Skin disorders are commonly encountered in intensive care unit and pose numerous diagnostic and therapeutic dilemmas to the attending intensivist. Variable presentation of a single critical illness or a common presentation of multiple critical illnesses is few of the challenging aspects of such dermatologic disorders. Lack of in-depth understanding of the dermatological manifestations of systemic diseases in critically ill patients is one of the prime factors for difficulty in accurate diagnosis and management. Services of a dermatologist are immensely helpful and essential in diagnostic and therapeutic management of such disorders. The present article reviews in detail the clinical profile, diagnostic measures and therapeutic interventions of various dermatologic disorders encountered in the critically ill patients.

Background: In India, the incidence of deep vein thrombosis (DVT) is not well highlighted and literature survey shows scanty works in this field. Most of the literature available in India is from the orthopaedic departments, overall incidence of DVT in general population is largely unknown. Materials and Methods: A 2 year prospective study to analyze the clinical profile and management of DVT of lower limb was conducted at Regional Institute of Medical Sciences, Imphal. Patients having limb pain, swelling with or without skin changes suspected of DVT were subjected to Doppler examination. Thirty-one patients with Positive test were admitted and treated with standard regimens of low molecular weight heparins (LMWH), oral warfarin, compressive stockings and supportive care. The risk factors, response to treatment, clinical course were documented using physical examination and relevant laboratory tests at regular intervals. The data was prospectively analyzed. Results: Majority of patients were less than 45 years old with no sex preponderance. No risk factors were identified in 45%, 26% had lower limb fractures, Seven percent were pregnancy related and cellulitis, electric burns, antecedent blunt Trauma, Systemic lupus erythematosis were observed in three percent of patients each. Ten percent of patients had history of immobilization due to medical illness. There was excellent response to LMWH in 93.54% of patients with two poorly responding patients requiring mechanical thrombectomy using Fogarty venous thrombectomy balloon catheter. No significant hemorrhagic complication or pulmonary embolism encountered clinically. No recurrent thrombosis or Malignancy noted during 6-16 months. Conclusion: Most of the DVTs are idiopathic and occur in less than 45 years age group. Irrespective of the etiology, LMWH and Warfarins are efficient, safety is well demonstrated, and domiciliary treatment is advisable with surveillance. Idiopathic DVTs require long term follow up to watch for recurrent thrombosis. Owing to small sample size the data cannot be extrapolated to general population to conclude the incidence. Further studies are necessary to stratify risks, and incidence in our Indian population.

Aims and Objectives: To study of clinical and laboratory findings of 14 young (< 45 years) patients with cerebro vascular accident who were positive for anti-phospholipid antibodies (aPLs). Materials and Methods: The clinical, laboratory, and radiologic findings in 14 young patients with cerebrovascular accident and positive tests for aPLs referred to Shohada Hospital were studied. The analysis for aPLs included estimation of lupus anticoagulant (LA) test, anticardiolipin (aCL) antibodies and anti beta2 glycoprotein 1 antibodies. Other relevant tests included anti-nuclear antibody, human immunodeficiency virus, Venereal Diseases Research Laboratory, platelet count, echocardiography and carotid Doppler. aPL positive strokes were those cases where either the immunoglobulin G (IgG) and/or immunoglobulin M (IgM) were raised or LA or anti beta2 glycoprotein 1 antibodies was positive and other known causes were excluded. Results: Levels of IgG aCL antibody was raised in nine cases and IgM aCL antibody was elevated in 11 cases. Three cases were positive for LA test. Only one patient was positive for anti beta2 glycoprotein 1 test. Seven patients showed small multiple bilateral cerebral infarcts on computerized tomography (CT) scan. Four patients had a history of recurrent strokes. Hemiparesis was more frequent than hemiplegia. One of patient presented with dense hemiplegia. Eleven patients recovered to normal functional capacity and did not have a recurrence on drugs. Conclusion: Cerebrovascular accident in young patients with positive tests for aPL showed certain clinical and radiological features, mild to moderate stroke, pre-treatment recurrences, and multiple smaller infarcts on CT, which could be clustered in a subgroup of stroke in young. These patients showed a better prognosis in terms of long-term outcome.

Objectives: To grade the severity of airway obstruction in the cases of obstructive airway disease (OAD) selected for the study and to observe for any electrocardiographic changes and correlate it with the severity of airway obstruction. Materials and Methods: 50 cases of OAD, 37 of chronic obstructive pulmonary disease (COPD) and 13 of Bronchial Asthma, attending the out patient department (OPD) of Respiratory Medicine, Regional Institute of Medical Sciences (RIMS), Imphal were included in the study. Spirometry was performed and electrocardiogram (ECG) was recorded for the cases in the Department of Physiology, RIMS, Imphal. For analytical purposes, well known statistical techniques like mean, standard deviation, X² -test and F-test are used whenever found suitable and necessary through SPSS software and accordingly interpretations are made. Results: The cases were found to have mild to moderate to severe to very severe degree of airway obstruction. The ECGs showed normal to varied findings. Conclusion: Electrocardiographic changes are found to be observed more with those who have higher grade or degree of airway obstruction. Relationship between ECG findings and degree of airway obstruction is found to be highly significant.

Background: Rehabilitation is now an essential and integral part of burn treatment starting right from the time of admission. Objectives: The objective of the study is to create a liaison between burn victims and rehabilitation services so as to help the patients lead a better life. Methods: A longitudinal study of one and half year duration (May 2009 to October 2010) was conducted among adult female burn victims admitted in a tertiary care hospital in Mumbai, India. Sampling technique adopted for the study was universal sampling i.e. all the female burns victims above 18 years of age who were admitted during the study period and were willing to participate in the study were included. A pre-tested questionnaire was used to obtain socio-demographic details and details about burns injury. Subsequently each of them was followed up for two months duration after their discharge from hospital to keep track of their health status / social problems and utilization of rehabilitation services depending upon their needs. Statistical analysis was done using SPSS-17 version. Results: Case fatality rate was found to be 35%. Out of 48 women who were followed up, only 3(6.2%) had undergone reconstructive surgery for contractures while 14(29.1%) women had developed contractures. Conclusion: Counseling services deserve special attention and play a vital and indispensable role in rehabilitation of burn victims not only during hospital stay but also after discharge. There is an immense need of giving emphasis on promotion of positive thinking, significance of physiotherapy and occupational therapy, measures for prevention of secondary infections & contractures and facilitating vocational guidance for earning own livelihood for an independent living.

Objectives: To determine the association between plasma homocysteine concentration and metabolic parameters in type 2 diabetes mellitus with and without cardiovascular complications. Materials and Methods: Cases of sixty type 2 diabetes mellitus patient (thirty with cardiovascular complications and another thirty without cardiovascular complications) were randomly selected from patients attending Diabetes Clinic and Medical wards, RIMS, Imphal. Another thirty age and sex-matched normal volunteers were taken as control. Serum homocysteine was estimated by ELISA. F-test (ANOVA) and correlation technique were used to analyze the data sets. Results: The serum homocysteine levels of type 2 diabetes mellitus patients both with and without cardiovascular complications were found to be significantly higher (P < 0.001) than the control subjects with 27.20 ± 6.02 μmol/l and 18.03 ± 4.61 μmol/l compared to 9.36 ± 1.70 μmol/l in the controls. Homocysteine is positively correlated with total cholesterol (r = 0.121, P < 0.05) and negatively correlated with HDL level (r= −0.166, P < 0.05). A positive correlation is found between the serum homocysteine level and blood pressure. Conclusions: Homocysteine and dyslipidaemia increases the cardiovascular risk significantly in type 2 diabetes mellitus. Homocysteine may be estimated as a prognostic indicator to assess the risk of developing cardiovascular complications.

Aim: To obtain feedback from the postgraduate students on their perception of various lecture delivery methods use in Regional Institutes of Medical Sciences (RIMS), Imphal. Materials and Methods: The study was conducted among the postgraduate students in RIMS. A questionnaire was circulated among 109 randomly selected postgraduate students from different departments and was asked to tick appropriately the teaching aids and the methods, which were preferred. Results: The majority of the postgraduate students (66.05%) preferred power point (PPT) presentation, while 22.21% of the students preferred the lecture using blackboard (BB) and 11.73% preferred overhead projector transparency (OHPT) for teaching. Some important comments of the students were also recorded. Conclusion: The postgraduate students clearly preferred the use of PPT presentation over the other methods. It also appears that in the hands of a trained teacher, any teaching aid would be appropriate and effective.

Objectives: To assess the knowledge of Preventions of parent to child transmission (PPTCT) among married women and to assess the association between knowledge level with some important variables. Materials and Methods: A cross sectional study was conducted during September to December 2010 among married women between the age group of 18-45 years in an urban community of Imphal West, Manipur. After taking an informed consent, a face to face interview was conducted using a pretested, predesigned structured questionnaire. Chi-square test was used for analysis. Results: Only one third of the study population had adequate knowledge on PPTCT program with the mean score of 6.4 ± 2.5 (range; 1 to 12) out of total 14 score. All of them had heard of HIV/AIDS however, only 58% knew PPTCT program. Knowledge of the respondents was significantly associated with age and parity. Conclusion: Only one third of the participants have adequate knowledge on PPTCT. Information, education and communication effort to increase awareness about PPTCT program among married women is urgently needed to reduce this deadly disease among children.

Background: The role of estrogen on pulmonary function tests was well-known in the normal course of the menstrual cycle. Significant increases in both progesterone (37%) and estradiol (13.5%), whereas no change in plasma follicle stimulating hormone and leutinizing hormone FSH and LH was observed in exercising women in previous studies ^[10],[11] Therefore, this study was intended to see the limitations of the pulmonary system in adaptability to exercise in the proliferative phase of the menstrual cycle in perimenopausal women. Materials and Methods: Healthy young adult females between 42 years and 45 years who regularly undergo training and participate in competitive middle distance running events for at least past 3 years were considered in the athlete group, whereas the non-athlete group did not have any such regular exercise program. The two groups were in perimenopausal age group. They were made to undergo computerized spirometry after undergoing maximal exercise testing on a motorized treadmill. Results: It was observed that exercise per se does not cause a statistically significant change in dynamic lung function parameters maximum mid expiratory flow rate MMEF, peak expiratory flow rate, mid expiratory flow 25% to 75% in either of the groups. Discussion: This finding supports the hypothesis that the respiratory system is not normally the most limiting factor in the delivery of oxygen even under the predominant influence of estrogen in proliferative phase, which is further accentuated by exercise.

Objective: To determine the effect of age on serum homocysteine (Hcy) level among adult urban population of Manipur. Materials and Methods: A total of 200 serum samples (98 males and 102 females) were taken from the adult urban population of Manipur within the age group 20-60 years. Estimation of serum Hcy level was carried out by enzyme linked immunosorbent assay method using axis Hcyenzyme immunoassay kit from Ranbaxy Diagnostic Ltd., India in the Department of Physiology, Regional Institute of Medical Sciences, Imphal. Results: The mean serum Hcy level was 14.62 ± 11.46 μmol/L. Serum Hcy level increases with age from 20 to 29 year age group till 40-49 year age group (P > 0.001). 37% of the subjects studied have normal serum Hcy level. Conclusion: Serum Hcy level was positively associated with age but the association was not linear.

Objective: The objective of this study was to analyze hanging deaths occurring in Imphal in relation to several factors associated with such deaths. Materials and Methods: This study was performed on 35 cases of hanging deaths brought for an autopsy to the mortuary of Regional Institute of Medical Sciences, Imphal. Factors associated with these deaths and post-mortem findings were recorded and statistically analyzed. Observation: It was observed that the most vulnerable age group was 21-30 years in both sexes. Nearly, 51.42% of the cases belonged to the lower socio-economic group; and the majority of the female victims were house wives (34.29%) who were going through marital disharmony. 82.86% of suicides by hanging occurred indoors and the bedroom was the preferred site in 18 cases (51.42%). The commonly used ligature materials were means which were easily available to the victim viz. nylon rope, chunni, etc. Petechial hemorrhage on the face and eyes were observed in partial hanging cases only. Conclusion: The findings of the present study will help in highlighting the prevailing scenario of hanging deaths in this state.

Aim: The aim of this study was to report the outcome of ureteroscopic lithotripsy (URSL) under local anesthesia (LA) as a day care procedure in patients with lower ureteric calculus. Materials and Methods: Patients with lower ureteric calculus attending urology out patient department, Regional Institute of Medical Sciences (RIMS) Hospital during August 2011 to February 2012 underwent URSL under LA-analgesia as day care procedure. The results are analyzed on aspects of perioperative pain, completion of procedure, stone clearance, hospital stay, complications and patient compliance. Institutional ethical clearance and written informed consent for the procedure taken from all patients for the study. Results: A total of 30 patients with lower ureteric calculus size ranging from 8 to 15 mm underwent URSL with Double J stenting under local anesthesia in RIMS urology operation theatre. Twenty four patients completed the procedure in single session, five required two sessions (four with ureteric stricture DJ stent kept for passive dilation and one patient had edematous non visualized ureteric orifice) and another patient converted to open ureterolithotomy due to hard stone resistant to our pneumatic energy. None of the patients required hospital stay following the procedure except for two patients for IV antibiotics. Visual analog scale was mild in 15 patients, moderate in 10 and severe in five patients. Dysuria with transient hematuria was the most common complication; all were managed conservatively on OPD basis. Overall patient compliance for this procedure was excellent. Conclusion: Ureteric colic is a urological emergency in terms of the severe pain experienced by the patient. In view of the long waiting period for routine OT, fear of obstructive uropathy with urosepsis and consequent decrease in renal function, the initiative of URSL as a day care procedure started in our department and our early experience of this procedure in carefully selected patients is having encouraging results.

Objectives : To study the profile of cryptococcal meningitis in acquired immunodeficiency syndrome (AIDS) patients. Materials and Methods: AIDS cases admitted in the medicine ward of Regional Institute of Medical Sciences, Imphal from July 2003 to June 2011, with signs and symptoms of meningitis were included in the study. Routine cerebrospinal fluid (CSF) analysis, India ink preparation, cryptococcal antigen latex agglutination (CALA), adenosine deaminase, Vitek-2 technology for species identification, culture, and sensitivity for CSF, serum CALA, skin scraping, fine needle aspiration cytology from lymph nodes, sputum for Acid Fast Bacillus, Cryptococcus by Giemsa stain, computed tomography scan/magnetic resonance imaging brain, CD 4 T-cell count, HbsAg, Hepatitis C Virus-Ab and Venereal Disease Research Laboratory test were done for all patients. Results : Out of 391 AIDS cases, 89 had cryptococcal meningitis. Age ranged from 21 years to 61 years (Male:Female = 3.4:1). CSF findings were suggestive of chronic meningitis in 71 (78.86%) cases. Causative species of Cryptococcus strains were Cryptococcus neoformans in 86 cases and Cryptococcus albidus in 3 cases. India ink was positive in CSF examination in 74 (83.1%) cases while CSF and serum CALA were positive in 84.3% and 100% cases respectively.Mean CD4T-cell count was 44.64 ± 25.3. Commonest co-opportunistic infection was tuberculosis (n = 8). Hepatitis B virus and HCV co-infection was found in 2 and 5 cases respectively. Six cases out of 19 Anti-Retroviral treatment naοve patients developed cryptococcal meningitis as a result of Immune reconstitution inflammatory syndrome. Conclusion: Cryptococcosis is still prevalent in AIDS and new variants of cryptococcus other than C. neoformans have been detected.

Background: In elderly, healthy lifestyles are critical in reducing disease risk and increased wellness. Among the many top causes of morbidity, chronic lifestyle-related diseases contribute a major chunk. Objectives: The present study examined self-reported frequencies of smoking, alcohol use, physical activity and dietary practices among older persons and the influence of these on functional limitation among older persons. Materials and Methods: The study sample consisted of 400 study subjects of Shimla hills in North India, aged 60 to 92 years. Participants were recruited from urban and rural areas. Behavior and lifestyle factors information was obtained through a structured interview. Results: 12% currently consumed alcohol and 28.0% were current smokers. Less than half engaged in regular physical activity. Only 41% were regularly consuming milk products, fruits and vegetables in their diet. 20.1% of elderly had inadequate functional ability in instrumental activities of daily living. Conclusion: Adoption of healthy lifestyle activities especially a regular nutritious diet can help preventing functional limitation in elderly.

Aims: To determine the treatment outcome of Olecranon fracture by open reduction and internal fixation using figure of eight tension band wire loop without kirschner's wire and to assess the association between Olecranon fracture and selected variables of interest. Materials and Methods: Patients with Olecranon fractures Mayo type IIA were managed with tension band wire loop without kirschner's wire. Final result assessed at 12 weeks. Clinically and radiologically as regard to pain, range of movement, status of union and function. Results: Twenty patients (m: 13, f: 7) with a mean age of 39.7 were operated. They were assessed at 12 weeks. Final result was Excellent in 14 patients (70%). Good in 3 patients (15%) and Fair in 3 patients (15%), using Mayo's elbow performance score. There were 2 patients with stiffness and 1 patient with hypertrophied scar post-operatively. Conclusion: Olecranon fractures Mayo type IIA managed with tension band wiring using figure of eight wire loop without kirschner's wire results in improved patient oriented outcome, improved surgeon's oriented outcome, earlier return to function and decreased rate of non-union and the possible complication could be prevented by subjecting to open reduction and internal fixation in time.

Background: Combined spinal-epidural anesthesia (CSEA) is being increasingly used for elective caesarean section. We evaluated its effectiveness in three positions: The left lateral, the Oxford position, and the sitting position. Materials and Methods: One hundred and fifty parturients (aged 18-40 years and ASA I and II) undergoing elective caesarean section were enrolled in this prospective randomized study after obtaining written informed consent and institutional ethical clearance. CSEA was performed in the left lateral position (Group A, n = 50), the Oxford position (Group B, n = 50), and the sitting position (Group C, n = 50) using the single space needle through needle technique with Espocan epidural set (B ^' Braun). Intrathecal injection of 2.2 ml of bupivacaine heavy 0.5% was given with 27 G spinal needle present in the set, and the parturient was positioned supine after the subarachnoid block. Epidural anesthesia was supplemented with 3 ml of 0.5% bupivacaine plain after a test dose with 2 ml of 2% xylocaine with adrenaline 1:200,000 only, if intrathecal block level did not reach T ₄ dermatome level within 15 min. Injection mephenteramine 3 mg incremental doses were given intravenously to bring back the systolic blood pressure (SBP) > 100 mm Hg, and total mephenteramine consumption in each group was noted. Intraoperative hemodynamic parameters, the degree of motor blockade (modified Bromage score) and time to reach T ₄ dermatome as well as post-operative complications were monitored. Results: Time to reach T ₄ dermatome was minimum in the left lateral position (8.60 ± 3.11 min versus 12.70 ± 4.35 min in the Oxford position and 10.64 ± 3.63 min in the sitting position; P < 0.001). The incidence of hypotension was maximum in the left lateral position (Group A 42%; Group B 30% and Group C 26%; χ² = 6.0 and P = 0.199). Similarly, mephenteramine consumption was also maximum in the left lateral position (2.52 ± 3.05 mg vs. 1.50 ± 2.32 mg in Group B and 1.20 ± 2.01 mg in Group C; P = 0.03). However, Group A patients had the least requirement for epidural supplementation (Group A, 2 parturients; Group B, 9 parturients; and Group C, 4 parturient; χ² between A and B = 5.06; P = 0.03). Conclusion: The lateral position had the least requirement for epidural supplementation but required more vigilance because of faster and higher block and tendency for more episodes of hypotension.

Hibernoma is an uncommon benign tumor arising from the remnants of the fetal brown fat. We report a case of a 55 year old male with history of swelling over anterior abdominal wall on right side. Till 2009, 170 cases have been reported. As abdominal wall is rare site of its occurrence, we report this case.

Arterial anomalies of the upper limb are frequently encountered during cadaveric dissections. An adult female cadaver was found to have double brachial arteries bilaterally. The superficial brachial arteries ended near the elbow by dividing into radial and superficially running ulnar arteries whereas the deep brachial artery continued as common interosseous artery. Persistence of both the primitive arterial systems has been claimed to lead to such anomalies. Knowledge of such anomaly is important to avoid diagnostic and therapeutic misadventures.

Linear IgA disease is a rare chronic autoimmune subepidermal blistering disorder characterized by the linear deposition of IgA along the dermoepidermal junction. A 40-year-old housewife presented with symmetrically distributed generalized intensely pruritic vesiculobullous lesions of 1 year duration. Previous treatment with oral and topical steroids had induced only a temporary remission of the skin lesions. There was no history of drug intake in the recent past and her medical history was insignificant and there was no similar illness in her family members. Examination findings included vesicles arranged at the periphery of healed lesions along with post-inflammatory hyperpigmented macules on the trunk and extremities. There was no genital, mucosal or ocular involvement. Skin biopsy from the leg showed dense neutrophilic infiltration along with eosinophils at the tip of the dermal papillae and focal areas showed dermoepidermal clefting with bulla formation. Direct immunofluorescence of perilesional skin revealed linear deposits of IgA at the basement membrane zone. Therapeutically the patient responded well to dapsone. Though the presentation was classical, the case is reported for its rarity.

Thyroid cancer is rare in children and is mostly of the papillary carcinoma histologically. Follicular carcinoma constitutes 10-20% of all primary thyroid cancers with the age peak at the fourth and fifth decades. Iodine deficiency appears to be the main contributing factor for follicular carcinoma because iodine supplementation to the diet has been associated with a decline in the incidence of this tumor in iodine-deficient areas. A 9-year-old female patient who was under treatment for hypothyroidism presented with a single thyroid nodule, which on fine needle aspiration cytology, a cytologic diagnosis of follicular neoplasm was made. A histological diagnosis of minimally invasive follicular carcinoma was done after subtotal thyroidectomy. This case was presented with review of the literature.

Genitourinary tuberculosis is caused by metastatic spread of the organism through the bloodstream during the initial infection. The kidney is usually the primary organ infected in urinary disease, and other parts of the urinary tract become involved by direct extension. Primary prostatic TB is a very rare form of presentation of the tuberculous infection, which is generally caused by the M. tuberculosis, and which has shown an increase in incidence and prevalence, due to an increase of immunocompromised patients and the pandemic of the Syndrome of Acquired Immune Deficiency. However, it can exceptionally be found as an isolated lesion in immunocompetent patients as in this case. Hence we wish to report an unusual case encountered and successfully managed in our department in which primary TB of the prostate produced obstructive urinary symptoms and eventually many months later, the patient presented with anuria and deranged renal function.