bluuebunny/crossref_metadata_2025 huggingface dataset:
A Problem-Solving Environment to Teach Students Assembly Line Balancing Techniques
Authors: YILMAZ Hamid , DEMİR Yunus
Published: December 2019

Assembly line balancing is a production planning strategy that has been
widely used in industrial applications. Most line balancing problems are known
as nondeterministic polynomial time (NP-hard) problem, and they have different
structures and solution methodology approaches. In this study, newly developed
production planning software which is called Visual Assembly Line Balancing Software
(VALBS) is introduced for educational purposes. The aim of the software is to
support teaching activity for assembly line balancing techniques; facilitate
understanding characteristics of different assembly lines and solution
approaches, and enable to compare the results of them. The proposed VALBS is
easy to use in various manufacturing environments, and suitable to support
teaching line balancing procedures in undergraduate students. The software was
used in classes of industrial and mechanical engineering students and feedbacks
of students measured by Likert Scale survey. The results show that proposed
visual software is an effective method to teach line balancing procedures.
A Comparison of Drying Performances of Red and Green Apple Particles in a Tray Dryer
Authors: TOZLU Alperen
Published: December 2019

The green and the red apples were selected as drying materials in order
to dry in a tray dryer for this study. They were washed with distilled water to
wipe out all contaminants that can be affected negatively the results of
experiment and they were chopped to the same dimensions. The length, width and
thickness of each apple piece were adjusted as 65 mm, 37 mm and 12 mm,
respectively. The apple particles were weighed with precision scales and they were
grouped into 50 g, 100 g and 200 g. Then the particles were placed in the tray
dryer for each set of experiments. Thereafter, drying process was carried out
at different weights of red and green apple particles (mp), drying air velocity
(U) and drying temperatures (Td). Herein, the moisture content (MC) is considered as the significant
parameter in order to express the drying performance of drying materials. Moreover,
energetic efficiency and normalized moisture content are compared with the
empiric equation, which is proposed for the drying systems. The experimental
study is performed with the range of 50 g ≤ mp ≤ 200 g, 18 % ≤ MC ≤ 614.29 %, 0.03 ≤ MR ≤ 1, 59 oC
≤ Td ≤ 99 oC and 0.992 m/s ≤ U ≤ 1.488 m/s. The result of this study
is that the red apple particles have better drying performance at same
conditions due to its physical properties when compared to green apple
particles
Subacute toxicity study of an aqueous extract of dried leaves of Gymnosporia spinosa on albino rats
Authors: Kubavat Amita R. , Rajguru Hetal D. , Malek Shahenaz M.
Published: December 2019

Background: Leaves of Gymnosporia spinosa have been used by people for treatment of jaundice. Traditional herbal drugs are popular all over the world and it is presumed that herbal medicines have lesser or no side effects. This generalized belief and no information available regarding toxicity study of G. spinosa with search from limited available information prompted us to carry out work on subacute toxicity study of aqueous extract of dried leaves of G. spinosa.Methods: Subacute toxicity study was carried out using aqueous extract of G. spinosa leaves. 30 rats of either sex were randomly divided in to 4 groups. First group received distilled water (control). Second, third and fourth groups received single daily dose of drug orally as 40, 120 and 240 mg/100 g of body weight respectively for 3 weeks. Animals were observed for various parameters. After 21 days blood was collected for blood counts and biochemical parameters. Liver, lungs and kidney were subjected to histo-pathological studies.Results: Throughout study there was no mortality in any group. Degenerative changes in the liver. Other organ does not show any changes. Analysis of biochemical data showed serum glutamic pyruvic transaminase and s. alkaline phosphatase levels were decreased. Serum bilirubine, blood urea and serum creatinine level were increased significantly.Conclusions: The data showed that there was hepato-renal toxicity at higher dose level which is about 100x human therapeutic dose.
A questionnaire-based survey among clinicians and postgraduates regarding knowledge, awareness and practice of p-drug in Government General Hospital, Rangaraya Medical College, Kakinada
Authors: Kanthi Grandhi Ramya , Prayaga Usha Kiran
Published: December 2019

Background: P-drug is a personal or preferred or priority choice drug of a clinician. The aim of the study is to evaluate knowledge, awareness, practice of p-drug which helps the clinician to prescribe drugs rationally.Methods: The study was a prospective cross-sectional pre-validated questionnaire-based study conducted in Government General Hospital, Rangaraya Medical College, Kakinada. During the study period a total of 300 members were enrolled and instructed to fill the questionnaire forms. These filled forms were collected and data were analyzed.Results: Out of 300 members, 240 filled the questionnaire, and these forms were evaluated. Among them 16.6% were aware of p-drug, 27.5% were aware of P treatment, 32.5% were not including FDC’s in their p drug list, 28.33% were aware of advantages of prescribing P drug and 82% felt that teaching programs were needed for preparing p drug list.Conclusions: For promoting and achieving rational use of medicine, P drug concept is one of the milestones. As few were aware of p-drug concept, institutional teaching review board should conduct teaching programs regarding p drug concept.
Pattern of use of anti-hypertensive drugs amongst hypertensive patients in a tertiary care hospital: a cross sectional, observational study
Authors: Khan Sharmin , Maiti Ram N. , Mandal Sekhar
Published: December 2019

Background: Hypertension is one of the primary modifiable risk factors for cardiac and renal diseases and is the single most important risk factor for stroke. Despite different guidelines for management of hypertension like Joint National Committee, British Hypertension Society, National Institute for Health and Care Excellence; there are still the clouds of controversy. The objective of the study was to evaluate the prescribing pattern of antihypertensive drugs among the patients attending medicine outpatient department of a tertiary care teaching hospitalMethods: A cross-sectional, observational study was conducted in our hospital over a period of six months. Relevant information was collected from medical records of 209 hypertensive patients fulfilling inclusion criteria. The collected data were sorted and analyzed.Results: Out of 209 patients, maximum were of age group of 45-65 years (55.02%). 115 (55.02%) were male and 94 (44.97%) were female. Diabetes mellitus (24.4%) was the most common associated disease with hypertension. Most of the patients had received single antihypertensive drugs (49.28%). Among the monotherapy category calcium channel blocker (82.78%) was the most commonly prescribed antihypertensive drug class followed by angiotensin receptor blocker (36.36%). Amlodipine (81.82%) was the most common among calcium channel blockers. The most frequent fixed drug combination prescribed consisted of amlodipine and atenolol. Most of the drugs were prescribed in generic name (90.9%).Conclusions: The treatment pattern, in general, conformed to standard treatment guidelines.
Safety evaluation of chromium picolinate in experimental rats
Authors: V. S. Harish Kumar , Baleed Sindhura Reddy , A. N. Pradeep , L. J. Kiran , K. G. Shivashankaramurthy , M. S. Raghu Prasada
Published: December 2019

Background: Chromium, an essential trace mineral plays an important role in the metabolism of carbohydrate, fat and proteins. Chromium picolinate (Cr.Pic) is used in alternative medicine to treat chromium deficiency. Though Cr.Pic is increasingly used to treat diabetes and obesity, studies on its safety profile is limited.Methods: Acute toxicity study was conducted by oral administration of Cr.Pic (2000 mg/kg body weight). The animals were maintained another 14 days with once a day observation. For sub-chronic studies, test groups were treated with Cr.Pic 10 mg/kg/day for 90 days. Tests for hepatic and renal function were conducted. Effect of Cr.Pic on behavioural changes and motor co-ordination was done on every week. Histopathological studies were conducted on day 90 at the end of the experiment.Results: Acute toxicity study of Cr.Pic showed no signs of toxicity and mortality. Absence of any behavioural alteration or mortality during the period of 14 days indicates that Cr.Pic has no latent effect. Similar results were obtained with sub-chronic studies suggesting safety of Cr.Pic. Cr.Pic treated groups showed no changes in learning and motor co-ordination compared to the untreated group. No gross histopathological changes were seen in any group indicating safety of Cr.Pic.Conclusions: The present study conferred safety profile of Cr.Pic from normal results obtained in hepatic function, renal function, behavioural and histopathological studies, suggesting its safety.
Pattern of adverse drug reactions reported at a tertiary care teaching hospital in Punjab
Authors: Punj Vaishalee , Kumar Rahat
Published: December 2019

Background: This study was undertaken to characterize the pattern of adverse drug reactions (ADRs) reported through spontaneous reporting system at ADR reporting unit in a tertiary care teaching hospital (Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar).Methods: A prospective, observational study was conducted over one year between 1st July, 2013 and 30th June, 2014. The ADRs reported were from patients attending outpatient department (OPD) and in-patient department (IPD) of this hospital. Evaluation of the data was done for various parameters which included patient demographics, drug and ADR characteristics and outcome of the ADRs. Causality and severity assessment was done by WHO-UMC system and modified Hartwig and Siegel criteria.Results: A total of 202 ADRs which were reported over one year were evaluated. Overall ADRs were more common in females than in males (60.2% vs. 39.8%). Majority of the ADRs were reported from psychiatry department (50%). Most ADRs occurred due to antidepressant drugs (55.1%). Majority of the ADRs involved the central nervous system (25.24%). Upon causality and severity assessment, majority of the reports were rated as probable (57.42%) and mild (57.92%). None of the ADRs were severe or fatal.Conclusions: In conclusion, majority of the ADRs were reported by psychiatry department and occurred due to antidepressant drugs. Most of the ADRs were mild. This data reveals the need for regular spontaneous reporting by healthcare professionals of all specialties. This data also reveals the opportunities for interventions and policy initiatives to ensure safer use of drugs in future.
Observational study on the utilization pattern of adjuvant anti-epileptics and their adverse effects
Authors: Rangarajan Punitha , Moorthy Kulandaiammal , Subbiah Arunan
Published: December 2019

Background: Epilepsy is a disease characterized by an enduring predisposition to generate epileptic seizures. Pharmacological therapy is the cornerstone of treatment of epilepsy. In more than 50% patients seizure not controlled with first-line anti-epileptic drugs so added with adjuvant drugs. Therefore adjuvant anti-epileptic drugs play an important role in preventing seizure remission in known epilepsy patients. Observational study was to evaluate the utilisation pattern of adjuvant anti-epileptic drugs and to assess their clinical correlation and observe the adverse effects of the adjuvant anti-epileptics.Methods: Eligible 100 patients who attended the neurology outpatient department where enrolled in the study. Demographic data, type of epilepsy, presence or absence of seizure episode (4 months), adjuvant anti-epileptic prescribed along with the first-line drugs and adverse effects were noted. Clinical correlation and rationale for the usage of adjuvant anti-epileptics were assessed. Descriptive statistics used for statistical analysis.Results: The most common types of seizures were generalised tonic clonic seizures (41%) and complex partial seizures (37%). Most commonly used 1st line drug was phenytoin tablet. Most common adjuvant anti-epileptics used were clonazepam (30), clobazam (24) tablets. Most common adverse effect noted was dizziness (31%).Conclusions: Tablet clonazepam is effective adjunct for tonic clonic seizures. Clobazam table is recommended as add-on drug for focal and generalised seizures. Adjuvant anti-epileptic drugs decrease seizure remission with fewer tolerable adverse effects.
A comparative clinical study on efficacy of terbinafine and griseofulvin in patients with tinea corporis
Authors: Muthu Kavitha G. , Shanthi M. , Ahil M. S.
Published: December 2019

Background: The objective of the present study was to compare the efficacy of terbinafine and griseofulvin in patients with tinea corporis in a tertiary care hospital, Madurai.Methods: About 60 patients are selected from the outpatient department of Dermatology according to inclusion and exclusion criteria. They were divided into 2 groups of 30 patients each. Group 1 received tab. terbinafine 250 mg OD and group 2 received 250 mg BD for 4 weeks. All patients were investigated at baseline, end of 2nd week and at end of 4 weeks. Effectiveness of both the drugs were determined by achieving clinical as well as mycological cure. The results were recorded, tabulated and analysed using student’s t test.Results: Patients in group 1 showed higher clinical and mycological cure rate when compared with group 2.Conclusions: Oral terbinafine is the effective antifungal agent in the treatment of extensive tinea corporis infection.
Effect of sitagliptin on depression in male wistar rats
Authors: Mahalmani Vidya M. , Hogade Anil P. , Mishra Sanjay K.
Published: December 2019

Background: Growing evidence supports relationship between depression and inflammation. The hypothesis of involvement of inflammatory pathways in depression is supported by the findings of increased levels of proinflammatory cytokines. So, we decided to evaluate the effect of sitagliptin on depression using forced swim test (FST) and possible effects of sitagliptin on serum oxidative stress markers and cytokine gene expression in rat hippocampus.Methods: FST model was used to evaluate antidepressant effect in male wistar rats. Rats in group I (control group) were given normal saline, group II (standard group) were given fluoxetine, group III and IV (test groups) were given sitagliptin 5 mg/kg and sitagliptin 9 mg/kg respectively. All the drugs in all groups were given per orally. At the end, animals were sacrificed and blood was collected. Hippocampus of rat brain was dissected out. Serum oxidative stress markers and hippocampal pro inflammatory cytokine gene expression analysis was carried out.Results: Sitagliptin 5 mg/kg and 9 mg/kg showed reduction in depressive symptoms and hippocampal cytokine gene expression in comparison to control. In case of serum oxidative stress markers, there was statistically significant reduction in nitric oxide levels with stagliptin 9 mg/kg. Although there was a decrease in the levels of catalase and increase in the levels of glutathione with standard and test groups, the results were not statistically significant.Conclusions: The present study showed significant antidepressant effect activity of standard and test groups. Hence, further research should be carried out to substantiate above results.
Oxaliplatin induced laryngospasm: a case series
Authors: George Ancy , M. Anuradha
Published: December 2019

Oxaliplatin is a third-generation platinum derivative used as a first-line agent in the treatment of colorectal carcinoma, biliary tract cancer and gastric cancers and can be used as a neoadjuvant/adjuvant in these cancers. The dose limiting toxicity is peripheral neuropathy, others include hypersensitivity reactions, haematological toxicity and pulmonary fibrosis. Hypersensitivity reactions can extend from milder reactions like urticaria, rash to severe symptoms like hypotension and laryngospasm. The laryngospasm due to oxaliplatin is reported to be reversible with corticosteroids, antihistamines and oxygen. This case series suggest that oxaliplatin has a propensity to cause severe hypersensitivity reaction presenting as laryngospasm not with a single dose but with subsequent doses of oxaliplatin. Prompt symptomatic treatment with corticosteroids leads to reversal of symptoms and improvement in the condition of the patient.
Investigation of the incidence of vitamin B12 deficiency in leukopenia and neutropenia secondary to infection
Authors: Sarbay Hakan
Published: December 2019

Background: Infections and nutritional deficiencies are the most common causes of the leucopenia and neutropenia. In this study, we aimed to find the incidence of vitamin B12 deficiency in patients with leukopenia and neutropenia secondary to infection.Methods: Between September 2018 and December 2018, patients who were referred to Diyarbakır Children Hospital's Pediatric Hematology and Oncology Clinic for leukopenia and/ or neutropenia were thought to develop secondary to infection retrospectively evaluated.Results: Of the 60 patients that evaluated, 23(38.3%) were female and 37(61.7%) were male. The mean age±SD was 4.75±4.5 years. Severe neutropenia was detected in 5(8.3%), moderate neutropenia in 31(51.7%) and mild neutropenia in 17(28.3%) patients. Neutrophil counts were within normal limits in 7(11.7%) patients. When vitamin B12 levels were examined, 17(28.3%) patients had B12 deficiency.Conclusions: Investigation and treatment of vitamin B12 deficiency in patients with leukopenia and neutropenia may shorten the duration of cytopenia and prevent the development of secondary complications.
Clinical features and septic screen in neonatal sepsis in a teaching hospital in India
Authors: Vijayan Soja , Nair Gopalan A. Velayudhan , Narayanan Dhanya
Published: December 2019

Background: Sepsis remains a leading cause of mortality and morbidity, especially during the first five days of life and in low and middle-income countries. The purpose of this study was to note the clinical features and analyze the relationship between the septic screen and blood culture positive sepsis in the neonatal unit.Methods: A one-year descriptive cross-sectional study was carried out at the NICU of a teaching hospital in India.Results: The incidence of clinically suspected septicemia was 19.3 per 1000 live births and the incidence of blood culture positive septicemia was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organisms causing sepsis were Coagulase negative staphylococci and Klebsiella. In the septic screen CRP was found to have a statistically significant association with blood culture positive sepsis. CRP also had the highest sensitivity and negative predictive value among the studied parameters.Conclusions: Incidence of blood culture positive sepsis was 2.9 per 1000 live births among the inborn of the hospital. The most common clinical features were poor suck and lethargy in culture positive sepsis. The most common organism isolated in neonatal sepsis in the NICU was Coagulase negative staphylococcus. In resource poor settings, CRP continues to be an important tool in diagnosis and treatment of neonatal sepsis.
Prevalence and clinical manifestations of vitamin K deficiency in complicated severe acute malnutrition
Authors: Kumar Suresh , Choudhary Vibha , Suman Rameshwar Lal , Meena Pradeep
Published: December 2019

Background: In Severe Acute Malnutrition (SAM) clinical and biochemical abnormalities are commonly observed. In this institute author observed that many children of complicated SAM had bleeding manifestations but there is no defined prevalence of vitamin K deficiency in SAM that’s why author have planned this study.Methods: This was the hospital based prospective study conducted in 150 complicated SAM children. All children were treated according to WHO protocol for SAM management. Prothrombin Time (PT), International Normalized Ratio (INR), activated Partial Thromboplastin Time (aPTT) along with routine investigations were done on admission. All the collected data was managed and analyzed with standard software Biostatics (SPSS Version 20).Results: Total 150 complicated SAM children were studied for prevalence and clinical manifestations of vitamin K deficiency. Mean age of children was 17.03±11.0 months, 52.0% were male and 48.0% were female children. Average weight was 5.92±1.57 kg. Average height/length was 70.66±8.38 cm and mean MUAC was 10.47±1.31 cm. Out of 150, 42(28%) children had abnormal INR and 28(18.7%) had abnormal aPTT with abnormal INR. The mean INR was 2.11±1.1 and mean aPTT was 45.30±9.59 in children those had abnormal INR. Twelve out of 42(28.6%) had various bleeding manifestations and majority (66.6%) had gastrointestinal bleeding.Conclusions: More than one fourth children (28%) of complicated SAM children are having vitamin K deficiency and majority of children present with gastrointestinal bleeding.
Peripheral cytopenia in children: a hospital-based study
Authors: Gupta Aditi , Bhatnagar Ruchika , Prasad P. L.
Published: December 2019

Background: Peripheral cytopenia with its ramifications as pancytopenia and bicytopenia is a common hematological phenomenon in children. Its etiology ranging from benign self-limiting illness to severe life-threatening conditions decide the management and prognosis in these children. This study aims to describe the clinical, haematological and etiological profile of peripheral blood cytopenia in children of Rohilkhand region.Methods: A hospital based prospective observational study conducted in the Pediatric ward of a teaching hospital over a period of 30 months. All children between age 6 months to 14 years with bicytopenia and pancytopenia on hemogram were included. Detailed history, clinical examination, haematological tests followed by bone marrow aspiration wherever indicated was performed. Additional tests like parasitological and sepsis work up was undertaken on case to case basis, to ascertain the cause of cytopenia.Results: Bicytopenia was more common than pancytopenia (61.2% vs. 38.8%) The most common age group observed was 10-14 years. Normocytic normochromic blood picture was seen in all cases of cytopenia while macrocytic normochromic blood picture had statistically significant association with pancytopenia. Fever was the commonest symptom, while pallor was the commonest sign followed by hepatosplenomegaly. Most common etiology in bicytopenia was infective (68%) while pancytopenia reported equal incidence of infective (50%) and non-infective causes. Malaria was the commonest infective cause of bicytopenia (46.3%) and pancytopenia (27%). Children with bicytopenia had higher incidence of malignancy (22% vs. 7.7%) and lesser incidence of nutritional causes (7.3% vs. 27%), and aplastic anemia (2.4% vs. 15.4%) as compared to pancytopenia.Conclusions: Clinical assessment coupled with haematological tests plays a pivotal role in ascertaining the cause of cytopenia in children. As the etiologies are varied, their knowledge and distribution unique to a particular region may help in better management and outcome.
A study on parental perspectives towards childhood fever
Authors: Sothinathan Pavithira , Kumar Radha
Published: December 2019

Background: Parents play an important role in recognizing and treating paediatric fever as well as initiating home treatment. Their knowledge and attitude can greatly influence paediatric fever treatment and parental phobia may at times lead to overtreatment of fever. Objectives of this study was to assess the knowledge, attitudes and practices of parents towards childhood fever. Methods: This cross-sectional observational study was conducted in the Paediatric department at Saveetha Medical College, Chennai. Data collection from parents was done using a questionnaire to study the knowledge, attitude and practices of parents towards fever and its management in children. Data analysis was done using SPSS 16 software.Results: Total 100 parents participated in the study, most of participants were mothers (69%) and 51% were between 20-30 years. 67% parents believed that fever could cause harmful effects like convulsions and delirium whereas 61% parents believed that consumption of large doses of antipyretic is harmful. Majority of parents 87% were aware that vaccinations can cause fever. Around 82% of parents declared that they had sleepless nights whenever their child was febrile. Majority of the parents 95% stated that they confirmed the presence of fever in their child by tactile assessment. About half the parents preferred using injections for reducing fever than oral medications.Conclusions: The study revealed presence of high levels of anxiety in majority of parents highlighting the need for reassurance and counsel ling by health professionals. Since most of the parents relied on tactile assessment for fever, there is a need to educate them about proper use of a thermometer for accurate detection and better assessment of fever.
Deviation of paradigmatic mutations found in shprintzen-goldberg syndrome
Authors: Nandy Arnab , Das Sankar K. , Roy Sumit , Das Shreyasi
Published: December 2019

Shprintzen-Goldberg (S-G) Syndrome known as rare congenital connective tissue disorder where craniosynostosis and marfanoid habitus found to be the usual presentation. Craniofacial dysmorphism with multi-organ involvement documented to be amongst prominent features of this syndrome. Case characteristics is five-month-old male infant with craniosynostosis, and motor developmental delay was evaluated for congenital connective tissue disorder. Dysmorphic craniofacial features like dolichocephaly, triangular forehead, ocular hypertelorism, micrognathia and retrognathia were noticed besides congenital umbilical hernia, empty scrotal sac, clinodactyly with long slender fingers, hyper-mobile joints, hypotonia. Subsequent investigations revealed normal male karyotype (46, XY) while genetic analysis depicted missense mutations in six different genes. Conventionally, mutation in SKI gene reported for its’ associated with S-G syndrome where dysregulation of TGF-β signaling was discussed as the primary reason. In the present case discussed here, it was found to have polygenic mutational association where few novel genetic mutations were seen.
Cardiovascular dysfunction in patients of cirrhosis of liver
Authors: Chandey Manish , Mohan Gurinder , Kaur Japnit , Vaid Aarti
Published: December 2019

Background: Cirrhosis of liver refers to a progressive condition that disrupts the normal architecture of the liver. It is increasingly recognized that cirrhosis per se can cause cardiac dysfunction. The aim was to assess cardiovascular dysfunction electrocardiographically and echocardiographically in patients with cirrhosis of liver and to find the correlation between cardiovascular dysfunction and severity of liver cirrhosis as per child-PUGH score.Methods: Total 90 patients of cirrhosis of liver of both sexes were included in this cross-sectional study conducted from January 2018 to August 2019 in SGRDIMSR, Sri Amritsar. The severity of liver cirrhosis was assessed as per Child Pugh Score. QTc interval was calculated by Bazett’s formula. Systolic and Diastolic dysfunction was seen on 2D-echocardiography.Results: QTc interval increased linearly with the severity of liver cirrhosis. Mean values of QTc in Child Pugh Class A=425.00(±20.97), Class B=437.35(±42.60), Class C=479.71(±29.48) with p value of 0.04 which is significant. Diastolic dysfunction was also related with the severity of liver cirrhosis. In Child Pugh Class A= 2(33%) patients had grade 1 diastolic dysfunction, Class B=23(59%) patients had grade 1 diastolic dysfunction while in Child Pugh Class C=3(7%) had grade 1 diastolic dysfunction, 33(73%) patients had grade 2 diastolic dysfunction and 1(2%) patients had grade 3 diastolic dysfunction with p value of 0.04 which is significant. Systolic function was found normal in all the patients.Conclusions: Diastolic dysfunction and QTc interval prolongation are both related with the severity of liver cirrhosis and are major criteria of cirrhotic cardiomyopathy.
The evaluation of QTc prolongation and QT dispersion in type 2 diabetes mellitus as an indicator of cardiac autonomic neuropathy
Authors: Mahajan Devinder Singh , Deep Hardeep Singh , Singh Navdeep , Kaur Sukhjit
Published: December 2019

Background: Diabetes mellitus refers to group of metabolic disorders characterized by hyperglycemia due to an absolute or relative deficit in insulin production or action. Diabetes mellitus produces pathological changes in most organs of the body including heart, blood vessels, kidneys, nerves and eyes. Cardiovascular autonomic neuropathy (CAN) is a severely debilitating yet underdiagnosed complication of diabetes. Diabetes-associated cardiovascular autonomic neuropathy damages autonomic nerve fibers that innervate the heart and blood vessels causing abnormalities in heart rate and vascular dynamics.Methods: Total 80 cases of diabetes mellitus were selected. Cardiac autonomic neuropathy in them was diagnosed by a series of tests recommended by Ewing et al, which include - Valsalva ratio, Deep Breath Test, Heart rate response to standing, Postural Hypotension, SHGT Increase in diastolic BP on sustained hand grip. They were divided into 2 groups A and B depending on presence or absence of cardiac autonomic neuropathy. ECG was done to calculate QTc and QTd.Results: In group A mean QTc was 0.344 sec and in group B in patients with mild CAN mean QTc was 0.432, moderate CAN mean QTc was 0.444, and in patients of severe CAN mean QTc was 0.481. p value was 0.001 that it is highly significant. Means more was degree of CAN more was prolongation of QT and similarly more the degree of CAN more was QTd.Conclusions: Diagnosis of cardiac autonomic neuropathy by battery of cardiac autonomic function tests is a comlex procedure. The prolongation of QTc interval and more specifically QTd interval on ECG is a marker in diagnosis of cardiac autonomic neuropathy which can be easily evaluated.
Evaluation of cardiac performance among asymptomatic obese subjects in comparison with normal individual
Authors: Wanjari Shishir K. , Ghogale Prakash R. , Singh Daneshwar , Mendhe Harshal G.
Published: December 2019

Background: Obesity constitutes a major health issue in the modern world. The purpose of this prospective study was to assess the effect of obesity on ventricular function by conventional 2D echocardiography and echocardiogram for assessment of early cardiac changes.Methods: In the present study, 50 asymptomatic obese subjects having BMI >30 were compared with 50 normal individuals having BMI in the range 20-24.9 to assess cardiac performance. The study was conducted over a period of 2 years, from 2009 to 2011.Results: There were 20(40%) males and 30(60%) females in both the groups. The ejection fraction was not significantly affected in obese subjects (60.86±1.34%) than normal individual (60.42±1.18%) which was found to be statistically not significant. So, in this study systolic function was not affected. The thickness of left ventricle was significantly increased in obese subjects (1.016±0.113 cm) than normal individual (0.77+0.073 cm) which was found to be statistically significant.Conclusions: The current study revealed increased wall thickness and mass of Left Ventricle (LV), significantly increased risk of LV diastolic dysfunction, evidence of Left Atrial (LA) enlargement associated with diastolic dysfunction, evidence of subclinical LV systolic dysfunction and Right Ventricular (RV) dysfunction among obese subjects in comparison with normal individuals.
Clinical significance of vanillylmandelic acid in neuroblastoma
Authors: Rathnakumar Geeta , Bolkar Smita , Ghosh Kinjalka , Inamdar Nitin
Published: December 2019

Background: The second most common solid tumor in children is Neuroblastoma (NB). In about 90% of cases of NB, elevated levels of catecholamines or its metabolites are found in the urine or blood which includes Vanillylmandelic Acid (VMA) and Homovanillic Acid (HVA). Ferritin, Neuron-Specific Enolase (NSE) and Lactate Dehydrogenase (LDH) are commonly assessed in children suspected to have NB, and the levels of these markers are commonly used for differential diagnosis. Multiple clinical and imaging tests are needed for accurate patient assessment. Iodine 123(123I) Metaiodobenzylguanidine (MIBG) is the first-line functional imaging agent used in neuroblastoma imaging. To evaluate the utility of these marker present study was undertaken with 91 NB patients and 40 normal healthy control.Methods: The study comprised of blood samples and 24 hour’s urine sample from 40 normal healthy subjects and 91 untreated patients with histologically proven Stage III and IV NB cases referred to our institute. Method used for NSE was Enzyme Immunoassay (Elisa), serum Ferritin was MIA, LDH-photometry and VMA by Column Chromatography.Results: Amongst the parameters studied VMA showed highest sensitivity (91%), specificity (94.4%) positive predictive value (97.8%) and 85% negative predictive value at the cut off levels of 7mg/ ml of creatinine as compared to other studied parameters.Conclusions: This study suggests that the detection of VMA in combination with routine histological examination, MIBG scan, serum NSE and LDH may improve the diagnosis of Neuroblastoma.
Aetiopathological evaluation of pleural effusions
Authors: Krishna Nallamothu Murali , Sreeramulu Vietla , Gurrala Sai Krishna , Chandra T. Jaya
Published: December 2019

Background: Pleural Effusion (PE) is a sign of disease and not a diagnosis itself. Hence an attempt was made to find out the etiological diagnosis of pleural effusion in cases.Methods: Single center, observational, cross sectional hospital-based study. Samples were collected by systematic random sampling method; study was conducted in GSL Medical College. Patients admitted with pleural effusion in medical wards and ICU were taken. The patients >14 years age, both genders were included. All patients were interviewed to obtain detailed history and examined thoroughly as per pre-determined protocol. Chest x-ray, chest ultrasonogram, PF analysis, routine general investigations were conducted for all the participants; and pleural cytology in certain cases. PF was aspirated send for various microbiological investigations such as gram stain, culture.Results: Out of 104 study participants, 78 were men and 26 were women and peak incidence of pleural effusion is 41-50 years. In this study, 58% cases were found to be tuberculoid, 25% malignant, 6% pyogenic.Conclusions: Tuberculosis was found to be commonest and more prevalent cause of pleural effusion. Every case of pleural effusion should be meticulously investigated in order to arrive a diagnosis, whether tuberculous or non-tuberculous to proceed for specific therapy.
Clinical study of 2D Echo cardiography findings in stroke- ischemic patients
Authors: Saligommula Rajendraprasad , Alam Krishna Chaitanya
Published: December 2019

Background: The Echocardiography is the mainstay investigation tool used in stroke patients. Stroke has acquired third place as leading cause of death with ischemic stroke being very common among all the types of the stroke.Objective of the study was to evaluate 2D Echo cardiography findings in the stroke (ischemic) patients.Methods: Hospital based cross sectional study was carried out among the confirmed 50 patients of ischemic stroke. Routine investigations has been done to all the patients included in the study, specific investigations like 2D echo and CT brain (Plain), Doppler study of carotids and fasting lipid profile has been done.Results: Majority of the study subjects belonged to the age group of 60-69 years i.e. 36% followed by the age group of 50-59 years. The most common risk factor for this ischemic stroke found out in the present study was hypertension in 66% of the cases. The prevalence of ischemic stroke was 70% in the males and 30% in the females. Out of 50 cases, 43 cases i.e. 86% were having abnormal lipid profile. Bilateral carotid atherosclerosis (64%) is more common than the unilateral carotid atherosclerosis (36%) on color Doppler study. Mitral annular calcification was the most common finding in 2D ECHO study in 52% of the cases.Conclusions: Males are more affected than females. Hypertension and smoking are two major and predominant risk factors for stroke. Elderly age group is commonly affected. Bilateral carotid atherosclerosis is common finding on color Doppler study and Mitral annular calcification the most common finding in 2D ECHO study.
Primary surgery for locoregional advanced oropharyngeal cancer: prognostic factors
Authors: Gomes Patrícia S. , Breda Eduardo , Monteiro Eurico
Published: December 2019

Background: Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rising in developed countries. These malignancies usually present in advanced stages and are associated with poor outcome. This work aims to ascertain the clinical and histopathological prognostic factors of locoregional advanced OPSCC treated with primary surgery in a tertiary oncology centre.

Methods: Retrospective chart review of all patients with advanced OPSCC who underwent primary surgery from 2011 to 2016. Overall and disease-free survivals were estimated using Kaplan-Meier method. Clinical and histopathological prognostic factors were determined by univariate (Log Rank tests) and multivariate (Cox models) analyses.  

Results: 89 patients (89.9% male) with a mean age of 57.6±10.0 years were included in the study. Five-year overall and disease-free survivals were 53.9% and 57.7%, respectively. Pathologic N stage (HR=2.65 95% IC 1.32-5.32, p<0.01), distant metastasis (HR= 3.26 95% IC 1.24-8.62, p=0.01) and postoperative radiotherapy (HR=0.02 95% IC 0.01-0.12, p<0.01) were significantly correlated with overall survival. Pathologic N stage (HR=2.41, 95% IC 1.04-5.63, p=0.04) perineural infiltration (2.45, 95% IC 1.01-5.95 p=0.04), distant metastasis (HR=5.24, 95% IC 2.31-11.89, p<0.01) and postoperative radiotherapy (HR=0.02 95% IC 0.00-0.18, p<0.01), were significantly correlated with locoregional disease-free survival.

Conclusions: Knowledge of survival prognostic factors is crucial for selection of the appropriate treatment of oropharyngeal cancer. Pathological nodal stage, postoperative radiotherapy and the occurrence of distant metastasis were the main prognostic factors for overall and disease-free survivals in the present series. These findings may help to provide proper stratification in future randomized trials.
Is cartilage shield tympanoplasty better than fascia tympanoplasty
Authors: Sheikh Shahnaz , Bajaj Anushree , Vaze Vikrant
Published: December 2019

Background: Temporalis fascia and cartilage are the most commonly used graft materials, though contradictory reports are available in literature as regards their efficacy in tympanoplasty. The aim of the study was to compare the graft uptake rates and hearing results in case of temporalis fascia and cartilage in type 1 tympanoplasty.

Methods: A total of 400 cases with large, subtotal and total perforation were considered in the study. All the selected patients were divided into two groups. Group A in which temporalis fascia graft was used and including 200 cases and cartilage graft was used in Group B patients including 200 cases. Pure tone audiometry was performed preoperatively and postoperatively at 6 months.

Results: The graft uptake rate was more than 90 percent and more than 80 percent in Group B respectively at the end of 14 week. There was no statistical difference in hearing improvement in both the groups.

Conclusions: Tragal cartilage graft can be used in cartilage tympanoplasty especially in moderate, large and subtotal perforations. The graft has better uptake rate, less graft failure and hearing improvement results were comparable to temporalis fascia graft.
Trend analysis in management of juvenile nasopheryngeal angiofibroma: our institutional experience
Authors: Vasani Heli H. , Joshi Chinmayee P. , Patel Kalpesh B.
Published: December 2019

Background: Juvenile nasopharyngeal angiofibroma is a vascular malformation rather than true neoplasm. It accounts for 0.5% of all head and neck tumors and its general incidence is 1:150,000. It is uncommon, benign, extremely vascular tumor that arises from tissues in the sphenopalatine foramen, the pterygoid base causing Early spread submucosally towards nasopharynx. Surgical excision is mainstay of treatment.

Methods: This is a retrospective observational study carried out from March 2002 to March 2019, 130 patients underwent surgical resection of juvenile nasopharyngeal angiofibroma at Civil Hospital, Ahmedabad. Patients were divided in two groups with Group-A having patients from 2002-2010 and Group B having patients from 2011-2019.

Results: A total 130 cases of juvenile nasopharyngeal angiofibroma with a mean age of 16.25 years (range 9-33) were treated by surgical excision from March 2002 to March 2019. In Group A patients open approach was used most often with endoscopic approach used only till stage II-A. In Group B patients the preferred surgical approach was trans-nasal endoscopic approach cases up to stage IV-A and open approach including the midfacial degloving approach and infratemporal approach was used cases with extensive intracranial, lateral infratemporal fossa, orbit, optic nerve, cavernous sinus involvement.

Conclusions: Our study shows that over the years there has been shift in surgical approaches used in treating angiofibroma with the advent of newer endoscopic method and addition of various technology such as coblation, navigation has made the procedure for a highly vascular tumor simpler.

 
Evaluation of serum lipid profile in female patients with hypothyroidism: a rural based study
Authors: R. Shilpa , Swamy K. Mallikarjuna
Published: December 2019

Background: Hypothyroidism is the most common of thyroid disorders in India affecting one in ten adults and more so in women than men by 6 to 8 times with overall prevalence accounting to 11%.

Methods: This hospital based prospective study was conducted in the outpatient ENT Department of district hospital, Koppal Institute Of Medical Sciences, Koppal, Karnataka between January to June 2019 which involved total 60 Female patients out of which 20 patients were euthyroid controls and the remaining 40 patients were having one or more clinical manifestations of hypothyroidism who were divided into group A (n=20, thyroid stimulating hormone (TSH) between 5 and 10 mIU/ml) and group B (n=20, TSH >10 mIU/ml) based on TSH values. All 60 patients were in the age group of 35 to 55 years with a mean age of 42 years. Objective of study were to estimate serum lipids in female patients clinically diagnosed with hypothyroidism, to quantify the effect of lipid lowering drug and L-thyroxine therapy on TSH and serum lipid profiles.  

Results: Mean total cholesterol, low-density lipoprotein cholesterol and triglycerides level in cases was higher than controls whereas high-density lipoprotein cholesterol was found significantly decreased in cases compared to controls.

Conclusions: In hypothyroid patients with TSH <10 mIU/ml, Lipid lowering drug seemed to be sufficient to treat dyslipidemia. While in all hypothyroid patients with TSH >10 mIU/ml, it’s imperative to institute L-thyroxine therapy for restoration of TSH and altered lipids back to normal levels.

 
Effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing: a hospital based prospective cohort study in Dar es Salaam, Tanzania
Authors: Abraham Zephania S. , Kahinga Aveline A. , Mapondella Kassim B. , Massawe Enica R. , Lengine Emmanuel Ole , Ntunaguzi Daudi
Published: December 2019

Background: Adenotonsillar hypertrophy remains to be the commonest causes of sleep disordered breathing in paediatric patients and has been implicated as a cause of primary and secondary enuresis. The aim of this study was to determine the effectiveness of adenotonsillectomy in resolution of enuresis in children with sleep-disordered breathing.

Methods: A hospital based prospective cohort study was conducted at Ekenywa Specialised Hospital in Dar es Salaam, from May 2018 to February 2019. Two hundred children aged 3 to 15 years with obstructive adenotonsillar hypertrophy who were admitted ready to undergo adenotonsillectomy were evaluated. Upon such evaluation, the primary outcome was the number of bedwetting incidents (nocturnal enuresis) post-operatively compared with pre-operative incidents. Patients were kept under follow-up for 3 months. Data were collected using structured questionnaires regarding number of bedwetting incidents, type of enuresis (primary or secondary) and family history of enuresis. Data was analyzed using SPSS version 21 and p-values <0.05 were considered to be statistically significant.  

Results: Of 200 children admitted for adenotonsillectomy, 80 (40%) had a positive history of preoperative enuresis, including 35 (43.8%) girls and 45 (56.2%) boys.  All parents for the children consented to participate in the study. Three months after adenotonsillectomy, enuresis had resolved completely in 50 (62.5%) children and had shown relative improvement in 25 (31.3%) children. Enuresis had not improved in the remaining 5 (6.3%) children (p<0.05).

Conclusions: Findings from this study indicates that adenotonsillectomy can improve nocturnal enuresis and day-time incontinence in the majority of children with adenotonsillar hypertrophy.

 
Unmask the silent hearing loss: a study of audiological profile in children with chronic adenotonsillitis
Authors: Satish Hosaagrahara Subbegowda , Abhilasha Somashekhar
Published: December 2019

Background: Chronic adenotonsillitis results in obstruction of eustachian tube (ET) due to edema, by mechanical obstruction and the upper respiratory tract infection disrupts the mucocilliary action of ET which can lead to otitis media with effusion (OME). This when unresolved can result in persistent hearing loss and this might cause subsequent delay in development of language, social behaviour, learning difficulties which will affect the academic performance. Young children as are unable to voice their hearing loss and sometimes due to inattentiveness of parents to child’s hearing disorder; this might be neglected. The condition remains masked for a long time and hence need to be unmasked for its appropriate management.

Methods: It is cross sectional study involving cases of chronic adenotonsillitis from November 2016 to May 2018. After enrolling the patients who met the inclusion criteria, their demographic details, examination findings including the findings of x-ray nasopharynx, pure tone audiometry (PTA) and tympanometry were noted for analysis.  

Results: Total 100 patients were studied in which history of hearing loss was seen in 23% and parents’ suspicions was in 22% of cases whereas hearing loss was demonstrated in 51% of cases using PTA ranging from 16-70 db in hearing level. Analyses of tympanogram revealed 43% to have either type B or type C tympanogram which are suggestive of OME.

Conclusions: Audiological screening for children diagnosed with chronic adenotonsillitis needs to be made mandatory to detect OME, the silent hearing loss as parents as well as children will miss out on it.