Arterial blood gas levels in high altitude Kashmiri population, India

Background: The valley of Kashmir lies at an average height of 1730 m above the sea level with a barometric pressure of 624 mmHg. The fall in atmospheric pressure at higher altitude decreases the partial pressure of inspired oxygen and hence the driving pressure for gas exchange in the lungs. At sea level the normal range of PaCO2 is 35 mmHg to 45 mmHg and at 1500m above sea level (barometric pressure 634 mmHg), the predicted normal PaO2 in a healthy young adult is approximately 80 mmHg; this contrasts with a value close to 95 mmHg at sea level. On these grounds this study was undertaken to formulate normal ABG values for this place as it lies at a higher altitude.Methods: The study was undertaken to measure "arterial blood gases" (ABG) in ethnic Kashmiri population and consisted of a sample of one hundred healthy Kashmiri subjects of either sex after proper inclusion and exclusion by spirometrically measuring Vital Capacity and Forced expiratory volume in one second/Forced vital capacity (Fev1/FVC). A modified Allen's test was performed to check for adequate collateral circulation ruling out Ischemia.Results: The average mean PaO2 of 78.51 ± 4.40 mmHg and the average mean PaCO2 of 33.37 ± 2.38 mmHg was obtained of the volunteers of both the sexes. The average mean pH of males (7.43 ± 0.02) was significantly lower than the mean pH of females (7.45 ± 0.021).Conclusions: The present study might provide useful base line normal values of Arterial Blood Gases for the local population and will be beneficial to the clinicians.

Closure of anterior palatal fistula using tongue flap: our experience

Background: Palatal fistula is one of the most common complications following cleft palate repair. It occurs mostly due to tip necrosis of palatal flaps. Small palatal fistulas are usually closed by transposition of adjacent tissues, however these local tissues are not sufficient for the closure of bigger fistulas. The tongue flap serves as a reliable and most easily obtainable local flap for closure of large sized palatal fistulas.Methods: This is a prospective study conducted from Aug 2006 to July 2015 in the department of Plastic & Reconstructive Surgery, SKIMS, Srinagar, Jammu Kashmir, India. A total of 25 patients with large anterior palatal fistula were treated using anteriorly based tongue flap. Patients were selected on the basis of size of fistula (> 1x1 cm), scarred local palatal tissue or history of fistula recurrence after previous attempts of closure using local palatal tissues.Results: In present study 25 patients of palatal fistula were treated using tongue flap. Eighty percent patients were in the age group of 3 to 5 years. Male-to-female ratio was 2:3. The largest dimension of treated fistula was 4x3 cm. There was partial dehiscence of flap suture line in two patients while remnant fistula was observed in three patients. None of our patients had flap necrosis.Conclusions: Tongue flap is an excellent and versatile option for closure of large palatal fistulas with high success rate and least morbidity

Analysis of Lithuania public debt during for the 2005-2009 period

The governmental borrowing does not cause damage to the economy if only the opportunities provided by debt are used in an optimal way. Increase in the public debt would not cause any special problems theoretically because the economical development and rise of revenue would promote in maintaining or indemnifying the public debt. The aim of this article to clarify what is the composition of public debt, what factors are stimulating the government borrowing. In the article is analysing the arrears variation tendencies of Lithuania's public debt in 2005-2009 period and what had the greatest impact for public debt increasing. The results show us that the Lithuanian public debt is relatively low compared with European Union countries and satisfy requirements of the Maastricht Treaty. However, during the analysis period, the public debt increased by two times. It gives us pause for thought and find decision how to solve this problem, because the rising public debt destine the increasing taxes for future taxpayers

Design and Pedagogy Features in Online Courses: A survey

Purpose: The study investigates the preferences of instructors and students for design and pedagogy features of online instruction at the post-graduate level. Design/Methodology/Approach: The study was carried out using questionnaire as a data gathering tool. Characteristics and features were identified through a comprehensive literature review combined with focus groups. Various design and pedagogy features were identified and the items were structured in a Likert Scale format. Respondents were asked to rate their preferences on a five-point scale, ranging from strongly agree to strongly disagree, for each individual feature. Participants include 7 instructors and 50 students at Indira Gandhi National Open University (IGNOU).An independent sample T-test was conducted to determine if there was a significant difference between the preferences of instructors and students on the rating of individual features.Scope: To better understand the design and pedagogy features of online instruction, India’s largest e-learning academic institution IGNOU was selected.Findings: Major findings include the high level of agreement on design and pedagogy features by instructors and students and the similarities in rank order by both students earning regular university credit and those pursuing professional development goals. When compared with the ranking of instructors and students, low preferences were being placed on social interactive features.Practical Implications: While there are many parallels between face-to-face teaching and online instruction, there are some differences also. Asynchronous online instruction must be designed in advance of being delivered.Keywords: Pedagogy; e-learning; Continuing education; Online instruction; Development expertisePaper Type: Researc

Vitamin D Toxicity in Adults: A Case Series from an Area with Endemic Hypovitaminosis D

Vitamin D deficiency state is endemic to the Kashmir valley of the Indian subcontinent. Physicians often treat patients with high doses of vitamin D for various ailments and on occasion the prescribed doses far exceed the requirements of the patients. Ten cases of hypercalcemia due to vitamin D intoxication are presented with features of vomiting, polyuria, polydipsia, encephalopathy and renal dysfunction. All the patients had demonstrable hypercalcemia and vitamin D levels were high in nine of the 10 cases. The patients had received high doses of vitamin D and no other cause of hypercalcemia was identified. Treatment of hypercalcemia resulted in clinical recovery in nine cases. We conclude that hypervitaminosis D must be considered in the differential diagnosis of patients with hypercalcemia in endemically vitamin D deficient areas. A careful history and appropriate biochemical investigation will unravel the diagnosis in most of the cases

Clinical correlation of retinal nerve fiber layer thickness in multiple sclerosis patients- A North Indian study

Background: Axonal loss is thought to occur early in the course multiple sclerosis (MS) and is supposed to be associated with, and predictive of, neurologic deficits progressing to permanent disability.Axonal loss in the retinal nerve fiber layer (RNFL) is measured by optical coherence tomography (OCT). Material and Methods: A longitudinal observational study, conducted on 30 MS patients. All subjects underwent neurological examination, including expanded disability status scale (EDSS) scoring and OCT on two visits, minimum 2 months apart. Results: Total of 60 eyes of 30 patients were subdivided into 21 eyes having optic neuritis (ON) [‘MS – ON’] and 39 eyes without ON. The RNFL thickness (RNFLt) was found to be significantly reduced in all parameters except in temporal quadrant, as the duration of disease increases. Average RNFLt were found to have negative correlation (r = -0.450) with disease duration. Negative correlation (r=-0.657) was also found between EDSS score change and average RNFLt change. The eyes having ON showed statistically significant RNFL thinning as compared to the non – ON fellow eyes. The baseline EDSS score was found to be negatively correlated (moderate degree, r = -0.348) with baseline average RNFL thickness, with p-value of 0.006. Conclusions: The RNFLt is not only significantly thinner in those with history of ON, but it is also affected remarkably even in absence of prior ON, suggesting subclinical ongoing axonal loss in patients with MS. The EDSS score is inversely correlated with RNFL thickness

Prevalence of gastro-intestinal parasitic infections in Sheep of Kashmir valley of India

Background: Geologically the J&K state (2, 22, 800 sq. kms) is both complex and varied. Climatic conditions of the state ranges from sub-tropical (Jammu), temperate (Kashmir) to cold artic (Ladakh) zones and belongs to the great Himalayan mountain range, which exerts significant influence on its agro-climatic conditions. Gastrointestinal parasitism is a major problem in sheep production worldwide, these parasites cause diarrhea, anaemia, reduced weight gain and increased production costs. Materials and Methods: Five hundred fecal samples of sheep (Ovis aries) were taken from two farms. All fecal samples were examined to determine the prevalence of gastrointestinal parasites. Direct microscopic examination, Centrifugation floatation and Sedimentation techniques were used to examine fecal samples. Results: Overall prevalence rate was 62.9%. most commonly encountered parasites were Strongyle spp., Strongyloides spp., Eimeria spp., Nematodirus spp., and Monezia spp. was 24.61, 15.5, 9.8, 9.0 and 3.3%, respectively. The highest prevalence of G.I parasites was recorded during monsoon season (March- May) followed by summer season (June – August) whereas the lowest prevalence was recorded during winter season. Analysis of the data on the basis of sex revealed a significant difference (P<0.05) in the overall incidence of gastrointestinal parasites between male (75.6%) and female (44.8%) sheep. The maximum infection was observed in younger age groups compared to adults (P<0.05). The prevalence of different species o

Clinical Profile, Complications, Management, and Outcome of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A North Indian Study

Aim: The aim of this study was to assess clinical profile, complications, management, and outcome of postendoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. Methods: In this prospective study, 1320 patients were followed for the development of post‑ERCP pancreatitis. Post‑ERCP complications and outcome were assessed. Results: The percentage of post‑ERCP pancreatitis in our patients was 5.3%. The mean age of patients with post‑ERCP pancreatitis was 49.9 years. About 15.7% of the patients who developed post‑ERCP pancreatitis experienced complications in the form of respiratory failure and sepsis. Conclusion: The incidence of post‑ERCP pancreatitis was 5.3%. The major complications after post‑ERCP pancreatitis were respiratory failure and sepsis. The outcome of post‑ERCP pancreatitis was good, as there was no mortality. However, majority of patients with severe post‑ERCP pancreatitis developed sepsis and received antibiotics

Comparison of hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients

 Abstract Backgrounds: Thyroid hormones play an important physiological role in human metabolism. Erythrocyte abnormalities are frequently associated with thyroid disorder. However, they are rarely investigated and related to the subclinical and primary hypothyroidism in Kashmiri Patients. In this study an attempt was made to study hematological parameters in untreated and treated subclinical hypothyroidism and primary hypothyroidism patients. Methods: This retrospective study included 600 subjects, among which were untreated subclinical hypothyroid (n=110), treated subclinical hypothyroid (n=110), untreated primary hypothyroid (n=100), treated primary hypothyroid (n=100) and euthyroid (n=180). This study was carried out at Department of Biochemistry, Government Medical College Srinagar. The hematological parameters and thyroid profile of the subjects were assessed by the Sysmex (Italy) and ECLIA (Germany) 2010 automatic analyzer. Mean, standard deviation (SD), analysis of variance (Two-way ANOVA), and multiple comparisons were used to report our results, with p<0.05 or p<0.01 considered as statistically significant. Results: In this study group we compared the hematological parameters in these groups, untreated subclinical hypothyroid, treated subclinical hypothyroid, untreated primary hypothyroid, treated primary hypothyroid and euthyroid. We found that hematological parameters like Hb, RBC, MCV, HCT, RDW,RBC% were significantly increased in untreated subclinical hypothyroidism and untreated primary hypothyroidsm, with the p value being less than 0.05 whereas, in treated SCH & Pr. Hypothyroid, results were insignificant. The results reported in these groups as mean±SD, were statistically tested by ANOVA and multiple comparison tests. In untreated subclinical hypothyroid the values were: Hb (10.83±1.33 g/dl ), RBC (4.21±0.66 106/μl), MCV (84.56±6.84 fL), HCT (38.5±2.2 %), RDW (17.91±2.37 fL), RBC% (84.36±13.2 %) and in untreated primary hypothyroid, Hb (10.73±0.86 g/dl), RBC (4.63±0.51 106/μl), MCV (83.34±6.92 fL), HCT (38.6±2.6%), RDW (14.93±5.47 fL), RBC% (92.63±10.30%) suggesting that these patients were at risk of anemia and other erythrocyte abnormalities. MCV is an inexpensive approach to study the types of anemia and explore related information like production, destruction, loss and morphological changes of RBC'S. Conclusion: The thyroid dysfunction is frequently associated with anemia in subclinical hypothyroidism and primary hypothyroidism. Subclinical hypothyroidism (SCH) is associated with serious complications. Substantial numbers of patients with the risk of SCH could be getting converted into primary hypothyroidism. Such conditions should be identified and corrected. On the other hand, their presence could move to a thyroid dysfunction, allowing its early management.&nbsp