Regional Institute Of Medical Sciences Research Articles

Functional outcome of ischemic stroke in relation to site of lesion: A prospective cohort study

Background: Accurate prediction of motor recovery and functional outcome is difficult, but it is important for proper rehabilitative planning and poststroke care. Infarct location may be more important for some patients in determining eventual clinical outcome. Objectives: To study the functional outcome of ischemic stroke in relation to the site of lesion. Materials and Methods: A prospective cohort study was conducted in the Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences, Imphal, Manipur. All computed tomography confirmed ischemic stroke patients attending the outpatient department within 7 days of stroke onset were included in the study. Functional Independence Measure (FIM) scoring was done on 7, 30, and 90 days poststroke. Site was categorized as cortical (C), subcortical (S), combined cortical and subcortical (CS), basal ganglia (BG), or combined cortical, subcortical, and BG. Results: Ninety patients with mean age of 58.26 ± 7.021 years in the range of 45–70 years were studied. Males constituted 55.6% of the total participants. The site of lesion was in BG in majority of cases 37 (41.1%), subcortical in 31 (34.4%) cases, and cortical in 20 (22.2%) cases. Mean FIM score was highest 53.70 (±13.2) when the site of lesion was in BG. The mean FIM scores differed significantly between the different sites of lesion (P = 0.000) at subsequent follow-up examinations. Post hoc test further revealed that there was statistically significant differences in the FIM scores between BG and all the other sites of lesion at baseline and at subsequent follow-up. Conclusion: Site of lesion influenced the functional outcome significantly early on and at 30 days and 90 days after stroke, and the most favorable outcome was observed when the site of lesion was in BG.

Study of incidence of externally visible congenital anomalies in stillbirth human foetuses of Manipuri origin

Introduction: Birth defect, congenital malformation, and congenital anomaly are synonymous term use to describe structural, behavioral, functional, and metabolic disorders present at birth. Causes of congenital anomalies are often divided into genetic and environmental factor. For 50-60% of congenital anomalies the etiology is unknown. In the present study, we only look for visible gross anomalies thereby the exact definition of congenital anomaly may not be fulfilled. Materials and method: Study was conducted in the Department of Anatomy, Regional Institute of Medical Sciences, Imphal, for the period of 1 year, i.e., from 1 st August 2011 to 1 st August 2012. 120 numbers of stillbirth human foetuses were collected from the department of Obstetrics and Gynecology, RIMS, Imphal with a due permission from ethical committee. The specimens were preserved in 10% formalin. After 2 weeks specimens were observed carefully for any visible anomalies. Results: Out of 120 foetuses; 15 foetuses, i.e., 12.5% were found to have congenital anomalies. The commonest anomaly is craniofacial anomaly (6.666%) in the form of anencephaly and cleft lip and palate. Next to craniofacial anomaly is vertebral arch defect in the form of spina bifida (2.5%). Other anomalies are abdominal wall defect and limbs defects, each contributing 1.666% of the total anomalies in the present study. Conclusion: The incidence of congenital anomalies in the present study is 12.5%. The commonest anomaly encountered is in the form of craniofacial anomalies. This high of incidence congenital anomalies encountered in this study may be due to the fact that the study was conducted only in stillbirth human foetuses. Further research is recommended in order to pinpoint the causes of these of anomalies with the use of modern sophisticated tools.

Sexual dysfunction among drug-naïve depressive disorder patient in a multidisciplinary teaching hospital

Background: Little is known about the prevalence, typology and natural course of non-drug-induced sexual dysfunction in patients with depressive disorders. The degree of sexual dysfunction and its prevalence appears to be correlated with the severity of disease. Aims: The aim of the study is to find the prevalence and pattern of sexual dysfunction among drug naive patient having depressive disorder and its correlation. Settings and Design: 2 years (September 2013- August 2015), cross-sectional study, out-patient department, Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur. Materials and Methods: Depressive disorder was established according to ICD-10 criteria. Patients fulfilling inclusion criteria were subjected to Hamilton Rating Scale for Depression to assess the severity of their depression and Arizona Sexual Experience Scale questionnaire to assess sexual dysfunction if any in confidentiality. Statistical Analysis Used: statistical package for the social sciences (SPSS) version 21. Chi square test was used and p value of less than 0.05 was taken as statistically significant. Result: 50 patients with depressive disorder were enrolled for the study. 44 percent of them were found to have sexual dysfunction. More problems were found with sexual desire and arousal phases of sexual life. A positive correlation was established between the severity of illness and the degree of sexual dysfunction. Conclusion: This study showed that majority of such patients has sexual problems especially with regard to desire for sex and arousability. The degree of sexual dysfunction was found to be proportional to the severity of depression and hence maybe an important predictor of sexual dysfunction among depressed patients.

Epicardial Adipose Tissue Thickness and its Corelation with Metabolic Risk Parameters in People Living with HIV: A RIMS Study.

Context:Epicardial fat envelopes the coronary vessel adventitia without fascial separation, thus pathologic inflammation in the fat may promote the growth of atherosclerotic plaque in coronary arteries in an ‘outside-in’ fashion. Epicardial fat is quantitatively increased in HIV compared to un-infected people.Aims:1. To assess Epicardial Adipose tissue (EAT) by Computed tomography (CT) in PLHIV receiving first line ART (antiretroviral therapy) 2. To correlate EAT with metabolic risk parameters.Material and Methods:215 HIV-infected patients aged >18 years on first line ART were included in the cross sectional study. EAT thickness were measured by CT scan. Metabolic parameters were measured based on metabolic syndrome criteria.Statistical Analysis Used:Data analysis was done using IBM SPSS version ver. 21. Probability value of less than 0.5 was taken as significant.Ethical Issues:The study was carried out after obtaining approval from the Institutional Ethical Committee (IEC), Regional Institute of Medical Sciences, Imphal.Results:Half of the patients were found to have EAT thickness of 8.1-9 mm and 12.6% of cases had EAT of >9 mm. Mean epicardial thickness was 8.3 mm ± 0.7 mm for whole population. Triglyceride and high density lipoprotein (HDL) were also found to have positive correlation with EAT thickness (rp= 0.364, P = 0.04 and rp= 0.343, P = 0.05 respectively).Conclusion:Epicardial adipose tissue thickness is increased in PLHIV receiving highly active anti retroviral therapy (HAART) and positively co-related with parameters of metabolic syndrome such as waist circumference, HDL cholesterol and triglyceride level.

ANTICONVULSANT EFFECT OF ETHANOLIC EXTRACT OF TRIGONELLA FOENUM GRAECUM LINN. AND SODIUM VALPROATE - A COMPARATIVE STUDY IN ALBINO MICE.

10Nov 2017 ANTICONVULSANT EFFECT OF ETHANOLIC EXTRACT OF TRIGONELLA FOENUM GRAECUM LINN. AND SODIUM VALPROATE - A COMPARATIVE STUDY IN ALBINO MICE. Tarun Kumar , P.Shyamasakhi Devi , Priyotosh Banerjee and N. Meena Devi. Post graduate Junior Resident, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal. Associate Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal. Post graduate Junior Resident, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal. Professor, Department of Pharmacology, Regional Institute of Medical Sciences, Imphal.

A study ofthe morphogenesis & mitral cell population of human fetal olfactory bulbs

Abstract Background and Aims: Human fetal olfactory bulbs have a six layered laminar architecture where mitral cells are the largest neurons. Volume of the bulbs is considered as an indicator of olfactory function. Fetal bulb cell transplants are used to treat many diseases of the central nervous system. The present study aims to trace the development of the fetal bulbs with respect to it’s gross appearance, volume, arrangement and the number of mitral cells. Materials and Methods: Sixty two normal fresh aborted fetuses were collected from Obstetrics and Gynaecology department of Regional Institute of Medical Sciences, Imphal. The fetuses were dissected and olfactory bulbs were gently taken out and fixed in 10& formal saline. Once fixed, the volume of the bulbs were measured using a measuring cylinder and insulin syringe. This was followed by tissue processing and staining with Toluidine Blue and Cresyl Violet. Stained slides were photographed and number of mitral cells were counted using Image J software. The correlation of bulb volume with fetal age, crown rump length [CRL 1 and fetal body weight was analysed using SPSS software. Similar analysis was also done between mitral cell number and fetal age. Result: Fetal bulbs attained adult morphology at 20 weeks. Bulb volume was found to rise significantly with advancing fetal age until it slowed down 32 weeks onwards. Mitral cells were identifiable at 16 weeks and maintained a laminar arrangement and showed progressive increase in number until 28 weeks. There after the orderly arrangement of cells as well their number declined. Conclusion: Very few studies have been conducted so far regarding the fetal olfactory bulbs in India. The present study is expected to supplement known data and knowledge regarding the development of the fetal bulbs and the mitral cell population and help in the diagnosis and treatment of central nervous system diseases.

An Unusual Presentation of Spasmoproxyvon Dependence from Manipur, India

International Journal of Medicine and Public Health,2017,7,3,178-180.DOI:10.5530/ijmedph.2017.3.36Published:Aug 2017Type:Case ReportAn Unusual Presentation of Spasmoproxyvon Dependence from Manipur, IndiaGojendra Singh, and Senilo Magh Gojendra Singh1*, Senilo Magh2 1Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, INDIA. 2Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, INDIA. Abstract:We report a case of a young male Opioid user who was taking an exceptionally high dose of Spasmoproxyvon (SP). Investigations did not reveal any significant deleterious effect to his health although he was using five times more than the documented toxic dose. Keywords:Opioid Dependence, Opioid User, SpasmoproxyvonView:PDF (95.75 KB)

Titanium elastic nailing for paediatric femoral shaft fractures: a prospective descriptive study

<p class="abstract"><strong>Background:</strong> Femoral shaft fracture is the most common major paediatric orthopaedic fractures. For generations traction and casting was the standard treatment for all femoral shaft fractures in children. Over the past two decades the advantages of fixation and rapid mobilisation have been increasingly recognised. Aim: To assess the functional and clinical outcome after closed reduction and internal fixation with titanium elastic nail in diaphyseal femoral fractures between 5 to 16 years.</p><p class="abstract"><strong>Methods:</strong> The study was conducted in the Department of Orthopaedic Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, from September 2013 to April 2015. Thirty children (20 boys and 10 girls) in the age group of 5 to 16 years with recent femoral diaphyseal fractures were stabilised by titanium elastic nails [TENS]. Results were evaluated according to Flynn’s scoring criteria.<strong></strong></p><p class="abstract"><strong>Results:</strong> After 25 months of follow up all thirty patients were available for evaluation. Radiological union were achieved in a mean time of 11.5 weeks. Mean duration of hospital stay was 15.23 days. According to Flynn’s criteria of TENS outcome score results were excellent in 66.7% patients, Satisfactory in 30% patients, Poor in 3.3% patient. All patients had early return to school. Per operative technical problems included failure of closed reduction in 2 cases.</p><p><strong>Conclusions:</strong> Titanium elastic nailing is an effective treatment in diaphyseal fractures of femur in properly selected patients. </p>

Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee

ABSTRACT Aim To find the effectiveness of single-dose intra-articular (IA) injection of high-molecular-weight hyaluronic acid (HMWHA) in patients suffering from primary osteoarthritis (OA) of knee. Study design A randomized control trial. Duration of the study One-and-a-half years, commencing from October 2014. Settings Physical Medicine and Rehabilitation (PMR) Department, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. Study population All patients suffering from OA knee, who fulfilled the American College of Rheumatology (ACR) criteria for classification of idiopathic OA knee and attending the department during the study period. Materials and methods Sixty-five patients were randomized to receive either visco-supplementation with single-dose IA injection of HMWHA (study group) or methylprednisolone (control group) and follow-up was done at 1, 3, and 6 months. Outcome measures were done with Western Ontario and McMaster University (WOMAC) and visual analog scale (VAS) for pain. Results Both the groups showed significant improvement in both WOMAC and VAS pain score at the end of 3 months. But at the end of 6 months, improvement in terms of WOMAC (p = 0.09) and VAS pain (p = 0.07) scores in control group was not significant, whereas the study group maintained statistically significant improvement. Conclusion A single dose of IA HMWHA is effective in reducing pain and disability in patients with primary OA of knee. How to cite this article Yengkhom JS, Nongmaithem RS, Chiru MSC, Thakur KB, Debnath U. Efficacy of Single-dose Intra-articular Injection of High-molecular-weight Hyaluronic Acid in Patients suffering from Primary Osteoarthritis of Knee. Indian J Phy Med Rehab 2017;28(3):89-94.

Profile of glucose intolerance in chronic hepatitis B virus infection

Background: The prevalence of diabetes mellitus and impaired glucose tolerance is higher in patients with cirrhosis of any cause than in the general population. Hepatitis B infection is one of the causes. Objectives: To study the prevalence of glucose intolerance in chronic hepatitis B (CHB) virus (HBV) infection and to find out the association between glucose intolerance and severity of fibrosis, genotype, and HBV DNA levels. Materials and Methods: The study was a retrospective cohort type conducted in the Department of Medicine, Regional Institute of Medical Sciences, which included 29 patients. Fasting blood sugar (FBS) and postprandial blood sugar (PPBS) were performed. HBV DNA levels and genotype were determined. Liver fibrosis was assessed by fibroscan. Results: The number of patients with impaired and diabetic range of FBS was 5 (17.2%) and 7 (24.1%), respectively. Similarly for PPBS, 8 (27.6%) patients had impaired range and 11 (37.9%) patients with diabetic range. Glycated hemoglobin (HbA1C) value ≥5.7 was present in 20 (69%) patients. A majority of patients were found to have genotype C (72.4%). Comparison for association between patients having impaired and diabetic range of FBS, PPBS, and HbA1C with fibroscan value >12.5 kPa was found to be statistically significant but that of genotype and HBV DNA levels was not considered significant. Conclusion: The prevalence of glucose intolerance is increased in patients with CHB infection. Patients having severe fibrosis or cirrhosis of the liver are found to be more glucose intolerant.

Clinicopathological profile of patients with non-hodgkin's lymphoma at a regional cancer center in Northeast India

Context: Incidence of non-Hodgkin's lymphoma (NHL) is increasing in all parts of the world, especially over the past few decades. An insight into the clinical presentation may help in the prevention, control, and treatment of NHL. Aim: To observe the clinicopathological patterns of NHL among patients in Northeast India. Subjects and Methods: A retrospective case study on 100 proven cases of NHL registered at the Regional Institute of Medical Sciences, Manipur, during the period January 2013–May 2017 was conducted, and data were reviewed and analyzed. Statistical Analysis Used: Data were analyzed using SPSS-21 and results were presented in percentages and simple frequency. Results: Majority (43.0%) of the patients were in the age group of 41 and 60 years. The mean age was 54.01 ± 18.1 years. Male:female ratio was 1.2:1. The most common presenting symptom was neck swelling (57.0%), and peripheral lymphadenopathy (76.0%) was the most common sign. Primary site distribution was nodal (57.0%) and extra-nodal NHL (43.0%). Most common nodal site involved was cervical lymph nodes (65.0%), and gastrointestinal tract (17.0%) was the most common extranodal subsite. Majority of the patients were in stage II (36.0%) at the time of diagnosis. B-cell NHL accounts for 66.0% compared to T-cell lymphoma (23.0%). Diffuse large B-cell lymphoma was the most frequent B-cell lymphoma (45.0%), and anaplastic large cell lymphoma was the most common T-cell variant (15.0%). Conclusions: A thorough insight into the clinical spectrum of NHL is necessary for optimum management and improved treatment outcome.

Evaluation of Single Unit Blood Transfusion: A Study in Regional Institute of Medical Sciences, Imphal

Blood transfusion can be a life-saving intervention. However,it may result in acute or delayed complications and carries the risk of transfusion transmissible infections.WHO emphasizes that blood is an expensive and scarce resource ; unnecessary transfusions may cause a shortage of blood products for patients in real need besides the risk to the recipient.A reduction in unnecessary transfusions through the appropriate clinical use of blood and blood products and the use of simple alternatives to transfusion wherever possible should be considered. Avoidance of single unit red cell transfusion is also one of the measures of rational use of blood. Some guidelines prefer single unit transfusion for it may reduce transfusion associated and dose- dependant morbidity and mortality.We follow that blood transfusion is indicated when haemoglobin(Hb) level is 10gm% in a non-bleeding patient. During the study period of two years from January 2014 to December 2015 in Regional Institute of Medical Sciences, Imphal ,single red cell units constituted 2232 out of 22546 total red cell units issued(9.9%).Based on our protocol, 480 single unit transfusions out of 2232 units were unjustified and in our context of limited resources, more demand and less supply. Group discussions and awareness sessions with clinicians will be of immense help towards rational use of blood. The study is being presented.

A Study on the Trend of Caesarean Section in Regional Institute of Medical Sciences in Imphal

A Study on the Trend of Caesarean Section in Regional Institute of Medical Sciences in Imphal

Study of Vaginal Birth after Caesarean Section

Objective: To determine the success rate and safety of vaginal delivery after previous one caesarean section (VBAC) Methods: The Cross sectional study was done in 100 cases of G2P1+0+0+1 with previous one caesarean section for trial of labour to determine the success rate and safety of vaginal delivery after previous one caesarean section (VBAC) in the Department of Obstetrics and Gynaecology, Regional Institute of Medical Sciences, Imphal. Data for the purpose of my study was collected over a period of 18 months i.e. from November 2013 to April 2015. Data analysis was checked for consistency and accuracy using IBM SPSS ver. 16and were described using means and percentages. Results: During the study period, only 100 numbers of cases were eligible to undergo trial of labour. Of these 20 patients opted out from the study, 61 patients delivered vaginally and remaining 19 cases had failed trial of labour and had to undergo repeat caesarean section (CS). Out of total 19(23.8%) cases that underwent caesarean section, maximum study cases presented with scar tenderness 10(52.7%). followed by foetal distress in 6(31.6%) cases. VBAC success rate at our institution during our study period was 76.2% which is in tandem with other studies from different author’s/scholars.

Suicide Risk Assessment in Major Depressive Disorder Patients Attending the Regional Institute of Medical Sciences in Imphal, Manipur.

Background: Majority of the clinically depressed persons have suicidal ideation, which is directly related to the severity of depression. Aims: The study aims to identify the socio-demographic factors for suicidal risk behavior and correlation between suicidal risk behavior and clinical variables of depression as well as with the degree of Major depressive disorder severity. It is a hospital based crosssectional study conducted in the Department of Psychiatry, Regional Institute of Medical Sciences (RIMS), Imphal. Materials and methods:50 consecutive cases of attempted suicide attending hospital for a period of 1year were taken up for the study. Consenting Patients fulfilling DSM-IV-TR Criteria for major depressive disorderwere evaluated for socio-demographic profile, precipitating events and mode of attempt. 17-Item Hamilton Rating Scale for depression and Suicide Intent Questionnaire were employed. The data thus obtained was analyzed using SPSS 20.0 windows. Results: Of the fifty (50) suicide attempters (66%) were males and. Mean age of the patients is 29.0400, unmarried males (62%), from joint family (72%), undermatric (52%) , unemployed (40%), from urban background (64%), having poor socio-economic status (42%) were found to be vulnerable factor for suicide attempt. Most common precipitating factors was stressful problems (20%), most common method of suicide attempt was by use of organophosphorus poisoning (38%).MDD severity, highest frequency is found in moderate degree (48%). Maximum SIQ score is found in the definite communicator (5 or more). Among the suicidal behavior, (42%) of depressed patients reported suicidal ideation. Conclusion:Correlation between suicidal behavior & degree of MDD severity was highly significant (P<0.01).

Ruptured Ovarian Pregnancy- A Case Report

Ovarian pregnancy accounts for up to 3% of all ectopic pregnancy but is the most common form of non-tubal ectopic pregnancy. Its diagnosis often is difficult to distinguish as it is frequently confused with a ruptured corpus luteum cyst and clinically with a tubal ectopic. Hereby, presenting a case of primary ovarian pregnancy in a 29-year-old patient, referred from District Hospital Thoubal as query ectopic to Regional Institute of Medical Sciences (RIMS) Imphal. She presented with the complaint of severe lower abdominal pain with history of loss of consciousness, severe pallor and per vaginal findings suggestive of ruptured ectopic.The decision for emergency laparotomy was taken and intraoperatively it was found that patient showing intact tube with ruptured ovarian pregnancy, hence proceeded with right oophorectomy. Aetiological, clinical and therapeutic aspects of this rare extrauterine pregnancy are described. Also, the problems of its differential diagnosis are discussed.

A Study of Prevalence of Obesity in Patients of Bronchial Asthma Attending The Chest Department At Rims,Imphal,Manipur.India.

Objective: To study the prevalence rate of obesity in patients of bronchial asthma attending the chest department at Regional Institute of Medical Sciences,Imphal,Manipur.India. Methods: In a cross-sectional study, I recruited patients with age more than 18 years and older with confirmed bronchial asthma diagnosis at Respiratory Medicine department,RIMS,Imphal,Manipur.Nutritional status was classified by body mass index (BMI). Result: 150 patients were included in this study.Mean age was 35 ± 1.24 years and there were 82 (54.7 %) female patients. Among female,asthma was more common in housewife (30.7 %).Mean BMI was 26.87 ± 4.18 and 60 (40.00 %) were classified as normal weight,49 patients (32.67 %) as overweight and 41 patients (27.33 %) as obesity. Conclusion: The prevalence rate of obesity in this study was 27.33 %.Female asthma patients were more likely to be obese than male asthma patients.

Histogenesis of gastric mucosa in human fetal stomach

Abstract Background and aims: Human fetal stomach starts developing at 4th week of gestational age. The precise knowledge of development of gastric mucosa is important for better understanding, diagnosis and treatment of different clinical conditions like Intestinal metaplasia, pernicious anaemia, heterotopic pancreatic tissue, atrophic gastritis etc. All these conditions are related to anomalous histogenesis of stomach. The aim of the study was to find out development of lining epithelium, gastric pits and glands and their ratio, time of appearance of different gastric mucosal cells in different weeks of gestation. Materials and methods: Sixty three normal fresh aborted fetuses were collected from obstetrics and gynaecology department of Regional Institute of Medical Sciences, Imphal. The fetuses were dissected and stomach was gently taken out, fixed in 10% normal saline and Bouin's fluid followed by processing of the tissue. Staining was done with Haematoxylin and Eosin and Masson's Trichrome. Results: The lining epithelium of stomach was seen to be simple cuboidal at 15 to 16 weeks which changed to columnar at 17th week of age. Gastric pits were seen to be very shallow in fundic part at 15th week and attained adult pattern by 28th week where as in pyloric part pits were deeper than fundic part from 17th week onwards. Parietal cells were frrst appreciated by 19th-20th week, chief cells and mucous neck cell were first seen by 25th-26th and 23rd-24th weeks respectively. Entero­ endocrine cells were seen from 26th week onwards. No funding was suggestive of intestinal metaplasia or heterotopic pancreatic tissue or any other histogenetic anomaly. Conclusion: Very few studies have been conducted so far regarding histogenesis of human fetal stomach in India. The present study is expected to supplement known data and knowledge regarding histogenesis of human fetal stomach and help in diagnosis and treatment of related congenital anomalies.

Study of Effectiveness of Shoulder Elbow Wrist Hand Orthosis in the Management of Glenohumeral Subluxation in Post-stroke Hemiplegic Patients

Abstract Objective Study of effectiveness of shoulder elbow wrist hand orthosis in the management of glenohumeral subluxation in post-stroke hemiplegic patients. Methods Design: Randomised control trial. Setting Department of Physical Medicine and Rehabilitation, Regional Institute of Medical Sciences (RIMS), Imphal. Participants Post-stroke hemiplegic patients (n=120) having glenohumeral subluxation (GHS) as confirmed by x-ray. Duration One and half years (August 2010 to January 2012). Intervention Control group (n=60) received routine rehabilitation programme for hemiplegic practice in the Department of PMR, RIMS while the experiment group (n=60) received shoulder elbow wrist hand orthosis in addition to rehabilitation programme. Outcomes Grade of glenohumeral subluxation using x-ray. Results Experiment group showed reduction in the glenohumeral subluxation which is statistically significant when compared to control group (p&lt;0.001). Conclusions Use of upper limb orthosis in addition to routine rehabilitation programme can effectively reduce glenohumeral subluxation in post-stroke hemiplegic patients.

Embryological analysis of a case of exstrophy of the cloaca

A case is reported here of a stillborn fetus of about 21 weeks of gestation that was collected from the Department of Obstetrics and Gynecology, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, India. The weight of the fetus was around 350 g. Crown rump (CR) length was not taken because of spine deformity and, therefore, the foot length, which measured 3.3 cm, was used to determine the age of the fetus. External examination of the fetus revealed an enormous defect in the anterior abdomen wall (omphalocele). The umbilical cord was attached on the right side of omphalocele. Incision of the membranous sac revealed liver, coils of intestine, and a muscular sac herniating through the defect in the abdominal wall. Further exploration of the abdomen showed continuity of the large intestine and ureters to the muscular sac. The sac is the cloaca. Exstrophy of the cloaca is a rare developmental anomaly involving the urinary bladder and the distal part of the digestive tract. This case report discusses the embryological background of the development of exstrophy of the cloaca and is reported because of the association of complete absence of external genitalia.