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   2013| January-March  | Volume 6 | Issue 1  
    Online since March 14, 2013

 
 
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REVIEW ARTICLES
Psychogenic dyspnea
Tushar R Sahasrabudhe
January-March 2013, 6(1):14-18
DOI:10.4103/0975-2870.108627  
Dyspnea is a very common presenting complaint of a patient. Though commonly due to an organic disease, dyspnea can be a manifestation of underlying anxiety disorder. Three typical patterns of psychogenic dyspnea, viz. panic attack, psychogenic hyperventilation, and compulsive sighing, have been reviewed in this article. The article also comments on the diagnostic features and treatment of these patterns. The overlap with organic causes of dyspnea such as bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD) has also been discussed. For literature review, a Medline and Pubmed search was conducted using appropriate keywords. Articles were also identified from the authors' own knowledge of the literature as well as reference lists in articles retrieved.
  150,093 1,785 2
ORIGINAL ARTICLES
Postoperative complications of mesh hernioplasty for incisional hernia repair and factors affecting the occurrence of complications
Karan Vir Singh Rana, Gurjit Singh, Niteen A Deshpande, Viju K Bharathan, Srihari Sridharan
January-March 2013, 6(1):25-31
DOI:10.4103/0975-2870.108634  
Context: Incisional hernia is one of the common postoperative complications of abdominal surgery. Mesh hernioplasty represents the standard of care for incisional hernia repair. Aims: We report our experience with the use of mesh for hernia repair, with respect to the postoperative complications and factors affecting the occurrence of complications. Settings and Design: Fifty four cases of incisional hernia presenting to the institute between April 2008 and September 2010 were included in the study. Materials and Methods: The predisposing risk factors were identified. Mesh hernioplasty was done by the onlay technique and the patients followed up for at least 6 months. Statistical Analysis Used: An association of complications with various risk factors was explored with chi-square test and odds ratio with 95% confidence interval. Results: Twenty four patients developed at least one complication, the most common being seroma (12 cases) and surgical site infection (9 cases). The factors that showed a significant relationship with the occurrence of complications were diabetes mellitus, obesity, smoking, hypoproteinemia, advanced age, size of fascial defects, and number of defects. The recurrence rate was 3.7% (mean follow up: 13.05 months). Conclusions: Mesh hernioplasty gives acceptable results for incisional hernia repair. A sound understanding of the factors affecting the occurrence of complications and recurrence is required to improve the results of the procedure.
  19,426 855 2
REVIEW ARTICLES
Dexmedetomidine: Expanding role in anesthesia
Jyotsna S Paranjpe
January-March 2013, 6(1):5-13
DOI:10.4103/0975-2870.108625  
The potential uses of dexmedetomidine (DEX), a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical 'ideal' sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole) with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction.
  14,730 1,381 12
ORIGINAL ARTICLES
Management of closed tibial plateau fractures with percutaneous cancellous screw fixation
Tushar Agarwal, Anil Salgia, Samar Kumar Biswas, Sahil Sanghi, Subash Rajendra Puri
January-March 2013, 6(1):43-48
DOI:10.4103/0975-2870.108639  
Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years) underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18), type II (n = 4), type III (n = 0), type IV (n = 8), type V (n = 2), and type VI (n = 1). Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm) with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15) days. All the fractures united radiologically after a mean of 3 (range 2.5- 5) months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.
  13,531 600 -
CASE REPORTS
Septate uterus with cervical and vaginal duplication: A rare Mullerian malformation
Meenal Patvekar, Vinayak Mahajan, Gazal Garg
January-March 2013, 6(1):105-108
DOI:10.4103/0975-2870.108666  
A rare case of Mullerian anomaly in a 26-year-old woman who presented with recurrent pregnancy loss and was found to have a longitudinal vaginal septum with cervical duplication and two endometrial cavities separated by a complete septum. The diagnosis of this unusual anomaly was aided by magnetic resonance imaging and was confirmed by hysterolaparoscopy. It was concluded that hysteroscopy aided in the diagnosis and treatment of this Mullerian defect with the highest quality of precision. Hysteroscopy therefore is considered gold standard in the management of septate uterus, thereby helping to regain the anatomical normality and because of its minimally invasive nature, it improves the reproductive outcome.
  10,083 335 1
Spontaneous mesenteric hemorrhage
Karan V. S. Rana, Sunil V Panchabhai, Sridharan Srihari, Kundan Kharde
January-March 2013, 6(1):95-97
DOI:10.4103/0975-2870.108663  
Spontaneous intra-abdominal hemorrhage or abdominal apoplexy is an acute abdominal emergency which can exhibit a wide spectrum of clinical presentation. With the expanding avenues for anticoagulation therapy, this condition is becoming commoner. The association of this condition with antiplatelet therapy is less well established. We present a case of spontaneous mesenteric hematomas causing intestinal obstruction in a patient on antiplatelet therapy for ischemic heart disease. A review of etiology, clinical presentation and protocol of management is also presented. A high index of suspicion on the part of the clinician is essential to ensure a favorable outcome in this condition.
  7,631 400 -
Retained surgical sponge: An enigma
Gurjit Singh, Siddharth P Dubhashi, Neha Jindal
January-March 2013, 6(1):98-101
DOI:10.4103/0975-2870.108664  
Retained surgical sponge in the body following a surgery is called "gossypiboma". A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation.
  7,479 320 -
Unilateral macromastia in a case of polymastia
Bharat B Dogra, Gurjit Singh
January-March 2013, 6(1):79-81
DOI:10.4103/0975-2870.108653  
Macromastia is a condition of abnormal enlargement of the breast in excess of the normal proportion. It can be unilateral or bilateral and generally manifest at puberty when secondary sexual characters start appearing. Other patients may develop this condition at the time of pregnancy (Gestational macromastia). We present a case of young unmarried girl having unilateral macromastia due to polymastia. Unique feature in this case has been presence of two nipple areola complexes over right breast mound, one at normal site and another just superior to the inframammary crease in the line of embryonic milk line. The affected breast was almost double the size of contra lateral breast. Besides she also had bilateral hypertrophy of axillary breasts. Vertical scar reduction mammaplasty along with excision of axillary breasts was successfully carried out with gratifying results.
  7,083 412 -
ORIGINAL ARTICLES
Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator
Osman A Mohamed, Salah Aldeen A Youssef
January-March 2013, 6(1):33-41
DOI:10.4103/0975-2870.108637  
Background: We treated 30 patients with high-energy fractures of the tibial plateau by the Ilizarov fixator and transfixion wires. Ten fractures were open, and 20 patients had complex injuries. Of all, 15 were treated by ligamentotaxis and percutaneous fixation, eight by limited open reduction, and seven by open reduction bone graft and screws. There is, however, no "gold standard" procedure for this complicated and multi-disciplinary problem. Objectives: Evaluation of Ilizarov circular fixation method of treatment for these fractures when extensive dissection and internal fixation are contraindicated due to trauma to the soft tissue, deficiency of bone stock, and bony comminution. Materials and Methods: Between October 2007 and October 2011, we treated 30 consecutive patients with severe bicondylar fractures of the tibial plateau by the Ilizarov fixator. They were reviewed 24 months postoperatively and the level of function, clinical and radiological findings, and the patients' opinion were assessed. There were 20 men and 10 women with a mean age of 39 years (18 to 69 years). Six patients were car drivers or passengers, 12 were pedestrians struck by motor vehicles, and seven were motor-cycle riders. Four had been injured by falls from a height and one had a crush injury caused by a collapsed wall. Ten (33.3%) of the fractures were open. There were 10 Schatzker (1987) type-V and 20 type-VI fractures; 20 (66.6%) were comminuted. Results: All the fractures united within mean duration of 14.4 weeks. The femoral fixator could be removed within mean period of 6 weeks (range, 4 to 7 weeks) and the tibial fixator was retained for a mean of 13 weeks (range, 12 to 20 weeks). Full weight-bearing was allowed at a mean of 14.4 weeks (range, 12 to 24 weeks). The patients were followed up for a mean of 36.5 months (range, 24 to 53 months). The results were assessed according to the criteria of Honkonen and Järvinen (1992) which considers the subjective opinion of the patient, the clinical state, the function, and the radiological assessment. On the basis of the clinical criteria, outcome in ten cases were excellent, ten good, five fair, and five poor. Conclusion: Our study confirms the low morbidity and good outcomes associated with the Ilizarov method. The technique is appropriate for complex fractures of the tibial plateau when extensive dissection and internal fixation are contraindicated due to comminution at the fracture site and compromise of the soft tissue.
  6,218 538 2
LETTERS TO THE EDITOR
Tuberous sclerosis with shagreen patch over the face
Milind A Patvekar, Avinash B Jadhav
January-March 2013, 6(1):110-111
DOI:10.4103/0975-2870.108668  
  5,975 270 -
ORIGINAL ARTICLES
Operative management of fracture of shaft humerus by dynamic compression plate versus interlocking intramedullary nailing: A comparative prospective study of 30 cases
Subhash R Puri, Samar K Biswas, Anil Salgia, Sahil Sanghi, Tushar Aggarwal, Ashish Kohli
January-March 2013, 6(1):49-54
DOI:10.4103/0975-2870.108641  
Background: Uncomplicated diaphyseal fractures of the humerus successfully healed in over 90% of cases when treated conservatively by reduction and immobilization. Open reduction with internal fixation, is preferred for open, segmental and pathological fractures. Objective: To compare functional outcomes, union and complication rates in patients treated with locked intramedullary nailing or dynamic compression plating for humeral shaft fractures. Materials and Methods: We randomized prospectively 30 patients with fractures of the shaft of the humerus were treated by open reduction and internal fixation by dynamic compression plate (DCP) in 15 cases and closed reduction and internal fixation with interlocking intramedullary nail in 15 cases. Patients were followed up for a minimum of six months. Result: There were no significant differences in the function of the shoulder and elbow, as determined by the American Shoulder and Elbow Surgeons' score, the visual analogue pain score, range of movement, or the time taken to return to normal activity. In our study, complications in DCP and IMN groups common were radial nerve injury and shoulder impingement. We had to perform secondary surgery on four patients in the IMN group, but on only one in the DCP group. Conclusion: Our findings suggest that open reduction and internal fixation with a DCP remains a better treatment option for fractures of the shaft humerus. Fixation by IMN may be indicated for specific situations, but is technically more demanding and has a higher rate of complications.
  5,011 456 1
Screening of β-thalassaemia trait by means of red cell indices and derived formulae
Shashikant Adlekha, Tandra Chadha, Ram Mohan Jaiswal, Ashina Singla
January-March 2013, 6(1):71-74
DOI:10.4103/0975-2870.108649  
Context: Thalassaemias are a group of genetic disorders with tremendous morbidity and mortality that are present widely across the globe. Aim of the Study: To evaluate the usefulness of automated haematology analyser-based red cell indices and formulae derived from these indices in β-thalassaemia trait (BTT) detection. Settings and Design: Prospective study conducted over a period of 1 year. Materials and Methods: The study included 301 cases with mild-to-moderate reduction in haemoglobin (Hb) with a lower cut-off value of 8 g/dl. Automated haematology analysis was done by using an "Arcus Diatron" (2000) for all these cases. A cut-off value of mean cell volume (MCV) < 76 fl and serum ferritin level < 12 ng/ml were taken for high-performance liquid hromatography (HPLC) screening. Based on these indices we evaluated eight automated analyser red cell indices and formulae - red blood cell count (RBCC), MCV, mean cell Hb (MCH), red cell distribution width (RDW), red cell distribution width index (RDWI), Mentzer index (MI), discriminant score (DS) and mean density of Hb per liter (MDHL) - for all 301 cases. Youden's index was computed for all derived indices. Results : Out of 98 cases screened by HPLC (D-10 VARIANT; Bio-Rad Laboratories), 88 turned out to be positive for BTT (HbA2 > 3.5%). Indices like RDW, RDW with low MCV, MCH, RDWI and DS were found to have a better discriminating function (higher Youden's index) compared with RBCC, MDHL and MI. Conclusion: Automated haematology analyser-based red cell indices and certain formulae derived from these indices have a high predictive value in screening BTT.
  4,844 594 1
Pulmonary functions in air conditioner users
Sandip M Hulke, Avinash Thakare, Prashant Patil, Shrikant A Shete, Yuganti P Vaidya
January-March 2013, 6(1):21-24
DOI:10.4103/0975-2870.108629  
Context: In the modern lifestyle, use of air conditioner (AC) has become very common. Aims: The present study was planned to assess the effect of ACs on pulmonary functions in young healthy non-smoker adults. Settings and Design: This study was a cross-sectional observational study. Sixty-six young adults (40 males and 26 females) using ACs were compared with 70 non-AC users (young adults, 40 males and 30 females). Materials and Methods: Pulmonary function test was done using medical international research (MIR) Spirolab II during home visits. Statistical Analysis Used: GraphPad Prism 5 software was used for analysis. Unpaired t test was used for lung function parameter. Chi- square test was used for the comparison of respiratory symptoms. Results: The results showed significant decrease in forced vital capacity (FVC) (P < 0.05), forced expiratory volume in 1 s (FEV1) (P < 0.05), FEV1 as percentage of FVC in % [FEV1 (%)] (P < 0.05), peak expiratory flow rate in L/s (PEFR) (P < 0.05), forced expiratory flow rate in L/s in 25% of FVC (FEF25%) (P < 0.05), and maximum voluntary ventilation (MVV) (P < 0.01). Frequency of respiratory symptoms was higher in AC users. Conclusions: The results are suggestive of predisposition of AC users toward respiratory disorders in the form of mild airflow obstruction.
  4,502 447 1
A comparative study of lipid profile and autonomic functions in vegetarian and non-vegetarian postmenopausal women
Arunima Chaudhuri, Nirmala Gopal Borade, Amit K Bandopadhyay, Samir K Hazra, Sudipta Saha, Sabyasachi Mondol
January-March 2013, 6(1):60-65
DOI:10.4103/0975-2870.108645  
Background: The prevalence of dyslipedaemia, autonomic dysfunction leading to cardiovascular diseases, increases with menopause and an ageing population. Autonomic dysfunction as measured by lower heart rate variability is an established risk factor for cardiac death. Diet and nutrition have been extensively investigated as risk factors for major cardiovascular diseases and are also linked to other cardiovascular risk factors. Objectives: To compare lipid profile and autonomic functions of postmenopausal women on vegetarian and non- vegetarian diet. Materials and Methods: 120 Postmenopausal women (menopausal duration and age-matched) without any gross systemic disease from an Industrial population were selected. Sixty women were on vegetarian diet and 60 on non-vegetarian diet. BMI and waist/hip ratios were calculated, lipid profile was analyzed, and autonomic function tests were carried out. A comparison was done between the two groups using Students t test. Pearson's correlation coefficient was calculated between the independent variable (lipid profile parameters) and the dependent variables (deep breath test, valsalva ratio, 30:15 ratio, OTT, IHG, CPT) to understand the effect of lipid profile on autonomic control of heart. Results : Significant increases in total cholesterol, triglyceride, LDL, cholesterol/HDL ratio were noticed in women on non-vegetarian diet. Results of autonomic function tests, i.e. valsalva ratio, deep breath test, 30: 15R-R intervals ratio, isometric hand grip test, cold pressor test, and orthostatic tolerance test were significantly worsened in postmenopausal women on non-vegetarian diet. Conclusion: Dietary factors may be an important cause of alteration of lipid metabolism. Increased cholesterol decreases heart rate variability and increased LDL cholesterol decreases baroreceptor sensitivity thereby worsening autonomic functions in postmenopausal women.
  4,305 533 1
CASE REPORTS
A rare case of recurrent pyogenic liver abscess since childhood: A case of Papillon-Lefèvre syndrome
Somak K Das, Tanusree Nath, Prabir Ganguly, Chanchal K Jana
January-March 2013, 6(1):86-88
DOI:10.4103/0975-2870.108659  
Recurrent pyogenic liver abscess since childhood is an uncommon finding in clinical medicine. Papillon-Lefèvre syndrome (PLS) is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis, and severe periodontal destruction involving both the primary and permanent dentitions. Till date, more than 200 cases have been reported worldwide. In addition to the skin and oral findings, patients may have immune suppression and an increased susceptibility to bacteria, associated with recurrent pyogenic infections of the skin. Pyogenic liver abscess is an uncommon presentation of this rare syndrome. We present a case of PLS presenting as recurrent pyogenic liver abscess since childhood.
  3,940 270 1
A case report on Felty's syndrome
Sahil Sanghi, Tushar Aggarwal, Anil Salgia, Samar K Biswas
January-March 2013, 6(1):92-94
DOI:10.4103/0975-2870.108662  
A 35 years old female came to orthopedic OPD with multiple joint pain since 1 year with history of fever and morning stiffness without any history of trauma and previous infection. On examination there was small joint tenderness involving metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints with splenomegaly. Routine investigation revealed neutropenia and rheumatoid factor (RF) was positive. Patient was diagnosed to be suffering from Felty's syndrome. Treatment was initiated with methotrexate. Overall treatment was tolerated well, except for the development of mild fever, mild arthritis and transient thrombocytopenia. She is currently on methotrexate with reasonable control of her symptoms.
  3,910 288 -
ORIGINAL ARTICLES
Obesity and weight control measures: Findings from female college students of Agra
HK Thakkar, K Srivastava, SK Misra, SC Gupta
January-March 2013, 6(1):66-70
DOI:10.4103/0975-2870.108648  
Context: Obesity has negative health impacts. Obese people have higher risk of non-communicable diseases (NCDs). Overweight and obesity during young adulthood can track into later adulthood along with its higher risk for NCDs. Aims: To identify the weight control intention and dietary practices used among normal, overweight, and obese college females and to know the reasons for discontinuation among ever tried subjects. Settings and Design : A cross-sectional study conducted in urban and rural colleges of Agra. Materials and Methods: This was a cross-sectional study among 400 female college students. Height and weight were measured to assess body composition according to BMI (Body Mass Index) criteria (WHO 2002). Study included a semi-structured and semi-open-ended instrument to assess practices related to weight control. Their responses were collected, tabulated, analyzed, and interpreted. Statistical analysis used: Frequency. Results: The prevalence of overweight and obesity was found to be 18.5% and 4.5%, respectively, according to BMI (WHO 2002). One third of the subjects were recording their weight monthly. Slightly less than half of the subjects (46%) were trying to maintain optimum weight. Almost one third of these subjects (33.5%) were presently trying to lose weight. About one fifth of total 400 subjects (20.5%) were not concerned about their weight status. Majority of the subjects (85%) irrespective of their obesity status did not take any professional advice. More than half (52.7%) were resorting to physical activity to lose weight. Taking more fruits/vegetables (44.7%) was found to be the most common healthy dieting practices and most unhealthy was fasting (15.3%). More than one fourth (28.8%) of the subjects abandoned weight control practices because of shortage of time followed by 22.4% due to physical weakness. Conclusions: Collectively, results indicate female college students, regardless of weight status, would benefit from open discussions with health educators regarding healthy and effective dieting practices to achieve/maintain a healthy body weight.
  3,825 319 1
CASE REPORTS
Amebic liver abscess and polycystic liver disease
Karan V. S. Rana, Trupti Tonape, Bharat B Dogra, Srihari Sridharan
January-March 2013, 6(1):89-91
DOI:10.4103/0975-2870.108660  
Polycystic liver disease is a rare disorder which remains asymptomatic. Infection of cyst is a major complication and is usually pyogenic. We report a rare case of amebic liver abscess in a patient with polycystic liver disease. In our search we found one such case report. Clinical features and radiological findings are usually sufficient, but atypical history and the presence of multiple hepatic abscesses in CT scan delayed diagnosis in our case. Histopathology of the cyst wall and enzyme immunoassay asserted the diagnosis.
  3,754 267 -
Toluene-induced acute lung injury
Abhishek Singhai
January-March 2013, 6(1):82-83
DOI:10.4103/0975-2870.108655  
Toluene inhalation is an important occupational health hazard in persons working in factories manufacturing paint, chemicals, pharmaceuticals, and rubber. The present report describes an unusual case of toluene-induced acute lung injury threatening life.
  3,338 336 2
ORIGINAL ARTICLES
The effect of Helicobacter pylori infection on oxidative stress status in erosive reflux disease
Masoud Sadreddini, Yousef Rasmi, Zahra Shahsavari, Fariba Khosravifar, Mohammad Rahmati
January-March 2013, 6(1):55-59
DOI:10.4103/0975-2870.108643  
Background and Objectives: Helicobacter pylori (H. pylori) infection has been associated with increased production of reactive oxygen species, which leads to oxidative stress in the gastrointestinal mucosa. Nevertheless, the association of H. pylori infection and oxidative stress in erosive reflux disease (ERD) is still unclear. We sought to investigate the association between oxidative stress status and H. pylori infection in ERD. Materials and Methods: Eighty-three ERD patients (45 male/ 38 female; mean age: 40.4 ± 14.3 years) who had heartburn and/or regurgitation and erosion(s)-confirmed by endoscopy-in the distal esophagus were enrolled. Two antral biopsies were taken from the patients for rapid urease test. Blood samples were drawn for measurement of oxidative stress parameters, including malondialdehyde (MDA), ferric reducing antioxidant power (FRAP), superoxide dismutase (SOD) activity, and glutathione peroxidase (GPX) activity. Data were compared among H. pylori(+) and H. pylori(-) patients. Results : The overall prevalence of H. pylori infection was 71% (59/83). There was a significant increase in the levels of MDA in H. pylori(+) patients (0.98 ± 0.28 μmol/l) when compared with H. pylori(-) patients (0.84 ± 0.33 μmol/l; P = 0.048). However, the levels of FRAP in the H. pylori-infected patients were significantly lower than in those without infection (941 ± 211.8 vs. 1060.3 ± 216.6 μmol/l, respectively; P = 0.028). There were no significant differences in SOD activity, GPX activity, age, sex, and body mass index (BMI) of H. pylori(+) vs. H. pylori(-) patients (P > 0.05). Conclusion: Increased levels of MDA in H. pylori(+) patients showed association between oxidative stress and H. pylori infection in EDR patients. Also, considerable changes of antioxidant concentrations indicate a compensatory mechanism to cope with the increased oxidant status in H. pylori(+) patients. It may be concluded that oxidative stress increases in the presence of H. pylori in ERD patients, and antioxidant defense mechanisms, try to minimize oxidative stress damage.
  3,230 298 1
QUIZ
Wordoku: Answers
Garima Lakhanpal
January-March 2013, 6(1):113-113
DOI:10.4103/0975-2870.108670  
  3,168 215 -
ORIGINAL ARTICLES
Echocardiographic assessment of hypertensive changes in elderly patients with isolated systolic hypertension and its correlation with pulse pressure
Shubhangi A Kanitkar, Meenakshi Kalyan, Anu N Gaikwad, Neeti Singh, Amit S Bhate, M Midhun
January-March 2013, 6(1):75-78
DOI:10.4103/0975-2870.108651  
Context: Isolated systolic hypertension (ISH) is increasingly recognized as a cardiovascular risk factor. Increase in pulse pressure is a powerful independent predictor of cardiovascular events. Aims: To study the hypertensive changes by 2D echocardiography in elderly patients with ISH and to compare the hypertensive effects in patients with pulse pressure between 50-70 mmHg and >70 mmHg. Settings and Design: This observational case series study was conducted over a period of 2 years (2009-2011) at a tertiary care hospital in Pune. Materials and Methods: Seventy-six newly diagnosed cases of ISH among the geriatric population over 60 years of age who attended the medicine and geriatric outpatient departments (OPDs) were studied for the hypertensive changes on 2D echocardiography and Doppler. Inclusion criteria were patients ≥ 60 years of age having systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) ͳ90 mmHg. The patients were divided into two groups according to pulse pressure (50-70 mmHg and >70 mmHg). Left ventricular hypertrophy (LVH), diastolic dysfunction, and systolic dysfunction were evaluated on 2D echocardiography and correlated with the pulse pressure. Statistical Analysis Used: Chi-square, Odds Ratio (OR) with 95% Confidence Intervals (CI) were done using SPSS. Results: Out of 76 patients, 48 patients (63.1%) had diastolic dysfunction, 46 patients (60.5%) had LVH, and 36 patients (47.4%) had systolic dysfunction on 2D echo. Patients with pulse pressure >70 mmHg showed increased incidence of LVH (75.6%) than those with pulse pressure 50-70 mmHg and (46.2%) respectively. There was no significant change in incidence of systolic dysfunction in the two groups. Conclusions: Incidence of LVH and diastolic dysfunction was more in ISH. Incidence of LVH and diastolic dysfunction was found to be more in patients with wide pulse pressure.
  3,017 339 -
LETTERS TO THE EDITOR
Concept of specialty - OPD for diabetes
Vijayashree Gokhale, Neha Chaudhary
January-March 2013, 6(1):111-112
DOI:10.4103/0975-2870.108669  
  3,055 256 -
CASE REPORTS
Adult benign multicystic nephroma: A diagnostic dilemma
Chandan Chatterjee, Dawood Khan, Utpal De
January-March 2013, 6(1):84-85
DOI:10.4103/0975-2870.108657  
Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, non-genetic, benign, unilateral renal multicystic lesion. The non-specific clinical findings and the paucity of information from imaging techniques make the preoperative dilemma from othercystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in forty years male patient presented with asymptomatic lump in abdomen.
  2,695 288 -
COMMENTARY
Changing trends in the management of incisional hernias
Subhash Chawla
January-March 2013, 6(1):31-32
  2,582 277 -
EDITORIAL
Industry and the medical profession: Sleeping with the enemy
Amitav Banerjee
January-March 2013, 6(1):1-2
DOI:10.4103/0975-2870.108622  
  2,368 283 -
LETTERS TO THE EDITOR
Enuresis in people with intellectual disabilities
Rajendra C Pande, Neha R Pande
January-March 2013, 6(1):109-109
DOI:10.4103/0975-2870.108667  
  2,406 215 -
COMMENTARY
Broadening horizons in psychiatry and respiratory medicine
Darpan Kaur
January-March 2013, 6(1):19-20
  2,319 252 -
Tibial plateau fractures
Samar K Biswas, Ajit Swamy
January-March 2013, 6(1):41-42
  2,180 363 -
GUEST EDITORIAL
Bending the truth ostensibly for public good: The case of the pneumococcal conjugate vaccine
Jacob Puliyel
January-March 2013, 6(1):3-4
DOI:10.4103/0975-2870.108623  
  2,216 305 -
CASE REPORTS
A case of double meningomyelocoele with hydrocephalous in a four months' infant
Anuja A Goyal, Vangapuram Raghavachari Rangachari, Chhaya Suryavanshi
January-March 2013, 6(1):102-104
DOI:10.4103/0975-2870.108665  
Meningomyelocoele is a developmental congenital disorder caused by failure of the neural tube to close during the first month of embryonic development thus presenting with herniation of neural elements along with meninges. Myelomeningocoeles most commonly occur in the lumbosacral region, but can also occur at any level in the neuraxis, including occipital/suboccipital areas or nasally (encephalocoele).We report a rare case of double meningomyelocoele in a 4-month-old infant (cervical as well as thoracic meningocele) with weakness in the left lower limb (power grade 0) posted for resection with difficult intubation because of obstructive hydrocephalus, fear of rupture of neuroplaque, positioning and care of blood loss and temperature. The infant was discharged within 15 days, and his hospital stay was uneventful.
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