Huge Mesenteric Lymphangioma – A Rare Cause of Acute Abdomen

Lymphangiomas are benign congenital masses which occur most commonly in head and neck of children and incidence of mesenteric lymphangiomas is very rare. We report such a case of huge mesenteric lymphangioma in a 20 year old male who presented to us with acute abdomen. Pre-operative diagnosis is difficult due to silent clinical course and lack of awareness of the clinical and morphological features of this disease.Keywords: Benign tomours; Congenital masses; Lymphangioma

Diastolic And Systolic Right Ventricular Dysfunction Precedes Left Ventricular Dysfunction In Patients Paced From Right Ventricular Apex

Background: Cardiac dysfunction after right ventricular (RV) apical pacing is well known but its extent, time frame of appearance and individual effect on left ventricular (LV), RV systolic and diastolic parameters has not evaluated in a systematic fashion. Methods: Patients with symptomatic bradycardia and ACC-AHA Class I indication for permanent pacemaker implantation (PPI) were implanted a single chamber (VVI) pacemaker. They were followed prospectively by echocardiographic examination which was done at baseline, 1 week, 1 month and 6 months after implantation. Parameters observed were chamber dimensions (M-line), chamber volumes, cardiac output (modified Simpson's method), systolic functions (ejection fraction, pre-ejection period, ejection time and ratio) and diastolic functions( isovolumic relaxation time & deceleration time) of left and right heart. Results: Forty eight consecutive patients (mean age 65.6±11.8 yrs, 66.7% males, mean EF 61.82±10.36%) implanted a VVI pacemaker were enrolled in this study. The first significant change to appear in cardiac function after VVI pacing was in diastolic properties of RV as shown by increase in RV isovolumic relaxation time (IVRT) from 65.89±15.93 to 76.58±17.00 ms,(p<0.001) at 1week and RV deceleration time (DT) from 133.84±38.13 to 153.09±31.41 ms, (p=0.02) at 1 month. Increase in RV internal dimension (RVID) from 1.26±0.41 to 1.44±0.44, (p<0.05) was also noticed at 1 week. The LV diastolic parameters were significantly altered after 1 month with increase in LV-IVRT from 92.36±21.47 to 117.24±27.21ms, (p<0.001) and increase in LV DT from 147.56±31.84 to 189.27±28.49ms,(p<0.01). This was followed by LV systolic abnormality which appeared at 6 months with an increase in LVPEP from 100.33±14.43 to 118.41±21.34ms, (p<0.001) and increase in LVPEP/LVET ratio from 0.34±0.46 to 0.44±0.10, (p<0.001)]. The reduction in LV EF was manifested at 6 months falling from 61.82±10.36% to52.52±12.11%, (p<0.05) without any significant change in the resting cardiac output. Conclusion: The present study shows that dysfunction of right ventricle is the first abnormality that occurs in VVI paced patients, which manifests by 1 week followed by LV dysfunction which starts appearing by 1 month and the diastolic dysfunctions precede the systolic dysfunction in both ventricles

Clinical characteristics of epilepsy in resource‐limited communities in Punjab, Northwest India

Objectives: To describe clinical characteristics of a community‐based epilepsy cohort from resource‐limited communities in Punjab, Northwest India. / Methods: The cohort was gathered following a two‐stage screening survey. We cross‐sectionally examined and followed up the cohort for one year. A panel of neurologists assigned seizure types, syndromes, and putative etiologies and categorized drug responsiveness. / Results: The cohort of 240 included 161 (67.1%) men, 109 (45.4%) illiterates and 149 (62.1%) unemployed. Current age was >18 years in 155 (64.6%) but age at epilepsy onset was <18 years in 173 (72.1%). Epilepsies due to structural and metabolic causes were diagnosed in 99 (41.3%), but syndromic assignments were not possible in 97 (40.4%). After one year, drug‐resistant epilepsy was established in 74 (30.8%). Perinatal events (n = 35; 14.6%) followed by CNS infections (n = 32; 13.3%) and traumatic brain injury (n = 12; 5.0%) were common risk factors. Most of those with CNS infections (n = 19; 63.3%), perinatal antecedents (n = 23; 76.7%), and other acquired risk factors (n = 27; 90.0%) presented with epilepsy due to structural and metabolic causes. Perinatal events were the putative etiology for nearly 40.7% of generalized epilepsies due to structural and metabolic causes and 28.2% of all epilepsies with onset <10 years. / Significance: Existing classifications schemes should be better suited to field conditions in resource‐limited communities in low‐ and middle‐income countries. The finding of drug‐resistant epilepsy in nearly at least a third in a community‐based sample underscores an unmet need for enhancing services for this segment within healthcare systems. Perinatal events, CNS infections, and head injury account for a third of all epilepsies and hence preventative interventions focusing on these epilepsy risk factors should be stepped up

A study on clinical attachment loss and gingival inflammation as etiologic factors in pathologic tooth migration

Background: Several etiologic factors have been listed for pathologic migration of periodontally involved teeth based mainly on clinical observations with scarce scientific evidence. Present study was carried out to find out relationship of clinical attachment loss and gingival inflammation with pathologic tooth migration.Materials and Methods: A total of 37 patients having 50 pairs of migrated and non-migrated contralateral teeth were taken into consideration.Results: Mean total attachment loss per tooth in migrated and non migrated tooth is 13.32 &plusmn; 0.74 S.E. and 8.34 &plusmn; 0.58 S.E., respectively (P &lt; 0.001), which reveals a positive correlation. There seems to be an association between frequency of migration and severity of attachment loss since highest percentage of migrations were seen in maximum total attachment loss group. Relationship could not be established between severity of attachment loss and severity of migration for which more data may be required. Also, it was seen that gingival index was significantly higher in migrated group.Conclusion: Findings suggest that there exists a direct relationship between pathologic migration and clinical attachment loss as well as gingival inflammation. Clinical relevance: Results emphasize the importance of early treatment of periodontitis to curb inflammation, which seems to be more important since it is completely reversible, and attachment loss also in order to prevent unaesthetic complications. Moreover bleeding along with recent change in position of teeth should be considered as important sign of active, moderate to severe periodontal disease by general dentists and hygienists so that they can refer for specialist consultation

Epilepsy knowledge, attitudes, and practices among primary healthcare providers in an Indian district

Introduction: Scaling up the involvement of primary care providers in epilepsy management in low- and middle-income countries (LMICs) requires an understanding of their epilepsy knowledge, attitudes, and practices (KAP). / Aim: The aim of the study was to document levels of knowledge about, attitudes towards, and practices regarding epilepsy among different ranks of primary healthcare providers in a North-Western Indian district. / Methods: The survey included government medical officers (MOs), auxiliary nurse midwives (ANMs), and accredited social health activists (ASHAs). They were administered a specially designed KAP questionnaire. Responses were analyzed according to rank. / Results: The survey showed that nearly 10% of ANMs and almost a fifth of ASHAs had never heard about epilepsy. A quarter of MOs and over two-thirds of ANMs and ASHAs had never provided care to someone with epilepsy. There were significant differences in the levels of knowledge between the three groups of workers. / Conclusions: Closing the huge gaps in KAP by educating primary care and community health workers about epilepsy should be a priority before engaging them in the epilepsy care delivery

Arranged marriages in people with epilepsy: A pilot knowledge, attitudes and practices survey from India

Introduction: Marriage is a socially challenging barrier in the personal lives of people with epilepsy worldwide. However, it is during arranges marriages, which are common in South Asian communities, that epilepsy is most profoundly stigmatizing. We hypothesized that the felt stigma associated with epilepsy during arranged marriages affects women more frequently and intensely. // Materials and methods: A pilot study in married (n = 38) and unmarried PWE (n = 58) and general public (n = 150) to explore gender-based differences in the stigma associated with epilepsy during arranged marriages. // Results: Majority unmarried PWE (87%) considered arranged marriage as the best way to realize their matrimonial plans. More unmarried women (72%) apprehended problems in adhering to their epilepsy medications regime after marriage (p 0.009) and 50% apprehended victimization in marriage on account of epilepsy (p 0.001). Moreover, 41% of the married women with epilepsy felt that the disclosure had a negative impact on their married life (p 0.047). // Conclusions: South Asian WWE experienced more felt stigma than men before and after arranged marriages and this might impact a number of health related psychosocial outcomes. The lack of past experience with epilepsy was associated with a number of misplaced beliefs about and attitudes towards epilepsy

Effectiveness of antihypertensive agents in stage I/II hypertensive patients with ace (I/D) gene polymorphism

Background: Angiotensin converting enzyme (ACE) is the key enzyme, regulates the blood pressure which is encoded by 21kb gene that consists of 26 exons and is located on chromosome 17, contains a polymorphism in the form of either Insertion (I) or Deletion (D). The aim was to study the effect of antihypertensive drugs in patients of essential hypertension associated with ACE gene polymorphism. Methods: Hypertensive patients were recruited followed by genetic test was done for detecting ACE gene polymorphism, then patients were divided as Group-A & B. Group –A and B patients were treated with atenolol (25mg) and azilsartan (40 mg) for three months respectively. Results: Systolic and diastolic blood pressure was recorded in both the groups before and after commencement of treatment. Among 88 patients of newly diagnosed hypertension, majority of study population belongs to genotype D/D (38.63%) followed by I/D (31.81%) and II (29.54%) genotype. Significant difference was found in systolic blood pressure (p0.05). Conclusion: The rate of control of blood pressure was high in I/I genotype followed by D/D genotype irrespective of treatment group. Overall better prognosis was observed with azilsartan 40mg compared to atenolol 25mg treatment in patients with ACE gene polymorphisms

Painful vertical diplopia as a presentation of a pituitary mass

BACKGROUND: Pituitary tumours may present with a variety of neurological and endocrinological signs and symptoms. It is very rare however for them to present with sudden onset painful diplopia. The current literature and possible mechanisms for this are discussed. CASE PRESENTATION: We describe a case of a pituitary mass which presented with sudden onset painful diplopia with an associated restricted pattern on Lees Chart testing. This led to an initial working diagnosis of orbital myositis. CONCLUSION: Awareness of different modes of presentation of pituitary lesions is important so that appropriate imaging may be requested and delay in diagnosis prevented