Agenesis of the extrahepatic bile ducts: report of five cases

Five patients were encountered in whom agenesis either of the proximal extrahepatic biliary ducts (four patients) or total absence of the extrahepatic bile ducts and gall bladder (one patient) were evaluated. Jaundice was diagnosed from at birth to 3 weeks of age (average, 1.2 weeks of age) in these five patients. The patients' ages ranged from 2 to 8 weeks at the time of surgical exploration. Findings at surgery showed either absence of the entire extrahepatic biliary ducts or proximal bile duct remnants, no evidence of an inflammatory process, and no fibrous mass present at the portahepatis. Liver biopsy specimens showed histological evidence of cholestasis, minimal bile duct proliferation and fibrosis, and nearly complete absence of inflammation. In three patients in whom a portocholecystostomy was performed, no bile flow was obtained. Two patients underwent surgical exploration and liver biopsy only. One patient died as a result of severe congenital heart disease at 3 months of age. Four patients have undergone successful hepatic transplantation. These patients are now 10 months to 6 years of age. In our review of the literature, we were unable to find any reports of bile duct agenesis despite the fact that it appears to be a known phenomenon. We conclude that patients with biliary agenesis have early onset of jaundice when compared with patients with biliary atresia, absence of inflammation at the portahepatis at the time of surgical exploration, as well as on biopsy of the liver. Portoenterostomy or portocholecystostomy are likely to fail. We believe that liver transplantation is the treatment of choice for this rare entity.     

Diversity in Bird’s Eye Chilli (Capsicum frutescens L.) Landraces of North-East India in Terms of Antioxidant Activities

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Bird’s eye chilli (Capsicum frutescens L.) is one of the most important species of the genus Capsicum,...     

Screening for HIV infection by health professionals in India

BACKGROUND: Stigma and discrimination, particularly in access to healthcare, remains a major problem for people Infected with HIV in most parts of India. METHODS: We did a multicentre study (n = 10) with a cross-sectional survey design using a standardized, interviewer-administered questionnaire. RESULTS: A total of 2200 healthcare providers participated. The knowledge, attitude and practice (KAP) related to HIV service delivery were very poor with a mean overall KAP score of only 49.7% (CI: 49.1-50.3). Only 5%, 5% and 1% of the participants scored more than 75% separately for the dimensions of knowledge, attitude and practice, respectively. Only 24.4% and 36.7% of responders knew that HIV screening was not recommended prior to surgery and pre-employment check-up. Many doctors (19.4%) had refused treatment to people living with HIV/AIDS (PLHA) at least some of the time and nearly half (47.2%) identified and labelled them; 23.9% isolated them in separate care areas and 13.3% postponed or changed treatment based on the patient's HIV status. Screening for HIV prior to elective surgery was done by 67% of providers. While 64.7% of responders were aware of the existence of national guidelines on and recommendations for HIV testing, only 38.4% had read the policy document. CONCLUSION: There is a growing need to provide care, support and treatment to a large number of PLHA. The capacity of healthcare providers must be urgently built up so as to improve their knowledge of and attitude to HIV to enable them to deliver evidence-based and compassionate care to PLHA in various healthcare settings.     

Spatial distribution and characteristics of injecting drug users (IDU) in five Northeastern states of India

Background  

Injecting drugs is the major driving force of human immunodeficiency virus (HIV) epidemic in Northeastern India. We have assessed the spatial distribution of locations where injecting drug users (IDU) congregate, as well as the risk behaviour and key characteristics of IDUs to develop new strategies strengthening intervention measures for HIV prevention in this region.     

Seroprevalence of toxoplasma infection among primigravid women attending antenatal clinic at a secondary level hospital in North India

A study was carried out among primigravid women attending a secondary level hospital in a district of North India. The objective of the study was to determine seroprevalence rate of Toxoplasma gondii infection using enzyme-linked immunosorbent assay (ELISA) test. Associations between toxoplasma seropositivity and selected variables (socio-demographic and biologically plausible variables) were also studied. Five hundred three women were enrolled from the antenatal clinic between August, 1996 and September, 1997. Of these, 210 women (41.75%) were seropositive for Toxoplasma gondii infection. These results indicate that a large number of the study subjects were vulnerable to toxoplasma infection. If these infections had occurred during the pregnancy, their foetuses would have been at high risk of infection. There was no statistically significant association between toxoplasma seropositivity and the variables studied except, in the case of type of meat usually consumed. There is a need to provide health education to pregnant women in order to prevent primary toxoplasma infection during pregnancy.     

Patients' satisfaction with hospital care in a referral institute in Manipur

A cross-sectional study was conducted to determine the level of patients' satisfaction with hospital care in Regional Institute of Medical Sciences, Imphal among inpatients during the month of May 2007. Interview schedule was developed covering certain domains regarding patients care. Overall satisfaction level was determined by using a summated Likert score. Most of the patients (260, 74.1%) were satisfied with the overall care received. Patients were found to be unsatisfied in the domains pertaining to admission procedure (145, 41.3%), comfort and cleanliness (164, 46.7%), food service (194, 55.3%). Patient admitted in the Obstetrics and Gynecology ward showed a significantly higher level of dissatisfaction as compared to patients from other departments (p<0.03).     

Persistence and Metabolism of Imidacloprid in Rice

Imidacloprid is a systemic insecticide which gives effective control of plant and leaf hoppers in rice. The persistence and metabolism of imidacloprid in paddy leaves, rice grains, bran, straw and husk were studied following two applications of imidacloprid (Confidor 17.8 SL) @ 20 and 80 g a.i. ha^?1 at an interval of 10 days. Samples of paddy leaves were collected at various time intervals. The samples of rice grains, bran, straw and husk were collected at the time of harvest. The limit of quantification of imidacloprid and its metabolites was worked out to be 0.01 mg kg^?1. The maximum residues of imidacloprid and its metabolites in paddy leaves after 0 day (1 h after last spray) of its application @ 20 and 80 g a.i. ha^?1 were found to be 4.57 and 13.94 mg kg^?1, respectively. These residues could not be detected after 60 and 90 days following last application of imidacloprid at lower and higher dosages, respectively. In rice, olefin metabolite was found to be the main constituent, followed by nitroguanidine, urea, 5-hydroxy, chloronicotinic acid and nitrosimine. The samples of rice grains, bran, straw and husk did not reveal the presence of imidacloprid or its metabolites following its application at both the dosages at harvest.     

Precision carving of costal cartilage graft for contour fill in aesthetic and reconstructive rhinoplasty

Background:

Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. “Warping” can also be utilized to change the curvature of the graft.

Materials and Methods:

We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.

Results:

All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.

Conclusion:

The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.KEY WORDS: Autogenous cartilage, balanced section, costal cartilage graft, rhinoplasty, warping