iosr-JDMS   Volume-15 ~ Issue-2 ~ February-2016

Abstract: Brunauer-Fuhs-Siemens palmoplantar keratoderma, commonly known as striate palmoplantar keratoderma, is a rare, autosomally inherited disease of linear hyperkeratosis in which patient usually presents with conspicuous longitudinal hyperkeratosis on volar surface of hands and feet. Mutations in 3 genes namely desmoglein 1, desmoplakin and keratin 1, have been identified and held responsible for this type of keratoderma which can efficiently lead to the structural defects in desmosomal plaque proteins manifesting as mechanical weakness in the pressure areas of palm and soles. Apart from the cutaneous features, woolly hair and cardiomyopathy may also be assosiated with striate palmoplantar keratoderma. We herein report a unique case of striate palmoplantar keratoderma in a 18 years old male having linear hyperkeratosis over dorsal surface of hands and feet alongwith nummular keratoderma since chilhood.

[1]. Ketsell DP, Leigh IM. The inherited keratoderma of the palm and soles. In: WolffK, Goldsmith LA, Katz SI, Gilchrist BA, PallerAS, Leffell DJ, editors Fitzpatrick's Dermatology in General Medicine. 7th ed. New York: McGraw Hill; 2008. p. 424-31.
[2]. Barber AG, Wajid M, Columbo M, Lubetkin J, Christiano AM. Striate palmoplantar keratoderma resulting from a frameshift mutation in the desmoglein 1 gene. J Dermatol Sci 2007; 45: 161–6.
[3]. Whittock NV, Ashton GH, Dopping-Hepenstal PJ et al. Striate palmoplantar keratoderma resulting from desmoplakin haploinsuffi ciency. J Invest Dermatol 1999; 113: 940–6.
[4]. Lucker GPH, Van de Kerkhof PCM, Steiljen PM. The hereditary palmoplantar keratoses: an updated review and classifi cation. Br J Dermatol 1994; 131: 1–14.
[5]. Wachters DHJ. Over de Verschillende Morphologische Vormen van de Keratosis Palmoplantaris. Thesis, Leyden: 1963.

Abstract: Objective: To determine the prevalence and pattern of retinochoroidal pathologies at our tertiary eye care centre in western India.
Method: A hospital based retrospective randomized study was done which included 475 patients who attended the Retina clinic during last one year study period. Detailed history was taken from the patients and a thorough ocular and systemic examination was done. All patients were examined by conventional methods of ophthalmoscopy (direct, indirect and slit lamp examination with +90 D lens) followed by a Fundus fluorescein angiography. Patients were advised necessary ocular and systemic treatment.
Results: 475 cases were analyzed and sub-divided into different categories of Age related macular degeneration (ARMD), Diabetic retinopathy, Hypertensive retinopathy, vascular occlusive disorders, central serous chorioretinopathy (CSCR) and other macular disorders, optic nerve related disorders, vasculitis & other inflammatory disorders. Of total 475 cases, 119 cases were of diabetic retinopathy (25.05%), 76 cases of ARMD (16%), 49 cases of vascular occlusions (10.31%), 45 cases of vasculitis & other related inflammatory disorders (9.47%), 31 cases of optic nerve related disorders (6.52%), and 27 cases of CSCR (5.68%) were studied. On statistical analysis, using chi square test FFA proved to be a far superior diagnostic modality than clinical examination (ophthalmoscopy).
Conclusions: FFA has major role in diagnosing various retinal and choroidal pathologies. It is a superior diagnostic modality to confirm the diagnosis and monitoring of the treatment of retinal vascular, macular disorders, and chorioretinal diseases. It provides definitive diagnosis in CSCR and detects exact leakage points. FFA has a limited role in evaluation of macular dystrophies.

[1]. Kanski JJ. Retinal vascular diseases. Chapter 14, In : Clinical ophthalmology – A systemic approach, 7th edn. New Delhi: Elsevier;
[2]. Chao P, Flocks M. The retinal circulation time. Am JOphthalmol 1958;46(Pt.2):8.2011 p.601.
[3]. Novotny HR, Alvis DL. A method of photographing fluorescence in circulating blood in the human retina. Circulation 1961;24:82
[4]. Klein R, Klein BEK, Moss SE, Davis MD, DeMets DL. et al. The Wisconsinepidemiologic study of diabetic retinopathy II (WESDR ).Prevalence and risk of diabetic retinopathy when age at diagnosis is less than 30 years. Arch Ophthalmol 1984;102:520.
[5]. Kahn HA, Hiller R. Blindness caused by diabetic retinopathy. Am J Ophthalmol 1974;78:58.

Abstract:
Background: Diabetic nephropathy may be a consequence of the actions of certain cytokines and growth factors. Prominent among these is transforming growth factor beta (TGF-beta) because it promotes renal cell hypertrophy and stimulates extracellular matrix accumulation.
Aim: The aim of this study was to evaluate the plasma and urinary βig-h3 levels in type 2 diabetic patients and examined the association with albumin creatinine ratio. Materials and
methods: Sixty type 2 diabetic patients with more than 5 year diabetic duration in the age group of 35 to 60 years were selected for this study and 30 age matched healthy individuals were selected as control group. Plasma and urinary beta ig-h3 levels were assessed by ELISA method and microalbumin by turbilatex method. Results: The plasma and urinary beta ig-h3 levels were significantly increased in type 2 diabetic patients compared with healthy control group, and significantly increased in microalbuminuric diabetic patients compared to normoalbuminuric diabetic patients. The plasma and urinary beta ig-h3levels were positively correlated with the albumin creatinine ratio (ACR), glycated hemoglobin (HbA1C) and insulin resistance and negatively correlated with HDL cholesterol.
Conclusion: Plasma and urinary β ig-h3 could be useful to identify the early stage of diabetic nephropathy.

[1]. Skov J, Christiansen JS, Poulsen PL. Hypertension and Diabetic Nephropathy. Endocr Dev. 2016; 31:97-107.
[2]. Elsherbiny NM, Al-Gayyar MM. The role of IL-18 in type 1 diabetic nephropathy: The problem and future treatment. Cytokine. 2016; 81:15-22.
[3]. Sharma K, Ziyadeh FN: Hyperglycemia and diabetic kidney disease.The case for transforming growth factor-beta as a key mediator.Diabetes.1995; 44:1139-1146.
[4]. Wolf G, Ziyadeh FN: Molecular mechanisms of diabetic renal hypertrophy. Kidney Int.1999; 56:393-405.
[5]. Ha SW, Kim HJ, Bae JS, Jeong GH, Chung SC, Kim JG, Park SH, Kim YL, Kam S, Kim IS, Kim BW. Elevation of urinary betaig-h3, transforming growth factor-beta-induced protein in patients with type 2 diabetes and nephropathy.Diabetes Res Clin Pract. 2004; 65(2):167-73.

Abstract: Background and objectives: Patients with chronic kidney disease (CKD), a critical and rapidly growing global health problem, suffer from a number of complex neurological complications potentially affecting all levels of the nervous system including vascular damage and cognitive dysfunction. Neurological complications in hemodialysis patients are often underdiagnosed and undertreated. It is of great significance to detect the neurological complications and improve the prognosis of CKD patients. Neurological examination alone is usually not sufficient to distinguish the underlying pathologies. Many new noninvasive Magnetic Resonance Imaging (MRI) techniques have been steadily used for the diagnosis of occult central nervous system complications in CKD patients. This gives an opportunity to understand the pathophysiological mechanisms of these neurological disorders. This article illustrates the range of MRI findings of neurological complications in chronic kidney disease patients and outlines the applications of advanced MRI techniques.

[1] World Kidney Day: Chronic Kidney Disease. 2015; http://www.worldkidneyday.org/faqs/chronic-kidney-disease.
[2] Jha V, Garcia-Garcia G, Iseki K, et al. Chronic kidney disease: global dimension and perspectives. Lancet, 382 (9888), 2013, 260-272.
[3] National Kidney Foundation. K/DOQI Clinical Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification and Stratification. Am J Kidney Dis, 39(S1-S2), 2002, 66.
[4] R. Brouns, P.P. De Deyn. Neurological complications in renal failure: a review. Clinical Neurology and Neurosurgery, 107, 2004, 1–16.
[5] Hatice Lakadamyali, Tarkan Ergün. MRI for acute neurologic complications inend-stage renal disease patients on hemodialysis. Diagn Interv Radiol 17, 2011, 112–117.

Abstract: Background- Despite the minimal invasive nature laparoscopic surgery, postoperative pain in patients is substantial and limits an otherwise speedy recovery. Adequate analgesia is of the utmost importance for early ambulation and discharge reducing hospital stay. The use of opioid drugs for pain control during and after surgery is a common procedure in anaesthesia. However, their use is associated with side effects such as nausea, vomiting, sedation, and respiratory depression. Parecetamol and diclofenac the two non opioid drugs that are being used in perioperative period were selected to evaluate their relative efficacy.

[1]. R. Cecchio, BV MacFayden, F. Palazzo. History of laparoscopic surgery. Panminerva Me 90. [PubMed: 11019611]
[2]. MD.Dunn, AL Shalhav, EM McDougall, RV Clayman. Laproscoic nephrectomy and nephroureterectomy for renal and upper tract transitional cell cancer. Semin Laparosc Surg.7,2000,:200-10
[3]. I S Gill, SF Matin, MM Desia, JH Kaouk, A Steinberg, E Mascha. Comparative analysis of laparoscopic versus partial nephrectomy for renal tumors in 200 patients. J Urol 170:2003, 64-68.
[4]. SA Hosseini Jahromi, S Sadeghi, SM Hosseini Valami, A Javadi. Effects of suppository acetaminophen, bupivacaine wound infiltration and caudal block with bupavacaine on post operative pain in pediatric inguinal herniorrhaphy. Anesth Pain 1(4): 2012, 243-7.
[5]. N. Rawal. Analgesia for day care surgery. Br J Anaesth.87: 73-87. [PubMed: 1146]

Abstract: One of the commonest injuries particularly with growing industralization as well as mechanization of agriculture is upper arm injury. For such injuries various types of Brachial plexus blocks are in use now-a-days, Supraclavicular Block is a better approach. The present study has undertaken to know the efficacy of ropivacaine through Supraclavicular block among Orthopedic upper limb surgeries mainly by notifying the onset and duration of sensory and motor blockade. 35 patients undergoing orthopedic surgeries were selected for doing this study, belonging to ASA grade 1 and 2 between 20-60 years age of either sex were included in the study. Under aseptic precautions either Ropivacaine was injected into supraclavicular brachial plexus. Onset and duration of sensory blockade was observed after injecting Ropivacaine by noting pin prick sensation, it was 11.95±7.4 and 589.1±131.5 respectively. Motor blockade onset and duration was assessed by looking for loss of finger movements, it was 15.45±2.4 and 473.8±187.2. Duration of Analgesia after giving ropivacaine injection was 654.13±176.12. Among various complications, only Tachycardia has noted in two cases after injecting ropivacaine.

[1]. AF. Mccrae, H. Jozwiak, and JH. Mccllure, Comparison of ropivacaine in extradural analgesia for the relief of pain in labour, British Journal of Anaesthesia, 74, 1995, 261-265.
[2]. A. Lee, D. Fagan, M. Lamont et al, Disposition kinetics of ropivacaine in human, Anesth Analg, 69, 1989, 736-738.
[3]. BM. Emaneulson, J. Persson, S. Sandin et al, Intra and inter variability in the deposition of the local anesthetics ropivacaine in healthy subjects, Ther Drug Monit, 19(2), 1997a, 126-131.
[4]. BM. Emanuelson, C. Norsten-Hoog, R. Sandberg et al, Ropivacaine and its 2H3-labelled analogue-bioanalysis and deposition in healthy volunteers, Eur J Pharmaceut, 5, 1997b, 171-177. Analyzing Efficacy Of 0.75% Ropivacaine Hydrochloride Through Supraclavicular Block Among DOI: 10.9790/0853-152113235 www.iosrjournals.org 35 | Page
[5]. JA. Katz, PO. Bridenbaugh, DC. Knarr et al, Pharmacodynamics and pharmacokinetics of ropivacaine of ropivacaine in humans, Anesth Analg, 70, 1990, 16-21.

Abstract: Background and Objective: Information is lacking on the impact of visual impairment on quality of life of visually disabled persons.This study is undertaken to identify the magnitude of visual impairment among certified visually disabled individuals in Nellore district of Andhra Pradesh, India. This study stresses the need for establishment of low vision rehabilitation centres in order to improve the quality of life of visually disabled persons and to give them an economically productive life.

[1]. Sood S, Nada M, Nagpal RC. Psychosocial implications of blind child. Indian J Community Med 2004; 29:94-5.
[2]. Kulasekharan P, Vidyavati M. Blind school children: an integrated survey. In: Kalevar V, editor. Proceedings of the All India Ophthalmological Society Conference. New Delhi: All India Ophthalmological Society; 1988. p 411-14.
[3]. Desai NC, Desai R, Iyer KK, Sharma R. Low vision therapy: Indian perspective. In: Kalevar V, editor. Proceedings of the All India Ophthalmological Society Conference. New Delhi: All India Ophthalmological Society; 1991. p 614-15.
[4]. Silver J, Gilbert CE, Spoerer P, Foster A. Low vision in east African blind school students: need for optical low vision services. Br J Ophthalmol 1995; 79:814-20.
[5]. R Jose, Sandeep Sachdeva Community rehabilitation of disabled with a focus on blind persons: Indian perspective Indian J Ophthalmol: 2010; 58:137-142.

Abstract: Five cases of atypical mycobacterial infection were encountered following laparoscopic inguinal hernia repair in our surgical unit from 2012 to 2015. Few weeks after surgery the patient presented with erithematous indurated swelling on working port with discharge of pus and sinus formation .CECT of abdomen showed abscess formation at the site of mesh and sinus extending extraperitoneally up to the working port without intraperitoneal connection. Pus culture was sterile with positive PCR for mycobacterium tuberculosis. The cases were clinically diagnosed to be atypical mycobacterial infection .Before opting to remove the implanted mesh to control infection by reoperation we attempted a conservative approach to control infection..We treated with local irrigation of sinus with gentamicyn and oral antibiotic combination of clarithromicyn and prulifloxacin for few weeks. With this management the sinus healed and infection was controlled. Reuse of tacker after chemical sterilization was thought to be the reason of contamination with atypical mycobacteria in these cases which is a preventable by using ethylene oxide sterilization.

[1]. Sumit Choudhuri, Debojyoti Sarkar, Reshmi Mukherji: Diagnosis and management of atypical mycobacterial infection after laparoscopic surgery:Indan J surg:2010: Dec:72(6):438-442 (PMCID/PMC-3077207)
[2]. Kalita.J.B, Rahman H,Baruah K C: Delayed post-operative wound infection due to nontuberculous mycobacterium : Indian J Med Res: 2005;Dec 122(6);535-539 (PMID-16518006) A Typical Mycobacterial Infection Following Laparoscopic Inguinal Hernia Repair: Experience… DOI: 10.9790/0853-152114042 www.iosrjournals.org 42 | Page
[3]. Rajini M,Prasad S R,Reddy R R,,Bhat R V, Vimla K R: Post operative infection of laparoscopic surgery wound due to Mycobacterium Chelonae: Indian J Med Microbiol:2007:April ;25(2):163-5 (PMID-17582193)
[4]. Muhammad R Sohail, Jerry D Smilack:Herniarepair mesh associated mycobacterium goodii infection: J Clin Microbiol :2004:June:42(6)2858-2860: (PMCID:PMC427896)
[5]. Mathews M R,D M Caruso,R B Tsujimura,J D Smilaack,B A Pockaj,J M Malone: :Ventral hernia synthetic mesh repair infected by mycobacterium fortuitum: Am Surg:1999:NOV;65(11):1035-1037(PMID-10551752)

Abstract: Vitamin B-12 is a water soluble vitamin, found exclusively in products of animal origin. Vitamin B-12 deficiency presents as hematological, gastrointestinal, and neuropsychiatric disorders. Anemia is usually most common presentation of vitamin B-12 deficiency. Neuropsychiatric manifestations are usually late, but irreversible in many cases. Cases of vitamin B-12 deficiency are common in India. Sociocultural practices in Uttar Pradesh make women more vulnerable to vitamin B-12 deficiency. This is a rare case of vitamin B-12 deficiency presenting with bilateral pedal edema, simulating edema of cardiac origin, and without any other clinical manifestation. Patient was prescribed oral cobalamin. Edema started to resolve by second week, and disappeared completely after two months of treatment.

[1]. I Elmadfa, and I Singer, Vitamin B-12 and homocysteine status among vegetarians: a global perspective, The American Journal of Clinical Nutrition, 89(suppl), 2009,1693S-1698S.
[2]. C.A. Linker, and L.E. Damon, Blood disorders, in S.J. McPhee, M.A. Papadakis (Ed.), Current medical diagnosis & treatment, 51 (New York: The McGraw-Hill Companies, 2012) 481-482.
[3]. D.M.P.U.K. Ralapanawa, K.P. Jayawickreme, E.M.M. Ekanayake, and W.A.T.A. Jayalath, B12 deficiency with neurological manifestations in the absence of anaemia, BMC Research Notes, 8(458), 2015, 1-4.
[4]. G. Santra, R.Paul, S.K. Ghosh, D. Chakraborty, S. Das, S. Pradhan, and A. Das, Generalized hyperpigmentation in vitamin B12 deficiency, Journal of the Association of Physicians of India, 62(8), 2014, 714-716.
[5]. A. Miller, M. Korem, R. Almog, and Y. Galboiz, Vitamin B12, demyelination, remyelination and repair in multiple sclerosis, Journal of the Neurological sciences, 233(1-2), 2005. 93-97.

Abstract: Background: Postoperative nausea and vomiting (PONV) is commonly seen after laparoscopic surgery. In this study, we investigated and compared the efficacy of palonosetron and ondansetron to prevent postoperative nausea and vomiting after laparoscopic cholecystectomy.

Key Words: PONV, Ondansetron, Palonosetron, Laparoscopic cholecystectomy.

[1]. Watcha MF, White PF. Postoperative nausea and vomiting. Its etiology, treatment, and prevention.Anesthesiology 1992;77: 162–84.
[2]. Kapur P A . The big "little problem" .AnaesthAnalg 1991; 73:243-245.
[3]. Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology 1999; 91: 693-700.
[4]. Gan TJ. Mechanisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy.CNS Drugs 2007; 21: 813 – 833.
[5]. Wallenborn J, Eberhart LH, Kranke P. Postoperative nausea and vomiting – what's new in anti-emetic pharmacotherapy.[Article in German]? AnasthesiolIntensivmedNotfallmedSchmerzther. 2009;44:296–304.

Abstract: Back Ground: Low birth weight (LBW) is the most important determinant of infant mortality rate. In India, 80% of births occur in the rural areas, only about half of the newborns are weighed at birth and for a smaller proportion of them gestational age is known. Hence there is a constant search for newer methods to detect low birth weight babies. One such method may be the use of anthropometric surrogates to identify LBW babies.

Keywords: Anthropometric parameters, Birth weight, predictive value, relation, sensitivity, specificity, neonates

[1]. McCormickMC.Thecontributionoflowbirthweighttoinfantmortalityandchildhoodmortality.NEnglJMed1985;312:82–90.
[2]. World Health Organization. Perinatal mortality: a listing of available information. FRH/MSM967 WHO, Geneva. 1996.
[3]. Lawn JE, Cousens S, Zupan J., Lancet Neonatal Survival Steering Team. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365:891–900. doi: 10.1016/S0140-6736(05)71048-5.
[4]. Save the Children Federation. World Health Organisation 2001 estimates. Saving newborn lives, state of the world's children Washington, DC. 2001. pp. 1–49. A Study of Relationship between Birthweight and Various Anthropometric Parameters in Neonates DOI: 10.9790/0853-152115057 www.iosrjournals.org 57 | Page
[5]. Blanc AK, Wardlaw T. Monitoring low birth weight: an evaluation of international estimates and an updated estimation procedure. Bull World Health Organ. 2005;83:178–85.

Abstract: Certain short durable surgeries need the only sensory block. Way to offer hemodynamic stability during surgery by neuraxial block is always highly acceptable. For the above purpose in the lower limbs, we administered lumbosacral posterior roots block to 50 patients of ASA 11 and 111 with 2.5ml of 0.25 % (hypobaric) bupivacaine in the prone position through the 1st or 2nd dorsal foramen of the sacrum. Intrathecal deposition of low concentrated local anaesthetic produced only sensory block without the motor involvement and hemodynamic disturbance. Lumbosacral posterior roots block are good for the short durable surgery in the lower limbs. It does not disturb the hemodynamic status of the body even in the ill patients.

Keywords: Hypobaric, local anaesthetic, posterior roots, sacral dorsal foramen.

[1]. Paria R, Combined Sacral Spinal Epidural Anesthesia. IOSR- JDMS 2014; 13(11):40-43
[2]. Paria R, Surroy S, Majumder M, Paria B, Sengupta S, Paria A. Sacral Saddle Block IOSR-JDMS 2014; 13(4) 39-40.
[3]. Paria R, Surroy S, Majumder M, Paria A, Paria B, Das G. Sacral spinal anesthesia Indian J Anesth 2014; 58(1) : 80-2
[4]. Schelew BL, Vaghadia H.Ankylosing Spondylitis and neuraxial anaesthesia—a 10 year review.Can J Anaesth 1996; 43: 65—8
[5]. Crighton,I.M., Barry,B.P., Hobbs,G.J. A study of the anatomy of the caudal space using magnetic resonance imaging. Br. J. Anaesth 1997: 78; 391