Role of USG guided FNAC in diagnosis of abdominal and thoracic lesions

A prospective study was carried out during 2010 - 2012 in which a total of 194 patients underwent USG guided FNAC from lesions in deep seated thoracic and abdominal organs. These included liver, lungs, intra-abdominal lymphnodes, gall bladder, ovary and adnexa, pancreas, stomach, omentum, other mass of unknown origin in peritoneal cavity, mediastinum, kidney, colon, small intestine, pleura, appendix and adrenal gland. Of these, FNAC was diagnostic in 168 (86.7%) cases, in 15 (7.7%) cases it was not conclusive. In next 6 (3.1%) it was suspicious of malignancy and the smears were acellular and /or contained blood only in 5 (2.6%) cases. Of all diagnosed cases, 153 (78.9%) cases were malignant, 28 (14.4%) were non-noplastic which included inflammatory, infective and granulomatous lesions and 13 (6.7 %) were benign neoplastic lesions. In liver, metastatic adenocarcinoma was the most common FNAC diagnosis, in lungs non-small cell carcinoma. The aim of this study was to evaluate the overall role of USG guided FNAC in diagnosis of abdominal and thoracic lesions.

Sonographic assessment of placental migration in second trimester low lying placenta

To assess the migration of low lying placenta diagnosed in the second trimester ultrasonogram (USG). All the women attending antenatal OPD clinic had undergone routine obstetric USG in the second trimester (14 weeks onwards). Those cases who had low lying placenta lower edge of placenta within 3.0 cms from the cervical internal os were included in the study. These cases were subjected to be followed up at 4 weekly interval to repeated serial ultrasonogram by Transabdominal and/or Transvaginal USG well through 3rd trimester of pregnancy or delivery which ever was earlier. Of the total 1229 second trimester USG, 312 (25.3%) women had low lying placenta in the second trimester. Follow up of this 312 cases indicated that in 288 (92.4%) cases it had migrated to upper segment by 3rd trimester. The migration of placenta was 92.4% and 68.0 % where the distance between the leading edge of placenta and cervical internal os was more than 2.0 cm or less than 2 cm respectively. Migration was not observed in women where the distance was less than 1.5 cm. Placental migration was 94.5% in anteriorly situated placenta and 90.2% in posteriorly situated placenta. The rate of placental migration was 95.1%, 77.7%, 55.5% in women who had previous normal delivery, previous caesarean delivery and prior history of dilatation and curettage (D & C) or manual removal of placenta (MRP), respectively. The prevalence of low lying placenta in 2nd trimester is 25.3%, which reduces to 7.3% at term. The rate of placental migration was over 90.0%. Factor like initial distance between the lower edge of the placental and cervical internal os. placental position and previous birth by caesarean section influence the placental migration.

Plasma Cell Gingivitis: A Case Report

Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction. This is sometimes considered as a hypersensitive reaction. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds with minimal trauma. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen along with nonsurgical periodontal therapy. We report a 29-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. The patient gave history of herbal dentifrice for a period of one year. Nonsurgical periodontal therapies along with discontinuation of herbal dentifrice lead to remission of the condition within a month. Keywords: Herbal dentifrices, non-surgical periodontal therapy, plasma cell gingivitis

Tricuspid Valve Repair: Devega’s Tricuspid Annuloplasty in Moderate Secondary Tricuspid Regurgitation

Background Moderate secondary tricuspid incompetence has variable natural history if left unattended during mitral valve surgery. Recent data suggest progression of the secondary tricuspid incompetence over time. Secondary moderate tricuspid regurgitation in rheumatic mitral valve disease may regress after mitral valve surgery without direct intervention. Objectives: The present retrospective comparative hospital based tudy was done to assess early result of DeVega tricuspid valve annuloplasty amongst those with moderate tricuspid regurgitation due to rheumatic mitral valve disease. Methods: Group I (mitral valve replacement with tricuspid repair) and Group II (mitral valve replacement only) were compared regarding functional class, heart rate, rhythm, cardiac dimensions, function and valve pathology. The two groups were followed up at three months post-operatively and evaluated for their functional class and echocardiography variables. The data was analyzed with SPSS 16.0 Results: There were 43 patients who underwent mitral valve replacement with moderate tricuspid regurgitation. Twenty three underwent mitral valve replacement with tricuspid repair group (Group 1). Most of the patients were women (28/43). The mean age was 31.4 + 14.8 and 25.13 + 9.4 years. Group I had 21(91.3%) and Group II had 17 (85%) in NYHA class III & IV. The pre-operative echocardiographic cardiac left ventricular and left atrial dimensions, left ventricular function and valve lesions were statistically similar for both groups, except PASP was higher amongst tricuspid repair (Group 1: 38.60 + 12.75mHg, Group 2: 61.52 + 19.76mmHg; p= <0.05). At three month’s review after surgery, four patients were in NYHA II amongst those without tricuspid repair (Group II), whilst the rest were in NYHA I. Left ventricular dimensions, Left Ventricular function and valve prosthetic valve function were similar between groups. Eleven (47.8%) patients in Group I and only five (25%) of Group II had trace or less TR at the follow-up (p < 0.05). There were 7 (16.2%) patients who had persistent moderate TR. Higher PASP and larger LV dimensions at three months were predictive of persistent moderate TR. Conclusion Mitral valve replacement does decrease the severity of tricuspid regurgitation amongst those with secondary moderate tricuspid regurgitation by at least one grade, but DeVega’s annuloplasty confers a better repair result. http://dx.doi.org/10.3126/kumj.v9i1.6266 Kathmandu Univ Med J 2011;9(1):64-8

Early initiation of community-based programmes in Nepal: a historic reflection

Community-based programmes have long been an integral part of Nepal's health sector strategy and has contributed to the progress seen in maternal and child health. This paper reviews three early community-based programmes - the acute respiratory infection programme and its evolution to the fully scaled-up community-based integrated management of childhood illness programme, the national vitamin A programme and the female community health volunteer programme - and how the Government of Nepal rapidly accepted them to address pressing maternal and child health issues in an evidence-informed manner, moving rapidly from research to feasibility studies, to implementation and scale-up.

Plasma cell gingivitis: a case report

Plasma cell gingivitis is a rare benign condition of the gingiva of unknown etiology characterized by sharply demarcated erythematous and edematous gingiva often extending to the mucogingival junction. This is sometimes considered as a hypersensitive reaction. It presents clinically as a diffuse, erythematous and papillary lesion of the gingiva, which frequently bleeds with minimal trauma. The histological appearance consists of a dense infiltration of normal plasma cells separated by collagenous stroma, usually confined to free and attached gingiva. The lesion can be eliminated by identifying and avoiding the source of the allergen along with nonsurgical periodontal therapy. We report a 29-years-old female patient diagnosed clinically as plasma cell gingivitis and confirmed histologically. The patient gave history of herbal dentifrice for a period of one year. Nonsurgical periodontal therapies along with discontinuation of herbal dentifrice lead to remission of the condition within a month.

Interrelationship between Diabetes and Periodontitis- A Review

Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes. Keywords: Diabetes mellitus; inflammation; insulin resistance; periodontitis.

Interrelationship between diabetes and periodontitis: a review

Evidence for the link between periodontal disease and several systemic diseases is growing rapidly. Diabetes mellitus is a systemic disease with several major complications affecting both the quality and length of life causing morbidity and mortality. Periodontitis, one of these complications, is a chronic infection associated with substantial morbidity in the form of tooth loss and that affects the quality of life directly. The association between diabetes and inflammatory periodontal disease has been studied extensively. The relationship between these two conditions appears bidirectional. The presence of one condition tends to promote the other and the meticulous management of either may assist treatment of the other. It also provides a perfect example of a cyclical association, whereby a systemic disease predisposes the individual to oral infections, and once the oral infection is established, it exacerbates the systemic disease. This review focuses to explain the interrelationship between the two based on information in the literature and the potential common immunoregulatory connections involved, exploring the mechanisms through which periodontal infection can contribute to the low-grade general inflammation associated with diabetes.

Preliminary investigation of test-retest reliability of a robotic assessment for Parkinson's disease

Several systems have been proposed to objectively quantify the motor signs of Parkinson's disease. While validity has been investigated for a subset of these systems, test-retest reliability of automated assessments has been more neglected. We have created a protocol that uses a robotic system to measure force and position as the user performs tracking tasks with and without a simultaneous cognitive or motor task. We present preliminary results for test-retest reliability with eight individuals with early to moderate PD. Based on this data, we identified variables with large, significant correlations between the test and retest data. A total of 21 reliable variables were identified with all portions of the assessment protocol producing reliable variables.

Impalement injury to the heart

Cardiac impalement injury is rare and one of the most severe penetrating chest injuries, often fatal. The management of penetrating cardiac injuries is a challenging one. The success in management of impaling cardiac trauma requires stabilization of the impaling object, expeditious transfer to a facility for open heart surgery, rapid imaging, access to blood and blood products and a ready surgical team. We report a case of impalement injury to the heart by a stick, transfixing the right ventricle and its successful treatment.

Immunoglobulin IgG Fc-receptor polymorphisms and HLA class II molecules in Guillain-Barré syndrome

OBJECTIVE

To analyze host genetic factors immunoglobulin G Fc receptors (FcgammaRs) and human leukocyte antigen (HLA) class II in GBS patients.

METHODS

FcgammaRIIA, IIIA and IIIB polymorphisms were studied in 80 each GBS patients and healthy controls by allele specific PCR. HLA class II DRbeta1 and DQbeta1 typing was performed at the two-digit level by PCR in randomly selected 54 GBS patients and 202 controls.

RESULTS

FcgammaRIIA-H/H (56% vs 9%; P < 0.0001) and FcgammaRIIIA-V/V (40% vs 13%; P < 0.0001) genotypes, H131 allele frequencies (0.73 vs 0.26, P < 0.0001) and HLA DQbeta1*060x (OR, 1.96; 95% CI, 1.26-3.04; P < 0.01) were significantly increased in GBS than controls. DRbeta1*0701 alone (OR, 10; 95% CI, 45.90-2.25; P < 0.001) and together with FcgammaRIIA-H/H (OR, 11.03; 95% CI, 2.63-46.20; P < 0.001) was significantly associated with GBS patients having microbiological evidence of recent infection.

CONCLUSIONS

The study indicates that homozygous FcgammaRIIA and FcgammaRIIIA genotypes and FcgammaRIIA H131 allele are associated with GBS. HLA class II molecule DRbeta1*0701 is identified as novel genetic risk factor for development of GBS in patients with preceding infection.

Nitrogen reduction in wastewater treatment using different anox-circulation flow rates and ethanol as a carbon source

We studied the optimization of nitrogen reduction from municipal wastewater in a laboratory-scale modified Ludzack-Ettinger activated sludge wastewater treatment plant (WWTP). The unit consisted of primary denitrification, secondary nitrification, a sludge clarifier and a post-denitrification unit. The process simulates the Kuopio WWTP, which provided the influent utilized. We describe the effect of varying anox-circulation schemes on the nitrogen removal efficiency. We further compare the denitrification efficiencies of ethanol and methanol applied in the post-denitrification unit, and compare the properties and costs of these chemicals as carbon sources. Maximum efficiency of total nitrogen removal (70.8%) was obtained with 256% anox-circulation. The process was, however, not very sensitive, as a wide range of 150-400% of anox-circulations gave good results for nitrogen reduction. The unit achieved high BOD, and COD reductions of wastewater also when nitrogen reduction was moderate. The addition of 40 mg/L/day of ethanol to the post-denitrification tank meant that the nitrate-levels of effluent could be controlled to below 10 mg/L of nitrate nitrogen. Methanol and ethanol were equally effective for denitrification. The use of ethanol instead of methanol could reduce treatment costs by 30% to 0.02 E/m3 of treated wastewater according to 2008 market prices.

Feature selection for classification based on fine motor signs of Parkinson's disease

Effective evaluation of potential neuroprotective interventions for Parkinson's disease (PD) requires precise quantification of the motor signs associated with this disease. We have created a protocol that uses force tracking in a simultaneous task paradigm to quantify the fine motor control deficits in individuals with PD. We have used this protocol to collect data from 30 individuals with early to moderate PD and 30 age-matched controls. Based on this data, we computed 60 variables. We generated all possible combinations of three of these variables, and we then computed the classification accuracy of a support vector machine (SVM) trained on each variable combination. We were able to correctly classify 85% of subjects as with or without PD. We found that root-mean-square error variables were the most important features for classification and that utilizing a simultaneous task paradigm improves classification accuracy.

Role of the oestrogen receptor (ESR1 PvuII and ESR1 325 C->G) and progesterone receptor (PROGINS) polymorphisms in genetic susceptibility to migraine in a North Indian population

We aimed to explore the single-locus, haplotype and epistasis patterns and the contribution of oestrogen receptor [ESR1 PvuII (rs2234693), ESR1 325 C→G (rs1801132)] and progesterone receptor [PROGINS (rs1042838)] polymorphisms in genetic susceptibility to migraine by analysing 613 subjects consisting of 217 migraine patients, 217 healthy controls (HC) and 179 patients with tension-type headache (TTH). Entire data were analysed by taking the Bonferroni corrected P-value into account. We found significant association of TT genotype [odds ratio (OR) 3.458, confidence interval (CI) 1.757, 6.806; P = 0.0003] and T allele (OR 1.729, CI 1.309, 2.284; P = 0.0001) of ESR1 PvuII single nucleotide polymorphism with migraine when compared with HC. Significant association was seen only in female migraine patients at both genotype (P = 0.002; OR 3.834, CI 1.625, 9.043) and allele level (P = 0.002; OR 1.721, CI 1.228, 2.413). Moreover, higher risk was limited to migraine with aura (MA) (in case of TT genotype, P = 0.002; OR 4.377, CI 1.703, 1.246; in case of T allele, P = 0.001; OR 1.888, CI 1.305, 2.735) rather than migraine without aura (MoA) (P-value of TT genotype = 0.003; OR 3.082, CI 1.465, 6.483; P-value T allele = 0.002; OR 1.630, CI 1.188, 2.236). In case of a recessive model, risk was seen with migraine patients (P = 0.0003; OR 2.514, CI 1.635, 3.867), MA (P = 0.0001; OR 3.583, CI 1.858, 6.909) and MoA patients (P = 0.002; OR 2.125, CI 1.304, 3.464) when compared with HC. No risk was observed when TTH patients were compared with HC. No significance of ESR 325 G→C polymorphism was seen in any of the models under study. Significant differences in genotypic (P = 0.0001) and allelic frequency (P = 0.0002) were seen in case of PROGINS polymorphism when migraine patients were compared with HC, showing a protective effect (for A1A2 genotype, OR 0.292, CI 0.155, 0.549; for A2 allele, OR 0.320, CI 0.174, 0.589). Moreover, significance was seen only in case of female migraine patients at genotype (P = 0.002; OR 0.344, CI 0.176, 0.684) as well as allele levels (P = 0.004; OR 0.379, CI 0.198, 0.727) in case of PROGINS polymorphism. ESR1 PvuII TT*ESR1 325 C→G CG genotype, PROGINS A1A2*ESR1 325 C→G CG genotype and ESR1 PvuII CT*PROGINS A1A2 interacted significantly, but significance was lost after Bonferroni correction. In conclusion, ESR1 PvuII polymorphism is a significant risk factor for migraine particularly in women and MA patients, but ESR 325 C→G polymorphism is not associated with migraine susceptibility. PROGINS polymorphism seems to play a protective role in genetic susceptibility to migraine in the North Indian population.

Investigation of TNFA 308G > A and TNFB 252G > A polymorphisms in genetic susceptibility to migraine

We aimed to look for the association of tumor necrosis factor (TNF) gene polymorphisms (TNFA 308G > A, and TNFB 252G > A) in genetic susceptibility to migraine. The pathogenesis of migraine involves many immune-mediated mechanisms in the vascular endothelium. TNF, being a potent immunomodulator and pro-inflammatory cytokine, is suggested to be involved in inflammatory reactions leading to migraine attacks. A total of 216 normotensive migraine patients, 160 tension type headache (TTH) patients and 216 healthy controls (HC) were recruited in the study. The genetic polymorphisms were investigated through SNP association analysis using a matched case control migraine population. Genotyping of TNFA 308G > A polymorphism and TNFB 252G > A was done using ARMS PCR and PCR-RFLP, respectively. A borderline association was observed in TNFA 308GA genotype in migraine patients versus HC (p = 0.043; OR = 1.763; 95% CI = 1.019-3.051). After sub-grouping migraine into migraine with aura (MA) or without aura, significant difference at genotypic (p = 0.015; OR = 2.293; 95% CI = 1.172-4.487) as well as allelic (p = 0.035; OR = 1.955; 95% CI = 1.047-3.651) level was evident. The difference was even more significant in female MA at genotypic (p = 0.006; OR = 2.901; 95% CI = 1.361-6.181) and allelic level (p = 0.017; OR = 2.318; 95% CI = 1.159-4.635) as well as for A allele carriers in MA [p value = 0.020; OR = 2.205 (1.132-4.295)] and female MA (p value = 0.008; OR = 2.741; CI = 1.297-5.792). No association of TNFB252G > A was observed in migraine patients or any subgroups. We did not find any association of TNFA or TNFB gene polymorphisms with TTH. In conclusion, the TNFA 308G > A polymorphism was found to be associated with MA, particularly in females, whereas we could not find any association of TNFB 252G > A polymorphism in genetic susceptibility to migraine on comparing the migraine patients with HC or TTH patients.

Role of ultrasound in early pregnancy in differentiating normal and abnormal pregnancies

A prospective study was carried out from November 2006 - December 2008 in which a total of 304 patients with early pregnancy were examined by ultrasound (US). Of these, 203 (66.8%) cases were normal pregnancies (including 8 cases of twin pregnancy), 32 (10.5%) missed abortions, 19 (6.3%) incomplete abortions, 14 (4.6%) complete abortions, 12 (4.0%) blighted ovums, 11 (3.6%) without sonographic evidence of pregnancy, 7 (2.3%) ectopic pregnancies and 6 (1.9%) molar pregnancies. US in early pregnancy gave a reliable and accurate differentiation between a viable normal pregnancy and an abnormal/pathological pregnancy.

Gingival enlargement in antihypertensive medication

INTRODUCTION

Drug-induced gingival enlargement is a well documented side effect with the use of phenytoin, cyclosporine and calcium channel blockers. The prevalence of gingival enlargement induced by calcium channel blockers is uncertain. Several studies show conflicting results ranging from 20% to 83%. This study was conducted to determine the prevalence of gingival enlargement in patients taking antihypertensive medication.

METHODS

All consecutive patients on antihypertensive agents attending the Dental OPD were studied. The prevalence of drug induced gingival enlargement was determined. The periodontal condition of all subjects were assessed including plaque index and probing depth.

RESULTS

Total 81.2% of subjects taking antihypertensive were seen to have significant enlargement. Among them 71.1% were taking calcium channel blocker, 21.5% were taking ACE Inhibitors, and 7.4% were taking beta-blockers.

CONCLUSIONS

Patients taking antihypertensive agents are at increased risk for gingival enlargement and inflammation is an important cofactor for the expression of this effect.