On the Multivariate Normal Hazard

AbstractIt is well known that the hazard rate of a univariate normal distribution is increasing. In this paper, we prove that the hazard gradient, in the case of general multivariate normal distribution, is increasing in the sense of Johnson and Kotz

Epidemiological study on body mass index distribution and health awareness among women at an urban tertiary care centre of north India

Background: Obesity has become a new worldwide health problem and is gradually moving towards an epidemic. overweight and obesity implies an abnormal excessive fat accumulation that poses health risk. According to National Family Health Survey-4, prevalence of obesity has doubled in country over the last decade. Asian Indians stand at higher risk for development of obesity related non-communicable diseases at lower body mass index levels.Methods: It was an observational interpretive study carried on 1000 randomly selected women over 3 months in a tertiary center of urban northern India. BMI was obtained by dividing weight in kilograms and height in meters squares. Patients were enquired about any menstrual complains, known comorbidities, awareness of obesity in terms of its cause and effects, about weight reduction and benefits of exercise and its practice and details noted in a preformed performa. No prior intervention or health education was given to avoid bias.Results: Out of 1000 women, mean BMI was found to be 31.85±8.85kg/m2. BMI classification (Asian standards) stated that 8.1% were overweight and 78% of patients were pre obese and obese (maximum in age of 21-40 years). Menstrual complaints were present among 39% of overweight and obese groups. Among comorbidities, hypothyroidism was found to be maximum being 9.5% in the obese group, followed by hypertension and diabetes mellitus. Only 26.3% of obese women were aware of the factors causing obesity. Knowledge of exercise benefits was grossly limited, with only one fourth of the pre obese and obese population being aware of it.Conclusions: Rising obesity in Indian women needs measures for prevention. Though there is knowledge of the cure among Indian females but there is limited ability to implement the same. Health education of women regarding obesity related comorbidities along with the benefits of weight loss with exercises should be promoted strongly

Role of diagnostic laparoscopy in chronic pelvic pain

Background: Laparoscopy in chronic pelvic pain can reveal findings that cannot be detected clinically, so it can be treated and diagnosed at same sitting. This study was undertaken to evaluate role of diagnostic laparoscopy in chronic pelvic pain.Methods: It was a prospective study conducted at department of Obstetrics and Gynecology, ESI PGIMSR, Basaidarapur, New Delhi. The study was carried out from 2012- 2014. Total 110 cases were enrolled. 55 cases who had been suffering from chronic pelvic pain for ≥6 months were taken as study group (A). 55 cases without any symptoms that underwent laparoscopic sterilization were taken as control group (B). Results were statistically analyzed using Karl Pearson's correlation coefficient.Results: Chronic pelvic pain whereas on laparoscopy normal finding were seen only in 25.45% cases. This difference was found to be statistically significance (P value 0.04). Normal findings were seen in 60% cases of chronic pelvic pain on USG as compared to 25.14% cases on laparoscopy was statistically significant .( p value <0.05.)Conclusions: Laparoscopy is a gold standard tool in evaluation of women with chronic pelvic pain, because diagnosis and often treatment can be accomplished in one sitting, without subjecting them to exploratory laparotomy

A rare case of urinary bladder rupture and rupture uterus in an unscarred uterus during vacuum assisted vaginal delivery

Operative vaginal delivery is the use of a vacuum or a forceps device to assist the mother in effecting vaginal delivery of a fetus. The incidence of operative vaginal delivery in U.S.A is 5% or one in 20 deliveries. A 30 year old Para 2 was referred to our institute with complaints of abdominal distension and urinary catheter draining hemorrhagic urine since her delivery. Patient gave history of a Vacuum assisted vaginal delivery three days back at a government hospital. Her previous obstetric history was uneventful. On general examination, she was conscious, with B.P. 110/60 mm of Hg and pulse rate was 84/min. Mild pallor was present.  Abdominal examination revealed a distended and tender abdomen. Laparotomy was performed along with a team of general surgeon and Urologists. Rupture of uterus in an unscarred uterus is a very rare entity with an estimated occurrence of one in 8000 to 15,000 deliveries8. Common risk factors for rupture uterus are caesarean section, inappropriate prostaglandin and oxytocin usage, previous instrumental abortion, instrumental delivery, vigorous fundal delivery, etc. Assisted vaginal delivery using vacuum or forceps avoids unnecessary caesarean sections, and thus reduces the associated morbidity. Different studies have proved vacuum is safer than forceps; however expertise is needed for the application of both the instruments

A review of wound healing activity on different wound models

Wound is an injury of living tissue or break in the epithelial integrity of the upper layer of skin. This may lead to disturbance of skin anatomical structure and their function. The normal wounds start to heal immediately after an injury. Normal healing process involved: inflammatory phase, proliferation phase and maturation phase. Now a day wound healing is a challenging clinical problem. So, necessity of effective wound management is required. The various screening models play important role to understand the basic process of tissue repair and treatment of wounds. Wide varieties of in-vitro, ex-vivo and in-vivo models have been developed for evaluation of wound healing activity. The in-vitro models includes Chick chorioallantoic membrane assay, Fibroblast assay, Collagen assay, Scratch assay, Endothelial cell in vitro tube formation assay, Keratinocytes assay. Ex-vivo models includes organotypic culture, human ex vivo skin culture, porcine model, Human organotypic skin explanted culture and the&nbsp; in-vivo models includes Excision wound model, Incision wound Model, Burn wound model, Dead space wound model.The aim of this review article is detailed study of different types of in-vitro, ex-vivo and in-vivo models for evaluation of wound healing activity

Comparative study of transperineal and transvaginal sonography for localization of placenta in antepartum haermorrhage

Background: Haemorrhage is one of the leading causes of maternal mortality and morbidity in world in pregnant patients.Patients with antepartum haemorrhage confirmation of location of placenta by sonography is must for management. Transvaginal sonography(TVS) has main disadvantage of need of penetration of vagina and  provoking vaginal haemorrhage It can also result in uterine contraction & requirement of special transducer. Transperineal sonography(TPS) is more convenient and safer means of imaging the cervix and lower uterine segment overcoming the short coming of transabdominal sonography and eliminating the risk associated with Transvaginal sonography.  Thus present study was undertaken with a view to evulate patients of antepartum haemorrhage by Transvaginal as well as by transperineal sonography to compare accuracy of transperineal with Transvaginal sonography.Methods: Transvaginal probe was gently introduced for about 3-4 cm beyond the introitus. Distance between internal os and lower edge of placenta was measured. The diagnosis of placenta previa was made if placental edge was located within 5cm of internal os. Transperineal sonography was performed with convex transducer. Bladder was kept empty The transducer was positioned directly on perineum in sagittal orientation over the labia minora with center of transducer typically posterior to urethra and anterior to vaginal orifice and measurement taken.Results: TPS diagnosed placenta previa in 31 cases, 30 of which had placenta previa. TPS  negated placenta previa in 19 cases, none of which had placenta previa. So false positive rate of TPS was found to 4.7%, false negative 0% sensitivity 100% specificity 95.2%. Positive predictive value of TPS was found to be 96.7% and negative predictive value of TVS was found to be 100%.Conclusions: So, to conclude transperineal sonography is easy to perform, well tolerated accurate diagnostic tool with high sensitivity specificity, positive and negative predictive values for localisation of placenta cases of APH. TVS can be replaced by TPS in cases of APH for localisation of placenta

Ultrasonographic evaluation of first trimester bleeding per vaginum

Background: First trimester is a very crucial period of pregnancy having high risks of pregnancy losses. The objective of this study was to assess the accuracy of ultrasound in diagnosis of cause of first trimester bleeding per vaginum.Methods: 200 women who attended the out-patient department with the complaint of bleeding per vagina in the first trimester pregnancy were taken for the study. Clinical assessment by pelvic examination was done and a provisional diagnosis was made. All necessary routine investigations were done followed by ultrasonographic scan of each patient. All the data was recorded in a proforma.Results: Among these 200 cases, threatened abortion in 72 cases. It was the commonest cause for bleeding. There were 20 cases of ectopic pregnancy out of which 16 were correctly diagnosed. There were 16 cases of missed abortion. There were 8 cases of hydatidi form mole. There were 40 cases of incomplete abortion, 16 cases of inevitable abortion, 8 cases of an embryonic gestation and 20 cases of complete abortion. By this study it is concluded that the accuracy of USG in diagnosing the cause of first trimester bleeding per vaginum is 96%.Conclusions: Use of USG in diagnosis of cause of bleeding in first trimester can lead to accurate and early diagnosis and save the patients from unneeded interventions based on history and clinical examination

An Innovative 3 Dimensional Model of Middle Ear

Background: Physical models are particularly useful in demonstrating complex topics in anatomy or those ones that are difficult to access when seen in the textbook or cadaver. One such topic is middle ear. Aim of the present study was to introduce a multicolored cardboard model of middle ear to provide ease in understanding of its anatomical structure.Methods: The participants were 2nd semester medical undergraduate class of students. They were exposed to a cuboidal multicolored model (made from cardboard box) with 6 walls that could be opened to see the details of structures related to them. Student feedback was taken through a structured Questionnaire based on Likert Scale (5 to 1).Results: More than 80% of students felt that this model was a good tool for visualizing complex anatomy of middle ear in small groups and it reduced the time needed for self- study. This model provided multifaceted feedback with active participation from students. A low fidelity middle ear model proved to be a practical low cost tool for use in both didactic and small group teaching.Conclusion: Low fidelity models continue to have a place in anatomy and can be integrated in the current curriculum.Keywords: Middle ear, 3 dimensional, teaching methodologies, gross anatomy education

Isolation, identification and antibiotic sensitivity pattern of Escherichia coli isolated from various clinical sample in a tertiary care hospital, Jaipur, Rajasthan, India

Background: Escherichia coli is one of the most frequent causes of many bacterial infections, including Urinary Tract Infections (UTI), blood stream infections, otitis media, pneumonia, meningitis, traveler’s diarrhoea, enteric infections and systemic infections. This study was done with the aim to surveying antibiotic sensitivity pattern of isolated Escherichia coli in both sex attended in NIMS Hospital, Jaipur under the taken time period.Methods: In this cross-sectional study, 62 Escherichia coli were isolated from various clinical specimens of the patients attending both OPD and IPD. The strains were selected using the laboratory standard methods and culture-specific. The antibiotic susceptibility testing was performed using Kirby-Bauer disk diffusion method.Results: Out of total 62 isolates of Escherichia coli 26(41.93%) isolates were from male while 36(58.064%) from female patients. Maximum sensitivity were shown by Polymyxin B and Colistin i.c 100% followed by Nitrofuratonin 82.5% followed by Meropenem 79.03%, Aztreonam 72.58%, Piperacillin/ Tazobactam and Ciprofloxacin 61.30%, each Amikacin 56.45%, Imipenem 54.83%, Ofloxacin 45.16%, Cefepime 43.54%, Ceftazidime 38.71%, Gentamycin and Ceftriaxone 37.09% each, Cefotaxime 30.64%, Norfloxacin 27.5%. Maximum resistance shown against Norfloxacin 72.5%, followed by Gentamycin and Ceftriaxone 62.90%, Ceftazidime 61.30%.Conclusions: Escherichia coli infected more in urinary tract infection as compare to other sample in human, and it is common in female than male. Regular monitoring of antimicrobial susceptibility for E.coli is recommended to improve treatment. A changing trend in antibiotic sensitivity profile of the isolates need to be monitored as there is limited availability of newer drugs and the emergence of resistant bacteria far exceeds the rate of new drug development

Determination of ethambutol MICs for Mycobacterium tuberculosis and Mycobacterium avium isolates by resazurin microtitre assay

Objectives: To test susceptibilities of Mycobacterium tuberculosis (MTB) isolates to ethambutol by the Lowenstein-Jensen (LJ) proportion method and resazurin microtitre assay (REMA) and to evaluate REMA for the determination of ethambutol MICs for MTB and Mycobacterium avium isolates. Methods: A total of 50 MTB and 20 M. avium isolates were tested to determine the MICs of ethambutol by REMA and agar dilution method. MTB isolates were also tested by the LJ proportion method. Results: REMA provided ethambutol susceptibility results for all the isolates within 8-9 days. For MTB isolates, REMA showed 96.7% sensitivity, 100.0% specificity and 98.0% accuracy when LJ proportion results were taken as 'gold standard'. For both MTB and M. avium isolates, the MICs determined by REMA were lower than those determined in agar medium, indicating that MIC values determined by REMA are closer to the actual MICs for the isolates. Conclusions: REMA can be used as a rapid and inexpensive method for mycobacterial drug susceptibility testing against ethambutol. In comparison with the agar method, the MICs determined by REMA can more accurately be correlated with achievable plasma concentrations of antimycobacterial agents