Introduction: Dengue is a major public health problem in tropical and sub-tropical regions of the world. Detection of specific Immunoglobulin M [IgM] antibodies forms the mainstay for diagnosis of dengue infection. However, IgM antibodies develop after 4-5 days of infection and there is an urgent need for an alternative diagnostic tool that can detect dengue infection during this phase. Materials and Methods: We carried out a prospective study with the aim to analyze the utility of a commercial non-structural protein 1 antigen (NS1 Ag) based rapid immunochromatographic test for detection of dengue infection in anti-dengue IgM seronegative serum samples. Results: A total of randomly selected 86 IgM negative samples were tested for the presence of dengue NS1 Ag. Of these, 59.30% (51/86) were positive for NS1 Ag. Conclusions: Our findings, therefore, supplement the findings of other similar studies suggesting NS1 Ag as an early diagnostic marker that is feasible to look for in a routine diagnostic laboratory. Furthermore, NS1 Ag assay may be a useful tool for detecting dengue infection during acute phase of infection when IgM antibodies are not formed to the detectable levels.

Aim: To determine the nasal indices of fetuses of Manipuri population in order to classify the nose type and to derive at a regression equation for determining gestational age from nasal dimensions. Materials and Methods: Sixty four Manipuri fetuses, between 12 weeks and 40 weeks of gestation were used. Nasal height and width were measured using vernier caliper. The data obtained were subjected to statistical analysis using descriptive statistics, Pearson correlation 'r', and linear regression model were used. Results: A statistically significant correlation between gestational age and nasal height (r = 0.89, P < 0.01) as well as nasal breadth (r = 0.85, P < 0.05) were observed. The nasal index of a Manipuri fetus at full-term was platyrrhine/chamaerhine. Conclusion: The nose of fetuses of Manipuri population at birth is platyrrhine which is round and wide. Its relevance may be found in forensic and clinical practice.

Objective: To test sympathetic division of autonomic nervous system and observe any dysfunction in patients of bronchial asthma. Materials and Methods: Fifty four patients, 18 males, 36 females, and 30 healthy control subjects attending Respiratory Medicine out-patient department Regional Institute of Medical Sciences, Imphal were included in the study. Age ranging from 15 to 60 years were recruited for the study. Spirometry values of forced vital capacity (FVC), forced expiratory volume in first second (FEV ₁ ) _, FEV ₁ /FVC, peak expiratory flow rate (PEFR), forced expiratory flow (FEF _25-75% ) recorded by using HELIOS 702 (Recorders and Medicare System, Chandigarh). Predicted values were taken as values for normal subjects. Sympathetic nervous system tested by measuring diastolic blood pressure response to sustained hand-grip for 2 min and from supine to standing for 3 min. Results: FVC, FEV ₁ , PEFR, FEF _25-75% were significantly lower in asthmatics as compared to controls. Diastolic blood pressure response to sustained hand-grip for 2 min and from supine to standing for 3 min was higher in asthmatics as compared to controls. Conclusion: Sympathetic nervous function assessment of the patients shows that sympathetic abnormalities occur in patients of bronchial asthma.

Objectives: To study the pattern of diseashe in palpable supraclavicular lymph node using fine needle aspiration cytology (FNAC) in Regional Institute of Medical Sciences (RIMS) Hospital, Imphal, Manipur. Materials and Methods: A retrospective study was done by critically analyzing the FNAC reports of palpaple supraclavicular lymph node in last 5 years (January 2006-December 2010) at the Department of Pathology, RIMS Hospital, Imphal, Manipur. Review of all the reports were done and diagnosis was made according to standard guidelines and correlated with patient's age, sex, and side of involvement to explore the disease pattern. Results: Out of 255 cases, 48.28% were metastatic tumors, 27.5% were tuberculous lymphadenitis, 15.3% were of non-specific reactive lymphadenitis, 4.3% were non-caseating granulomatous lymphadenitis, 2.7% were of lymphoma and 1.96% was of acute suppurative lymphadenitis. Mean age of presentation of metastatic tumor was 57 years, whereas in case of tuberculous (Tb) lymphadenitis it was 34.5 years. Females were more commonly affected than males with male female ratio of 1:1.4. Left sided involvement was seen in 50%, right sided involvement in 46% and bilateral involvement in 4% of patients. Conclusion: Enlarged supraclavicular lymph node often has some serious underlying pathology both in young adults and old patients. Further, our study highlights the importance of FNAC in the initial evaluation of enlarged supraclavicular lymph nodes.

Objective: To evaluate the histology and histochemistry of endometrium in dysfunctional uterine bleeding (DUB). Materials and Methods: This was a prospective study conducted in Regional Institute of Medical Sciences, Imphal during the period between 1 ^st December 2004 and 31 ^st August 2006. A total of 50 cases of DUB and another ten matched normal subjects were selected. Endometrial samples taken between the 21 ^st and the 24 ^th day of the menstrual cycle and at random for continuous vaginal bleeding were studied with conventional H and E, periodic acid schiff and alcian blue stains. Results: Endometrial patterns of DUB were proliferative (44%), secretory (20%), irregular ripening (14%), atrophic endometrium (18%) and irregular shedding (4%), respectively. Conclusion: The commonest types of endometrium in DUB are proliferative and secretory endometrium is seen in all the normal subjects.

Objectives: Abdominal wound dehiscence occurs in 0.5-3% of the patients following laparotomies. As the vacuum assisted closure technique is now well established to manage chronic wounds, we hereby describe an innovative approach to apply negative pressure to acute wounds. Materials and Methods: The innovative negative pressure device was applied in 5 patients, three with wound dehiscence after cesarean section and two after hysterectomy. A commercially available closed suction apparatus 14 gauge in size and 5 cm thick sponge were used. The sponge was covered with an adhesive transparent sheet. The dressing was changed every 48-72 hours depending on the amount of secretion present in the chamber. The suction device was charged as and when it got deflated. Results: All the wounds had gradually decreasing area of undermining and the discharge from the second dressing change onwards. Whereas three of them underwent a two-layered closure, the other two healed with 100% take of the skin graft. Discussion: Healing by secondary intention is a time consuming process that leads to prolonged hospital stay. The negative pressure wound therapy (NPWT) has been used to treat chronic wounds and pressure ulcers, It evacuates the drainage from the wounds and thereby decreases edema of wound margins and the adjacent areas. It also improves the blood flow to the wounds and decreases bacterial burden. The innovative device used by us is easily available, affordable, and simple to use with good outcome. Conclusion: NPWT is a valuable alternative in selected cases when a surgical closure is not indicated or not desired by the patient. The innovative device was well accepted by our patients as it did not add to their postpartum or post-operative stress. It can be used in any set-up in any patient, meeting the criteria of NPWT.

Objective: To study, the effect of prophylactic ketamine (K) gargle in reduction of post-operative sore throat (POST) following endotracheal intubation. Materials and Methods: 90 adult patients between 18 years and 60 years with American Society of Anesthesiologists I and II, scheduled for elective open cholecystectomy surgery under general anesthesia were randomly assigned into 2 groups of 45 patients each. Group S-received 30 ml of normal saline (NS) and Group K-received 40 mg of K in 30 ml of NS. Then the patients were asked to gargle with the preparation for 30 s after their arrival in the operation room. Anesthesia was induced 5 min later. On arrival in the post-anesthesia care unit (0 h), and at 2 h, 4 h, and 24 h thereafter, the patients were questioned by a blinded investigator whether he/she had experienced sore throat or any other side- effects. POST was graded on a four-point scale (0-3). Results: The incidence of POST was higher in NS group compared with K group at 0 h, 2 h, 4 h, and 24 h. In addition, there is reduced incidence of hoarseness of voice in K group compared to NS group at 0 h, 2 h, 4 h, and 24 h after extubation. Conclusion: In conclusion, gargling with K decreases the incidence and severity of POST and hoarseness of voice.

Background: Hemodynamic instability is one of the most imminent conditions during general anesthesia (GA), especially, during laryngoscopy and intubation. The aim of the study was to study the perioperative hemodynamic effect of clonidine in normotensive patients undergoing elective surgery under GA. Materials and Methods: A randomized double blinded placebo controlled study was conducted in the department of Anesthesiology, Regional Institute of Medical Sciences, Imphal on 150 normotensive adult patients of either sex aged 18-60 years (American Society of Anesthesiologist I and II) undergoing elective surgery under GA. The patients were allocated into three groups viz.: Group 1-2 μg/kg clonidine; group II-3 μg/kg clonidine; and group III - placebo/normal saline. The test drug was administered 30 min before the induction of anesthesia. Upon arrival at theatre, the following data were recorded viz.: (1) Visual analogue score of anxiety, (2) loss of consciousness, and (3) dryness of mouth. Pre-induction heart rate (HR) and blood pressure (BP) were recorded 5 min after resting on the operating table. HR and BP were recorded during the time of intubation every 8 min and ½ h after intubation during the intraoperative period (post-intubation). Postoperative BP and HR on arrival at the post-anesthetic care unit and then every ½ h for 3 h were recorded. Any episodes of nausea and vomiting, shivering and analgesic requirements were noted. Results: Clonidine 2 μg/kg and 3 μg/kg both significantly controlled the perioperative hemodynamics. The hemodynamic changes were statistically significant at all times intervals except at preoperative, at 8 min post-intubation to 1 h post-intubation period. Conclusion: Clonidine is useful as a premedicant in controlling the perioperative hemodynamics changes in normotensive patients undergoing operative procedures under GA.

Background : Childhood obesity is a precursor for later disease risk and it is important to obtain a better understanding of the body composition and body mass index (BMI) in children. Objective: To determine the body composition and its relation with BMI of adolescents. Materials and Methods: A cross sectional study of 3356 school children in age group 12 to 19 years residing in Imphal-West District, Manipur was conducted during May 2005 to May 2008. BMI and Body composition were determined using the TANITA Body Composition Analyzer (TBF-300, JAPAN). Results: The mean (Standard Deviation) BMI among boys and girls were 18.7 (2.6) and 19.2 (2.8) respectively and the difference was statistically significant (P = 0.000). Multiple linear regression analysis shows that BMI was significantly associated with waist circumference, weight, fat%, total body water (P = 0.000) and fat free mass (P = 0.041) among the boys and inversely associated with height, hip circumference and waist-hip ratio (WHR) (P = 0.000). Among girls, BMI was positively associated with hip circumference (P = 0.035), weight (P = 0.000), fat% (P = 0.000) and total body water (P = 0.000) and inversely associated with height (P = 0.04). Conclusion: Though fat percentage was found to be significantly correlated with BMI, it could explain little of the variation in BMI.

Objective: The aim of this study is to avoid psychological distress to the mother and baby by avoiding General Anaesthesia and overnight hospital stay which will be required, if the abscess is to be drained by incision drainage and to avoid leaving an ugly scar on the breast. Materials and Methods: In our prospective study, 50 patients with breast abscesses were treated by needle aspiration of pus, oral antibiotics, and repeat aspiration, if necessary. All were outpatients, and treated in Department of Surgery, Regional Institute of Medical Sciences, Imphal. Ultrasonography was not used. Out of 50 patients, 31 were lactating mothers. Results: The mean age of the patient was 32 years (19-80 years). Staphylococcus aureus was the most common organism isolated in both lactating and non lactating cases. Of the 50 cases, 39 (78%) resolved well without recurrence. Eight (16%) cases failed to respond to repeated aspiration and underwent incision and drainage. Three (6%) cases had recurrent abscess occurring 1 month after the last aspiration. Conclusion: Needle aspiration with antibiotic is an effective treatment for breast abscesses.

Gastrointestinal mucormycosis is an uncommon disease most often occurring in immunocompromised individuals, patients with diabetes, and patients suffering from hematologic and solid malignancy. Rarely, it may occur in normal persons without any contributory factor. We report a rare case of gastric mucormycosis in an immunocompetent individual who recovered with Amphotericin-B treatment.

A man sustained firearm injury in the abdomen and later on died due to bronchopneumonia following postoperative complications. This case is being reported to establish the importance of Medical Audit Sessions to improve patient care service in the hospital.

Primary pulmonary hypertension is rare condition. Pregnancy with this condition is associated with high maternal mortality.

A case of recurrent painless swelling of the gingiva which was clinically diagnosed as pyogenic granuloma in an 18-years-old female is reported to highlight the prevalence of recurrent peripheral ossifying fibroma, the need for a thorough curettage up to the deepest possible tissue at the time of excision and strict postoperative follow-up.

We report a case of axillary vein thrombosis in a 45-year-old-man, sustained after fall of heavy object over the right upper limb. Three days later, a diagnosis of right distal axillary vein thrombosis was made. Patient was given subcutaneous low molecular weight heparin followed by oral warfarin. His symptoms disappeared after 3 months of treatment. It is important to be aware of this unusual but potentially serious complication, as early diagnosis and treatment may limit morbidity and mortality.