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Wolff-Parkinson-White (WPW) syndrome is a rare congenital cardiac pre-ex citation syndrome encountered during pregnancy. However, WPW under this physiological process might be responsible for life threatening arrthymias leading to dangerous outcomes for both mother and the fetus. It is a ventricular pre-excitation syndrome of anterograde activation of the ventricle resulting from aberrant conduction pathway as well as the AV node. Very small percent of patients with WPW syndrome that is less than 1% are at risk of sudden cardiac death. Most of the antiarrthymic drugs are a threat to the fetus therefore careful choice of drug has to be made. Digoxin is the drug that is contraindicated in adults with WPW syndrome and some drugs like verapamil increase danger of ventricular fibrillation and therefore use of drugs are a topic of concern. We present a case of 25-year-old primi gravida 31 weeks 5 days woman was admitted with oligohydramnios. Patient known case of WPW syndrome not on treatment showing ECG changes ofshort PR interval and delta wave slurring along the QRS complex with heart rate of 98 beats/ min and echo demonstrated mild tricuspid regurgitation (TR) and mild pulmonary arterial hypertension (PAH). Patient was taken for emergency LSCS in view of Doppler changes (CPR less than 1) and delivered an alive preterm baby.
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INTRODUÇÃO: A craniotomia torna mais fácil a compreensão e abordagem do cérebro, mas acompanha as doenças. As unidades de terapia intensiva são equipadas com fisioterapeutas profissionais treinados para lidar com esses efeitos deletérios após este programa cirúrgico, mas falta um protocolo progressivo, definido e apoiado por evidências para esses pacientes. OBJETIVO: Avaliar a viabilidade do protocolo de neuro-reabilitação elaborado para pacientes pós-craniotomia durante sua internação em Unidade de Terapia Intensiva (UTI) para melhorar seus resultados funcionais e reduzir seu tempo de internação (LOS). MATERIAIS E MÉTODOS: Será um ensaio de quase viabilidade pós-teste de pré-teste de grupo único. Quinze pacientes submetidos à craniotomia serão recrutados para o estudo e serão processados com protocolo de Neuro-reabilitação por 60 minutos do primeiro dia da cirurgia até o 15º dia da cirurgia. O resultado primário será a Escala de Habilidades Funcionais Precoces (EFA) para medição de resultados funcionais como nível de consciência, habilidades sensório-motoras, habilidades cognitivo-perceptuais e habilidades oromotoras de pacientes que serão avaliadas no primeiro dia após a craniotomia. Os resultados secundários incluirão Escala de Coma de Glasgow (GCS), Escala de Recuperação de Coma - Revisada (CRS-R), Técnica de Reabilitação de Avaliação de Modalidade Sensorial (SMART), Escala de Ashworth modificada modificada (mMAS), Pontuação de Avaliação Cognitiva de Montreal (MoCA) e Conselho de Pesquisa Médica Escala (MRC). As avaliações serão feitas no primeiro e no décimo quinto dia pós-operatório. PERSPECTIVAS: Espera-se que este protocolo melhore os resultados funcionais e reduza a incidência de ocorrência de comorbidades em pacientes após craniotomia em UTI.
INTRODUCTION: Craniotomy makes insight and approach towards the brain easier but accompanies ailments. Intensive care units are equipped with trained professional physical therapists working over these deleterious after-effects of this surgical program, but a progressive, defined, and evidence-supported protocol for such patients is lacking. OBJECTIVE: To assess the feasibility of a Neurorehabilitation protocol devised for post-craniotomy patients within their stay in the Intensive Care Unit (ICU) to improve their functional outcomes and reduce their length of stay (LOS). MATERIALS AND METHODS: It will be a single group pre-test post-test quasi feasibility trial. Fifteen patients undergoing craniotomy will be recruited for the trial and will be rendered with Neuro-rehabilitation protocol for 60 minutes from the first day of surgery up to 15 days of surgery. The primary outcome will be the Early Functional Abilities (EFA) Scale to measure functional outcomes like conscious level, sensorimotor abilities, cognitive-perceptual abilities, and oro-motor abilities of patients, which will be assessed first-day post craniotomy. Secondary outcomes will include Glasgow Coma Scale (GCS), Coma Recovery Scale-Revised (CRS-R), Sensory Modality Assessment Rehabilitation Technique (SMART), Modified Ashworth Scale (mMAS), Montreal Cognitive Assessment Score (MoCA), and Medical Research Council Scale (MRC). Assessments will be taken on the first and fifteenth days post-surgery. PERSPECTIVES: It is expected that this protocol might improve functional outcomes and may reduce the occurrence of comorbidities in patients after Craniotomy in ICUs.
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Craneotomía , Coma , Unidades de Cuidados IntensivosRESUMEN
Background:To assess length and shape of nasopalatine canal on human dry skulls. Subjects and Methods:Fifty- four dry human skulls of either gender was recruited for the study. The length of the nasopalatine canal was measured from the definite point (interproximal region) of the central incisors to the distal end of the incisive foramen. Incisive foramen diameter was calculated in the sagittal plane by measuring the anteroposterior distance of the oral entrance of the NPC. Shape was categorized into 4 types, Cylindrical, funnel, hourglass and spindle shape.Results:The mean length of nasopalatine canal was 16.2 mm in males and 13.4 mm in females. A significant difference was observed (P< 0.05). A non- significant difference in male (5.3 mm) and females (4.9 mm) incisive foramen diameter was observed. The most common shape of nasopalatine canal was cylindrical in 23, funnel in 7, hourglass in 21 and spindle shape in 3 skulls. A significant difference was observed (P< 0.05).Conclusion: Nasopalatine canal morphology assessment is essential to prevent iatrogenic injury to the anatomical structures. Mostcommon shape found to be hour glass and cylindrical
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Background: Birth is often referred to as “the miracle of life” and very rightly so since successful pregnancy represents a complex, a highly coordinated succession of biological processes. In this regard, it is remarkable that pregnancy ever occurs at all. Infertility is a reproductive system disorder affecting 10.7% to 15.5% of couples. Highly heterogeneous in etiology. Investigating the cause is necessary for guiding treatment options. Aim of the study was to determine the percentage of immature oocytes retrieved at the metaphase 1 stage and germinal vesicle stage and its outcome.Methods: Total 30 cases were included for this retrospective analysis of data done at ARC fertility center, Saveetha Medical College. This study analyzed the data of patients with unexplained infertility who underwent ICSI centers (affiliated to Saveetha University) meeting inclusion criteria and willing to participate in the study.Results: The mean number of fertilized oocytes among those with more than 25% immature oocyte proportion was 1.18 while among those with less than 25% immature oocyte proportion was 4.13. The chance of fertilization of the oocyte increases when the percentage of immature oocyte was less than or equal to 25%. The association was found to be statistically significant with p-value <0.05.Conclusions: Thus, some intrinsic oocyte factor could be involved in causing maturation arrest in such couples and resulting in multiple failed IVF cycles.so this oocyte factor could be a major cause in many cases of unexplained infertility.
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Introduction: The sulci of the human brain are specifically the result of an evolutionary infolding process. Theseare the anatomical structures which border and divide the adjacent gyri. Knowledge of pattern of sulci and theirsulcul and intersulcal length is important for diagnosis of neurological, functional and cognitive disorders.Aim: The aim of the study is to present the significance of morphological and morphometric measurements ofsulci of superolateral surface of frontal lobe and their comparison between right and left cerebral hemispheres.Materials and methods: The study comprised of 50 formalin fixed cerebral hemispheres 25 right and 25 left, ofhuman cadaver of unknown sex which were obtained from the Department of Anatomy, Government MedicalCollege, Amritsar. . All the parameters were taken by using standard digital vernier calliper and calibrated scale.Result and conclusion: All the sulci of superolateral surface of frontal lobe were found to be present in all thespecimens of right and left cerebral hemispheres except AHR which was absent in 4%(2) specimens of the rightside. The mean length of CS and PreCS was found to be more in right hemispheres where as mean depth of bothsulci was more in left hemispheres. Mean length and depth of lateral sulcus was more in left side as comparedto right. Mean length of SFS and IFS was greater in right hemispheres whereas the mean depth of both the sulciwas found to be similar in both sides. Hence the differences in sulcul length and depth indicate that the twocerebral hemispheres differ structurally and it can be speculated that some morphological asymmetries couldbe related to other functional hemispheric specialization
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Introduction: Chronic obstructive pulmonary disease (COPD)is a major cause of chronic morbidity and mortality throughoutworld. Pulmonary hypertension (PH) is a common and wellestablished complication of COPD. Therefore, the presentstudy was designed to investigate the pulmonary hypertensionfrequency of hospitalized COPD patients with the PFTparameters, demographic aspects, smoking status, and historyof use of biomass.Methodology: Subjects were chosen from the patientspresented to OPD and IPD patients in the Department of TBand Chest (Respiratory Medicine), Geetanjali Medical College,Udaipur, Rajasthan, India. The duration of study was over aperiod of six months.Results: In our study 160 total numbers of cases wereincluded. Among all cases 63.75% had exposure of tobaccosmoke and 36.25% had biomass exposure. The prevalence ofsevere pulmonary hypertension from all categorization were17.6% in cigarette cases followed by other.Conclusion: We conclude that strategies like modification ofstove design, switching over to other high-efficiency & lowemission fuels for cooking to reduce exposure risk.
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Introduction: Spondyloarthropathies are a heterogeneousgroup of inflammatory interrelated diseases involvingperipheral joints and spine. All forms of spondyloarthropathiesare known to have a strong association with HLA-B27 gene invarious studies done. There was a paucity of literature aboutclinical and demographic characteristics of the HLA-B27positive arthritis patients in Rajasthan. So this study wasplanned to know the seropositivity of HLA-B27 amongseronegative spondyloarthritis patients and to find outassociation between socio-demographic and clinicalcharacteristics and HLA-B27 seroprevalence.Materials and Methods: A cross sectional observational studywas carried out from May 2017 to April 2018 in Department ofPathology, SMS Medical College, Jaipur (Rajasthan). A total of100 cases of spondyloarthritis disease were enrolled in thestudy to find out seroprevalence of HLA-B27 and todifferentiate the clinical and demographic characteristics inHLA-B27 positive and negative patients.Results: In the present study 29% seroprevalence of HLA-B27was observed. Seropositivity of HLA-B27 was significantlyassociated with age (P-value < 0.05) while sex, religion, caste,family history, raised ESR, Positive C-reactive protein, RAfactor etc. were showed no significant association (P-value >0.05).Conclusion: This study confirms the previously reportedassociation in ankylosing spondylitis patients between HLAB27 and earlier disease onset with male preponderance &family aggregation.
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Staphylococcus pseudintermedius is a part of canine skin and oral flora. It is a bacteria mainly pertaining to veterinary interest. Here, we present the case of a 40-year-old female presented in the surgical department with non-healing pyoderma for 1 year. Culture and sensitivity of the pus drained from the abscess showed S. pseudintermedius (methicillin-susceptible) identified by Vitek 2. She was treated by amoxy clavulanic and responded well with no recurrence. The patient owned a pet dog which was apparently healthy. However, her symptomatic duration started very soon after the pet dog was brought into the house. Isolation of the organism from the pet could not be done. S. pseudintermedius is an underrecognized zoonotic domestic infection. A proper clinical history and advanced diagnostic technology play a role in the identification of such infections.
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Background: The imbalance of the adipoinsular axis has been shown recently to predispose to cardio renal syndromes. Epigenetics, which deals with the metabolic influences on genetic signaling, is a new concept. Diabetes during gestation can also cause an inflammatory response in placenta. The levels of leptin/adiponectin in the neonate of a mother with diabetes can affect post insulin signaling leading to fuel mediated teratogenicity. The reactive oxidative species generated at the maternal-fetal interface can alter inhibitory or permissive gene expression resulting in chromatin epigenetic remodeling of genes in multiple organs dysfunction, including the pancreas, kidney, heart, and the muscle. The fetal cardiac malformations can be mediated by these modifications of the transcriptome. Objectives: The primary objective of the study was to explore the relationship between maternal type II diabetes mellitus and gestational diabetes with congenital heart disease in new-borns. The secondary outcome of the study was to do pre-conception counseling and emphasize the importance of peri-conceptional sugar control. Materials and Methods: This prospective study involved cardiovascular system examination of 229 single pregnancies with pre-gestational and gestational diabetes (19 pregnant women were lost for follow up in control group). Two hundred twenty nine non-diabetic women of were taken as matched controls. The case and control group were comparable with no significant differences in maternal age, ethnicity and parity. Diabetic pregnant women were also offered fetal echocardiography at 24-28 weeks of gestation in second trimester. Results: In this study, 1 out of 78 gestational diabetes and 7 out 132 pregnancies with type 2 diabetes mellitus resulted in Congenital Heart Defects. Overt diabetes mellitus (p value significant) as compared to gestational diabetes was found to be a more likely risk factor associated with CHD. There were two cases of Ventral Septal Defect (VSD) in non-diabetic pregnant women diagnosed postnatally. Conclusion: Community education programmes should be initiated in high-risk population to promote better fetal surveillance in diabetic mothers for early in utero detection of cardiac defects. Maternal counseling for peri-conceptional control of blood glucose, adequate weight maintenance, intake of Insulin and exercise is needed to prevent CHD. Fetal echocardiography is a useful tool to screen high-risk fetus that require tertiary neonatal set up and emergency cardiac surgical interventions.
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Background: Preterm delivery is a major cause of neonatal mortality and morbidity. Various modalities have been used to prediction of patient at risk of preterm labor. But due to multi-factorial etiology these predictors are not always useful. Tocolysis has a major role in arresting preterm labor. The purpose of this study was to compare the safety and efficacy of oral nifedipine with transdermal nitroglycerine in the inhibition of preterm labour.Methods: This single blinded randomized control trial was conducted in the labour room of department of Obstetrics and Gynecology from January 2011 to June 2012. One hundred women with singleton pregnancy between 28 weeks to 34 weeks preterm labour and no contraindication for tocolysis were enrolled in the study. After taking the informed consent subjects were randomized into two groups. Randomization was done by random number table. Fifty-one subjects in nifedipine group received oral nifedipine (Tab Depin 10mg). Forty-nine subjects receiving transdermal nitroglycerine patch (Nitroderm Patch 10) were included in NTG group. The variables analysed were delay in delivery for 48 hours, 7 days or more than 7 days, period of gestation at delivery and side effect profile of drugs.Results: The percentage of women delivering after 48hours of administration of nifedipine group (52.9%) and nitroglycerine group (53.1%). Failure of tocolysis, defined as delivery within 48 hours, with nitroglycerine group (32.7 %) was comparable to nifedipine (33.3 %). Headache was significantly higher in nitroglycerine group as compared to nifedipine group (p≤0.001). Maternal tachycardia was more common in nifedipine group compared to NTG group (p=0.001).Conclusions: Oral nifedipine and transdermal nitroglycerine have similar efficacy as tocolytic agent in patients with preterm labour.
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Background: Congenital Heart Diseases (CHD) are defined as malformations of the heart and great vessels that develop in utero which may manifest at birth or later in childhood. They can be caused by numerous genetic and environmental factors. Genetic factors are nonmodifiable. However, identification of modifiable environmental risk factors is important to develop population based prevention strategies to reduce the incidence of CHD. Objectives: The primary objective of the study was to find an association of the maternal lifestyles with CHD in new-borns. The secondary outcome of the study was to identify maternal factors that can be modified for the primary prevention of CHD. Materials and Methods: This prospective study involved cardiovascular system examination of newborns after delivery in term gestations in 1394 singleton pregnancies. The maternal risk factors considered were age, prepregnancy Body Mass Index (BMI), consanguineous marriage, caffeine intake, diabetes, stress and intake of periconceptional Folic acid tablets. Results: In this study, 22 (1.58%) out of 1394 pregnancies resulted in Congenital Heart Defects. Teenage pregnancy (p value= 0.0002), consanguineous marriage (p value=0.0004), overt diabetes mellitus (p value=0.0001), caffeine intake (p value=0.0031), prepregnancy BMI>24(p value=0.0001), maternal stress (p value<0.0001, history of previous congenital malformations (p value=0.004) and non intake of folic acid tablets in the first trimester (p value=0.0023 were found to be the most likely risk factor associated with CHD. Conclusion: Community education programmes should be initiated in the high-risk population to prevent teenage pregnancies and consanguineous marriages. Maternal counseling for periconceptional control of blood glucose, adequate weight maintenance, intake of folic acid tablets, avoidance of stress and caffeine is needed to prevent CHD.
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Background: Preeclampsia is defined as new onset hypertension and albuminuria in previously normotensive pregnant women after 20 weeks of pregnancy. There is no cure; management is reliant on a structured antenatal surveillance programme and antihypertensives. Recent advances in immune histochemistry study of placenta have elucidated an increased Vascular Endothelial Growth Factor (VEGF) expression in various placental bed disorders like recurrent pregnancy loss, preeclampsia, fetal growth restriction, preterm and abruption placenta. Increased release of VEGF family proteins has been attributed to atherosis and placental hypoxia. However, some studies have found normal VEGF concentrations in placenta in these disorders of feto-maternal interphase. Objectives: The study aims to analyse the VEGF expression in placental biopsy from preeclampsia and normotensive pregnancies. Materials and Methods: This prospective study involved the gross and immune histology examination of human placenta after 31-40 weeks gestation period in 20 singleton preeclampsia pregnancies. Twenty placentas of normotensive pregnancies were taken as controls. Results: In the present study, VEGF density was more in the placentas from preeclampsia pregnancies as compared to placenta from a normal pregnancy. The mean weight of placenta was smaller in preeclampsia group. Additionally, the fetal capillaries were also small in diameter and lumen was collapsed. The pulsatility index of uterine artery supplying the placenta was also higher in preeclampsia pregnancies. The high velocity blood flow can mechanically damage the tender fetal villi floating in the intervillous space. This damage collapses the fetal capillaries as evidenced by the smaller diameter of fetal capillaries in the placental biopsy. Conclusion: Placental hypoxia in cases of preeclampsia is a potent stimulus for VEGF expression. Nevertheless, the increased VEGF expression should be seen in the light of collapsed fetal vessels in a small placenta.
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Introduction-Leprosy is a chronic infectious disease which still remains a serious public health problem due to its ability to cause disability. The prevention of leprosy ultimately lies in the early diagnosis and treatment of the individ-uals having leprosy. Changing leprosy scenario has led to requirement of leprosy education. However the knowledge of medical college students on leprosy remains unknown. Aim: To assess the post-sensitization knowledge and awareness of medical students after state leprosy sensitization program. Materials and methods: A questionnaire based, cross sectional study was conducted among 107 medical students of different years starting from 2ndyear and onwards in the month of July 2017 after state leprosy sensitization program. Results: Among the medical students 70 (75%) were male students and 37(25%) were female students coming from different years of their admission in med-icalcollege.Regardingthebasicknowledgeofleprosy100%of3ndyear and final year students were having knowledge about the cause of leprosy and 100% of final year and 3rdyear medical students know about other name of Leprosy (Hansen,s disease) respectively.100% of final year ,3rdyear and 2ndyear medical students had knowledge about multidrug therapy (MDT) in in-depth knowledge of leprosy respectively. Regarding the virulence of bacilli 87%, 60% and 63% of final, 3rd and 2nd year medical students had apt knowledge respectively. Conclusion-These observa-tions suggest that the basic and in-depth knowledge of medical students about cause, types, prevention and treat-ment etc. of leprosy shows increasing trend owing to the part of their curriculum. However there is still a need to organize sensitization programs at regular intervals to impart basic and in-depth knowledge to new medical stu-dents, as well as to update the knowledge of those who already had such sensitization programs.
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Background: Arm span is the most reliable anthropometric parameter to predict the body height of an individual. It is useful in predicting the age related loss in stature and in identifying individuals with disproportionate growth abnormalities and skeletal dysplasia. Previous studies show that stature can be measured effectively from various body parameters and length of long bones also. However, the relation between arm span and height was found to vary from race to race. The present study was undertaken to measure the stature as well as arm span and to determine whether there is any correlation between the stature and the arm span. Methods: This study was carried out with a total number of 400 subjects of Teerthanker Mahaveer University, 200 male and female each, age range (18-25). Stature was measured with the Stadiometer and arm span was measured using steel tape. The relationships between body height and arm span were determined using correlation coefficients. Then a linear regression analysis was evaluated to examine the extent to which arm span can reliably predict body height. Results: The results have shown the mean of arm span for the male subjects was 175.03± 7.00cm and the height 168.13±5.89 cm, while female arm span 159.01±6.32 cm and height 156.00±5.61cm. The arm span was consistently more than height. The arm span exceeded stature in 87.5% of the participants.Conclusion: There is a good correlation between body height and arm span.
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Background: Aminoglycoside antibiotics are still the drug of choice in variable conditions like resistant tuberculosis and septicaemia. Toxic effects are the greatest hurdle in their liberal use. Their central neuro-toxicities specially in terms of affinity are yet to be explored. Methods: Experimental rats received streptomycin, kanamycin and gentamycin in a dose of 30mg/kg, 400mg/kg and 135 mg/kg respectively, IMI, daily for 21 days. Total lipids, phospholipids, cholesterol and gangliosides were estimated in auditory cortex, medial geniculate body, inferior colliculus, cerebellum and spinal cord in both control and experimental rats. Results: On the basis of statistically significant alterations in aforementioned biochemical parameters, affinity of drugs was quantified by scoring. Streptomycin and kanamycin showed maximum toxicity in terms of scoring of 4 with preferential targets i.e. medial geniculate body and inferior colliculus respectively. Gentamycin showed affinity for higher centres only with equal scoring of 3 for toxicity at three locations i.e. auditory cortex, medial geniculate body and inferior colliculus. Conclusion: Such preferential toxicities might reflect some aspects of mechanism of toxicity of different drugs.
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Background: Estimation of stature is basic and major section of Anthropological research which is necessary for unmistakable conformation and is used by medico- legal experts, forensic examiners and Anatomists. Methods: In the present, morphometric, cross sectional study of the measurement of stature from index finger length among the population of India is done. This study consist of 400 subject among them 200 are males and 200 females between the age group of 17-25 year. The subjects are students of Teerthanker Mahaveer Medical College and Research centre. The data was statistically analysed by calculating mean and standard deviation as well as standard error. Regression formula was also derived by calculating the stature and the index and ring finger length. Result: The high value of the regression coefficient shows that the index finger length may clearly predict the body height in both sexes. It is a good predictor for estimation of the height of the males and females subjects. Regression equations are- For male:- Y= 124.26+6.41(RIFL), For female:- Y= 110.16+5.82(RIFL). Conclusion: The finding of the present study shows that the index finger length can be used successfully to predict the height of the human being. Medico-legally it is a considerable parameter which determines the height of subject which is a major step in recognition of a deceased subject.
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Background: External ear is a significant feature for human face identification. Its size, shape and spatial location on human face are vital from aesthetic point of view. The knowledge of morphometry of normal human auricle and its symmetry is also required for the surgical resection. Aim: The aim of the current study was to estimate the morphometry of external ear and its anatomical landmarks with respect of identification. Methods: In the current, morphometric, cross sectional study was done on 400 Indian students (males = 200 and females = 200) of Teerthanker Mahaveer Medical College and Research Centre.The parameters was analysed by using camera and adobe Photoshop software (version 7.0). The data was statistically analyzed by using student’s t test. p <0.05 was considered statistically significant. Results: In our cohort, all parameters were higher in males except left lobular width, which was higher in females. The mean observation of the right and left ear length of males were 4.61± 0.41 cm, 4.54± 0.44 cm respectively, while in females were 3.68± 0.42 cm, 3.67±0.54 cm respectively. The mean value of the right and left ear width of males were 3.17±0.37 cm, 3.03±0.47 cm respectively, and while in females 2.57 ± 0.32 cm, 2.55±0.41 cm respectively. The mean value of the left right and left lobular length of males were 1.56±0.12 cm, 1.50± 0.19 cm and in females were 1.09± 0.13 cm, 1.08±0.13 cm respectively. The mean values of the right and left lobular width of males were 1.58± 0.26 cm, 1.51± 0.37 cm and in females were 1.53± 0.35 cm, 1.53±0.35 cm respectively. Free lobule = 88.5% and the attach lobule = 11.5% respectively. Conclusion: This study makes possible the identification of an individual such as race, sex and age whose identity is unknown. Medico legally it is considerable parameter for forensic investigation to optimize the crime.