International Journal of Medical and Pharma Research (IJMPR)

Index Copernicus Journal id: 7526

ISSN 2277-2413

Volume 1 (2) June 2012

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Research Papers

1. Utility of Ultrasound Criteria of Roundness Index to Differentiate Between Benign and Malignant Cervical Lymphadenopathy
Dr. Sushil. G. Kachewar¹, Dr. Smita Balwant Sankaye²
Associate Professor¹, Chief Registrar²
Rural Medical College (RMC), PIMS, Loni, India
Vol. 1(2) : pp 51-56 (2012)
Abstract: Objective: The purpose of this study was to assess the utility of ultrasound criteria of Roundness Index (RI) to differentiate between benign and malignant cervical lymphadenopathy.
Methods: We evaluated 305 patients having clinically palpable enlarged cervical lymph nodes by using the grayscale ultrasound criteria of Roundness Index i.e. the ratio of longest diameter of the node to the shortest perpendicular diameter (RI) . Nodes having RI<2 were considered as malignant and those having RI > 2 were considered as benign. This ultrasound diagnosis was verified with findings of fine needle aspiration cytology (FNAC) which was considered as gold standard for this study.
Results: In total, out of the 305 patients the RI was less than two in 60 patients (19.67%) and was more than two in 245 patients (80.33%). Out of the total 244 patients with benign (80.00%) nodes, 237 (97.13%) had the index more than two. Out of the total 61(20%) patients with malignant nodes, 53 patients (86.88%) had the index less than two.
Conclusions: The grey scale criterion of RI was 86.89% sensitive and 97.13% specific in differentiating between benign and malignant causes of lymph node enlargement. Our results indicate that RI can be utilized for early diagnosis and follow up of cases presenting with suspected neck nodes.
Keywords: Roundness Index, Benign nodes, Malignant lymph nodes, Sonography, Cervical lymphadenopathy, Ultrasound criteria

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2. Significance of Upper Gastrointestinal Endoscopy before Cholecystectomy: A Prospective Study
Dr. Shiveta Razdan¹, Dr. Rayees Yousuf²
Department of Surgery¹, Department of Medicine²
Acharya Shri Chahder College of Medical Sciences and Hospital, Sidhra, Jammu, India
Vol. 1(2) : pp 57-67 (2012)
Abstract: Introduction: Cholelithiasis can present with varying symptoms often mimicking other gastrointestinal pathologies. A significant proportion of patients with post cholecystectomy syndrome have other underlying gastrointestinal diseases which remain undiagnosed as symptoms are often attributed to gallstones.
Materials and methods: Thirty patients with diagnosis of cholelithiasis underwent UGI endoscopy before cholecystectomy at department of Surgery at Acharya Shri Chahder College of Medical Sciences and Hospital, Sidhra, Jammu with effect from November 2008 to September 2009. Post operative symptoms relief was recorded and findings were corroborated with UGI endoscopy results.
Results: Majority of patients belonged to age group 35 to 50 years (46.6%). 28 patients (93.3%) presented with pain abdomen which was the most common symptom. Total of 23(76.6%) patients had abnormal finding on endoscopy. Gastritis was the commonest abnormality seen in 18(60%) patients. All patients with persistence of symptoms beyond 1 & 3 months had abnormal endoscopic findings preoperatively.
Coclusions: All patients of cholelithiasis presenting with dull and constant type of pain with more dyspeptic symptoms should undergo Upper gastrointestinal (UGI) endoscopy before cholecystectomy.
Keywords: Upper gastrointestinal (UGI) endoscopy, Cholecystectomy, Post cholecystectomy syndrome, Cholelithiasis, Endoscopy, Gastrointestinal endoscopy

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3. Efficacy of Topical Nifedipine in the Management of Chronic Anal Fissure: A Prospective Randomised Controlled Study
Dr. Umesh Jethwani, Dr. Vipul Kandwal, Dr. Chetan
Senior Resident, Department of Surgery, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Vol. 1(2) : pp 68-75 (2012)
Abstract: Background: Chronic anal fissure is the most common cause of anal pain associated with internal anal sphincter hypertonia. Reduction of hypertonocity is a special treatment for fissure healing. For this purpose chronic anal fissures were conventionally treated by anal dilatation or by lateral sphincterotomy. However, both of these methods may cause a degree of incontinence in some patients. The uptake of medical therapies that create a reversible chemical sphincterotomy has recently become widespread. The aim of this prospective clinical trial study was to assess the effectiveness of nifedipine in healing anal fissure, a calcium channel blocker that reduces sphincter pressure.
Materials and Methods: 100 patients were included in this randomised open control study in a surgical unit of a medical college hospital, 50 patients in the nifedipine group and 50 patients in the control group and the therapeutic outcome and side effects were recorded.
Results: Healing had occurred in 76% of patients in the nifedipine group and in 12% of patients in the control group after 4 weeks of treatment (P < 0.005). Recurrence of symptoms occurred in two patients in the nifedipine group and two patients in the control group after two months. The final result of nifedipine application after 6 months follow up was recurrence in 8 patients (21.05%). Mild headache occurred in four patients (8%) of the nifedipine group. Patients in the nifedipine group showed significant healing and relief from pain compared with patients in the control group
Conclusion: Topical nifedipine can be used as an effective conservative therapy for chronic anal fissures, substituting other topical agents.
Keywords: Topical nifedipin, Chronic Anal Fissure, Anal Fissure, Anal pain, Efficacy of topical nifedipine, Anal sphincter hypertonia

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4. Rapid Slide Culture: A Useful Tool in Early Detection of Mycobacteria
Dr. Anahita V. Hodiwala¹, Jitendra Panda², Dr. A. Urhekar³
Professor¹, Student², Professor and Head³
Department of Microbiology, M.G.M. Medical College and Hospital, Kamothe, Navi Mumbai, India
Vol. 1(2) : pp 76-79 (2012)
Abstract: Background: Worldwide prevalence of tuberculosis is greater than 40 million and about 10 million new cases are added per year. The conventional culture method using L.J. medium is highly sensitive, however it is very time consuming.
Materials and Methods: Hence a comparison of the above was done with rapid slide culture (RSC) method, which is simple, safe and rapid as it gives results within 7 days. 189 new cases of suspected pulmonary tuberculosis of which 99 were smear positive and 90 were smear negative for acid fast bacilli were included in this study. All the 189 samples were processed for culture by both RSC and LJ method.
Results: It was found that sensitivity of RSC was 100% in smear positive cases but 81.3% in smear negative cases when compared with the growth on LJ medium which is still considered a gold standard in diagnosis of pulmonary tuberculosis. This indicates that less number of bacilli in the sample was a major factor affecting the sensitivity of this rapid method.
Conclusion: We conclude that RSC although not an alternative for conventional LJ culture, could be a useful tool to detect and confirm clinically suspected cases, and since it gives results within 7 days, it hastens the diagnosis thereby helping in the treatment of the same.
Keywords: Tuberculosis, Rapid Slide Culture, LJ medium, Mycobacteria, TB, RSC

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5. Role of MCA-PSV in Managing Fetal Anaemia in Alloimmunized Pregnancies: A Review
Dr. Sushil G. Kachewar
Associate Professor, Rural Medical College (RMC), PIMS, Loni, India
Vol. 1(2) : pp 80-84 (2012)
Abstract: The joy when a fetus is conceived knows no bounds when a normal healthy child is born. This beautiful picture is sometimes charred by the onset and manifestation of fetal anaemia.
Objective: This review was conducted to assess the worldwide utility of fetal middle cerebral artery peak systolic velocity (MCA- PSV) for the diagnosis of fetal anemia.
Materials and Methods: Different articles detailing the methods of diagnosis of fetal anemia were accessed by from the departmental library as well as from the World Wide Web. Important features of these methods, their pros and cons were then highlighted.
Results: Amniotic fluid spectrophotometric analysis to detect bilirubin is an indirect as well as an invasive approach. Cordocentesis under ultrasound guidance gives fetal blood sample directly to estimate haemoglobin in it, but this too is an invasive method. Both of these methods have the potential to result in fetal loss. The use of colour Doppler ultrasound to show abnormal rise in MCA-PSV in presence of fetal anaemia is not only a non invasive approach to assess fetal anaemia but is also an effective, economical and repeatable method for the same.
Conclusions: Of the various methods available to diagnose fetal anemia, Colour Doppler estimation of fetal MCA-PSV is the most effective and widely practiced non invasive method.
Keywords: Fetal anaemia, Middle cerebral artery peak systolic velocity, Doppler Ultrasound, Anaemia, Alloimmunized Pregnancies

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6. Role of Early Enteral Nutrition by Nasojejunal Tube Feeding in Cases of Peptic Perforation Peritonitis
Dr. Umesh Jethwani¹, Dr. Sanjay Jain², Dr. M.C. Songra³
Senior Resident¹, Department of Surgery, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Associate Professor², Professor & Head³, Department of Surgery, Gandhi Medical College, Bhopal, India
Vol. 1(2) : pp 85-97 (2012)
Abstract: Background: Withholding enteral feeds after an elective gastrointestinal surgery is based on the hypothesis that this period of “nil by mouth” provides rest to the gut and promotes healing.
Aims: To assess whether early postoperative naso-jejunal tube feeding in the form of a balanced diet formula is safe and beneficial in patients of peptic perforation peritonitis.
Setting: A surgical unit of a Medical College Hospital.
Design and Subjects: Prospective randomised open control study.
Materials and Methods: Patients undergoing surgical intervention for peptic perforation peritonitis were randomised to the study group receiving feedings of a balanced diet formula through a nasojejunal tube from the second postoperative day, or the control group in which patients were managed with the conventional regimen of intravenous fluid administration. The groups were compared for incidence and duration of complications, biochemical measurements and other characteristics like weight loss/gain. Statistical Analysis includes techniques like Chi square test and ‘T’ test.
Results: Eighty patients were enrolled in each group. 88% subjects in the study group achieved positive nitrogen balance on the eighth postoperative day as compared to none in the conventionally managed group. Average loss of weight between the first and tenth day was 3.10 kg in the study group as compared to 4.5 kg in the conventionally managed group (‘P’ value <0.001). Total number of complications were more in control than study group.
Conclusion: Early enteral nutrition is safe and is associated with beneficial effects such as lower weight loss and early achievement of positive nitrogen balance as compared to the conventional regimen of feeding in operated cases of peptic perforation peritonitis.
Keywords: Nasojejunal tube, Enteral nutrition, Peptic perforation peritonitis, Eternal nutrition, Nasojejunal tube feeding, Peritonitis

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7. Antibiotic Susceptibility Profile of Bacterial Isolates from Intensive Care Unit in a Tertiary Care Hospital in Punjab
Dr. Prerna Aggarwal¹, Dr. Satish Gupte², Dr. AK Chopra³, Dr. Maninder Kaur¹, Dr. Ashwani Manhas¹, Dr. Manju Bala⁴
Assistant Professor¹, Professor and Head², Associate Professor³, Senior Resident⁴
Department of Microbiology, Gian Sagar Medical College & Hospital, Ramnagar, Rajpura, District Patiala, India
Vol. 1(2) : pp 98-103 (2012)
Abstract: Purpose: To study the prevalence and antibiotic susceptibility pattern of bacterial isolates from intensive care unit of a tertiary care hospital.
Methods: A retrospective study was conducted on specimens from ICUs, isolated from July 2009 to May 2010. The specimens were processed using standard microbiological techniques. MRSA was detected using the Cefoxitin disc by disc diffusion method.
Results: Majority of the specimens showing positive cultures- 42 % consisted of invasive devices from the upper respiratory tract like tracheostomy tubes and endotracheal tube tip cultures used in interventions, followed by pus and wound swabs - 25 %, urine – 13 % and blood cultures-10.43%. The organisms isolated predominantly were E.coli - 21 % (mainly from urine), Pseudomonas aeruginosa and Acinetobacter spp. - 19 % and 18 %, respectively (mainly from invasive device cultures). Acinetobacter spp and Pseudomonas aeruginosa were found to be the most resistant organisms to the commonly used antibiotics followed by Klebsiella spp. and Coagulase negative Staphylococci. The percentage of MRSA strains was found to be 17 %.
Keywords: Antibiotic resistance, Bacterial isolates, Intensive care unit, Invasive devices, Antibiotic susceptibility, Antibiotic susceptibility profile

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8. Effect of Glycyrrhiza Glabra on the Liver of Pregnant Mice
Manorama Pandey¹, Dr. Shashikant Pandey², Dr. Y.B. Tripathi³
PhD Scholar¹, Professor², Department of Anatomy,
Professor and Head³, Department of Medicinal Chemistry,
Institute of Medical Sciences, Banaras Hindu University, Varanasi (UP), India.
Vol. 1(2) : pp 104-109 (2012)
Abstract: In the present study the Swiss white female mice were obtained from the department of Anatomy and the central animal house, Institute of medical sciences, Banaras Hindu University. Each group of experimental animal received, orally, 400mg/kg body weight of the drug with 0.5mlof distilled water, whereas the control mice of each group received the same volume of distilled water. The first group was treated with daily single oral dose of the Glycyrrhiza glabra for 1-3 days of gestation, the second group with daily dose of the same drug for 1-7days, whereas the third treated group received single dose from 1-17 days of gestation. All groups of pregnant mice were sacrificed on day 18th of gestation i.e. one day prior to delivery. The liver of the female pregnant mice were collected after laparotomy and observed for gross malformation, but there were no any external abnormalities in any treated group as compared to the control. The weight of the liver of the first and second group showed no significant change as compared with their corresponding controls, whereas in the third group there was significant increased in the weight compared with control.
Microscopic examination of treated liver of first group was appeared to be normal as compared with the control group, whereas second group & third group showed dilation of and destruction of endothelial lining of central vein along with necrosis of hepatocytes. The pericentral necrosis was also observed in the third group.
Keywords: Glycyrrhiza glabra, Liver, Endothelial lining, Central vein, Hepatocytosis, Pericentral necrosis, Antioxidant

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9. A Study on Inducible Clindamycin Resistance among Staphylococcus aureus in a Tertiary Care Hospital
Dr. S. Senthamarai, Dr. C. Anitha, Dr. S. Sivasankari, Dr. V. Venugopal, Dr. S.K. Amshavathani
Department of Microbiology, Meenakshi Medical College and Research Institute, Enathur, Kanchipuram, India
Vol. 1(2) : pp 110-114 (2012)
Abstract: Clindamycin resistance has been reported due to constitutive or by the presence of low level inducers due to erm genes. The routine antimicrobial susceptibility testing for clindamycin may fail to detect inducible clindamycin resistance resulting in treatment failure. These strains can be detected by simple routine D-test (disc diffusion test) as per the CLSI guidelines. This present study was aimed to detect percentage of inducible Clindamycin resistance among the MRSA and MSSA Staphylococcus aureus isolates from various clinical samples. A total of 524 Staphylococcus aureus isolates were obtained among which 219 (41.79%) were MRSA and 305 (58.21%) were MSSA.
Highest isolation of S.aureus 463 (88.36%) were found in pus samples. Among the 524 S.aureus isolates, 93(17.75%) were inducible phenotype (i MLSB), 71 (13.55%) were constitutive phenotype (c MLSB), and 78(14.88%) were MS phenotype (MSB). The inducible, constitutive and MS phenotypes were 47 (21.46%), 38 (17.35%) and 26 (11.87%) among 219 MRSA isolates, and 46 (15.08%), 33 (10.82%) and 52 (17.05%) among 305 MSSA isolates respectively. The percentages of inducible and constitutive resistance were found to be higher amongst MRSA isolates than MSSA isolates and routine ‘D’ test can be used to detect the inducible clindamycin resistance for all erythromycin resistant isolates. In order to guide the clinicians regarding judicious use of clindamycin in skin and soft tissue infections as well as to prevent therapeutic failure.
Keywords: Staphylococcus aureus, inducible clindamycin resistance, Constitutive phenotype, MRSA, MSSA, MLSB, Clinical and laboratory standards institute (CLSI)

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10. A Study of Occurrence of Drug Defaulters and Evaluation of Safety Profile among Anti Tubercular Drugs
Dr. M.K. Vijayalaxmi¹, Dr. Dheeraj Alexander², Dr. Natasha J. Nambiar³
Associate Professor¹, Intern², Assistant Professor³
Department of Pharmacology, Father Muller Medical College, Mangalore, India
Vol. 1(2) : pp 115-120 (2012)
Abstract: Objective: To assess the frequency of drug defaulters among patients on anti tubercular treatment along with the occurrence of drug related adverse effects.
Methodology: Patients (n=35) diagnosed with tuberculosis and undergoing treatment under Directly observed treatment short course (DOTS) were enrolled based on specific inclusion and exclusion criteria. Details of medical history and relevant investigations were filled out in a proforma sheet and revised at the end of 1st, 2nd and 3rd month of follow-up treatment. Data was analyzed by chi square test and fishers test.
Results: Important factors for patient non compliance in the present study were adverse drug reactions and symptomatic improvement in patient’s health. Majority of the defaulters were males and 80% were in the age group 35-54 years. The adverse drug reactions encountered were pruritus (17.1%), nausea (11.4%) and vomiting (8.6%) and joint pain (2.9%).The study revealed that 69.2% of the patients developed adverse effects during the 1st month of treatment.
Conclusion: Although not significant the present study attempts to study the adverse effects of anti tubercular drugs and the reasons behind patient non compliance. Defaulting is a major obstacle in the cure of tuberculosis and efforts to narrow this subset must be made to increase adherence to drug treatment and curtail the emergence of drug resistant strains.
Keywords: Anti tubercular drugs, Patient compliance, Adverse drug reaction, Drug defaulters, Drugs, Anti tubercular treatment

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11. Embella – A Medical Boon
Dr. Rahul R. Deshpande^1,3, Dr. Pallavi K. Kakade¹, Dr. Priyanka Mahajan¹, Dr. Vishwas Patil¹, Gayatri S. Kamble², Nirmala R. Deshpande^2
1Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India
²Dr. T. R. Ingle Research Laboratory, Department of Chemistry, S. P. College, Pune, India
³Deenanath Mangeshkar Hospital, Pune, India
Vol. 1(2) : pp 121-129 (2012)
Abstract: A child has always been the center point of concern and focus in society. Thus the health of a child has been the trigger of various anxious episodes happening in that tender age. Various means are available over the counter as preventive and therapeutic remedies. Indian traditional medicines have a lot to offer to the world in this aspect also. Embelia is a medicinal plant used in traditional Indian medicine for the treatment of the various ailments. In Ayurveda the plant is popularly known as ‘Vidanga’. Embelia is one of medicinal plants which is pluripotent in nature and offers a great preventive as well as well protective umbrella for child’s health.
The seeds, leaves and fruits of the same plant have different therapeutic activities like antibiotic, antihelmentic, antibacterial, astringent, demulcent, depurative, anticonvulsant and used in prevention of pleurities, sore throat, ulcers of mouth, skin diseases, jaundice and mental disorders also in treatment of dental caries thus make this plant unique. This paper focuses not only on the antibacterial and antimicrobial but also antihelmentic, antifungal, and antioxidant properties of Embelia basal.
Keywords: Embelia Basal, Antibacterial, Antihelmentic, Antifungal, Anticonvulsant activity, Wound healing, Antioxidant properties

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Case Reports

1. Improved Outcome in a Rare Variant of Ileosigmoid Knotting With Extensive Bowel Gangrene: A Case Report
Dr. R.S. Mohil, Dr. P. Panwar, Dr. G.J. Singh, Dr. V. Kandwal, Dr. U. Jethwani, Dr. R. Bamal
Department of Surgery, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, India
Vol. 1(2) : pp 130-136 (2012)
Abstract: We report a rare variant (Type 2A) of ileosigmoid knotting presenting with features of peritonitis, and causing extensive small bowel gangrene with gangrene of sigmoid colon, leading to short bowel syndrome post operatively. The mortality rate reported in such cases is very high. These patients require combined oral and parenteral nutritional support. We report improved outcome in this case using the technique of enteroclysis feeding of distal loop, making the early closure of stoma possible.
Keywords: Ileosigmoid knot (ISK), Enteroclysis, Ileosigmoid, Bowel Gangrene, Peritonitis, Gangrene

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2. Bilateral Tubal Pregnancy Involving Ampullary Segments: An Uncommon Case
S. Chourasia, J. Aggrawal, R. Bamania, D. Jethwani, M. Dudve
Department of obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College,Bhopal (MP), India
Vol. 1(2) : pp 137-139 (2012)
Abstract: The rarest form of ectopic pregnancy is bilateral ectopic pregnancy and is usually the result of assisted reproductive technologies. We here discuss an unusual case of spontaneous bilateral tubal ectopic pregnancy. We report a 25 year old woman with ruptured tubal ectopic pregnancy on the right side and intact tubal pregnancy on the left side. She was admitted after abdominal pain associated with vaginal bleeding, 42 days after her last menstruation. The diagnosis of bilateral ectopic pregnancy was made after laprotomy and pathology report confirmed the diagnosis. Thus it is crucial to perform a close inspection of the pelvis and contralateral tube during laparotomy.
Keywords: Bilateral ectopic pregnancy, Ruptured ectopic pregnancy, Salpingostomy, Bilateral tubal pregnancy, Ampullary segment, Tubal pregnancy

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3. Obsessions of Musical Themes: A Case Report
Dr. Amitabh Saha
MD, Psychiatry, Armed Forces of India, India
Vol. 1(2) : pp 140-142 (2012)
Abstract: Obsessive-compulsive disorder is a common psychiatric illness. A case of OCD is presented in which the chief symptom was recurrent imagery of musical sounds of different instruments experienced by the person. Patient was a musician who played various musical instruments. Such obsessions with predominant musical themes, lyrics and tunes have not been described in detail in standard textbooks of psychiatry or phenomenology, nor are they considered in the various diagnostic procedures for OCD. These symptoms are rare and may at times go unnoticed because of low clinical awareness.
Keywords: Obsessive-compulsive disorder, Obsessive image, Musical obsession, Sensory obsession, Obsession, Obsession of Musical Theme

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4. Bilateral Tubercular Epididymocutaneous Fistulae: A Report of Two Rare Cases
Dr. P. Panwar, Dr. Gupteshwar Prasad
Department of Surgery, Safdarjung Hospital & Vardhman Mahavir Medical College, New Delhi, India
Vol. 1(2) : pp 143-146 (2012)
Abstract: We report two cases of bilateral epididymocutaneous fistulae which is a very rare presentation of tubercular epididymitis. Epididymis is the commonest structure affected by tuberculosis in male genital tract. The diagnosis of tubercular epididymitis can be made with Ultrasonography and FNAC. Antitubercular drugs are effective and avoid unnecessary surgical interventions.
Keywords: Tubercular, Epididymitis, Epididymocutaneous fistulae, Fine needle aspiration cytology (FNAC), Anti tubercular therapy (ATT), Bilateral tubercular

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5. Review of Ophthalmoyiasis in India with Special Reference to Oestrous ovis larval External Ophthalmomyiasis
Dr. Vijay G. Kumar¹, Dr. Anita T. Girish², Dr. Tejasree³, Dr. Rajeshwari K. Pradeep⁴, Dr. Rajendra⁵
Professor and Head¹, Professor³, Assistant Professor⁴, Department of Microbiology,
Assistant Professor², Professor⁵, Department of Ophthalmology,
JSS Medical College and Hospital, JSS University, Shri Shivarathreeshwara Nagar, Mysore, India
Vol. 1(2) : pp 147-150 (2012)
Abstract: Flies are the most common mechanical carriers of filth causing human infections in rural places of developing countries. Many of these flies feed on lachrymal and sebaceous secretions and sometimes invade into deeper areas causing a condition called myiasis. Myiasis is the infestation of live human or animal tissues with the dipterous larvae. Oestrus ovis is the nose bot fly of sheep. Human infections due to this fly and its larvae are rare; it is more common among people living in sheep-raising regions of the world. Recently it has also been reported from urban areas.
In India, O. ovis ophthalmomyiasis is rare. Though there are few case reports from northern Indian states, very few cases are reported in south India. We report first case of external opthalmomyiasis due to first instar larva of O. ovis in an adult male person having no close contact with sheep. Present case report stresses the importance of thorough eye examination in all eye infections and that good personnel hygiene prevents such infestations. The discussion and findings conclude that a first case of Ophthalmomyiasis in this region is reported with Ocularmyiasis more common in North India along with an uncommon infestation in south Indian cities.
Keywords: Myiasis, Diptera, Ocularmyiasis, Oestrous ovis, Ophthalmoyiasis, O. ovis

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