Comparative study of single versus multiple gallstone disease in KGH, Visakhapatnam

Objective: To evaluate the differences in the presentation, their operative implications and difficulties of single stone versus multiple gall stone disease.Methods: This is a prospective study of a minimum of 60 patients with gall stone disease (Group 1-single, Group 2-multiple) from January 2019 to December 2019 in KGH, Visakhapatnam.Results: More common in females, 40-50 years symptoms and complications, TC count difficult cholecystectomies were more in multiple gall stone pts.Conclusion: Multiple gall stones have led to more severe symptoms and complications and difficult surgery. should be motivated for early surgery even in incidental finding and should not opt for conservative management.

Clinical, etiological and laboratory profile of febrile thrombocytopenia and correlation of platelet count with outcome in a South Indian tertiary hospital

Background: Febrile thrombocytopenia is commonly encountered by doctors especially during monsoon and peri-monsoon period, many of these patients have a turbulent cthisse with multi organ dysfunction and might land up in ICU with significant morbidity and mortality. Infections are the commonest causes of thrombocytopenia and they vary with season and geographical location. A systematic approach, carried out with an awareness of causes, clinical presentation and laboratory profile of febrile thrombocytopenia can shorten the duration of investigations and bring out the diagnosis early, reducing morbidity and mortality of patients and reducing burden on hospital resthisces. The objective of the study is to study the underlying etiology, the various clinical presentations, laboratory profile and complications of fever with thrombocytopenia in this community during monsoon period and to correlate thrombocytopenia with outcome, co morbidities and its etiology.Methods: The prospective observational study was conducted in tertiary centre in Kolar between June-December 2017. Patients meeting inclusion and exclusion criteria were grouped into 4 groups based on platelet counts, and correlated with comorbidities, etiology and outcome. Detailed clinical and laboratory examination were done in all patients and p value of <0.05 was considered statistically significant.Results: Among 465 patients were included in the study. Dengue was the most common cause for febrile thrombocytopenia and mortality. Hepatic complications and petechiaes were the most common complications and bleeding manifestations. 135 patients received platelet transfusion but there was no relationship between platelet transfusion and outcome, there were 9 deaths in the study and there was no association between death and platelet count at admission.Conclusions: There was no relation between platelet count on admission and mortality and also there was no relationship between platelet transfusion and outcome. Knowing the clinical presentation, etiology, complications and its monitoring can significantly reduce the morbidity and mortality due to febrile thrombocytopenia.

Multidetector Computed Tomographic Evaluation of Mandibular Fractures in Eastern Indian Population: A Retrospective Study

Background. The aim of the study is to analyze the pattern of mandibular fracture in eastern Indian population. Methods: A retrospective study of 92 computed tomographic examination imaging data showing mandibular fractures during the period from January 2016 to June 2019 were retrieved from radiology data storage and was evaluated. Data were analyzed statistically. Result-The study revealed 83 (90.2%) male and 9 (9.8%) female cases with mean age 34.3 and male female ratio 11.8/1. The most common cause of injury was road traffic accident. The most common fracture sites were parasymphyseal location (92%) followed by mandibula body fracture. The mandibular fractures were treated by open reduction and internal fixation. Conclusion: The most common cause of mandibular fracture in eastern Indian population was RTA. The parasymphyseal fracture is the most common type of mandibular fracture.

Magnetic Resonance Evaluation of Normal Optic Nerve Sheath and Optic Nerve Diameter in Eastern Indian Paediatric Population- A Retrospective Study

Background: Prospective magnetic resonance imaging (MRI) of orbits in healthy paediatric population is difficult as it involves sedation or general anaesthesia in most of the cases. The data of normal value of healthy paediatric optic nerve and optic nerve sheath diameter is also scant in literatures for Indian paediatric population. The normal data will help in defining abnormal optic nerve such as congenital optic nerve hypoplasia, optic nerve atrophy and distended optic nerve sheath in raised intracranial pressure. AIM: The aim of our retrospective study is to define the normal value of optic nerve and optic nerve sheath diameter in MRI of paediatric Indian population. MATERIAL AND METHODS:190 MRI studies of paediatric brain with normal radiology reports and no history of raised intracranial pressure were retrospectively reviewed by two senior radiologists using T2 weighted axial brain images. RESULT: The mean optic sheath diameter and optic nerve diameter of 380 eye balls were 4.746 and 2.59 mm respectively. The age wise distribution of optic sheath diameter and optic nerve diameter were 4.08±0.019, 2.05±0.608 in 0-2-year age group, 4.83±0.575, 2.54±0.456 in 3-6-year age group, 4.789±0.553, 2.704±0.447 in 7-12-year age group, and 4.82±0.567, 2.65±0.412 in 13-18 years age group in mean (mm)±standard deviations respectively. Three hundred seventy-one (97%) optic sheath measurement of the 380 eye balls was below the threshold of 6 mm and about 352 (92%) optic nerve measurements out of 380 globes were having optic nerve thickness above 2 mm. This normative data will help the ophthalmologist, clinician, neuro-ophthalmologist and radiologists for better quantitative evaluation of pediatric patient with vision abnormality.

Significance of APTT as early predictor of bleeding in comparison to thrombocytopenia in dengue virus infection

Background: Dengue is a systemic viral infection transmitted by mosquitoes such as Aedes aegypti or Aedes albopictus. Dengue Fever (DF) is characterized by fever, headache, muscle or joint pain, and rash. The spectrum of dengue virus infection spreads from an undifferentiated fever and dengue fever (DF) to dengue haemorrhagic fever (DHF) with shock. Factors responsible for bleeding manifestations in dengue are vasculopathy, thrombocytopenia, coagulopathy, and disseminated intravascular coagulation (DIC). Coagulopathy results in derangement of activated partial thromboplastin time (APTT) which is an indicator of impending bleeding risk.Methods: A prospective study was conducted from June to December in 2017 in R L Jalappa Hospital. Patients aged above 18 years with febrile thrombocytopenia who are positive for dengue virus serology (NS1Ag and/ or IgM) were included in the study. Serial daily monitoring of platelet count and analysis of APTT levels were done. APTT was considered abnormal if it was more than 33.8s. Patients were followed up for evidence of leaking and bleeding manifestations.Results: Out of 170 patients 28.1% patients had bleeding manifestations. Bleeding signs were seen on clinical examination in 52.37% of patients. capillary leak was found in the form of Pleural effusion in 35.3%, Ascites in 41.2% and Periorbital edema in 31.2% of patients. Elevated APTT levels were seen in 110(64.7%) patients. Among patients with abnormal APTT platelet transfusion was done in 78.9% of patients, and among those with normal APTT levels platelet transfusion was done in 21.1% of patients.Conclusions: Our study showed significant correlation between bleeding manifestations and prolonged APTT levels as well as thrombocytopenia with abnormal APTT levels. Study concluded that 21.1% of platelet transfusions could have been prevented considering prolonged APTT as a predictor of bleeding manifestation, thus saving the resources and reactions due to platelet concentrate transfusion.

Autopsy findings of miliary tuberculosis in a renal transplant recipient

Miliary tuberculosis is a lethal form of disseminated tuberculosis (TB), deriving its name from the millet-seed-sized granulomas in multiple organs. As TB still remains a leading cause of morbidity and mortality in India, its disseminated forms need to be diagnosed early to ensure more aggressive treatment at the earliest possible time. However, a considerable number of cases are missed ante-mortem. We discuss the case of a 32-year-old immunocompromised, non-HIV patient with an ante-mortem diagnosis of pulmonary TB. However, multiple organ involvement by was demonstrated on autopsy. This case highlights the role of autopsy as a research and learning tool, and prudential clinico-pathologic correlation, which will improve clinical outcomes in the future.

Pyramidal molar roots in primary and permanent dentition along with non syndromic oligodontia in a 11 year old boy.

Primary and permanent molars are usually multi rooted. At times we can encounter cases with a single root, called pyramidal root. Oligodontia is defined as the developmental absence of six teeth or more, excluding third molars. It can be isolated (Oligodontia-I) or as a part of a syndrome (Oligodontia-S) such as in ectodermal dysplasia. The present report describes a case of single-rooted primary and permanent molars associated with oligodontia in an 11 year old boy with no apparent systemic complications.

Management of three fused primary teeth.

Fusion is a dental anomaly in which two dental germs have developed separately and then become united. It is often confused with germination, unless until carefully evaluated clinically and radiographically. This paper describes a case of a six year old boy who presented with pain and swelling in right lower back tooth region. Intra oral examination revealed three fused primary teeth, which were confirmed radiographically. Radiographs also revealed missing permanent tooth buds associated with them. Since all the fused teeth were pulpally involved they were managed by pulpectomy. The incidence, prevalence, complications and treatment modalities are also discussed in this case report.

Association of Helicobacter pylori restriction endonuclease-replacing gene, hrgA with overt gastrointestinal diseases / Associação entre o hrgA (Helicobacter pylori restriction endonuclease-replacing gene) com as principais doença gastrointestinais

BACKGROUND and AIM: Helicobacter pylori has been proven to be responsible for causing various gastrointestinal disorders including gastric adenocarcinoma. Several genes of pathogen (the genes of the cag-PAI, vacA, iceA, and babA) either in combination or independently have been reported to significantly increase the risk of ulceration/gastric carcinoma, with the cagA gene having the strongest predictive value. Pursuit to identify new genes which could serve as a marker of overt disease progression, lead to the discovery of hrgA gene. METHODS: Fifty-six indigenous strains of H. pylori from subjects with various gastric disorder were screened to assess the status of hrgA gene along with the cagA gene using simple polymerase chain reaction using specific oligonucleotide primers. Post-amplification, amplicons were subjected for sequencing to identify any strain specific variations in sequences from the H. pylori isolated from different disease manifestations. Histopathological analysis was done to ascertain any significant change in the histological scores of subjects infected with cagA+/hrgA+ and cagA-/hrg+ strains. RESULTS: All the 56 (100 percent) subjects amplified with the oligonucleotide primers specific to hrgA gene, whereas 81.71 percent subjects showed the presence of cagA gene. Sequencing of the amplimers showed 99 percent homology. Histology of the cagA+/hrgA+ and cagA-/hrg+ subjects did not show any significant difference. CONCLUSION: hrgA gene of Helicobacter pylori is not a ideal surrogate marker for identifying individuals with higher risk of developing overt gastro-duodenal diseases such as neoplasia of the stomach.

RACIONAL e OBJETIVOS: O Helicobacter pylori tem sido incriminado como causador de vários distúrbios digestivos, incluindo o adenocarcinoma gástrico. Diversos genes patogênicos (os genes do cag-PAI, vacA, iceA e babA), em combinação ou independentes, têm sido reportados como fatores de aumento de risco para ulceração/carcinoma gástrico, tendo o gene cagA forte valor preditivo. A procura da identificação de novos genes que possam vir a ser marcadores da progressão da doença levaram à descoberta do gene hrgA. MÉTODOS: Cinqüenta e seis amostras de H. pylori provenientes de pacientes com diversas afecções gástricas foram examinadas para caracterizar a presença do hrgA juntamente ao cagA, usando iniciadores específicos da reação de cadeia da polimerase. Após amplificação, os produtos amplificados pela PCR foram seqüenciados para a identificação de variações específicas nas seqüências do H. pylori isolado de diferentes doenças gastroduodenais. A análise histopatológica foi feita para assegurar qualquer mudança significativa nos escores dos indivíduos infectados com cagA+hrgA+ e cagA-/hrgA+. RESULTADOS: Todas as 56 amostras (100 por cento) foram amplificadas com iniciadores específicos para o hrgA, enquanto que 81,71 por cento mostraram a presença do cagA. O seqüenciamento do produto amplificado pela PCR mostrou 99 por cento de homologia. A histologia entre os grupos cagA+/hrgA+ e cagA-/hrgA+ não mostrou nenhuma diferença significante. CONCLUSÃO: O gene hrgA do H. pylori não é o marcador ideal para identificar indivíduos com alto risco de desenvolvimento de doenças gastrointestinais como a neoplasia de estômago.