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   2013| October-December  | Volume 2 | Issue 4  
    Online since February 7, 2014

 
 
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REVIEW ARTICLE
The cochlear implantation surgery: A review of anesthetic considerations and implications
Sukhminder Jit Singh Bajwa, Ashish Kulshrestha
October-December 2013, 2(4):225-229
DOI:10.4103/2278-344X.126698  
The advancement in the technology of the cochlear implants has resulted in increasing trend of cochlear implantation in both the children and elderly population. The anesthesiologist is faced with the task of smoothly conducting the surgery without any interference in the stimulation techniques used. The preoperative evaluation is mainly focused on the presence of any congenital anomalies in these patients which may affect anesthetic technique. The reduction of anxiety of the patient as well as the parents of small children is an important aspect of the preoperative visit. Intraoperatively the anesthetic technique chosen should not interfere with the stimulation of the cochlear implant electrode assembly. The postoperative management is mainly focused at prevention of agitation and good analgesia. A close cooperation between the surgeon and the anesthesiologist is essential for a positive outcome in this surgery. The current review focuses on the important anesthesia aspects related to cochlear implant surgery.
  16,112 2,507 2
ORIGINAL ARTICLES
Levocetirizine dihydrochloride and ambroxol hydrochloride oral soluble films: Design, optimization, and patient compliance study on healthy volunteers
V Senthil, Rizwan Basha Khatwal, Varun Rathi, Siddhartha T Venkata
October-December 2013, 2(4):246-255
DOI:10.4103/2278-344X.126713  
Objective: The aim of this study was to develop taste masked oral soluble films (OSFs) for levocetirizine dihydrochloride (LCT) and ambroxol hydrochloride (AMB) using different combination of polymers such as polyvinyl pyrrolidone (PVP) K30, propylene glycol (PG), gelatin, sodium alginate (SA), pectin, gaur gum (GG), and hydroxypropyl methylcellulose (HPMC) K15M and super disintegrants like carboxymethyl cellulose (CMC) and sodium starch glycolate (SSG). Materials and Methods: The different basic formulations were developed using solvent casting method for with and without drugs loading and prepared films were evaluated different morphological and mechanical parameters facilitated the screening of a formulation with best characteristics. Results: The films made from HPMC K15M (42.2% w/w) and pectin (35.2% w/w) and considered as an optimized batch among the other formulations. The addition of (titanium dioxide) (TiO 2 ) films was shown opaque nature. The optimized films were subjected to further of drugs content, drugs release profile, stability, and organoleptic properties by human volunteers. The percentage release at end of 90 th s found 73.11 ± 5.2% in pH 6.0 and 81.07 ± 5.6% in water for LCT and 89.2 ± 4.5% in pH 6.0 and 86.22 ± 4.2% in water for AMB, respectively and there were insignificant changes showed at stability study. The organoleptic properties revealed that by complexing drugs with hydroxypropyl β-cyclodextrin (HPβ-CD) in 1:1.5 ratios masked the bitter taste of drugs. Conclusion: Developed OSFs can be considered as one of the promising formulation to administer bitter drugs such as LCT and AMB especially for pediatric, geriatric, and non-cooperative patients.
  11,390 523 1
Hypertension: An emerging threat among tribal population of Mysore; Jenu Kuruba tribe diabetes and hypertension study
Basavanagowdappa Hathur, Madhu Basavegowda, Nagaralu Channabasappa Ashok
October-December 2013, 2(4):270-274
DOI:10.4103/2278-344X.126748  
Introduction: Cardiovascular diseases are leading cause of morbidity and mortality. Such phenomenon is not only seen in urban and rural population, but is also evident among the tribal population. There is a need to understand the burden of hypertension among people residing in Jenu Kuruba Tribe of Karnataka. Objectives: (i) To estimate the prevalence of hypertension in the Jenu Kuruba tribal population and (ii) To describe the age- and sex-wise pattern of blood pressure (BP). Materials and Methods: A population-based cross-sectional study was carried among 1,290 individuals aged between 20 and 60 years. Information about their sociodemographic characteristics, risk factor profile was collected in a pretested proforma by interview technique. Measurements of BP were performed as per standard procedures. Results: Mean systolic and diastolic BP (SBP and DBP) among the study subjects was 123.07 ± 14.09 and 77.43 ± 10.33 mmHg, respectively. Mean SBP and DBP were significantly higher with increase in age and were also significantly different for men and women. Overall prevalence of hypertension was 21.7% (95% confidence interval (CI) =19.45-23.95%). Prevalence of hypertension among men was 28.2% and among women was 16.5%. Conclusions: Hypertension is emerging as a significant public health problem even among Jenu Kuruba tribal population.
  4,065 441 3
LETTER TO EDITOR
Emergency medicine: The emerging medical field in India
Sasidharan Sameer, Deepak Verma
October-December 2013, 2(4):298-299
DOI:10.4103/2278-344X.126767  
  4,061 359 -
ORIGINAL ARTICLES
Clinical effects of short and long lever spinal thrust manipulation in non-specific chronic low back pain: A biomechanical perspective
S Gopal Nambi, Dipika Inbasekaran, Ratan Khuman, Surbala Devi, Kalpesh Satani
October-December 2013, 2(4):230-236
DOI:10.4103/2278-344X.126706  
Background: Non-specific chronic low back pain (nCLBP) is prevalent in 80% of low back pain patients and it is multi-dimensional illness. This study aims to test whether short lever or long lever spinal manipulation alleviates clinical symptoms of nCLBP in terms of pain and functional disability. Materials and Methods: Sixty aged 20-60 years with nCLBP were randomly assigned to three groups: the short lever manipulation group received only short lever manipulation (SLM); the long lever manipulation group (LLMG) received only long lever manipulation (LLM); and the control conventional exercises group received conventional exercises (CE). Baseline and after 1 month, 2 month and 6 month follow-up scores were measured with visual analogue scale (VAS) and self-reported functional disability with the Roland-Morris disability questionnaire (RDQ). Results: After treatment, the SLM, LLM, CE all had lower VAS and RDQ scores. Significantly higher reduction and improvement in VAS and RDQ scores were found in the SLM compared to the LLMG. Conclusion: The present study indicates that SLM is more effective than LLM in nCLBP patients in biomechanical perspective.
  3,716 258 1
SHORT COMMUNICATION
A study of respiratory rate, tidal volume, inspiratory capacity and inspiratory reserve volume in different trimesters of pregnancy
Anita Teli, Parveen Doddamani, Shrilaxmi Bagali
October-December 2013, 2(4):294-297
DOI:10.4103/2278-344X.126766  
Background: The anatomical, physiological and biochemical adaptations in pregnancy are profound. Many of these changes begin soon after fertilization and continue throughout the gestation and changes in the respiratory system are part of the same process. However there is insufficient information regarding the changes in respiratory parameters in different trimesters of pregnancy. Aims: The aim of the study was designed to evaluate the pulmonary function tests in 1 st , 2 nd and 3 rd trimesters of pregnancy and compare them with non-pregnant control group. Materials and Methods: A cross-sectional study was carried in 200 healthy women in the age range of 19-35 years. The subjects were distributed in four groups, as control (non-pregnant) group and 1 st , 2 nd and 3 rd trimester pregnant groups. Number of subjects in each group was 50. Respiratory parameters in control and study groups were recorded. Statistical Analysis: By 'Z ' test. Results: There was gradual significant increase in respiratory rate in all trimesters of pregnancy. There was a gradual decrease in tidal volume in 1 st , 2 nd and 3 rd trimesters of pregnancy when compared to non pregnant women. There was significant decrease in Inspiratory Reserve Volume and Inspiratory Capacity. Conclusion: The changes in pulmonary function are attributed to major adaptations in the maternal respiratory system and are influenced by the mechanical pressure of enlarging gravid uterus, elevating the diaphragm and restricting the movements of lungs thus hampering the forceful expiration and also might be due to decline in alveolar Pco 2 caused by hyperventilation which acts as bronchoconstrictor; in addition to sensitization of respiratory center due to progesterone
  3,644 281 1
ORIGINAL ARTICLES
A review of postinfectious glomerulonephritis cases from a tertiary care renal referral center in South India
Sujatha Siddappa, R Kowsalya, KM Mythri
October-December 2013, 2(4):264-269
DOI:10.4103/2278-344X.126745  
Background: Postinfectious glomerulonephritis is an immune mediated renal disease and one of the causes for end stage renal disease in developing countries like India. The disease spectrum has changed significantly in the past few decades. The goal of this study is to review the prevalence and clinicopathological spectrum of the disease in a major tertiary care renal referral hospital. Materials and Methods: Between July 2007 and July 2012, 54 cases of postinfectious glomerulonephritis were identified at our medical center. The patients' records were retrospectively reviewed with respect to clinical presentation, laboratory, histopathology, and clinical course. Results: There were 32 males and 22 females. The mean age was 24.1 years. Twenty six percent of patients presented with acute renal failure and required dialysis support during the course of disease. Hypocomplementemia was present in about 90% of the patients. Histologically, characteristics showed distinct patterns of glomerulonephritis with predominant "starry sky pattern" on immunofluorescence. At the last follow-up, none of the patients were dialysis-dependent, and 53% were in complete remission. Conclusions: We hereby report cases of postinfectious glomerulonephritis with history of recurrence and cross infection to highlight the importance of treatment and awareness regarding this preventable cause of chronic renal disease.
  3,345 426 -
Study of socio-demographic profile, phenomenology, course and outcome of bipolar disorder in Indian population
Santosh Ramdurg, Santosh Kumar
October-December 2013, 2(4):260-263
DOI:10.4103/2278-344X.126729  
Context: Though many researchers have made an attempt to study the phenomenology, clinical syndromes, course of bipolar mood disorder. However there was no orderliness in the research pursuit of understanding this disorder in the Indian context. Aims: Assessment of socio-demographic profile, age of onset, phenomenology, course and outcome of patients with bipolar disorder in south Indian population. Settings and Design : This prospective-retrospective study was done in a general hospital psychiatric unit including both out-patient and in-patients. Materials and Methods : All patients were diagnosed with bipolar disorder during out- and in-patient setting was evaluated by using the semi-structured questionnaires and standard tools for socio-demographic profile, age of onset, phenomenology and course and outcome in-patients with bipolar disorder. Results: In 100 bipolar patients socio-demographic data suggest mean age of presentation was 34 years, with majority being males, married, belonging to Hindu religion and were from rural background. Mean age of onset of illness was 27 years total mean number of episodes were 5.26 ± 7.4 (mania: 3.72 ± 5.2, depression: 2.1 ± 1.3). Majority had 2-5 episode (n = 62) commonly followed by recurrent mania (n = 22). Mean duration of symptoms were 116.2 ± 145.2 days in depression and 109.3 ± 124.9 days in mania. Two-third reduction in symptomatology was seen in 80% of in-patients at the time of discharge. Conclusions : Recurrent mania was a commonly observed phenomenon and duration of suffering in both phases (depression and mania) was nearly 4 months. We need long-term follow-up of these group of patients for better course and outcome data from developing country.
  3,035 430 3
CASE REPORTS
Prosthodontic rehabilitation of edentulous patient with surgical induced microstomia
Virsen Patil, Milind Limaye, Santosh Shingote, Koyena Mishra
October-December 2013, 2(4):290-293
DOI:10.4103/2278-344X.126765  
A restricted mouth opening which seems smaller than the size of a complete denture can make prosthetic treatment challenging. Several techniques have been described for use when either standard impression trays or the denture itself becomes too difficult to insert and remove from the mouth. This case report describes innovative techniques of primary impression, sectional custom tray, sectional denture base, and fabrication of 'customized hinge' for hinged mandibular denture.
  2,720 249 -
Mucocele appendix: A rare differential diagnosis of pelvic mass
Vishal Yadav, Rama Borse, S Joseph, Puneet Bansal
October-December 2013, 2(4):286-289
DOI:10.4103/2278-344X.126764  
Mucocele of the appendix is a descriptive term that implies a dilated appendiceal lumen caused by abnormal accumulation of mucus. Mucocele is found in 0.2-0.3% of all appendectomy specimens. The male to female ratio is 1:4 and the average age at the time of diagnosis is over 50 years. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. Pre-operative diagnosis is a major component for minimizing intra operative and post-operative complications. We herein report a case of 40-year-old female presented as pelvic mass and this pose a diagnostic challenge
  2,695 169 1
ORIGINAL ARTICLES
Career choices in allied health: A study of influencing factors on students of medical technology at an Indian University
Sammita J Jadhav, Rajiv Yeravadekar, Shoma Shrivastava, Meenal Kulkarni
October-December 2013, 2(4):256-259
DOI:10.4103/2278-344X.126714  
Background: In India, entry level medical technology (MT) students usually decide their career choice before the commencement of the graduate programs. There is no provision for assimilating the intricacies of different specializations in the field of MT. Aim: The research aims at identifying the factors that play a major role in reaching a career choice by MT students and disseminating this information to stakeholders for effective program design and delivery. Setting and Designs: An exploratory study was carried out at an Indian university on 78 students of MT programs in Cardiac care, dialysis, respiratory therapy, imaging sciences, clinical laboratory, operation theater and Anesthesia technology. Materials and Methods: Students were surveyed to ascertain the influencing factors that shape their preferences for career choice preceded by focus group interview. Statistical Analysis: Data was analyzed using SPSS Inc. Version 16.0; frequency distribution was used to obtain valid percentage. Cross tabulation was used to arrive at P value. Results: The prime factors influencing career choices emerged as Hospital infrastructure (91.3%), working environment (87%), alumni (P = 0.04) and status of specialization (P = 0.02) at 95% of the confidence interval however; profile of patient, use of equipment and career growth (78%) also played an influential role. Conclusion: It is critical to understand and address the influencing factors that affect career choices; necessitating academia and the health care industry to partner in creating better adapted medical technologists.
  2,462 225 -
Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore
Giriyanna Gowda, Chitra Nagaraj, BG Parasuramalu, N Huliraj
October-December 2013, 2(4):237-241
DOI:10.4103/2278-344X.126710  
Background: Asthma is a serious public health problem throughout the world and its prevalence has increased in last 2-3 decades. Allergens are one of the many factors which trigger an attack of asthma. Skin prick test is useful in identifying the offending allergen in bronchial asthma. Aim: To identify the possible offending allergens in patients of bronchial asthma. Materials and Methods: The study was a descriptive study conducted at allergy center, Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore from January to December 2011. Skin prick test was done in 139 patients suffering from bronchial asthma using 49 allergens extracts. Statistical Analysis: Frequency, proportions, Chi-square test, odds ratio, and 95% confidence interval was used. Results: Out of 139 patients who underwent the skin prick tests, 40% (56) were males and 60% (83) were females. Majority, that is, 60% were in the age group of 21-40 years. Forty-three percent (60) had family history of asthma/atopy, 80% (111) had allergic rhinitis, 24% (34) had chronic urticaria, and 24% (33) had allergic conjunctivitis. Out of 139 patients, 100 (71.94%) were sensitive for one or more allergens. The common offending allergens found in the study were dust mites (Dermatophagoides farinae and D. pteronyssinus (DF and DP)) - 49.28%, dusts - 7.2%, pollens - 6.77%, insects - 6.62%, fungi - 4.53%, and epithelia - 1.92%. Conclusion: The most common allergens in bronchial asthma were dust mites followed by dusts and pollens. Identifying possible allergens in asthma patients help in allergen avoidance and immunotherapy in these patients.
  2,387 251 2
Dry eye risk factors after phacoemulsification cataract surgery at a secondary care hospital
Kamla Dodia, Siddhesh Bapat, Rajesh K Chudasama
October-December 2013, 2(4):242-245
DOI:10.4103/2278-344X.126711  
Background: Dry eye disease is no longer a trivial eye problem ignored by eye care professionals. Aim: The present study was conducted to detect dry eye problem level and evaluate risk factors associated with phacoemulsification cataract surgery. Settings and Design: Study conducted at Ophthalmology Department, Pandit Deendayal Upadhyay Medical College, Rajkot with longitudinal study design. Materials and Methods: The study included 272 patients undergone for phacoemulsification cataract surgery from May 2010 to April 2011, assessed for tear film status by tear film break up time (TBUT) and Schirmer's test on the pre-operative day, on the 1 st , 7 th and 45 th post-operative day. Statistical Analysis: statistical analysis was performed by using Epi Info software (Centre for Disease Control-CDC, Atlanta) with the use of proportions and z-test Results: On the 45 th post-operative day, 42 (15.4%) patients reported altered TBUT and Schirmer's I test (SIT) value indicating dry eye. Statistically significant difference was observed between TBUT and SIT value on day 1 and 7 when compared with pre-operative value. Maximum change in value was reported in both sexes above 65 years for 1 st and 7 th post-operative day. Similar findings were reported for TBUT value also. Conclusion: Phacoemulsification cataract surgery with higher age and female sex is associated with risk of dry eye. Significant percentage change of TBUT and SIT values reported during 1 st and 7 th post-operative day compare to pre-operative status.
  2,282 347 2
CASE REPORTS
Orlistat-induced acute pancreatitis in a type II diabetic and hypothyroid young woman : A case report
Patralekha Ray Chaudhuri, Ranjita Santra, Shovan Palodhi, Somnath Mondal
October-December 2013, 2(4):278-282
DOI:10.4103/2278-344X.126752  
Background: Orlistat is an anti-obesity drug that acts by inhibiting pancreatic and gastric lipase in the gastrointestinal tract. It has been linked to rare instances of acute pancreatitis, some of which have been severe. Case Report: A 31-year-old obese woman was prescribed orlistat 120-mg capsule three times a day with each main meal containing fat for 6 months. She developed acute abdominal pain and vomiting with epigastric tenderness 5 weeks after starting anti-obesity therapy. Serum lipase and computed Tomography (CT) scan of the patient suggested the presence of acute pancreatitis. The patient was hospitalized; orlistat was stopped and she was treated symptomatically. A diagnosis of drug-induced pancreatitis was made following exclusion of other possible factors precipitating pancreatitis. Conclusion: This case report suggests that orlistat can trigger drug-induced acute pancreatitis in some cases and clinicians should be vigilant about it. A total of 99 cases of orlistat-related pancreatitis have been reported to the US Food and Drug Administration (FDA), but no causative link has been found in the clinical trials. It is therefore not in the list of adverse drug reactions of orlistat.
  2,352 147 -
Intracystic hemorrhage complicating multiple liver cysts
K Mohan Kumar, N Prathiba, K Nischal
October-December 2013, 2(4):283-285
DOI:10.4103/2278-344X.126755  
The occurrence of intracystic hemorrhage in benign liver cysts is usually seen in huge solitary cysts in older individuals. Hemorrhage complicating one of the multiple cysts has rarely been reported. We report a case of multiple simple hepatic cysts with intracystic hemorrhage complicating one of the cysts. A 60-year-old woman was admitted with complaints of abdominal discomfort of 6 months duration and abdominal pain with increasing intensity of 2 months duration, not responding to analgesics and was anicteric. On thorough evaluation, a diagnosis of complicated liver cyst was made and her severe symptoms necessitated intervention. Per-operatively, multiple thick walled huge cysts were seen on the surface of the liver. The largest one in the right lobe was complicated by hemorrhage. The cysts were aspirated and deroofed. There were no solid components or biliary communications in the cysts.
  2,324 159 -
EDITORIAL
Adolescents and HIV: This is time to prioritize
Praveen Kulkarni, Prashant Vishwanath
October-December 2013, 2(4):223-224
DOI:10.4103/2278-344X.126691  
  1,176 998 -
CASE REPORTS
Infarcted paratesticular adenomatoid tumor: A diagnostic challenge
Jayashree Krishnamurthy, Shakuntala C Patil, Manjunath V Gubbanna
October-December 2013, 2(4):275-277
DOI:10.4103/2278-344X.126750  
Adenomatoid tumors are regarded as distinctive benign mesothelial neoplasm of the paratesticular region. We present a case report of an adult male who presented with right testicular swelling and pain, which was reported as paratesticular tumor on ultrasound examination. The cut-section of the orchidectomy specimen showed a well-circumscribed nodule with wide areas of necrosis. Microscopically, the lesion was composed of tubules that were lined by flat to cuboidal cells with round to oval nuclei and abundant vacuolated cytoplasm which were diagnostic of adenomatoid tumor. But the associated extensive areas of coagulative necrosis and reactive changes of fibroblasts and myofibroblasts obscured the main lesion and posed diagnostic difficulty. Positivity for calretinin and cytokeratin-7 are useful for confirming the diagnosis. Infarction of an adenomatoid tumor obscures the nature of the underlying lesion and causes diagnostic challenge.
  1,217 170 -
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