Self limiting fetal bradycardia associated with maternal evidence of dengue and chikungunya virus co-infection: a case report

Dengue and chikungunya infections are commonly encountered by the clinicians in a tropical country like India. We report this case to emphasize the rare manifestations of self-limiting intrapartum bradycardia in fetuses of chikungunya and dengue infected mothers. A primigravida at 32 weeks of gestation presented with history of fever for one day. The blood investigations were positive for both dengue and chikungunya virus infection. On the third day of fever, NST showed a low baseline fetal heart rate of 95 to 100 beats per minute but good beat to beat variability and three accelerations in 10 minutes. This pattern persisted for 48 hours. Although, the finding initially appeared alarming, the change in baseline heart rate of fetus was transient and self-limiting and recovered completely. Hence, a judicious approach and close fetal surveillance can avoid hasty decisions regarding an early termination of pregnancy

Craniovertebral Junction Instability: A Review of Facts about Facets

Craniovertebral junction surgery involves an appropriate philosophical, biomechanical and anatomical understanding apart from high degree of technical skill and ability of controlling venous and arterial bleeding. The author presents his 30-year experience with treating complex craniovertebral junction instability related surgical issues. The facets of atlas and axis form the primary site of movements at the craniovertebral junction. All craniovertebral junction instability is essentially localized to the atlantoaxial facet joint. Direct manipulation and fixation of the facets forms the basis of treatment for instability

C2–3 Fusion, C3–4 Cord Compression and C1–2 Posterior Facetal Instability: An Evaluation of Treatment Strategy Based on Four Surgically Treated Cases

Study DesignFour patients had C2–3 vertebral fusion and radiologically demonstrated cord compression at C3–4 level related to disc bulge with or without association of osteophytes and C1–2 posterior facetal dislocation. The outcome of treatment by atlantoaxial and subaxial facetal fixation is discussed.PurposeThe article evaluates the significance of atlantoaxial facetal instability in cases having C2–3 vertebral fusion and cord compression at the level of C3–4 disc.Overview of LiteratureC2–3 vertebral fusions are frequently encountered in association with basilar invagination and chornic atlantoaxial dislocations. Even when basilar invagination and atlantoaxial dislocation are not identified by conventional parameters, atlantoaxial instability can be the nodal point of pathogenesis in cases with C2–3 vertebral fusion.MethodsBetween June 2013 and November 2014 four patients having C2–3 fusion presented with progressive symptoms of myelopathy that were related to cord compression at the level opposite the C3–4 disc space. Further investigations revealed C1–2 posterior facetal dislocation.ResultsAll patients were males. Ages ranged from 18 to 50 years (average, 36 years). All patients were treated by atlantoaxial facetal plate and screw, and subaxial single or multi-segmental transarticular screw fixation. Follow-up (average, 15 months) using a recently described clinical grading system and the Japanese Orthopaedic Association scoring system confirmed marked improvement of symptoms.ConclusionsIdentification and treatment of atlantoaxial facetal instability may be crucial for a successful outcome in cases having C2–3 fusion and high cervical (C3–4) disc related cord compression

Liver abscess caused by Serratia grimesii in an immunocompetent patient

In tropical and subtropical countries, the most common cause of liver abscess is Entamoeba histolytica. However, pyogenic infections are common due to bacteria like Kleibsella pneumonia followed by Escherichchia coli and enterococcus species. The possibility of atypical organisms should be considered especially with recurrent liver abscess. We report a case of recurrent liver abscess caused by Serratia grimesii in an immunocopetent individual. Early isolation of the organism along with drug susceptibility testing would make a marked difference in improving the management of the patient and associated prognosis

Alcohol and Tobacco Use Among Undergraduate and Postgraduate Medical Students in India: A Multicentric Cross-sectional Study

Background: Substance use among medical fraternity is a well-known phenomenon among both undergraduate (UG) and postgraduate (PG) medical students. Yet, there have been very few multi-centric studies to estimate the actual burden of this problem in this important population group in India. This study was conducted to estimate the prevalence of alcohol and tobacco use, assess the knowledge and attitudes towards this issue, and identify factors associated with substance use among UG and PG medical students in India.Methods: A pre-tested, self-report, anonymous questionnaire was administered to medical undergraduates and post graduate medical residents of eight medical colleges across India. This study used a convenience sample of medical colleges with random selection of study participants within each college for each group, UG and PG.Results: Prevalence of alcohol and tobacco use among UG students was 16.6%, 95% CI [14.5, 18.9] and 8.0%, 95% CI [6.4, 9.6], respectively, whereas prevalence was 31.5%, 95% CI [26.3, 37.0] and 14.5%, 95% CI [10.7, 18.9], respectively for PGs. For both substances, males had a higher prevalence of use compared to females in both groups (p < 0.001). Positive family history of substance use (p < 0.001 for both groups) and early age of initiation (p = 0.011 for tobacco; p > 0.05 for alcohol) were associated with a greater difficulty to quit the habit. Over 90% of study participants felt that substance use adversely affected their skills and reported not using substances prior to managing their patients.Conclusions: Since substance use is a relatively common phenomenon among UG and PG medical students in India, future prospective studies and interventions are required to better understand the pattern of substance use and reduce its prevalence.

Evaluation of surface roughness of enamel after various bonding and clean-up procedures on enamel bonded with three different bonding agents : an in-vitro study

The purpose of this study was to analyze and compare the enamel surface roughness before bonding and after debonding, to find correlation between the adhesive remnant index and its effect on enamel surface roughness and to evaluate which clean-up method is most efficient to provide a smoother enamel surface. 135 premolars were divided into 3 groups containing 45 premolars in each group. Group I was bonded by using moisture insensitive primer, Group II by using conventional orthodontic adhesive and Group III by using self-etching primer. Each group was divided into 3 sub-groups on the basis of type of clean-up method applied i,e scaling followed by polishing, tungsten carbide bur and Sof-Lex disc. Enamel surface roughness was measured and compared before bonding and after clean-up. Evaluation of pre bonding and post clean-up enamel surface roughness (Ra value) with the t test showed that Post clean-up Ra values were greater than Pre bonding Ra values in all the groups except in teeth bonded with self-etching primer cleaned with Sof-Lex disc. Reliability of ARI score taken at different time interval tested with Kruskal Wallis test suggested that all the readings were reliable. No clean-up procedure was able to restore the enamel to its original smoothness. Self-etching primer and Sof-Lex disc clean-up method combination restored the enamel surface roughness (Ra value) closest to its pre-treatment value

Evaluation of nested Polymerase Chain Reaction targeting hup B gene in the diagnosis of tubercular ascites

Abdominal tuberculosis usually has nonspecific presentation, frequently mimicking other diseases. Because of the limitations of the conventional methods of diagnosis of extra pulmonary tuberculosis, focus is shifted to molecular methods. The objectives of this study are to evaluate the role of nested Polymerase Chain Reaction (PCR) targeting hup B gene as a rapid diagnostic modality of tubercular ascites and also to detect the infecting species (Mycobacterium tuberculosis and Mycobacterium bovis). 100 suspected tubercular ascites patients were enrolled in the study. Ascitic fluid was processed by Universal Sample Processing (USP) method and two steps nested PCR was performed targeting hup B gene. Patients were put on Anti Tubercular Therapy [Category I, (2 HRZE + 4 HR) 3, RNTCP, India]. A positive response to therapy was considered as gold standard and PCR assay was compared to determine sensitivity, specificity, positive and negative predictive value in diagnosis of tubercular ascites. 79 patients could be followed up to see the response to therapy. Of these, 39 were PCR positive and 35 responded to Anti Tubercular therapy. The sensitivity, specificity, positive and negative predictive value were found to be 97.1%, 88.6%, 87.2% and 97.5% respectively. The good sensitivity and specificity obtained in the study suggests the use of PCR targeting hup B gene as a routine diagnostic tool for tubercular ascites. Another added advantage is the ability to identify between M. tuberculosis and M. bovis which otherwise have similar clinical presentation.Keywords: Hup B gene; M. tuberculosis; M. bovis; Nested Polymerase Chain ReactionInternet Journal of Medical Update 2012 July;7(2):9-1

Increased Sleep Fragmentation Leads to Impaired Off-Line Consolidation of Motor Memories in Humans

A growing literature supports a role for sleep after training in long-term memory consolidation and enhancement. Consequently, interrupted sleep should result in cognitive deficits. Recent evidence from an animal study indeed showed that optimal memory consolidation during sleep requires a certain amount of uninterrupted sleep