Surgical Manifestation Of Filariasis

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surgical Aspect Of Family Planning

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Review Of 41 Cases Of Hyatid Disease

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Appendicular Fistula

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A CASE OF CHOLEDOCHOASCARIASIS

Abstract

Vas Recanalisation

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Descriptive Epidemiology of a Gastroenteritis Out Break in Sunsari District, Nepal

Gastroenteritis (GE) outbreak and cholera epidemics continue to be the major publichealth problems in Nepal. Every year during and immediately after the rainy season,outbreak of GE occurs. In the post monsoon period of 1998 also, outbreak of GEoccurred in a wide area covering several districts in terai region. In this paper, severalepidemiological aspects of the current outbreak are being reported. This study wascarried out in sunsari district. The cases of GE brought to district hospital wereinterviewed by a trained health worker to collect information about the episode andpossible source of infection. Stool samples were collected from the patients and testedfor organisms. On the spot visits were made to collect more information. Water sampleswere also collected and tested in Microbiology laboratory, B. P. Koirala Institute ofHealth Sciences (BPKIHS). There were 947 cases of GE. Among them 55.2% werefemales and 44.8% males patients. The age ranged from 7 months to 86 years withmean age of 22.8 years. There were 8 deaths. Maximum number of cases occurred inthe first fornight of October 1998. Due to prior administration of antibiotics, no growthwas seen in 27 samples. However, 4 samples showed growth of Shigella. Vibrio cholerawas isolated from 2 cases. Eight out of thirteen water samples were found to beunsatisfactory for drinking. The contamination of drinking water source andunhygienic habits were the main causes for such outbreaks. Therefore, it is pertinentthat GE outbreaks may be prevented by simply promoting sanitation and hygienicpractices related to handling of drinking water and defecation.

Surgical Treatment Of Peptic Ulcer

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Prevalence of spasticity post stroke

OBJECTIVES

To establish the prevalence of spasticity 12 months after stroke and examine its relationship with functional ability.

DESIGN

A cohort study of prevalence of spasticity at 12 months post stroke.

SETTING

Initially hospitalized but subsequently community-dwelling stroke survivors in Liverpool, UK.

SUBJECTS

One hundred and six consecutively presenting stroke patients surviving to 12 months.

MAIN OUTCOME MEASURES

Muscle tone measured at the elbow using the Modified Ashworth Scale and at several joints, in the arms and legs, using the Tone Assessment Scale; functional ability using the modified Barthel Index.

RESULTS

Increased muscle tone (spasticity) was present in 29 (27%) and 38 (36%) of the 106 patients when measured using the Modified Ashworth Scale and Tone Assessment Scale respectively. Combining the results from both scales produced a prevalence of 40 (38%). Those with spasticity had significantly lower Barthel scores at 12 months (p < 0.0001).

CONCLUSION

When estimating the prevalence of spasticity it is essential to assess both arms and legs, using both scales. Despite measuring tone at several joints, spasticity was demonstrated in only 40 (38%) patients, lower than previous estimates.

A multicentre observational study of presentation and early assessment of acute stroke

OBJECTIVE

To investigate delays in the presentation to hospital and evaluation of patients with suspected stroke.

DESIGN

Multicentre prospective observational study.

SETTING

22 hospitals in the United Kingdom and Dublin.

PARTICIPANTS

739 patients with suspected stroke presenting to hospital.

MAIN OUTCOME MEASURES

Time from onset of stroke symptoms to arrival at hospital, and time from arrival to evaluation by a senior doctor.

RESULTS

The median age of patients was 75 years, and 400 were women. The median delay between onset of symptoms and arrival at hospital was 6 hours (interquartile range 1 hour 48 minutes to 19 hours 12 minutes). 37% of patients arrived within 3 hours, 50% within 6 hours. The median delay for patients using the emergency service was 2 hours 3 minutes (47 minutes to 7 hours 12 minutes) compared with 7 hours 12 minutes (2 hours 5 minutes to 20 hours 37 minutes) for referrals from general practitioners (P<0.0001). Use of emergency services reduced delays to hospital (odds ratio 0.45, 95% confidence interval 0.23 to 0.61). The median time to evaluation by a senior doctor was 1 hour 9 minutes (interquartile range 33 minutes to 1 hour 50 minutes) but was undertaken in only 477 (65%) patients within 3 hours of arrival. This was not influenced by age, sex, time of presentation, mode of referral, hospital type, or the presence of a stroke unit. Computed tomography was requested within 3 hours of arrival in 166 (22%) patients but undertaken in only 60 (8%).

CONCLUSION

Delays in patients arriving at hospital with suspected stroke can be reduced by the increased use of emergency services. Over a third of patients arrive at hospital within three hours of stroke; their management can be improved by expediting medical evaluation and performing computed tomography early.

Natural history and risk factors in fulminant hepatic failure

BACKGROUND

The natural history of fulminant hepatic failure (FHF) without liver transplantation is not well known.

AIMS

To study the natural history and prognostic factors, especially the presence of ascites and spontaneous bacterial peritonitis (SBP), in children with FHF.

METHODS

FHF was defined by the onset of encephalopathy within 12 weeks of onset of jaundice. From August 1997 to December 2000, 67 children (< or =12 years) were diagnosed with FHF. Their clinical features, investigations and outcome were noted. Viral markers A to E (IgM, anti-HAV; IgM, anti-HEV, HBsAg, and anti-HCV) were determined by ELISA. SBP was defined by the presence of > or =250 neutrophils with or without a positive culture in ascitic fluid.

RESULTS

Mean age of the children was 5.8 years with an almost equal sex distribution. Viral markers were positive in 63 (94%) cases: hepatitis A in 34 (54%), E in 17 (27%), A+E in seven (11%), and B in five (8%). Thirty one children presented with grade I or II encephalopathy and all recovered, whereas 17 of 36 children who had grade III or IV encephalopathy died. Ascites was detected (both clinically and ultrasonically) in 34 (51%) cases, nine (26%) of which had SBP. Overall mortality was 25%. Mortality was higher in those who had ascites than in those who did not (32% v 18%); among those with ascites it was maximum in those who had SBP (78% v 16%). Total serum bilirubin and grade of encephalopathy were significantly higher, serum albumin was significantly lower, and prothrombin time was significantly prolonged in those who died than in those who recovered.

CONCLUSION

The natural history of FHF in Indian children depends on age, grade of encephalopathy, ascites, and SBP. SBP depicts worse outcome. In all cases of FHF with ascites, the presence of SBP should be investigated.

Properties of a thermostable and solvent stable extracellular lipase from a Pseudomonas sp. AG-8

An extracellular lipase isolated from Pseudomonas sp. AG-8, had an optimal activity at 45 degrees C and pH 8.0-8.5. It retained more than 80% of its initial activity after keeping for 1 h at 65 degrees C. The enzyme was stable in 5 M NaCl and 6 M urea. Triton X-100 increased the lipase activity by 2.4 fold. Ca2+ ions activated the enzyme, while Zn2+, Fe2+, Fe3+ strongly inhibited its activity. Ethanol, methanol and acetone at 20% (v/v) enhanced the lipase activity by 2.9, 3.6 and 4.5 fold respectively. Dimethylsulphoxide at 90% (v/v) enhanced the enzyme activity up to 5.7 fold.

Carbon fibres and plasma-preserved tendon allografts for gap repair of flexor tendon in bovines: gross, microscopic and scanning electron microscopic observations

The efficacy of carbon fibres and plasma-preserved tendon allografts for gap repair in the superficial digital flexor tendon in the mid-metatarsal region was evaluated in 12 crossbred calves. Experimental tenectomies were performed, followed by implantation of carbon fibres in group I (12 legs) and plasma-preserved tendon allografts in group II (12 legs). Gross observations in group I showed filling of the defect with granulation tissue with more vascularity on day 7, which was less prominent at day 14. On day 30, the neotendon formed was slightly thicker and comparable to normal tendon in appearance and texture. On day 90, it exhibited all the characteristics of a fully developed tendon. Whereas, in group II increased vascularity at the site and encapsulation of the graft with connective tissue in early periods was observed. The gap between graft and host was filled with fibrous connective tissue. Peritendinous adhesions were maximum on day 7 which were gradually reduced in both groups. Microscopically, an acute inflammatory reaction in the periphery of carbon fibres was observed on day 7. Immature fibroblasts were arranged in a haphazard pattern at this stage. By day 14, numerous newly formed capillaries and comparatively more mature fibroblasts were present in between and around the carbon fibres which were aligning parallel to the longitudinal axis of the tendon. By day 30 the healing tissue exhibited longitudinal orientation of collagen fibres and was at a more advance stage of maturation. By day 90, the neotendon formed simulated the picture of normal tendon. In the grafted tendon group, there was normal healing tissue at the functional sites between host and grafted tendon. The fibroblastic activity appeared to be both extrinsic and intrinsic in origin. The connective tissue had invaded the graft to a variable distance and there was resorption of graft which was replaced by newly formed connective tissue on day 90. Scanning electron microscopic observation revealed formation of neotendon between carbon fibre strands, resulting in thickening of the implant. In later stages parallel collagen fibres resembling normal tendon were observed in both groups.

Distribution, population structure, and conservation of lion-tailed macaques (Macaca silenus) in the Anaimalai Hills, Western Ghats, India

The lion-tailed macaque is an endangered species, and hence it is necessary that the remaining populations in the rainforests of the Western Ghats, India, be located and their habitats assessed for effective conservation. The Anaimalai Hills in the state of Tamil Nadu harbor 31 groups of lion-tailed macaques. However, the rainforest in these hills is highly fragmented. Since lion-tailed macaques are typically arboreal, the groups have become isolated. Two large rain-forest complexes in these hills harbor 12 and seven groups, respectively, and the remaining 12 groups inhabit small, isolated forest fragments. Group size ranges from six to 53 individuals, with a mean size of 16.3. In the small forest fragments, the standard deviation (SD) of group size was considerably higher than it was in the larger forest complexes. The disturbed fragments also had a higher variability in group size than the relatively undisturbed habitats. It is believed that fragmentation may impede male migration. We suggest that the fragments be managed in such a way that male migration among groups can be facilitated to overcome the potential effects of isolation.

Carbon fibres and plasma-preserved tendon allografts for gap repair of flexor tendon in bovines: clinical, radiological and angiographical observations

Twenty-four tenorrhaphies were performed at the mid-metatarsal region in 12 crossbred calves under xylazine-ketamine spinal analgesia. A 2.5-cm long gap was created in the superficial digital flexor (SDF) tendon and immediately repaired with carbon fibres in the animals of group I and with plasma-preserved tendon allografts in group II. Clinical examination revealed a slight increase (P > 0.05) in rectal temperature, heart and respiratory rate for 2-4 days postoperation in both groups. Milder pain and exudation as well as earlier restoration of tendon gliding movements and weight bearing were observed in group I as compared to group II. Air-tendogram in the carbon fibre group on day 30 revealed restoration of continuity across the defect of the tendon. whereas, in the allograft group, a dense homogeneous swelling was seen along the flexors. Regression of peritendinous adhesions and swelling at the reconstructed site at later stages was seen in both groups. Angiography showed hypervascularization at the reconstructed site on day 14 in the carbon fibre group, however, in the allograft group the site appeared to be relatively avascular. On days 30 and 90, blood vessels were normally organized in both groups.

Hindu-Muslim differences in the prevalence of coronary heart disease and risk factors

Differences in coronary risk factors and coronary heart disease (CHD) prevalence between the Hindus and the Muslims have not been adequately studied. This study aims to determine the prevalence of certain socio-economic and biological coronary risk factors in urban communities and to compare the findings found in the Hindus and the Muslims. The study employed a cross-sectional survey design and stratified random sampling technique consisting of 1,415 males and 797 females. Among males there were 1,092 Hindus (77.2%) and 272 Muslims (19.2%) while in females there were 685 Hindus (85.9%) and 91 Muslims (11.4%). Prevalence of illiteracy and sedentary lifestyle were significantly more in Muslims (p<0.05). Smoking or tobacco use in males was similar but in females it was more in the Hindus. Self-reported diabetes was found in 1.4% Hindu males and in 1.2% Hindu females. No Muslim reported diabetes. Hindu males were significantly taller than Muslims (163.9 +/- 8.3 versus 160.9 +/- 8.9 cm; p < 0.001). In both males and females there was no significant difference in body mass index and obesity. In Hindu males the diastolic BP was significantly greater than in Muslims (81.2 +/- 9.2 versus 79.0 +/- 8.6 mm Hg; p < 0.001); prevalence of hypertension (30.5% versus 25.7%) was also significantly more (p = 0.048). In Hindu females the mean systolic BP was significantly more and there was also difference in hypertension prevalence (35.2% versus 25.3%). CHD prevalence was significantly greater in Hindu males as compared to the Muslims when determined by the presence of either ECG changes alone (4.3% versus 0.7%; p = 0.008) or ECG changes combined with clinical history (7.1% versus 1.8%; p = 0.002). A similar, though not significant, trend was seen in females (ECG changes: 8.9% versus 6.6%, clinical and ECG changes: 10.4% versus 6.6%). The prevalence of CHD is significantly more in Hindu males as compared to the Muslims and is associated with a greater prevalence of diabetes and hypertension.

Chromosome painting - principles, strategies and scope

Chromosome Painting is emerging as a powerful tool in the exact localization of different gene sequences of chromosomes at the microscopic level. It is principally based on molecular hybridization in situ with sequence specific probes on chromosomes. Different strategies have been adopted for the preparation of probes, hybridization and visualization. The impact of this method lies in identification of genes for desired characters in the chromosomes, including those of genetic disorders, in cancer research, in transgenesis and in studies on biodiversity and evolution.

Cytophotometric estimation of in situ DNA content in several species of Araceae

A wide variation in the in situ 4C DNA content, ranging from 15.02 pg to 54.09 pg was found in thirteen genera of the family Araceae. The obligate perennial species showed greater 4C DNA values compared with the facultative perennials and annuals. A remarkable heterogeneity in 4C nuclear DNA amounts was noted among obligate perennials. Intraspecific constancy in the amount of 4C DNA was recorded. The nuclear DNA content correlated positively with chromosome size, duration of the mitotic cycle, and annual to perennial growth forms. Despite an extensive variation in DNA content among the aroids investigated, each species was distinctly characterized by its specific nuclear DNA value, indicating its usefulness in taxonomic characterization and comparison of different aroids.

Congenital H-type rectourethral fistula

An H-type rectourethal fistula was seen in a male child. The anus and anterior urethra were normal. The embryology and surgical management of this rare anomaly are discussed.

Rupture of the right hemidiaphragm due to blunt trauma in children: a diagnostic dilemma

The diagnosis of right-sided diaphragmatic rupture (RDR) due to blunt abdominal trauma is often missed in the acute setting, especially in the absence of other thoracoabdominal injuries. We describe two such children. The problems associated with the diagnosis and management of RDR are discussed to emphasize the need to have a high index of suspicion for this entity.

A new glycoside, 3-O-demethylcolchicine-3-O-alpha-d-glucopyranoside, from Gloriosa superba seeds

A new colchicine glycoside, 3-O-demethylcolchicine-3-O-alpha-D-glucopyranoside, has been isolated from Gloriosa superba seeds. The assigned structure has been corroborated by spectroscopic data and enzymatic hydrolysis.