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   2012| July-December  | Volume 5 | Issue 2  
    Online since November 10, 2012

 
 
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ORIGINAL ARTICLES
Comparison of modified Petroff's and N-acetyl-L-cysteine-sodium hydroxide methods for sputum decontamination in tertiary care hospital in India
Mukesh Sharma, Rabindra Nath Misra, Nageswari Rajesh Gandham, Savita Vivek Jadhav, Kalpana Angadi, Vivian Wilson
July-December 2012, 5(2):97-100
DOI:10.4103/0975-2870.103323  
Background : Tuberculosis is the second leading cause of death worldwide, killing nearly two million people each year. Sputum decontamination with N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) is expected to improve detection of Mycobacterium tuberculosis (M. tb) by culture better than that with modified Petroff's; which is widely used in laboratories. In this study, sputum samples collected from suspected cases of pulmonary tuberculosis (TB) were cultured directly on Lowenstein-Jensen (LJ) medium and after decontamination by both the methods and the results of smear and culture positivity were evaluated to assess whether the NALC-NaOH treatment method improves smear and culture. Materials and Methods : For each decontamination method, 30 samples were obtained from suspected cases of Pulmonary TB, from Pad. Dr. D.Y. Patil Medical College and Hospital. Two sputum samples from each patient were collected on day 1 and 2. These samples then underwent decontamination process by performing the 4% NaOH, NALC-2% NaOH treatment methods and direct inoculation. After each process a smear was made and culture was done on LJ medium. Results: The modified Petroff's and NALC-NaOH treatment methods did not significantly affect the AFB smear positivity of the sputum samples (66% and 72.3%, respectively). (However, the culture positivity for M. tb on LJ medium was significantly different by the three processes. With NALC-NaOH and modified Petroff's it was 63% and 46%, respectively, while with direct culture it was 23%. Conclusion: NALC-NaOH treatment is better than modified Petroff's treatment for the detection of M. tb by culture. However, AFB microscopy does not seem to be significantly different by either process.
  31,417 1,605 8
LETTERS TO THE EDITOR
Surgical staple suture removal: A simple and innovative technique
Manjit Singh, Sukhminder J. S. Bajwa, Sukhwinder K Bajwa
July-December 2012, 5(2):168-169
DOI:10.4103/0975-2870.103355  
  19,674 432 -
Incidental tracheo-bronchial calcification
Amit Agrawal, Saginela Satish Kumar, K Raghu, Surya P Singh
July-December 2012, 5(2):166-167
DOI:10.4103/0975-2870.103353  
  12,733 592 1
CASE REPORTS
Isolation of Acinetobacter baumannii from cerebrospinal fluid following craniotomy
Nageshwari R Gandham, Neeta Gupta, Savita V Jadhav, Rabindra N Misra
July-December 2012, 5(2):151-153
DOI:10.4103/0975-2870.103347  
Central nervous system infection due to multi-drug resistant Acinetobacter baumannii is being increasingly reported. Here we report a case of infection by multi-drug resistant Acinetobacter baumannii following a craniotomy for biparietal epidermoid. The organism, in vitro, showed multi-drug resistance, which was confirmed by automated identification and susceptibility system. However the patient responded to a combination of Amikacin and Cefotaxim therapy. Multiple drug resistance in Acinetobacter baumannii is mostly plasmid mediated; hence, the case report emphasizes the importance of the identification and susceptibility testing of any non-fermented isolate from clinical samples.
  10,861 416 1
ORIGINAL ARTICLES
High resolution ultrasound evaluation of synovial thickness as a marker to assess response to deep tissue heating for pain relief in knee osteoarthritis
Bhawana Anand, Amit Kharat, Amarjit Singh, John Franklin, Satish Naware, Sarabjit Singh Thind
July-December 2012, 5(2):129-136
DOI:10.4103/0975-2870.103341  
Background: High-resolution ultrasound (HRUS) is a useful tool in assessing synovial tissue response to deep tissue heating (DTH)/short wave diathermy (SWD) for pain relief in knee osteoarthritis. Shortwave (SW) diathermy can be used to improve vascular circulation and reduce inflammation and pain in patients with osteoarthritis. The purpose of this study was to assess the role of ultrasound in investigating whether repetitive SW diathermy, could reduce synovial thickening in patients with knee osteoarthritis. Materials and Methods: Synovial thickness measurement of superior, medial, and lateral patellar recesses was done using ultrasonography over a span of nineteen months from April 2010 to Nov 2011 following three sessions of short wave diathermy. The sum of these three measurements was taken as the total synovial thickness and pre and post test analysis was done using primer statistical software. Result: Synovial thickening continued to become significantly thinner with sessions of treatment and after the twelfth SW diathermy treatment, there was 20.58% reduction in the synovial thickening. Conclusion: Synovial thickness is a sensitive marker in gauging the response to short wave diathermy therapy. Synovial thickness is an objective marker to assess pain relief in knee osteoarthritis following deep tissue heating.
  9,805 597 3
Surgical treatment of thoracic outlet syndrome; by supraclavicular approach
Osman Abd Ellah Mohamed, Hedaya Mohamed Hassan, Hatem Mohamed El Samouly
July-December 2012, 5(2):101-105
DOI:10.4103/0975-2870.103327  
Background: Thoracic outlet syndrome comprises a wide spectrum of disorders with different compressive pathologies attributed to the neurovascular bundle passing from the root of the neck to supply the upper extremity. New concepts and advances in diagnosis and treatment are emerging. This study evaluates effectiveness and safety of the supraclavicular approach in management of neurovascular compression at the thoracic outlet. Materials and Methods: Twenty patients (15 females and 5 males) with mean age of 20 years (ranging from 18 to 40 years) underwent anterior neurovascular decompression procedures because of symptoms of lower plexus compression (C8 - T1). Preoperative plain radiography, MRI and nerve conduction velocity studies confirmed the clinical diagnosis. Nine patients had neck pain, all had sensory deficit and eight had motor deficit. Results: After 35 months of follow-up, 17 patients showed excellent results, two cases had good results and one case had fair results according to the visual analog scale, and nerve conduction velocities. Conclusions: We recommend nerve conduction velocity studies beside clinical assessment for diagnosis and follow-up, and supraclavicular approach in neurogenic decompression which is relatively safe and effective.
  9,856 521 -
GUEST EDITORIAL
Application of qualitative methods to health and biomedical research
Carol Vlassoff
July-December 2012, 5(2):93-96
DOI:10.4103/0975-2870.103321  
  7,030 2,265 -
ORIGINAL ARTICLES
Management of appendix stump: The technique
Gurjit Singh, Apoorva Pandey
July-December 2012, 5(2):106-109
DOI:10.4103/0975-2870.103328  
Introduction: Time and again the technique of appendectomy for acute appendicitis has been debated, and optimal management of the stump is still a matter of discussion. Thus, a study was proposed to compare two techniques of management of the stump i.e., simple ligation alone vs. ligation and invagination of the stump with purse string sutures. Aim: To compare and evaluate simple ligation alone with ligation and invagination of the stump during appendectomy. Materials and Methods: A total of 102 patients were included in this study. Each patient was alternately divided under two groups (Group A: Simple ligation of the stump and Group B: Ligation and invagination of the stump with purse string sutures). The two techniques were compared with respect to duration, intra-operative and post-operative complications. Results: It was observed that simple ligation is not only an equally safe a procedure, but is also better in terms of duration of the procedure, which was seen to be less in the case of simple ligation alone. Post-operative course as well as duration of hospital stay was similar in both the groups. Conclusion: Simple ligation is as good a technique as ligation and stump invagination with purse string sutures with respect to the results of the procedure.
  8,259 622 1
Evaluation of efficacy of chemical peeling with glycolic acid in hyperpigmentation disorders of the skin
Supriya P Deshmukh, Nitin C Chaudhari, Kedarnath Dash, Yugal K Sharma, Kirti S Deo
July-December 2012, 5(2):122-124
DOI:10.4103/0975-2870.103335  
Background : Chemical peeling entails application of chemical agents to the skin causing a controlled chemical burn, thereby achieving improved texture and quality of skin. Aim: To evaluate the efficacy of glycolic acid in melasma and other causes of hyperpigmentation. Materials and Methods: A total of 20 patients were included in the study. After adequate priming, application of glycolic acid in various concentrations in biweekly interval for a period of 16 weeks was done. Post-treatment photographs were taken and were subjected to analysis. Results: Melasma constituted 11 patients and hyperpigmentation, ie, post acne marks and freckles due to sun exposure accounted nine patients. Complete resolution of melasma was possible only in one (9%) patient and good improvement in four (36.3%), whereas five (45.5%) patients showed fair improvement. In cases of hyperpigmentation, three (33%) patients showed excellent improvement, one (11%) showed good improvement, and five (55.5%) patients showed fair improvement. The patients of melasma took an average of 7.33 number of peels to show improvement and those of hyperpigmentation took 4.2 peels. Conclusions: Melasma shows fair to good improvement and requires more number of peels as compared to other causes of hyperpigmentation in skin. Postinflammatory pigmentation shows excellent improvement in the majority of patients.
  8,006 566 -
Colour Doppler evaluation of extracranial carotid artery in patients presenting with features of cerebrovascular disease: A clinical and radiological correlation
Sanjeev Sehrawat, Sarabjit Singh Thind, Vikram Singh, Rajesh Kuber, Satish Naware, Harshawardhan Shrotri
July-December 2012, 5(2):137-143
DOI:10.4103/0975-2870.103344  
Aim: To evaluate the morphological and hemodynamic changes that take place in carotid arteries by colour Doppler in patients presenting with features of stroke. Background and Objectives: Cerebrovascular accidents constitute a major cause of adult mortality. The principal indication for cerebrovascular Doppler examination is stroke prevention. Colour Doppler sonography is a sensitive method for detection of atherosclerotic plaque and provides considerable information about the extent and severity of plaque as well as the resulting diminution of arterial lumen. The main strengths of sonography of carotid arteries are patient comfort, lack of risk and accuracy in detecting carotid stenosis. Material and Methods: A prospective study of Colour Doppler in carotid arteries was carried out for 12 months from 1 st July 2009 to 1 st July 2010. The study was carried out on 40 individuals, suspected of cerebrovascular insufficiency and having one or the other risk factors for cerebrovascular disease. A detailed clinical history, CNS examination findings and evidence of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease were noted. Carotid Doppler evaluation was done by using Siemens Antares Ultrasound system. The data gathered were grey scale and Doppler findings of common carotid artery, internal carotid artery and external carotid arteries. Doppler findings were correlated with clinical features and risk factors. Results: In our study of 40 patients, the commonest lesion found was the atherosclerotic plaque. Highest incidence of plaque was seen in males 41% in the age group of 60-70 years and in females 37% in age group of 70-80 years. Cigarette smoking was the most common risk factor (60%) associated with stroke/ Transient Ischaemic Attacks (TIA). Hemiparesis was the most common presenting symptom (35%) among the symptomatic cases. Atheromatous plaque was most commonly found in the right carotid system (60%). Most common site for atheromatous plaque was found to be carotid bifurcation (33.3%). Significant stenosis, i.e., >50% was found in 12 (60%) of the cases. Peak systolic velocity ratio showed significant stenosis in 12 (60%) of symptomatic cases and in 4 (20%) of asymptomatic controls. Plaque characteristics showed 9 hyperechogenic, 8 calcific, 4 low echogenic and 5 moderate or heterogeneous plaques. Conclusion: The role of carotid Doppler in detecting the site and morphology of atherosclerotic plaque with quantifying the amount of stenosis is very well-justified. In addition carotid Doppler can also be used to assess the prognosis in potential symptomatic and asymptomatic patients with one or the other risk factors for cerebrovascular disease.
  7,492 607 1
CASE REPORTS
A case of sleep bruxism treated through behavioural change using hypnosis
Shakir Quaid Johar
July-December 2012, 5(2):154-157
DOI:10.4103/0975-2870.103348  
The mouth has been a natural site for release of stress. Right from the time of birth, a new born child cries and attracts attention of parents during stress. As the child grows, they spit and bite to release stress and frustration. As an adult, the same child uses abusive language, alcohol, smokes, and uses drugs (all orally) to release stress. Clenching, grinding, and bruxism are also a form of stress release using the oral route. Dentist is the first to detect such habit, and treat such cases with habit breaking appliances, which usually fail. This article highlights the need to refer cases for psychiatric treatment and hypnotherapy may be a choice of treatment. A female aged 26 year, reported with pain in all her teeth due to bruxism. All conventional dental treatments failed. This outlined a strong psychological component, hence hypnosis was tried. A 5-year follow-up showed no relapse.
  6,943 574 1
Osteoblastoma of radius
Soma Datta, Soumya Ghosh, Arunima Chaudhuri, Bikash C Mondal
July-December 2012, 5(2):147-150
DOI:10.4103/0975-2870.103346  
An 18-year-old male presented with a huge swelling in his left forearm, which was progressively increasing for four years with episodic pain in the outpatient department of Burdwan Medical College and Hospital, Burdwan. Investigations and clinical examinations were done that revealed the swelling to be a bony tumor. The patient was operated upon with en bloc removal of tumor and the site replaced by bone graft. Preoperative fine needle aspiration cytology showed the tumor to be a giant cell containing lesion of bone reported as osteoblastoma, a benign bone-forming tumor on histopathological evaluation. Postoperative follow-up of the patient showed good response with complete union of bone graft and full range of joint movement.
  6,829 371 -
EDITORIAL
Searching for wisdom lost in data
Amitav Banerjee
July-December 2012, 5(2):91-92
DOI:10.4103/0975-2870.103320  
  2,813 3,838 1
ORIGINAL ARTICLES
Epidemiological study of under nutrition among under five years children in an urban slum
Anjali B Dhone, Uday B Chitnis, Jitendra S Bhawalkar, Sudhir L Jadhav
July-December 2012, 5(2):110-113
DOI:10.4103/0975-2870.103331  
Background: Child undernutrition is internationally recognized as an important public health indicator for monitoring nutritional status and health in populations. Prevalence of under nutrition is very high in India; especially in urban slums. Objective: To estimate the prevalence and factors affecting undernutrition among under five years children using WHO growth standards. Materials and Methods: Community-based cross sectional study was done during November-2008 to December-2009 in urban field practice area of Medical College Pune, India. All the under five years children (336) were enumerated by house-to-house survey. Parents were informed about the objectives of the study and their written consent was obtained. Anthropometric measurements of the children who were available during the study period were carried out as per WHO guidelines. Various indices of nutritional status were expressed in standard deviation units (z scores) from the reference median. The children were examined for nutritional deficiencies and other morbidities. Epi-Info 2002 and Primer of Bio-statistics software package was used for statistical analysis. Results: Total 336 children were enumerated by house-to-house visit. Only 319 children were available during the study, out of which 208 (65.2%) were undernourished. Undernutrition was significantly (P < 0.001) higher among boys than among girls. It was maximum in 49-60 months age group. The higher the level of the mother's education, the lower was the level of child weight for age (P = 0.003). The overall prevalence of morbidities was 43.4%. Conclusion: Malnutrition continues to be a public health problem in children particularly in marginalized groups.
  5,673 703 8
CASE REPORTS
Kartagener's syndrome
Pradip V Potdar, Mitali M Nayak, Aushutosh Chitnis
July-December 2012, 5(2):158-160
DOI:10.4103/0975-2870.103349  
Bronchiectasis may have varied etiologies. In patients presenting in middle or old age with bronchiectasis, congenital and hereditary causes of bronchiectasis are not commonly encountered. In majority of adult patients, bronchiectasis follows necrotizing infection. We report a case of Kartagener's syndrome in a female patient diagnosed in her sixties.
  5,368 297 1
Molluscum contagiosum of nipple
Nisha Marwah, Sumiti Gupta, Sunita Singh, Divya Sethi
July-December 2012, 5(2):161-162
DOI:10.4103/0975-2870.103350  
Molluscum contagiosum is a virus-induced dermatologic condition causing characteristic pearly lesions on the surface of skin. The lesion is common in children. In adults, it is usually a sexually transmitted disease. Molluscum contagiosum may be found anywhere on the body, although it rarely occurs on the palms and soles. Dermatosis of nipple due to molluscum contagiosum is rare. If it occurs, it is accompanied by lesions in other sites. Isolated involvement of nipple by the virus is unusual and has been reported only once in previous literature to the best of our knowledge. Here, we report this unusual case of isolated molluscum contagiosum of nipple in 30-year-old female.
  4,835 276 1
ORIGINAL ARTICLES
Spectrum of hematological disorders observed in one-hundred and ten consecutive bone marrow aspirations and biopsies
Srikanth M Shastry, Sachin S Kolte
July-December 2012, 5(2):118-121
Introduction: The study was done to know the spectrum of hematological disorders. Materials and Methods: This was a retrospective and prospective study of bone marrow aspiration (BMA) and biopsies done on patients who were referred for bone marrow examination. Cases were analyzed in detail regarding clinical examination and other investigations. Results: BMA from 110 patients were analyzed. Nutritional anemia contributed highest number of cases among the nonhematological group. Out of nutritional anemia megaloblastic anemia was the most common disorder. Acute myeloid leukemia was the commonest malignant hematological disorder in the present study. Among 110 cases 56 cases were male and 54 were female patients with highest number of cases in the age group of 21-30 years. Conclusion : Although bone marrow examination is an invasive procedure this is well tolerated by patients. The examination helps in many cases to arrive at a final diagnosis within a short span of time.
  3,860 485 -
Clinical and epidemiological study of acute respiratory infection cases in children below twelve years of age in a tertiary care teaching hospital in Pune, India
Dhrubajyoti Debnath, Arun Wanjpe, Vandana Kakrani, Samir Singru
July-December 2012, 5(2):125-128
DOI:10.4103/0975-2870.103337  
Context: Pneumonia is the leading killer of children worldwide. AIMS: To study clinical and epidemiological factors associated with Acute Respiratory Infection (ARI) cases and find the case fatality rate. Setting and Design: Hospital-based cross-sectional study. Materials And Methods: Detailed clinical examination of all ARI cases were done in children below 12 years of age. The relevant socio-demographic and epidemiological information of the cases were collected by interviewing the parents/guardians of the children through a pre-tested proforma. Duration of the study was one year. Statistical Analysis Used: χ² test, P < 0.05 was considered as statistically significant. Results: There were 539 (11.3%) ARI cases from a total of 4,764 admissions. There were 317 males and 222 females. Out of 539 ARI cases, 455 (84.4%) were in the age group of 0-5 years. Malnutrition was associated with 360 (79.1%) of the 455 under-five cases. A total of 283 (62.2%) cases were incompletely immunized for age. Case fatality rate was 3.8% in males and 8.1% in females. Conclusion: Children who were incompletely immunized for age suffered from severe forms of ARI, and this was statistically significant. The case fatality rate was much higher in females, and this was statistically significant. The comorbid factors/illnesses with ARI, which were statistically significantly associated with mortality, were malnutrition, acute diarrheal illness, septicemia, meningitis, and congenital anomaly.
  3,481 388 1
Thirty cases of distal humerus intra-articular fractures treated by open reduction and internal fixation: A 3-year review
Ajit Swamy
July-December 2012, 5(2):114-117
DOI:10.4103/0975-2870.103332  
Introduction: Fractures of the distal humerus involving articular surface remains one of the challenging situations for any orthopedic surgeon. Congruent articular reconstruction is mandatory for an acceptable functional recovery. Materials and Methods: This was a case series of 30 patients of distal humeral intraarticular fractures treated by open reduction and internal fixation and followed up at the end of 3 years.Fractures were classified according to AO [Arbeitsgemeinschaft für Osteosynthesefragen] and the results were evaluated using Cassebaums rating system, and other parameters. Results: Majority of the patients had a favourable outcome.There was no neurovascular complications and majority had a sound union. One case developed postoperative infection. Two cases resulted in nonunion. Conclusion: Open reduction and internal fixation with congruent articular reconstruction in young patients resulted in acceptable and good functional recovery. This was achieved with the use of recent AO ASIF plates. [AO/ASIF - Arbeitsgemeinschaft fuer Osteosynthesefragen - Association for the Study of Internal Fixation].
  3,244 335 -
CASE REPORTS
Non-specific granulomatous or tuberculous mastitis
Gurjit Singh, Trinath Tummetalli
July-December 2012, 5(2):144-146
DOI:10.4103/0975-2870.103345  
The significance of breast tuberculosis is due to rare occurrence and mistaken identity with breast cancer and pyogenic breast abscess. A 70-year-old woman presented with a gradually increasing swelling in the right breast involving the outer upper quadrant since 6 months. Examination of the axilla revealed no lymphadenopathy. FNAC from the lump was inconclusive. Straw-colored discharge from the FNAC site was negative for acid-fast bacilli on Z-N staining and on culture. Modified radical mastectomy was done since malignancy could not be ruled out. Histopathology showed features of granulomatous mastitis. Lymph nodes recovered from the specimen showed caseation necrosis. Anti-tubercular treatment was given to the patient, and she has remained asymptomatic over 1 year of follow-up so far. Extrapulmonary tuberculosis occurring in the breast is extremely rare and is uncommon even in countries where the incidence of pulmonary and extrapulmonary tuberculosis is high.
  3,141 334 -
Non syndromic Pierre Robin sequence: On the lookout for breathing difficulty
Meryl S Parekkat, Shradha Salunkhe, Sharad Agarkhedkar, Vineeta Pande
July-December 2012, 5(2):163-164
DOI:10.4103/0975-2870.103351  
A full-term vigorous baby male, was born at term. His micrognathia and cleft palate were immediately apparent but there was no clinical evidence of upper airway obstruction. Feeding was commenced with no initial problems. Prior to discharge on day 7 he was reviewed and found to be well and without upper airway obstruction. On day 42 of life he arrived with failure to thrive.
  2,934 273 -
LETTERS TO THE EDITOR
Is preoperative color doppler essential for arteriovenous fistula surgery?
Ananta A Kulkarni, Suhas V Abhyankar, Rohit R Singh, Santosh H Bhatia
July-December 2012, 5(2):165-166
DOI:10.4103/0975-2870.103352  
  2,197 203 -
Wordoku: Pharmacology quiz
Garima Lakhanpal, Pratibha S Worlikar
July-December 2012, 5(2):171-171
DOI:10.4103/0975-2870.103361  
  1,819 267 -
Correction in the names of parasites
Dakshayani Pandit, Padmakar Pandit
July-December 2012, 5(2):170-170
DOI:10.4103/0975-2870.103356  
  1,853 217 -
ERRATUM
Erratum

July-December 2012, 5(2):109-109
  1,869 191 -
LETTERS TO THE EDITOR
Localized outbreak of chikungunya fever in rural field practice area of a medical college in Pune, India
Jitendra S Bhawalkar, Ravi Gupta, Sanjay S Darade, Rajabhau J Thorat
July-December 2012, 5(2):167-168
DOI:10.4103/0975-2870.103354  
  1,744 263 -
EDITORIAL COMMENTARY
Editorial Commentary
Amitav Banerjee
July-December 2012, 5(2):157-157
  1,707 213 -
LETTERS TO THE EDITOR
Authors' reply
Narayanan K Panicker, Archana C Buch, Shruti Vimal, Arpana P Dharwadkar
July-December 2012, 5(2):170-171
  1,371 175 -