diabetics as well as diabetic individuals who were engaged in drinking, smoking and regular physical exercise showed a significant rise in glucose levels compared to normal subjects. Similarly, cholesterol, triglyceride and high-density lipoprotein cholesterol levels and activity of catalase were found to be increased in all diabetic subjects, but that of superoxide dismutase decreased as compared to normal subjects. In all cases, exercise has a beneficial effect. Furthermore, females were more prone to destructive effects of diabetes than males. Conclusion: We can conclude that smoking and drinking by diabetic subjects further deteriorates the effects of diabetes, while regular physical exercise has beneficial effects.
  2,268 369 7
CASE REPORTS
A rare case of Balo concentric sclerosis showing unusual clinical improvement and response with oral prednisolone
Amit Nandan D Dwivedi, Vaibhava Srivastava, Anubhav Thukral, Kamlakar Tripathi
July-December 2012, 2(2):136-138
DOI:10.4103/2229-516X.106358  PMID:23776828
The present report is a rare case of Balo Concentric Sclerosis. Most cases have either been diagnosed post mortem or have succumbed to the disease after being diagnosed ante mortem. In our case, the patient showed a dramatic response to treatment, and after a one-year follow-up, he was asymptomatic, with no relapses or residual effect of the illness.
  2,196 251 1
ORIGINAL ARTICLES
Influence of genetic and environmental factors in peripheral arterial disease natural history: Analysis from six years follow up
S Archetti, M Martini, E Botteri, D Di Lorenzo, E Cervi, S Bonardelli
July-December 2012, 2(2):117-122
DOI:10.4103/2229-516X.106354  PMID:23776824
Background : Peripheral arterial disease (PAD) is a disease affecting million of patients worldwide. Though traditional cardiovascular risk factors have been associated with the development of PAD, the possible existence of an inherited genetic predisposition to PAD has been investigated in few familial aggregation studies. A link between genetics and PAD may open new avenues for the prevention of this morbid and mortal disorder. Aim : The aim of this study is to investigate a possible role of some genetic determinant involving into coagulation and homocysteine metabolism in the progression of PAD. Materials and Methods: We follow one-hundred patients affected by PAD for six years. We evaluated Ankle-Brachial Index (ABI) two times; first at the time of recruitment and then after six years, in order to assess the progression of disease. Genotypes for the genes of Factor V Leiden, Prothrombin or Factor II G20210A, Cystathionine Beta-Synthase 844ins68bp and Methylenetetrahydrofolate Reductase C677T was ascertained after taking blood samples. Chi-square test was performed to determinate the possible correlation of these genes and the most common environmental factors in the progression of PAD. Results: Genetic disorders resulting in high level of homocysteina or thrombophilic phenotype are not so frequent. None among the genetic factors we considered were correlated with PAD. Conclusion: PAD is a chronic disease whose course can be slowed down especially with the control of environmental risk factors. Genetic analyses are not useful to determine the disease progression or its tendency to remain stable.
  2,077 232 1
CASE REPORTS
Heterotopic pancreas in gall bladder associated with chronic cholecystolithiasis
Poonam Elhence, Rani Bansal, Nivesh Agrawal
July-December 2012, 2(2):142-143
DOI:10.4103/2229-516X.106360  PMID:23776830
Heterotopic pancreatic tissue in the gallbladder is a very uncommon lesion, which is an incidental finding in most cases. We report here, a case of an 18-year-old, post puerperal female, suffering from right upper quadrant abdominal pain with a clinical diagnosis of chronic cholecystitis, in whom heterotopic pancreatic tissue was found in the gall bladder.
  2,055 205 2
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