Pharmacologic hyperprolactinemia is a problem of underestimated prevalence. This is due to lack of externally visible symptoms, patients' reluctance for embarrassing disturbs, and/or clinicians' lack of awareness. The secretion of prolactin is mainly controlled by hypothalamus over lactotrophs of anterior pituitary through D2 receptor along with many inhibitory and excitatory transmitters particularly serotonin, histamine, and estrogen. Here, the role of histamine receptors (H1 and H2) and their antagonists in the change of serum prolactin level with special reference to the mechanism of action of cimetidine is discussed. It may also conclude with the modifying role of histamine in inducing prolactin secretion through dopamine- GABA-serotoninergic system or modifying PRFs or other unknown mechanism. Therefore, proper evaluation of the hyperprolactinemia, particularly in infertile women, is recommended before extensive diagnosis and therapeutic procedures as hyperprolactinemia may be associated with normal pituitary function. Based on this basic idea, the role of histamine receptor (H ₁ and H ₂) and cimetidine is discussed. It is concluded that cimetidine may be acting on modifying the role of histamine-induced prolactin secretion, which in term is through dopamine GABA-serotoninergic system/modifying PRFs/other unknown mechanism.

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Background: Children and adolescents are the most vulnerable victims of sexual assault even though no age is considered safe. The aim of the present study was to determine the socio-demographic characteristics of sexually assaulted children in Manipur, the relationship between the victim and the assailant, and the pattern of the injuries sustained by the victims. Materials and Methods: This retrospective descriptive study was carried out in our department and all cases of child sexual assault (below 18 years of age) brought for examination during January 2005 to December 2011 have been considered. The history given by the victims or parents or relatives and the police were recorded; general as well as local examination findings were noted and the data collected were analyzed. Results: Out of the total 144 cases of sexual assault, 51.4% were child victims. Nearly, 29.73% of the cases were constituted by children below 12 years while 31.08% and 39.19% were children of 12 to <15 years and 15 to <18 years respectively. The mean age of the victims was 12.4 years. Most of the cases (40.54%) occurred in the house of the assailant or his friend; however, children below 15 years (16.22%) were sexually assaulted in their houses. Almost, 78.4% of the assailants were known to the victims and only 9.5% had stranger assailants. Majority of the cases (89.15%) occurred during the afternoon or early evening. Nearly, 14.8% of the cases showed associated external injuries. Hymenal tear was present in 60.8% of the cases and 16.2% had vulval injuries. Conclusion: Child sexual offence is on the rise in this part of the country. Spreading of awareness to encourage early reporting, stringent punishment to the perpetrators and immediate proper care and protection of such innocent victims remain key factors to deal with this heinous crime.

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Objective: To compare clinical diagnosis with computed tomography findings in identifying the types of stroke. Materials and Methods: The study was carried out after obtaining approval from the Institutional Ethical Committee, in the Department of Medicine, RIMS, Imphal, Manipur, from October 2010 to September 2012. The study sample consisted of 150 patients presenting with first-ever acute stroke who were clinically evaluated. An interviewer-structured questionnaire was administered and Siriraj stroke score computed. Clinical diagnosis of stroke-type (hemorrhagic or ischemic) was made based on Siriraj stroke score. The stroke-type was classified and compared with CT scan diagnosis. Data were analyzed using SPSS 16 software. Results: There were 150 patients in the study sample, out of them, 71 were hemorrhagic stroke patients and remaining 79 were ischemic stroke patients diagnosed by CT scan. The correlation between stroke-type, headache, level of consciousness at presentation, vomiting, and diastolic blood pressure achieved statistical significance. Sensitivity, specificity, positive predictive value, and negative predictive values of Siriraj stroke score for cerebral hemorrhage were 78.87%, 91.13%, 88.88%, and 82.75%, respectively. Conclusion: Hemorrhagic and ischemic stroke cannot be distinguished clinically with a simple clinical evaluation, and it is virtually impossible for all stroke patients to have a computed tomography scan immediately after admission, especially in rural area. When computed tomography is not immediately available and the clinician wishes to start anti-thrombotic treatment, the clinical diagnosis based on the Siriraj stroke score can be useful to identify patients at low risk of intracerebral hemorrhage.

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Primary anorectal malignant melanoma is very rare disorder accounting for 1% of all anorectal malignancies other than adenocarcinoma. It presents usually like polypoid lesion which projects into the anorectal lumen and progresses rapidly towards the rectal wall. We report a case in a 40 years old woman presented with a polypoidal mass and bleeding per rectum. The tumour is usually at advance stage at the time of diagnosis. Because of their relative scarcity, only few clinical trials have evaluated the treatment options. Aggressive surgical treatment is usually not recommended for a clinically localized disease. The disease should be considered as one of the differential diagnosis in anorectal malignancies other than adenocarcinoma. Early diagnosis with histological features confirmed with immunohistochemistry will help in appropriate treatment and long term survival of the patient.

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Non-immune hydrops fetalis is an uncommon but serious disorder associated with an overall poor prognosis, characterized by abnormal fluid accumulation in two or more fetal serous compartments, together with generalized soft tissue edema. Sonographic detection of hydrops fetalis is usually straightforward, and detailed prenatal diagnostic investigations allow identification of disorders which may be amenable to treatment and avoidance of inappropriate fetal interventions in cases associated with a poor outcome. We present a case of non-immune hydrops fetalis incidentally detected on routine obstetric sonography in a 32-year-old, third gravida woman. She had past history of hydrops fetalis in her first pregnancy, but the second baby was still alive. She had undergone cesarean section and the baby died after a few minutes. Past history and investigations excluded the immune cause of hydrops fetalis, therefore making it most likely the non-immune type.

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Background: Currently, a greater emphasis is being placed on the active participation of patients and their families; it is time that the attitude and feelings of the families with regard to autopsies are investigated. Objectives: Therefore, the present study was planned with an objective to analyze and ascertain deceased family member's attitudes toward medico-legal investigation and forensic autopsy. An additional objective was to determine factors influencing autopsy refusal by relatives of the deceased. Materials and Methods: Two hundred family members or relatives were selected randomly from the list of address and contact number prepared from all the cases on whom autopsy was performed from 2010 to 2012 at the MM Institute of Medical Sciences. Results: Data of 165 deceased personnel were processed and analyszd. 30.9% of the respondents had a primary level of education while 35.2% of them were illiterates. A high proportion of study subjects considered that autopsy would result in visible disfigurement of the body. Involvement of police/court (92.1%), no use in knowing the cause of death/nature of death (88.6%) and autopsy delays funeral (83.4%) were the three top most causes responsible for autopsy refusal by family members or relatives of the deceased. Conclusion: The experience and opinions of relatives and family members can be utilized in more effective management of medico-legal cases.

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Objectives: The objective of this study was to investigate the technical feasibility, safety and benefit of three-port laparoscopic cholecystectomy (LC) over the conventional standard four-port LC as routine setup. Materials and Methods: A total of 50 patients willing to participate in the study with valid consent were allocated into two groups by computer generated chit system. The first group, three-port LC group consisted of 25 cases and the second group, the standard four-port LC group consisted of 25 cases were analyzed for the following outcome measures namely conversion rates, operating time, intra-operative complications, post-operative pain score, analgesic requirement and hospital stay. Results: Demographic data was comparable in both groups. Conversion rate was nil in both groups. The mean operating time was comparable in both groups. Post-operative pain was significantly less in three-port group (P < 0.008) and analgesic requirement (P < 0.001) when compared with the four-port group. Hospital stay was significantly less in three-port group compared with the four-port group (P < 0.004) owing to post-operative pain score. There was no statistical difference in the complications rate in both groups; gallbladder perforation (P = 0.691), bile leakage (P = 1.00) and bleeding from liver bed (P = 0.691). Conclusion: three-port LC is technically safe and feasible with less post-operative pain score, less analgesic requirement, less hospital stay with comparable operating time and complications when compared to four-port LC. Three-port is also associated with less scars and cosmetic superiority.

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Objective: To study the pattern of various oral cavity lesions in a tertiary care hospital in Manipur, India. Materials and Methods: This is a 5 year retrospective study from January 2006 to December 2011. All the oral cavity specimens received in the Department of Pathology, Regional Institute of Medical Sciences (RIMS) during the study period was included for the study. Data such as age, sex, and site of the lesion was collected and restaining of the slides with hematoxylin and eosin (H and E) was performed whenever required. Data's collected were analyzed. Results: A total of 119 cases was analyzed during the study period. Age ranged from 3 to 90 years in the study. Overall females were affected more than the male with male:female (M:F) ratio of 1:1.5. Buccal mucosa (26.9%) was the commonest site involved followed by tongue (26%). Neoplastic lesions accounted for 61.4% cases and nonneoplastic accounted for 38.6% cases. Among the neoplastic lesion, squamous cell carcinoma (SCC) was seen in 82% cases; verrucous carcinoma and ameloblastic carcinoma in 5.1% cases each; and mucoepidermoid carcinoma, adenosquamous carcinoma, and small cell carcinoma in 2.6% cases each. Most of the neoplastic lesions were located in the tongue (30.8%), followed by buccal mucosa (28.2%), alveolus (5.1%), floor of mouth (10.3%), and palate and lips (12.8%) each. The M:F ratio of the neoplastic lesion was 1:1.2. Chronic inflammatory lesions accounted for the maximum number of nonneoplastic lesions (26.1%), followed by fibrosis (23.9%), and fibrous hyperplasia and cystic changes, 17.4% each. Epulis accounted for 10.8% and ranula and hamartoma accounting for 2.2% each. The commonest site of involvement was gingiva and buccal mucosa with 32.6% each. Conclusion: A variety of lesions were encountered in the study with predominance of malignant lesions. SCC was the commonest malignant lesion. A larger epidemiopathological study in this region needs to be carried out.

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Context: Pattern of psychiatric admission in Regional Institute of Medical Sciences (RIMS), Imphal. Aims: To examine the socio-demographic and clinical correlates of patients admitted in psychiatry ward, Regional Institute of Medical Sciences (RIMS), Imphal between April 2010 and March 2012. Settings and Design: It was a retrospective file study conducted in the Department of Psychiatry, RIMS. Materials and Methods: A review of case notes of all patients admitted to the psychiatric ward of the hospital between April 2010 and March 2012 was carried out and information regarding socio-demographic characteristics (e.g. age, gender, domicile, and diagnosis) was recorded on a Proforma designed by the authors. Statistical Analysis Used: Data were analyzed using the Statistical Package for Social Sciences (SPSS) 13 for Windows 7. Cross tabulation, frequency statistics, and chi-square test were used for finding the relationship between variables, and the level of statistical significance was set at 5%. Results: Eight hundred and forty-one cases were admitted and analyzed. Out of these, 65.04% were males and 34.9% were females. The mean age of the patients was 34.68 ± 12.68 years. Majority of the inpatients (30.8%) were from the 25-35 years age group. Alcohol dependence syndrome accounted for majority of the cases (34.01%) in males and dissociative disorder accounted for the maximum cases among the female patients (10.3%). The common psychiatric diagnoses were alcohol dependence syndrome, dissociative disorders, psychosis not otherwise specified, bipolar affective disorder, and depressive disorders. Conclusions: Most of the patients were males, young, and from a rural background. Commonest psychiatric diagnosis for which admission was made in RIMS was alcohol dependence syndrome. In spite of prohibition being in place in the state, the abundance of alcohol-related disorders may have important implications for care and planning in the community.

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Context: An estimate of the determinants of contraceptive usage and the extent of unmet need for contraception is necessary to determine the maximum potential demand for family planning services to achieve the targeted Total fertility rate of 2.1 in our country. Aims: To assess the contraceptive uptake and its determinants and to estimate the unmet need of contraception. Materials and Methods: A cross-sectional study was conducted amongst 728 married women of an urban Muslim dominated community in the age group 15-45 years at Khetrigao, Imphal East, Manipur, during April-June 2012. A semi-structured proforma was used to collect the respondents' characteristics. Chi-square test and multiple logistic regression analysis were used to test for association. Results: Contraceptive prevalence was found to be 55.5%, but only 351 respondents were effectively protected and were using modern methods (Couple Protection Rate 48.2%). The total unmet need calculated was 23.9%. Fear of side effect (29.9%) was the major reason for not using family planning methods. Almost half of the respondents [345 (47.4%)] gave history of undergoing abortions. Multiple logistic regression analysis showed that having access to health facility [odds ratio (OR) 1.989, 95% confidence interval (CI) 1.083-3.665], husbands having a favourable attitude toward family planning (OR 3.224, 95% CI 1.268-8.199), women who had undergone an abortion (OR 2.471, 95% CI 1.707-3.576), and women who discuss with their husbands about using contraceptives (OR 3.069, 95% CI 1.696-5.551) were significantly more likely to be users of modern contraceptive methods. Conclusion: Education of women and increased accessibility to family planning services in this community will empower them to take decisions regarding adoption of contraception.

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Background: The reported incidence of postoperative nausea and vomiting (PONV) following laparoscopic cholecystectomy (LC) is very high. Various treatment modalities have been tried by several workers with varying results. This study was undertaken to compare the efficacy of ramosetron and granisetron with the intention to prevent postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy in this part of the country. Materials and Methods: In a randomized, double-blind study in our tertiary care hospital, 80 inpatients of ASA I and II were enrolled and received either 3 mg granisetron or 0.3 mg ramosetron i.v. (n = 40 each) ten minutes before induction of anesthesia. Standardized anesthetic technique was used, and data was collected for early (0-2 hr) PONV in the post-anesthetic care unit (PACU) and late (2-24 hr) PONV in the ward. Results: The incidence of early PONV (0-2 hr) was 22.5% for granisetron and 15% for ramosetron (P > 0.05; 95% Confidence interval (CI) = 0.20 to 1.97; OR = 0.63), late PONV (2-24 hr) was 25% and 15%, respectively (P > 0.05; CI = 0.18 to 1.68; OR = 0.56). The most common side-effects observed in the two groups were headache and drowsiness, and these were mild and self-limiting. There was no significant difference in the side-effects of drugs between the two groups. Conclusion: PONV is a distressing symptom in laparoscopic cholecystectomy cases, and ramosetron is as effective as granisetron in preventing early (0-2 hr) and late (2-24 hr) PONV.

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A 70-year-old patient presented with episode of colicky upper abdominal pain associated with vomiting and fever since 4 days. While investigating the patient, CECT abdomen showed features of neoplastic lesion in head of pancreas and CA-19-9 level was > 2000 U/ml, and it was a resectable disease. Whipple's procedure was carried out. Histopathological report showed features suggestive of ampullary adenomyoma. Adenomyoma of ampulla is very rare with only a few cases reported till now, and adenomyoma secreting CA-19-9 has not been reported till now in literature.

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Aims: 1) To compare three microbiological methods of detection of Mycobacterium tuberculosis 2) To find their correlation with (a) chest x-ray (CXR) findings and (b) absolute CD4 counts. Materials and Methods: 147 human immunodeficiency virus (HIV)-pulmonary tuberculosis (PTB) suspects were enrolled. Sputum from 108 of them were subjected to light microscopy of Ziehl-Neelsen (ZN) stained smear, fluorescence microscopy of Auramine-O (AO)-stained smear, and culture on Lowenstein-Jensen media for detection of M. tuberculosis. The results were analyzed statistically and compared with CXRs and CD4 counts. Results: Of 147 eligible patients, 108 were studied and 78 were diagnosed as HIV-PTB coinfection. Positivity rates for ZN, AO, and culture were 39 (36.1%), 80 (74.1%), and 78 (72.2%), respectively. Sensitivity and specificity for ZN were 48.7% and 96.6%, respectively, whereas those for AO were 100% and 93.3%, respectively. Additional yield of AO over ZN was 42 (38.8%). AO was able to detect all the culture positives. The difference in case-yields between ZN and AO has been found to be highly significant at P value 0.05 and χ² test = 3.84. The sensitiveness of these methods of detection was higher for patients showing active disease on CXR and those with CD4 count > 200 cells/μL. Conclusion: Fluorescence microscopy is recommended in HIV-PTB coinfection to enhance case detection and management.

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Background: Urban life in modern times is completely laden with stressors. Caregivers of chronically sick patients are likely to suffer from mental and physical exhaustion leading to stress. This is important in view of the prevailing socioeconomic conditions as well as the healthcare system available in any developing country. Therefore, the present study was designed to measure the heart rate variability (HRV) in this special group of population who gives care to long-term bedridden patients in an urban setting. Materials and Methods: Fifteen female subjects were enrolled from among the attendants of patients admitted with immediate history of a cerebrovascular accident with locomotor deficits, who required constant care. They were free from any type of physical and mental health issues, nonsmokers, and nonaddicts. Each caregiver was subjected to HRV analysis on three occasions: the first record was performed in the 1st week of their arrival in the hospital as caregivers and the second observation was recorded after 4 months of caregiving. Two types of parameters were analyzed: time domain and frequency domain. Statistical analysis was done using paired t-test. Results: Both the HRV parameters - time and frequency domains - showed decreased values during the 3rd month and 6th month recording as compared to the 1st week recording. The decrease was much more during the 6th month recording as compared to the 3rd month recording. Statistically significant decrease was observed in the mean RR interval, heart rate, Very Low FrequencyVLF, and Low Frequency LF]. On comparing the 1st week recording with the 4th month recording significant decrease was found in mean RR interval and heart rate. Conclusion: Subjects involved in taking care of chronically ill bedridden patients are likely to undergo a lot of physical and mental stress, thus affecting their autonomic status. HRV analysis with short-term electrocardiogram (ECG) recording was used to detect changes consequent to this stress. It was found that almost all HRV parameters measuring heart rate complexity were decreased in the period of caregiving.

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Objective: The objective of this study was to assess the perception and experiences of a tribal community on health-care provider-patient communication and to find out the association between patients' place of seeking health-care and their socio-demographic characteristics. To see any differences between the government and private health-care providers in explaining treatment options and helping in their decision making. Materials and Methods: A cross-sectional study was conducted between September 2008 and February 2010 at Komlathabi area of Chandel District, Manipur. All the eligible subjects were interviewed by using a structured questionnaire. An informed verbal consent was obtained from the participants before collecting the data. Results: Out of 1947 population above 18 years, 1800 completed the interview. A total of 1679 respondents had an illness in their families in the past 1 year. Older people above 60 years, illiterate and unemployed persons went to government health center more than home/private clinic (P = 0.001) when they got sick. More than half of the respondents (58.8%) were not explained of the treatment option with benefits and risks involved. Nearly, 76.3% of the respondents perceived that they should be involved in making a decision for the treatment and nearly 64% of them felt that health-care provider should not see patients at home or private clinics. The majority of government health-care providers (70.3%) did not explain about the treatment option to their clients and also did not take patients' opinion while arriving at treatment option (66.5%), which was found to be statistically significant. Conclusion: Private health-care providers explained more to their patients about the treatment options with the benefits and risks involved, and took patient's opinion while arriving at treatment option than the government health-care providers. Therefore, it is necessary to develop a good communication skill among all the physicians, more so among public sectors.

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A 40 years male on highly active antiretroviral therapy presented with fever and hepatosplenomegaly. On evaluation it came out to be visceral leishmaniasis. Visceral leishmaniasis is an unusual opportunistic infection in Acquired immunodeficiency syndrome. Here we report a case of visceral leishmaniasis in Acquired immunodeficiency syndrome.

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Background: Early diagnosis of cutaneous lesions in HIV-infected patients is essential as most of these lesions are associated with significant morbidity and mortality. Objectives: To analyze the cutaneous lesions, the role of aspiration cytology in diagnosing these lesions and correlation with CD4 counts. Materials and Methods: This is a cross-sectional study of 34 cases of HIV sero-positive patients attending the cytology section of the Department of Pathology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur over a period of 3 years (January 2009 to December 2011). The aspirated materials were stained with May-Grunwald Giemsa (MGG)/Leishman stain, and special stains were also done whenever necessary. Cultural confirmation in fungal lesions (ten cases) and serological tests in cryptococcal lesions were also done. Histological examinations were performed in case of neoplastic lesions (2 cases) and cases which were inconclusive by fine needle aspiration cytology (FNAC). History of receiving anti-retroviral therapy and data for CD4 count in all the cases were also analyzed. Results: Majority of the cases (91.2%) could be diagnosed by FNAC. The patterns of skin lesions were fungal (61.8%), viral (14.7%), Kaposi sarcoma (8.8%), tuberculosis (2.9%) and eosinophilic folliculitis (2.9%) respectively. Conclusion: FNAC is a rapid, safe, useful, inexpensive, and patient-friendly procedure in detecting various cutaneous lesions in HIV-infected patients.

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A 52-year-old woman presented with a painless lump at right buttock of 14 years duration with history of sudden increase in size for the last 2 months. Fine needle aspiration cytology (FNAC) examination suggested a fibrohistiocytic lesion. Histopathological examination with subsequent immunohistochemistry diagnosed the case as inflammatory myofibroblastic tumor (IMT) of the peripheral soft tissue. IMT of the peripheral soft tissue especially in older patients are comparatively rare and the case is reported for its rarity.

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