Indian Journal of Medical and Health Sciences

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 Turner syndrome (TS) is a sex chromosomal disorder. It is due to complete or partial absence of the second sex chromosome in females. Liver functions test abnormalities is common in Turner patients, but vascular hepatic involvement in Turner syndrome patients has been scarcely reported. 18­ year­old girl presented with complaints of discomfort/dragging sensation in left upper abdomen for last one year and primary amenorrhea. She had short stature, short neck and low hairline with multiple naevi over face. Her TSH was 2.29 uIU/ ml. FSH was 100.40 mIU/ml and LH was 18.40 mIU/ ml. HBsAg and Anti HCV antibody was negative. Ultrasonography abdomen with Doppler revealed splenomegaly of 20cm with collaterals at hilum and lateral surface with formation of portal cavernoma. Agenesis of gonads with hypoplastic uterus was noted. Endoscopy revealed Grade I x III varices in esophagus. Echocardiography revealed bicuspid Aortic valve with mild Aortic stenosis. Karyotyping revealed 45, XO. Patient was started on beta­blockers and conjugated estrogen. Conclusion: This case report highlights that vascular hepatic involvement in Turner syndrome patients is not uncommon and it could be part of a more generalized vascular disorder.

Keyword: Turner Syndrome; Portal Vein; Non Cirrhotic Portal Fibrosis; Thrombosis.

 The term sickle cell disease (SCD) describes a group of inherited red blood cell disorders. People with SCD have abnormal hemoglobin, called hemoglobin S or sickle hemoglobin, in their red blood cells. The red cell sickling and poor oxygen delivery can also cause organ damage. Over a lifetime, SCD can harm a person’s spleen, brain, eyes, lungs, liver, heart, kidneys, penis, joints, bones,or skin. Sickle cells cannot change shape easily, so they tend to burst apart or hemolyze. Normal red blood cells live about 90 to 120 days, but sickle cells last only 10 to 20 days. We present a case of 17­year­old male, a known case of sickle cell disease, admitted in the medical ward with vaso­occlusive crisis. During treatment, he developed high grade fever with sweating and worsening of his condition. Blood investigations, septic screen and serology for Parvovirus B19 revealed that he was parvovirus IgM positive. He was diagnosed as a case of sickle cell disease with aplastic crisis and low reticulocyte count. He recovered after ten day of treatment.

Keywords: Aplastic Crisis; Parvovirus B19; Pancytopenia; Sickle Cell Anaemia.

 The outbreak of Ebola Virus Disease in 2014 caused by one of member of Filoviridae family in west Africa was the witness of its fatality, which rate is up to 50­90%. Ebola first occurred in 1976 in two simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. Ebola reached in human through animal body fluid, most of researchers think of fruit bats as natural host of Ebola virus. Ebola spreads in the community through human­to­human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. The entry of Ebola Virus is mediated by cholesterol transporter protein Niemann­Pick C1 (21) and T­Cell immunoglobulin &mucin domain 1(TIM­1). The disease is common with the symptoms onset of fever, intense weakness, muscles pain, nausea, headache, & sore throats followed by severe hemorrhage, shocks, breakdown central nervous system, vomiting, diarrhea, loss of kidney and liver function, internal & external bleeding, low WBC & platelet, elevation in liver enzymes. The severe hemorrhage occur due to mixed proinflammatory mediators and vasoactive substances , which is result of immune responses to save the body which result in storm of chemokinins and cytokinins leading in turn bursting of blood vessels. There is neither any specific treatment nor any FDA approved vaccine or medicine. Severely its patient required intensive supportive system, require oral rehydration with solution containing electrolytes, maintenance of circulatory volume, blood pressure & oxygen supplements. Some researches on NPC­1 gene and (TIM­1) showing positive signals on treatment aspects of Ebola virus disease. The mutant NPC­1 and silencing of TIM­1 do not leads to virus replication inside the host.

Keywords: Ebola Virus Disease; Filoviridae Family; NPC­1(Niemann­Pick C1) Protein; TIM­1(TCell Immunoglobulin & Mucin Domain 1); Proinflammatory Mediators; Vasoactive Substances.

 Disorders of lipids and their transporting molecule, i.e. the lipoproteins, are well known to cause cardiovascular diseases (CVD) and death. Evaluation of lipid status of an individual mainly consist of determination of Total Cholesterol (TC), Triglyceride (TG), Low density lipoprotein­cholesterol (LDL­C) and High density lipoprotein­cholesterol (HDL­C) levels in their plasma or the serum. For over three decades lots of emphasis has been given to these molecules. Various guidelines were laid down for the evaluation of these parameters which were then modified regularly in order to improve the quality of life. The National Cholesterol Education Program– Adult Treatment Panel (NCEP­ATP) released its first guidelines in 1988. Continuous updates and modification has been done till date. Recently many new and novel analytes have shown strong correlation with CVD. Some of these analytes includes Apo A1, Apo B100, Lipoprotein(a) [Lp(a)], Lipid Associated Phospholipase A2 (LpA2), LDL particle number, homocysteine and high sensitive C Reactive Protein (hs­CRP). This review article is written with the intention to highlight the diagnostic guidelines, grouping of individuals based on risk factors, therapeutic targets and approach towards management of dyslipidemia based on the criteria put down by NCEP­ATP III. Above mentioned novel markers are also highlighted as they hold lots of potential in improving the quality of health care provided to risk population.

Keywords: Lipid; Lipoproteins; Extended Lipid Profile; NCEP­ATP III.

 An occlusal appliance (often called a splint) is a removable device, usually made of hard acrylic that fits over the occlusal and incisal surfaces of teeth in one arch, creating precise occlusal contact with the teeth of opposing arch. It is commonly referred to as a bite guard, night guard; inter occlusal appliances, intra­oral arthotic, or even orthopaedic device.

Keywords: Splints; Pain; TMJ; Muscle Deprogrammers; Device.

 Objective: Comparative study of the extent of oxidative stress and antioxidant enzymes between control healthy subjects and pesticide sprayers. Materials & Methods: This study was conducted in 100 pesticide sprayers, who were engaged in agriculture sector and 40 healthy subjects as control. Superoxide dismutase, catalase, cholinesterase and glutathione were the antioxidant enzymes and MDA was taken as oxidative stress for biochemical investigations. Comparative study was made between healthy control subjects and pesticide sprayers. Results and Conclusion: There were significantly fall in cholinesterase ( AchE, BuchE ) levels in the pesticide sprayers group as compared to healthy control 18.2% and 18% respectively. Decline level of AchE and BuchE were noticed respectively in exposed sprayers with regard to healthy control. The significant increase in the level of superoxide Dismutase (SOD), Catalase (CAT) were noticed. While the level Of GSH ( Glutathione ) was diminished in the exposed sprayers compared to the control. The increase in lipid peroxidation was reflected by elevated levels of malonalaldehyde (MDA) in pesticide sprayers, indicates oxidative stress. Conclusion: The increased level of MDA is due to over production of free radicals in pesticide sprayers. Pesticides might be responsible for excess lipid peroxidation to produce higher level of reactive oxygen species. It is supposed that the rise in SOD, CAT because of compensatory mechanism to combat the over produced free radicals. Fall in cholinesterase and GSH might be exhaustion of these by compensating over produced oxidative stress and free radicals.

Keywords: Oregano Phosphorous Pesticide/ Insecticide; Cholinesterase; Oxidative Stress (MDA); SOD; CAT; GSH.

 Introduction: Data on vitamin D status in COPD in Indian population are limited while those comparing with GOLD stages, frequency of AECOPD, hospitalization and smoking status are lacking. Aim: To evaluate vitamin­D levels in patients of COPD and its clinical correlation. Materials and Methods: A total of 100 patients of COPD (post­bronchodilator FEV1/ FVC <0.70) with age e”40 years (82 male and 18 female) were studied. Serum vitamin D levels were measured by ELISA and clinically analyzed for Age, sex, BMI, smoking status, FEV1 %predicted, FEV1 volume, FVC, FEV1 /FVC ratio, GOLD stages, frequency of AECOPD and hospitalization during the previous year. Results: Prevalence of vitamin­D deficiency and insufficiency were 42% and 31% respectively among COPD patients. We found positive correlation of Vitamin­D levels to FEV1% predicted (r =0.891; P<0.0001), FVC (r = 0.859; P<0.0001) and FEV1 /FVC (r =0.637; P <0.0001). The mean vitamin­D levels were not statistically significantly different in relation to age, gender, BMI and residence but were significantly lower in current smokers (P <0.0001) and significantly decreased with increasing frequency of AECOPD (P<0.0001). The mean vitamin­D levels of frequent exacerbators was lower than nonfrequent exacerbators (P= <0.0001) and it was also lower in hospitalized patients for AECOPD as compared to not hospitalized (P= <0.0001). Lower levels of vitamin­D was found with increased severity (GOLD stages) of COPD (P<0.0001). Conclusions: COPD is associated with a significantly low level of vitamin­D which was independent to patient’s age, gender, BMI and residence but dependent on current smoking. The lower level of vitamin­D is associated with severity of COPD, increased frequency of AECOPD and increased risk for hospitalization. The relationship between lung functions and levels of vitamin D is almost linear.

Keywords: Vitamin­D; COPD; AECOPD; Frequent Exacerbator; Current Smoking; GOLD Stage.

 Telemedicine includes the use of information and communication technology for education in the health sector, tele­education. Tele­education can be defined as “education in which students receive instruction over the Internet, from a video, etc., instead of going to school.” Also known as E­learning, it comprises all forms of electronically supported learning and teaching. Content is delivered via the Internet, intranet/extranet, audio or video tape, satellite TV, and CD­ROM. It can be self­paced or instructor­led and includes media in the form of text, image, animation, streaming video and audio. Tele­education has the potential to provide access to education both formal and continuing medical education.  We present our experience of tele education in a tertiary healthcare.

Keywords: Tele Medicine; Tele Education; Video Conferencing.

 Formalin is water­based­solution of formaldehyde. It is used as preservative in anatomy,bio­monitoring and many other laboratories. The present study aimed to determine Threshold odor number (TON)for formalin. TON is the greatest dilution of sample with odor free water at which a definite perceptible odor is achieved.The test was conducted with a panel of 20 individuals which were subdivided into 2 panels; panel 1­ lab workers and panel 2­ non lab workers. These individuals were exposed to varied concentrations of formalin ranging from 0.01 to 0.1% with blanks inserted in series at regular intervals to avoid tiring the senses of testers. The observations were recorded by indicating whether odor is noted or not in each test bottle. The TON for lab workers was observed to be 1333 while for non­lab workers it was 2000.As per the findings of test, it can be concluded that increase in TON indicates more sensitivity towards formalin.The observed difference in TON value is due to some day to day exposure of the testers of panel 1 to formalin, thereby having olfactory adaptation to the odorant. As formalin is toxic even in very low concentration, therefore, use of mask while working with formalin in lab is recommended for occupational health of lab workers. This test has been standardised for formalin only but is equally applicable to determine TON for other chemicals used in laboratories and to check the quality of water bodies.

Keywords: Formalin; Occupational Health; Perceptible Odor Limit; Threshold Odor Number.

 Background: Wide coverage of internet and telephonic access have the power to provide physicians with access to an abundance of electronic medical information. This information is available in a variety of forms that may be used to support clinical decision making. Mobile phone applications like Skype Whats App and telephonic conversations are widely used as means of communication in the medical community. This is inexpensive when compared to two­way, fully interactive, real­time, video telemedicine. Methods: The study is an observational retrospective study conducted in the Department of Plastic Surgery, Jawaharlal Institute of Postgraduate Medical Education & Research (Jipmer), Pondicherry from March 2015 to April 2016. The tele­ward rounds consisted of WhatsApp messages and telephonic conversations between the consultant and the residents. At the end of the study period, the feedback was obtained from consultants, residents and analyzed. Results: The consultants and residents found the tele­ward rounds to be a userfriendly and cost­effective method to obtain support from consultants in less time­critical contexts. Conclusion: Tele­rounds is found to be a promising method of communication, especially in nonemergency situations where there is a limited number of consultants or the respective consultant is on leave. It is User­friendly and cost­effective means to obtain decision support from consultants in less time­critical contexts.

Keywords: Telemedicine; Tele­Ward Rounds.

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