Journal of the Indian Medical Association最新文献

The study aims to analyse the role of hysteroscopy-laparoscopy in diagnosis and treatment of infertility with effect on pregnancy outcome. The study group comprised 200 patients of 20-30 years age (125 with primary and 75 with secondary infertility). Hysterosalpingography (HSG) was done in all. Diagnostic as well as operative hysteroscopy-laparoscopy if required were performed in the same sitting in cases who have already been treated for 6 months and did not conceive, with unexplained cause or with abnormal HSG findings. All cases were followed up till they conceived or up to 1 year. Fifty patients of unexplained infertility were used as control and given only folic acid 5 mg/day. HSG was normal in 102/200 (51%) and abnormal in 98/200 (49%) cases in form of fimbrial block in 48 (48.97%) out of 98, cornual block 25 (25.51%), peritubal adhesions 15 (15.31%), filling defect in uterus 10 cases (10.20%). Hysteroscopy was abnormal in 150/200 cases (75%) with uterine synechiae 58 (38.66%) out of 150, endometrial hypertrophy 22 (14.67%), endometrial polyps 20 (13.33%), submucus fibroids 20 (13.33%), atrophy 25 (16.66%) and malformations 5 (3.33%). Hysteroscopy surgery was performed in 70 (46.66%), alone in 14 and with laparoscopic procedures in 56 cases, with subsequent pregnancy rate of 35.71-42%. HSG missed the abnormalities in 58 cases (38.66%) which were diagnosed with hysteroscopy with difference in findings in 58 cases (38.66%). Operative laparoscopy was performed in 140 cases (70%), divided between adhesiolysis in 38(27.14%), tubal surgery in 53 (37.86%), electrocoagulation or excision of endometriotic nodule in 25(17.86%) and ovarian drilling for polycystic ovarian disease in 24(17.14%). The HSG missed 30(20%) abnormal tubal and peritubal findings which were diagnosed with laparoscopy. All cases were followed for one year. Subsequent pregnancy rate was 64 (45.71%) after laparoscopic surgery. The results were analysed by applying Chi-square test and calculating p-value at 1 df. Hysteroscopy-laparoscopy is diagnostic and therapeutic both for uterine, tubal infertility and ovarian abnormalities. They give an advantage in diagnosis and treatment of female infertility at the same sitting. As compared to HSG, it is more accurate in 25% cases and improves the rate of pregnancy to 35%-45% almost comparable to 56.52% in cases with normal hysteroscopy-laparoscopy findings.

Gynandroblastoma is a rare ovarian mixed sex cord stromal tumour with very few cases reported in literature. These tumours are considered to be potentially malignant. Here a case of gynandroblastoma occurring in a 30-year female is reported who gave history of irregular menstrual bleeding and pain abdomen, there were no signs of virilisation. Computed tomography scan showed a left adnexal mixed density pelvic mass suggesting malignant ovarian tumour. Histological study revealed, the tumour was composed of mixed sex cord elements with predominantly intermediate differentiated Sertoli-Leydig cell component and a second adult type granulosa cell component.

Epilepsy is a common paediatric neurologic disorder that is difficult to manage in a substantial portion of children, highlighting the continued need for more effective and better tolerated drugs. A multicentric study was conducted from August, 2011 to July, 2013 using levetiracetam (LEV) in newely diagnosed epilepsy in 122 young children of 1-5 years age group to find its role in practical scenario depending upon the knowledge from prior literature available. It has been demonstrated effective as adjunctive therapy as well as monotherapy for new-onset partial seizures and generalised tonic-clonic seizures (GTCS) but it acts better as adjunctive therapy than the monotherapy. When LEV was used as adjunctive therapy 15.4% children with partial seizure were seizure-free as compared to 11.12% in GTCS and when LEV was used as monotherapy 16.17% children with partial seizure were seizure-free as compared to 15.38% in GTCS. When LEV was used as add on therapy 16.67% children < 2 years were seizure-free as compared to 17.85% in > 2 years. When LEV was used as monotherapy 25.00% children < 2 years were seizure-free as compared to 18.18% > 2 years. So, it was found more efficacious in partial group of seizures than the GTCS variety. It also shows more efficacy in older age group (> 2 years) than the younger ones (< 2 years). Somnolence and behavioural changes were noted as ad- verse effects in a few cases. So, LEV is an important addition to the treatment of paediatric epilepsy.

The study was aimed for molecular detection of mycobacterial DNA in different clinical samples using real-time polymerase chain reaction (RT-PCR) system and rapid diagnosis of tuberculosis. A total of 508 clinical specimens (blood 343, menstrual fluid 53, endometrial tissue 43, body fluid 36, pus from lymph nodes 18, sputum 8, urine 5 and semen 2) were included in this study. We extracted DNA using QIAamp DNA Mini Kit (QIAGEN, Germany) and performed real-time assay using Rotor-Gene Q machine from Corbett Research, Australia for specific amplification of IS6110 sequence of mycobacterial genome. The RT-PCR result was also compared with bacterial culture and acid-fast bacillus staining. RT-PCR assay showed positivity in 52 cases and negative in 456 cases. Corresponding positive results in culture and acid-fast bacillus staining methods were 49 cases and 24 cases respectively. The sensitivity and specificity of detecting Mycobacterium tuberculosis by RT-PCR were 93.87% and 98.69% respectively taking positive culture results as reference standards. The overall positive and negative predictive values were 88.46% and 99.34% respectively. RT-PCR is a useful diagnostic tool for rapid and sensitive detection of mycobacteria in different clinical samples. The easy processing, fast reporting and relative lack of contamination issues make it worthy as a possible replacement to time consuming culture techniques. Moreover, it has added advantage of quantification of mycobacterial DNA, hence bacterial load.

Post-traumatic seizure (PTS) is the development of recurrent seizures following head trauma and has a high clinical relevance. We tried to understand the epidemiology of PTS in a multicentric pro- spective study during the period May 2010 to April 2012. We included 320 patients excluding poor Glasgow coma scale (GCS) ie, <4 and history of previous epilepsy. At a median follow-up of one year, 49 patients (15.31%) developed PTS. Incidence of immediate, early and late onset seizures were 27 (8.4%), 14 (4.4%), 9 (2.8%) respectively. In this study incidence of PTS was high in patients of the age group 20-30 years, with road traffic accident, with poor GCS ie, < 9. High incidence of PTS was associated with x- ray findings of skull fracture and abnormal CT findings. Early use of anticonvulsants is ineffective in preventing early post-traumatic epilepsy.

Headache is a common symptom in paediatric hospital practice, the causes may be primary or secondary. A study was conducted in department of paediatrics from May 2005 to February 2007 in order to find out common causes for recurrent headache in children. A total of hundred children in age range of 3-14 years were included in the study. Children with secondary headache were excluded from the study. Various clinical characteristics were studied and based on these, types of headache were categorised using International Headache Society criteria. The most common type of headache observed was migraine (46%) followed by tension headache (31%), psychogenic headache (8%), mixed migraine and tension headache (7%) and other non-specific recurrent headaches (8%). There was clear cut female preponderance in adolescent patients having migraine. Tension headache is becoming a matter of concern in paediatric age group probably due to more competitive and stressful environment.

Eosinophilic ascitis is probably the most unusual and rare presentation of eosinophilic gastroenteritis and is generally associated with the serosal form of eosinophilic gastroenteritis. It is characterised by eosinophilic infiltration of any or all layers of the gut wall and may involve any segment of the gastro-intestinal tract. Peripheral eosinophilia may or may not be present. A case of eosinophilic ascitis that developed eight weeks postpartum in a 30-year-old young female has been reported. She presented with gastro-intestinal symptoms, ascitis and right sided pleurar effusion. Bood counts, ascitic fluid analysis and bone marrow examination showed evidence of eosinophilia. On high index of suspiscion, she was evaluated for eosinophilic gastroenteritis and treated with oral steroid (prednisolone). She responded well with satisfactory recovery.

To study the effects of anti-oxidant on tear film parameters in patients with diabetes mellitus, a total of 100 patients of diabetes mellitus with defective Schirmer test and tear film break-up time were enrolled in this study and they were given vitamin C (1000 mg/day) and vitamin E (400 IU/day) for 30 days. Schirmer test and tear break-up, time were re-examined after 1 month. There was significant improvement in values for Schirmer test (p < 0.001) and tear break-up time. Oxidative stress has an influence on how diabetes mellitus affects various systems of body. This study clearly depicted im- portant roles of vitamins C and E in improving the well-being of the ocular surface.

Bronchiectasis is an abnormal permanent dilatation distortion and destruction of the airways with both pulmonary and extrapulmonary side-effects. The aim of the study was to find out the presenting features, aetiologies and socioeconomic factors in patients of bronchiectasis. It is a prospective observational study comprising 53 patients over aperiod of two years. Aetiologies were determined using Kuppuswamy's socioeconomic scale. Number of exacerbations and mortality were noted. The age ranged from 14 to 80 years (mean: 43.33 ± 16.37 years). There were 35 males (66%) and 18 females (34%). Clubbing was seen in 58% cases (n = 31); 11% patients (n = 6) had haemoptysis. Bilateral involvement was seen in 64% cases (n = 34). Allergic bronchopulmonary aspergillosis and post-tuberculous sequelae were the commonest causes (n = 12, 23% each). The range of household medical expenditure in these patients varied from 6% to 47%. Lower the Kuppuswamy scale poorer the follow-up (p-value < 0.05). Multiple exacerbations were seen in all classes of patients (p-value 0.09). Death occurred in 4 patients. It is concluded that bronchiectasis is a chronic illness with significant morbidity and socioeconomic implications. Lower the socio-economic scale, poorer the compliance of therapy.

The aim of this study is to compare the effectiveness of 100 mg versus 200 mg mifepristone along with misoprostol for medical abortion in gestation upto 56 days. This is a prospective controlled study. Eighty women seeking medical abortion with a gestation up to 56 days were included in the study. The women were randomly allotted into two groups. They received 100 mg/200 mg mifepristone on day 1 followed by 800 mcg misoprostol two days later. Women who had not aborted completely by day 14, received a repeat dose of 400 mcg misoprostol and were evaluated on day 21 for completeness of the procedure. Five women in both the groups had incomplete abortion by day 14 (12.5%), while one woman in the test group had to undergo dilatation and evacuation on day 3 due to excessive bleeding. By repeating a second dose of misoprostol, all of them aborted completely and the complete abortion rates were markedly improved from 85% and 87.5% in the test and the control group, respectively to 97.5% and 100%, respectively. It may be concluded that 100 mg mifepristone is as effective as 200 mg and appears to be the lowest effective dose for medical abortion.