Municipal Medical College Research Articles

Current practice in management of animal bites in First Referral Unit of Ahmedabad, Gujarat

Background: Rabies is a zoonotic disease, which is caused by animal bites. Dog bites are responsible for 99% of rabies cases. Postexposure prophylaxis with anti-rabies vaccine is the only way to prevent rabies infection. Aims and Objectives: To analyze the magnitude of animal bite and actual practices following such bites, and to evaluate the quality of care delivered to the victim of animal bite in community health centers (CHCs). Materials and Methods: A hospital-based cross-sectional study was carried out in Rural Health Training Center of NHL Municipal Medical College (Singarva CHC), Ahmedabad, Gujarat, India. Total 580 animal bite cases were interviewed with pretested questionnaire during November 2012 to January 2013. Results: In our study, median age of the study population was 22 years; 4% of patients were below 5 years of age. Majority of bites were due to dogs (98%) followed by monkeys (1%) and cats (1%). Bites in male subjects were 76%. Class II bites constituted 91%. Most common site of bites was legs (61%) followed by hands (16%) and thighs (10%). Timing of the bites showed that 42% bites occurred in the evening, about 33% in the morning, and 23% in the afternoon. Majority of cases (60.3%) were reported within 24 h after bite and 2% cases after 5 days. Total 72% patients have missed one or more doses. Among them, default for second dose was 19% followed by 21% for third dose. Fourth and fifth doses were missed by 26% and 34% patients, respectively. 27%, 31%, 24%, and 17% delayed dose were found in second, third, fourth, and fifth doses, respectively. Conclusion: Majority of patients believed that anti-rabies vaccine is not given on Sunday, and it is the most common cause for

Best practices for transradial angiography and intervention: A consensus statement from the society for cardiovascular angiography and intervention's transradial working group

Duke University Medical Center, Durham, North Carolina Stanford University Medical Center, Palo Alto, California Penn State Hershey Medical Center, Hershey, Pennsylvania Brigham and Women’s Hospital, Boston, Massachusetts Mayo Clinic, Rochester, Minnesota University of Illinois at Chicago/Jesse Brown VA Medical Center, Chicago, Illinois First Coast Heart and Vascular Center, Jacksonville, Florida G.V. (Sonny) Montgomery VA Medical CenterJackson, Mississippi. Stern Cardiovascular Foundation, Memphis, Tennessee Reid Heart Center at FirstHealth of the Carolinas, Pinehurst, North Carolina Deborah Heart & Lung Institute, Browns Mills, New Jersey Duke University Medical Center, Durham, North Carolina Lahey Clinic, Burlington, Massachusetts Geisinger Medical Center, Danville, Pennsylvania Apex Heart Institute, Seth N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India The Wright Center for Graduate Medical Education, The Commonwealth Medical College, Scranton, Pennsylvania

A study of morphology of vermifrom appendix in 200 cases

Aims: To study the various positions of vermiform appendix, and its relation to various diseases of the vermiform appendix, and average length and external diameter of the vermiform appendix. Materials & Methods: This study was conducted on 200 cases - 100 cadavers from the dissection laboratory with an age range of 50 - 90 years. The dissection was performed in the dissection hall of Smt. N.H.L. Municipal Medical College, Ahmedabad, B. J. Medical College, Ahmedabad, A.M.C.M.E.T. Medical College, Ahmedabad, and 100 cases from postmortum room of V. S. Hospital from August 2009 to December 2012. Result and Observation: classic coeliac trunk with emission of the left gastric, splenic and hepatic arteries was found in 76(76 %) cadavers. Haller's tripod, in which the three arteries originated at the same level and in the terminal portion of the coeliac tru nk was observed in 18(18%) cadavers. In 16 cadavers inferior phrenic arteries originated from coeliac tru nk was observed. In 8 cadaver's variations regarding disposition of the left gastric, splenic and hepatic arteries also regarding the number of emitted arteries observed. Conclusion: Appendix is only organ in our body which has not constant anatomical position. From various positions of vermiform appendix we can understand the possible outcome of the appendicitis specifically location of site of pain.

Study of Patterns of Homicidal Death during Post Mortem Examination Conducted in V.S. General Hospital

Background: Homicide is killing of human being by another human being, which is one of the oldest crimes in human civilization. It started from the murder of Abel by the hands of Cane. Violence is a significant public health problem and homicide is severest form of violence, depriving a human being of his fundamental right to live. Homicide is prevalent widely almost all over the world. Nowadays, the increasing incidence of homicide is worldwide and it is manner of great concern. Methods: This study was conducted at Dept. Of Forensic Medicine and Toxicology, Smt. N. H. L. Municipal Medical College, Ellisbridge, Ahmedabad. The present study was conducted over period of July 2009 to November 2011. Out of which 50 were considered as homicidal death after going through inquest papers and indoor case papers. Results: Homicidal deaths constituted of 50/2639 (1.86%) all autopsies. Ratio of male to female victim was 1.94:1. Near half of victims were of age 21-40 years (48%). Head injury constituted the most common cause of death (34%) and near half of homicides (46%) caused by sharp and pointed weapons. The head, neck and face sustained the highest numbers of injuries 28 (56%) followed by thorax 12 (24%) and abdomen 10 (20%). Majority of cases were occurred during summer season (40%) very closely followed by winter (30%) and monsoon (30%). More than half (58%) of the cases occurred during night hours 15 (30%) and evening hours 14 (28%). 31 (62%) cases were with known motives among which personal dispute plays a major role. Conclusion: In this study, young age victims constituted the dominant group. Sharp weapons were commonly employed in this region for homicide. Proper counselling for developing positive attitude and controlling the aggression in youth have to be promoted at large by the government.

Prevalence, pattern and perceptions of self-medication in medical students

Background: The use of self-medication is highly prevalent in the community more so amongst the medical students. Self-medication can be defined as the use of drugs to treat self-diagnosed disorders or symptoms, or the intermittent or continued use of a prescribed drug for chronic or recurrent disease or symptoms. Aims and Objectives: To study the prevalence and pattern of use of self-medication among medical students from first year to internship. Methods: This cross sectional study was carried out among under graduate medical students including interns of Smt. NHL Municipal Medical College, Ahmedabad during the period of March 2010 to May 2010. Results: Out of 747 students and interns enrolled, 685 responded (91.7%). Out of 685 respondents 564 (82.3%) reported self-medication within one year of recall period. Most common conditions/symptoms for self-medication in students were fever (72.7%), headache (69.1%), upper respiratory tract infections (64.1%) followed by others like body-ache, abdominal pain, diarrhoea etc. Over the counter drugs (84.2%) was the most common category of drugs used by all the students except first year students who used prescription only drugs more frequently (48.5%). Herbal and Ayurvedic drugs were also used as self-medication (17.8%); most frequently by the first year students (22.7%). Conclusion: The pattern of self-medication practice changes with time and advancement of knowledge.

The burn unit: L T M medical college and general hospital

The burn unit at Lokmanya Tilak Municipal Medical College and General Hospital was established in 1983 and since then continues to be an integral part of the Department of General Surgery. It has been recognized as the center of excellence in western region of India by The Association of American Physicians from India and it has several firsts to its credit and has undergone some metamorphosis over the years. The focus has always been to provide comprehensive, quality-of-care to the burn victims.

Modified extraperitoneal Caesarean section: clinical experience

The objective of the study was to study postoperative progress of modified extraperitoneal Caesarean section (MECS) technique (group A) and its comparison with standard transperitoneal Caesarean section (TCS) (group B). It is a prospective observational study with sample sizes of 93 and 105 for groups A and B, respectively, in the settings of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India, which see over 10,000 deliveries per annum. Five parameters were studied. Postoperative febrile morbidity was significantly lower in group A than in group B (6.5% versus 21%; P = 0.004). Gastrointestinal function recovery occurred earlier in group A than B (6 h versus 18.5 h; P < 0.01). Although the difference between skin incision to baby delivery time was significant (6.0 min versus 3.1 min; P < 0.01), there was no significant difference in Apgar score at 1 min (P = 0.3). There was no difference in intraoperative complications in two groups. MECS is associated with less febrile morbidity and early postoperative recovery than TCS.

Study of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai

Background:Sex ratio, an important social indicator measuring extent of prevailing equity between males and females in society, is defined as number of females per 1000 males. Changes in sex ratio reflect underlying socioeconomic, cultural patterns of a society. As per 2011 census sex ratio in India is 914/1000 males, which continues to be significantly adverse towards women.Objectives:This study was conducted to assess the knowledge and attitude regarding Prenatal Diagnostic Techniques (PNDT) Act among the pregnant women at a tertiary care teaching hospital in Mumbai.Materials and Methods:A cross-sectional study was carried out in the antenatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai during the period of January to April 2008. A total of 143 women were included and a pre-designed and pre-tested questionnaire was used to get information regarding socio-demographic details of the pregnant women. They were asked regarding the knowledge and attitude towards the PNDT Act. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0.Results:In the present study, out of 143 women, 105 (73.5%) knew about sex determination. Even out of those who had heard, the correct knowledge regarding PNDT act was very less. Sonography as a technique for sex determination done at private hospital was known to the majority of women.Conclusion:Education of women about gender equality and recommendations under PNDT act in order to improve declining sex ratio in our country must be done. Wide publicization in the media of the Act must be scaled up.

Prevalence of anemia in the postnatal women at a tertiary care teaching hospital in Mumbai

Background: Anemia is rampant in India. Around 20% of maternal deaths are due to indirect causes and anemia is the most significant cause. The prevalence of anemia in pregnant women has remained unacceptably high worldwide despite the fact that routine iron supplementation during pregnancy has been almost universally recommended to prevent maternal anemia, especially in developing countries over the past 30 years. Materials and Methods: A cross-sectional study was carried out in the postnatal ward of Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, during the period of January 2008 to June 2008. A total of 408 women were included and a pre-designed and pre-tested questionnaire was used for the study. Data was analyzed by using Statistical Package of Social Sciences (SPSS) 16.0. Results: In the present study, 312 (76.5%) women were found anemic. Anemia was classified into mild (30.1%), moderate (59.6%), and severe (10.3%). Only 72 (25.5%) had more than three ANC visits during the pregnancy. About 234 (57.4%) received iron and folic acid (IFA) tablets, while 174 (42.6%) didn't receive. Conclusion: Most of the women did not receive IFA tablets and out of those very few consumed more than 100 tablets as per the National Nutritional Anemia Prophylaxis Program. There is a need to promote, educate, and increase the awareness regarding the National health programs at the community level.

Atypical manifestations of malaria.

Malaria remains a major cause of morbidity and mortality worldwide. The classic presentation of malaria with paroxysms of fever is seen only in 50%-70% of patients. Development of immunity, increasing resistance to antimalarial drugs, and indiscriminate use of antimalarial drugs have led to malaria presenting with unusual features. This review compiles a description of the various atypical manifestations of malaria.

Deceased donor skin allograft banking: Response and utilization

ABSTRACT Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

Deceased donor skin allograft banking: Response and utilization

Background:In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country.Aims:The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study.Settings and Design:This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms.Results:During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries.Conclusions:Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

Simultaneous Brain and Ocular Cysticercosis in a Five-Year-Old Boy

To the Editors: ysticercosis caused by the parasitic tapeworm Taenia solium is a major public health problem in developing countries and also in developed countries as a result of increasing migration.1,2 The disease occurs when humans become the intermediate host in the life cycle of T. solium by ingesting its eggs from contaminated food.1,2 Neurocysticercosis is the commonest helminthic disease of the human nervous system.1,2 We present a 5-year-old boy who had simultaneous brain and ocular cysticercosis. In September 2005 this child was admitted because of multiple generalized seizures to another hospital near Mumbai. A computed tomography scan of the brain revealed multiple ring-enhancing cystic lesions with perilesional edema. A few cysts had an enhancing nodule suggestive of a scolex. Normal physical and neurologic examination findings, negative Mantoux test, normal chest radiograph, and absence of chronic fever or anorexia excluded central nervous system tuberculosis. Direct ophthalmoscope findings were normal. With a diagnosis of multiple brain cysticercii the child was treated with oral prednisone (2 mg/kg/d) for 3 days, followed by oral albendazole (15 mg/kg/d for 4 weeks) and discharged after a 7-day stay.3 Oral valproic acid was given to prevent recurrent seizures.3 In January 2006, the parents brought the child to our outpatient department for complaints of repetitive closure of the left eye lid and watering from left eye. On enquiry it was found that these symptoms had begun in October 2006, while the child was receiving albendazole therapy. As the child did not complain of pain, the parents completed the albendazole course. On examination it was found that the child had almost no perception of light in his left eye. The remainder of the physical examination was normal. The child was hospitalized. Indirect ophthalmoscopic examination revealed retinal detachment in the left eye. Computed tomography scan of the brain with orbital cuts showed multiple ring-enhancing cystic lesions, some with perilesional edema, and a cystic lesion along the posterior retina in the left eye (Fig. 1). Ultrasonographic examination of the left eye showed a subretinal cyst (9 × 9 mm) with 2 calcified specks with surrounding retinal detachment. The child was treated with oral prednisone (2 mg/kg/d for 3 weeks and then tapered and continued on 1 mg/kg/d). During the next 4 months the child developed inflammatory phthisis and lost all vision in his left eye.FIGURE 1.: Contrast-enhanced CT scan orbit showing cystic lesion along posterior retina in left eye (subretinal cysticercosis).The recommended treatment of intraocular cysticercosis is surgical removal of the intact cyst.4 Larvicidal drugs, such as albendazole, are contraindicated in ocular cysticercosis because the degeneration of the cyst can cause severe inflammation and visual loss.4 Simultaneous occurrence of brain and subretinal cysticercosis is extremely rare.5 We are not aware of any other reports of iatrogenic blindness developing in a child with this clinical condition. This case has important diagnostic and therapeutic implications. Indirect ophthalmologic examination or ultrasonographic examination of the eyes of children with neurocysticercosis should be considered before treatment of neurocysticercosis. Sunil Karande, MD Nilesh Kumbhare, DCH Department of Pediatrics Lokmanya Tilak Municipal Medical College and General Hospital Sion, Mumbai India [email protected]

History of the Plastic Surgery department at Lokmanya Tilak Municipal Medical College and General Hospital at Sion, Mumbai

D r. A. D. Dias and Dr. R. L. Thatte established the Department of Plastic Surgery at Sion Hospital in 1979 and the rest as they say is history. It is this history that we attempt to narrate here. There will inevitably be gaps and omissions, for no narrator is perfect. For these possible lapses we crave your indulgence for they are unintentional and inadvertent. The use of the first person by the chroniclers has been retained as it adds to the feeling of a story being told in the best of India’s oral tradition with love and affection.

History of the Plastic Surgery department at Lokmanya Tilak Municipal Medical College and General Hospital at Sion, Mumbai

History of the Plastic Surgery department at Lokmanya Tilak Municipal Medical College and General Hospital at Sion, Mumbai

Hypogastric artery ligation: a new perspective.

This study was conducted at the Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Bombay. An analysis was made of the hypogastric artery ligations done at our institution from January 1985 to December 1990. A prospective pilot study beginning June 1989 was added to the existing data. The hemostasis achieved intraoperatively and the collateral circulation maintained after main trunk ligation vs selective anterior division ligation have been studied prospectively with pelvic angiography postoperatively. Pelvic angiography using the standard Seldinger technique was done 14 days posthypogastric artery ligation in emergency obstetric cases. In selected gynecologic cases posted for Wertheim's hysterectomy, pelvic angiography was done both before and after hypogastric artery ligation. All the collected data, including operative time, blood loss, and complications, have been tabulated and compared with other studies in the literature.

Disseminated intravascular coagulation, cardiovascular and metabolic disturbances in acute myocarditis induced by scorpion (Buthus tamulus): R. K. M. Kari, D. M. Jeem, Z. Hessein, A. G. Joshi, M. E. Yeolekar and F. R. Billimoria (Departments of Physiology, Medicine and Biochemistry, Lokmanya Tilak Municipal Medical College, Sion, Bombay 400022, India)

Disseminated intravascular coagulation, cardiovascular and metabolic disturbances in acute myocarditis induced by scorpion (Buthus tamulus): R. K. M. Kari, D. M. Jeem, Z. Hessein, A. G. Joshi, M. E. Yeolekar and F. R. Billimoria (Departments of Physiology, Medicine and Biochemistry, Lokmanya Tilak Municipal Medical College, Sion, Bombay 400022, India)