All India Institute Of Medical Sciences Research Articles

Hepatic venous outflow tract obstruction: treatment outcomes and development of a new prognostic score.

Results of endovascular interventions in hepatic venous outflow tract obstruction (HVOTO) have been reported from limited studies. Treatment outcomes and prognostic scores need further validation. To evaluate treatment outcomes and prognostic scores for hepatic venous outflow tract obstruction in an Indian population. Consecutive patients with hepatic venous outflow tract obstruction diagnosed at a tertiary centre were included. Technical success and clinical response after endovascular interventional therapy were documented. Predictors of survival were assessed with Cox-proportional model. A new score was derived from the factors significant on multivariate analysis and compared with Child-Turcotte-Pugh, model for end-stage liver disease (MELD), Rotterdam prognostic index (PI) and Budd-Chiari syndrome-transjugular intrahepatic portosystemic shunt ( BCS-TIPSS) PI. Three hundred and thirty-four patients (56.6% males), median age 24 (3-62) years were included. Hepatic vein was the commonest site of block-isolated hepatic vonous block in 48%, combined hepatic venous-inferior vena cava block in 46%. Endovascular interventional therapy was performed in 233/334 (70%) with 90% technical success. Clinical response was complete in 166 (71.2%), partial in 58 (24.9%) and no response in nine (3.9%). Majority of cases with HV block did not require TIPSS and could be treated with angioplasty (with/without stenting). On Cox-proportional multivariate analysis, Child class C and response to intervention were independent predictors of outcome and used to derive the All India Institute of Medical Sciences (AIIMS) hepatic venous outflow tract obstruction score. The 5-year survival was 92% (95% CI, 81-97%) for score ≤3, 79% (95%CI, 63-88%) for score >3 and ≤4, and 39% (95% CI, 21-57%) for score >4. The performance of AIIMS hepatic venous outflow obstruction score was superior to other prognostic indices. Advanced Child class and no response to intervention are associated with poor outcomes. The All India Institute of Medical Sciences hepatic venous outflow tract obstruction score predicts survival better than other prognostic scores.

Experience of Delphi technique in the process of establishing consensus on core competencies.

Introduction:The Department of Community Medicine and Family Medicine (CMFM) has been started as a new model for imparting the components of family medicine and delivering health-care services at primary and secondary levels in all six newly established All India Institute of Medical Sciences (AIIMS), but there is no competency-based curriculum for it. The paper aims to share the experience of Delphi method in the process of developing consensus on core competencies of the new model of CMFM in AIIMS for undergraduate medical students in India.Methods:The study adopted different approaches and methods, but Delphi was the most critical method used in this research. In Delphi, the experts were contacted by e-mail and their feedback on the same was analyzed.Results:Two rounds of Delphi were conducted in which 150 participants were contacted in Delphi-I but only 46 responded. In Delphi-II, 26 participants responded whose responses were finally considered for analysis. Three of the core competencies namely clinician, primary-care physician, and professionalism were agreed by all the participants, and the least agreement was observed in the competencies of epidemiologist and medical teacher. The experts having more experience were less consistent as responses were changed from agree to disagree in more than 15% of participants and 6% changed from disagree to agree.Conclusion:Within the given constraints, the final list of competencies and skills for the discipline of CMFM compiled after the Delphi process will provide a useful insight into the development of competency-based curriculum of the subject.

Evaluation of chikungunya virus infection in children from India during 2009-2010: A cross sectional observational study.

Chikungunya virus, a small (about 60-70 nm diameter), spherical, enveloped, positive, single stranded RNA virus is transmitted by Aedes mosquitoes. After a short period of incubation (3-5 days) symptoms like fever with joint pains and others start appearing. After a gap of 20 years, this virus re-emerged during 2006-2008 in India causing a major outbreak of CHIKV in India. This study was conducted subsequent to the major outbreak in order to evaluate the proportion of chikungunya virus infection in children with suggestive symptoms at three geographical locations of India. Lineage of circulating strains and changes in the E1 structural polypeptide were also determined. Blood samples were collected (in Sodium citrate vacutainer tubes) during 1st June 2009 to 31st May 2010 from children (age 0 ≤ 18 years) suspected to have chikungunya infection, that is, those who presented with sudden onset of fever and/or joint pain, myalgia, and headache from three regions of India, All India Institute of Medical Sciences (AIIMS) in New Delhi, Karnataka Institute of Medical Sciences (KIMS) in Hubli and Sawai Mansingh Medical College (SMS) in Jaipur. Detection of CHIKV antibodies in all acute-phase patient plasma samples was done by IgM ELISA and for samples within ≤5 days of fever, a one-step RT-PCR was carried out on a block thermo-cycler targeting 294 bp region of E1 gene that codes for the viral envelope protein. Comparison of nucleotide and amino acid sequences from few positive samples of two regions was done with African S-27 reference strain using BioEdit. A phylogenetic tree was constructed using MEGA 6 by using the Maximum Likelihood method based on the Kimura 2-parameter model. Out of the 723 acute phase samples tested from three geographical locations of India, Chikungunya virus infection was detected in 249/723 (34.44%) subjects by either IgM Elisa (180/723) or RT-PCR (69/412). RT-PCR was employed in samples collected from children with ≤5 days of fever. Maximum positive cases were from KIMS center, Hubli. Seasonally, positivity varied with number of enrolled cases at KIMS and SMS. Joint pain was significantly associated with CHIKV positivity (P = 0.0156). Presence/absence of certain clinical features varied with age (P < 0.05). Sequence analysis revealed four amino acid changes. Phylogenetic analysis with partial sequences of E1 gene from KIMS (n = 12) and SMS (n = 5) showed that the study isolates clustered with Indian Ocean Lineage strains (IOL) of East, Central and South African (ECSA) type. Evaluation of chikungunya virus infection in children from India during 2009-2010 showed high proportion of CHIKV infection in Southern region of India compared to Northern region. The circulating CHIKV strains were of Indian Ocean Lineage (IOL) group within the East, Central, and South African (ECSA) genotype. However few amino acid changes were observed in E1 polypeptide with reference to African strain S-27 (AF369024). Further studies are needed to know the implications of these changes in vector-pathogen compatibility and host-pathogen interactivity. As a whole, this study highlighted the proportion of CHIKV cases, lineage of causative strain and evolutionary pattern of circulating strain in terms of amino acid changes in the structural protein.

Automatic detection of non-convulsive seizures: A reduced complexity approach

Detection of non-convulsive seizures (NCSz) is a challenging task because they lack convulsions, meaning no physical visible symptoms are there to detect the presence of a seizure activity. Hence their diagnosis is not easy, also continuous observation of full length EEG for the detection of non-convulsive seizures (NCSz) by an expert or a technician is a very exhaustive, time consuming job. A technique for the automatic detection of NCSz is proposed in this paper. The database used in this research was recorded at the All India Institute of Medical Sciences (AIIMS), New Delhi. 13 EEG recordings of 9 subjects consisting of a total 23 seizures of 29.42min duration were used for analysis. Normalized modified Wilson amplitude is used as a key feature to classify between normal and seizure activity. The main advantage of this study lies in the fact that no classifier is used here and hence algorithm is very simple and computationally fast. With the use of only one feature, all of the seizures under test were detected correctly, and hence the median sensitivity and specificity of 100% and 99.21% were achieved respectively.

Information Technology Usage Scenario in Academic Libraries of Higher Education in Chhattisgarh: Challenges and Opportunities

The Chhattisgarh State was formed in 2001 carved out from the then Madhya Pradesh. Ever since its establishment as a fully fledged state, a considerable number of academic institutions have sprungup. To promote education a Indian Institute of Management (IIM) and All India Institute of Medical Sciences (AIIMS) have been established along with universities and colleges. As libraries are heart of any institution, present study attempts to analyse the status of libraries in various academic institutions of Chhattisgarh with emphasis on status of automation and ICT applications and use. Survey method was followed to collect the data and six libraries were selected for detailed analysis. There are one central university, one state university, one special university, one open university, along with NIT and IIM. The results indicate that all libraries are discharging their services with functional library buildings. However, their collection is uneven and staff strength is less. Most of the libraries are yet to develop any collection development policies and still collection of non-book materials is very less. Although most of the libraries have implemented automation either by using Libsys or SOUL, staff of the libraries have required skill to handle various bugs in using software. Digitisation of collection is not well adopted in most of the libraries.To excel in services, staff training and staff appointment seem to be urgent need of these libraries.

Cochleotopy of human cochlear nucleus

IntroductionThe human peripheral auditory pathway in infants is a relatively less explored domain in auditory research. In the present study, the cochlea, auditory nerve (AN) and the cochlear nucleus (CN) were examined using immunohistochemistry and light and electron-microscopy. MethodsThe study was performed on specimens retrieved from a 40-day-old infant who could not survive after corrective surgery for congenital cyanotic heart disease. The donation was done in accordance with the protocol approved by the Human Ethics Committee, All India Institute of Medical Sciences (AIIMS), New Delhi, India. ResultsThe AN revealed degeneration of nerve fascicles originating from the spiral ganglion neurons of the middle and basal turns of the cochlea. The proximal and middle segments of the nerve showed varying degrees of degenerating fibers with macrophages whereas the most distal part of the nerve showed dilated endoneurial capillaries without any degeneration. On electron-microscopy, the nerve revealed features of acute myelinopathy. The differential perisomatic synaptophysin immunoreactivity was observed in the CN. The unaffected neurons showed strong microtubule-associated protein 2 (MAP-2) immunoreactivity, while those denervated revealed decreased staining. The VCN showed varying degree of parvalbumin (PV) and calbindin (CB) immunostaining with AN fibers and terminals showing strong immunoreactivity for PV. The AN revealed strong immunoreactivity for CB on the affected side. The spiral ganglion neurons did not reveal any pathological changes. DiscussionThe results provide a cochleotopic map of the human CN that maybe relevant in better understanding of the tonotopic organization and will be helpful during auditory implants in children.

Editorial introductions

Current Opinion in Psychiatry was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS James C. HarrisJames C. HarrisDr James C. Harris is the founding Director of the Developmental Neuropsychiatry Program at the Johns Hopkins University School of Medicine and the Kennedy Krieger Institute and Professor of Psychiatry and Behavioral Sciences, Pediatrics, Mental Health, and History of Medicine, USA. Dr Harris’ two volume single authored textbook, Developmental Neuropsychiatry, established the agenda for this emerging clinical specialty garnering the “Medical Book of the Year” award from Doody's Health Science Books. He is Series Editor for Developmental Perspectives in Psychiatry for Oxford University Press US and writes the section on Developmental Neuropsychiatry for the Oxford Textbook of Psychiatry. In 1983 he founded the Autism Clinic at Johns Hopkins University School of Medicine. He is the recipient of the Agnes Purcell McGavin Award for Distinguished Career Achievement from the American Psychiatric Association in recognition of his pioneering work in Developmental Neuropsychiatry. In 2011 he received the Leon Eisenberg Award from Harvard Medical School, USA, for outstanding leadership and stewardship in the field of mental health and disabilities. His goal in working with children with neurodevelopmental disabilities has focused on helping each child to reach his or her individual potential believing, as he does, that all children are capable of personal self-expression and growth. Perminder S. SachdevPerminder S. SachdevDr Perminder S. Sachdev is Scientia Professor of Neuropsychiatry at the University of New South Wales, Australia, Co-Director of the Centre for Healthy Brain Ageing (CHeBA), and Clinical Director of the Neuropsychiatric Institute, the Prince of Wales Hospital in Sydney, Australia. He graduated from the All-India Institute of Medical Sciences, New Delhi, India, and completed his MD in psychiatry from the same institution before migrating to New Zealand and then to Australia where he completed his psychiatric training and went on to head the Neuropsychiatric Institute. His doctorate was on the ethnopsychological concepts in Maori culture. His early work in neuropsychiatry was on drug-induced movement disorders, in particular akathisia, tardive dyskinesia and neuroleptic malignant syndrome. His most recent work has been in cognitive ageing, dementia and pre-dementia syndromes. Dr Sachdev is Past President of the International Neuropsychiatric Association and was inaugural Chair of the Section of Neuropsychiatry of the Royal Australian and New Zealand College of Psychiatrists. He was the recipient of the Organon Senior Research Award of the RANZCP in 1995, the Novartis Oration of the Australasian Society for Psychiatric Research in 2004, and the inaugural INA-India lecture in 2005. He has published five books and over 350 original papers in peer-reviewed journals. His recent academic book is Secondary Schizophrenia (Cambridge University Press). His foray into popular science writing was celebrated with his recent book, The Yipping Tiger and other tales from the neuropsychiatric clinic, which won the 2009 Rotary Health Knowledge Dissemination Award. He was awarded the NSW Biomedical Scientist of the Year 2010. He was made Member of the Order of Australia in 2011. He is the current President of the International College of Geriatric Psychoneuropharmacology.

Dehabilitation in the era of elimination and rehabilitation: a study of 100 leprosy patients from a tertiary care hospital in India

To study the clinical profile of leprosy patients; to assess dehabilitation in leprosy patients and to study the factors affecting dehabilitation. A cross-sectional questionnaire-based study was carried out on 100 leprosy patients visiting the All India Institute of Medical Sciences (AIIMS), New Delhi between February 2009 and February 2010. Demographic and clinical data were collected and subjects were administered the 52-item Anandaraj Dehabilitation scale which measures the negative impact of leprosy on family relationships, vocational condition, social interaction and self-esteem. The mean patient age was 30.9 years, 81% were males, 51% were at the lepromatous end of the spectrum, 87% had multibacillary leprosy, 22% each had Type 1 and Type 2 reactions, 22% had Grade 1 disability and 39% had Grade 2 disability. The mean duration of symptoms before diagnosis was 20 months. On the Anandaraj scale, 23% had high levels of dehabilitation; on an average, scores were in the range of medium level dehabilitation. Nearly 80% of patients avoided meeting friends, one-third hid the diagnosis from their families and worried about losing their jobs due to the disease, while around a quarter avoided sexual relations, used separate utensils and avoided touching children. Over 40% of unmarried patients faced matrimonial difficulty due to leprosy. Anxiety and guilt were common and incidence of suicidal ideas was much higher than the lifetime incidence in general population. Lack of education, Type 2 reactions, Grade 2 disability and lower age were predictors of greater dehabilitation. Dehabilitation of leprosy patients continues in this post-elimination era of rehabilitation. A large segment of preventable disability and resultant dehabilitation is likely being missed. There is an urgent need for corrective and preventive measures.

Janani ?Shishu Suraksha Karyakram (JSSK): Is This Scheme Enough For a Sick Newborn with Congenital Disorders

Meely Panda1, Shasanka Shekhar Panda2*, Rashmi Ranjan Das3, Sushree Samiksha Naik4, Aparajita Panda5 and Pankaj Kumar Mohanty6 1Department of Community Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, 124001, India 2Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar-751019,India 3Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar-751019, India 4Department of Obstetrics and Gynecology, SCB Medical College & Hospital , Cuttack-753007, India 5Department of Anaesthesia, All India Institute of Medical Sciences (AIIMS), Bhubaneswar-751019, India 6Department of Neonatology, Manipal Hospital, Bangalore560017, India

Portfolio of Outpatients Attending Centre for Urban Health, Madhya Pradesh, Central India.

Background:Knowledge on distribution and burden of diseases in a community is essential for planning of public health services. In the absence of information on morbidity profile through community-based surveys, facility-based data provide a good alternative. The aim of this study was to describe the morbidity profile of patients attending the Centre for Urban Health All India Institute of Medical Sciences (AIIMS) Bhopal (CUHA).Methodology:A record-based descriptive study was carried out in the CUHA Bhopal, Madhya Pradesh, Central India. Information on age, gender, residence, new case, and principal diagnosis were extracted from the outpatient registers for the period between January 2014 and December 2014. Only newly registered patients for the study year (2014) were included. Descriptive analysis was done.Results:A total of 6685 new episodes of illnesses were treated. Adults (>15 years) constituted about 85.0%. Overall, the respiratory disorders were the most common (27.2%) followed by the digestive disorders (10.9%), circulatory disorders (9.9%), musculoskeletal disorders (8.8%), and infectious and parasitic disorders (7.4%).Conclusion:This study gives a brief description of the morbidity profile of patients attending a primary health care center over a period of 1 year. This knowledge would help in planning health services to meet the patients’ needs and help in training health staff.

Caudal bupivacaine plus ketamine compared with bupivacaine plus tramadol for postoperative analgesia in children

Background Caudal epidural block has been used commonly in pediatric postoperative pain management. However, the analgesic effect of caudal of bupivacaine lasts for 4-12 h. Aim The aim of this study was to compare the analgesic efficacy of the coadministration of tramadol (2 mg/kg) and ketamine (0.25 mg/kg) on the duration of caudal block produced by 0.25% bupivacaine 0.75 ml/kg on postoperative pain after an elective subumbilical surgery in children. Settings and design This is a controlled, randomized, single-blinded study. Patients and methods This study was carried out on 40 children between 2 and 12 years of age, ASA grade 1, of both sexes in Tanta University after obtaining the approval of the local hospital organization and parents' consent. The patients were divided into two equal groups. The patients in the bupivacaine plus ketamine group (group 1) received caudal bupivacaine 0.25%, 0.75 ml/kg mixed with ketamine 0.25 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. The patients in the bupivacaine plus tramadol group (group 2) were administered caudal bupivacaine 0.25%, 0.75 ml/kg mixed with tramadol 2 mg/kg, diluted in a 0.9% NaCl solution to a total volume of 1 ml/kg. Statistical analysis Mean and SD were calculated as numerical data. Continuous variables were compared using the unpaired Student's t -test. Nominal nonparametric data were analyzed using the χ 2 -test. Results Patients were monitored over the first 24 h postoperatively to assess analgesia using the All India Institute of Medical Science (AIIMS) objective pain discomfort scale and associated hemodynamic and respiratory changes. Our results showed that the addition of tramadol in group 2 significantly prolonged the analgesic effect of bupivacaine; also, there was hemodynamic stability and pain scores indicated minimal pain. Conclusion Caudal epidural tramadol has been proven to be safe at the concentration used and to prolong bupivacaine's analgesic duration postoperatively in children.

Investigation of jaundice outbreak in a rural area of Odisha, India: Lessons learned and the way forward

Background and Objectives: Hepatitis, a condition with liver inflammation, mostly follows hepatitis virus infection of different types A, B, C, D, and E. Each year, numerous outbreaks of hepatitis virus are being reported from around the country, more so from the “Empowered Action Group (EAG) States.” The present outbreak investigation was performed in Odisha, India to study the epidemiology, explore the reasons behind it, and suggest preventive measures for the future. Materials and Methods: A team consisting of public health doctors from All India Institute of Medical Science (AIIMS), Bhubaneswar, Odisha, India investigated the hepatitis E outbreak as per standard guidelines in one of the villages of Tangi block in the state of Odisha, using a questionnaire between January 1, 2015 and January 15, 2015. The data were entered and analyzed in Microsoft Excel 2007. Time, place, and person analysis were performed for all case patients. Result: Hepatitis E outbreak occurred between November 16, 2014 and January 1, 2015, affecting 22 individuals. The attack rate was 44/1,000 in the population and young males were mostly infected. Spot map of the outbreak probably points toward point source epidemic. Most of the infected cases had visited allopathic doctors as well as traditional healers. Less than 50% people had some knowledge about the prevention and control of hepatitis virus infection. Open defecation was highly prevalent in the village. The well was the commonest source of drinking water and the condition of wells was non-sanitary. Less than 2% started hand-washing after the end of the outbreak in the community. Conclusion: Focus of outbreak investigation should not restrict only to immediate control but should rather lead to intervention by the health system in the area for construction of community toilets, improved drinking water facilities, and sustained information, education, and communication (IEC) activities to promote personal hygiene and water safety behavior in the community.

Cost-effective use of investigations in developing countries.

In recent years, the cost of health care around the world has risen at a rate that is deemed unsustainable. It has been estimated that 20% of this could be saved by rationalising laboratory investigations and reducing inappropriate requisitioning of the investigations. There are several reasons for the excessive, redundant, inappropriate or unnecessary investigations and procedures, which in some instances are unethical practices. The impact in financial terms is more in developing countries such as India with <5% of the population having medical insurance and hardly any other third-party payer system. The 'Choosing Wisely' campaign of the American Board of Internal Medicine, Canadian Rheumatology Association's Choosing Wisely Committee and the 'Society for Less Investigative Medicine' (SLIM) initiative of the doctors of All-India Institute of Medical Sciences (AIIMS), New Delhi, all have provided recommendations to reduce unnecessary investigations, and these are among some of the efforts to reduce the cost of investigations without compromising the quality of care.

Changing population of neurons and glia in the human cochlear nucleus with progressive age – A stereological study

IntroductionThe human cochlear nucleus (CN) is populated by morphologically diverse types of neurons that contribute specifically in the formation of the complex functional networks in the auditory pathway. On the basis of cytoarchitecture and topography different types of neurons can be identified in the CN. The present study was undertaken to investigate the morphological parameters of neurons and glia of the human CN with aging. MethodsForty-one brainstems (Birth-90 years) from cadaveric donors were collected from the mortuary of the All India Institute of Medical Sciences (AIIMS), New Delhi, with ethical committee permission. They were grouped into nine decades and processed for light microscopy and morphometry. Hierarchical clustering was done to classify the neuron population according to their neuronal and nuclear area into different clusters. ResultsThere was a gradual increase in the mean neuronal and neuronal nucleus volume from decade 1 to 3. Decade 1 had minimum and 3 had maximum nuclear volume and neuron number respectively. An increase in total glial population was observed in decade 9. Eight neuron clusters were identified which were present in the decades 2 and 3 whereas decades 1 and 4 had seven, decades 5–8 had six and decade 9 had four clusters respectively. DiscussionMajor changes were observed within the clusters from middle to old age, especially after decade 5. This may be useful in explaining the vulnerability of some specific subpopulation of neurons more than others and understanding the pathophysiology of altered hearing loss with age.

Indian medical research: perception and paradox.

In order to improve Indian Health System, a committee was set up by the government of India under the Chairmanship of Sir Joseph Bhore in 1943 and this committee in its landmark recommendation in 1946 said If it were possible to evaluate the loss, which this country annually suffers through the avoidable waste of valuable human material and the lowering of human efficiency through malnutrition and preventable morbidity, we feel that the result would be so startling that the whole country would be aroused and would not rest until a radical change had been brought about . In this context Sir Joseph Bhore also recommended the establishment of a national medical centre which would concentrate upon high quality medical care, education and research. Pandit Jawahar Lal Nehru's dream to develop the temples of modern India became instrumental in the establishment of All-India Institute of Medical Sciences (AIIMS) as an institution of national importance by an act of Parliament in the year 1952.

Need for an acute poisoning registry data base in India

To the Editor, Acutepoisoningisoneofthecommonreasonsforhospitalisation in developing countries. 1 In countries like India, where the economy is linked substantially to agriculture, thenumberofcasesofacutepoisoningincreaseeveryyear. While in developed countries, the rate of mortality from poisoning ranges from 1% to 2% in developing countries like India, it varies between 15% and 30% and is the fourth mostcommoncauseofmortality,especiallyinruralIndia. 2 The rapid increase in the use of newer chemicals with potentiallyharmfuleffectsisamatterofconcerntothephysician and makes the management more challenging. 3 The monsoon-dependent agricultural practice and socioeconomic factors related to it also play a role in the incidence of acute poisonings. 4 Insufficient regulation for the sale and use of pesticides, lack of surveillance systems, insufficient enforcement regarding safe use of pesticides, lack of training of healthcare professionals regarding the managementaspects,inadequateaccesstoinformationsystem,and poorly maintained or non-existent personal protective equipmentarethemajorfactorsresponsibleforhigherincidence rate of poisoning. 5 Early diagnosis, treatment and prevention are crucial in reducing the burden of poisoning-related injury in any country. 6 A thorough knowledge about the nature andmagnitude of the problem in a particular area is essential for the doctors in hospital practice. In Indiathe exactincidenceofacutepoisoningcannot be defined properly due to under-reporting of cases to Government authorities. India has an over-usage of pesticides, and in particular organophosphate poisoning is most commonly reported in the emergency departments of Indian hospitals. 7 The data from poison information centre of All India Institute of Medical Sciences (AIIMS) reveals that highest incidence of poisoning cases was found in the age group of 14–40 years, with a preponderance of males affected. 8 According to the World Health Organization (WHO), 99% of the fatal poisoning cases occur in developing countries, predominantly among farmers. 4, 9, 10

Burden of maxillofacial trauma at level 1 trauma center.

There is an upward trend in facial injuries following changes in population pattern, increasing industrialization and urbanization, hence maxillofacial trauma is becoming a burden and a leading medical problem in emergency rooms worldwide. This study was performed to evaluate the pattern of maxillofacial fractures, associated injuries, and treatment used at Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India, between January 2007 and June 2010. The study provides basis for establishment of trauma as major etiology of maxillofacial injuries and planning for preventive strategies. A retrospective study of patients seen and treated at JPNATC, AIIMS, New Delhi, between January 2007 and June 2010 was performed. Data extracted from patient records included etiology, age, sex, types and sites of fractures, treatment modality, and concomitant injuries. There were 795 fractures of the maxillofacial skeleton and 86 concomitant injuries from 542 patients. Road traffic accident (RTA) (56.8%) was the most common etiologic factor, followed by falls (22.3%) and fights (18.5%). The age range was from 3 to 75 years (mean, 34.7 years) with a peak incidence in the third decade with a male-to-female ratio of 3.7:1. The most common location of maxillofacial fractures was the mandible 615 (77%) and middle third 180 (23%). With regard to mandibular fractures, the body (29.6%) was the most common site, followed by the angle (24.4%), ramus (19.5%), dentoalveolar (14.6%), symphysis (11.0%), condyle (0.8%) while in the middle third, the nasal bone (36.7%) was the most common, followed by zygomatic bone (27.8), Lefort II (14.4), Lefort I (7.8%), dentoalveolar (10.0%), and Lefort III (3.3%). Majority of the patients were treated by open reduction and internal fixation (70.6). Concomitant injuries were 84 (10.8%) with orthopedic injuries accounting for the majority (63.9%). Head injury was associated in 16.3% of cases. RTA was the major etiologic factor of maxillofacial injuries in our setting and the young adult males were the main victims. Henceforth, establishment of regionalized, efficient, and focused trauma centers in various parts of the country particularly for acute trauma should be emphasized. Also, the laws regarding the precautions such as seat belts, speed limits, and traffic rules must be observed strictly to reduce the incidence of RTA.

Medico-legal autopsy of 1355 unclaimed dead bodies brought to a tertiary care hospital in Delhi, India (2006-2012).

In India, it is estimated that about 13 million people are homeless. As these individuals have no close acquaintances, in the event of death, their bodies remain unclaimed. These unclaimed corpses pose a major challenge for the local law enforcement agencies in identification and thus become an obstacle in solving the cases of missing persons. We sought to review the autopsy characteristics and causes of death in the unclaimed/unidentified bodies autopsied at the All India Institute of Medical Sciences (AIIMS) from 2006 to 2012. Among the total of 11,786 cases autopsied during the year 2006 to 2012, 1335 (11%) were unclaimed. Most of the cases were males (91%) with a male-to-female ratio of 9:1. Mean age of the cohort was 43 years (range, 1-85 years). Natural events were the foremost cause of death and were more commonly seen in males. While accidental, suicidal and homicidal modes were common in younger age groups; natural manner of death predominated in the elderly. Most of the cases were found dead on the roadside. This paper also compares with the previous study in the same set-up during the time period 2001 to 2005. The authors believe that knowledge about the existing healthcare facilities need to be reinforced and their utilisation promoted.

Reproductive toxicity of lead, cadmium, and phthalate exposure in men.

Environmental toxicants viz lead or cadmium and phthalate esters (di(2-ethylhexyl) phthalate [DEHP], dibutyl phthalate [DBP], and diethyl phthalate [DEP]) widely found in different environmental strata are linked to deteriorating male reproductive health. The objective was to assess the relationships between the seminal lead, cadmium, and phthalate (DEHP, DBP, DEP) concentrations at environmental level and serum hormone levels and semen quality in non-occupationally exposed men and specify the effect of individual and combined exposure of toxicants on semen quality. A study of 60 male partners of couples attending the Andrology Laboratory of the Reproductive Biology Department, All India Institute of Medical Sciences (AIIMS), New Delhi, India for semen analysis to assess their inability to achieve a pregnancy was selected for the study. The results of univariate and stepwise multiple regression analysis in the unadjusted model showed a significant correlation between lead or cadmium and phthalates DEHP/DBP/DEP and sperm motility, sperm concentration, and DNA damage. After adjusting for potential confounders, an association with lead or DEHP was only observed. The present data shows that lead (Pb) or cadmium (Cd) or phthalates might independently contribute to decline in semen quality and induce DNA damage. Phthalates might influence reproductive hormone testosterone. These findings are significant in light of the fact that men are exposed to a volley of chemicals; however, due to the small sample size, our finding needs to be confirmed in a larger population.

Age associated changes in the human cochlear nucleus – A three-dimensional modelling and its potential application for brainstem implants

IntroductionThe cochlear nucleus (CN) is vulnerable to physio-pathological alterations with age that may contribute to varied degree of hearing impairment.It was planned to study the age changes in the three-dimensional (3-D) structure of human CN. MethodsForty-one human brainstems were collected (birth − 90 years) from the mortuary of the All India Institute of Medical Sciences (AIIMS), New Delhi, with ethical committee permission. Tissues were fixed in 4% paraformaldehyde (pH 7.4), cryosectioned (40 μm) serially and stained with cresyl violet. A 3-D reconstruction model of the adult human CN was made using the 3-D Solid body tracing probe of the Stereo Investigator software (MBF Biosciences, VT, USA). ResultsThe CN appeared as a thin, crescent-shaped protuberance along the floor and lateral recess of the 4th ventricle in relation with inferior and middle cerebellar peduncle at the level of the pontomedullary junction. The rostral tip was observed deep in the middle cerebellar peduncle and the dorsal subdivision, within the wall of lateral recess of the 4th ventricle. Microscopically, different types of neurons were observed in all the ages studied and no change in the distribution was noted. The volume of the CN did not change with ageing. DiscussionThe 3-D model of the CN can be used as a landmark for safe surgical route to access the intraventricular surface of the 4th ventricle and to engineer brainstem implants.