Traumatic subarachnoid-pleural fistula

BACKGROUND

Traumatic subarachnoid-pleural fistula is a very uncommon but important condition. Only 21 cases have been reported so far in the world literature.

METHODS

We encountered 2 cases of subarachnoid-pleural fistula, both in pediatric patients presenting without any neurologic deficit. Whereas our first patient presented with recurrent, rapidly filling clear pleural effusions with an obscure cause, posing a diagnostic problem for the pediatricians, the second patient had trauma to the pleura and dura mater by the sharp edge of Kirschner wire, with impending risk of injury to spinal cord and infection.

RESULTS

Surgical intervention was undertaken after we had a strong suspicion of subarachnoid-pleural fistula in both cases. A subarachnoid-pleural fistula was found at the level of the eleventh thoracic vertebra in the first patient and at the level of the eighth thoracic vertebra in the second patient. Autogenous tissues (mediastinal pleural flap and hammered intercostal muscle covered with methylcellulose) were used to repair the fistula. The subarachnoid space was decompressed with a lumbar drain in the second patient.

CONCLUSIONS

The diagnosis of subarachnoid-pleural fistula is difficult when it is not associated with any neurologic deficit. We found that a high degree of suspicion and early surgical intervention to repair the fistula are rewarding.

Prolactin and thyroid stimulating hormone affecting the pattern of LH/FSH secretion in patients with polycystic ovary syndrome: A hospital-based study from North East India

Introduction:

Polycystic ovary syndrome (PCOS) is one of the most important endocrinal diseases in reproductive age group, clinically manifested by hyperandrogenism and anovulation and different other metabolic disturbances that may have important implications for long-term health.

Aim and Objective:

The aim of this study was to determine the incidence of abnormal luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio in women with polycystic ovary and to assess the influence of prolactin and thyroid-stimulating hormone (TSH) in the elevated LH/FSH ratio.

Study Design:

Retrospective observational study.

Materials and Methods:

Eighty-five women in reproductive age diagnosed with PCOS between June 2012 to June 2014 at the Department of Obstetrics and Gynecology in a tertiary care hospital were selected for the study. Serum LH and FSH levels were determined and LH/FHS ratio (normal range ≤2) calculated in the study subjects. They underwent a detailed clinical, hormonal, and metabolic evaluation, which was performed between the second and third days of a natural or induced menstrual period.

Results:

Elevated LH/FSH ratio was found in 60 women (70.58%). Normal gonadotropin ratio was detected in 25 women (29.41%). Statistically significant differences in serum TSH levels were noted between groups with normal and elevated LH/FSH ratio. However, no statistically significant difference was noted in other endocrine parameters. Further analysis revealed a slight negative correlation of TSH with prolactin in the study subjects of PCOS with an ‘r’ value of − 0.3.

Conclusions:

LH/FSH ratio is one of the characteristic attribute of PCOS women. In the present study, this abnormality was detected in 70% of patients. Hypothyroidism was a common endocrinal abnormality and prolactin was inversely correlated to TSH levels in PCOS patients.

Cough plate versus cough swab in patients with cystic fibrosis; a pilot study

BACKGROUND

Accurate identification of lower respiratory tract pathogens is important in the management of cystic fibrosis patients.

AIM

To evaluate the cough plate as an alternative method of obtaining respiratory samples for microbiological culture.

METHODS AND RESULTS

Using sputum culture as the "gold standard", the cough plate method identified significantly more positive cases than either dry or moistened cough swabs. Of 20 patients who had a positive sputum culture, 16 had a positive culture on cough plate compared to seven positive cultures each on moistened swab and on dry swab respectively.

CONCLUSIONS

In this study cough plates were more sensitive than cough swabs in isolating respiratory pathogens in sputum producers. As patients prefer it, the cough plate merits further evaluation, particularly in non-sputum producers.

Laparoscopic cholecystectomy under epidural anesthesia: a feasibility study

Background:

Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia.

Aims:

The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated.

Materials and Methods:

In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study.

Results:

The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia.

Conclusions:

The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

Micropropagation and in vitro flowering of Rauvolfia tetraphylla; a potent source of anti-hypertension drugs

A simple protocol for in vitro mass multiplication of Rauvolfia tetraphylla (Apocynaceae) has been developed. The endophytic microflora was controlled by adopting integrated measures. Multiple shoot development was achieved on MS + Kin (0.1-0.2 mg/l) + BAP (0.4-0.5 mg/l) media. Rooting from in vitro shoots occurred on NAA containing media. In vitro flowering was induced in shoot multiplication media.

Clinical and Laboratory Presentation of Hydatid Disease: A Study From Northeast India

Introduction

Hydatid disease is an immense health problem in developing countries. The diagnosis of hydatid cyst is often difficult because of its protean manifestations. Our objective was to evaluate the various clinical and laboratory presentations of hydatid disease and various modalities of treatment from a tertiary care center.

Materials and methods

We reviewed the clinical and laboratory features of patients presenting with hydatid cyst through retrospective analysis from January 2018 to December 2019 from a tertiary care hospital in northeast India.

Results

Of the 26 adult patients with hydatid cysts who were part of the study, 14 (53.8%) were males and 12 (46.2%) were females. The mean age was 34.6 years. The most common site of involvement was the liver (69%) followed by lung (19.2%) and brain (7.7%). Palpable mass in the right upper quadrant of the abdomen was the most common symptom (88.3%) for liver hydatid cyst followed by pain abdomen (66.6%). Systemic symptoms like fever and weakness were present in most of the patients. The majority of patients (80%) were from rural areas.

Conclusion

Hydatid cysts present with varied symptomatology. History of exposure to infected animals may not be present. A high degree of clinical suspicion combined with meticulous history and clinical examination supported by laboratory investigations are required for its diagnosis.

Clinical study of burn patients requiring admission: A single center experience at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences

Background:

Although burns are a major problem in health care, a lot of the variation in risk factors exists from region to region which if uncovered correctly could help take effective prevention measures.

Aims and Objectives:

To assess the 3-year (January 2012 to January 2015) epidemiology of burn injuries admitted to our hospital (primary objective) and to find areas of improvement in burn care (secondary objective).

Materials and Methods:

After obtaining ethical approval data were obtained from the medical record section regarding age, sex, residence, occupation, marital status, socioeconomic status, dates of admission and discharge, circumstances regarding the place, intent, cause, and source of heat. Clinical assessment was done using Wallace's “Rule of Nine” in adult and “Lund and Browder” chart in the pediatric age groups. The interrelationships between clinical and epidemiological variables with burn injury were studied.

Results:

An increasing trend in the admission rates of burn victims noted in last 3 years males (55.47%) outnumbered females (44.52%). The most common age group affected is older children, adolescents, and young adults (between 11 and 30 years). Flame (38.3%) and scald (25.3%) burns contributed to most of the injuries. Females (52.30%) are the major victim of flame burns. Electrical and chemical burns affected only the males suggesting work-related injuries. Trunk (30.8%) is the most severely affected site in all cases. Depression (6.8%) and power line workers (4.7%) seem to be important risk factors in our study. Inability to complete treatment (26.7%) was a major concern in our study.

Conclusions:

This study highlights the need for proper burn care that could be provided at the primary health-care level. The majority of burns were accidental in nature in school going children, young adults, and females. Flame and scald burns were the most common cause. Preventive measures directed toward burn safety and first aid measures may improve the outcome in burn injuries.

A Rare Case Report of Hepatic Subcapsular Pseudocyst of Pancreas

A pancreatic pseudocyst arises as a result of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct by a neoplasm. Most of the pseudocysts are located within the head and the body of the pancreas but 20% are extra-pancreatic. We report a case of a 33-year-old gentleman presenting with acute on chronic alcoholic pancreatitis with hepatic sub-capsular pseudocyst involving left lobe of liver, with intra-cystic bleed was successfully treated with Ultrasonography (USG) guided drainage. Computed tomography (CT) and high level of amylase in the collection plays an important role in diagnosing this condition. Large hepatic sub-capsular pseudocyst presenting with severe pain due to intra-cystic bleed can be treated with percutaneous drainage to pre-empt rupture.

An Anatomical Study on the Measurement of Stature From Ulnar Length in the Adult Ethnic Khasi Tribal Population of the North Eastern Region of India

Introduction

The stature of an individual is an important parameter for establishing identification. The height of an individual can be indirectly estimated from different parts of the skeleton and such measurements are of great use in forensic science, anatomy, and anthropometry. This study was an attempt to formulate a linear regression equation for estimation of stature by measuring the ulnar length in the living adult Khasi population.

Methods

The study population consists of 164 subjects (Male: 118; Female: 46) between 25 and 45 years of age. The left and right ulnar lengths were measured from the tip of the olecranon process to the tip of the styloid process with the elbow flexed and palm spread over the opposite shoulder by a spreading caliper. The measurements of the stature of the volunteers were done in the standard anatomical standing position with a bared foot with the head in the Frankfort plane. The documented data were calculated by the standard statistical software.

Results

The height and ulnar length in males (160.85 ± 6.34 cm and 24.41 ± 1.10 cm, respectively) were found to be significantly (p < 0.001) higher than females (149.56 ± 2.95 cm and 22.58 ± 0.47 cm, respectively). Significant positive correlation coefficient (r) between height (cm) and ulnar length (cm) were observed in both males (r = 0.955, P < 0.001) and females (r = 0.915, P < 0.001), respectively.

Conclusion

The length of the ulna provides an accurate and reliable means in estimating the height of an individual; being almost a percutaneous bone, its length can be measured easily. The regression formulae that were derived in this study will be useful for clinicians, human anatomists, archeologists, anthropologists, and forensic experts.

Dermatological manifestation can be an early sign in Covid-19: Report of three cases with a novel manifestation masquerading Steven Johnson syndrome

Various dermatological manifestations have been observed in patients with Coronavirus disease (COVID-19) infection ranging from maculopapular rashes, urticaria, chickenpox-type lesions, chilblain-like, distal-limb ischemia, and livedo racemosa. While most of these cutaneous findings are self-resolving, they may aid in the timely diagnosis of this infection. We are reporting three patients presenting with dermatological features resembling (i) varicella zoster, (ii) herpes labialis, and (iii) Steven Johnson Syndrome (SJS) who were subsequently diagnosed with Covid-19 infection. The skin lesions disappeared after successful treatment of Covid-19.

High frequency plant regeneration of Cymbopogon martinii (Roxb.) Wats by somatic embryogenesis and organogenesis

Embryogenic callus cultures were obtained upon repeated sub-culture of non-embryogenic callus from nodal segments of Cymbopogon martinii (Roxb.) Wats. Murashige and Skoog's medium supplemented with 1mg/l 2,4-dichlorophenoxyacetic acid and 0.5 mg/l kinetin and Linsmaier and Skoog's medium supplemented with 2mg/l 2,4-dichlorophenoxyacetic acid and 0.4 mg/l kinetin were used as maintenance media for non-embryogenic and embryogenic cultures, respectively. Plant regeneration occurred through organogenesis in MS basal media containing 2 mg/l kinetin, 1 mg/l 6-benzylaminopurine, 0.2 mg/l biotin, 0.2 mg/l Ca-pantothonate and 0.1 mg/l napthalene acetic acid. Embryogenesis was induced in LS medium supplemented with 1 mg/l kinetin, 0.5 mg/l 6-benzylaminopurine and 0.1 mg/l 3-indole acetic acid. Plant regeneration at high frequency was recorded both through organogenesis and embryogenesis in different passages of long term callus cultures.

A Study to Evaluate the Association Between Thyroid Function and Serum Potassium Level in Diagnosed Cases of Diabetic Nephropathy

Introduction Coexistence of diabetes mellitus and thyroid diseases is common. One of the main microvascular complications of diabetes is diabetic nephropathy (DN) and it is found to be the leading cause of chronic kidney disease. The aim of the present study was to assess the association between hypothyroidism and serum potassium levels in diabetic nephropathy patients. Materials and methods A cross-sectional study was conducted from March 2020 to January 2021. We enrolled 100 patients with DN along with 50 healthy controls belonging to the same localities. Serum potassium, creatinine, thyroid-stimulating hormone (TSH) and total triiodothyronine (T3) levels of all the cases were measured to establish the correlation of serum potassium along with each parameter separately. Results Serum potassium, creatinine, TSH levels were increased in all the cases of diabetic nephropathy showing positive correlations of serum potassium with serum TSH and serum creatinine levels with correlation coefficient values 0.71 and 0.7 respectively and serum T3 levels were decreased in all the cases significantly showing negative correlation with serum potassium levels with correlation coefficient value -0.34. Conclusion Estimation of serum TSH and T3 levels along with serum potassium levels is important and helpful in patients with diabetic renal disease. Changes in thyroid parameters like decreased TSH or increased T3 are significantly associated with deterioration in the severity of renal function in diabetic patients.

A Study of Factors Leading to Difficult Laparoscopic Cholecystectomy at a Tertiary Care Center in Northeastern India

BACKGROUND

Laparoscopic cholecystectomy (LC) is currently the gold standard of care for managing gallstone disease. The time taken to perform LC depends on both patient-related and surgeon-related factors. Recognizing factors associated with difficult LC (DLC) can aid in appropriate surgeon selection and judicious scheduling of cases.

METHODS

This prospective study was conducted to identify preoperative factors (clinical and ultrasonographic) and intraoperative factors that can help predict or prepare for DLC. The study took place in the Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India. A total of 100 cases of LC were enrolled over a two-year period. All patients had symptomatic cholelithiasis and were scheduled to undergo elective LC. The time taken to perform LC was compared against individual parameters of interest, including clinical features, ultrasonography (USG), and intraoperative findings.

RESULTS

Forty-one LCs were classified as difficult and 59 as non-DLC (NDLC), based on the time limit set by the mean operating time for all LC cases. Seven out of the 41 difficult LCs required conversion to open cholecystectomy (OC). Patient, USG, and intraoperative factors were found to have a significant correlation with difficult LC. Patient factors included male gender, body mass index (BMI), number of past attacks, and previous abdominal surgery. USG factors included calculi number, calculi size, impaction of calculi, and a thick gallbladder (GB) wall. Intraoperative factors included pericholecystic adhesions, Calot's triangle dissection, GB mobilization from the liver bed, and GB specimen extraction.

CONCLUSION

Preoperative identification of difficult LC cases can guide rational allocation of cases based on surgeon experience, leading to better utilization of operating theatre time and reducing the probability of conversion and complications.

In vitro regeneration of Hypericum patulum Thunb.--a medicinal plant

A protocol was developed for high frequency plant regeneration in H. patulum by shoot-tip culture. H. patulum plants were collected from a wild source growing at high altitude in the eastern Himalayas. Multiple buds were initiated from shoot-tips cultured on Murashige and Skoog's medium supplemented with BAP, kinetin. Addition of thiamin HCI, Ca-pantothenate and biotin enhanced multiple shoot formation. Upon transfer to phytohormone free liquid medium following a brief exposure to auxin, root formation occurred from the micro shoots . Rooted plants were hardened and transferred to soil. Regeneration potentiality was found to be constant throughout the year in long term cultures.