iosr-JDMS   Volume-17 ~ Issue-12 ~ December-2018

Abstract: Alport syndrome (AS) is an inherited disorder of basement membranes. It results from mutations affecting specific proteins of the type IV (basement membrane) collagen family. This condition affects the kidneys, the eyes, the hearing, among others. The renal component of the Alport syndrome manifests as hematuria and/or proteinuria, with progressive chronic renal failure, while the ears involvements presents occasionally as high-tone sensorineural hearing loss. The condition manifests with progressive impairment of the affected organs. Renal failure is a major manifestation .Early diagnosis and symptomatic management are key especially in delaying the renal failure. There is paucity of data from Africa about Alport syndrome. We present three cases managed in our hospitals in Kenya, East Africa, literature review and treatment.

[1]. Baikara, B.T., et al., A Novel Mutation in a Kazakh Family with XLinked Alport Syndrome. PLoS ONE, 2015. 10(7): p. e0132010.
[2]. Alport, A.C., Hereditary familial congenital haemorrhagic nephritis. BMJ (London), 1927. 1: p. 504-506.
[3]. Lagona, E., et al., Skin biopsy for the diagnosis of Alport syndrome. Hippokratia, 2008. 12: p. 116-118.
[4]. Heidet, L. and M.C. Gubler, The renal lesions of Alport syndrome. J Am Soc Nephrol, 2009. 20: p. 1210-1215.
[5]. Williamson, D.A., Alport syndrome of hereditary nephritis with deafness. Lancet, 1961. 2: p. 1321-1323.

Abstract: BACKGROUND: Anaesthesiology and Anaesthesiologists as a subject and specialist are less recognized by the common patient population as reported with previous studies in few parts of the country and it is perceived that illiteracy is a major reason. METHOD: This cross sectional observational study after Institutional Ethical clearance was conducted at Indira Gandhi Institute of Medical Sciences, Patna among 400 participants (n=400) undergoing various major surgery and had no history of previous surgery or anesthesia. The data gathered from the questionnaire.........

Keywords: Anaesthesiologist; Perception; Cross-sectional observational study

[1]. Curpod Girivas Srinivas Prasad, Govindswamy Suresh. A survey on public awareness about role of anaesthesiologists. Ain-Shams Journal of Anaesthesiology.2014;07:456-459.
[2]. U.Naithani,D.Purohit,P.Bajaj.Public Awareness about Anaesthesia nad Anaesthesiologist: A survey IJA 2007;51(5):420-426.
[3]. Uma B.R,Anitha Hanji S,Anaesthseia and Anaesthesiologists: How Famous are we among general population?-A survey. JCDR 2013 DEC;7(12):2898-2900.
[4]. Swinhoe CF,Groves ER.Patient knowledge of Anaesthetic Practice and role of Anaesthetist. U.S NATIONAL LIBRARY OF MEDICINE.NATIONAL INSTITUTE OF ANAESTHESIA.1994 FEB;49(2):165-166.
[5]. Herman CR.An appraisal of Anaesthetist-Patient Relationship.ANAESTHSEIA.1978 JAN; 33(1):45-48.

Abstract: Abdominal tuberculosis usually caused by mycobacterium bovis but in India the organisms most commonly isolated from gastrointestinal tract lesions is mycobacterium tuberculosis. Abdominal tuberculosis is predominantly disease of young adults. Sex incidence is almost equal although some Indian studies have suggested a slight female predominance. The postulated mechanism by which the tubercular bacilli reach the GI tract are haematogenous spread form primary lung focus, ingestion of bacilli-infected sputum, direct spread from adjacent organ and also through lymphatic from infected lymph node. The ileocaecal region is the most common site followed by jejunum........ .

[1]. Kumar S, Pande HI, Saggu P. Abdominal tuberculosis. In: Taylor, Johnson CD, editors Recent advances in surgery, 28th ed, London, Royal Society of medicine Press 2008: pp 47-58
[2]. Berhard JS, Bhatia G, Knauer CM. Gastrointestinal Tuberculosis. J ClinGastroenterol 2001; 1: 397-402
[3]. Vij JC, Malhtora V, Choudhury V, Jain NK, Prasaed G, Choudhury A et al. A clinicopathological study of abdominal tuberculosis. Indian J Tuberc 1992; 39: 213-20
[4]. Kapoor VK. Abdominal tuberculosis. Postgrad Med J 1998: 74: 459-6
[5]. Paustian F F.Tuberculosis of the intestine.In:Bockus H,ed.Gastroenterology.Saunders,1976:750-74.

Abstract: Acute appendicitis (AA) is the most common non-obstetrical surgical emergency during pregnancy, the incidence is 1/1000 to 1/2000 pregnancies. The diagnosis of acute appendicitis is little changed by pregnancy, both in the first and second trimester, with some significant differences in the clinical presentation between these two quarters. We report a case of a 32-year-old patient with no significant pathological history of 16 weeks of amenorrhea.

Keywords: Appendicitis; Pregnancy; Laparoscopy; Ultrasonography

[1]. HUNT, M.G., MARTIN, J.N., MARTIN, R.W. (1989 ) « Peri natal aspects of abdominal surgery for non obstetric disease ». Am. J.peri natal; 6(4): 412-417. [2]. KORT, B., KATZ, V.L., .WATSON, WJ. (2003) «The effect of non obstetric operation during pregnancy: ». Surg. Gynecol.Obstet ; 177(4): 371-376

[3]. TO, W.W.K., N.GAI, C.S.W., MA, AND H.K. .( 1995) « Pregnancies complicated by acute appendicitis ». Aust.N.Z.J.Surg ; 67:799-803

[4]. [Mahmoudian, S. ( 1997) « Appendicitis complicating pregnancy ». Southem Medical J; 85(1): 19-23 [5] MAZZE, R.I., KALLEN, AND B.:

[5]. MAZZE, R.I., KALLEN, AND B. (1991) « APPENDICECTOMY DURING PREGNANCY: A Swedish registry study of 778 cases». Obstet Gynecol.; 77(6): 835-840

Abstract: With the increasing incidence of Methicillin Resistant Staphylococcus Aureus(MRSA), Vancomycin Intermediate Staphylococcus Aureus(VISA) & Vancomycin Resistant Staphylococcus Aureus (VRSA) strains now a days. The study was conducted to find out the magnitude of vancomycin resistance in both MRSA and MSSA and antibiotic susceptibility pattern of those isolates in a tertiary care hospital, Jaipur between January 2017 to June 2018.In this cross sectional study,287 Staphylococcus aureus were isolated and identified from various clinical specimens collected from different departments of the hospital.Among these 287 strains,146 were found to be MRSA and 141 MSSA. Subsequently.......

Keywords: MIC, S.aureus, VISA, VRSA, Vancomycin Screen Agar

[1]. Koneman E, Procop G, Schrekenberger P et al.Taxonomy of Staphylococci and related Gram Positive Cocci,clinical significance of Staphylococci and related Gram Positive Cocci. Koneman's Colour Atlas and Text book of practical Microbiology; 6th Edn USA 2007;624-642.
[2]. Mackie and McCartney. In: Practical Medical Microbiology 14th edition, South Asia: Churchill Livingstone Elsevier.2006;246.
[3]. Dhawan B, Gadepalli R, Rao C, Kapil A, Sreenivas V. Decreased Susceptibility to Vancomycin in Meticillin-Resistant Staphylococcus aureus: A 5 year study in an Indian tertiary hospital. Journal of Medical Microbiology. 2010; 59: 375-376.
[4]. Oliveria DC, Tomasz A, de Lencastre H.Secrets of success of a human pathogen: molecular evolution of pandemic clones of methicillin-resistant Staphylococcus aureus. Lancet Infect Dis 2002;2:180-9. Barber M.1961. methicillin-resistant staphylococci. J Clin Pathol 14:385-393.
[5]. Priya datta, Neelam Gulati, Nidhi Singla, Hena Rani Vasdeva, Kiran Bala, Jagdish Chander and Varsha Gupta. Evaluation of various methods for the detection of Methicillin-resistant Staphylococcus aureus strains and susceptibility patterns. Department of Microbiology, Government Medical College Hospital, Chandigarh, India, Journal of Medical Microbiology (2011),60,1613-1616

Abstract: Gastro-esophageal reflux disease (GERD) is a chronic disorder of the upper gastrointestinal tract with global distribution. GERD leads to symptoms of heartburn and regurgitation, these defined esophageal symptoms are in dichotomy with extraesophageal symptoms of GERD1. These extra-esophageal symptoms include respiratory manifestations similar to the features of asthma. GERD often coexists with asthma and is often responsible for the repeated exacerbations.Bronchial asthma has been defined by GINA as a "Chronic inflammatory disorder of the airways in which many cells and cellular elements play a role2. 300 million individuals currently suffering from asthma worldwide3,4. In India, there is limited data on the exact prevalence of GERD in bronchial asthma. Little is known regarding the relationship between the degree of these 2 afflictions.

[1]. Jaspersen D. Extraesophageal disorders in gastroesophageal reflux disease. Dig Dis , 2004;22(2) 11-119
[2]. Bateman ED, Boulet LP , Cruz AA, Fitzgerald M, Haahtela T, Levy MC, et al, on behalf of GINA. Global initiative for asthma (GINA) (2012). Global strategy for Asthma management and Prevention (updated 2011).

[3]. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. [Last accessed on 2018 Sept 15].

[4]. Kant S. Socio-economic dynamics of asthma. Indian J Med Res. 2013;138:446–8.
[5]. Global Initiative for ASTHMA : updated 2016

Abstract: AIM: To analyze and describe our management strategies of failed neck anastomosis in pharyngo esophageal reconstructions after corrosive injury esophagus. MATERIAL AND METHODS: About 23 patients who underwent conduit interposition for corrosive stricture esophagus presented with various complications. At the end of study, type of corrosive ingested, type of conduit and techniques used in primary surgery, etiology of failed neck anastomosis and mode of management were analyzed. RESULTS: Most of the patients consumed acid substance (95%), and only one patient consumed alkali (18.75%). Among 23 patients, the corrosive ingestion was suicidal in 20 patients and............

Keywords: failed neck anastomosis, stricture esophagus, esophageal replacement, acid substance

[1]. Havanond C. Clinical features of corrosive ingestion. J Med Assoc Thai 2003; 86:918–924.1.
[2]. Thomas P, Fuentes P, Giudicelli R, Reboud E. Colon interposition for esophageal replacement: current indications and long-term function. Ann Thorac Surg 1997;64:757–764.
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[4]. Mutaf O, Genç A, Herek O, et al: Gastroesophageal reflux: A determinant in the outcome of caustic esophageal burns. J Pediatr Surg 31:1494, 1996.
[5]. Zhou J-H, Jiang Y-G, Wang R-W, et al: Management of corrosive esophageal burns in 149 cases. J Thorac Cardiovasc Surg 130:449, 2005.

Abstract: We aimed at assessing lipid profile and fasting blood sugar level in recently diagnosed subjects with nonalcoholic fatty liver disease and tried to find out correlation if any. METHODS: 100 individuals diagnosed with fatty liver disease by abdominal ultrasound were subjected to assessment of fasting blood sugar and serum lipid profile. Statistical analysis was done by unpaired t-test and Pearson's correlation test. RESULTS: Blood cholesterol level showed positive correlation with BMI, TG, LDL and HDL cholesterol. But fasting blood sugar did not show any significant correlation with other parameters in our chosen subjects. CONCLUSIONS: This study is not new in this field of research but we studied the patient population of our surrounding area to assess their lipid status at the outset of fatty changes in liver.]

[1]. Ascha, M. S. et al. The incidence and risk factors of hepatocellular carcinoma in patients with nonalcoholic steatohepatitis.Hepatology 51, 1972–1978 (2010).
[2]. Tiniakos, D. G., Vos, M. B. & Brunt, E. M. Nonalcoholic fatty liver disease: pathology and pathogenesis. Annu Rev Pathol.5, 145–171 (2010).
[3]. Angulo, P. et al. Liver Fibrosis, but No Other Histologic Features, Is Associated With Long-term Outcomes of Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology 149, 389–397 e310 (2015).
[4]. Chitturi, S. & Farrell, G. C. Etiopathogenesis of nonalcoholic steatohepatitis. Semin Liver Dis. 21, 27–41 (2001).
[5]. Sanyal, A. J. et al. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. Gastroenterology 120, 1183–1192 (2001).

Abstract: Background Newly graduated medical students receive no specific training in bedside procedures prior to starting internship. Most are not confident in bedside procedures, lack self-efficacy and are not inclined to acquiring these, being more inclined to preparing for entrance examinations. The transition to practice is difficult. This project studies whether a training given before start of internship will improve their self-efficacy and help them to acquire these skills and do procedures better, byan objective assessment (Kirkpatrick's level 4), taking one such procedure of- Nasogastric Tube Insertion (NGT) for the study. Method Study sample and setting –15 interns each of the last batch of 2014(untrained) and first batch of 2015(trained) who were posted in department of medicine..........

Keywords: assessment, bedside, internship, Kirkpatrick's level 3& 4, procedures, training,

[1]. Purushottam A Giri, Gaurav Singh Parhar. -Internship-A transition from a medical student to a doctor. Int J Biomed and Advanced research. 2012; vol 3:10.
[2]. Hannon F B. – A National Medical Education needs assessment of Interns and development of an Intern education and training program. Med Educ. 2000;34(9): 275-84.
[3]. Len Coberly, Linda M Goldenhar. Ready or not here they come; Acting interns experienced and perceived competency performing Basic Medical Procedures. JGen Intern Med. 2007; (4): 491-494
[4]. J Jaschinski, &De Villiers. Factors influencing the development of practical skills of interns working in regional hospitals of Western Province of Africa SA Fam Pract 2008;50(1):70
[5]. Ananthakrishnan N. Medical Education in India–Is it still possible to reverse the downhill trend? Nat. Med. J. India. 2010;23(3):157-160

Abstract: Chronic Obstructive Pulmonary Disease (COPD) is a chronic inflammatory disabling disease(1). It is a spectrum of airway disease characterized by the chronic bronchitis (airway obstruction ) & emphysema (parenchymal destruction )(2) . The major cause for morbidity & mortality in worldwide is COPD &it is the fourth leading cause of death in world (3,4,5). In US alone , 24 million people suffer from COPD & is the third leading cause of death(6). COPD is an inflammatory disease with significant airflow limitation that is not fully reversible (7) & is usually progressive (3) with remissions & exacerbations as Acute Exacerbations of Chronic Obstructive Pulmonary Disease(AECOPD) . Airflow limitation is caused by both airway obstruction & parenchymal destruction .An exacerbation of COPD is acute in onset ,which is the worsening of the patient's condition from the stable state characterized by change..........

[1]. Seemungal, TA, Donaldson, GC, Paul, EA et al, Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157:1418–1422.
[2]. S. Sethi, T.F. MurphyBacterial infection in chronic obstructive pulmonary disease in 2000: a state-of-the-art review,Clin. Microbiol Rev., 14 (2) (2001), pp. 336-363
[3]. GOLD (Global Initiative for Chronic Obstructive Lung Disease) -global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease-revised 2006. http//www.goldcopd.org.: 1-100.
[4]. World Health Report. Geneva: World Health Organization. Available from URL: http://www.who.int/whr/2000/en/statistics.htm; 2000.
[5]. Lopez AD, Shibuya K, Rao C, Mathers CD, Hansell AL. et al. Chronic obstructive pulmonary disease: current burden and future projections. Eur Respir J. 2006; 27(2): 397-412.

Abstract: Aims: To study the use of propranolol as a single therapy in problematic infantile hemangioma with special reference to the total duration of treatment and its short term outcome(s). Methods: Single institutional retrospective study of patients of problematic infantile hemangioma treated with propranolol between January 2016 to December 2017. Assessment was done by change in colour , redness & size. Accordingly, outcome was graded as excellent, good/partial and no response. Results: 17 girls and 9 boys with problematic infantile hemangioma were initiated treatment with propranolol at the mean age of 7 months(range 2-24 months) for a mean duration of 12 months(range 6-18 months). Head and neck was the most common site(65%)..............

Keywords: Propranolol, problematic infantile hemangioma, duration

[1]. Kilkline C, Frieden IJ. Infantile hemangioms: how common are they? Pediatr Dermatol 2008; 25: 168-73.
[2]. Bisht J, Kumar R et al. A prospective study of treatment of problematic infantile hemangiomas with propranolol and its outcome. IOSR JDMS. 2017;10:40-46.
[3]. Holmes WJM et al. Propranolol as first line treatment for rapidly proliferating infantile haemangiomas. J Plast Reconstr Aesthet Surg.2011 64: 445-51.
[4]. Lei Chang et al. When to stop propranolol for infantile hemangioma. Scientific reports; 7: 43292.
[5]. Chen Z et al. A survey on clinical use of propranolol for infantile hemangiomas in mainland China. Int J Clin Exp Med 2014; 8: 2138-46.

Abstract: Mucormycosis is caused by fungi of order mucorales. Rhizopus is a medically important fungi of this order as it is known to cause invasive disease with a fatal outcome. It is commonly seen in immunocompromised individuals like uncontrolled diabetes mellitus, organ transplant, corticosteroids intake, neutropenia or any other condition known to compromise the immune system. Mucormycosis in immunocompetent individuals is extremely rare. We present a rare case of cutaneousmucormycosis of anterior chest wall in an immunocompetent individual therefore emphasizing the need to consider it as a differential diagnosis in patients with cutaneous chronic granulomatous lesions..

Keywords: Mucormycosis, Rhizopus, Chest wall, Cutaneous

[1]. Spellberg B, Edwards J, Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. ClinMicrobiol Rev 2005;18:556-69.
[2]. D. S. Hibbett, M. Binder, J. F. Bischo et al. A higher-level phylogenetic classification of the Fungi. Mycological Research 2007;111(5):509–47.
[3]. Morace G, Borghi E. Invasive Mold Infections: Virulence and Pathogenesis of Mucorales. Int J Microbiol 2012, Article ID 349278, 5 pages doi:10.1155/2012/349278.
[4]. M Pieters, CL Barrett, J Goedhals, L Badenhorst, WC Viljoen, MGL Spruyt. An unusual case of fatal gastrointestinal Rhizopus oryzae infection in a diabetic patient. South Afr J Epidemiol Infect 2008;23(3):18-20.
[5]. Ribes JA, Vanover-Sams CL, Baker DJ. Zygomycetes in human disease. ClinMicrobiol Rev 2000;13:236-301.

Abstract: Le syndrome de cushing secondaire à une sécrétion ectopique d'ACTH par une tumeur neuroendocrine pancréatique est une situation assez rare. Nous rapportons le cas d'une patiente âgée de 45 ans, chez qui on a fait le diagnostic d'une tumeur neuroendocrine du pancréas bien différenciée grade 2 avec un Ki 67 à 7% sur des critères cliniques, biologiques, radiologiques et histologiques, traitée par les analogues de la somatostatine. Six mois plutard, la patiente a accusée des douleurs lombaires intenses suite à un faux mouvement sans notion de traumatisme évident, d'où la réalisation d'un scanner lombaire, plusieurs tassements vertébraux étaient mis en évidence (T12-L1-L2-L4). L'évolution est marquée par la découverte d'un diabète sucré et une hypokaliémie réfractaire. L'association de ces trois éléments a permis d'évoquer et de rechercher un syndrome de Cushing paranéoplasique..........

[1]. WEN-YA LI, Paraneoplastic Cushing's syndrome associated with bronchopulmonary carcinoid tumor in youth: A case report and review of the literature. Oncol Lett. 2016 Jul; 12(1): 69–72.
[2]. A. Chadli , L. Alami , S. El Aziz , A. Lazghad , H. El Ghomari, M. Kafih , F. Essodegui , L. Jabri , A. Farouqi F. Marouan . Syndrome de Cushing révélateur d'un carcinoïde pulmonaire. Annales d'Endocrinologie Vol 67, N° 3- juin 2006. pp. 253-258
[3]. C. Dromain et all. Imagerie des tumeurs pancréatiques endocrines. Journal de Radiologie diagnostique et interventionnelle volume 97, n° 5 pages 518-536 (décembre 2016).
[4]. Milan SA, Yeo CJ. Neuroendocrine tumors of the pancreas. Curr Opin Oncol. 2012 Jan; 24(1):46-55.
[5]. Amikura K1. Role of surgery in management of adrenocorticotropic hormone-producing islet cell tumors of the pancreas. Surgery. 1995 Dec;118(6):1125-30.

Abstract: Eclampsia is alife threatening condition may occur before, during or after labour. Over half-a-million women die each year from pregnancy-related causes, and99 percent of these occur in developing countries. In Bangladesh though maternal mortality rate (MMR) declined significantly around 40% in the past decade, still eclampsia accounts for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure is delivery regardless of gestational age. A rational therapy for general management of hypertension and convulsion has been established in Bangladesh by the Eclampsia Working Group. But controversy still exists regarding obstetric management. The aim............

Keywords: Eclampsia, cesarean section, vaginal delivery, Feto-maternal outcome

[1]. Robson SC. Hypertension and renal disease in pregnancy.
[2]. Bangladesh maternal mortality and health care survey (BMMS) 2010. ICDDRB & NIPORT, September 2011
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[4]. Begum A. Role of caesarean section affecting the foetomaternal outcome in eclampsia [FCPS Dissertation]. Dhaka: Bangladesh College of Physicians and Surgeons; 2005
[5]. Hypertensive disorders in pregnancy. In: Arias F, Daftary

Abstract: Objective: To study the incidence and to analyze the maternal and perinatal outcome in gestational hypertension Methods: All pregnant women beyond 20 weeks with Blood Pressure ≥ 140/90 mm Hg without proteinuria admitted to Gandhi Hospital from September 2009 -September 2011 were enrolled in the study . Women with pre existing medical complications like chronic hypertension , renal disease , epilepsy ,heart disease ,anemia , diabetes, thrombophilias etc. were excluded from the study. Patients were managed as per the existing protocols in the department after proper history taking , examination and investigations. Blood pressure was controlled either by Tablet alpha methyl dopa or nifedipine or both. Injection Magnesium sulphate was the drug of choice to control convulsions...........

Keywords: Gestational Hypertension , maternal mortality ,perinatal mortality

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Abstract: Introduction:Primary implant stability plays an important role in determining implant success. Several methods have been used to determine primary stability during implant placement. The ability to determine primary stability preoperatively would enable implant planning with higher predictability. Aim: This study was performed to evaluate the reliability of CBCT in predicting primary implant stability by preoperative bone density measurement, through its correlation with clinical parameters of implant stability including insertion torque (IT) and resonance frequency analysis (RFA). Materials And Methods: A total of 30 implants placed in 24 patients were evaluated. The bone density values of the implant sites were assessed............

Keywords: primary stability, bone density, CBCT, dental implant stability, resonance frequency analysis, insertion torque

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