Indian Journal of Clinical Practice April 2016 web by IJCP

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Volume 26, Number 11

April 2016, Pages 1001â&#x20AC;&#x201C;1100

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American Family Physician y Cardiology y Community Medicine y ENT y Internal Medicine y Obstetrics and Gynecology y Oncology y Op hthalmology y Pediatrics y Ex p ert V iew y Medilaw y Conference U p date y Drugs U p date y Around the Globe y Insp irational S tory y L ighter R eading y

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Volume 26, Number 11, April 2016 FROM THE DESK OF THE GROUP EDITOR-IN-CHIEF

1005 CDC Zika Updated Recommendations KK Aggarwal

AMERICAN FAMILY PHYSICIAN

1006 Corticosteroid Injections for Common Musculoskeletal Conditions ZoÃ« J. Foster, Tyler T. Voss, Jacquelynn Hatch, Adam Frimodig

1015 Practice Guidelines 1016 Photo Quiz CARDIOLOGY

1019 An Open Label, Prospective, Multicentric, Post-marketing Surveillance Study to Evaluate the Lipid-lowering Efficacy and Safety of Rosuvastatin in Indian Patients with Dyslipidemia Prabhu Kasture, Shailaja Kale, Priya Palimkar

COMMUNITY MEDICINE

1026 The Etiology and Outcome of Patients with Fever Attending Civil Hospital, Ahmedabad, India R Varmora, V Siddhpura, N Gupta, BK Amin

ENT

1029 A Retropharyngeal Abscess: Lest We Forget Manish N Mehta, Hemang K Acharya, Ajay C Tanna, Jemima Bhaskar, Dhaval P Ajmera

INTERNAL MEDICINE

1032 An Interesting Case of a Patient Presenting with Green Urine Secondary to Thinner Poisoning Shakeel Ahmad Khan, Muhammad Uwais Ashraf, Juwairia Ashraf

OBSTETRICS AND GYNECOLOGY

1036 Omental Herniation: A Complication of Drain Site A Case Report Shweta Singh, Taru Gupta, Sangeeta Gupta

1038 Bilateral Pregnancy Luteoma: A Case Report P Thulasi, Shanthi M

1041 Secondary Abdominal Pregnancy Following Rupture of Rudimentary Horn: A Rare Case Report Kshama Vishwakarma, P Shukla, K Yadav

1044 Evaluation of Risk Factors and Prevalence of Gestational Diabetes Mellitus in a Tertiary Care Center: An Observational Study Parmjit Kaur, Ruby Bhatia, Nidhi Kailey, Himani Kundoo, Aman Dev

ONCOLOGY

1048 A Simple Inexpensive Surface Applicator for High Dose Rate Intraluminal Brachytherapy of Anal Cancer Meena J Shah, Rakesh K Vyas

OPHTHALMOLOGY

Published, Printed and Edited by Dr KK Aggarwal, on behalf of IJCP Publications Ltd. and Published at E - 219, Greater Kailash, Part - 1 New Delhi - 110 048 E-mail: editorial@ijcp.com

1056 Wooden Sticks as Object of Ocular Injury: Anti-infective Profile Mehul Shah, Shreya Shah, Pramod Upadhyay

PEDIATRICS

1063 A Randomized Open Label Comparative Clinical Study of a Synbiotic Against a Probiotic in the Treatment of Acute Diarrhea in Children

Printed at New Edge Communications Pvt. Ltd., New Delhi E-mail: edgecommunication@gmail.com

S A Ayisha, K M Sudha

EXPERT VIEW

The copyright for all the editorial material contained in this journal, in the form of layout, content including images and design, is held by IJCP Publications Ltd. No part of this publication may be published in any form whatsoever without the prior written permission of the publisher.

1067 Do Î˛-blockers Cause Sexual Dysfunction? KK Aggarwal

MEDILAW

1069 Contributory or Comparative Negligence KK Aggarwal

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CONFERENCE UPDATE

1072 53rd Annual Conference of Indian Academy of Pediatrics (PEDICON 2016) 1075 46th Annual Conference of the Indian Society of Nephrology (ISNCON 2015) 1078 56th Annual Conference of Indian Society of Gastroenterology (ISGCON 2015) DRUGS UPDATE

1081 Complete List of 344 Drugs Banned AROUND THE GLOBE

1089 News and Views INSPIRATIONAL STORY

1093 Words of Wisdom LIGHTER READING

1094 Lighter Side of Medicine

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CDC Zika Updated Recommendations en i c nfi ed ca e e i a i ee a e e a ei e

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1005

AMERICAN FAMILY PHYSICIAN

Corticosteroid Injections for Common Musculoskeletal Conditions ZOĂ&#x2039; J. FOSTER, TYLER T. VOSS, JACQUELYNN HATCH, ADAM FRIMODIG

ABSTRACT a i ician c n ide in c ic e id in ec i n a a a c e en i e ea en an i find e i a i die a i i e idence a ed deci i n a in M die c ic ea en e a i i endin a i i ne a inc de n a n e a ien n e ic e id in ec i n e ea en ad e i e ca ii e in ain and an e i n ac ia i in e en nd e c ic e id in ec i n ide i e en in nc i n n edia and a e a e ic nd i i c ic e id in ec i n e n and a e a i a e ec ence ic e id in ec i n ca a nne nd a id de a e i e fin e and de e ain en n i i a e ea ed e ec i e i c a ien i i nee e a i i a a e e e ie i c ic e id in ec i

Keywords: a i

ician c

e id in ec i n

a i ician en ea a ien i c e e a c ndi i n 1 n e ni ed a e a a i i a e c eea and i e c nce n and e an e e a ien a e a i i a a c id c nic c ndi i n an c n c e e a dia n e can e cce ea ed i c n e a i e ea en c a e ice ea in in a n n e ida an i in a a d and ica ea a id a i ician e c ic e id in ec i n a a a ea en an ea en c e e a c ndi i n a i a ca e ician can i e a ien a i ac i n4 and e a id c e e a i c i n e dia n ic enefi ec ni e and ad e e e ec

ZOĂ&#x2039; J. FOSTER, MD, is a faculty physician at St. Joseph Mercy Livingston Family Medicine Residency, Brighton, Mich., and for the University of Michigan Primary Care Sports Medicine Fellowship Program, Ann Arbor. She is also a team physician for the University of Michigan; Eastern Michigan University, Ypsilanti; and Pinckney (Mich.) Community High School. TYLER T. VOSS, DO, is a primary care sports medicine fellow at St. John Providence Health System, Brighton. At the time the article was written, he was a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency. JACQUELYNN HATCH, DO, is a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency. ADAM FRIMODIG, DO, is a third-year resident at St. Joseph Mercy Livingston Family Medicine Residency. Source: Adapted from Am Fam Physician. 2015;92(8):694-699.

1006

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e en

c e e a dia n e e id in ec i n e and a e inc n i en e i e en in e ain e ie and e i e en e a e a ien ic e id in ec i n n

e e a c ndi i n

corticosteroid inj ections is beyond the scop e of this a ic e e e i en e e ed a i ad e e e ec ician d c n ide e e a i e a e This article summarizes the research on corticosteroid in ec i n ide a i ician i e idence a ed ec enda i n ei e a e ADHESIVE CAPSULITIS d e i e ca i i de c i i ne in e de de c e en i n 5 - 7 i ene a p atients rep ort p ersistent i n a e ee ea

e a c n in ain and ed c n ac e e ad a ec e an e e i i in a e p ain and limited range of

M in e en i n ad e i e ca i i e in i e en n e e ei ee intra- articular or subacromial corticosteroid inj ections e a c ic e id and ica e e e di e ence in c e ea e een i n a i i ca i nifican a e e ani a i n i a c ic ne ea a i i e i in e an e i n and nc i n i ee a a ien ecei e in a a ic a c ic e id in ec i n a e i i a ain ee 7 ician d ec end c n e a i e ea en ini ia addin a in ec ed c ic e id i e e

AMERICAN FAMILY PHYSICIAN Table 1. Corticosteroid Injections for Common Musculoskeletal Conditions: Relative Success and Duration of Pain Relief Condition

Short-term relief

Long-term relief

++ to +++

Faster pain relief and improved range of motion and function in short-term; equivalent to other options in long-term

Carpal tunnel syndrome

+++

Short-term improvements in pain and function, with up to onehalf of patients having a recurrence in the long-term; reduces need for surgery in some patients

De Quervain tenosynovitis

Short-term improvements in pain and function compared with placebo

Greater trochanteric bursitis

+++

+ to ++

Short-term pain relief, although no better than usual care in the long-term

Hip osteoarthritis

++ to +++

+ to ++

Injections challenging to administer in office settings

Knee osteoarthritis

++ to +++

One to two weeks of pain relief after injection

Lateral epicondylitis

++ to +++

Short-term pain relief with significant risk of symptom rebound in long-term

Medial epicondylitis

Short-term pain relief, although no long-term difference compared with placebo

Morton neuroma

Success of therapy is unknown because of poor-quality studies

++ to +++

Short-term pain relief equal to systemic corticosteroids; similar long-term outcomes as other treatments

++ to +++

Cure rates range from 54% to 86%

No strong recommendation from the American College of Rheumatology

Adhesive capsulitis

Subacromial impingement syndrome Trigger finger Wrist and hand osteoarthritis

Strength of Success of therapy evidence

NA = Not available; + = Weak or conflicting evidence or poor success; ++ = Fair evidence or success; +++ = Good evidence or success.

i n ade a e i e en in ain an e i n nc i n e e e e in a a ien ani a i n nde ane e ia ician d c n ide a ac ia c ic e id in ec i n eca e i e e i SUBACROMIAL IMPINGEMENT SYNDROME S ubacromial imp ingement syndrome includes rotator c nd e endini i and i i e de 1 0 It results from a combination of intrinsic and ex trinsic ac a in e e a and a c end n in e ac ia ace 1 1 S ubacromial imp ingement syndrome is the most common diagnosis in p atients i de ain ic

e id in ec i n ide a a i 1 4 ee ain e ie Intra- articular inj ections are n e e an ace and ac ia in ec i n ide n ini a ain e ie 1 4 U ltrasound- guided in ec i n a e n enefi c a ed i and a 1 5 ided in ec i n e e i n di e ence in ain di a i i a ee i e ic ac ia in ec i n 1 6

Corticosteroid inj ections for subacromial imp ingement nd e a e i i a e c e c a ed i c n e a i e ea en c ina i n ica e a and c ic e id in ec i n ide e e ain e ie a i ee c a ed i ica e a a ne and ee e e i n di e ence e een ea en S ubacromial inj ections ia cin ne a e in e i e ac e i e en in a d e i n en and a ien a i ac i n 1 7 n an ind n ed d ap p lication of a heated lidocaine/ tetracaine p atch ided i i a i e en in ain and an e of motion as subacromial triamcinolone inj ections by i ee 1 8 c ane e ie nd n di e ence in c e a ee e een c ic e id in ec i n a n a ac nc e and a 1 4

ician d ec end c n e a i e e a ie initially for treatment of subacromial imp ingement nd e e a ien e e ence and d a i n d a e c n ide ed eca e c ic e id in ec i n a e e e ec i e e i e an ee d a i n

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1007

AMERICAN FAMILY PHYSICIAN LATERAL EPICONDYLITIS a e a e ic nd i i enni e i an e e in a ec in e i in e i e en c e n e i in i e a e a e ic nd e M ca e e In p atients with symp toms of up n ea i ee d a i n c ic e id in ec i n ide One trial showed ain e ie i ee corticosteroids to be sup erior to local anesthetic in terms ain and di a i i a ee ee ee e c ic e id ad a ec ence a e comp ared with no recurrences in the local anesthetic n e c e a e c ic e id in ec i n The indica e n enefi enin ec ence a e ne ea a e a in e c ic e id in ec i n i e an c a ed i a ec ence a e in a ien ecei in a ace Physical therap y also has p oor longin ec i n e e i a ne ea ec ence a e ea en i a c e ene ec ni e i ed ain ee i en and ain a ee c a ed i a in e in ec i n c ic e id Corticosteroid inj ections can be p art of a treatment an a e a e ic nd i i a a ien d e a ned a e e i a i ec ence a e a ien d e c n e ed a c en e idence indica e a n e c e a e en e a e e a d e ini ia ea en MEDIAL EPICONDYLITIS Media e ic nd i i e e i ain e e edia e ic nd e Corticosteroid inj ection can ide e i e en in ain a e e i n n e di e ence in c e e een c ic e id in ec i n and ace a i ee and a e e ic a a in ec i n ide ne ea ea e i e en in ain and nc i n a ee c a ed i c ic e id a i i nc ea whether these outcomes are clinically meaningful to i en e ac e idence ician d a ien die a e a e ic nd i i idance CARPAL TUNNEL SYNDROME Carp i a e i

al tunnel syndrome is caused by entrap ment e edian ne e nde e an e e ca a Genetic p redisp osition and en a e i Y ounger p atients with shorter i a e i ac d a i n a e e i e a e n ane e en c a ed i e a e i a e a and a i i e a en e

1008

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e id in ec i n a e eneficia in i in e c e Triamcinolone inj ections e in i ed c e and nc i na a a ne ee c a ed i ace in ec i n Methylp rednisolone inj ection reduces symp tom e e i a ee c a ed i ace At two ee e ic c ic e id and ca in ec i n ide i i a i e en in e e a ien ecei e in ec i n a e i nifican e e c e ei and ee L ocal corticosteroid inj ection and oral NS AIDs with a neutral i in e in i i a e i e en in e e i 4 0 Two corticosteroid inj ections ide n addi i na i e en c a ed i 4 1 n a in e in ec i n L ong- term outcomes are mix ed in p atients with carp al tunnel syndrome who are treated with corticosteroid in ec i n ne a a e ec ence a n a a i e e d a i n e ec and e a a e e a i nifican c The need for surgery at one year is reduced with corticosteroid in ec i n a i nifican n e a ien in ne d e en a nde ica ea en Physicians can tailor their treatment recommendations e a ien e e ence ic e id in ec i n i an op tion as long as p atients are aware that it may not e en ec ence e need e DE QUERVAIN TENOSYNOVITIS e

e ain en n i i i endin i e a d c ici n and e en ici e i in e fi d a c a en e i R esearch on i c ndi i n i i i ed a a ien n e di e ence in e e in ec a e c ic e id ed 4 4 and n e c ane e ie e e ic e id in ec i n e in in in a ien i de e ain en n i i 4 4 although the study on which the recommendation is based included only e nan and ac a in en 4 5 A more recent study i e en in ain and nc i n a ne ee a e c ic e id in ec i n c a ed i ace 4 6 ic e id in ec i n a ne e in i ed outcomes comp ared with a combination of inj ection and in in e ea ea en i e a ne a ne d e n i e c

Physicians should consider corticosteroid inj ections for a ien i de e ain en n i i e e a e a e c n ide ed i d n e e

AMERICAN FAMILY PHYSICIAN a e in ec i n 4 6 eca e ana ic a ian in e fi e en c a en a e ain ea en ai e

TRIGGER FINGER i e fin e i e i e in c in a fin e caused by histologic changes in the A1 p ulley that e en i n e e di i 4 7 nd and e ficia i end n R heumatoid a i i dia e e e i ca a nne nd e and de e ain en n i i a e a cia ed i i e fin e 4 8 e a e a e c ic e id in ec i n a e ene a de a e an in Comp ared i ace in ec i n c ic e id e in e i e in and i ed ain a ne ee and e e e ec e i ne ea 5 0 n ne d corticosteroid inj ections resulted in less top ical and in ain a ne ee and ne n c a ed i e c ane and en e ea e e e a ien nde en e ad e e c e a i 4 8 n e a e cc ed in a ien ecei ed ne in ec i n e ecei ed a ec nd in ec i n and n ne nde en e 48 e e a c ane e ie n e a die c ic e id in ec i n i e fin e a e i i ed 4 7 a e i e and d a i n ician d e a c ic a ien i i e fin e n n ica ea en i n

e id in ec i n a e ee in a

WRIST AND HAND OSTEOARTHRITIS e e ican e e e a a e â&#x20AC;&#x153;n o strong recommendationâ&#x20AC;? for intra- articular corticosteroid inj ection in p atients with hand e a ii 51 c ane e ie in a a ic a corticosteroid inj ections for wrist or hand rheumatoid arthritis found only one study with moderate bias that recommended against sp linting or resting the wrist a e in a a ic a c ic e id in ec i n Physicians a e e ad i ed e e a ien de i e c an in e en i n a ecia i GREATER TROCHANTERIC BURSITIS ea e c an e ic i i i in e di e en ia dia n i ain in e a e a i i c ndi i n has recently been referred to as greater trochanteric ain nd e e ec in e e adi ic and i a ic die a indica e n in a a i n e e a i a

a ed i a ca e ana e ic and ica e a c ic e id in ec i n ide ea e ain e ie a e and i ac i i a i ee and ee n n di e ence in ain nc i n a i n and ne ea 5 4 Physicians may consider corticosteroid inj ections for p atients with greater trochanteric p ain who desire more p romp t resolution ei HIP OSTEOARTHRITIS i e a i i a ec e an ne i d a ien de an ea 5 5 Treatment with intra- articular c ic e id in ec i n in e a ien e in i c a en in i en e need adi a ic idance 5 6 A small double- blind study comp aring corticosteroid and p lacebo inj ections using an ultrasound- guided an e a e a a ac ed i e en in ain n a in a and ee e c ic e id a a i e en di a ea ed 5 7 Fluoroscop ically guided corticosteroid ee n in ec i n ide i e en in ain i ne and p hysical function at two months comp ared with ace in ec i n 5 5 Most p rimary care p hysicians should consider orthop edic referral for p atients who de i e in ec i n ea en i e a ii KNEE OSTEOARTHRITIS nee e a i i i a c n ca e nee ain in de ad i e i a ed a ne in i e n de an ea e en i nee ain in a i en ea 5 8 More than onehalf of p atients older than ea i e a e a ic nee e a ii Guidelines from the American College of R heumatology conditionally recommend the use of intra- articular c ic e id in ec i n ea en nee e a i i 5 1 The duration of p ain relief is one to two ee in ia i a e in i e en R esearch uniformly a in ee ee sup p orts the safety of intra- articular corticosteroid in ec i n ea en nee e a ii e e e e die a e i i ed ac i ic da a and 6 4 c ane e ie nd n e ea e idence e e c ic e id in ec i n e ea en nee e a id a i i Physicians may consider intra- articular corticosteroid inj ections e e edic e e a ica e a a i n in a ien i nee e a ii MORTON NEUROMA Morton neuroma refers to p ain between the metatarsal ead e an a di i a ne e c n

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1009

AMERICAN FAMILY PHYSICIAN a ec in e i d e ace 6 5 c ane e ie n e that although corticosteroid inj ection is considered a anda d ea en M n ne a e die a e in e i a ed i a e and e ec i ene and e 6 5 Physicians may a a e i ed a e ai c n ide c ic e id in ec i n e e a ien d e ad i ed e e i n d a i e idence i

an de ind e de n e a di de in ene a ac ice incidence c a ac e i ic and ana e en nn e

de a ien i

e id e

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ende a M d ead e a ic e id in ec i n a e a e ic nd i i a e a ic e ie en ac

a d e i e e ie e id in ec i n

ac na n a c e e a n e a i e ana e en ad e i e ca i i e de a c i ne a ica i n e in a a ic a c i ne in ec i n de

de ain a e c

e a i ada e ia e a de ad e i e ca i i ani a i n and a c ic a i in a a ic a e id in ec i n n

a i na a

e ican cade a i ician inica ced e e ed ician a ei ac ice aa a e aa a i edicine ac a e cce ed an a

e e e M

in ee cacie c ic e id in ec i n a di e en i e e de e ea en ad e i e ca ii de

i ede M Miede a e a en e a Multidiscip linary consensus on the terminology and c a ifica i n c ain e a nec and de cc n i n Med

naee M a in a e ia n ic acc ac c inica e ac ia i in e en nd e a e a ic e ie and e a ana i c Med e a i

1010

a ea

a e i e en M e a e ci e a e c ic e id in ec i n de a e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

AMERICAN FAMILY PHYSICIAN

e i e e a ec ic e id in ec i n i ea n c inica c e in a ien i ni a e a a e a e ic nd a ia a and i ed c n ed ia M

ei e an nanici ic n n e ida an iin a a d in ca a nne nd e

Ma dani i i M a i i M a a e M a i i e a e e ec c ic e id in ec i n e local anesthetic inj ection in the treatment of lateral e ic nd i i a and i ed in e inded c inica ia c a a

n M i e a in e e id in ec i n ca a nne nd e a and i ed c inica ia n in ac

en i a a i e a M c e ene ec ni e e c ic e id in ec i n ana e en c nic a e a e ic nd i i and i ed c n ed ia i ea c Med e a i a a an e e cac an in ec i n e id edia e ic nd i i ec i e d i e ne in e i e icen in cac and a e of corticosteroid inj ections and other inj ections for ana e en endin a a e a ic e ie and i ed c n ed ia ance ee i e n e a i i e e ec an autologous p latelet concentrate in lateral ep icondylitis in a d e ind and i ed c n ed ia a e e ic a a e c ic e id in ec i n i a ea Med

a nd

and

i n inica e n Med

a a

nne

ac ice a a nd

ad a ad a i e e a a a nne nd e M i e ec i e n ea ed ca a nne nd e a icen e d e

ee e a anin a in e enie e a R andomised controlled trial of local corticosteroid in ec i n ca a nne n d e in ene a ac ice M a ac

i nde M e M e a Me edni ne in ec i n e ca a nne nd e a and i ed ace c n ed ia nn n e n Med

en nd de a e a ica dec e i n e ca e id in ec i n in ca a nne nd e a ne ea ec i e and i ed en c n ed c inica ia ii e

Ma a a di ca c ic e id in ec i n ca a nne nd e c ane a a a e e

Ma i i i e a c e and c e ec i ene ca a nne in ec i n in n a ic need e id ance in e a

ic ie ine ic e id in ec i n ea en de e ain en n i i a ed an i a i e i e a e e a a i n a d a ac

ee e a anin a an de ind in e e a i c e id in ec i n de e ain en n i i c ane a a a e e

ci i a a i a i n n n ica ea en ea e de e ain di ea e e nanc and ac a i n and

ee e a anin a R andomised controlled de e in ec i n ac ice M M c

ee e a anin a an de ind in e e a i c e id in ec i n i e fin e in ad c ane a a a e e

nne M

n M i an e a ca e ic c ic e id in e ea en ca a nne nd e e

e id in ec i n and in in Med e a i

in e enie e a trial of local corticosteroid ain en n i i in ene a ee i d

a e an fin e an d i ed c inica c ic e id in ec i n e e e a

e a ea en i e ia c a in e e d c ane e ea e and en d

an Midde M i ede M e e a ec i ene in e en i n ecific c ain e a nec de c e e a di de e and in ain

e a anin a in e enie e a e id in ec i n e ec i e i e fin e in ad in ene a ac ice a d e inded and i ed ace c n ed ia nn e i ic

e M an i e a e ican e e e a ec enda i n e use of nonp harmacologic and p harmacologic therap ies in e a i i e and i and nee i i a e e en

a en M i ie n a a ic a e id and in e c i d en i eni e idi a ic a i i and adults with rheumatoid arthri i c ane a a a e e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1011

AMERICAN FAMILY PHYSICIAN i a da ein ein e a c an e ic e in e in a a i n in e

ii a

in an n M i e en e a ic e id in ec i n ea e c an e ic ain nd e a and i ed c n ed ia in i a ca e nn a Med a e in ec i n d e ind

c in ace M e a e a i i e i a and ace c n ed ia ii

e n M e ec i ene in a c a e ace in ec i n in a ien de i n a and i ed d e M M c ee i d

e id i ed e

e an M e a c ic e id in ec i n i i e a ii inded c n ed ia

i a ic ia e

aa d i en en ede en e a n a a ea en i e a i i a and i ed a nic acid c ic e id and i nic a ine a i i a ia e

ea Mc a ne nee ain and in de ad a e ie c ni c en e i a ea ca e nn

e a ii den and e i ■■■■

1012

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

en da ni i idence a ed nee in ec i n a i i ain Med

c a e ic e a i e i e i a ic nee e a ii ii e

e a

an e a ana e en

d ea i ic e id in ec i n i i e nee e a ana i M

e e a n ncan e a e e cac and duration of intra- articular corticosteroid inj ection for nee e a i i a e a ic e ie e e die cad c

e a a e in n e a n aa ic a ic e id ea en e a i i e nee c ane a a a e e

a na and e in e ace in

d c and i a d e a a e cac n e in aa ic a e id in ec i n a i i e nee a and i ed d e ind c n ed ia i ed c ec i n a ea ii e ii e

n i ea en M e

n Ma in n e en i n e n ne a c ane a a a e

AMERICAN FAMILY PHYSICIAN

Practice Guidelines EARLY PEANUT INTRODUCTION AND PREVENTION OF PEANUT ALLERGY IN HIGH-RISK INFANTS: CONSENSUS COMMUNICATION n e e ni ed c n ie c i d en a e a ean a e i a ne ca e eac ea in e ni ed a e and ni ed in d i consensus communication focuses on new data that in d cin ean ea in in an and i aims to assist with decisions about introduction; it can be used for guidance while formal guidelines are ein de e ed e c n en c nica i n i a a ie ani a i n inc din e e ican cade e a n e ican cade edia ic e ican e e e a n a a ian cie Clinical Immunology and Allergy; Canadian S ociety of Allergy and Clinical Immunology; Europ ean Academy of Allergy and Clinical Immunology; Israel Association e and inica n a ane e cie for Allergology; S ociety for Pediatric Dermatology; and d e ani a i n e i ide ine e a e e i n need ai in d ce ean n i a e i n a e e a did n ecifica ec end in d cin ean in i i in an e een and i n a e and ce ain ide ine a e a e i i in an d a e c n a i n i an e e e e in d c i n ecen da a e a ea in d c i n i a e and e ec i e in e ec ed a ien LEAP TRIAL e ea nin ea a ean a e ia ic i e fi ec i e and i ed d e a din ea ean in d c i n e a a ed in an a i i i in in e ni ed in d n an e e c n ide ed i i i e did n a e a i e e ance did a e a ea dia e e a ea n a in ic e en e ed a en e i e ad a ea dia e e a ea en e ed a e i ed en e i e a e a a cia ed a e

Source: Adapted from Am Fam Physician. 2016;93(1):61-62.

ad e e e ec e a ca cine in in i i ice in in an days twice in the p an i n c in a

e i in ica c ic e id a a ed a ea da n e an i n ast six months in children older c ed a ea a n e di fied ic de a i i e a a i n

The study included infants four to 1 months of age e e and i ed a id d c c n ainin ean n i fi e ea a e ea d c c n ainin ean a ea ee i e e ee Ap p rox imately 17% of infants not consuming p eanuts ad a ean a e fi e ea a e c a ed i a in an c n in ean a e i ed c i n n e needed ea e a i e i ed c i n e i a cia ed i in d cin ea n ea in i e a i n e en c i d en in e a c n ed ea n a in eac i n d in e a e ine d c a en e indicating that introducing p eanuts early is a safe and ea na e a ac d e n ed a in an i a e i e e n e a a ed in e ia e e e da a n ea ean in d c i n in ene a i a i n a e ac in INTERIM GUIDANCE n in an a i i i e in c n ie i a e a ence ean a e ie d c c n ainin p eanuts should be introduced at four to 1 months of a e ai in an n e can e in an inc ea ed i a e n an in e ia e e in e ean c n i n a e a edian ean ein eac ee in fi ea e a e d c n ed inc de ean e i ed i i i a a nac ean and nd ean i ed i e d e ia did n a e c n i n a di e en a n ean ein en ea en needed i e i di c n in in in e i en ea in ean d c Consultation with an allergist or ex p ert in managing a e ie a e eneficia in in an a e an a ic di ea e ea in i e e a e ie in e fi four to six months; these sp ecialists can assist with diagnosis and determine how ap p rop riate early p eanut in d c i n d e in ic e in an e ed ean c a en e a e e a a i n i n in i ai n

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1015

AMERICAN FAMILY PHYSICIAN

Photo Quiz SKIN ULCERS OF UNKNOWN ETIOLOGY A 41- year- old woman p resented to the emergency dep artment with leg ulcers and ecchymoses on her ea a e an de e ne n i e e ce e an a ain id fi ed i e and e ed in ce i a ac c e e i n ad a ea ed and e ed e e a i e e e e i ee ea e did n ee edica a en i n e edni ne in e i en ia i and ad a n i c caine a e

Figure 1.

Physical ex amination showed multip le ulcerated lesions on the anterior asp ect of both lower ex tremities i e and i e ende ic e i n n ea i e e e a ina i n ed ia ic a e n e e e and fin e e i a i n e e n a c e e d c n c e en i e e a ic ane and c a a i n a a e e e e n a ine ic e in a i i e c caine e ad an e e a ed eac i e ein e e e n e and e c e edi en a i n a e e

Question a ed n e a ien i and ica e a ina i n findin ic ne e in i e i e diagnosis?

e a i

e ind ced a c i i

i i i

idica dia e ic

a an en

e ic e

e ene an

Source: Adapted from Am Fam Physician. 2016;93(1):57-58.

1016

Figure 2.

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

SEE THE FOLLOWING PAGE FOR DISCUSSION.

AMERICAN FAMILY PHYSICIAN i i a a e a ene i i n n i can c nfi e dia n i 5

DISCUSSION e an e i e a i e ind ced a c i i in i ed a e c c a ic a c i i c n i en i e a i e ind ced a c i i e a i e i an antihelminth drug that was used as an antineop lastic a en ad e e e ec c a a an c i and an ce ca in a c a a e n i i ed i e e e ina edicine i c n ed ace c caine eca e i c ac i e e ec It is estimated that 70% of cocaine in the U nited S tates c n ain e a i e e e i n a cia ed i e a i e e e a e c n a n e ea n e and c ee in ce i a e a ic a e a a cc e e e i n a e e n ane i in a e ee di c n in in e d can ec i e en e e Necrobiosis lip oidica diabeticorum occurs in p atients with diabetes mellitus or a strong family history of e di ea e i c a ac e i ed in e i e a a ic ed e in a e a ad a en a e and c n ain de a d e e ce a i n e a e i c n and can cc Summary Table Condition

Cause

Characteristics

Levamisoleinduced vasculitis

Levamisole exposure

Purpura on the ears, nose, cheeks; skin ulcers with a hemorrhagic base

Necrobiosis lipoidica diabeticorum

Unknown but associated with diabetes mellitus

Single or multiple asymptomatic red to yellow, shiny plaques; gradual enlargement and possible ulceration

Pyoderma gangrenosum

Septic emboli

Neutrophil dysfunction

Heart valve infection

Wegener Autoimmune granulomatosis vasculitis

Pyoderma gangrenosum is an idiop athic condition a cia ed i in a a e di ea e a ii in in a a i n and a i nanc i c a ac e i ed ain e and a id e i e ce i i ace nde ined de nd in e e a and a en a e e a ene i i e ie ed e e a ed ne i d nc i n i a dia n i e c i n 5 ac e ia and e e a i n n an in ec ed ea a e a ca e e ic e i e a e ia e d ea and can ca e e dden de e en ain ic in ce e a e a cia ed i e e ic i n ac e e ia inc din e e a ai e a ia a a ia and e e a ed i e d ce c n e ene an a i i a a edi e e i ne a c i i a i c a ac e i ed in n and idne in e en in findin inc de nec ic ce a a e a and di i a in a c a ien i i c ndi i n a e n n d e e e ia ac di ea e and e en a nec i in e ne i i a

REFERENCES Me a a idi M n end a a ai n a e c caine ai e a i e ind ced e c c a ic a c i i in a c caine e

Painful pustules and rapidly progressive ulcers with violaceous undermined borders, surrounding erythema, and a purulent base

Sudden development of painful, purpuric skin ulcers; other systemic signs of bacteremia Necrotic ulcers, palpable purpura, digital infarcts; skin, lung, and kidney involvement

i M e e a i e ad a ed c caine ind ced a c i i i in ce a i n e e Med d a in an an e e a i e ind ced a c i i c a en ee e a enea ind ced a c i i a ca e e

e M ni Med

nic e a i M

an ncia an a an a n a ca e c ane ce a i n in

ic a a a e e M c e Mi e c ane ic a c a nd e an in c ndi i n e ini cen ca ci a i ca ci a i ine ca cifica i n e a a

e ia n ic a ac a ien i a c ii ad Med

ec ed

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1017

■■■■

CARDIOLOGY

An Open Label, Prospective, Multicentric, Postmarketing Surveillance Study to Evaluate the Lipid-lowering Efficacy and Safety of Rosuvastatin in Indian Patients with Dyslipidemia PRABHU KASTURE*, SHAILAJA KALE†, PRIYA PALIMKAR‡

ABSTRACT a a in i a en a in i a ac ic and a ac ine ic ad an a e i a ni en e e a c e c ncen a i n ic e in e i e cac a e in c e e and i ce ide a e a in c e e e e ic a een e ca e in i c en d a i ec i e c i ed da a indi id a e ea ed a ee ea en i a a in i nifican i ed e i id a a e e inc ea in e e cen a e indi id a a ained i e e a e i id a ia e a c nc ded a a a in a ea e e cac in ndian d i ide ic i i indica i e enefi a a in ea en a ide e en e ene a ai n

a i i

Keywords:

a a in ndian d

i ide ic a in ca di

a c a i

a e in

in e a ea e idence a accumulated showing dramatic reduction in ca di a c a i in d e a c en e M ed c a e in i i a in e e e den i i ein c e e n ene a a ed c i n in e i a ca di a c a e en i a cia ed i e e d dec ea e in c e e 1 e e de i e i e a e ic cce e e id a i a ca di a c a e en e ain i i i e a i cien ific and ic ea in e e in ne d and in e en i n a e ie ai ed a ed cin e i i ca di a c a i in e a i n

a in e a i e e a in a a in e e a greater number of binding interactions with H MG- CoA ed c a e and a a i a ni e ac i e i e e en e a a in i e a i e d i ic and i e ec i e a en and ac i e in e a ic ce a a in a e n e e ina a i e a n statins and is only minimally metabolized by the c c e en e e i n i nifican in e en e en e n i en i i findin i e a ence c inica i nifican d in e ac i n e een a a in and e d n n in i i en e

a a in i a ad ance in e a

e enefi a in a e e d c en ed e e i id e in d a ca e a e en a d i e i ic i inc ea ed ce ain in e ac i n a a in i e c e ed ain nc an ed and i a a c ncen a i n a e n i nifican inc ea ed c c e in i i e a e and e a i i a a in e e a e ed in da a a ien ad ecei ed a a in in a ina i na a e a ic e e en ed a ien ea c n in e e a a in inica i nifican e e a i n in a anine a in an e a e

n e ic a in a e e en an ac ic and c inica e ie

*Medical Services, Micro Labs, Bangalore †Professor and Research Associate Dept. of Internal Medicine, KEM Hospital, BJ Medical College and Consultant Diabetologist, KEM Hospital, Sahyadri Hospital, Pune, Maharashtra ‡Interventional Cardiologist Jehangir Hospitals, Sahyadri Hospital, Pune, Maharashtra Address for correspondence Micro Labs Ltd 27, Race Course Road, Bangalore - 560 001

SAFETY AND TOLERABILITY OF ROSUVASTATIN

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1019

CARDIOLOGY i e e e i i n a and c ea ine ina e i e e e i i n a e e nc n in e a ecei ed a a in and c aa a in M a i e e e i i n a i c e i e a ed ea en cc ed in a i ae a ien a a in a d e ncidence ein ia d in a a in ea en a c a a e a een i e a in and e de e en ein ia a n edic i e ac e e i e ena di ea e dea in e a e e a i ed a a in n did a d i cc in a ien ecei ed a a in i a i ae a a in 4 a a ein nd ain a in a a in i e i i ic an a a a in and i a a in i i ici i an i an de e inan of ex tent of p enetration of statins into the muscle cells a i e di i n n inc ea ed ene a i n in e ce c d ean an inc ea ed i a d i DOSE, TITRATION, TARGET e de ee ed c i n i i an ac ie e e ea en a e ed ide ine e a i na e e d ca i n a recommends a goal of <10 mg/ dL for p atients at high i c na ea di ea e n e e in ean cie ie indica e a c e e a d n e a i a ai a e c inica ia e e i n e idence a ac ie in and ain ainin c e e c e e e in e ce ad e e e ec n e en a in a a in i ca a e ac ie in e de i ed c e e a in e a i a ien 7 a ien a e i i c na a e di ea e enefi ea en a e c e e a a e e e d and e ec enda i n e e a ended inc a e i eac e e e a e i e a and a a c e e ed c i n e a e i e e a ie i e e i ed i can e ac ie ed i e e ne e e en a in e ecia a a in a a a in e e e en a in a ea e a e e en en ed a i e d e e incidence a and a d i a d c en ed in n e c inica ia i and e ec i e 8 a a in a een n inc ea e e a a den i i ein c e e and ap olip op rotein- I concentrations in the metabolic nd e in a d e de enden anne i c d e e a ed e ed c i n in a a i ce ide i

1020

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

with remodeling of H DL p articles and reduction in a i ein ac i na ca a i Treatment with a a in in a ien i e c e e e ia a ead a i nifican ed c i n in a a a e ic di e a inine M e e ic a ea e e a ed e i e en in end e ia nc i n a a in 1 0 a a de n a ed e enefi i e en anced a i i a e c e ic a e and in i i i n in a a a e a enic e n e in a e ia a 1 1 STUDY OBJECTIVE i d a c nd c ed e a a e e i id e in e cac and a e a a in in ndian a i n with dyslip idemia by measuring the p ercent change in e n e ec ed i e en in e i id a ia e e a e i d ee

Study Design i a an en a e ed icen ic n nc a e in ei ance d

a a i e

Inclusion Criteria a e and e a e i d e an e

i ide ia

ea and a

Exclusion Criteria e nan ac a in e a e

a a in

e en i i i

ec e e nc i n

e in

ec i i

idi

a c c

e e

e a ic idne

d and

METHODOLOGY c i ee e ini n eade a ed c nd c in i d i a e in d included 416 doctors for collecting the data and it was comp leted through recording the p atient in a i n n i id a ia e e and ea en in e a ien ec d a de e ed Each p articip ating doctor was distributed these ca e e and e e ed ec i p atients according to the inclusion and ex clusion c i e ia i id fi e eac ec i ed a ien a assessed before initiating therap y and at the end of ee a a in a i en a a d e ei e d ee

CARDIOLOGY RESULTS

i e ec d e e e ec ad a ic d e e e in e en i n e ea e e ainin ad an in e en i n e e a a considerable reduction in the p ercentage of subj ects i ie nde anda the remainder of these p atients went into the group of ec i i ia and 6% of the subj ect p ool had a diastolic blood p ressure and e ec i e in e en i n e e n e c an ed and e ec i e a e ec in i d e e a in i e d a inde M a e e e and e n ed e ei and e i ca e e ec i e n ee in i e ec i e e d e i id fi e eac a ien was scrutinized p re- and p ost- treatment and the results a e a e

Percentage of subjects

a ec e e ec i ed in i d ic c e e e e ained e e c e ed e ee treatment and the remaining subj ects were lost to and e e c n ide ed a d e d inc ded a e and e a e Ma i e ec e e in e a e ea and ea an ia e cen a e e e a nd in e n a e e een and ea e e e a e ea a e

83.78

73.21 56.99

26.79

16.22 0

Pre-study

Post-study

Percent increase/ decrease

-50

-56.99

-100

â&#x2030;¤200 mg/dL

>200 mg/dL

Figure 1. e and in e en i n e e e i e cen a e inc ea e dec ea e

a e e een and nd a e a e e a e and i

a c

d and een and

e e

e e d

Table 2. Distribution of Subjects Improved to the Optimum Levels of Total Cholesterol Post-intervention Total cholesterol

Pre-study

Post-study

<180 mg/dL

501 (5.8)

3,425 (40)

180-190 mg/dL

415 (4.8)

1,501 (17.5)

190-200 mg/dL

481 (5.6)

1,342 (15.7)

7,218 (83.8)

2,297 (26.8)

>200 mg/dL

Total cholesterol

Total Cholesterol

Table 1. Total Cholesterol Pre-study and Post-study (Percent) Pre-study

Post-study

â&#x2030;¤200 mg/dL

1,397 (16.2)

6,278 (73.2)

>200 mg/dL

7,218 (83.8)

2,297 (26.8)

100 Percentage of subjects

a e ec a i n ad a e ea en a c e e a e d which is high according to the Adult Treatment Panel III ea en i a a in ide ine i n e ed ced e an i d i e n ic ean e d a i n i ed ei e e d ic i i nifican a e and i n e a ec in e en i n e ec e e nd a e a n a a e d a a ain n e e e ea en e e ec ad n a e e in e en i n e e a in a e d e e a in

Total cholesterol

100

83.79

80 60

40 20 0 -20

5.8 4.8 5.6 Pre-study

Post-study

-40 -60 -80

-100

Figure 2. i i e e a c

26.79 17.515.7

34.2 12.710.01 Percent increase/ decrease

<180 mg/dL

190-200 mg/dL

180-190 mg/dL

>200 mg/dL

i n e e

-56.99

ec i ed e in e en i n

HDL Cholesterol e ea en e an a e ec ad a i a e e d in ea en i a a in ec i i a c e e e e ad een ed ced a e e i in e e e e d a i n a e and i

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1021

CARDIOLOGY Table 3. Pre- and Post-intervention, the Percentage Improvement in Subjects having Suboptimal Levels of HDL Cholesterol Pre-study

Post-study

≤40 mg/dL

5,255 (61)

2,961 (34.5)

>40 mg/dL

3,360 (39)

5,614 (65.5)

HDL-C

Percentage of subjects

60 34 36.1 29.9

40 20 0 -20

5.2 13.7 Pre-study

Post-study

-40

34.5

26.5

28.8 22.4 Percent increase/ decrease -51.2

-60

65.5

100-130 mg/dL

>130 mg/dL

Figure 4. e and in e en i n e e cen a e ec a in ean e e c e e in e n a an e

0 -20 Pre-study

Post-study

≤40 mg/dL

-26.5 Percent increase/ decrease

>40 mg/dL

Figure 3. e and in e en i n e e cen a e i e en in ec a in i a e e c e e

e e cen in e inc ea e e ec i e e ea en a and d and e een and d e ec i e a c a ed e e ea en e cen a e indi id a e e e a a in a nd e a i nifican n e ec an i ed c i n in c e e in in i d n e a e a e c e e

Non-HDL Cholesterol

LDL Cholesterol e e a a i nifican ed c i n in e n e ec ad i e e c e e i a a in ea en ec ad d c e e ic i a e e de i ed e e ic ea en i a a in ed ced n ed cin e c e e e e in e d a i n e a ec in e en i n ec e e nd a e n a a e c e e e d a a ain n e e e ea en e

81.1

≤100 mg/dL

-40

100 Percentage of subjects

HDL-C

LDL-C

e di i i n e e ec ad n a e e c e e in e en i n e e a in a e d e e a in a e e een and d a e and i Table 4. Pre- and Post-intervention, the Percentage of Subjects having Mean Levels of LDL Cholesterol in the Normal Range

e e a a i nifican ed c i n in e n e ec ad i e e n n c e e ca c a ed i a a in ea en ec ad i e a e n n c e e ic ea en i a a in ed ced n n

e a ec in e en i n e ec nd a e e ed ced a e n n c e e ec e de i a e e e d e e e ea e ained in e de ine ca e a e and i e e a a i nifican e cen indi id a i in ei n n c e e e e e n a e e a e a in e ea en ee Table 5. Pre- and Post-intervention, the Percentage of Subjects having Mean Levels of Non-HDL Cholesterol in the Normal Range Non-HDL-C

Pre-study

Post-study

LDL-C

Pre-study

Post-study

<130 mg/dL

258 (3.0)

7,503 (87.5)

≤100 mg/dL

449 (5.2)

2,915 (34)

130-159 mg/dL

560 (6.5)

1,030 (12.0)

100-130 mg/dL

1,178 (13.7)

3,097 (36.1)

160-189 mg/dL

5,514 (64.0)

42 (0.5)

>130 mg/dL

6,988 (81.1)

2,563 (29.9)

>190 mg/dL

2,283 (26.5)

00 (0.0)

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Percentage of subjects

CARDIOLOGY n e a ec in e en i n e ec nd a e e n a a e a e d a a ain n e e e ea en e e a a i nifican e cen indi id a i in ei e e e n a e e a e a in e ea en ee

Non-HDL-C

100 90 80 70 60 50 40 30 20 10 0

87.5 64

26.5 3

Safety Profile

6.5

0.5

Pre-study

Post-study

<130 mg/dL

130-159 mg/dL

160-189 mg/dL

>190 mg/dL

Figure 5. e and in e en i n e e cen a e ec a in ean e e n n c e e in e n a an e

Triglycerides a a in ed a a a e end dec ea in e a a e e e in e en i n ec ad e e e een and d e ea n ad i a e e i e d ic c a e i e i e e e ed in ndian e in e en i n i a a in e e ai n a a c n ide a e i e en in e d a i n in e e e ic e e ed ced e d a e and i Table 6. Pre- and Post-intervention, the Percentage of Subjects having Mean Levels of TGs in the Normal Range TG

Pre-study

Post-study

â&#x2030;¤150 mg/dL

1,485 (17.2)

3,902 (45.5)

150-400 mg/dL

6,991 (81.1)

4,639 (54.1)

139 (1.5)

34 (0.4)

Percentage of subjects

>400 mg/dL

100

81.1

54.1 45.5

60 40 20 0

17.2

1.5

28.3 0.4

-20 -40

Pre-study

â&#x2030;¤150 mg/dL

Post-study

150-400 mg/dL

-1.1 -27.0 Percent increase/ decrease >400 mg/dL

Figure 6. e and in e en i n e e cen a e ec a in ean e e in e n a an e

d e e e en e e e ed ec a d ina ain and na ea e ed in ec e e n e a ed e d d e ad e e e en in e e ainin ec ic e e a i ed e d e e i d de a e in na e e e e e a ia ini ia da c n i a i n a d ina ain and na ea e e e e an ien and i d e ec ad e ed e ad e e e en ec e ed c ee i an edica i n ein i en and n ne e ad an e e ae DISCUSSION a a in i a en a in i and a ac ine ic ad an a e i anic ani n an e ein en e a i e a c e c ncen a i n in e i e cac a e in c e a e a i in c e e e e een e ca e in i c en d a

a ac ic a ni ic e e and ic a

ecen d n e e a ence d i ide ia in di e en a and an a ea in ndia nd a e e a ence a ea ne i id a n ai a ie e an a e ndian a i n a a ea ne a n a i id e e ic in n d inc ea e i a ca di a c a e en e e a e e e a ia indica in e e cac a a in in i in i id fi e ifica i n e e a in in e en i n n n e en i n ia a a in a a in a a and a ia and a nin in in i a ca di a c a di ea e e en i n a a and i ed d e ind ace a c ed icen e ia c nd c ed a i e ac c n ie a a ici an ecei ed ei e a a in ace and e e ed e e n ne ea in e d e a a in ad a e edian c e e e edian i en i i i eac i e ein and e edian e e a a i ica i nifican e ed i d c e i n a

a a in ed ced e i a end in a fi ca di a c a e en a e i

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1023

CARDIOLOGY a a d a i a e a a ec nda endp oints with the ex cep tion of hosp italizat ion for n a e an ina a a in a n e i nifican ed c i n in fi a ca di a c a e en n e d e a in e a ie e a ed i id e e c a ed c d e a a in d c a ed e e cac and a e a a in e a a a in i a a in and a a a in ac d e ed a a di e en d e a a in ed ced e e an e a in and e e an i a a in and a a a in ddi i na a a e a ien ac ie ed en c a ed i a e ec i e a in ed a a c a cc e e an a i in ac ie e en

i n c a a in

e e

a a in a e

d e a a e e d e a a in and a a in in e c e e e ic a ien i i e di ea e a a in a a a in a ed cin c e e e i id a a e e and ena in and ean ea en a

inica ia da a and a e in ei ance a e de n a ed i an in a i n a a a in e e a ca di a c a c e die a e c nfi ed e eneficia e ec a ad een an ici a ed a c a i a in die ed e ed c i n in ca di a c a e en and a ca e a i i e a a in in i a e en i n in a ien i e ca di a c a i i i e n a in a a n ed ce a a i e ca di a c a and a ca e ai 18 die a e n e en ia enefi a a in in ec nda e en i n and i in en i e a CONCLUSION n e a i e a e da a i can e c nc ded a a a in eneficia a e e en i e ec i ein a ic e e e i and i ed ia a e n a in e en i n a e c e e c ncen a i n can i nifican ed ce e incidence and e a a c a e en in a ide an e indi id a i ec i e c i ed da a indi id a e ea ed a ee ea en i a a in i nifican i ed e i id a a e e a i een e inc ea e in e e cen a e indi id a a ained i e e a e i id a ia e ince e e e e n a i ica i nifican d e a ed

1024

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

ad e e e i e en e i d i i e iden a a e and e a e

ed i e d nde e d a a in i

c nc de a a in a n ea e e cac in e in c e e and e e and inc ea e in e c e e c ncen a i n a been shown to enable more p atients to reach their L DL c e e and i e e i an acce a e ae fi e i en i enc and a e a a in i a e a i e a in a can e ed in di e en c inica c n e REFERENCES

ai en eec ea ne M ac e c icin e a e e ea en ia i a a cac and a e c e e e in ea en ec i e e a ana i da a a ici an in and i ed ia a in ance

en n a a in a ne in i i M ed c a e e ea en d i ide ia e e a di a c e

Mc enne M cac and a e ea en d i ide ia ea

e e d nnin a e a i ea e a a e

a a in in a

ein a e ein a a in a di

ic M ane a a c nec in e and i e d e a ac ine ic and a e e ne M ed c a e in i i e ce i

Ma in Mi c e c nec a ac d na ic e ec and a ac ine ic a ne M ed c a e in i i a a in a e nin e enin ad ini a i n in ea n ee in Pharmacol

a a e end i

den i i ein c e e e i an an e ean

ed c i n a di

Mc enne M a ac ic i n a e i e den i i ein c e e e in enefi e i a di

i M a e e i id an a e e de enden e a i n i den i i ein e a i i a a in in e e a ic nd e in nd c in Me a

M in e in e ec a a in n a a e e a di e a inine in a ien i ec e e a di

M e ic e ia

in n e i ide ia ia n i and Mana e en d di i n nd n dde n d

CARDIOLOGY

e ean e ni ia i e n e na i na cie e a i a Medicine M ean cie e en i n ean cie ene a ac ice a i Medicine M ean ea e ean ide ine n ca di a c a di ea e e en i n in c inica ac ice e ec i e a in a Force of the Europ ean S ociety of Cardiology and other cie ie n ca di a c a di ea e e en i n in c inica ac ice c n i ed e e en a i e nine cie ie and in i ed e e a di a c e e a i

e ane n e ec i n a a i n and ea en i d e e in d ec i e a The Third R ep ort of The National Cholesterol Education a e ane n e ec i n a a i n nd ea en i d e e n d d ea en ane M

Ma in a ic M ane i i e i i e a Me a i e c e i n and a ac ine ic a a in in ea ad a e n ee in e

id e M anie n n eca ene M a e ein e a d a a in e en a c a e en in en and en i e e a ed eac i e ein n Med ne a id n M ein a Mc enne M Mi e e a d a i n e e cac and a e a a in e a a a in i a a in and a a a in ac d e a di ia

ea fie d M e ena a and e n nde a c a Mi e e e a a i n e e cac and a e a a in and a a a in in i i a ien i e c e e e ia ec i e d e a a e e e d e e a in a a in and a a in Trials

id e M anie n n eca ene a a a c n en en e M a e ein e a ia d a e a ean cie a di ed c i n in eac i e ein and c e e and ean cia i n a di a c a e en i n ca di a c a e en a e a e ini ia i n a a in and e a i i a i n nci n a di a c a a ec i e d e ia ance Nursing; Europ ean Association for S tudy of Diabetes n e na i na ia e e ede a i n e ■■■■ i

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1025

COMMUNITY MEDICINE

The Etiology and Outcome of Patients with Fever Attending Civil Hospital, Ahmedabad, India RAVI VARMORA*, V SIDDHPURA, N GUPTA, BK AMINâ&#x20AC;

ABSTRACT e e i a e c n ic a e n a ee edica ad ice and i ne e a c i e ia i a ad i i n n ed e ca e a ence in ec i n i c i ica in de a e c inica and ea en e e e e in ndia e in n e e i e e and e ia e ei ance da a a e n a ai a e i a an e a i na ec i e d c nd c ed a i i ia eda ad ic i a e ia ca e cen e d in e e i d an a ece e i e ain ec i e de c i e e e i e e and d c e c ca e a e end e d n e en d a ien e a c i e e den e in ec i n a a ia in ec i n i a e aii en e ic in ec i n e e ia ac in ec i n and enin i i n ec i e e i ie e e nd e in a ien i e ad n nin ec i e e i and a ien e ained ndia n ed e findin c nfi e ea den in ec i n a a ca e e e e i in i a i a i n i ec ne di ea e c i in a i ca e e e

Keywords:

e e i a ic a e n i ne e a Most common reason e e e i in d e a ei ie a i i n deficienc i nd e and ne na a in ec i n i i n dea e ec c n ie 1

e e e ec

ne di ea e

e c n a ee edica ad ice and c i e ia i a ad i i n for which is infection hidden e d ea ani a i n eac e ain in ec i ne nia dia ea an ac i ed i ne deficienc a a ia ec i ca e e een and i e e ea in inc e

e e i i e a i an ice e and i in a a e n e a ien a e een nd a e i an in e en and an e c ica i n ic might cause rap id deterioration in general condition a a ien n e ce i i ed e in e e a e

ea ed e i ica e ea ed d e ac acce dia n ic e e e c inica a i in de di e en ia e a a ia in ance e ca e e e a e n ecific n ed e ca e a ence in ec i n i c i ica in de a e c inica and ea en e e e e in ndia e in n e e i e e and e ia e ei ance da a a e n a ai a e e ain ec i e i d a de c i e e e i e e and d c e of such cases at the end of the study among p atients at i i ia eda ad METHODS

Study Setting e e en d inc ded a ien e e ad i ed in Medica a d i i ia eda ad d in e e i d an a ece e

Design *Intern BJ Medical College, Ahmedabad, Gujarat â&#x20AC; Additional Professor Dept. of Medicine BJ Medical College and Civil Hospital, Ahmedabad, Gujarat Address for correspondence

Dr BK Amin Additional Professor Dept. of Medicine BJ Medical College and Civil Hospital, Ahmedabad, Gujarat

1026

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

i a a ec i e e in a ien nc i n c i e ia e ea e an ea i e ec i c i e ia e e a a ien e c i ica i a ien a ien a e i a i a i n a ien e ca a

a i na d a n e a a ien i a e e ende c i n an ea a e de e ed e e i e a cia ed d i e e e ea

COMMUNITY MEDICINE in e a i e a ien and a ien i an surgical illness; p regnant and p ostp artum p atients or a ien i nec e a ed i ne

Table 2. Diagnosis Distribution Diagnosis

Present study % of patients (n = 108)

Dengue

20 (n = 22)

Malaria

19 (n = 21)

Viral hepatitis

17 (n = 18)

Enteric

09 (n = 10)

LRTI

07 (n = 8)

Meningitis/Encephalitis

06 (n = 6)

Febrile neutropenia

02 (n = 2)

Diarrhea

02 (n = 2)

in e ea e i d d e i e a ien e e en ed de ai a e i en in a e

Chikungunya

02 (n = 2)

ICH

03 (n = 3)

e ean a e in i d a Ma e e e e a ec ed an e a e Ma i a ien e e in a e ic e e a e and e e e a e

Malignancy

02 (n = 2)

Undiagnosed

03 (n = 3)

Others

06 (n = 9)

Data Collection a a e e c ec ed i a ec d and di ec a in a ien e inc din a e and ende e e ec ded a e a c inica da a inc din e e d dia n e and dea adi ica i c ic i ica e e ed e e e i

edica a a ic da a ec i e a i n fina e ica and e ed

RESULTS

n e en d a ien in e i ie e e ec ded den e in ec i n a a ia in ec i n i a e aii en e ic in ec i n e e ia ac in ec i n enin i i in ac ania eed e i e ne enia dia ea a i nanc and a ien e ained ndia n ed de i e e a e e a ien a ien ad c ined a a ia and i a e a i i in ec i n and a ien in ec i e end ca di i ce a in ec i n id e ic e e a e e ia ac in ec i n and ne e ic a i nan nd e eac e e nd n e en d in ec i e ei ie e e nd e in a ien i e ad n nin ec i e e i and in a ien e ained ndia n ed a e n e en d a ien en a ain edica ad ice a ien i Table 1. Age-wise Gender Distribution of Study Patients Age (years)

No. of males No. of females

% of total patients (n = 108)

13-15

16-20

21-30

31-40

41-50

>50

Total

100

LRTI: Lower respiratory tract infection; ICH: Intracranial hemorrhage.

Table 3. Etiological Distribution Etiology

Present study % of patients (n = 108)

Abrahamsen et al study % of patients 2 (n = 100)

Infective

Noninfective

Undiagnosed

malignancy were transferred to sup er sp ecialty hosp ital and a ien ad e i ed d in ia a e e a ien a ien ad ec enin i i M and in a ien dia n i a n eac ed de i e e DISCUSSION ac da a n i a ed d i ic i a ec i e e a ien i e e d ne a a e e a i ad ndia e ean a e in i whereas in Abrahamsen et al a c

n e in and n a i e

e d e a e a a en e a d a i na d e ia ca e cen e in d a study the mean age

e en d in ec i e e i ie e e nd a ien i e ad n nin ec i e e i a ien e e e ained ndia n ed a en e a d ad in ec i e e i ad n nin ec i e and a ien

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1027

COMMUNITY MEDICINE e ained ndia n ed a e e e i ica di e ence c d e eca e e a ica a ia i n of some diseases in a p articular area and mean d a i n e e a e i e e en a i n ic a da in e e en d e ea i a ee in a a en e a d in e e en d e c n e i e e a d e in ec i e ca e in n nin ec i e ca e in ac ania e a e and a i nanc e e e c n e a ien ic ad e i ed in e en d a ien ad M and in a ien dia n i c d n e a i ed de i e e n a a en e a d a ien e i ed ic ad and ad a i nanc M c n e i ie e e in e en d e e d e in ec i e ca e c a den e ed c e a a ia and i a e a i i n n nin ec i e ca e intracranial hemorrhage and malignancy were more c n Ma a ia den e and c i n n a a e a ec ne di ea e whereas hep atitis and acute a en e i i a e e a a e ne di ea e 4 n e e en d a ien a ien ad ec ne di ea e e ea a ien ad ae ne di ea e e i e de e en a i a e c n ec ne di ea e ec ne di ea e c i e a i ca e e e

e e and i ni n ica ac ca e ea na and e a ica a ia i n in ec ne di ea e in ndia e die a e needed a i n and i a a ed in de ide e e idence a ed in a i n a e e a ence a i e i ica e a ence e e in ndia CONCLUSION i n e in ec i e di ea e in den e a a ia and i a e a i i in ec i n e e nd in a c ad a ien ad i ed a e ia ca e i a i e e a i i ia eda ad i nde ine e i ance ec ne and a e borne diseases in p ublic health and the need to control e ead c e i ica i n a i health p rograms and early diagnosis and p romp t in e en i n a e in ed cin e a i and idi REFERENCES

e a e n e e e i nd in i d d n e e e en a i e e ca e e e in e ene a a i n e e a e ee ain i i a i n e ainin i e e ec i n a ien ad i ed a e ia care hosp ital in India is biased as a result of factors c a e e i di ea e ende and acce i i i n i d n ad e e inc ded i e c i d en d e ec a e di e en e e e i ie d e

d ea ani a i n ac ee e a e ea e eadin ca e dea inc e ac ee Ma

a a en a en an e and ide e a e and ca e a a i a ec i a e ia ca e i a in

a i na ec ne i ea e n a e i ec a e ene a ea e ice Mini ea a i e a e ai a e a n dc in cce ed n ne

a i na en e i ea e nicd nic in inde a id n ne

en ad

a i Ma ai e in e ic ae i e e a i na d in ndia M n ec i

ai a e a in id cce ed

■■■■

Urgent, Concerted Efforts Needed to Stem Diabetes Epidemic: WHO n ie in e a ia e i n a e i and c nce ed ac i n e en ea and ea dia e e a en ia a a di ea e a a eac ed e ide ic i n and i e ec ed e inc ea e in c in ea ia e e a e a e ead ine and e i i e e d e en a e i e n e in en e and c ed e a e ade e n en c ni ie and indi id a n e cca i n d ea a i na e a a in e i na i ec a ia aid a i ea c n dia e e and ca e e e en ca e and de ec e di ea e a e e a e ide ic ic i i in e and idd e inc e c n ie e ia e e i a ic a c nce n in e e i n M e an ne e e e i i n dia e e e a ed dea a cc in e e i n i e i e a ence e ace a e di c ie in e c n a in ec i di ea e c a ec i a e i i n e e e in e di ea e d n n e a e i dia e e e a ence c n in e i e e e na cia and ec n ic c n e ence i dee en e aid

1028

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

ENT

A Retropharyngeal Abscess: Lest We Forget MANISH N MEHTA*, HEMANG K ACHARYA†, AJAY C TANNA‡, JEMIMA BHASKAR#, DHAVAL P AJMERA¥

ABSTRACT R etrop haryngeal abscess usually p resents with symp toms of up p er resp iratory tract infection and swelling of p osterior a n ea a a e e en i e c ania ne e a ie and a ne e i e ne n M acia ne e a and ac e idne in d e e i nd e

Keywords: e

a n ea a ce

e M acia ne e a

i a i n ne

nia

CASE REPORT

P8 5 L

de ia c a e

Chest X-ray (CXR) - a i a i n ne

ea i n e in ic d

d a e a ad i ed i i an e e ince da na i i e i e e ec ain e e di c in n e a ina i n a ien a ane ic ad i i nec i ne and a candidia i e

R S - bilateral crep itations. i

ne e

n M

ne e a

ca c d i ee c

ca c d a

in in

X-ray neck AP - a e a ie e ea

i a e a e a e

e ea

Urine routine examination: a ni ic ce

ine a

e en

USG abdomen: i a e a inc ea ed c ica ec e e i i in e a ic ic an a ina e e ea

*Professor and Head of Department †Professor and Head of Unit ‡Assistant Professor #Senior Resident ¥Junior Resident Dept. of Medicine, GG Hospital, Jamnagar, Gujarat

ided ne

ace an i en

e aii i di e en ia c n ac ed ce e ; random blood ce d ea d e

nia

CT scan neck multiloculated p erip heral enhancing c ec i n in e a n ea ace e endin a e e de e e a d a e a n e ide i e end e a ca ae c e and e n c eid a id Ma ne ic e nance i a in M can ain i ided a idi i

e aii

a n ea a

Investigations a c n in P7 8 L M e aee a c ea inine d

1 0

i n a ne a i e

ne a i e

en ic a d

nc i n

ne a i e

USG chest: M de a e a n id e en in ide i ic in e na e ae and nde in n c n ida i n Pure-tone audiometry: e ea n and i ea i d ea in

a ea in e e

Retropharyngeal pus culture and sensitivity: K lebsiella i a ed n en i i e e acin The abscess was asp irated and 50 mL of p us drained inci i n a e e in e a n ea ace a ien de e ed ac e e i a ai e and a n en i a and ni ed and e a ed n nd e a i e da a ien ec e ed e a a e e ea e

c ea inine e e a e

d d

i n a a i a ed

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1029

ENT The rare features in this p atient are

DISCUSSION

Patient is an adult and not a child

R etrop haryngeal abscess occurs p rimarily in children but can be seen in adults due to direct ex tension from ad acen c e ene a in a a ec i and ce ica ine e e i i eca e i ana ic ca i n i can e a i e ea enin i ne

The asp irated p us from the retrop haryngeal abscess e e ie a n e c cc a ien e en ed i M ne e a e e ence ne e a can e e ained communication of retrop haryngeal sp ace with a a a ea ace ic c n ain c ania ne e e e ence M ne e a can e acc n ed n e ence a cia ed a ed a idi i eca e e e a n c inica e idence a idi i e e a n ea anic e ane a n a n a ic a ain ne e a i cc ed d e e c ene e acia cana e a id ai ce n i a ien can e nec ed e idence a idi i

e e a n ea ace e end a e in e edia in i e e i nd ei e e e a a cia and an e i cc a n ea a cia e in in idi a e an an eceden up p er resp iratory tract infection and p resents with e a e e nec i ne and i d ic i a ina i n a n e ea e in ei a n ea a There is communication between retrop haryngeal ace and a a a n ea ace i ace c n ain ca id a e in e na a ein i n c ania ne e a ina i n a e ea i and nec i idi e in a e a a n ea a can e i ed

Patient had torticollis due to ex tension of p us to e e n c eid a id ce Asp iration p neumonia is common in retrop haryngeal abscess but this p atient had iae a e a e i n and e ne a ic an i d e e a ed a e a id ed en c e and i ein c n en

ica i n e e en i n e a ea R up ture into p osterior p harynx may lead to asp iration ne nia and e e a Media ini i ai a c i n and i in e na a ein can a cc a e a i e adi a nec e in dia n i e e i fi ed ic enin e a n ea i e e dia d e a

e a n ea ace a e e e i ice e e e e e a d e n a ce ica ine i a e e adi a e ca e ined e e a di ea e c e adi a d e a en e a i a i n ne nia

ed a can nec central hyp odensity associated with ring enhancement and i e a ca ed a e a n ea a ce i ea ed inci i n and d aina e e a e e inen in a ea e a ani n i e c cc

e e en in ea e ac e idne in e i nd e CONCLUSION

The rare p resenting features of this retrop haryngeal abscess should p romp t us to diagnose each p atient indi id a and ea dia n ic di e a i nd c inica ac en e ad ea ed ne e a and n e e a n ea a ce e d a e e a ien SUGGESTED READING

L MN facial p alsy is caused by lesions during its long c e e ain e e a id a en i a ne e ca ed a e a n ea a ce can e in ed a e d e i i edia and mastoiditis because the mastoid air cells are close e acia cana in idd e ea a ien i a e clinical features of acute otitis media with otorrhea and ende ne e e a id e ind e ea in addi i n e acia a ■■■■

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d e

a i n inci e n e na Medicine di i n

a n

in a n

a n

i ea e a a e

ae e and

e a

di i n

di i n a e a e

in a

di i n

INTERNAL MEDICINE

An Interesting Case of a Patient Presenting with Green Urine Secondary to Thinner Poisoning SHAKEEL AHMAD KHAN*, MUHAMMAD UWAIS ASHRAF†, JUWAIRIA ASHRAF‡

ABSTRACT e c an e in e c ine i en an eni a ic findin and a ec e a ca e c nce n e ea in ician e ain d ic c n ain en a ca e a een di c a i n ine i e e a ine ci e idine and e e en e e an in e e in ca e ic ca e i een ine in addi i n e c inica ea e i case is interesting because as such green discoloration of urine is rare and the cause of this discoloration in our p atient was inne i nin ic i e en a e in i e a e

Keywords:

een di c

a i n

ine inne

e c an e in e c ine i en an eni a ic findin and a ec e a ca e c nce n e ea in ician e ain d ic c n ain p henol group s may cause a green discoloration of urine i e e a ine ci e idine and This may be caused by conj ugation of p henol in the i e and e en e c e i n e idne 1 The strength of the green discoloration has been rep orted e d e e a ed e n n en c nd i e e c a ide a i i ine and ind e acin a a d ce een ine e e a e e ca e e e e e a d na a ene a e icide a a ca ed een di c a i n ine c e which is a maj or cause of the normal yellow color of ine c ine i e i en c ea e a een c a e an a e e c e e a e an ca e e ic a e n a e ene e n ine een a e in addi i n e e e n n e di c a i n4

*Senior Resident Dept. of Medicine Sanjay Gandhi Memorial Hospital, Mangolpuri, New Delhi †Assistant Professor Dept. of Medicine JN Medical College, AMU, Aligarh, Uttar Pradesh ‡Ajmal Khan Tibbiya College, AMU, Aligarh, Uttar Pradesh Address for correspondence Dr Muhammad Uwais Ashraf Assistant Professor Dept. of Medicine JN Medical College, AMU, Aligarh - 202 002, Uttar Pradesh E-mail: uwaisashraf@gmail.com

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

i nin c n

a i n

A p atient who has come in contact with these c nd d nde ic a i i a i n and i e ad i i n e in en i e ca e ni W e p resent here a similar case which came to us with een ine in addi i n e c inica ea e i case is interesting because as such green discoloration of urine is rare and the cause of this discoloration in a ien i e a e in i e a e CASE HISTORY An 18- year- old male p atient was brought to the casualty an a and i Me ia i a Man i e Delhi with a history of altered sensorium for the last e e a n e i i e ce ici n in e i n e n n n ance a the time of p resentation as the p atient was brought by nei e e e c nfi ed a e e a n i e e eadac e an e c nic i ne e e a n i i i a c ain in e a n e a ina i n a ien a i ed in i c an i was p resent and the p ulse rate of the p atient was 106/ in e e i a a e a in e d e e a e a i a e a c ea ea nd e e n a a ien a nc n ci i an M e e a n ca defici i e e i a e a e a in i e and an e e e i a e a e en a a i n a i in e i a i n e ea ed and d a e in a e c e c n ce a di e en ia e c e c n mm i a n

INTERNAL MEDICINE e e

ii an an

c ea inine a i e in a ina e a ina e

a a ca ci d e ia

d d ea a e di a d a e a ic a e a ic a a ine d a a and a e e ce

d a e ace ic ic a a e in

a ien a i edia e n a e and ad ec an i i ic a ic a a e a a d ne a ien a ca e e i ed and e e i e e ea ca e a e c e ine a een i and e e a n c ea c i of p oisoning at that p oint of time and substance was not n n ca ic acid i nin a ec ed ee in in ind e ea a ai a i i i a ien d e e a n e ndin a e

in a en id ica na e e en a i n and i e e ic i in i e a ien a in a ed and n en i a cyanosis was increasing so methemoglobinemia was ec ed e en e a ien a i en in i n methylene blue and about 10 0 mg of methylene blue a i en e a e i d and i a a i n d a ica i ed i in e c e a ien ine c an ed een e Mean i e e a ien e a i ed and a e e i a e a ien a a e in a inne ac and a e a a a e ca i n in e a i e ad c n ed inne e e i i e a e e ini ia i n e ene e in i n a ien had i nifican i ed and i d e e a a i in eac in e i e i d in i n e a ien c ndi i n ed i nifican i e en and e e a a d a ic i e en in M c e e a ien d e e inc ea ed and did en a a i n e e a e a e a a i n a a ic a nd i a decided i e e e ene e and e ne a e e ene e a i en a ed d in a ain and eac ed a a ien i e nc i n e idne nc i n e e e de an ed e in e and e i e a ea a in e ic ic e i a d ed as a tox icity of methylene blue and the infusion was ed en i a a c n in ed and ni ac ed e e an ed e en e a ien a a i n i ed and ene a c ndi i n a ain eca e e e e e ne da a ien a e en i a and e i c e ica a a e e i ed in ne da and a ien a di c a ed in d c ndi i n

Figure 1. a ien a ca e e i ed

DISCUSSION

Figure 2. a e e

in een c

ed ine

a e ided ine i e in c i e i e and c ea and a a i acidic Abnormal color of urine may be seen in an underlying a enic c ndi i n a e a eni n en en n Commonest cause of abnormal discoloration of urine i e a ia e e a in ed n ine i een een ine enc n e ed in ca e i an nc n cc ence een c a i n in ine can e end en e en nd en ca e inc de c ndi i n i e c i e a ndice e e e ence ida i n d c i i in i e i i e din in ine can i e a een c

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1033

INTERNAL MEDICINE e ca e een ine ic need a en i n include Pseudomonas bacteremia and urinary tract in ec i n e dia e nd e and a n di ea e a e a a ece i e di de in ic an acc a e in e a in e ina ac ca in ac e ia e a i e i ind e ic i e i e a i d indican in e ine e e color per se i n dan e i in ad an nde in c ndi i n a e i e in e i a i n 5 a c n ed en c n ainin in a en ane e ic d i n n ca e een di c a i n ine 6 This could be a p ossibility in ca e eca e a ien ad nde ne a c a in a i n in e ca a e e a e ie of the anesthesia notes showed clearly that p rop ofol a n ed a an a e e ane e ia ea inne c nd ic a e ed c n in in e d ain a e n n ca e e e ine ia e e d c c n ain ic a a ic d ca n en ene ene and ene a ena ed d ca n ca n e ac ide e ce e and ic e ene 7 Most of the c inica ea e a e d e e e ine ia Diagnosis dep ends on clinical susp icion and a history in ica i n e d e a ien a e n in c e e ence c an i i n a PaO e e a a e e dia n i ana i i e ea a n a a e ia en en i n and e e a e e a ic acid i i na e e e i ia inica ea e de end n e c ncen a i n e e in an i a de e in a e e d and a e e d acid i ad ca dia ei e c a a ia and dea a cc e e e a n always correlate with methemoglobin concentration in d8 e

p resence of methemoglobinemia e n e a een in c inica ea en i e ene e ici e ene e e a di in i e i i e ene e in ca e e e CONCLUSION

een di c a i n ine i a a e en i n e n n ca e e d inne i nin ca in een ine i e en e a e a ien had p resented with green urine secondary to thinner i nin e a ien e nded e e e ene e e a e e a e e a ien de e ed ici e ene e eca e ic e ea ea ed and e a ien ec e ed a ain n a e e e a a di c n in ed and a ien a an ed e d REFERENCES

ca e i in e e in eca e in e fi ace een ine i a a e e en a i n in c i ica ca e edicine ec nd e e ca e een ine a e een e ed ec nda inne i nin id p atient resp onded to methylene blue which indicates ■■■■

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and thus a drastic i e en a e e e i e a i n a ain a ed e dici e ine ia

i e M Med

Medica i n and een ine n e n

a n a een di c a i n e ine a e n ed in i n a ca e e in a e an ine a

n i M cia ed i

a e i Med

dian ea

e a d een Med

Green urine due to a p rop rietary

nd Mic ae d e dia e nd e a i ia e ca ce ia i ne ca cin i and indican ia a ne a i ia di ea e i defini i n e e a ic a n ai Med e

ec e c e ana e a een ine ance

e a e e

e a

e inne in ica i n ani e in a ine ia ndian edia

e ande Me e ine ia a ac and c inica ana e en nn e Med

OBSTETRICS AND GYNECOLOGY

Omental Herniation: A Complication of Drain Site A Case Report SHWETA SINGH*, TARU GUPTA†, SANGEETA GUPTA‡

ABSTRACT n a e i nea d ain a e a in e ed in a d ina e e e e en in id acc a i n e e e e cac and a e in a d ina d ain in a d ina e a e een c n en i n e ic and nec ac ice d ain a e e d in ed ec ic i e e i ne i ce a ean ec i n and a a ie i di c e a i e en a d ina c ec i n d e e en e ca e a ea d e a e nde en e ided a in ec i i ide a i a i n and de e ed en a e nia i n a e d ain i e n a

Keywords: n a e i nea d ain c

ica i n c

en a e nia i n

e dic en in d d ain a n ai i e n n e n n in a e i nea d ain c n ed surgeons usually inserted in abdominal surgery for the e e en in id acc a i n ad a a een c n e ia e e d ain a e een n ed i c ica i n c a ec nda in ec i n in e ina e a i n ad e i n e a e and i a i n 1 Omental herniation at the drain site is one of the comp lications and illustrated case rep ort is about the en a e nia i n d ain i e

ide a i a i n a d ne ince e e a cc e e i ne a e c i n a e ic d ain a e d aina e a ien a ne en in e i d ain a e ed n a e en d ain a cc in e ecedin and d e in a d ne n a en a ien a ca ed ic e a a ed a i e a a nd c a din d ain i e Ma a n n ende fi and n n ed ci e i a and

CASE REPORT

and ain side in e

d e a e 4 came to Gyne casualty of i a a aida a e e i i i ee a en ea and in e a in ain a d en e ine e nanc e a i i e e a dia n ed a a ca e e rup tured ectop ic p regnancy and was op erated e enc and e ided a in ec i i

*Senior Resident †Professor ‡Senior Consultant Dept. of Obstetrics and Gynecology ESI-PGIMSR, Basaidarapur, New Delhi Address for correspondence Dr Taru Gupta Professor Dept. of Obstetrics and Gynecology ESI-PGIMSR, Basaidarapur, 110 015, New Delhi E-mail: tarugupta1971@yahoo.com

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Figure 1 a and b.

ain i e

en a e nia i n

OBSTETRICS AND GYNECOLOGY cc din a ien e de e ed c n a e a d en a d ne e e in e en

a ien a a ain a en in i e a a i n a a e n e e ca ed e e a i n ni ia d ain i e inci i n a inc ea ed c mass was reached till the base and it was found to be en a in i in Ma a e ci ed and d ain i e a c ed i in e ed i c e i a e c nfi ed e ence fi a i e ic a e i e en e i d a ne en and a ien a di c a ed DISCUSSION e e cac and a e in a d ina d ain in a d ina e a e een c n en i ica d ain e a e e e a e ic e i e e ac a e e i in c ec i n id e en in c ec i n id ac ica e e a e e e nia i n in e ine a endi 4 gallbladder5 en in e e and a 6 in e e ica d ain i e n e ic and nec ac ice d ain a e e d in ed ectop ic with gross hemop eritoneum or with cesarean ec i n and a a ie i di c e a i e en a d ina c ec i n d n a ien a a i e c ed en e d ain n a aced ac ica in c a e d ain ed ad ide e ic d n a e an in ence n d aina e ead i e en an e en edi in factor for herniation are recurrent increase in intraa d ina e e ca ed c in ainin n ed e n i i n nd in ec i n e i and e id e ic a e n n ca e ea in and e nia i n 7 It has been rep orted that e nia i n i ce a inc ea e i inc ea e in i e 8 ≥ e e e e i e a cia de ec ≥10 mm d e c ed a e e a ana e a e e ea ed that the indications of p rop hylactic drains should be ini i ed in ca e nc ica ed e ie n ca e e a ien de e ed c n a ic ed e nia i n en ene e a d ain i e c ainin and nd in ec i n d e e en ed a id c c ica i n

n ec ni e in e i n and e a can a e a ca a i e ac i a n in i ca e Asymmetrical method which causes p eritoneal stretching for insertion of drain should be used rather an in di ec a inci i n a a inci i n i e ade i d e ade i e and n eac e e i ne a e a e i e c ed a e d ain i in e ed i e e in ad a ained e e d e ed i d a e d ain CONCLUSION e e ic and e d e n e ea e add e ed

ica d ain a e ed in e en in nec e e ic ed and dicia ac iced i e en c ica i n i e e i d edi in ac d e e en e c ica i n

REFERENCES M e an e e nia i n a e i e an a d d ain in ac

a ni nca ce a ed a n

i dan e nia i n e a

a d M e a i e a a

an a e e nia

ina

ai a d ain i e nn

an a id n endi

ain i e

eene en a e nia i n a e c ca e e e d Med

eda i e in i ce a i n a adde a e i e a e e d ain a ca e e a e

ian n n a c

a d

i e M e i i a i n an a an ica i n a d ina d aina e

ne i ce a i n and ina d ain ad Med

e c

ica i n

a ne i i anai i ca e e of incisional hernia through a 5 mm lateral p ort site in a a c ic c ec ec Mini cce

a a a M e a a id n R outine abdominal drainage for uncomp licated a a c ic c ec ec c ane a a a e e

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OBSTETRICS AND GYNECOLOGY

Bilateral Pregnancy Luteoma: A Case Report P THULASI*, SHANTHI M

ABSTRACT e a e nanc i a eni n e a ic i e e i n e a a een a ed a e e nanc e a a i e e e i in eini ed a ce ic e nd in an e a e a ed anne e e e a ed e e nad in d in e nanc n ene a e a a e a a ic and nd inciden a a e i e ce a ean ec i n a a i a i n a e a dia n ic and ana e en c a en e a i can i ic e e en a i n a i nan a ian e e a ea d i i a ida ee e a i n ca e c ic a nd e a nd a e i a e a a ed adne a a e in a e na a d en in i d in e na a c a i i e a ian i in e a ien a in e i a ed dia n ed a e i a e a e nanc e a

Keywords:

e nanc eni n

e nanc e a a fi de c i ed e n e and a c a in n i n e e an ca e e nanc e a a e een e ed n ene a e a a e a a ic and found incidentally at the time of cesarean section or a a i a i n e a e nanc i a eni n e a ic i e e i n e a The etiology is unclear and it has been p ostulated that the p regnancy luteoma arises from p re- ex isting luteinized a ce ic e nd in an e a e a ed anne e e e a ed e e nad in d in e nanc H yp ersecretion of androgens occurs in ap p rox imately en i e nanc e a to 50% of these women will show clinical signs of hyp erandrogenism and 60% to 70% of female infants n a c ini ed e i e e e e i i e de ee i i i a i n M ca e e e c e e in a n a a e a diagnostic and management challenge as it can mimic e e en a i n a i nan a ian n acc a e dia n i i i an a id nnece a e

*Associate Professor Dept. of Obstetrics and Gynecology PK DAS Institute of Medical Sciences, Palakkad, Kerala Address for correspondence

Dr P Thulasi Associate Professor Dept. of Obstetrics and Gynecology PK DAS Institute of Medical Sciences, Vaniyamkulam Ottapalam, Palakkad - 679 522, Kerala E-mail: drpthulasi@rediffmail.com/drrckkrishna@rediffmail.com.

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e and

eni

CASE REPORT e

ea d i i a ida ee e a i n ca e c ic a nd e ca e a an ena a ca e i a e ad n ane c nce i n i and ec nd i e e e e ne en ne ee i ia e a ad i ed i i e e i in and p ain abdomen at a local hosp ital and treated a ica Medica i id n e in d ea a ien a nd e i e d a inde M e a d en e a ee i e e a ed ead e e e a ea a e d d in e i a i n n a e ic can in e i e intrauterine gestation corresp onding to gestational age ee ni ic id inde two large heterogeneous p redominantly hyp erechoic bilateral lobulated adnex al masses in maternal abdomen in i d in e na a c a i i e a ian i in i i i ie inc ded a ian e i a i n i e a ic c an e en e ance an i en Patient was counseled and we p roceeded with magnetic e nance i a in M e e a a i n i a e a a ian a e M e ed a i a e a a e a ed i e i na in en i a e i n in adne ae i ea in c and e ea in c ea e a e e e een in ide e a e a ie e e n een e a a e e e i n e e a n ca cifica i n nec i i in and e e a n a ci e e di c ed e

OBSTETRICS AND GYNECOLOGY d in e nanc and i n n n ane e e ic e in i in da a e e de i e It is multinodular in half the cases and bilateral in a i d ca e e and en e e dec ea e a id a e de i e a eac in n a c ncen a i n i in ee a da e e e an ca e a e een e ed in i e a e M a ien a e a a ic i en a ed a di c e ed incidentally during cesarean section or at time of a a i a i n n ca e e a a e na ac i e eadin ec e i n and en causing masculinizat ion in mothers and female infants ca e

Figure 1 a and b. i a e a

en a ed a ie een n e ec i e

ca e i e a ien and a endan and e e e c n e ed e a din a ian a e a anned to continue p regnancy up to term and terminate by e ec i e e e en ce a ean ec i n e a ien nde en e ec i e i iae a a ia ec indin a c ed ini a e i nea id ic a en c i e ac i e a a de i e ed i d a c e and a i ei i eni a ia e e n ed e ine an a i and e a ie e e en a ed a i e c i a and n a ina i e in a e ce a ean ec i n a ien a nd a e c i e a n a e a i e and e a i e e i d a ne en e e e e ed n a 6 and p atient was discharged with H PR of right and e a iec eci en e i e e nanc e a e i nea id a ne a i e a i nan ce na fi e i de d e iand e ne a e d e e ne a e e ne a nd e n a DISCUSSION e

a e nanc i a a e c ndi i n en cc in e d and decade and i a cia ed i inc ea ed e a ence in ican e ican a i n and in e i a a e e nanc e a i a n n ne a ic e i n a cc in

e nanc e a a e a ia e in i e an in ic c ic e c in dia e e n ca e i a e a a ie ea ed c in di en i n n e a ina i n c ace e a a e id an e c ed i e a ic ci Mic c ica luteomas are sharp ly circumscribed nodules comp osed na ce a an ed in ee c d a c e e nd ic e i e ace c n ainin c id i e a e ia e c a i a ndan e in i ic and fina an a e n c ei a e i e ic and ec a ic ence i a dia n ed a e nanc e a e cc ence an a ian e en in d in p regnancy seems to be rare with the incidence ranging n e e e incidence a i nanc an e i a en a a an a eca en e p ap illary mucinous cystadenocarcinoma and mucinous c aden a e e c n een d in e nanc e di e en ia dia n i e nanc e a inc de an e ce ec a e i e di ce e e di i a ce nc a ified e c d a a e e i a e a and hyperreactio luteinalis. Y oung et al recommended an ultrasound if an enlarged a a a a e d in an ini ia e ic e a ina i n iden i e i e and e e i a c ic id The ultrasonograp hic features of luteoma of p regnancy a e een de c i ed a a a id a ic can be unilateral or bilateral with either single or multip le n d e i a e a i and in d a i a e e c n in e a a in e a ian e e i e nanc e a e ain nc ea i e i ed a e a i e a ce which were p resent before p regnancy and resp ond in an n a anne e e a ed e e nad in

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1039

OBSTETRICS AND GYNECOLOGY enc n e ed d in e nanc i ne c ndi i n p redisp osing a woman to form a luteoma during e nanc i e e ne in i e n i e i en a e a ead ad a e a d in a e i e nanc a e a i i a in an e e a e i ac a cia ed i e a a e i e e nancie ad anced a e na a e and a i ean e nici in a n a e nanc a e na ci c a in e e ne e e can inc ea e in i d i e e e e e a e e ne a i e i e e n n e nan e e and i i ica c ndi i n d e n ca e i i i a i n i i i a i n d in e nanc i a a e c inica e en i c n ca ed e nanc e a e eac i eina i Pregnancy luteomas typ ically undergo sp ontaneous a e e i n a i in n de i e e e e ne e e a e n n a ee a e a e nanc e di e en ia ed in e nan e a e i a ian a e a ec ni i n i en i i ia e nnece a ec d e c n ide ed in e di e en ia dia n i a ian a e in e a e a e e nan a e een ecen e nan CONCLUSION e a e nanc i a a e c ndi i n ic rep resents an unusual resp onse to the altered hormonal en i n en in e nanc and i ic ei e a id c e c ic a ian ne a e e e in a e i d d e c n ide ed in e a id nnece a adica e n di c clinical cases with atyp ical p resentation biop sy of this e i n i in a e a i e en ec i n a a e e a i n e a SUGGESTED READING

a an an a a e nanc a a e ca e e

Ma e na e a ni ea ci

en e a ca e nec

e nanc

an i an en Ma e na and e a e e a i i i a i n ca ed e nanc e a e i e i

e e en Ma an e e den i i i a i n in e nanc an a ian cin c aden a e ie i i i in a ian in nec

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den an de c e i in i ca e e and e nanc e

an e M n an Ma ne ic e nance i a in e nanc e a i

anda a e i ai iae a e a a ca e e an Med

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ian a i c i n in

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an e nanc e a ci e and e e a ed e a a ca e e and Med a e nanc

ann e e a ead M a n ni a e a e a e nanc i ic in a a i nan a ian a n a ne ic e nance and a nd Ma n e n a in

e en i e e i n e i e nanc n nec a

a a

i nai a ian di de nd c in Me a in

n de c an e di ce and nc a ified e c d a cia ed i e nanc a c inic a i i ca e nec nc

cia ed e nanc

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i a a anand an a ian and i e c ndi i n e a ie a e and i a en e e Ma nec

i ian e

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Endometriosis may Increase Women’s Heart Disease Risk en i ea di ea e a e inc ea ed i e a e end e i i e a ne d i ed in the j ournal Circulation: Cardiovascular Quality and Outcomes e e ea c e nd a en i end e i i e e i e e i e de e c e ain an ina i e e i e a e a ea a ac and i e e i e e i e e en in en c ed a e ie c a ed i en did n a e end e i i

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

OBSTETRICS AND GYNECOLOGY

Secondary Abdominal Pregnancy Following Rupture of Rudimentary Horn: A Rare Case Report KSHAMA VISHWAKARMA*, P SHUKLA†, K YADAV†

ABSTRACT Pregnancy in the rudimentary horn of the uterus is a rare form of ectop ic p regnancy; most of the cases were being diagnosed a a a e a ic c d e e n en e a ien e en ed in e ec nd i e e d ina e nanc i an e e e a e and e i e a e ine e a i n acc n in a ec ic e nancie e e dia n i i i e in ea e nanc in ici ca e e nanc in e di en a n a a a e na and e a c e and e e en i in a e i nea e a e in e ec nd i e e d e e e n ca e ec nda a d ina e nanc in e di en a n a ee i e e e ane ia i e ed ci i n e di en a n i acen a in situ a d ne

Keywords: nic n a e e

di en a

e nanc

he incidence of mullerian duct anomalies in general a i n i nd e nic n a e e cc in in en in e ene a p op ulation and a rudimentary horn is p resent in about e ca e 1 Most of these rudimentary horns are n nc nica in c ic e nanc cc in in a noncommunicating rudimentary horn has an estimated incidence e e nancie Pregnancy in the rudimentary horn usually culminates in e d in ec nd i e e in a e ca e e e dia n i i n a and c a en in but p ossible with high index of susp icion in the early e nanc Abdominal p regnancy is an ex tremely rare and serious form of ex trauterine gestation with an incidence of Abdominal p regnancies account e i a ec ic e nancie 4 It has a rep orted incidence in in a e nancie 5 e e a i na ac i i an ed ide e e a ie and a ian e e a e na ai

e dia n i

5 This is p rimarily because a e can e a i a e i a i e e a e a ia a acen a e a a i n e acen a can e a ac ed e e ine a e e en e i e een adde and i a en can de ac a an i e d in 6 e nanc eadin en ia d

It is thought that abdominal p regnancy is more common in de e in c n ie a eca e e i e enc e ic in a a di ea e in e e a ea 7 d ina e nanc i c a ified a i a ec nda acc din ddi d c i e ia 8 n e e c i e ia e dia n i i a a d ina p regnancy is based on the following anatomic c ndi i n a e and a ie a ence an e acen a fi a and a ac en e c i e to a p eritoneal surface early enough in gestation to e i ina e e i e i d ec nda i an a i n W e rep ort a case of a secondary abdominal p regnancy following rup ture of rudimentary horn who p resented in e ec nd i e e CASE REPORT

*Assistant Professor †Associate Professor and Head Dept. of Obstetrics and Gynecology GMH and Associated SSMC, Rewa, Madhya Pradesh Address for correspondence

Dr Kshama Vishwakarma Assistant Professor Dept. of Obstetrics and Gynecology GMH and Associated SSMC, Rewa, Madhya Pradesh

A - ea d i a a a ad i ed a a Medica e e M e a Mad a ade n in e e enc e a e e ed a i a e ac i i ne e e en ed i c ain n a en ea ain a d en ince da eedin e a in and ea ne ince da and ne ain in e i de da ac e ad i edica e ina i n e nanc M ed

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1041

OBSTETRICS AND GYNECOLOGY a a c ic ec a a ca n a da ac a a i a ea ca e cen e n e a ina i n e ad a e a e ene a c ndi i n i e a e ea in e d e and e a d e e and a ene a i ed ende ne e en n e a d en n e a ina i n e a ee an e e ed ne and ende ne in nice and n ce ica i n ende ne e e a i a ina eedin e e in n ad i i n a and e a a a a e e e e i in n a i i e ca e i e ee e in i in e ine ca i i i na dia n i e ic a i n i e i ni i a ade n i i ic e e i en and a ien a ana ed c n e a i e e a d en and e i a d ne ic e ea ed i a ed e i id and a ee id i in e na e a i n a een in e i nea ca i and e i a n a end e ia ic ne en a e an i i ic c e a e e e a n a ic i e en e deci i n a a en a a nde ina ane e ia a a a e ed and ie e e i ne a nd d ed di en a n e a nd n e ide ad acen a i e c d a ac ed i e ed di en a n a e ci ed e a de ia ed i i n a i a and i a ian e e a a n a e a ian e a ea and a ac ed di en a n e i

a a e ed i c c e e ed and i ica c d a een in ad c nd i i a eac in e e en e

Figure 1. On a a

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d ed di en a nd i e acen a and c d a ac ed

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

an e e c n e ad acen a ea e e c eaned ic ead i a i e e e e edded in e e en e e a e ed e a i ac ie ed e i nea ca i a a ed i n a a ine a ien ecei ed ni d in a e a i e e e i d a ne en and e a di c a ed n da DISCUSSION U nicornuate uterus results from the failure in the de e en ne e a a e ne ic d c ei e a ia c e e a ia de e en ne e d c i e i e a di en a e ine n e e i ed c a ifica i n M e ian an a ie i en e ican cie e d c i e Medicine nic n a e e i a e c a ifica i n i ni a e a a ia a ene i can e e c a ified in c nica in n nc nica in n ca i and n n Pregnancy in a noncommunicating rudimentary horn occurs through the transp eritoneal migration of the e a a e e i i ed a e idenced e e a ence a c e n e ide contralateral to the rudimentary horn containing the e ca e e e nanc in e nanc n e di en a n ead n ane a i n ee a in a e ine e ic i n e a de i e e d eaded c ica i n i e a i e in a e i nea e a e d e e e n ic can e i e ea enin e e ae e i e e ed in a d en and e ain a ac ed e n and e c n in e i e and ic i e e ed a ec nda a d ina e nanc The usual outcome of the rudimentary horn p regnancy i e in e ec nd i e e in a e ca e i e a de i e ic can e ca a ic n i e a ec ic e nanc eedin i e e e e in e e di en a n e e ine a i c ic e and e a c a e e ine e a cia ed i di en a n a fi e ed in Ma icea e i in e a ie ee de endin n e n c a e and i a i i e and di a e Ma e na ai d e e a e e n ca e 1 0 Few cases a e na dea a een e ed ince of p regnancies with late or false diagnosis p rogressing i d i e e e in in i e i a e een 1 1 n e e ne na a i a ii a e ed 1 1 Patient with abdominal p regnancy typ ically n e en i c n an a d ina ain e i e ane ia and dden ea e en

OBSTETRICS AND GYNECOLOGY

e c n e ence e can ca e i nifican a i and idi ea dia n i i e en ia ana e en e e e e e dia n i di en a n e nanc i c a en in an a nd i d ne in e fi i e e i a i inde ici n en ne d e a e a e a dia n i e nanc in e di en a n a nd e a ina i n i e a dia n ic ced e c ice e findin a e ei e e i na e e a e de enden n e e a ine e e ience and e ai e a nd an a ina a nd i e i an a d ina a nd in e e a a i n ec ic e nanc ince i a a e e ie e adne a and e ine ca i a i e a a e ed a e c i e ia dia n in e nanc in e di en a n e d a e n a e ica ic n a e e a en i a c n in i i e i e ndin e e a i n ac and e e ine ce i and e ence e ia i e ndin e e a i na ac e en i i i a nd i n and en i i i dec ea e a e e nanc ad ance 1 4 n c ca e a ne ic e nance i a in M i e e n n in c nfi in e dia n i i a e an e e 15 a e nanc c n a e nanc and abdominal p regnancy are common sonograp hic and c inica i dia n i i e di c e a i dia n i in ec nd i e e d e ac defini i e c inica c i e ia

e en i e ea enin c ica i n e ecen trend is to do lap aroscop ic ex cision of the rudimentary horn; lap arotomy is still an op tion when the p atient has de e ed a ndan e e i ne i in c REFERENCES

The traditional and established treatment for di en a n e nanc i ica e a e e nan n e en in n ed ca e e en e and ec en di en a n e nanc n i ca e a a a e ed and e ci i n e di en a n a d ne cce L ap aroscop ic ex cision of the rudimentary horn e nanc i e a een d ne cce 1 6 ince a decade R enal anomalies are found in ca e ence i i anda a e ena an a ie can CONCLUSION di en a n e nanc i a a e c ica i n ic ca ie a e i e e M e an e ca e e en in ec nd i e e i intrap eritoneal hemorrhage due to rup ture of the n ia n i i e d e e c nce n in early p regnancy with either ultrasound or MR I to

eic c

an a e M in n e nanc e in nic n a e e i a e ie e i e i

ea e nec

di en a

i di an d M a i en a e nanc a di Med

e nanc

i a

d i M ai i M a e ied ic e en c i d a ca e e e ic in a a d ina and in a e ine e nanc ca ied e e d

ina

e nanc

ician

n an e d ina e nanc a ca e e and i e a e e ie in a e Med

Maa a e ia n i and ea e a e ine e nanc Med

en ad anced

e nanc

ddi e

d nec

i a e i nea

Ma icea ai e de a adie de e e ai ne de i a ie a i ance

cen Med

di en a e ine n e nanc d ide e e ience ca e e

in i di en a

an a in e nanc a ca e e

a e i e i in a n n c n e nanc e

e d

nica in naec e

ec nda in a a d

ina

a i an e a i M ad a i M di en a n e nanc fi i e e e e n a ic dia n i and c nfi a i n a ne ic e nance i a in a nd Med

a a in e ane a e i e e p resentation and early diagnosis of the rudimentary e ine n e nec

a n a di en a e ine n e nanc dia n ed i a ne ic e nance i a in e nec

a a a M ai ad d a a a c ic e ec i n n ed di en a n e nanc n e d n ace e nec

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

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OBSTETRICS AND GYNECOLOGY

Evaluation of Risk Factors and Prevalence of Gestational Diabetes Mellitus in a Tertiary Care Center: An Observational Study PARMJIT KAUR*, RUBY BHATIA†, NIDHI KAILEY‡, HIMANI KUNDOO#, AMAN DEV¥

ABSTRACT Objective: e a a e e e a ence and a cia ed i ac e a i na dia e e e i M in e nan en e in ne e c e c a en e e i an d c e a ee e e nanc Material and methods: e e en d a d ne in e e e ic and nec e n en Medica e e a ia a n a e a e i d n an a ne n an ena a en i ee e e nanc M a dia n ed i c e a i ac i an e e e a a ed Results: e a ence M a e ed e in d Ma i e a ien e e a a ea i e cen a ien i M e e ea a e a e en i M e e e e a ien ad a cia ed e ec a ia i e ad i e i ad e e e nanc c e ad a i i dia e e e i Conclusion: e e a ence M a e ed e d anced a e na a e and e i a e inde enden i ac M e e i inc ea ed incidence e ec a ia in en i M

Keywords: e a i na dia e e e i

c e c a en e e

e a i na dia e e e i M i ne e c n c ica i n e nanc 1 M a ca d a e in e ance a ia e e e i i n e fi dia n ed d in e nanc is an imp ortant p ublic health p roblem in S outh- East ian c n ie ican e ican ian and i anic en a e a a i e i e a i na dia e e c a ed i e en e e a ence M in ndia a ie in a a i n in an a ea M i a cia ed i ad e e a e na

*Professor †Associate Professor Dept. of Obstetrics and Gynecology Govt. Medical College and Rajindra Hospital, Patiala, Punjab ‡Assistant Professor Dept. of Medicine, Himalayan Institute Hospital Trust, Jolly Grant, Dehradun, Uttarakhand #Postgraduate Student Dept. of Obstetrics and Gynecology ¥Postgraduate Student Dept. of Preventive and Social Medicine Govt. Medical College and Rajindra Hospital, Patiala, Punjab Address for correspondence

Dr Parmjit Kaur Professor Dept. of Obstetrics and Gynecology Govt. Medical College and Rajindra Hospital, Patiala, Punjab E-mail: dr.parmjit.obg@gmail.com

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e i

ad anced a e na a e i ac

e ec a

and e a c e inc din e ec a ia inc ea ed ce a ean ec i n a e e ina a ai d inc ea e i de ec ac ia ee d inc ea e de d cia e a ic c ica i n in ne na e and idi a cia ed i e en c i d d e i e ec ence i i e e nancie 4 and i de e in e is as high as 68% 5 The diagnosis of dia e e a ea M i an e ce en ind ni e en e de e en e dia e e e a i na a i ea e e ed inc ea in e a ence e ei en a ed ea an in in an a ea in a a ea a c a ed in The increasing incidence of gestational diabetes during the p ast 15 years is reminiscent of similar statistics for e i Ma e na e i i an i an c n ndin ac in e dia n i e a i na dia e e 6 The inc ea in incidence M a a e i factors is because of rise in maternal age and maternal d a inde M 7 MATERIAL AND METHODS e and

e en nec

d a d ne in e e e n en Medica

e ic e e a ia a

OBSTETRICS AND GYNECOLOGY n a e a e i d n an a ne a e nan en a ee e nanc e n e i n n a e dia e e e e ec ed ne e c e c a en e e i an d c e i e ec i e a in a and i e da M a dia n ed i en c e a a e ea ed ee a in a ca e e e M i ac c a ad anced a e na a e e i e ec a ia e i ad e e e a c e M in e i e nanc a i i dia e e and e i an e e e a a ed

Table 2. Demographic Profile of Pregnant Women with GDM (Total-15)

RESULTS

Gravida

a e nan en a ee e nanc e e e a en d a a ien e e nd a e en d c e e e n e in ne e i c e a e a e e e a ence M a in d a e de ic de a ic fi e M a ien ca e i M e e ed i i a n e a ien e e a ac nd ine a ien i M e e in a e ea and a e a e e a ien i M e e e ei a ien e e e e a e e d ea ani a i n c a ifica i n M ian a i n a e a ien ad a cia i n i e ec a ia ad i e i ad e e c e a a i n ac ia i i e i e e en ce a ean ec i n a e M e an ne ad e e c e a e ed in a e e nanc a ien e e n ea en idi e e a a i i dia e e in a ien a e Ma i a ien i M ac ie ed ce ic c n die difica i n and in in a e a ien ad di e en indica i n a e i n ad e e e a c e an ena a en a ee e nanc n e i n n a e dia e e e e ec ed in e e e in Table 1. Distribution of Patients in Relation to GCT with 75 g Glucose (Total-84) Venous blood glucose levels at 2 hours

No. of patients

Percentage (%)

<100 mg%

40.76

100-139 mg%

51.086

≥140 mg%

8.152

No. of patients

Percentage (%)

16-20

21-25

26-30

31-35

46.67

36-40

13.33

Age in years

>40

Booked

Unbooked

G3 and above

Rural

Urban

Educated

Uneducated

Residence

Literacy

Socioeconomic status Lower

Upper lower

Lower middle

53.33

Upper middle

26.67

Upper

Table 3. Distribution of Patients with GDM as per BMI (WHO Criteria for Asian Population) (Total-15) BMI (kg/m2)

No. of patients Percentage (%)

<18.5 (underweight)

18.5-22.9 (normal)

≥23.0 (overweight)

100

23.0-27.4 (preobese)

26.67

27.5-32.4 (obese Class I)

26.67

32.5-37.4 (obese Class II)

33.33

≥37.5 (obese Class III)

13.33

in a c e i e and ea in a a c as recommended by national and ana e en M e e e i

ec i e a in a e a e in e i n guidelines for diagnosis en d c e e i e M

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1045

OBSTETRICS AND GYNECOLOGY Table 4. Association of GDM with Risk Factors (Total-15) Risk factors

No. of patients

Percentage (%)

Advanced maternal age

Obesity

73.33

Gestational hypertension

Nonsevere pre-eclampsia

Severe pre-eclampsia

13.33

Thyroid dysfunction

13.33

Previous adverse pregnancy outcome

26.67

Ist trimester loss

Macrosomia

Stillbirth

Previous LSCS

Family history of diabetes mellitus

13.33

Previous history of GDM

Hypertension in pregnancy

Table 5. Management of GDM (Total-15) No. of patients

Percentage (%)

Diet + lifestyle modification

Glycemic control

Diet + insulin

Diet + oral hypoglycemics

No. of patients

Percentage (%)

Vaginal delivery

46.67

Cesarean section

53.33

CPD

13.33

Previous LSCS

Breech presentation

6.67

Major degree placenta previa

6.67

Severe pre-eclampsia

6.67

Table 6. Mode of Delivery (Total-15) Mode of delivery

Table 7. Comparative Evaluation of Risk Factors for GDM Risk factor

Australian Diabetes in Pregnancy Society

American Diabetes Association

Our study

Age

Yes (>30 years)

Yes (>25 years)

Yes (>30 years)

Obesity

Yes (not defined)

Yes (BMI >27 kg/m2)

Yes

Family history of diabetes mellitus

Yes

Yes (first-degree relative)

Previous GDM

Yes

Not mentioned

High Risk Ethnic Group

Yes

Previous adverse pregnancy outcome

Yes

Not mentioned

Yes

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

OBSTETRICS AND GYNECOLOGY DISCUSSION GDM is one of the most common medical comp lication in e nanc 1 e e a ence a e study is comp arable to the one estimated by Ministry ea and a i e a e ndia in ndia in an and in a ai n e incidence i e ec ed inc ea e i e ne in e e e nan en i i e a e M 8 The e a ence M in e ni ed a e i i a an e de endin n a ien de a ic fi e and dia n ic e d 7 S ix ty p ercent of a ien in d e e ea a e and a e indica in ad anced a e na a e e an inde enden i ac M a ien i M e e e ei i ein e e e e a ac inc ea e a an i de e in M inc din e i inc ea ed a e na a e i M a i history of diabetes and belonging to ethnic group a a inc ea ed i de e in e dia e e 7 Four p atients in our study group had e i e i ad e e e a c e i e a ien ad a i i dia e e e i ac a cia ed i i de e in M inc de a e n e n a i an ea i e ace M history of diabetes and no history of glucose intolerance ad e e e nanc c e e a ed M 7 None e a ien a dia n ed i M in e i p regnancy may be due to smaller number of p atients a a and a e in d en i M a e a a inc ea ed i de e in e dia e e e i a i ae en de e e dia e e e i i in ea de i e 7 Ma i i ac i ed a ian ia e e in Pregnancy S ociety and American Diabetes Association 1 0 a e c a a e i d n d M a ien ad a cia ed e ec a ia n n e e e e e e c eenin and ea en M can i nifican ed ce i e ec a ia e a ac ia and de d cia 7 n e na i na cia i n ia e e and e nanc d and e in e na i na a cia i n ec end ni e a c eenin a ee e a i n in e nan en n e i n n a e dia e e in a c e e ance e n ne i i e e i an ade a e M dia n ic e a i na n i e ea c i e ia Consensus conference did not recommend adop tion d ec enda i n e e e American College of Obstetrics and Gynecology c n in e ec end c eenin all p regnant women with a p atient history or the a c e c a en e e Ma i M a ien e e ana ed i die i e e

difica i n a n i ad e e e a c e

i d e in

i n

CONCLUSION ni e a c eenin a ee e nanc n e i n n a e dia e e i ne e ide ine i ec ended dia n in M d anced a e na a e and e i a e inde enden i ac M e ec a ia e i ad e e e nanc c e and a i i dia e e a e a cia ed i ac e e M i e dia n ed nde dia n ed e in of screening and diagnosis is to decrease p erinatal and e ic idi REFERENCES

i ee n ac ice e in e ic ac ice e in e a i na dia e e e i e nec

e a a nc ea in e a ence e a i na dia e e e i a ic ea e ec i e ia e e a e

a ec e a e n en ndia i e e ence ea and a i e a e e a en e e n

n i e i e ec ence e a i na dia e e e i i ac e ina

ee e a e c

i c c ein a e e e e M i na dia e e e i c inica edic and n i de e in e dia e e a e ec i e d in i a ana i ia e e a e

i ia

a a iden ifica i n

e ic

th edi

i n

National guidelines for diagnosis and management of e a i na dia e e e i Ma e na ea i i i n Mini ea and a i e a e e n en ndia

an an i n a i n e a i na dia e e e i ana e en ide ine e a a ian ia e e in e nanc cie Med

e ican ia e e cia i n anda d edica ca e in dia e e ia e e a e

International Association of Diabetes and Pregnancy d n en ane Me e a e e n c anan a a an a e a International Association of Diabetes and Pregnancy study group s recommendations on the diagnosis and c a ifica i n e ce ia in e nanc ia e e a e

and en d n e and M an i e M Me ce M e a c n en de e en c n e ence dia n in e a i na dia e e e i n en a e ci a e en

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1047

ONCOLOGY

A Simple Inexpensive Surface Applicator for High Dose Rate Intraluminal Brachytherapy of Anal Cancer MEENA J SHAH*, RAKESH K VYASâ&#x20AC;

ABSTRACT e a e ed i d e a a e e ea i i i and a e i d e a e in a ina ac ea ace a ica de i ned in ana cance and de e ine e e a an ad an a e in e i e e n e a e and inc e e e a i n i a e e e i ina c inica e e ience i ca cin a ana cana ea ed in i ace a ica e e ac ie ed e e a e c a a e de i e ed i c n en i na ed in e i ia i an i a ica i n d e n e i e ane e ia an e a ed i e e ience e a in a ace a ica a ea e a a i ac defini i e ec ed a ien i e e ficia and a a e e na ea adia i n e a in ana cance

Keywords: na cance in a

ina

adi

e c a en e ea in ana cance i e e e e ana inc e nc i n i e i in i doses to the tumor and sp aring the organ at i adi e a c ined i c e ea has an imp ortant role in the treatment of anal cancer a ien n e e na ea adi e a is an established method for p rimary treatment of anal cance ac e a i a an a ed e d ana cance i d e a e ac e a can 1 a defini i e ea e ed a a a e en in e ec ed ca e in e i ia and in a ina ec ni e a e een ed e c ina i n and ac e a a e c inician de i e i e doses to the tumor and to reduce dose to the normal i e e en in ca c n and ed c i n in ici e e e ec e i e a in e i ia brachytherap y is p referred but imp lantation has to be d ne nde ane e ia and a c n an e e ana e ia i e ain ained c a e ea en a ien a e e i ed e i a i ed da Main

*Associate Professor Government Medical College and New Civil Hospital, Surat, Gujarat â&#x20AC; Incharge Director Gujarat Cancer and Research Institute, Ahmedabad, Gujarat Address for correspondence

Dr Meena J Shah 206, Tulsishyam Apartment,Opp. Ratnadeep Society Behind Police Tenament, Bhatar-Althan Road, Surat - 395 017, Gujarat E-mail: drmeena.maheshwari@gmail.com

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

in a ac ie in a ien e ea en and i e e ea en in e ana e en

i i a i n in a ina ec ni e i e e ance n a ana c a ic ecei e a c i e d e an e e en i n in e a n i d e e e i ina e e ience in a ina ac e a in e ana cance in ace a ica de i ned i a i e and ine en i e a ica i ne de i ned a e adin ace a ica a a ide an e adj ustments of dose distribution MATERIAL AND METHODS e ini ia ed a c inica d in a e adi e a Dep artment of our institute for anal cancers by using ace d a ica de i ned a eligible p atients of anal carcinoma referred to our de a en e e ea ed i i ec ni e a ien e e e ec ed en e e e in e i i i i c i e ia i ica en ana an ec a a ce ca cin a di a a in ca ed i in c e ana e e n end c a i n i dina en n e an c ic ne n e an n e an a e ci c e ence in e en a e n e a i e nc e ance a and n a e a ica a a e e i a ien ecei ed a c e c e e a i adi e a e c e ea c e a i en da i in ec i n i cin n a and in ec i n aci dai a

Every citizen of India should have the right to accessible, affordable, quality and safe heart care irrespective of his/her economical background

Sameer Malik Heart Care Foundation Fund An Initiative of Heart Care Foundation of India

E-219, Greater Kailash, Part I, New Delhi - 110048 E-mail: heartcarefoundationfund@gmail.com Helpline Number: +91 - 9958771177

“No one should die of heart disease just because he/she cannot afford it” About Sameer Malik Heart Care Foundation Fund

Who is Eligible?

“Sameer Malik Heart Care Foundation Fund” it is an initiative of the Heart Care Foundation of India created with an objective to cater to the heart care needs of people.

Objectives Assist heart patients belonging to economically weaker sections of the society in getting affordable and quality treatment. Raise awareness about the fundamental right of individuals to medical treatment irrespective of their religion or economical background. Sensitize the central and state government about the need for a National Cardiovascular Disease Control Program. Encourage and involve key stakeholders such as other NGOs, private institutions and individual to help reduce the number of deaths due to heart disease in the country. To promote heart care research in India.

All heart patients who need pacemakers, valve replacement, bypass surgery, surgery for congenital heart diseases, etc. are eligible to apply for assistance from the Fund. The Application form can be downloaded from the website of the Fund. http://heartcarefoundationfund.heartcarefoundation. org an s mitte in the C n office.

Important Notes The patient must be a citizen of India with valid Voter ID Card/ Aadhaar Card/Driving License. The patient must be needy and underprivileged, to be assessed by Fund Committee. The HCFI Fund reserves the right to accept/reject any application for financial assistance itho t assigning an reasons thereof. The review of applications may take 4-6 weeks. All applications are judged on merit by a Medical Advisory Board who meet every Tuesday and decide on the acceptance/rejection of applications. The HCFI Fund is not responsible for failure of treatment/death of patient during or after the treatment has been rendered to the patient at designated hospitals.

To promote and train hands-only CPR.

Activities of the Fund Financial Assistance

The HCFI n reser es the right to a ise irect the eneficiar to the designated hospital for the treatment.

Financial assistance is given to eligible non emergent heart patients. Apart from its own resources, the fund raises money through donations, aid from individuals, organizations, professional bodies, associations and other philanthropic organizations, etc.

he financial assistance grante treating hospital/medical center.

After the sanction of grant, the fund members facilitate the patient in getting his/her heart intervention done at state of art heart hospitals in Delhi NCR like Medanta – The Medicity, National Heart Institute, All India Institute of Medical Sciences (AIIMS), RML Hospital, GB Pant Hospital, Jaipur Golden Hospital, etc. The money is transferred directly to the concerned hospital where surgery is to be done.

Drug Subsidy

ill

e gi en

irectl to the

The HCFI Fund has the right to print/publish/webcast/web post details of the patient including photos, and other details. (Under taking needs to be given to the HCFI Fund to publish the medical etails so that more people can e enefitte . The HCFI Fund does not provide assistance for any emergent heart interventions.

Check List of Documents to be Submitted with Application Form Passport size photo of the patient and the family A copy of medical records Identity proof with proof of residence Income proof (preferably given by SDM)

The HCFI Fund has tied up with Helpline Pharmacy in Delhi to facilitate

BPL Card (If Card holder)

patients with medicines at highly discounted rates (up to 50%) post surgery.

etails of financial assistance ta en applie from other so rces rime Minister’s Relief Fund, National Illness Assistance Fund Ministry of Health Govt of India, Rotary Relief Fund, Delhi Arogya Kosh, Delhi Arogya Nidhi), etc., if anyone.

The HCFI Fund has also tied up for providing up to 50% discount on imaging (CT, MR, CT angiography, etc.)

Free Diagnostic Facility

Free Education and Employment Facility

The Fund has installed the latest State-of-the-Art 3 D Color Doppler EPIQ 7C Philips at E – 219, Greater Kailash, Part 1, New Delhi.

HCFI has tied up with a leading educational institution and an export house in Delhi NCR to adopt and to provide free education and employment opportunities to needy heart patients post surgery. Girls and women will be preferred.

This machine is used to screen children and adult patients for any heart disease.

Laboratory Subsidy HCFI has also tied up with leading laboratories in Delhi to give up to 50% discounts on all pathological lab tests.

About Heart Care Foundation of India

Help Us to Save Lives The Foundation seeks support, donations and contributions from individuals, organizations and establishments both private and governmental in its endeavor to reduce the number of deaths due to heart disease in the country. All donations made towards the Heart Care Foundation Fund are exempted from tax under Section 80 G of the IT Act (1961) within India. The Fund is also eligible for overseas donations under FCRA Registration (Reg. No 231650979). The objectives and activities of the trust are charitable within the meaning of 2 (15) of the IT Act 1961.

Heart Care Foundation of India was founded in 1986 as a National Charitable Trust with the basic objective of creating awareness about all aspects of health for people from all walks of life incorporating all pathies using low-cost infotainment modules under one roof. HCFI is the only NGO in the country on whose community-based health awareness events, the Government of India has released two commemorative national stamps (Rs 1 in 1991 on Run For The Heart and Rs 6.50 in 1993 on Heart Care Festival- First Perfect Health Mela). In February 2012, Government of Rajasthan also released one Cancellation stamp for organizing the first mega health camp at Ajmer.

Objectives Preventive Health Care Education Perfect Health Mela Providing Financial Support for Heart Care Interventions Reversal of Sudden Cardiac Death Through CPR-10 Training Workshops Research in Heart Care

Donate Now... Heart Care Foundation Blood Donation Camps The Heart Care Foundation organizes regular blood donation camps. The blood collected is used for patients undergoing heart surgeries in various institutions across Delhi.

Committee Members

Chief Patron

President

Raghu Kataria

Dr KK Aggarwal

Entrepreneur

Padma Shri, Dr BC Roy National & DST National Science Communication Awardee

Governing Council Members Sumi Malik Vivek Kumar Karna Chopra Dr Veena Aggarwal Veena Jaju Naina Aggarwal Nilesh Aggarwal H M Bangur

Advisors Mukul Rohtagi Ashok Chakradhar

Executive Council Members Deep Malik Geeta Anand Dr Uday Kakroo Harish Malik Aarti Upadhyay Raj Kumar Daga Shalin Kataria Anisha Kataria Vishnu Sureka

This Fund is dedicated to the memory of Sameer Malik who was an unfortunate victim of sudden cardiac death at a young age.

Rishab Soni

HCFI has associated with Shree Cement Ltd. for newspaper and outdoor publicity campaign HCFI also provides Free ambulance services for adopted heart patients HCFI has also tied up with Manav Ashray to provide free/highly subsidized accommodation to heart patients & their families visiting Delhi for treatment.

http://heartcarefoundationfund.heartcarefoundation.org

SANGHI MEDICAL CENTRE (P) Ltd. World Class Diagnostic Center

Patient Services Offered

Fully Computerized Automated Laboratory

Radiology & Imaging Facilities

Other Facilities

PFT (Pulmonary Function Test)

Corporate Office ADDRESS Sanghi Medical Centre Pvt. Ltd. S-51, Greater Kailash – I, New Delhi – 110048 Tel.: +91 11 29232010, +91 11 29234400

Audiometry

Cardiology Facilities Laboratory

ONCOLOGY e na adi e a a a ed n a id e ic d e c a de i e ed in ac i n in ee a a e ed a of 6 p atients showed p artial resp onse to the treatment e an e e i n in i e e e i n i e a ien ac ie ed c e e e n e n a a e e i n a ien e e ca ed ac e a ea en a e e ee e ac ea a c e c i ed a c e ace ice a da da a ac i n c e e de i e ed e i a en c ac e a ne a e een ac i n a e ec nd c e c e e a a e ea ed a e c e i n adi e a and ac ea a ien i ea i a n e an c in i e e e ea ed i adi e a a ne e e na adi e a ed ac ea a ien a in e ficia e i n ecei ed ac ea e e c i ed d e a c ice a da da e i a en ac e a in a ien ea ed i ac e a a ne

Applicator The ap p licator was fabricated from clear cast acrylic c ind ica d c en and c in dia e e Its central p ortion was drilled and metallic rod was fi ed in i a c e ec ani ac a a and e i e e e e d i ed n e ace e a ica along its length in such a manner that the distance e een eac a a e e a c e e were wide enough to accommodate steel needles of dia e e e need e e e ided in e i ia ea en n Mic e ec n ac e a ni c e n nc and e need e c d e inserted only through the lower end; the up p er ends of e e e e ind eed e nce in e e d n c e n e ed e e ide S chematic diagram of surface ap p licator is shown in i e Lateral view 100 mm 6 mm

Acrylic cylinder

Steel needles

Holding rod

Cross-sectional view Grooves 2 mm x 5 Nos.

Figure 1. c e a ic dia a e

ace a

ica

Treatment Technique The p atients were treated in lithotomy p osition with e e n ide e e ec a e a ina i n a ca ied a e ac ca i a i n e a e a ea in c e adi e a a e accurate clinical descrip tion with a drawing was a nece a e e ac i e e e i n an e i e i a e a and e en e ea ed e e a ce ained ac need e a ed in ide e e up to the blind end and was secured in p osition by a c in ec ani e ea en en a a ed n e a ica ace and i a d e a e e e ana ifice e a ica a a ed in a c nd e e in e i n e a ed ace e a ica a e ica ed i ane e ic e a e a a a e in e ana cana a in e ed a e e di a a i n e ana cana fin e in ane e ic e e e fi in e a ica i i n e e a c ec ed a e d ie e ac i e e e i n The handle was clamp ed to the selectron treatment a e a e e a en in an e i e i and ae a i i n annin e a e e a a ed n e ia a and ea en annin a ca ied n e a ea en annin e e an a e ified e adia i n nc i e need e en e e c nnec ed e ec i e c anne e Mic e ec n i i nin e a ica a a ain c ec ed e n e e a in ea en and e ea en a de i e ed RESULTS e ac e a ea en a e e a ed Patients were instructed to stay on low residue diet d in ea en e did n ace an e in e en in e i n e a ica a ien e e ca ed a e ee ee e i e ac e eac i n e en e e e ca ed n Median d a i n e a n M c i i de e ed ee a e ac e a a a i a a e ee and ea ed i in ee ca in en and a ana e ic e e i en e e ade c i i and eedin e ec e e een in n in a ien and e e e ana ed n e a ien a ica i n ca ane e ic e and e a a i e d e a ed i e e ea ed n ec i e c ain ec a di c ene enc i a di ea e a nde c n in a e e a ien i e a

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1053

ONCOLOGY DISCUSSION in a ina in aca i a ac ea i e n n ea en da i nec ic a ea na i ia ac and na a n ea c ic ace a ica a e een a i nancie c n c ed e in ca cin a a ina n e i ia in a ina in a e a i e ac ea a e ed in e ea en ana and ec a cance ana cance ac e a can e ed a a a e e e na ea adi e a 1 a defini i e ea en in e ec ed ca e n e i ia i an i i the p referred treatment for brachytherap y in the anal cance eca e e e d e di i i n in and a nd e a e

ea a in in e i ia ac ea a a ine ec ni e e ca c n a e e een and ca e i e e e nec i a e e i in c n e ceedin d e i ad an a e a id a adia i n d e a e de i e a i d e i e a in normal structures such as normal anorectal mucosa and a e ddi i na a ed ce e a adia i n ea en i e and e ai in e i d adia i n e ecia in adia i n cen e Pap illon et al a e i en end ca i a adi e a in the case of cancer of the rectum and anorectum in c n ac e a ni e i ed e e e e enc a in i c e e c inica e n e e ed in a i e ca e i i a can e e e e ed c i d e a 1 0 e a a e e a i e a ac e ec a e n e ec a e ca ad anced ec a cance in e a e and ec en di ea e a ia i e e ie ec en in e a e ec a cance a een ed d ide 1 4 - 1 6 e in e i a ed e c n c i n and e an ac ic multichannel cylindrical surface ap p licator with a cen a d and i e e a c anne aced a n i e i e n i an a ec de i nin i ap p licator for radiation treatment was the ability to ini i e d e e n nin ed a e ana a and a id in e i ia i an e ea en a e e a ed e ac ie ed a i i a i d e i a tumor by using the surface ap p licator as in interstitial i an and e ed e e i n e i a tumor in all cases treated by the combined ap p roach or adi e a a ne eca e e a i i e ana cana c a i ee a ia e de i e ac i n e aced a ea a a

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

n defini e c inica e a e a ai a e a e ac ea ace a ica e nd i e a i ac in ea e i n ic a e e ficia or ex op hytic and that resp ond well to chemotherap y and adi e a e a ica ade i e i e and ine en i e e e i n need ec e p atient to anesthesia and for p arenteral administration ana e ic ic a e e i ed in a e a ien nde in e ic in e i ia ac e a ea en can e de i e ed a an a ien CONCLUSION efini i e c ined adi c e e a i e c en anda d nc i n e e a i n ea en ana cance e i e i i e ac e a i a ac e a in e in e i ia ac ea e e ience i in ace a ica i n cien a i e an ec enda i n e ec ed a ien i e e ficia a e ea ed i ac ea a in e an in a ina a ac i c n enien has satisfactory resp onse rates and can be safely used a a e e d in c e adia i n ne can ea an ecific a ea e anal canal without irradiation of the whole lumen with i i e and ine en i e ace a ica REFERENCES

e e nne ei e M de an ann ie ni inica c e a e ea en i a ac ea e e e na ea ana ca cin a ac ea

a e e a ac ice a e n among member in e n

e ne a i i danec M a M e a n a ina ac e a in e ana e en a ca cin a e e a i a

a dai a ac i ana a a a i a ai n n e e a i n a ien i roentgenograp hically occult lung cancer treated with ex ternal irradiation and intraluminal irradiation using d e a e i idi n in nc

i nec adi group s nec

a na a eed i na a ic ance n e e a in end e ia cance of the gynecologic cancer ance

e da e en e Ma i a a na i ian e e a ac e a in i ia ac e n adia nc i

cci e ca cin

Macc ia adia i n and a n e

ed M a a a a e e M in e a ac e a i a and ec en na a n ea ca cin a ea e e ience a

ONCOLOGY

d i n e ad e nine i an a e i e ine en i e a ica i adia i n ca i ed a ea e a ina i in aca i a ac e a n adia nc i

n e i ea Mic e M a a en de e a n a e e a i e end ec a ca ad anced ec a ac e a ea en cance ea e a a e d i n ec di c i n

n e ic d a i d e a e end ec a ac e a a a ne ad an ea en a ien i e ec a e ec a cance in nc adi

n eac Me

ia n adia

nc i

e acc ia a i i e e d e a in c d in aca i a ea en nec ica cance n adia nc i

a i n e a d nd ca i a i adia i n in c n e a i e ea en aden ca cin a e ec d

a M nd c ic cance ac

ec a

e a a ida an M an i dose rate intraluminal brachytherap y in combination with e e na ea adi e a a ia i e ea en cance ec ician a

a i n a nda en a and c inica die e e a i e adi e a i i d e a e in a ina ac e a i n a a en a ai a i ■■■■

in de an a M ne an nne ne i d e a e a e adin in a ina ac e a ad anced in e a e ec a ca cin a adi e nc

c i d Ma en n nde n nd ca i a adi e a ec a cance n adia nc i

e ee a e M an ac ea c i e c ea

Pioglitazone Linked with Bladder Cancer i i a ne i a cia ed i a i e i adde cance an e dia e e d e ed a a e p op ulation- based cohort study p ublished in The BMJ ead a Ma c cc i a e e i ene a i a in M n ea anada and c ea e ana ed nea a ien in e ad ecen a ed a in an an idia e ic d e n i i a ne aced an inc ea ed i adde cance e e n ea a n e n e dia e e d i a ien ecei in i i a ne e e dia n ed i cance a e a ean ea e n i i a ne didn ee an inc ea ed i adde cance

Acupuncture Helps with Hot Flashes in Breast Cancer en i ea cance can ana e a e e e ec i e and i e ei add ac nc e an en anced e ca e e i en e ed a and i ed c n e e ea ed a a anda di ed ac nc e c en anced e ca e a c e e en anced e ca e a ne e e e ec e e een a e end a and n i i and e e n a cia ed i an i nifican ad e p ublished in the Journal of Clinical Oncology

ai i e en e ed icen e ia e d ced i nifican e e ee ea en and e e ec e findin a e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1055

OPHTHALMOLOGY

Wooden Sticks as Object of Ocular Injury: Anti-infective Profile MEHUL SHAH*, SHREYA SHAH*, PRAMOD UPADHYAY*

ABSTRACT Background: c a e e incidence in ec i n and da a e d ne den ic i a ca ed e ec and e a a e ec ca in c a in Methods: Setting: e ia ca e i a in a a a en a e e n ndia i a a ec i e e a i na c d de i ned in en e in ie in ei e e e a e e dia n ed and ana ed e een an a and ece e e e en ed in d e a ien e e ed acc din in ie ca ed ic e ec a a e e c ec ed in e n e na i na cie c a a a ini ia and and ana ed Outcome measures: ina i a ac i and in ec i n Results: The study comp rised ca e inc din en e ca e den ic e e ne e c n ec ca in e e in in e a e in e in ie ca ed den ic e e n a cia ed i in ec i n and e fina i a c e in ic in ed e e a i nifican e e an a in in ie ca ed e ec Conclusion: ic ca e a i e cen a e e e in ie e incidence in ec i n in ic in ed e e i and e fina i a c e i d

Keywords:

a ic ca a ac

ec ca

in in

rauma is a cause of monocular blindness in the de e ed d a e die a e add e ed a a in a a ea 1 The etiology c a in in a a ea i i e di e a in an a ea and i in e i a i n n a e e en i n e i e n ed e e ca e in ic a ena e e a ia e a e in e ce a d e en in c in ie e e a a ic i and cie ea a a e en ia e en a e den Op en globe inj ury i a cia ed i a eac in e a e e e a which may be associated with entry of organisms into e e e e a i e in i n n ca e in ec i n a ic a n a a e in fina i a c e OBJECTIVES d e

ec ca in e e in

S tudy infection associated with obj ects causing eye in

*Drashti Netralaya, Dahod, Gujarat Address for correspondence

Dr Mehul Shah Drashti Netralaya Near GIDC, Chakalia Road, Dahod - 389 151, Gujarat Email: omtrust@rdiffmail.com

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Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

den ic

e in

a end

Comp are incidence of infection and eye damage ca ed den ic e e ec PATIENTS AND METHODS e ained a a e i a ad ini a and e ea c c i ee c nd c i d and ecei ed e a ici an i en c n en i a a ec i e e a i na c d de i ned in a a ic ca a ac in ei e e e a e e dia n ed and ana ed e een an a and ece e e e en ed in d and a ien c n en in a ici a e and n a in e e i d in ie e e inc ded eac a ien en ed in d e ained a de ai ed i inc din de ai e in and information on eye treatment and surgery p erformed to ana e a c a a a a a e ini ia and follow- up rep orts were collected using the online the i in a e a a e in e format of the International S ociety of Ocular Trauma e ai e e e e a c ec ed in a ecified e e ed n ine The cases of traumatic cataract were group ed as op en c ed e in ie en e in ca e e e inc ded in e d en e in ie e e further categorized into those with lacerations and e a ad ed ace a i n e e e a

OPHTHALMOLOGY i ed in e e i e a in in ie ie in ie in in an in a c a ic inc ded ee anc e fi e d did n inc de an a i ned

Other demograp hic details collected included entry e a ien e idence ac i i a e i e in ec ca in in and e i e a ina i n and ea en e en en a a ien e e e a ined in a anda d e d i a ac i a c ec ed in ne en c a and e an e i e en a e a ined in a i a a ed n en ic a aci e ca a ac e e c a ified in a e an i e and e e e en an a i did n e e c ea en a e e een e ca e and e n c e e ca a ac a defined a a a ca a ac en e ca e and ani ed a e e e ed and ed a e ane a in den i i a defined a a e an ca a ac en e c ica material was found in the anterior chamber together i a ed en ca e e ca a ac a defined a a i e ca a ac en i a e e a e n aci a c a ified a a e e e ca a ac a en a a a ia a e e ei segment ex amination was p erformed with an indirect a c e and a en en e ica edi a n c ea a can a e ed e a a e e e i e en e ica ec ni e was selected according to morp hology and the condition i e e an e en ac e ifica i n a ed e a e n ca a ac i a d a e n c ei i a en a ad ei e a i e e e e ca a ac ni i an a a i a i n a ed Me anec and an e i i ec ei e ia an an e i a ana e e e e ed en e ca a ac a e an n a a ien nde in c nea nd e ai e a a ic ca a ac a ana ed in a ec nd ced e n c i d en n e an ea en ec and i ec ia a a ana e e e e ed and e a e ica ced e e e ed ana e e a a ic ca a ac L ens imp lantation as p art of the p rimary p rocedure a a ided in a c i d en n e an ea All p atients with inj uries and without infection were treated with top ical and systemic corticosteroids and c c e ic e d a i n edica ea en de ended n e de ee in a a i n in e anterior and p osterior segments of the op erated e e e e a ed a ien e e e e a ined a e da and and ee ena e e ac i e c ec i n a c ed ed e

i d da ee ee and e e n ea

e e e a ina i n i a ac i a e ed i ne en c a e an e i e en was ex amined with a slit lamp ; the p osterior segment was e a ined i an indi ec a c e e i i i n e e an a e a e a in en ee e e defined a a in a a i ac ade i i n in e e a ina i n da a e e en e ed n ine in a ecified e e ed a de i ned e ini ia and ic a e ed a Mic ce ead ee e da a e e e i dica a di ed en e c e i n e ed e a i ica ac a e cia cience ana e e da a e ni a ia e a a e ic e d a ed ca c a e e enc e cen a e i n and c nfidence in e a e ed in ina e e i n ana i de e ine e edic e a i e a i ac i i n e de enden a ia e a i i n n ed a e ee a e ca a ac e e inde enden a ia e e e a e ende e idence i e in e a e een in and ca a ac e i a e i ca ec and i ec ced e and e c a in RESULTS Our cohort consisted of 687 p atients with traumatic ca a ac inc din e e i en e c a in ie and e e i c ed e in ie i e a ien inc ded ae and e a e e ean a ien a e a an e ea cc din c a a i n and a i ica e n ne e ana ed de a ic ac ed a i nifican e a i n i i e fina i a ac i e e ac inc ded ende a ien en and ci ec n ic a e e a e ci ec n ic c a and e idence e e a a a ea e ec

Percentage (%)

e e ca e ene a in in ei n d and n ea ed a e ia

100 90 80 70 60 50 40 30 20 10 0

72.2

27.8

Open-globe injuries

Closed-globe injuries

Figure 1. Distribution of p atients with traumatic cataract acc din e in

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1057

OPHTHALMOLOGY ca in e in and e ac i i a e i e e in e e a n i nifican a cia ed i a i ac fina i a ac i e c a ified e in ie acc din ic e e e c n in ca in ec acc n in e e e in ie in d a e and e ac i i ie ein e ed a e i e in a e inc ded ea in ic i e c ec in d Table 1. Objects Causing Eye Injury Object

Frequency

Percentage (%)

Ball

Cattle horn

2.37

Finger

1.0

Firework

1.5

Glass

0.7

Iron wire

6.7

Other

8.4

Sharp

1.2

Stone

13.5

Unknown

7.9

Wooden stick

384

55.9

Total

687

100

in i din ence idin n e e ic e p laying with sharp obj ects and laboring without eye ec i n in a e a a a c n ac i i a e i e in in a ca ed an a a e fina i a c e in ca e in i a den ic a i nifican di e en the outcomes following inj uries caused by other obj ects a e e e a incidence in ec i n a n i a den ic ad a e incidence in ec i n i a n i nifican di e en the infection incidence associated with inj uries caused e ec a e e fina i a c e a i nifican a ec ed in ec i n a e Table 4. Vision Outcome Comparison between Injuries Caused by Wooden Sticks versus Other Objects Vision outcome

Wooden sticks

Other

Total

Uncooperative

<1/60

171

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

145

20/40 to 20/20

144

223

Total

379

297

676

χ2

Table 2. Frequency of Injuries Caused by Wooden Sticks versus Other Objects Object

Frequency

Percentage (%)

Wooden sticks

384

55.9

Other

303

44.1

Total

687

100

Number

Percentage (%)

Fall

1.6

Fighting

0.6

Firecrackers

0.7

Housework

187

27.2

Employment

137

19.9

Other

114

16.6

Walking

2.0

Playing

183

26.6

Traveling on top of a vehicle

4.2

Vehicular accident

0.4

687

100

Total

1058

Table 5. Infection of Injuries Caused by Wooden Sticks versus Other Objects Infection Absent Present Total

Wooden sticks

Other

Total

384

300

684

384

303

687

χ2 test, p = 0.08.

Table 3. Activity at the Time of Eye Injury Activity

test, p = 0.002.

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Table 6. Visual Outcome According to the Absence or Presence of Infection Vision outcome

Infection

Total

Absent

Present

Uncooperative

<1/60

168

171

1/60 to 3/60

20/200 to 20/120

20/80 to 20/60

146

20/40 to 20/20

223

Total

684

687

χ2

test, p = 0.02.

OPHTHALMOLOGY DISCUSSION

CONCLUSION

e died ec e e in and c a ified e in ie a ed n e c i e ia i d c ed n a a i a a i n in ic den ic and n a e c n ec e e in en a e n

i d i i e ca e

ec i e de i n and

den ic e e e c n ec in d a e and a in a d a an ania e ed a a e e ic are not common inj ury- causing obj ects according to the c a a a e i in

e a ca e e e in and e e e e en e a defined e c a ifica i n Man die a e e ed a an ec ca in an en e in a ca e in ec i n n e e en d e a incidence in ec i n a ic i c e an e incidence endop hthalmitis rep orted by V iestenz e a e a e fina i a c e in an en e in ca ed a ic a i nifican e e an a in in ie ca ed e ec e e e a i n ade in i d a an e d n cie a a e can e enefi ed e ea c an i ic ia i e an een in i a ea a een ide e ed a e ca i e ic c n i ed e a ien in e d a e n n e a i in edien e an a i in e a ea e and e ea c an i ic ia a en a ain een c ncen a ed n e an n i and ac e ia a ce The p resence of a nin annin a a id and e id in e an is an indication that the p lants are of p harmacological i ance Much less research has been conducted on antimicrobials i e an ince e ad en an i i ic in e e e an de i a i e a an i ic ia a een i a n ne i en e in e e in in p lant ex tracts for treatment of microbial infections has inc ea ed in e a e a c n en i na an i i ic ec e ine ec i e n e i a i n n an ed in adi i na edicine in a ic i n i ide ne ica an i e ic en needed ed ce e incidence e e in ie ca ed ic e e a e a i ie ide ead ade ence and a e na i e c in e e a e a e e and c n e a en a e ca e ei c i d en

in ie i ini d and

ic ca e a i e cen a e e e e incidence in ec i n in ic in ed e e a and e fina i a c e i d i a c nd c ed in a ecific e a ica a ea e e a n e ene a i a e

REFERENCES

a e i c ein a a M ad an a e e ide i c a a a in a e a a

a a i a e e e e in ie in a an ania

a d a n d i e n a M i a a M i an M e a i in e a ed c a a a a

a M a ande a c a in ie and i a a e e and a e ei ana e en in e i a a ea e e n ndia a i ica c d ae e c in a

e e ide i a ic ide i

Al- Mez aine H S Osman EA an a e Abu El- Asrar AM i ac c e i i e end a ii a e e ai en e in ie a

ade an an M nd a a ni de ea en and i a c e in n n ie ince a i an nn Med

ii e

Y ang CS L u CK L ee FL H su W M L ee Y F L ee S M Treatment and outcome of traumatic endop hthalmitis in en e in i e ained in a c a ei n d a ica

an an M nd a ii a

ian Y ao Y in en e in

a M e in ie

i i a e

Andreoli CM Andreoli MT e Ahuero AE a a Durand ML a e end a i i in a a e e ie en e in ie a e V iestenz A S chrader W e en a nd a i i e en i n ia en ei d

en c inica e

nn Mi e c n a end a ii c e a

ann a a ic K lin Monbl ic i

n and

Gup ta A ini a an Gulnar D an a Ma a a i i ac a a ic end a i i in a ien i i i e in a c a c e a

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1059

OPHTHALMOLOGY

Mic

M ic ec a ic end

d and i a a i i e ina

Chhabra S K unimoto DY K az i L R egillo CD H o AC e n e a nd a i i a e en e in ic i ic ec and ce i i i ie i a e a

Gup ta A ini a an a a ic n a end e nd

K aliap erumal S S aha I a i i a ec i e

Essex R W i Charles PG en end a ii a

d a ic

a an a i a and i a a a M aedia ic en e in ie i a c e and i ac end a i i ndian a

L ieb DF c nn Miller D e e en e in ie i i i e in a c a c e ac in encin fina i a ac i c e a a aci a e M M a a i di i nd a i i a e dead ea n e a ed en e in ie i ac a e ac ic an i i ic and i a c e a

a e M Dannenberg AL ac e ec ne ie c M a ac e i ic and ca e p enetrating eye inj uries rep orted to the National Eye a a e e i ic ea e n M i in a e a

i e a a e

n in

Me e e

ne ed M a M nd a i i in aedia ic ene a in c a in ie in de a ad a Med c c

a e M a ad a i M nd e in ie in

e a ii a

Mene in en

ad Me d M a ad c eenin e ndian edicina an ei an i ic ia e ie n a ac

ad M ance ii

a e a an

e ann ni e i e

i M e e na a

c i e an i n a ce

e an i n a c c e i

Ma n a a id e

nin

nd a

id e

ea n c ie anfie d n i e ia ee a en a a an a ice cac an e a ed ic i a i n a ain in ec i ac e ia ndian na adi i na n ed e ca e n i ic ia e ie annin c e i ■■■■

Some Patients with an Initial Slow Visual Response can Achieve Clinically Meaningful Improvements with Ranibizumab a ie e a e ec i e ana i e ia i ed n ine Ma c in JAMA Ophthalmology ed a c inica eanin ain in e c ec ed i a ac i c d e ac ie ed and ain ained i a n an a needed ani i a ea en e i en ea en i n ni in a e ec i e in ain ainin ea i i n ain and a in de a ed i i n ain enn e a ic n an n and n e and c ea e e a i i n i e en can c n in e in e a ien a e ac a ede a e e and dec ea e a i i e

1060

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

PEDIATRICS

A Randomized Open Label Comparative Clinical Study of a Synbiotic Against a Probiotic in the Treatment of Acute Diarrhea in Children S A AYISHA*, K M SUDHA†

ABSTRACT Objective: e a a e e a e e cac and e a i i a n i ic a ain a i ic in ed cin e e enc and e d a i n ac e dia ea Methods: ne nd ed c i d en a ed n ea i ac e dia ea i i in e a ien de a en Medica a en e n i e i d ea Mad a Medica e e ennai e e ec i ed in e d n ecei ed anda d ea en plus n i ic ifi ac® d ice dai ee n ecei ed anda d e a plus i ic ice dai ee a ien e e a e ed dia ea and de d a i n Results: e e enc dia ea a ed ced n a n a in c a ed i n a n a in n c a in e n a d ced a a i ica i nifican ed c i n in e e enc dia ea i i a e e a a a i ica i nifican ed c i n in e d a i n dia ea n c a in i e ean d a i n dia ea a in c a ed i in e ad e e e en e e i d and n e i ad e e e ec e e e ed Conclusion: It can be concluded from the study a e n i ic i e ec i e in ed cin e e enc and d a i n dia ea and i e e a ed

Keywords:

n i ic

i ic dia

ea c i d en

iarrheal disease is the second most common cause of death in children less than 5 years of 1 ia a e i i n ea defined a a a e ee e i id a e in a da e e en a i nifican ca e c i d d a i and idi a ec in nea i i n c i d en d ide Acute diarrhea refers to diarrhea e an da d a i n in a e i n a c i d and i a d e in ec i e e i e c n a e a ec ed i n ia ea i a a a in e ina in ec i n a can e ca ed a a ie i a ac e ia and a a i ic ani n ec i n i ead c n a ina ed d d in in a e e n e n d e iene Diarrhea a e en ia ca e de d a i n i c i d en

*Assistant Professor Dept. of Pharmacology, Chengalpattu Govt. Medical College, Chengalpattu, Tamil Nadu †Professor Institute of Pharmacology, Madras Medical College, Chennai, Tamil Nadu Address for correspondence

Dr K. M Sudha E-mail: m_sudha69@yahoo.com

e de and i a inc ea ed i a c c a

n c i ed indi id a ein e d a i n d e ea ed id c ica i n i e an da a e

Fluid rep lacement is the cornerstone of therap y for dia ea e a d e e i Mi d de d a i n i ea ed i a e d a i n e a i e e e e de d a i n i ana ed i in a en id Antibiotics and antimotility agents do not seem to be e ec i e in ac e dia ea inc a a d e i e a i n a e d a i n a and aci i a e ic ec e 4 The current guidelines by e e n en ndia ec end ai inc and c n in ed eedin ene den e foods in addition to breastfeeding in the management dia ea 5 i i i e de ia i n in c i i n nc i n e a ic i a a een e ed in ce ain di ea e a e i e a a e and a a ce iac di ea e c n cance e dia e e in a a e di ea e i i a e e nd e in ec i n an i i ic a cia ed dia ea and i ic and n i ic a e een ied in e e c ndi i n 6

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1063

PEDIATRICS i ic a e ic ani ed a e a ea enefi n e ani i ic ac i a e ca ac a e and inc ea e ec e i n in d c i n ca and e ica e d a e c ine fi e ca en e e ide adica i a e e i e ia cin d c i n and en ance in e ina a ie nc i n i ic a ea ed ce e d a i n dia ea 7 Prebiotics rep resent nondigestible food ingredients a en ance i ni e ec i e i a in e and ac i i ne a i i ed n e ac e ia in e c n and i e ea S ynbiotics are p rep arations in which p robiotic ani and e i ic a e c ined e a a ne i ic e a i n i There is a scarcity of studies regarding the use of p robiotics and synbiotics in dia ea e e en d a een nde a en c a e e e cac n i ic i i ic en ad ini e ed a n i anda d e a in ed cin e e enc and d a i n ac e dia ea in c i d en OBJECTIVE e a a e e a e e cac and e a ii synbiotic against a p robiotic in reducing the ep isodes e enc and e d a i n ac e dia ea METHODOLOGY and i ed en a e c a a i e d a c nd c ed a n c i d en a ed n ea i ac e dia ea i i in e a ien de a en Medica a en e n i e i d ea Mad a Medica e e ennai e een and e d d a i n a ee i ee ea en ee e a ien

Study Population ea c i d en a ed n ea i ac e dia ea i i in e a ien de a en Medica a en e n i e i d ea Mad a Medica e e ennai e e c eened ic e e e c ded e d a e ad e e e de d a i n ne nd ed c i d en e e ec i ed in e d a e ainin i en in ed c n en e a en e d a c nd c ed a e ainin e a a n i i na ic i ee e e i i i i c i e ia e e a Inclusion Criteria e e

1064

ende

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

i d en d ai n

i ac e dia

a en i in i e

ea e i en in

ed c n en

Exclusion Criteria i d en i e i en dia i d en i e e e de

dai n

i d en i e e e a n

ii n

i d en a in e i a

e ic in ec i n

ec a ici a ed in an in e i a i na i in da i d c eenin

i d en i n n i ic i ic i d en i c a en n c n en

nic i in

e en i i i

e ic i ne

i e

i en in

i d en e e c eened c e e edica i c inica e a ina i n and a a in e i a i n and e fi ed e inc i n and e c i n c i e ia were enrolled and randomized to either Group A or

Treatment n ecei ed anda d ea en plus ice dai n i ic ifi acÂŽ d ee n e e i en anda d e a plus i ic ice dai ee anda d ea en inc ded and inc a e ne a e dai ee ac

e ifi acÂŽ d

Streptococcus faecalis Clostridium butyricum

i i n

Bacillus mesentericus TO- A - 1 million Lactobacillus sporogenes

i i n

Dosage: Dry syrup made up to 50 mL by adding water; e a en a ice a da Each 5 mL of the p robiotic has Bacillus clausii i i n e ia Dosage: ne ia ice dai ee ac ia c n ain n en e ia e e ied and a en a in a a in e i a i n e e e ed e c i d en a a and a e in c n a e c e c n di e en ia c n aee c n d a d ea e c ea inine e e ec e i e nc i n e e a ic a ace ic an a ina e in

PEDIATRICS

Statistical Analysis Distribution of age was analyzed using analysis of a iance and e di i i n a ana ed i a e e i c e ica in e i a i n e e e ed n a and a e di e ence i in e e e and a e ea en a ana ed in den ai ed t e e ea e di e ence e een e and a ana ed in ne a e di e ence i in e in dia ea a ana ed in den ai ed t e e ea e di e ence e een e and in diarrhea assessment was analyzed using one way i c n ide ed e a i ica i nifican RESULTS c i d en in and in e e in e a e n ea c i d en in and in e e in e a e ea e e a n a i ica i nifican di e ence in a e e een and n a ien e e a e i e in a ien e e a e n i d e e a a a i ica i nifican ed c i n in e e enc dia ea i in e e e enc dia ea a ed ced n a n a in c a ed i n a n a in a e i a e a ie e e e ec i e in ed cin e e enc dia ea n c a in e n i ic i e i ic n a e e a a a i ica i nifican ed c i n in e e enc dia ea i a a e d e e e ec n i ic in ed cin e e enc dia ea e e a a a i ica i nifican ed c i n in e duration of diarrhea on comp aring the synbiotic with e i ic e ean d a i n dia ea a in c a ed i in a e and i i a e reduction in duration of diarrhea may be due to the

Table 1. Frequency of Diarrhea Groups

Day 1

Day 3

P value

Mean

Group A

9.03

3.41

0.81

1.01

<0.0001

Group B

10.1

4.42

6.24

3.32

0.006

P value

0.42

0.02

Table 2. Duration of Diarrhea Groups

Duration in hours Mean

Group A

36.2

12.3

Group B

72.6

31.2

P value

Duration in hours

e a ic ic an a ina e a ien e e a e ed dia ea and de d a i n ec e a defined a e a a e fi e i id n in e e i n ad e e e en e ed e ed e a en a ec ded a a i a e en ad e e d eac i n a d ne in e d ea ani a i n ca e e e i a e en a d ne in M dified a i ie e e e i a e en ca e

0.001

Group A

80 75 70 65 60 55 50 45 40 35 30 25 20

Figure 1.

Group B 72.6

36.2

Group A

a i n dia

Group B

ea a

and

e ec n i ic n a c i d en ad e de d a i n and ad n de d a i n in en c i d en ad e de d a i n and ad n de d a i n in ne e c i d en ad de d a i n n a in e e di e ence in e a ica and i c e ica a a e e e e n a i ica i nifican in e e ad e e e en e e i d and n e i ad e e e ec e e e ed e e categorized as p ossible according to the WH O causality a e en ca e e e e e n d d e ad e e e en n e ad e e e en a i e a e c n ed a d ina ain i in and a DISCUSSION c e dia ea c n a e

n a ec c i d en in e e n ea ed dia ea

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1065

PEDIATRICS can ead de d a i n acid i and e ec e i a ance e acin id and e ec e c ec de d a i n i e inci a ea en e i ed Fluid rep lacement is done by administration of oral e d a i n i n and in a en id i nece a S ynbiotics and p robiotics may help in reducing the e enc and d a i n e dia ea

CONCLUSION

i d a e ed e a e and e cac a n i ic and a i ic in ac e dia ea in c i d en ne nd ed c i d en e a di i ed in ecei ed ei e a n i ic a i ic a n i anda d e a e a e di i i n a i i a in e n i d e e a a a i ica i nifican ed c i n in e e enc dia ea i in e e e enc dia ea a ed ced n a n a in c a ed i n a n a in a e i a e a ie e e e ec i e in ed cin e e enc dia ea n c a in e n i ic i e i ic n a e e a a a i ica i nifican ed c i n in e e enc dia ea i a a e d e e e ec n i ic in ed cin e e enc dia ea e e a a a i ica i nifican ed c i n in the duration of diarrhea on comp aring the synbiotic i e i ic e ean d a i n dia ea a in c a ed i in a e and i i that the reduction in duration of diarrhea may be due e e ec n i ic i i in c e a i n i e die c nd c ed en in a Ma i and a e a ic a ed i i a ed c i n e enc and d a i n addin n i ic 8 - 1 0

REFERENCES

It can be concluded from the study that the synbiotic i e ec i e in ed cin e e enc and d a i n dia ea en ad ini e ed a n i anda d e a in c i d en i ac e dia ea and i e e a ed

e e a n a i ica i nifican di e ence in e a ica a a e e c n a e c e c n di e en ia c n e in a e e c n ena nc i n e d a d ea and e c ea inine e e ec e and i e nc i n e e e i in e i i i i a e e a d e e a 1 1 which also showed that synbiotics did not a ec e a ica and i c e ica a a a e e e i ad e e e ec e e e ed in i d All the ADR s recorded were categorized as p ossible nde ca a i a e en ca e e e M dified a i and ie e e e i a e en ca e a e ad e e eac i n e ed e e i d This was in correlation with the studies conducted by e e a 1 1 and a e a where addition of synbiotics did n inc ea e e e enc e e i ■■■■

1066

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

ac M i ce e e and i i n c i d en d in e e ea ance

a e

i n n en ac e a i d H ealth Ep idemiology R eference Group of W H O and a e i na and na i na a e e ecific a ca e and ca e ecific ai ca e dea a e a ic ana i e a den i ea e d ance

in a e en efini i n dia ea The U nited Nations Children´ s Fund/ W orld H ealth ani a i n

dia

e M inde inc in e ea en ac e ea c en a and a e en a en e

ed ced ai a e d a i n a a i n e a ee in e e in ani ed and e e

ae a e M M ic anda ini i ic in a in e ina di ea e in c i d en a d and n a d e idence e cac edia a en e

ande M ac i ic n c ni in ic e in a en e

en i ic a a a e

i a

Ma ine e i an ea in in ec i dia ea c ane e

a a a i e a in a Ma i e ac cac i ic in e en i n ac e dia ea a e a ana i a ed and i ed ace c n ed ia L ancet Infect Dis

ae a a c i M ie c a ia e Me a ana i ac aci ea in ac e dia ea in c i d en Aliment Pharmacol Ther

e in c inica

a a an a e ee M and a cac i d e Lactobacillus rhamnosus GG in c n in ac e a e dia ea in ndian c i d en a and i ed c n ed ia in a en e

in ne M an M i ic ac ice a a e e i in i

EXPERT VIEW

Do β-blockers Cause Sexual Dysfunction? KK AGGARWAL

ec i e d nc i n e e i en ina i i ac ie e and ain ain an e ec i n cien a i ac e a ac i i 1 i a i e a en edica e a ec in a i nifican i n en a i an i ac n a i i e and i e ie ed e e a ed d e a eadin n nc iance e a

a in ei e end a ide an an in e en en e a a e a in ace 4 in e i a ed e e a e e ae e e a c a e an i e en i e d β c e a a ni di e ic in n a and e en i e a e in a c a a i e d i ace nd a ac c n i en d e ec n ea e e a e n e

a di ac i e d a e c n a cia ed i ad e e ide e ec a n ic i a c n ne e ca e and e ec a e c n ed eca e ca di a c a di ea e per se a ca e a e e ap p ears to be a higher rate of sex ual dysfunction in n ea ed en i ca di a c a di ea e c a ed i en i i a a e

n acc dance i e d en e a a d c nd c ed i e i e a 5 in e i a e the role of p sychologic comp onent and of anx iety in e a d nc i n nd a e incidence in a ien inded n d d a n e d e incidence a a i a in e a ien n in e i e ide e ec e d i e in e a ien a did n n e d e e e a in e incidence a i e e e en

It has been rep orted that β c e c a an may induce ED through central and p erip heral eni a e ec a i inc ea e e a enc e c a e ac a i n e a enc ini ia e ec i n and ed ce e n e e ec i e e e e i i a findin a e been rep orted with other β c e a ei e ec n e a e a i i e e iden i e lip op hilic β c e an i e d i ic a an die a e e ed a i incidence in ea ed e en i e and e ed e en ce the idea that β c e a ind ce e e desp ite the common belief of the induction of ED with β c e e c inica die ai ed c nfi a ED in e a i n i e een e c d and a ien i ca di a c a di ea e a e e a ed c ica ac in in e ea e di ea e and e e ec e d e c i ed The role of p sychologic comp onent and of anx iety in sex ual dysfunction is well- demonstrated and p lacebo a e e e ec i e in e ea en d e c ica e Early rep orts from the Medical R esearch Council in a n Mi d M de a e e en i n ed a cc ed e e en in a ien

Senior Physician and Cardiologist, Moolchand Medcity, New Delhi Group Editor-in-Chief, IJCP Group, eMedinewS and eMediNexus

e e findin de n a e n ne and e i ance c ica ec ani ind cin and n e other hand the fact that the most of β c e a ec n i ca ed c ica c nce n e p sychological nature of β c e ind ced i e suggested by the fact that in the maj ority of cases ED a c e e e e ed ace The study data were in agreement with recent ec i e and i ed d e inded die a nd a e i e and a e n a ec ed die e a an ie i β c e 6 e e a c n a n e e i e a d nc i n i di e en e e and na e an ie and a an ie ed c i n ced e i e e a i a n a a ec e a d nc i n 7 e e e d ide e ec can d ce an nc i n n an e d e ec e M cc ence a e a e in e ea e en i e en i n

e a ie a e e a β c 8 a ed

n ed e a a a ec e ec i e e a ac ic e per se on the

i a e ec ed en a e i i ne dia n ed a e ia n c d e ea ed i M e e en e e and i ed in ee a ien e e in ed e ne

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

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EXPERT VIEW that the drug was METO and that it might induce n a ien e e a ia in ed e ne a e d a M e e n in ed a i i ind ce n a ien e e not informed either about the drug used or about the i e cc ence e fi a e e d a ed da da e incidence a in and in i en e ed e ec nd c e d a e e d M a c n in ed a d a e and ada afi and a ace ea

REFERENCES

e in a ien e ind nc an ed e e i en

ea en e e e a e ec i e e in e i a came to the conclusion that p rej udice about the i e cc ence i e e a ne e ec i M aci i a e e cc ence i ide e ec in e en i e en ince e e i i a a e c ica i a n i in a ace a a e ec i e a ada afi in e e in i ide e ec n c nc i n i can e aid a e cc ence ED in p atients on β c e i c e an c n i e ed a a ien and d c e ec a i n n e i e e iencin a in ence e cc ence i e e ide e ec

e e

n en n e ence ence en ane n ence M

i a a dai an nc i n e a ed an i e ani a de n

n en

a an e a e e en i e a en e e

en i e e i e a e a e e ae an i e en i e d ea en e ec n e rep ort and p hysiological measures in middle- aged male e en i e c e e a

e Medica e ea c nci in a n Mi d M de a e e en i n d e e eac i n end a ide and an e ea en i d e en i n ance

i e i a e a d nc i n a e a ien n ed ace ea

e e ani e a e e ec i e ea i ea c e i e a ed e ide e ec and i e e ed

an en Me a ei e e a ec e a c e n e a e ance in en i c na ea di ea e ec i e and i ed and d e inded d n e n e e e an ie in e a d a e ie c e e a cc e

ec i e d e a

nc i n

nc i n a e ea ne e ec a di

■■■■

Study Reports Favorable Results in ULMCA Patients Who Underwent PCI with Orbital Atherectomy i a a e ec in a ien i e e e ca cified n ec ed e ain c na a e M di ea e i ea i e e en in i i a ien e e c n ide ed ica candida e ced a cce a ac ie ed in a a ien e da a ad e e ca diac and ce e a c a e en a e a Mic ae ee M i i i n n e en i na a di Medica en e n ee and c ea e e e findin e ec i e e a a i n in e i i e e Journal of Invasive Cardiology e also recommend that randomized trials are needed to determine the role of orbital atherectomy in U L MCA di ea e

Evolocumab may be Best Option in Patients with Muscle-related Statin Intolerance n a ien i a in in e ance e a ed c e e a ed ad e e e ec e e in i i c a ed i e e i i e e ed in a i nifican ea e ed c i n in a a ne d e en ed a e ecen c nc ded nn a cien ific e i n a di in ica e a e a c ie e en e n i d in a in n e an ec ia e en i en M e e e and a i ed n ine i in e Journal of the American Medical Association

1068

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e c a a e e a e ee e e ican e e i i in an n i inic and c ea e i

MEDILAW

Contributory or Comparative Negligence KK AGGARWAL

is a substantial factor in bringing about his harm e en in ca e in ic ician a e n a ed c a a i e ne i ence c a e in e ed i as a defence in cases in which it is warranted by the ac and e e idence

What is contributory or comparative negligence? e e a e an d e en c a i in e aid

S ometimes the unex p ected results may not be due to negligence of the doctor but also due to ne i ence a ien e a i e i i n n a c n i ne i ence e a ien n c in a ad i ed ai e in ci n a ien ea in i a a ain edica ad ice e c The burden of p roof of contributory negligence on e a e a ien i n e d c 1 â&#x20AC;&#x153;S urgical op eration p erformed up on the p atient/ decea ed e e nden n e e a a d ina and a e e fi ed d ain e id c ndi i n e a ien deteriorated and he consulted another hosp ital a d e e e a dia n ed i a in e a i e c ica i n ad ena ec and gluteal abscess which resulted in his death a e ie in e edica i e a e and e e idence e inen d c M e a i na i i n di i ed e c ain a ea a e e di c a e e decea ed a ien e i a e d c ecifica ad i ed i â&#x20AC;&#x153;R egular Medical Follow- U p â&#x20AC;? which the deceased ai ed a end e da a e e anc ea was rep aired immediately with interrup ted n na a e e and d ain e e aced e nden n e ed e e a i n ad ea na e de ee i and n ed e i e ed a a n a e d c a e p erformed their duties and ex ercised an ordinary de ee e i na i and c e ence e cann e e d i edica ne i ence held no interference to the orders of the National Commission in dismissing the comp laint of the a e an a ea di i ed i c Illinois courts recognise that ex cep tions ex ist to the ene a e nde ce ain ci c ance in i c a e e d a c a a i e ne i ence a ie en e ain i ne i ence i a e a c n i in ca e i a i n i i

Senior Physician and Cardiologist, Moolchand Medcity, New Delhi Group Editor-in-Chief, IJCP Group, eMedinewS and eMediNexus

References

i a e

an M e a M

i ae

M a e i i ea a a e e an a a i a Medica e ea c en e e e nden a e eci i n dd an e

What is res ipsa loquitur? Res ipsa loquitur an a e a e in ea i e n a ca e e e ne i ence i e iden e inci e res ipsa loquitur op erates and the comp lainant does not a e e an in a e in res e i e n c ca e i i e e nden e a e a a en ca e and d ne i d e e e c a e ne i ence i inci e a een e ained in e ca e c nd n a e ine c e ed in ie ice e in e in anne e e e in i n e nde e ana e en e de endan i e an and e accident is such as in the ordinary course of things d e n a en i e a e e ana e en e e ca e i a d ea na e e idence in e a ence e ana i n e de endan a e acciden a e an ca e Following are illustrations where the p rincip le of res ipsa loquitur has been made ap p licable in the case of edica ne i ence Wh ere a p atient sustained a burn from a high e enc e ec ica c en ed e ec ic c a a i n e d a e a e i e Ma c e e an ene de e ed in e c ai an a in an in a c a in ec i n a an ic d

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1069

MEDILAW Wh en a p atient underwent a radical mastoidectomy and e ed a ia acia a a i ad ende enda d e e e de endan ai ed dia n e a n n c ica i n e n e a ien and a e di ea e ie e Man Wh ere there was a delay of 50 minutes in obtaining ex p ert obstetric assistance at the birth of twins en e edica e idence a a a e n e an in e d e a e e een e i e fi and e ec nd in e n ea ea i Med a e e in an e a i n nde ene a anae e ic a a ien in e ec e a d sustained brain damage caused by hyp ox ia for a e i d in e ne i an ea i Med e e in a ine a ene a anae e ic an e i e ed a fi and en in ind e Mid e e n ea a

endicec nde i e fi and ea a e anen c a a d

en a need e e in e a ien c i e e a ein i en an in ec i n a ie Mini e ence a e a Wh ere a sp inal anaesthetic became contaminated with disinfectant as a result of the manner in which i a ed ca in a a i e a ien e Mini e ea n Me n n and and ea ea i Wh ere an infection following surgery in a wella ed and de n i a e ained ndia n ed n i e a ien ained c i in in a a nd n ea cia i n d a Wh ere an ex p losion occurred during the course of administering anaesthetic to the p atient when the ec ni e ad e en een ed i an i a i e e d n

andi a a a in and e e e d a i a c in transfusion of blood resulting in death of e a ien a e da a a ca e edica ne i ence

Reference

i an a i i e ecia i Ma c an enc in

1070

ia i

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

a an

i i

i in

Are experts required in every case of negligence? There may be simp le cases of medical negligence e e e e e idence i n e i ed n a d e en da ed Ma c in i i ea i an a i i e ecia i ia n e e e ndia e d i e e a e i c ea a e e e Consumer Fora if any other p arties wants to adduce e e e idence e e e e a a in their mind to the facts and circumstances of the case and the materials on record can allow the p arties add ce c e idence i i i a ia e d in e ac e ca e e di c e i n in i a e i e e e e a e ecia en retired j udges of S up reme Court and H igh Court are ap p ointed to head National Commission and e a e i i n e ec i e e e e e e e i n a e e d ed n e ac eac ca e and e e cann e a ec anica ai ac e a ac a eac and e e ca e e e e ed e e e idence en e a find a e e e idence i e i ed e a ee in ind a an e e i ne in a i en ca e n a di c a e nc i n

e fi d e e e i e ain e technical issues as clearly as p ossible so that it can e nde d a c n an

e e nc i n i a i e a in decidin whether the acts or omissions of the medical ac i i ne e i a c n i e ne i ence

n c e a i nde

ica ed ca e e e e e e idence i e i ed ie a e a i e i i a e a ie i i i e e ed ec i n e c

Comment: As the courts may not call the ex p erts in an i a i n i i e e i e ini n of the ex p erts in anticip ation when you rep ly to a c ain fi ed a ain

What precautions can the doctors take to avoid negligence? e d c d i n in e e ca e read the Code of Medical Ethics which is p art of e ndian Medica nci e i na nd c i e e and ic e a i n i ed e Medica nci ndia inc din e a end en e ac

MEDILAW en ac ice in a c e a a edica and e a iene and e i i d e e ed ic e c i i n d dina i e i en i ac a e a ina i n e endenc i e e c i i n e ee ne e ce in an ac e e e enc e a ided

A doctor should not ex p eriment unless necessary and e en en e d dina i e a i en c n en e a ien

e d

n e

d e c n

ed in ca e an d

ec d e dia n i ea e ain ained

en e c

Reference

d c d n e e e e i n e a ien e a din i d a a e i n ana i inc din e and in e i a i n e e nece a

n e and c i ina c nd a e a ia e medical op inion before issuing notice to doctors e e Medica a a e c e a

■■■■

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1071

CONFERENCE UPDATE

53rd Annual Conference of Indian Academy of Pediatrics (PEDICON 2016) ene a e a e a Ma e na a n in e ene a i na

ROAD MAP TO HEALTH: NUTRITION AND GENETIC INTERACTION Dr Mrudula A Phadke, Mumbai Child malnutrition lies at the heart of U 5 mortality and fetal malnutrition contributes to early neonatal dea and M in e fi n Ma a a a iance in i d i i n in ongoing p rogram to ↓ anemia in adolescent girls and incidence ↑ rates of early initiation ea eedin and e c i e ea eedin and ini die a di e i in a ie a ed n e dic i d c a ea ne i e een i e a da a i a c a i e in e en i n en e ni e a acce e ec i e e a e ic eedin in M da i e c i ica e i d nce i n n da i ea da i e × da Lancet i i i e ind ni i i n ecific in e en i n a e a di ec ea in n n i i n e c i d i e n i i n en i i e in e en i n indi ec in ence n i i n a a i i n en i i e in e en i n a e and sanitation hygiene most imp ortant → en i n en a en e ic en e a e n d a ne i n ien a

ien a e nc i na n ien and a e e e n ien inc a i a e n d e and a e deficien c i d ec e n ed

n ena a edia ic e c e ed edia ician M

e da e ician a

d e a

The road to health is through nutrition. The pendulum of nutrition is in your hands. It should remain in the center and not swing from no or low sugar/fat to high calorie nutrition. INDIA NEWBORN ACTION PLAN Dr Ajay Gambhir, President NNF and Joint Secretary, IAP e n en ndia a nc Action Plan to strengthen nde a i na ea Mi e n en ed ce e ne n

ed e ndia e n the p rogram running i n i i e e a i and idi

ndia a ac ie ed M a e e e ain and ac ie e a e aina e de e en a e a and e e ice a e e in e a ed e e d e e e n ea e en enin and a i The model is continuum of care model under which e ca e e ne n i a in e ca e d in a ca e a i e en ia ca e e e ne n ca e e e and and e a ed ca e a e i an e e en ndia i d cin i i n a ie e e ea and i ne na a a i i e i e in e d Man in e en i n a e een anned nde this NH M and INM to address this issue of high a i and idi ASIA-PACIFIC PERSPECTIVES ON CHILD MALTREATMENT: WHAT CAN PEDIATRICIANS DO? Dr Shanti Raman, Australia

Child maltreatment is a global p ublic health e

c e d e d ne e en in i e in a i i e a e e idea a e a a in i ei

e e i d e idence a c i d a ea en i a cia ed i edi and n e ea c n e ence a e a i e n ec n ic c n e ence

c nde a inde M c e e a in

i i n i

Adult cardiometabolic syndrome has its origin in ea e a i in ad di ea e a e d e Ma n

1072

i i n i n c a ified a M and n a ade

M M M

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

The burden of child maltreatment in the Asiaacific e i n i an ia Child maltreatment must be considered within the ci c a c n e in ic e c i d e ide

CONFERENCE UPDATE c i d ec i n i e e d ine edia ician a e a i a e in e en in and a e i a in c i d a ea en edia ician need e i ed in iden i in and e ndin c i d a ea en Training for all trainee p ediatricians in addressing c i d a ea en d e anda edia ician a e a ead in ad ca in children and p romoting their rights whether this i ad cac a in e c i d a c i d en NEWER DIAGNOSTIC TESTS IN PEDIATRIC GASTROENTEROLOGY AND HEPATOLOGY

ea in i e en d e iden ified a i e a a ed and e edia ed e e n a e e edia i n e e n a e in a a ca e i ena e e c i d ac i e nea n a eec and an a e de e en e edia i n i ini ia ed a e ea an de e en i n e i a

Newborn hearing screening can be p erformed with in and e d e i en e in

Newer diagnostic modalities are now able to eci e dia n e c ndi i n ic e e n e i in ndia

edia ic i e e fi edia ic in Ap ollo H osp itals i en edia ic ac e c n i e e a a n

Inhalational insulin therap y is ex p erimental and not a ed in c i d en U sage of mobile ap p s and dietary guides will lead d ce ic c n c i d en n in in d a e acce e ne e in and ca n e e enc i a i n

Dr Abraham K Paul, Cochin e e

in in

Dr Rajesh Maheshwari, Gujarat e e add e in edia d e e e a ed and e in ed d e c ea about what you want to share and not indulge in nnece a a da a and a i ic en a e n e

e ca an a e id a d n e n ic an

e e in

n a a i n ic e

a Ma e e e c n ac e i n

i e

n e fid e a e nnece a e e Facial ex p ressions are imp ortant and must match e ne and c n en eec n e ne i e ea in DENGUE FEVER DEMYSTIFIED Dr Arun Kumar Agrawal, Ghaziabad Prevention is the still the bestâ&#x20AC;Ś en

NEWBORN HEARING SCREENING e incidence ea in i a ne n a i n and i i ne n

ne n ea in c eenin e di ic de i c eene ac ine c e in i a i a de

HANDLING PRESS AND OTHER MEDIA

ea e ed in ine c inica a c i d en i dia e e e i

Insulin p ump therap y and continuous glucose monitoring must be used in children as p er the ide ine and ci c a ac nd e a i

di ic i anc e can a e ini ia i e e en i de

Dr Hemchand Krishna Prasad, Chennai

d nde e a di d nc n

e c nfiden a e en n in a de a e

RECENT ADVANCES IN INSULIN THERAPY a a ac ice

a ie ne a

en a i ed na a c eenin e ica e

Prof Anupam Sibal, New Delhi

i e e a i en an an a i n in ndia transp lant was p erformed e i in and e a a en e e ice e e ne e de e en a ien ac ndia

a e c i a e fi c een ed in i i e ca e e ai i a ac ica de

a di

e e dia n ic e a e a e n ide an acc a e dia n i a n ica e

a e

e i a c i e

e e i n ed

n i a di ea e

ecific ea

en a ic a

id e a i e ain a ea ca e a a e e ace en

ic i

ead

ac e en n e e e d e d ne

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1073

CONFERENCE UPDATE d an id

i n in a ien i i nifican

n ea n e a i a e e c ea a e c ndi i n e a ien

Dr NB Mathur, New Delhi

a e c i d en

de e

Mi in a e can inc ea e i e e a e en ea e edia ician ca e ide i d e c nfidence and e a i c ec a c ed a e ea en e a e a e a and e and

en i i en ana ed eca e ac a a ene a n ca e ide NEWER DRUGS IN TREATMENT OF ITP Dr Wan Ariffin Abdullah, Kuala Lumpur ai ed a e e d c i n a a inc ea ed de c i n i a ec ani in

TPO- R A mimics endogenous TPO and increases aee c n ind cin i e a i n di e en ia i n and e ea e a e e ■■■■

1074

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

and a

a i

e in

e e n ined

e i

LONG-TERM MANAGEMENT OF ASTHMA IN CHILDREN

ac c nfidence and e ne a i e e i n i e an ie and ea e e cin e e e i e d n e e a ec in e i

e ni

i c i e i a e and e e ice needed ea eedin e i de

i ei e cen e a ie ad i ed in ne na a ni a e a e ce i n a ei i i in cien e a

e ca e

fi ea en a i e e en e a e e in a id i e a e e c n i in ee and i e e a ed and a id ad e e e en

ea eedin i ea i e e en in a ie e en ea e en e e e a e a ie ea n c and a

c in a ni e i ac a i n ai e

ec ani

It may be used as second- line treatment in e a ic c nic e ac

COMMON ISSUES IN BREASTFEEDING

ec a ac en a ea i a in i a e e e n a e e e ni e

i a e ec i e in c i d en a in ad i i a e cac a

e c n a e ai ed a ain i e i ina i n eedin a ea ac i n e en i i e e e an ne and a accina i n a e endin

e c n ca e e e ce i n a e i i n en n en i nd e i ac c nfidence in e e and ac c n e in

ide a di e en n en

Dr Santosh Kondekar, Mumbai d ca i n a en a dian i e e Ma in e nde and a ecific a e en a idance di ea e ce ec ni e in a a i n need using rescue medicine with close follow- up will a e e a e ai in e c e edicine e en in ne ec ed e ace a i n e c e in a a i n d n e e e ed en the symp toms are serious” but also for disturbing S udden ex acerbation in otherwise controlled a a ic c i d i en d e nea e cani e di in d ee need a ai ed e id d e

eec

eac in ea in dia a dai eca ec dia a en e e c a i and ni e e e i e n e and e i i n asthma and also enables them to understand and e e d c ana e a a in ei c i d n e ac di c a a i i i an ec nfi a e a e n dea in i n na a dia n i a c idi

CONFERENCE UPDATE

46th Annual Conference of the Indian Society of Nephrology (ISNCON 2015) CLINICAL TRIALS IN CKD: THE INTERNATIONAL SOCIETY OF NEPHROLOGY PERSPECTIVE (ISN-ACTS) Dr Adeera Levin, Canada AK I and CK D are global p roblems and are challenging for us all! n i e e i na and a i na cie ie i a i a ani a i n c i ed ed ca i n eac in e ea c e ica ac ice and ad cac e in e e ace and ac i i ie c e nci i e ea c d ca i n d cac and ini ia i e ini ia i e and ini ia i e e ea c i a e ea c c inica e ea c a i in e na i na ne c cia i n inica ia d ca i n ica i n

i a ed ca i n Mee in ed ca i n n ine a

cac i a ad cac en d idne a c nica i n ee in e a e annin a idne i

a an a and c i ee and eac a i in ed e i na a d and e ini ia i e e e a e e i na a d ic include members from R egion and National cie ie

FIGHT AGAINST CKD: IN THE INDIAN CONTEXT Dr Suresh C Dash, Bhubaneswar e ndian c n e i e a di e en e a c n e e n e dia e ic a i n in ndia i an e i a ed i i n ndian a e e en i e e e i a ica ic and in e a e n ed ea ca e e e en i a n ne i en i n in an ndia a di ea e ca e e a e in ace DM is the most common disease causing CR F in ndia e ca e inc de ca c Dash et al. 2000 A study p ublished in the Indian J Med Res. edic ed a e ea e n e diabetics is going to be around 7 0 million; we are in e ceed i n e e e a ence in ndia inc ea ed in in Mic a in ia i e e i a i e en in i d idne c ea inine

e i n e e nc i n e

The incidence of CK D is rising in India; a e a i i n ani e i a in di e en a e only the tip of the iceberg; >75% p atients p a e in a e

there ai resent

i e ene n i e i i e a ien c e ic a a ene e i na ed ca i n ic in ence ca e de i e e and e ea c

i a a in a n i a ia

R esearch is fundamental to all this; multinational e ea c i i ac ed di e i ea ca e e ndin and e a e and a

ec nda e en i n i en a a ead e in ea en a an ea a e c ec e dec ea e in iden i ac e i ac and c n e ed ce ena nc i n a e c n

e need inn a e in idne ca e and e a ien fi and c a a e e need a ien di e i c e e ce acce and ed ca i n e ec i e a ien nde in c n ide a i n

ea c a ca ide

e e

n e na i na in e en in c inica ia ead ea e acce ance e a die in di e en c n ie c

e a

e ed ca i n and ainin a i n and e ica a e in e ea c

e en i n can e d ne n e di ea e cc in e fi ace iden ifica i n e i a ene i and e in e en i n

i a e en i n i a da n in a e e d e a na i na ne a i n c eenin a e e e edica c e e M and ein ia and ea ade a e nd e M and idne di ea e i n in ndia and i i en

inc ea e i de e in ica e e e ac e idne ai

a e e in ndia

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1075

CONFERENCE UPDATE Ma a ia den e c e ica and in

id na e en en

a i n

id incine a i n n nc inica a e e e p ost- R O water? Dialyser reuse? ed ce ene ac ine

i a ad ance i i i an c inician e en and ea a e ac e e d ca e a ien a a ene a

ician

a ide

It should be made mandatory for PH C p hysicians c een ea ea M and

Dr Phil Halloran, Canada i a ed a e a en idne an an eci ien a e i en and a e e a e i en M a e en an an an M e ni i n e

M can e dia n ed ne a i e e ec ani

ie en

i n n

M a e a e a e

e ain en ic di e i c c d inan and e e aae n in i e a a i e n nad e ence Immune adap tations? H istology is p robably too error- p rone to be used a ne SUSTAINABLE NEPHROLOGY: REDUCING THE CARBON FOOTPRINT OF HOSPITAL-BASED CARE Dr Charlie Tomson, UK ed c i n in de and i a a ed ca e i a e en i n ea de ec i n ec nda e en i n e in e i n inc ea e a ien e e en and e ca e enc a e e dia i e e ne c inic i a c n a i n e ice n

in and cost

ed ce e e e ai ec c e e e a e a e

1076

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Mini i e a e d a i na i e di en in

a e ad e ence

e e e ec a e i i e and da e a e ea e n c na e a ien i in a acce ed i i d in in e a c a ified a n a e i ed e a e e in e i a and c ni Hemodial Int. a

Dr Harbir S Kohli, Chandigarh nd i e a e a e e a ien a i e e c inician and e i i ie i e ica and e a i e ac in a e a c d e e i a di inc i n e een e ana ia ician assisted suicide and allowing a p erson to die a na a dea dia i n

M ec a i ic e i n i e i e a c an e in c e ac ie e a c i ica da a d i en c a ifica i n

ed c i n in ca a ed ca e

ea e c an e n

END-OF-LIFE CARE IN ESRD PATIENTS

ANTIBODY-MEDIATED KIDNEY TRANSPLANT REJECTION

e en i n ea en acc a e defini i n ec

ed ce dia a e an c en a i ed dia a e a e an e d de and ec n i e n i e

ead

ad a ic ea ic n i i a a a ia and a ecia a end en n i ica i and ad ini a i e commitment along with p artnering NGOs and ind ie i e need e n d ce ea ed ca i n in e c c ic M e nd needed a i n c eenin

i n d e n

ean n ea

ician a e a a i a i n a e a ien a e e e and d in dea

a a e di e en e een c n ie a e e e a e nd e fi i e ica a ec i a ien a n

e ic an

Patients are now op ting out of life- sustaining ea en i e inc ea in e a i n ician need di ai a e e a i e a de i e and di ec i e e a ien a ia i e dia i i c an i n a i e and a ia i e ca e

and in and

d anced ca e annin and a in e in ac ie in i a

a ed deci i n

IRON DEFICIENCY: A COMMON CARDIORENAL INTERACTION Dr Sanjeev Gulati, New Delhi C nic idne di ea e i inc ea in in a ien i c nic ic ea ai deficienc i c n in and in die e a i n deficienc i an inde i ac a i in e e a e an

e a en e n ecen enden ca e

CONFERENCE UPDATE

in ena ai e ed ced i n in a e d e ein die and an e ia d d e e ia a ii a e e in i i an ic a an and a e inde ic can a ind i n i e can cause reduced iron absorp tion due to intestinal cell dysfunction due to bowel edema and other causes; ed ea ane ia e i n and i e en a i ca e in a a i n ena ai e and a e in a a c ndi i n and inc ea e c ine and and i can ca e ane ia and e can ca e e a ica a n a i ie ed ced d c i n in e idne eadin ina ia e e e in the blood for the degree of anemia p resent; reduced erythrop oietic resp onse of the bone marrow to ES As; hep cidin- induced failure of iron absorp tion from the gut and hep cidin- induced trap p ing of iron in iron e in e ac a e and e a c e e en in e e ea e i n in e d EFFECT OF FERRIC CARBOXYMALTOSE ON INFLAMMATION AND ADHESION MOLECULES IN PATIENTS WITH PREDIALYSIS CHRONIC RENAL FAILURE Dr Tushar Dighe, Pune ne ia in c nic idne di ea e a a i ac ia i in i i n deficienc ein ne e ain ec ani i a e a ence a a een e ed a i n deficien a ien a e a i e e e ad e i n ec e ic are per se a i ac de e in a e i c e i and a e inde enden ac ca di a c a dea n in a a a e and ad e i n molecules ex p ression are increased and there is an in e e e a i n i i ena nc i n e e e e a fi a i n e i e i e e i n ea en i i n i a e and e ec i e in correcting anemia in p atients with CK D in which iron e i e en a e inc ea ed e e e e a e e die e ecia n dia i a de n a e a e a e en i ned ea en inc ea e e in a a a e n a ecen d i ed in Nefrologia a ien i edia i and i n deficienc ane ia e e i en a in e d e e ic ca a e a d e and e result demonstrated that treatment with FCM does not ind ce in a a i n ca e an inc ea e in ad e i n ec e ea ed e en a e ee n M M The p ossible ex p lanation could be the characteristics of

e M ec e n e a a i n ec a ei and e ine ic a i i i n c na e i n c e ca e an a i e in e i n i an e in e a a i n and e ee i n ic de e ine an inc ea e in in a a ec e c n a M i a ac ec a ca d a e i n d ide c e de i ned a a c n ed release of iron in the cells of the reticuloendothelial e ini i in e i e ea in a e a n i nic i n in e i c nc de M i an e ec i e and a e i n in edia i a ien SYMPTOMATIC CARE AND PAIN RELIEF IN A DIALYSIS PATIENT Dr Suceena Alexander, Vellore Pain is the most common symp tom for p atients i i ac in i a e e a ec and i e ea e c nce n a e end ie The term “t otal” p ain refers to any unmet needs of e a ien a a a a a e ain and ca e e i ance a e in in e ac i n ica e i na an ie and de e i n cia i a i n and a and n en i i a ea c eanin and e and financia ea denin e a i c inica i nifican a cia i n ain ende a e ace i c e ica a a e e

e dia i a ien i c nic ain e e n e c i ed ana e ic de i e e a a i e e iencin de a e e e e ain e e e c i ed n i id Interdiscip linary ap p roach to manage “T otal p ain” addresses p sychosocial and sp iritual concerns a n i ica e a e en e e ana e en The WH

and

O analgesic ladder can be adap ted to ai n

The National K idney Foundation recommends acetaminop hen as the non- narcotic analgesic of choice for mild- to- moderate p ain for p atients with d an a e an ide e an and an ic n ed a n i n n i id i id

e a a e e idence a e ana e en in a i n a e e ic i e e e nd e ee di de de e i n

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1077

CONFERENCE UPDATE

56th Annual Conference of Indian Society of Gastroenterology (ISGCON 2015) eed

DIABETES, OBESITY, NAFLD AND HCC: THE LINK UNFOLDS

a ene

e a ence

i inc ea in

e na i e c ea e a e ie e a a ed a a da i i i a ene ic a eni

Natural history of NAFL D is ex p anding from simp le ea i e i M and in in e i ance a e n associated with NAFL D and increased incidence Follow- up of p atients with diabetes including c eenin i e di ea e d e ec ended M i an inde enden i ac e ei e i n in

can de e in a ien i ci i cance a e i ed i en e i e a ence and e i i a i n c en c eenin a e ie c i a i n a a a e in a a i n in in e i ance an i ene i and ce a p roliferation seen in these diseases p romote the de e en en

TREATMENT OF HCC: CURRENT CONCEPTS AND RECOMMENDATIONS Dr SK Acharya, New Delhi Globa i e en in dia n i c eenin c a i e and ea en c a i e a ia i n i i e i e i ea i a eac in i c a i e i n and i a ia i e i n n ndia i n a ien e ed an ea en in e e ed e ie a ie n e e e i i e c a i e i n and ecei ed a ia i e i n e i ia e ec a ien ecei e i e an e

1078

an i i i a

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

d e

Dr Oliviero Riggio, Italy

di ea e

TIPS FOR REFRACTORY ASCITES AND GI BLEEDING a e and e a ic ence a a

n d

nc i n

can i e e an an ee i a a ien i e ac a ci e an acc a e a ien e ec i n i needed a i i e e i a enefi

H CC incidence is increasing as NAFL D becomes e c n ca e i e di ea e

inica die e en e de e in a ien i e i M a e c i ica needed

acce

c eenin i i de ec ea i d i e nc i n Ablation/ Transp lant

Dr Deepak Amarapurkar, Mumbai ncidence and d ide

TIPS is fully utilizab le in the treatment of refractory/ ecidi an a ci e a ien e ec i n d e a ed n e c i e ia ed in e i ed n ic in e n i a i e ca i n in c n ide in a e fi ine ea en in e ac ecidi an a ci e eai e d i e nc i n and e ence other comp lications of p ortal hyp ertension may be c i e ia e e a acen e i a

a ien d e ca e e a a ed and in e i e a ic ence a a

e en i n e eedin e ed i e ea en c ice in a ien a ai fi ine ea The TIPS story started more than 20 years ago and is still going on… TIPS has to be definitely considered as an important therapy for patients with portal hypertension. DOWNSIZING HCC: HAVE THE RESULTS OF LT BEEN IMPROVED? Dr Paul J Thuluvath, USA S uccessful downsizi ng and absence of tumor p rogression for ≥ n a e d n i in c d

CONFERENCE UPDATE e ed e ec a ien i ad anced i e an an a i n d anced ci i and candida e d n i in

n i in c d e d ne an e e i da i

e d and

n i in d e c d i en i edefined inc i n and e c i n c i e ia and ec i e end in a e d n i in i e c e e e nde and e eci e e d n i in and de e ine e i i a i n HEPATITIS C TREATMENT: “A PARADIGM SHIFT” Dr Marc Ghany, USA ci

e a i i i a a ca e c nic i e di ea e i end a e i e di ea e and

e e a e an e i a ed i i n e n with chronic infection; deaths from H CV now e ceed a Treatment is recommended for all p atients with c nic e a i i in ec i n e ce e i short life ex p ectancies that cannot be remediated ea in an an a i n e di ec ed e a a ien i i e e ec ancie in i e di ea e d e ana ed in c n a i n i an e e n i

a i n needed e e ini ia in ea en en e a e fi i ea en c idi ie edica i n i

a e and e ec i e in e e n ee a ai a e c e c nic e a i i ac en e e c a en in

ea i a

a i n e ain

e ec a ne i e fi a e i en a e n a ai a e FECAL CALPROTECTIN IN CLINICAL PRACTICE Dr C Ganesh Pai, Manipal den ifie a ien

need

e e di ea e ac i i ea en

e in e i a i n i

en n

edic e a e edic ec ed

e ad c i d c ii

ence

c ii

FC testing in p rimary care could reduce referrals and c n c ie c n ide a e c a in i e

ide a ia i n in c a e e ance e in c i d en de a ed dia n i in ad en di ea e e and ca i n en e i i a a ec e e

c e en e i i ic c ic c i i e C. difficile

en e a in e ina i a ac i ed dia ea

↑

i n

a in

APPROACH TO CHOLESTASIS OF INFANCY Prof Anup Sibal, New Delhi e na a c e a i i defined a c n a ed i i in d i a e i i in i d i i d All neonates with j aundice beyond ee d e e a a ed e c de ne na a c e a i a e inc de e a e a ic c i e ne ein i ia a e ia and in a e a ic e a ic i e d c in e a ic in ec i e ei c

a c ed dia e a e i a

and da in e

ine a c i e e i

ain

GGT should always be p art of the L FTs as it ide a a e c e e i

Â ↑

a i e

U ncorrectable coagulop athy is a p ointer to e a ic ca e e ecia ine ia and a ac e ia Fasting and p ostp randial U S G by an ex p erienced sonologist can help in early diagnosis of biliary a e ia i e i ide defini i e dia n i in a i ca e and e an i e e en fi i ne c e can a e een in ca e i e e e ne na a e a i i and in e i i e d c a ci

a dia n i and e e a i e e a i a in i ia a e ia i n a nd a a ain a i in e i ia a e ia i e c i e an an a i n a i e an an a i n e cen e a e n een e e fi

cce

ne ca e edia ic e e d c ed

a a e ndia

edia ic i e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e e an in

1079

CONFERENCE UPDATE ndia a e ed a and e eci ien e ain e

i a e i in

M e an edia ic i e an an a e een e ed in c i d en in ndia and e an a e n e ed eac ea

nM i

a ec c e ea i in in e i ance and a e e in dia e e c in i e and dec ea e e i dia e e and i e ea i and fi c e i e e e and e a and an ea i a ne

nc en M and ea i a e in ed inc ea ed i ad anced fi i a n c e a i i a ien

i nic

e e ee e a ne a i e a cia i n and e a ic ea i a a e a e ec n ea i

i nifican i

de a e a c e and

e dec ea e ai

M de d in e a e e i e a ic fi and a nin e a c e a c nc en c d i ide ia a e n e d ici

idi

n e ene

cena i and ca e c

in edia in

n e

d ain

and a e c e en a methods and together they can stage almost the en i e edia in e c ice e i n i e e i ac ine

de end n i e and a ai a i i an and

IMMUNODEFICIENCY SYNDROMES AND MALABSORPTION

M e i i e

an e in a ic c nce ■■■■

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

ance a in

Dr Vivek Vij, Noida

1080

i a

nfi and define edia ina e i n een n e in e i a i n nd c

IMPROVING OUTCOMES IN LIVING-RELATED LIVER TRANSPLANT e a efine en in ec ni

c i n an e i ec

e en in i ia

en d

Dr Sundeep Lakhtakia, Hyderabad

nic e a i i and e a ic nd e a e in ed i inc ea ed i ci i and e a ce a ca cin a de endin n ende ici

EUS VS EBUS FOR MEDIASTINUM: IS THE JURY OUT?

ad ec i e

e i a e ne a i e edic i in en i ea ed a ien

a ec n e

e e a i i and e di c

Increased serum insulin at baseline is an indep endent edic ci i e a ed M M

ia e e and e e i n ci

e eci ien

i e a i M d aina e → e e e c n e i n e an e i e en → en ia a a J Hepatobiliary Pancreat Surg.

Metabolic syndrome is a global health p roblem with a e a ence in ad de e e a ic ea i i inc ea ed i

d ad i in d n i e an an a i n in e ended i e a can ac ie e ei e in e e ienced and Ann Surg.

Dr Yogesh Chawla, Chandigarh

cia ed

eci ien ei

a i e d e n a ec n Liver Transpl.

HEPATIC STEATOSIS AS A COFACTOR FOR OTHER LIVER DISEASE: FACT OR FICTION

i a idi

a ei

Dr Atul Sachdev, Chandigarh i a i

n deficienc c ndi i n a e a e

ec nda i ea na c GI i Ma a

n deficienc c ndi i n a e n

manifestations are seen n deficienc c ndi i n i n cc

i e

5- 50%

H igh index of susp icion be maintained in case of recurrent infections or unusual or op p ortunistic in ec i n

DRUGS UPDATE

Complete List of 344 Drugs Banned

A c

a e e n ifica i n Mini a i e a e a anned i ed d c ina i n

ea and edicine

ea Mini anned i ed d ina i n a a e e n ifica i n

e an ic c e in e ec i ec enda i n an e e c e a ine e e cac e e d c

i ed d e c Carnosine

Fix ed dose combination of Diclofenac + Paracetamol + Chlorp heniramine Maleate + Magnesium Trisillicate

edia e i ee ed ina i n

Aceclofenac

ina i n

Fix ed dose combination of Pseudoep hedrine + Cetirizi ne

enac

inc

Paracetamol

Fix ed dose combination Paracetamol + Tryp sin

Fix ed dose combination of Nimesulide + Cetirizi ne + a eine

Fix ed dose combination of Paracetamol Mefenamic Acid + R anitidine + Dicyclomine

Fix ed dose combination of Nimesulide + Tizan idine

Fix ed dose Dicyclomine

Fix ed dose combination of Paracetamol + Cetirizi ne + a eine

Fix ed dose combination of Paracetamol disp ersible tablets

Nimesulide

Fix ed dose combination en e ine a eine

Paracetamol

Fix ed dose Tap entadol +

i ed d e c L idocaine

Fix ed dose combination of Nap rox en + Paracetamol Nimesulide

Fix ed dose combination of Paracetamol + Diclofenac + Famotidine Fix ed dose combination of Nimesulide + Pitofenone + en i e ini en c Fix ed dose combination Paracetamol + Diclofenac

Omep raz ole

Fix ed dose combination Paracetamol inj ection

Nimesulide

+ +

Nimesulide

combination

Paracetamol

Fix ed dose combination of Tranex amic Acid + Proanthocyanidin

Fix ed dose combination of Diclofenac + Paracetamol + Chlorzo x azo ne + Famotidine of

L ornox icam

Fix ed dose combination of Glucosamine + Methylsulfonylmethane + V itamin D + Manganese + n e inc

Fix ed dose combination of Diclofenac + Tramadol + Paracetamol

Fix ed dose combination S erratiop ep tidase

combination

Fix ed dose combination of H ep arin + Diclofenac

Fix ed dose combination of Diclofenac + Tramadol + Chlorzo x azo ne Dicyclomine

Fix ed dose combination of Phenylbutazo ne + S odium S alicylate

Fix ed dose combination of Nimesulide + Diclofenac

Fix ed dose combination of Paracetamol + Domp eridone

+ +

Here is the complete list of all drug combinations banned by the ministry: Fix ed dose combination Paracetamol + R abep razo le

Fix ed dose combination of Paracetamol Phenylep hrine + Chlorp heniramine e e an a eine

+ +

Fix ed dose combination of Tamsulosin + Diclofenac

ina i n en

Fix ed dose combination Paracetamol + Tramadol

ide

L ornox icam

Fix ed dose combination of Paracetamol + S erratiop ep tidase

L ornox icam

Fix ed dose combination of Diclofenac + Paracetamol + Magnesium Trisilicate Fix ed

dose combination e id ne a eine

Paracetamol

Fix ed dose combination of Ammonium Chloride + S odium Citrate + Chlorp heniramine Maleate + Menthol Fix ed dose combination Prochlorp erazi ne Maleate

Paracetamol

i i a e e a i e ida e en e ic c a ed ni ic enac a i and a e c c ine

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1081

DRUGS UPDATE Fix ed dose combination Paracetamol S usp ension

Nimesulide

Fix ed dose combination Paracetamol + Famotidine

Aceclofenac

i ed d e c Carnosine

ina i n

cec

enac

i i c na e a e and Ornidaz ole tablets i ed d e c Phenazo p yridine

+ inc

ina i n

Fix ed dose combination of Diclox acillin + S erratiop ep tidase

cin a e i

i i c na e a e tablet and Ornidazo le tablets

Fix ed dose combination of Paracetamol + Methionine

i ed d e c Phenazo p yridine

ina i n

Amox ycillin

Fix ed dose combination of Paracetamol + Disodium d en i a e a eine DL

acin

+ cin

acin

Fix ed dose combination of Disodium H ydrogen Citrate + Paracetamol

Fix ed dose combination of Azi thromycin + Cefp odox ime

i ed d e c Codeine

Fix ed dose combination of L ignocaine i a e acin ec e a ne

i ed d e c Paracetamol

ina i n a ace a ina i n

a eine

cec

enac

Fix ed dose combination of Diclofenac + Paracetamol inj ection i ed d e c

ina i n

Fix ed dose Diclox acillin

combination

i ed d e c a i a

cin efi i e of

Amox icillin

ina i n ana e i ed

ici in

ina i n efi i e ine

i ed d e c ina i n a i a anic cid i ed d e c

acin i a

anide

Fix ed dose combination of Cefp odox ime Prox etil + e acin i i Fluconazo le

cin

ecnida

i ed d e c ina i n e Ornidazo le + Alp ha Tocop herol Acetate i ed d e c

ina i n i

e and acin

acin

Fix ed dose combination of Azi thromycin + acin

i ed d e c

Dox ycycline

ina i n efi i e e

i ed d e c ina i n Me nida e inc ce a e

acin

Fix ed dose combination of Dip henox ylate + Atrop ine + Furazo lidone

1082

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Fix ed dose combination of Metronidazo le + acin dose e ine

combination

Amox icillin

i ed d e c ina i n i Fluticasone + Clotrimazo le + Neomycin

acin

Fix ed dose combination of Azi thromycin + Ambrox ol Fix ed dose combination of Cilnidip ine + Metop rolol S uccinate + Metop rolol Tartrate i ed d e c

ina i n

i ed d e c ina i n D ic cid i a in i ed d e c Fix ed dose Telmisartan

inine i denafi a a in i a in + Pyridox ine

ina i n Me combination

in of

a a in

Clindamycin

+ +

Fix ed dose combination of L - 5Methyltetrahydrofolate Calcium + Escitalop ram

acin

nida

Fix ed dose combination of Olmesartan H ydrochlorothiazi de + Chlorthalidone

Fix ed dose combination of Amox ycillin + Tinidazo le Fix ed dose combination S erratiop ep tidase

acin

Fix ed dose combination of Cep halex in + Neomycin + Prednisolone

ici in efi i e

ina i n

i ed d e c ina i n inc i cina e

Fix ed dose combination of Metronidazo le + Tetracycline

Fix ed dose combination of Azi thromycin + e acin i ed d e c

Fix ed dose combination of Cefurox ime + L inezo lid

Fix ed

Fix ed dose combination Promethazi ne

Pholcodine

Fix ed dose combination Promethazi ne

Paracetamol

i ed d e c ina i n e a i ine in i a ac in ce ine i ace a

+ +

DRUGS UPDATE Fix ed dose combination of Cetirizi ne + Carbamazi ne

Diethyl

i ed d e c ina i n Metformin 50 mg

Fix ed dose combination of Dox ylamine + Pyridox ine + Mefenamic Acid + Paracetamol

Fix ed dose combination Pioglitazo ne + Metformin

i ed d e c ina i n Chlordiazep ox ide

i ed d e c ina i n Metformin 40 mg

a e ine idini

Fix ed dose combination of Imip ramine + Diazep

i a ne

Glimep iride i i ide

combination

Flup entix ol

Fix ed dose combination of Pioglitazo ne 15 Metformin 850 mg

Fix ed dose combination Prochlop erazi ne

Paracetamol

Fix ed dose combination of Metformin ER Gliclazi de MR + V oglibose

Fix ed dose Escitalop ram

Fix ed dose combination of Gabap entin Mecobalamin + Pyridox ine + Thiamine Fix ed

dose combination dia e ide Trihex yp henidyl

of i

Fix ed dose combination Polynicotinate + Metformin +

Imip ramine e a ine

Fix ed dose combination of Chlorp romazi ne + Trihex yp henidyl Fix ed dose combination Acid + S ilymarin Fix ed

U rsodeox ycholic

dose

combination of Metformin i i a ne i e i ide

Fix ed dose combination of Gliclazi de 80 Me in

mg +

Fix ed dose combination of V oglibose + Metformin + Chromium Picolinate i ed d e c ina i n i Metformin 50 0/ 10 mg

i a ne

Fix ed dose combination of Glimep iride 1 mg/ i i a ne Metformin 10 0 mg/ 10 mg/ 1 0 mg Fix ed dose combination of Glimep iride 1 i i a ne Me 850 mg/ 850 mg

mg/ in

mg + +

Chromium

Fix ed dose combination of Metformin + Gliclazi de + Pioglitazo ne + Chromium Polynicotinate Fix ed dose combination of Metformin + Gliclazi de + Chromium Polynicotinate Fix ed dose combination of Glibenclamide + Me in i i a ne i ed d e c e ea e

ina i n Me i i a ne

i ed d e c ina i n Me Pioglitazo ne 5 mg

in ained i e i ide in

Fix ed dose combination of Chloramp henicol + ec e a ne i a e i n caine i ed d e c ina i n i a e acin + L ignocaine + Glycerine and Prop ylene Glycol Fix ed dose combination of Chloramp henicol + i n caine e a e a ne i a e acin n i ine i ed d e c ina i n e a e a ne i n caine

acin

i a

Fix ed dose combination of Gentamicin S ulfate + i a e e a e a ne i n caine

Fix ed dose combination of Metformin 850 i i a ne i e i ide

mg +

Fix ed dose combination of Clotrimaz ole ec e a ne acin i n caine

Fix ed dose combination of Metformin 850 i i a ne i e i ide

mg +

i ed d e c ina i n ec e a ne Clotrimazo le + Chloramp henicol + Gentamicin + L ignocaine ear drop s

Fix ed dose combination of Metformin 05 mg/ ic a ide i i a ne

Fix ed dose combination of Paracetamol + Domp eridone i ed d e c Carnosine

Fix ed

Fix ed dose combination of Magaldrate + Famotidine + S imethicone

Metformin

Fix ed dose combination of Metformin + Glimep iride + Methylcobalamin

a e a

Fix ed dose combination of V oglibose + Pioglitazo ne + Metformin dose combination c i ine

ina i n

Flunarizi ne

e inc

Fix ed dose combination of Cyp rohep tadine + Thiamine

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1083

DRUGS UPDATE Fix ed dose combination of Magaldrate + R anitidine + Pancreatin + Domp eridone

Fix ed dose combination of Thyrox ine + Pyridox ine + Folic Acid

Fix ed dose combination of R anitidine + Magaldrate + S imethicone

Fix ed dose combination of Gentamicin + Dex amethasone + Chloramp henicol + Tobramycin + acin

Fix ed dose combination of Magaldrate + Pap ain + Fungal Diastase + S imethicone i ed d e c Domp eridone

ina i n

a e a

e inc

Fix ed dose combination of Famotidine + Ox ytacaine + Magaldrate Fix ed dose combination Domp eridone + S imethicone

R anitidine

Fix ed dose combination of Clidinium + Paracetamol + ic c ine c i a ed i e ic ne Furaz olidone

i ed d e c Ox etacaine

ina i n

acin

inc

a n ine

Fix ed dose combination of Ox etacaine + Magaldrate + Famotidine i ed d e c ina i n an a e a en e ic c a ed a e inc a n ine a i c a ed a e i ed d e c ina i n inc Magnesium H ydrox ide + Dried H ydrox ide + S imethicone

a n ine Aluminium

i ed d e c S ucralfate

a n ine

ina i n

inc

i ed d e c ina i n Me e e ine nne M ca e Streptococcus faecalis + Clostridium butyricum + Bacillus mesentericus + L actic Acid aci Fix ed dose combination of i a e ac ic cid aci i ed d e c V alerate

ina i n

i denafi

Fix ed dose combination of ideca en ne inc Methylcobalamin + Pyridox e eni e ca ni ine a

1084

Clindamycin

adi

Clomifene Citrate + ic cid ine + L ycop ene + a e inine

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Fix ed dose combination of Dex tromethorp han + e ine ai ene in Fix ed dose combination of Paracetamol + L oratadine + Phenylep hrine + Dex tromethorp han + a eine +

Fix ed dose combination of Azi thromycin + Acebrop hylline

Fix ed dose combination of R anitidine + Magaldrate

Fix ed dose combination of Nimesulide en e ine a eine e ce i i ine

Fix ed dose combination of R abep razo le + Diclofenac + Paracetamol i ed d e c ina i n Me nida e inc ce a e

Fix ed dose combination of Nimesulide + L oratadine + Phenylep hrine + Ambrox ol i ed d e c ina i n e ine Phenylep hrine + Chlorp heniramine Maleate

Fix ed dose combination of Alginic Acid + S odium ica na e ied ini d ide Magnesium H ydrox ide

Fix ed dose combination of Metronidazo le + L op eramide

Fix ed dose combination of Dex tromethorp han + e ce i i ine en e ine inc

Fix ed dose combination of Dip henhydramine + Terp ine + Ammonium Chloride + S odium Chloride + Menthol Fix ed dose combination of Nimesulide Paracetamol + Cetirizi ne + Phenylep hrine

Fix ed dose combination of Paracetamol + L oratadine + Dex tromethorp han + Pseudoep hedrine a eine Fix ed dose combination of Chlorp heniramine Maleate + Dex tromethorp han + Dex tromethorp han + Guaifenesin + Ammonium Chloride + Menthol Fix ed dose combination of Chlorp heniramine Maleate + Ammonium Chloride + S odium Citrate Fix ed dose combination of Cetirizi ne en e ine a ace a inc c na e

Fix ed dose combination of Ambrox ol + Guaifenesin + Ammonium Chloride + Phenylep hrine + Chlorp heniramine Maleate + Menthol Fix ed dose combination of Dex tromethorp han + e ine eni a ine Ma ea e Guaifenesin i ed d e c ina i n e ce i i ine Ambrox ol + Phenylep hrine + Guaifenesin Fix ed dose combination of Dex tromethorp han + Chlorp heniramine + Chlorp heniramine Maleate Fix ed dose combination of Cetirizi ne + Ambrox ol + Guaifenesin + Ammonium Chloride + Phenylep hrine + Menthol

DRUGS UPDATE Fix ed dose combination of Chlorp heniramine + en e ine a eine

Fix ed dose combination of Paracetamol Dex tromethorp han + Chlorp heniramine

Fix ed dose combination of Dex tromethorp han + Trip rolidine + Phenylep hrine

Fix ed dose combination of Phenylep hrine + Promethazi ne

Fix ed dose combination of Terp in H ydrate + Dex tromethorp han + Menthol

i ed d e c Menthol

Fix ed dose combination of Dex tromethorp han + en e ine inc c na e Men

Fix ed dose combination of Dex tromethorp han + Ambrox ol + Guaifenesin + Phenylep hrine + Chlorp heniramine

Fix ed dose combination of Chlorp heniramine + Codeine + S odium Citrate + Menthol S yrup i ed d e c e ine

ina i n

acin

i ed d e c ina i n e ine Dex tromethorp han + Phenylep hrine + Menthol

i ed d e c e ine

ina i n

i ed d e c R anitidine

ina i n

i ed d e c Phenylep hrine + Paracetamol

e e

acin

ce i i ine

ina i n e ce i i ine Ambrox ol + Guaip henesin +

Fix ed dose combination of Cetirizi ne + e e an en e ine inc Gluconate + Paracetamol + Menthol

ina i n

Pholcodine

deine e

+ +

ce i i ine

Fix ed dose combination of Cetirizi ne Phenylep hrine + Dex tromethorp han + Menthol

Fix ed dose combination of R ox ithromycin + S erratiop ep tidase Fix ed dose combination of Phenylep hrine + Trip rolidine

Paracetamol

Fix ed dose combination of Acetaminop hen + L oratadine + Ambrox ol + Phenylep hrine Fix ed dose combination of Cetirizi ne Acetaminop hen + Dex tromethorp han en e ine inc c na e

Fix ed dose combination of Dip henhydramine + ai ene in e ine ni ide Menthol Fix ed dose combination of Chlorp heniramine Maleate + Codeine S yrup

Fix ed dose combination of Paracetamol + Pseudoep hedrine + Dex tromethorp han + Cetirizi ne

Fix ed e

Fix ed dose combination of Dip henhydramine + ai ene in ni ide e ine

Fix ed dose combination of Paracetamol + en e ine e a adine inc c na e Ambrox ol

Fix ed dose combination of Chlorp heniramine + Dex tromethorp han + Phenylep hrine + Paracetamol Fix ed dose combination of Dex tromethorp han + Promethazi ne Fix ed dose combination of Diethylcarbamazi ne Citrate + Cetirizi ne + Guaip henesin Fix ed dose combination of Pseudoep hedrine + Dex tromethorp han + Cetirizi ne Fix ed dose combination of Chlorp heniramine + Phenylep hrine + Dex tromethorp han + Menthol Fix ed dose combination of Ambrox ol + Terbutaline + Dex tromethorp han Fix ed dose combination of Dex tromethorp han + Chlorp heniramine + Guaifenesin Fix ed

dose combination of e ine ai ene in e

Terbutaline + e an

Fix ed dose combination of Dex tromethorp han + Trip olidine + Phenylep hrine

+ +

dose e

combination of Cetirizi ne an inc c na e Men

i ed d e c ina i n M n e a ce ine

ce i i ine

Fix ed dose combination of Dex tromethorp han + Phenylep hrine + Ammonium Chloride + Menthol Fix ed dose combination of Dex tromethorp han + e ine ai ene in Men i ed d e c ina i n a ace a a eine en e

c i a ine ine

Fix ed dose combination of Nap hazo line + Carbox ymethyl Cellulose + Menthol + Camp hor + Phenylep hrine Fix ed dose combination of Dex tromethorp han + Cetirizi ne Fix ed dose combination of a ace a e ce i i ine a eine

Nimesulide + en e ine

Fix ed dose combination of Terbutaline + Ambrox ol + ai ene in inc Men

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1085

DRUGS UPDATE Fix ed dose combination of Chlorp heniramine + Alcohol S yrup

Codeine

Fix ed dose combination of Ambrox ol + S albutamol + Theop hylline

Fix ed dose combination of Dex tromethorp han + Phenylep hrine + Guaifenesin + Trip rolidine

Fix ed dose combination of Cetirizi ne + Nimesulide + Phenylep hrine

Fix ed dose combination of Ammonium Chloride + e ine e e an

Fix ed dose combination of Chlorp heniramine + en e ine a ace a in c na e

Fix ed dose combination of Diethylcarbamazi ne + Cetirizi ne + Ambrox ol

Fix ed dose combination of Acetaminop hen + Guaifenesin + Dex tromethorp han + Chlorp heniramine

Fix ed dose combination of Ethylmorp hine + Noscap ine + Chlorp heniramine Fix ed dose combination of Dex tromethorp han + Ambrox ol

Cetirizi ne

Fix ed dose combination of Cetirizi ne Dex tromethorp han + Phenylep hrine + Tulsi +

i ed d e c ina i n e ine Dex tromethorp han + Ammonium Chloride + Menthol Fix ed dose combination of Ambrox ol + Guaifenesin + Phenylep hrine + Chlorp heniramine Fix ed dose combination of Paracetamol + en e ine eni a ine inc Gluconate Fix ed dose combination of Dex tromethorp han + en e ine e i i ine a ace a a eine Fix ed dose combination of Dex tromethorp han + Chlorp heniramine + Guaifenesin + Ammonium Chloride i ed d e c ina i n e e an inc

ce i i ine

Fix ed dose combination of Paracetamol en e ine e ce i i ine a eine

Fix ed dose combination of Chlorp heniramine + Ammonium Chloride + S odium Chloride Fix ed dose combination of Paracetamol + e e an e ine en e ine Dip henhydramine Fix ed

dose combination of S albutamol e ine ai ene in Men

Fix ed dose combination of Chlorp heniramine + Ammonium Chloride + Noscap ine + S odium Citrate Fix ed e

dose e

combination of Cetirizi ne + an e ine ai ene in

Fix ed dose combination of Diethylcarbamazi ne + Chlorp heniramine + Guaifenesin Fix ed dose combination of K etotifen + Cetirizi ne Fix ed

dose combination e ine ine

Terbutaline

Fix ed dose combination of K etotifen + Theop hylline

1086

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

Fix ed dose combination of Phenylep hrine + Paracetamol + a eine Fix ed dose combination Dex tromethorp han

Cetirizi ne + Ambrox ol + Guaifenesin

i ed d e c ina i n e ce i i ine a ace a en e ine a eine i ed d e c ina i n a eine a ace a Phenylep hrine + Chlorp heniramine i ed d e c

ina i n e

i en e

ce i i ine

Fix ed dose combination of Paracetamol + e ce i i ine en e ine in c na e Fix ed dose combination of Paracetamol en e ine i idine a eine

i ed d e c ina i n a eine a ace a + Phenylep hrine + Cetirizi ne i ed d e c ina i n a eine a ace a Chlorp heniramine

Fix ed dose combination of Ammonium Chloride + Dex tromethorp han + Cetirizi ne + Menthol Fix ed dose combination of Dex tromethorp han + Paracetamol + Cetirizi ne + Phenylep hrine Fix ed dose combination of Chlorp heniramine + Terp in + Antimony Potassium Tartrate + Ammonium Chloride + S odium Citrate + Menthol Fix ed dose combination of Terbutaline + Etofylline + Ambrox ol Fix ed dose combination of Paracetamol + Codeine + Chlorp heniramine Fix ed dose combination of Paracetamol e d e ed ine e i i ine a eine

Fix ed dose combination of Chlorp heniramine + Ammonium Chloride + Menthol Fix ed dose combination of N- Acetyl Cysteine + en e ine e ce i i ine

DRUGS UPDATE Fix ed dose combination of Dex tromethorp han + Phenylep hrine + Trip olidine + Menthol

Fix ed dose combination of Dex tromethorp han + en e ine e i i ine inc Men

Fix ed dose combination of S albutamol + Cetirizi ne + Ambrox ol

Fix ed dose combination of Terbutaline + N- Acetyl L - Cysteine + Guaifenesin

Fix ed dose combination of Dex tromethorp han + en e ine e ine ai ene in Chlorp heniramine

Fix ed dose combination of Calcium Gluconate + e ce i i ine

Fix ed dose combination of Nimesulide + Cetirizi ne + Phenylep hrine Fix ed

dose combination of Nap hazo line + eni a ine inc a e ic cid S odium Chloride + Chlorobutol Fix ed

dose combination of e ine en e ine Guaifenesin Fix ed

dose e ine

combination

Paracetamol + eni a ine S albutamol

Fix ed dose combination of Dex tromethorp han + Phenylep hrine + Guaifenesin + Cetirizi ne + Acetaminop hen Fix ed

dose combination of Guaifenesin e ine eni a ine a ace a

Fix ed dose combination of Chlorp heniramine + Ammonium Chloride + Chloroform + Menthol Fix ed dose combination of S albutamol + Choline Theop hyllinate + Ambrox ol Fix ed dose combination of Chlorp heniramine + Codeine Phosp hate + Menthol S yrup Fix ed dose combination of Pseudoep hedrine + e ine Fix ed dose combination en e ine a ace a Nimesulide

Cetirizi ne + a eine

Fix ed dose combination of Dex tromethorp han + Cetirizi ne + Guaifenesin + Ammonium Chloride Fix ed dose combination of Ambrox ol + S albutamol + Choline Theop hyllinate + Menthol Fix ed dose combination of Paracetamol + Chlorp heniramine + Ambrox ol + Guaifenesin + Phenylep hrine Fix ed dose combination of Chlorp heniramine + a a a a a ni ide S odium Citrate + Menthol i ed d e c ina i n e ine e i i ine Phenylep hrine IP + Guaifenesin + Menthol Fix ed dose combination of Dex tromethorp han + Ambrox ol + Ammonium Chloride + Chlorp heniramine + Menthol

Fix ed dose combination of Paracetamol e ce i i ine e d e ed ine

Fix ed dose combination of S albutamol + Choline Theop hyllinate + Carbocisteine Fix ed dose combination of Chlorp heniramine + V itamin C Fix ed dose combination of Calcium Gluconate + Chlorp heniramine + V itamin C Fix ed dose combination of Chlorp heniramine + a ace a e d e ed ine a eine Fix ed

dose combination of Guaifenesin + e ine eni a ine en e ine a ace a e a i e ida e a en e ic c a ed an e ni

Fix ed dose Pheniramine

combination

i ed d e c idic cid d c d

Paracetamol

ina i n e a e a ne en a icin na a e in ine

i ed d e c ina i n Mic na e inc ae

acin

Fix ed dose combination of Clobetasol + Gentamicin + Mic na e inc ae i ed d e c ina i n e ce i i ine Ambrox ol + Phenylep hrine + Paracetamol

Fix ed dose combination of Permethrin + Cetrimide + Menthol i ed d e c Clotrimazo le d c d

ina i n ec e a ne + Neomycin + in ine

Fix ed dose combination of Neomycin + Dox ycycline i ed d e c Fluocinolone + Chlorocresol

ina i n i acin Clotrimazo le + Neomycin +

i ed d e c ina i n e c na e inc ae i ed d e c en a icin d c d

ina i n in ine

acin

e a e a ne na a e

Fix ed dose combination of Clobetasol + Gentamicin + na a e d c d in ine K etoconazo le

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1087

DRUGS UPDATE Fix ed dose combination of Allantoin + Dimethicone + ea ene ce in i id a a n

i ed d e c S usp ension

i ed d e c Cetrimide

Fix ed dose combination of Albuterol + Etofylline + e ine Men

ina i n c i a ine

Fix ed dose e a e a ne d c d

combination of e cin na a e in ine ce

Fix ed dose combination of Clobetasol + Neomycin + Miconazo le + Clotrimazo le Fix ed dose combination of K etoconazo le + Tea Tree i an in inc ide e e a a i a ende i a de

Fix ed

ina i n ec e a ne e cin na a e in ine ce ina i n e a e a ne inc a e i a e

i ed d e c ina i n a ic cid Nap hazo line + Menthol + Camp hor + Methyld en a e i ed d e c ina i n Dex tromethorp han

e ine

Fix ed dose combination of Menthol + Anesthetic Ether Fix ed dose combination of Dex tromethorp han + Chlorp heniramine + Ammonium + S odium Citrate + Menthol

Phenytoin

S albutamol ine

dose combination ena ne a eine

Paracetamol

Fix ed dose combination of Dried Aluminium H ydrox ide Gel + Prop antheline + Diazep am i ed d e c ina i n e ine Phenylep hrine + Chlorp heniramine + Paracetamol i ed d e c Clotrimazo le d c d

ina i n ec e a ne + Gentamicin + in ine

Fix ed dose combination of Ammonium Citrate + i a in ic cid inc ae i ed d e c ina i n Phyridox ine + Nicotinamide i ed d e c Metformin

ina i n

ine

ia ine

Fix ed dose combination of Thyroid + Thiamine + i a in id ine a ci an ena e Tocop heryl Acetate + Nicotinamide

Fix ed dose combination of Clotrimazo le + ec e a ne i n caine acin ce ic Acid + S odium Methyl Paraben + Prop yl Paraben

Fix ed dose combination of Paracetamol + Ambrox ol + Phenylep hrine + Chlorp heniramine ■■■■

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

dose combination of e e ine e ine

e ine

Fix ed dose combination of Phenylep hrine + eni a ine a ace a e ine a eine

Fix ed dose combination of Gliclazi de 40m g + Metformin 40 mg

1088

Fix ed dose combination of Ascorbic Acid + Menadi ne di i a e in i a ic Calcium Phosp hate + Adrenochrome Monosemicarbazo ne

Fix ed dose combination of Ergotamine Tartrate + e ad na ac a eine a ace a of

Fix ed dose combination of Telmisartan + Metformin

Fix ed dose combination of Dex tromethorp han + eni a ine e ine

Fix ed dose combination Phenobarbitone

ina i n

nida

Fix ed dose combination of Guaifenesin + i en d a ine e ine en e ine

Fix ed dose combination of Clobetasol + Neomycin + Mic na e inc ae

i ed d e c en a icin Chlorocresol

Fix ed d

acin

Fix ed dose combination of Paracetamol + en e ine e ce i i ine di i a e

Fix ed dose combination of Clobetasol Prop ionate + acin nida e e inafine

i ed d e c i i na e d c d

i ed d e c Theop hylline

ina i n

AROUND THE GLOBE

News and Views Standards Certification for Products and Services Concerning Health, Safety, Environment to be Made Mandatory Ma c ea ndian anda d i a ed e a ia en i a a e a d in en in i a i d c and e ice in e c n e i i n in ne ea ndian anda d i i e a c e a i d c and e ice anda ce ifica i n and a n a c iance ndian anda d e e a ien ea e e i a e e i e e e e n en in an a ic e ce e ice ic i c n ide nece a in ie ea a e en i n en e en i n dece i e ac ice ec i e c nde e anda ce ifica i n e i e i i e c n e e ai d c and i a e in e en in i anda d d c In order to sup p lement ease of doing business i i in nnece a fie d in ec i n e i a i i n e dec a a i n c n i e ndian anda d ce ain ca e ie i ane in en ena i i n a e een ade i a i n c iance the standards which include imp risonment up ea i fine en i e e a e d d ced d i e i i n e i can n de eca d c n c nfi in e anda d in addition to cancellation of the license of the an ac e can a de c en a i n e c n e in ca e d and e ice d n c n e anda d e e ice ec in e c n a n and ec e a a e ec n en e a i e e ice c a ea e ice ed ca i n e ice n e ice and e a e also been included under the standardizat ion e i e in addi i n a ic e and ce e n

e i i i n e ea ndian anda d a e a i na anda d d

CDC Adds Another Destination to its Zika Interim Travel Guidance n edne da e en e i ea e n and e en i n added ne e de ina i n i in e i a e idance e a ed i a i e a i ed a a e n ice e e ac ice n anced eca i n e e a e in e i n and ce ain c n ie i n in i a i an i i n can e e c e e i e a ec ed c n ie e i n a nc cdc a e a e i a a e in ai n

N95 Respirators may not be Superior in Efficacy to Surgical Masks in Clinical Settings en e i a a ea ed a e a ec i e ad an a e e ica a in a a e in e a e a ic e ie and e a ana i a e e a n i nifican di e ence e een e i a and ica a en ed ea ca e e a ec i n a ain an i i e ac e e i a in ec i n in c inica e in n an article p ublished online March 7 in the Canadian Medical Association Journal e e i M c ic ea n a i n anada and c ea e e further large randomized controlled trials to detect a en ia c inica i an di e ence in a e en a e Vitamin D does not Slow Disease Progression or Structural Change in Knee OA, Says Study i a in e en a i n a in a ien i a ic nee e a i i and e d i a in e e did n ed ce nee ain ed n a di e ence in M ea ed i ia ca i a e e a a ne d i ed in e March 8 issue of in JAMA an ai in M Men ie n i e Medica e ea c ni e i a ania a a ania a ia and c ea e en ed a ien i a ic nee and d i a in e e defined a n in ei icen e d ic a c nd c ed in a ania and ic ia a ia

Site of Metastasis Site Impacts Overall Survival in Prostate Cancer A study p ublished online March 7 in the Journal of Clinical Oncology a a ecific i e e a a e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1089

AROUND THE GLOBE in men with metastatic castration- resistant p rostate cance a e a cia ed i di e en ia e a i a e in e a ed ana i indi id a a ien da a en i en ed n nine a e ia nd a en i i e e a a e ad e edian e a i a n en i n e a a e ad i nifican e edian i a d a i n an en i n n i ce a ne e a a e n Men i n de n di ea e ad a edian e a i a n cc din an a a i a i a i ician a e ni e i Medica en e a a ina and ead a e d e e e a i n c d e ed di ec ea en and in a ien c inician di c i n

Amniotic Patch Graft Safe for Patients Undergoing Glaucoma Drainage Implant Surgery For p atients undergoing glaucoma drainage imp lant e ac a a ni ic e ane and i ica c d ni a d i i e a e a a e and e ec i e c e in e i an e a e n e a i ed e ica di a c a a a ic e i e a e e c e ic e eca e e a e e an a en e en in e results at the recently concluded Annual Meeting of the e ican a c a cie M a ed a ed M e a c a e e n i e a e Mia i Mi e c Medicine aid e ad ea e e nd a e a ni ic e ane in e a e e e i e i e a de n a ed an e i e en ica c e ence a

Prevention Strategies should also Focus on Nonhip and Nonvertebral Fractures d i ed in e Ma c i e e Journal Osteoporosis International a a ac e e en i n a e ie d a c n indi id a i i i ainin n n i n n e e a ac e a e a n e a i a i ac e and e e a ac e Men and en i e e n e and ad a e e a nec ne ine a den i M c e e e e a e i e e e ei an e i i ac e ea ie ei a a a i ac en i c a ed e e a ac e

Retreatment with Sofosbuvir + Simeprevir may Help Hepatitis C Patients Who Failed to Respond to NS5A Inhibitor indin a d fi i ed Ma c in the j ournal Hepatology sup p ort the concep t of retreating

1090

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

NS 5 A inhibitor failures with the combination of i and i e e i e d e a e di c c e a ien a need ee ea en and e addi i n i a i in The study included 1 6 p atients who had failed to ac ie e ained i ic e n e n i a ed e a i dac a a i e in e e n and i a i in i i a na e i ea e in i i e e e a e ea ed ee i i i e e i i i a i in e end ea en a a ien ac ie ed e e i i an ifica i n and e a ien in e d ac ie ed ained i ica e n e a ien di c n in ed ea en d e ad e e e en i ic ai e

NACO Gets Rs 300 Crore More In a bid to further strengthen the national AIDS control a e e ea ini a ann nced an addi i na in e en e c e e ed i e Ma in i e ndia e new p lan to be imp lemented from Ap ril includes introduction of third- line treatment for more than a a ien inc ea in c n ace i e and raising the criteria for selecting p atients for free an i e i a e a nde e ne an p atients whose CD4 cell count is below 5 0 0 will be candida e ee

Brazil Lowers Limit of Measure for Microcephaly e e n en a i a e ed e ead circumference norm used to measure susp ected cases of microcep haly in line with the norms p rescribed by e d ea ani a i n cc din e ea Mini a ec ed a in e c ndi i n a i a e a ead ci c e ence c e inc e e a e in an e c i n c e ea ie c a c a e and e a e in an

The First Uterus Transplant in US Fails e c e e and inic ann nced a e fi e transp lant p erformed in the U nited S tates in late e a a e e and inic i ea a ai ed cc din e e e and inic e an an ed e a e ed a e e a ien e ed a dden c ica i n e e e c inic a n ided de ai a e ea n e an an ai e

AROUND THE GLOBE Ultrasound may be Better at Cancer Detection in Women with Mammography-negative Dense Breasts n e i indin e ec i e c a a i e ia a a nd ad a e e incremental breast cancer detection rate as comp ared n e i and a i i a a e i i e a e in a a ne a i e den e ea n a a ne a i e c eenin a ici an i den e ea addi i na ea cance e e de ec ed n e i de ec ed ea cance e a nd de ec ed cance e a a i M M dne c ic ea dne Medica c ni e i dne dne a ia and c ea e e ei findin in e Journal of Clinical Oncology

Patients with Psoriasis have High Prevalence of Subclinical Inflammation ne d a nd a e e a ence c inica in a a e i n c a n i i ei i e en n i i and e ia ic a in a a i n i i in a ien i c ane ia i nd e i de e in ia ic a i i a a i a i a ien ad c inica n i i and e a ed a a ia a ien i in a a e i n e e i nifican de an e i e i n ea ea e e ence in a a i n in e M a a a cia ed i ac i e in e results of the cross- sectional and longitudinal analysis ance ca a ini M a ni e i an en e e en e e an and c ea e a e i ed n ine e a in e Annals of the Rheumatic Diseases cc din e a i transition to p soriatic arthritis is considered a critical e in definin e n e c e e a di ea e in a ien i ia i and a e ea in e en i n

Percutaneous Septal Ablation may be Safe in the Young Too Percutaneous alcohol sep tal ablation is similarly e ec i e ed c i n in n and e de a ien n e a ien a e a e i ced e e a ed a i en ic a c nd c i n di ance e n e a i a e and i ad e e a ic e en in e ced e a e in n and e de a ien and a e c a a e a e a c ed n n c i e e ic ca di a a ien Ma ie e M e e a di n ni i a ie e ein ie e ein e e e and and c ea e e

the long- term outcome of alcohol sep tal ablation for c i e e ic ca di a in e n and the elderly online in the March issue of the Journal of American College of Cardiology: Cardiovascular Interventions The American College of Cardiology/ American H eart Association guidelines recommend p ercutaneous sep tal reduction therap y for elderly p atients and those with e i c idi ie

A Bedside Urine Test may Guide TB Treatment in HIV-positive Hospitalized Patients In a randomized controlled trial in four countries in ica e ed ide ine a ed i a a in annan e a a cia ed i a e a i e i ed c i n in a ca e a i a e ee a n i i e i a a ien i a a in annan i a c i id ec e ee an eda M c e ni e i a e n in ica and c ea e e a i dec ine in a i a a e een d e e ac a ea en a a ed e ic and in e a ien e a aid a e imp lementation of lip oarabinomannan testing may be eneficia in i a e e dia n ic e ce a e ca ce and e e a ien e en i e e e i ne ad anced i n e i n and an ina i i e e ec a e e findin a e i ed n ine Ma c in The Lancet

Canada Task Force Releases Guidelines on Lung Cancer Screening e anadian a ce n e en i e ea a e a i ed i i e e ide ine n n cance c eenin i d e c ed a The guidelines recommend that adults aged 5 to 74 ea and a e a i n cance i d undergo yearly low- dose CT up to three times only at centers with ex p ertise in early diagnosis and treatment n cance d e e i c eenin e a ed a e ec end a ain e e c e a i i c e ide ine d n ec end c eenin e e n e an de an i e a in i an ac ea e ide ine e e i ed n ine March 7 in the Canadian Medical Association Journal

Study Finds Association Between Pregnancy Hypertension Disorders and Risk of Cardiomyopathy en ad e a i na e en i n e e p reeclamp sia and moderate p reeclamp sia are at a a i ica i ni ican inc ea ed i ca di a e an n a e de i e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

e a

1091

AROUND THE GLOBE says a new study p ublished March 8 in the Journal of the American Medical Association e d c c n i ed i i n en i a ea ne e nanc endin in i e i i i in en a a i na a ien e i e e d a c nd c ed da e en M e ide i e ea c a en e n i en a en en a and c ea e

NGOs Campaign for Antibiotics-free Meat Products NGOs in R aj asthan camp aigned against the use of an i i ic in ea d c a e e ed e d n e i a n Ma c n e n e na i na a d ede a i n c n e a e c n e acce n i i and a e d decided e e e d n e i a i e e e n i i ic e Men “ The organiz ation urged the fast food comp anies around e d a e a c i en e a e ea ai ed i e ine e an i i ic ee a a ena a ice n e ni cie aid e e e ad een a en in ie d ea ani a i n a nin that the antibiotic resistance was rising to dangerously i e e in a a e d a ena aid e rep ort also outlined that we were heading to a p ostan i i ic e a in ic i an edicine d in and c n in ec i n and in in ie c d nce a ain i e aid

DIPSI Declares March 10 as Gestational Diabetes Mellitus Day in India i

e a i na ia e e Me i M ic i nd a n e nan en a a in e ide ic i n e i i n ann a in ndia e ia e e in e nanc d in ndia dec a ed Ma c a M a i a e fi i e e e a an c n a dec a in e M a in e d e ian e ea c and ainin n i e i an e d ia e e nda i n ede a i n e ic nec ica cie ie ndia ined and

with DIPS I to launch nationwide camp aign against M ic e ee need e ac ed a e e e India Today

ABO Blood Groups May be an Important Risk Marker for Venous Thromboembolic Events d i i n d d n in e da a a e in en a and eden a nd a indi id a i n n d a e a i e i en e ic and ca di a c a e en e i e a e a i e e e ed e nanc e a ed en e i dee ein i and na e i en i a an e Medica ide i and i a i ic a in a n i e c eden and c ea e c nc ded a a d a en ia e ed i a ai a e edic i n e iden i in a i indi id a i c inica i i e i ed e c a i n i e i a e e d a i ed n ine Ma c in e Journal Circulation

Long-term use of Metformin may Increase risk of B12 Deficiency L ong- term use of metformin is associated with increased i deficienc and ane ia e e ea c e ed da a e ia e e e en i n a and e ia e e e en i n a c e d ic ed a ici an a i i e dia e e e an ea ea e a e a e e e were lower in the metformin group than the p lacebo and deficienc a e c n a ec in e n e in e n a in e d de ine e e e e e ed in e n e in n ace ani a da M Med a ea e ea c n i e a i e M and c ea e e ine e in i a in e e in a ien ecei e n e e in e dia e e e a i na dia e e c ic a ian nd e e indica i n e d findin e e fi i ed n ine e a in the Journal of Clinical Endocrinology and Metabolism

■■■■

1092

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

INSPIRATIONAL STORY

Words of Wisdom WORDS OF GREAT WISDOM, THE NATIVE AMERICAN CODE OF ETHICS: i e i e e

a a ne

e an e a e a a e i find

ea c e e a a i i

n ei a idance

n a e a i n n ea ned i en i i n n e e e eac e n e i

e e

a e

n i ea

id e

i i a

in e ea

a a i e

Ma e c n ci

ee e a anced e and ea

d and

e e i e e

e ec

e ei i

i n

a ne

d i e e e e ed and a c

e i a

de i ic e

in e ni e e i

and i e e

d a i

and a e e i i d

ain i e

i e e ne i i in i ni e e

i e and

cann n

e ie ne i

ad and

i i

e in ei ea

e an

ac ice

and eed e i

Men a e i i a e i na e and e d en en e ind ic in

deci i n a

e fi

e a e a

e ec e i ac and e na ace e ac ed and e i i ec i i idden

a e

i en

ca e i ne e ind

ni e i de ne

n a e i a e nd a i a e can e

i d en a e e eed e an en e a e n i e e ace

n a c

i e and d e e in e e na e e i n

e in a ad a

e i n

i i i i en i

n ance c ncei an e ea

e ne a i e ene

ad a

c c n ide a i n e e e e e

e ec a in a a e aced

e n a e a e n ne can a i

ea e e in e i ea e i e ec and n

e e ea i e n

n e

i eac e e

e and e

ica e a need e i i c e e i na ai

c e e

e i

e ie n

n i e

cann n

e and e

n ac i n

e e ecia

e fi

a ici a e in c a i

“There is perhaps nothing so bad and so dangerous in life as fear.” —Jawaharlal Nehru “Success usually comes to those who are too busy to be looking for it.” —Henry David Thoreau

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1093

LIGHTER READING

COFFEE DILEMMA

FROM SKIPPING

nde an i e i d c e n a die

an ea e a da en i a da and e ea i ced e ee e ne i e ee a e a ea fi e nd e nde e ned e in nea nd

a a a in e d c follow my instructions? ” e

nde n dded a in d

n e

c ed

aid

e dead a d da

i e e ie d d i and e ide i i in e i e a e an d d e c ee and e ie can e ie e a e e e c ed e i e and ened e e e a en and i a e e e a a e a i indeed a

Two old men were arguing the merits of their d c e fi ne aid d n anc d c e ea ed d a e a an a idne ai en nea a ea and en a e died a i e ai en a a e in d c i an e e a ed i iend en d c ea a idne can e e die a idne

ON TRIAL e a ia ad een in n da an acc ed c i in e c i e d and a ac ed e d e enc n d i e c an e ea inn cen i e c a e

Paul J Meyer

Dr. Good and Dr. Bad SITUATION: An HIV+ patient was found to have increased upper trunk subcutaneous adipose tissue.

It makes you prone to diabetes

e an ed ide e ed and a ed e en e ia a ed a inn cen a a e e ea d a e e idence a ain e

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

“Determine what specific goal you want to achieve. Then dedicate yourself to its attainment with unswerving singleness of purpose, the trenchant zeal of a crusader.”

It has no significance

e d e an i an ed i fi n e de e i didn a in e fi ace and a e i c a i e and inc n enience e de anded

1094

e i e aid d d i eca e e fi and en e d n a e ai a n e c ee e and aid a e in c a e e c in a nd e e and d d i eca e a i and can ai c ee

ean a ed e d c

KIDNEYS AND LIVERS

eca e ai en ai en

en d c

an and i i e e e a in an a en a d e e c ee eac nin

QUOTE

HUMOR

Lighter Side of Medicine

LESSON: In the study of Fat Redistribution and Metabolic Change

in HIV Infection (FRAM) trial, increased upper trunk subcutaneous adipose tissue (SAT) and decreased leg SAT are associated with higher 2-hour glucose in HIV infection. These body fat characteristics may identify HIV-infected patients with normal fasting glucose but even so at increased risk for diabetes.

Information for Authors Manuscripts should be prepared in accordance with the ‘Uniform requirements for manuscripts submitted to biomedical journals’ compiled by the International Committee of Medical Journal Editors (Ann. Intern. Med. 1992;96: 766-767). Indian Journal of Clinical Practice strongly disapproves of the submission of the same articles simultaneously to different journals for consideration as well as duplicate publication and will decline to accept fresh manuscripts submitted by authors who have done so. The boxed checklist will help authors in preparing their manuscript according to our requirements. Improperly prepared manuscripts may be returned to the author without review. The checklist should accompany each manuscript. Authors may provide on the checklist, the names and addresses of experts from Asia and from other parts of the World who, in the authors’ opinion, are best qualified to review the paper. Covering letter –

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The covering letter should explain if there is any deviation from the standard IMRAD format (Introduction, Methods, Results and Discussion) and should outline the importance of the paper. Principal/Senior author must sign the covering letter indicating full responsibility for the paper submitted, preferably with signatures of all the authors. Articles must be accompanied by a declaration by all authors stating that the article has not been published in any other Journal/Book. Authors should mentioned complete designation and departments, etc. on the manuscript.

Manuscript – Three complete sets of the manuscript should be submitted and preferably with a CD; typed double spaced throughout (including references, tables and legends to figures). –

The manuscript should be arranged as follow: Covering letter, Checklist, Title page, Abstract, Keywords (for indexing, if required), Introduction, Methods, Results, Discussion, References, Tables, Legends to Figures and Figures.

–

All pages should be numbered consecutively beginning with the title page.

Note: Please keep a copy of your manuscript as we are not responsible for its loss in the mail. Manuscripts will not be returned to authors. Title page Should contain the title, short title, names of all the authors (without degrees or diplomas), names and full location of the departments and institutions where the work was performed,

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Confidence intervals for the measurements should be provided wherever appropriate.

Results –

These should be concise and include only the tables and figures necessary to enhance the understanding of the text.

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

1095

Discussion –

This should consist of a review of the literature and relate the major findings of the article to other publications on the subject. The particular relevance of the results to healthcare in India should be stressed, e.g., practicality and cost.

References These should conform to the Vancouver style. References should be numbered in the order in which they appear in the texts and these numbers should be inserted above the lines on each occasion the author is cited (Sinha12 confirmed other reports13,14...). References cited only in tables or in legends to figures should be numbered in the text of the particular table or illustration. Include among the references papers accepted but not yet published; designate the journal and add ‘in press’ (in parentheses). Information from manuscripts submitted but not yet accepted should be cited in the text as ‘unpublished observations’ (in parentheses). At the end of the article the full list of references should include the names of all authors if there are fewer than seven or if there are more, the first six followed by et al., the full title of the journal article or book chapters; the title of journals abbreviated according to the style of the Index Medicus and the first and final page numbers of the article or chapter. The authors should check that the references are accurate. If they are not this may result in the rejection of an otherwise adequate contribution. Examples of common forms of references are: Articles Paintal AS. Impulses in vagal afferent fibres from specific pulmonary deflation receptors. The response of those receptors to phenylguanide, potato S-hydroxytryptamine and their role in respiratory and cardiovascular reflexes. Q. J. Expt. Physiol. 1955;40:89-111.

Figures – Two complete sets of glossy prints of high quality should be submitted. The labelling must be clear and neat. – All photomicrographs should indicate the magnification of the print. – Special features should be indicated by arrows or letters which contrast with the background. – The back of each illustration should bear the first author’s last name, figure number and an arrow indicating the top. This should be written lightly in pencil only. Please do not use a hard pencil, ball point or felt pen. – Color illustrations will be accepted if they make a contribution to the understanding of the article. –

Do not use clips/staples on photographs and artwork.

–

Illustrations must be drawn neatly by an artist and photographs must be sent on glossy paper. No captions should be written directly on the photographs or illustration. Legends to all photographs and illustrations should be typed on a separate sheet of paper. All illustrations and figures must be referred to in the text and abbreviated as “Fig.”. Please complete the following checklist and attach to the manuscript: 1. Classification (e.g. original article, review, selected summary, etc.)_______________________________ 2. Total number of pages ________________________ 3. Number of tables ____________________________ 4. Number of figures ___________________________

Books

5. Special requests _____________________________

Stansfield AG. Lymph Node Biopsy Interpretation Churchill Livingstone, New York 1985.

6. Suggestions for reviewers (name and postal address) Indian 1. ___________Foreign 1. _______________

Articles in Books

2. ___________

2. _______________

Strong MS. Recurrent respiratory papillomatosis. In: Scott Brown’s Otolaryngology. Paediatric Otolaryngology Evans JNG (Ed.), Butterworths, London 1987;6:466-470.

3. ___________

3. _______________

4. ___________

4. _______________

Tables –

These should be typed double spaced on separate sheets with the table number (in Roman Arabic numerals) and title above the table and explanatory notes below the table.

Legends – These should be typed double spaces on a separate sheet and figure numbers (in Arabic numerals) corresponding with the order in which the figures are presented in the text. –

1096

The legend must include enough information to permit interpretation of the figure without reference to the text.

Indian Journal of Clinical Practice, Vol. 26, No. 11, April 2016

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Acute Renal Failure and Silent Myocardial Infarction Following Multiple Honey Bee Stings

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