International Archives of Integrated Medicine

1-10

Authors: Patel K, Savjiani N, Gharia B, Falleiro JJJ

Introduction: For diagnosis of hematological disorders there are three modalities to examine bone marrow, bone marrow aspiration cytology (BMA), bone marrow biopsy (BMB) and touch imprint cytology (BMI). BMA gives cytological picture, BMI also gives cytological picture but cells are less in number and BMB gives cytological as well as bone marrow architectural picture. BMA alone may not be sufficient to reach diagnosis therefore the present study was undertaken to compare the above three modalities. Material and methods: The present study was a prospective study done from January 2013 to December 2013. Total 51 cases, where BMA, BMI and BMB were performed on OPD and IPD patients at Dhiraj General Hospital, Vadodara were included. Complete clinical data were recorded including physical examination, complete hematological study along with other relevant investigations and proforma filled. Results: The various diseases diagnosed by BMA, BMI and BMB were megaloblastic anemia (19.6%), aplastic/ hypoplastic anemia (13.7%), iron deficiency anemia/ micronormoblastic erythroid hyperplasia (2.0%), dimorphic anemia (5.9%), idiopathic thrombocytopenic purpura (2.0%), plasma cell dyscrasias (3.9%), Myeloproliferative disorders (3.9%), leukemia (15.7%), normocellular marrow (13.7%), metastasis (15.7%) and miscellaneous (3.9%). Conclusion: BMA is found to be the superior procedure for evaluation of hematological disorders compared to BMI and BMB.

20-25

Authors: Rathod GB, Rai P

Background: FNAC is cost-effective, high diagnostic accuracy, reliable, rapid and inexpensive procedure in diagnosis of various clinically palpable as well as deep seated swellings. This study was intended to discover factors associated with repeat aspiration with the help of audit of cytology laboratory. Material and methods: Retrospective study of 248 cases which came to Cytology Laboratory of Dhiraj Hospital during the period of 1st January 2013 to 30th December 2013 had included. All patients who attended the Cytology laboratory for the FNAC procedure and USG guided FNAC were included in the study. Data for the audit was collected from the cytology records. The following information was documented for this audit: Age and sex, site of FNAC, documented reasons for repeat and patient IPD/OPD numbers. We had also noted the documented reasons for repeats and the duration between the repeats. Results: Out of 248 aspirations, 61 from breast swellings, 75 from the lymph nodes, 58 from the thyroid lesions, and 54 were from the miscellaneous lesions. 31 patients (12.5%) were advised repeat aspiration and 22 (8.87%) were actually repeated. In our study the most common cause for the repeat aspiration was inadequate cellularity (51.61%). Outcome of the repeat aspirations included 16 (72.73%) diagnostic and 6 (27.27%) non diagnostic aspirations. Conclusion: In our study, there were so many reasons for the repeat aspirates. In order of occurrence these are: Inadequate aspirates, non-diagnostic descriptive reports and hemorrhagic aspiration.

33-39

Authors: Chandrasekhar G, Kumar S, Varalakshmi U, Shaik MV

Objectives: A clinical study of visual outcome and intraocular pressure control after cataract surgery in Lens Induced Glaucoma. Material and methods: A minimum of 50 cases of lens induced glaucoma were selected based on simple random sampling, who attended the department of Narayana Medical College Hospital and were diagnosed to be having Lens Induced Glaucoma. Appropriate medical management was given followed by surgical intervention. Patients were followed up on the 1st week, 4th week and 6th week postoperatively. Results: Finally after the analysis of the data, it was demonstrated that the longer the duration of symptoms and higher intraocular pressure (IOP) at presentation, the poorer the visual prognosis. It was also noticed that the intra-operative and postoperative complication were more in cases of LIG as compared to normal population. It was also noticed that after cataract extraction surgery few cases had post-operative IOP above borderline. These cases can be controlled by anti-glaucoma medication and regular follow-up of these cases. If necessary, trabeculectomy may be done in future to control the IOP. Conclusion: The incidence of postoperative uveitis was more in LIG when compared to the normal population and more so if associated with intra-operative complications. The visual recovery was fairly good in all those cases that have undergone treatment quite early. Also the higher the IOP pre- operatively, the prognosis for good vision following surgery is poor. A sustained rise of pressure for a long time was a bad prognostic factor for post-operative development of good vision. It is to be stressed upon, imparting health education and creating awareness regarding cataract and its implications among the rural community, ophthalmic assistants and peripheral health workers.

47-50

Authors: Shetty H, Gangadhar KS

Aerodigestive tract foreign bodies are commonly seen either in children or in elderly age group, making its management a challenge for the otolaryngologist. Various methods have been described in literature for its removal. In our study a review of 44 patients was done who presented with history of accidental ingestion/ inhalation of foreign body to the ear nose throat out patient department. All 44 patients underwent rigid esophagoscopy/ bronchoscopy (depending on the site of lodgement) under general anesthesia, based on clinical and radiological evidence.

61-64

Authors: Kataria U, Chhillar D

Urticaria is a common condition faced by both dermatologists and allergists alike. There are various causes of urticaria many of times multiple factors are responsible and on the other side at times no specific cause is found which is responsible for chronic Idiopathic urticaria. Very few studies have been done in this regard, so this study was carried out to find out the etiopathological factors responsible for urticaria.

70-76

Authors: Puttaswamy

Mean organs’ weight in 2100 subjects who died and got autopsied at mortuary district hospital Mandya Institute of Medical Sciences (MIMS), Mandya revealed that they in general were heavier than reported from other parts of India. Various organs continued to attain their maximum weight up to 40-50 years of age.

82-87

Authors: Shah SA, Patel KR

Background: Abdominal exercises have become an important part of fitness and rehabilitation. Sit ups are most common abdominal exercise performed by people without proper training. Hypertension is a progressive cardiovascular syndrome arising from complex and interrelated etiology in which the blood pressure in the arteries is elevated. Material and methods: An experimental study including 30 hypertensive males and females aged 30-60 years was done. Exclusion criteria were back pain, spinal disorders, diabetes, renal disease, cardiovascular disease. They were divided into two groups: Group 1 performed straight and oblique sit ups with breath holding. Group 2 performed straight and oblique sit ups without breath holding. Instructions were given to perform 10 repetitions of straight and oblique sit ups with 10 min rest period between. Heart rate and blood pressure were measured before and after each set of repetition. Wilcoxon Signed Rank Test was used for within group analysis and Mann-Whitney ‘U’ Test was used for inter group analysis. Results: For group A, W= -3.426, -3.458, -3.458 respectively for heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) and p=0.001 and for group B, W= -3.426, -3.475, -3.464 and p=0.001. The U value for inter group analysis is U=103.00, 73.00, 81.00 respectively for HR, SBP and DBP and p= 0.68, 0.099, 0.183 respectively for HR, SBP and DBP. Conclusion: When performing the OPSU and SPSU exercises as used in this investigation, hypertensive individuals may experience peak heart rate and blood pressure increases. Voluntary breath holding significantly increased the blood pressure elevations for both the exercises, but particularly for the OPSU.

94-101

Authors: Manjunath SM, Nagesh Raju G, Someswara GM

Background: Adverse effects due to medicines are common cause of morbidity and mortality and have a major impact on public health. Aim: To assess the awareness of Pharmacovigilance among fifth term medical students. Material and methods: This was an observational, cross-sectional study based on the questionnaire. The study was conducted on fifth term medical students in the Department of Pharmacology of BMCH, Chitradurga. A questionnaire containing 15 questions with 2-5 options were given to each student and they were asked to mark one best suitable option. We analyzed data of 66 participants. The results were evaluated graphically using Microsoft excel sheet. Results: 89.93% of students were aware of all the activities involved in Pharmacovigilance. 48.48% of the students had an idea that all the health care professionals (i.e. doctors, pharmacists, nurses) are responsible for reporting adverse drug reaction (ADR). 34.84% of students had wrong perception that WHO online database for reporting ADRs was Medsafe and 31.81% thought Vigibase as the WHO online database. 48.48% had the correct understanding that CDSCO is the regulatory body for monitoring ADRs in India. 66.66% students thought that, all the types of ADRs (mild, moderate and severe) irrespective of their severity have to be reported. 61% of students thought that ADR reporting is a Professional obligation. 91% of the students were aware that all the measures (stop the drug, report ADR and treat the condition) have to be taken when an ADR is suspected. Other findings included like, 68% students knew drugs banned because of ADR. Majority of students wrote Thalidomide and Nimesulide as an example for a drug banned because of ADR. Conclusion: The current study revealed that medical students had good awareness about Pharmacovigilance and ADR reporting. Better understanding of subject will help in improving the quality of health care and safety of the patients.

111-115

Authors: Jagannath C, Penchalaiah T, Swetha M, Prabhu GR

Background: The incidence of ocular injuries in India is estimated to be 20.5% affecting mainly those aged less than 40 years and males. Cataract is the commonest complication after ocular injury resulting from either penetrating injuries from sharp objects like stick or thorn or with blunt trauma by objects like stone, cricket ball etc. The present study aims to find out the visual outcome of traumatic cataract cases. Material and methods: This was a cross sectional study conducted among 40 traumatic cataract cases attending outpatient units of SVRR Government General Hospital, Tirupati during July 2014 to June 2015. A predesigned interview schedule was used to collect the necessary information. All patients had undergone Posterior Chamber Intra Ocular Lens Implantation and visual outcome was assessed after 15 days, 6 weeks, 3 months and 6 months. The results were analyzed using MS excel software and Epiinfo 7 version statistical software. Results: It was found that a large majority of the cases were aged less than 40 years (67.5%) and males (62.5%). The most common type of cataract developed was found to be ‘white soft’ type (47.5%). In 52.5% of patients, the time lag between injury and surgery was found to be 1 week to 1 month. It was found that 70% patients had regained vision (>6/18) after surgery. Conclusion: Posterior Capsular Intra Ocular Lens Implantation is highly effective in restoring vision in traumatic cataract cases. The time lag between injury and surgery should be as short as possible for complete recovery. There should be quick referral of traumatic cataract cases to the specialized ophthalmic care units depending on condition of patients.

119-123

Authors: Kate M, Shinde SD

Tuberculosis of symphysis pubis is a rare condition with few reported cases. It is necessary to distinguish the entity from Osteitis pubis and Osteomyelitis of pubic symphysis to start the treatment early and thereby minimize morbidity and prevent complications. A case report of tuberculosis of symphysis pubis mimicking labial swelling in a 25 year old female was described. High index of suspicion along with an extensive workup including magnetic resonance imaging (MRI) scan of pelvis and fine needle aspiration (FNA) of swelling led to the diagnosis. A brief case report and review of literature have presented here.

129-134

Authors: Jain A, Rathod GB

Progressive multifocal leukoencephalopathy (PML) is a rapidly progressive AIDS-defining disease of the central nervous system. PML affects up to 8% of patients with AIDS and in most cases is fatal within 3–5 months. We presented here a case of 66 years old male who is non HIV with past history of splenectomy, and diagnosed as progressive multifocal leukoencephalopathy which is very rare. Here, we presented this rare entity which may be difficult to diagnose although, histopathological examination helps greatly in the diagnosis of this condition but the specificity and sensitivity of JC virus DNA PCR in CSF are quite acceptable.

141-143

Authors: Kataria U, Chhillar D

A 40 years old woman, presented with vulvar itching associated with warty lesions appeared after a trauma to vulvar region few months back. She gave history of fall on a sharp object and developed those lesions while working as a labourer. She was diagnosed as a case of Lymphangiectasia of vulva. It was a rare coincidence, so we are reporting this case.

148-151

Authors: Vanita Pandey, Kandukuri Mahesh Kumar, V. Hari Shanker, V. Indira

Sclerosing Adenosis (SA) is a lobulocentric proliferative process that involves both the epithelial and the mesenchymal component of the breast suggesting benignity. The disease has an increased incidence among reproductive-age and perimenopausal women, especially between 35 and 50 years of age. The clinical, radiological, and histopathological properties of sclerosing adenosis may resemble malignancy, which is the factor responsible for the clinical significance of the disease. Early diagnosis of sclerosing adenosis (SA) is very important as it is associated with a doubling of the risk of developing breast carcinoma, even though its role in carcinogenesis remains to be controversial and unclear. The main histopathological alterations of the terminal ductal lobular unit (TDLU) present as a widening and distortion of lobules with an increased number of acini and stromal fibrosis. The lesion is also called an “adenosis tumor of the breast” or “nodular sclerosing adenosis” if it presents as a palpable mass. Sclerosing adenosis is present in 12% of benign proliferative lesions and 20-25% of malignant lesions on histopathological examination. On mammography (MG), it can present as opacity, focal asymmetry, architectural distortion, or micro calcifications, mimicking a carcinoma. We have presented a case of 42 year old female who was diagnosed as carcinoma breast clinically and on radiology. Mammography showed a fibrosed lesion of size 4.5x3 cm with focal specks of microcalcification and irregular borders. But repeated fine needle aspiration cytology (FNAC) smears revealed small and large clusters of ductal epithelial cells with minimal anisonucleosis with background showing amorphous crystalline material and stromal fragments. Basing on FNAC, plan of surgery changed and a wide local excision with 2 cm normal margins was done and the specimen sent for histopathological examination (HPE), which revealed the lesion as sclerosing adenosis (SA).

157-164

Authors: Pagadala S, Tadikonda DC

Minor falls, local accidents, while participating in sports or childish pranks that are not intended to harm produce greatest number of teeth fractures and teeth displacements in children. From these seemingly benign accidents, child’s facial appearance becomes so altered as to make an attractive child appear unattractive. Dental injuries are considered emergency situation that require immediate care. The purpose of this article is aimed to overview the classification of the traumatized teeth.

172-173

Authors: Arora R, Arora A, Puri A

A 52 years old male presented with epigastric pain, continuing in the emergency department. He had a history of hypertension, and was on Amlodipine thinking that epigastric pain might be an anginal equivalent, the following ECG was recorded. The Emergency Residents were worried about Wellens' syndrome and treated for ACS. He was placed on a nitroglycerine drip and Heparin. Initial troponin was negative. Two follow up serial ECGs were done 3 hours later also showed up the same Electrocardiographic findings. All troponins were normal. A formal echo showed concentric LVH and there was not even a subtle regional wall motion abnormality on echocardiogram suspicious for LAD distribution ischemia. Later, he also underwent a coronary angiogram which was completely normal.

1-12

Authors: Patel A, Patel HV

Background: Amniotic fluid is vital to the well-being of the fetus. Disorders of liquor amnii has a significant impact on pregnancy and fetus, it prompted us to carry out this study with sincere efforts to find out its effect on pregnancy outcome. Aim and objectives: To find out incidence of polyhydramnios and oligohydramnios in our setup and to study possible etiological factors for abnormal AFI. Material and methods: We performed a study on 200 patients over a period of one year. Detailed history, general examination and local examination were done. All the cases were subjected to ultrasonography to see for maturity, AFI, congenital anomalies. Analysis were made regarding mode of delivery and perinatal outcome which includes maturity, birth weight, incidence of SGA or macrosomia, NICU admission, maconium stained amniotic fluid, low apgar score, incidence of birth asphyxia and congenital anomalies. Results: There were total 82 cases of oligohydramnios and 18 cases of polyhydramnios. And 100 cases with normal AFI. In ultrasonography 154 cases had full term maturity and 46 cases were preterm 82 cases had AFI ≤5 cm, 18 cases had AFI ≥24, and 100 cases had AFI between 6-23. Conclusion: Amniotic fluid index assessment has become an important part of ante-partum fetal surveillance and also it has a prognostic value for fetal and newborn outcome.

17-23

Authors: Rao NYL, Kanakamahalakshmi A, Vani I, Lakshmi Rama P

Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. During pregnancy mean arterial pressure and vascular resistance decrease, while blood volume and basal metabolic rate increase resulting in increased cardiac output In hypertensive disorders of pregnancy there is currently no consensus on the systolic and diastolic parameters of cardiac function and the literature is conflicting regarding whether there is increased, decreased or any change in cardiac output. Women with a history of preeclampsia/eclampsia have approximately double the risk of early cardiac, cerebrovascular, and peripheral arterial disease, and cardiovascular mortality. This study was undertaken to evaluate cardiovascular hemodynamic alterations in hypertensive disorders of pregnancy in comparison with appropriately age, parity and gestational age matched control normotensive pregnancies. In women with preeclampsia cardiac work index and left ventricular mass index are increased as a result of increased workload on heart to maintain cardiac output against increased after load. Systolic function is well preserved. Diastolic function is reduced and those with global diastolic function are at increased risk of developing pulmonary edema. Advanced techniques like speckle tracking echocardiography can better identify those with compromised cardiovascular function.

30-37

Authors: Rao NYL, Isuapalli V, Samyukta Ila S

According to ACOG committee, complications of non-medically indicated (elective) deliveries between 37 and 39 weeks are faced with increased NICU admissions, transient tachypnea of the newborn (TTN), respiratory distress syndrome (RDS), increased need for ventilator support, increased sepsis rates (suspected or proven) and higher incidence of newborn feeding problems and other transition issues. Cesarean sections done at less than 39 weeks gestation have increased risk of neonatal morbidity including respiratory distress, hypoglycemia, sepsis, NICU admissions, hospitalization for more than 5 days, etc this study aims at correlating fetal maturity with amniotic fluid optic density.

45-54

Authors: Parmar DJ, Bhagora LR, Parmar RD, Suvera KM

Introduction: Murder, the destruction of an individual is the most heinous expression of aggression found in any culture. To curb the menace of rising incidences of homicide is matter of public interest; else it may become an acceptable option. This study explores recent trends of homicide in Bhavnagar region to bring in to spotlight this emerging threat. Material and Methods: Study was conducted by retrospectively reviewing available data of 59 homicide victims, autopsied in Department of Forensic Medicine, Government Medical College and Sir T. General Hospital Bhavnagar during the period of two year, from May 2013 to April 2015. Results: The incidence of homicidal death was 2.40%. Male victim’s predominated over female victims with ratio of 2.47:1. Majority of victims belonged to age group of 21-30 years (28.81%) with male preponderance in all age groups except 0 to 10 years. Majority victims were married (62.71%) where also, male dominance prevailed. Offenders used sharp weapons (35.59%) more commonly than blunt weapons (23.73%) though head was most vulnerable part which suffered highest injuries (25.12%) as well as fatal wounds (32.86%). Alliance of Head targeted by blunt weapon (89.42%) and chest by sharp force (79.51%) was evident. Defence wounds were in 20.34% victims. Multiple injuries were more in male victims and most common cause of death was shock and haemorrhages (47.46%), where male predominated. However, female victims surpass male in death due to mechanical asphyxia and burns. About 50% victims died on the spot or were brought dead, while very few could survive more than 24 hours despite of hospitalization. Main motives of homicide emerged as arguments (20.34%) and revenge (18.64%) which is an apprehension to be addressed aptly. Conclusion: Murder is an act of moment in mind occurring under excitement or incitement. Hence, authors emphasize to focus upon once ability of making balanced thinking over any problem with reasonable tolerance.

59-70

Authors: Gajare RA, Gajare AV

Background: The purpose of this study was to determine age related changes in menisci using dimensions of menisci on MRI. The standard dimensions of lateral and medial menisci help us to determine age related changes, and this may be important for planning surgical interventions. Materials and methods: 100 Indian patients with history of knee pain were subjected to MRI. None of the patients had any pathological signal intensity suggesting meniscal tear. Patients were scanned in supine position with knees extended. All patients were studied in sagittal and coronal planes. The Anterior horn, Posterior horn and Mid-body of menisci were examined in sagittal and coronal plane for the following parameters. Height and width of anterior and posterior horn of lateral and medial meniscus on sagittal plane and height and width of mid-body of lateral and medial menisci on coronal plane were examined. Height and width of anterior and posterior horn were measured on sagittal plane where the highest and widest meniscal size was observed. The mid-body was measured at the level of inter condylar eminence, in the coronal plane. The total data of 100 patients collected, was numbered as per the ascending order of age. The relationship between age and meniscal parameters of the cases was evaluated in this study by using correlation analyses. Correlation was significant at the 0.01 level (2-tailed). The tests were applied and graphically represented. The SPSS 10.0 program was used for statistical analyses. Data are presented as mean + SD. Results: We found that, more meniscal tears were seen where height and width of meniscus was less. In a particular age group where height and width was less, early signs of osteoarthritis should be predicted. This study shall be useful for tissue banks and surgeons, for meniscal sizing during transplantation in a particular age group. Conclusion: It was observed that as age increases, significant decrease was seen in height of anterior horn of medial meniscus, height and width of posterior horn of both the meniscus, and width of anterior horn of lateral meniscus.

78-80

Authors: Parmar P, Rathod GB

Background: Didactic lecture is the current method of choice but it is not effective way of teaching. Interactive lecture with various innovative teaching methods is the best proven way for teaching and learning. Material and methods: Cross sectional study was conducted in Department of Forensic Medicine for period of 1 year by voluntary participation of 100 students of 2nd MBBS. Three topics of Forensic Medicine were taught by jigsaw, think-pair-share and team project to three equal number groups of students and they were subjected to pre and post intervention questionnaire. Results: There was significance increase in mean post test score for all the innovative teaching methods for all topics. There was no significance difference in mean post test scores of all three innovative teaching methods which indicated that all three innovative teaching methods were effective and good to practice. Conclusion: Instead of didactic lecture, interactive lecture with innovative methods like think-pair-share, team project, and jigsaw is very helpful and essential for effective teaching and learning.

94-98

Authors: Patel SM, Vora RK

Background: An opening into the bone shaft for passage of blood vessels to the medullary cavity of a bone for its nourishment and growth is called as nutrient foramen. There is always a need for a greater understanding of nutrient foramina in upper limb bones such as the humerus, radius and ulna. So the aim of present study was to record the location, number and direction of nutrient foramina in long bones of the upper limb. Material and methods: A total number of 120 long bones (40 humeri, 40 radii and 40 ulnae) were used for the study. Results: In the results, 66% of the humeri had a single foramen, 18% had double foramina and 26% had no foramen. For the radii, 68% had a single nutrient foramen and 32% had no nutrient foramen. 78% of the ulnae had a single nutrient foramen and 22% had no nutrient foramen. All the foramina except one (in the radius) were directed away from the growing end, that is, they were directed towards the elbow. Conclusion: Information and details about nutrient foramina is of clinical importance, especially in surgical procedures like bone grafting and bone transplantation.

105-108

Authors: Lakshmibai BM, Basavaraj HT, Narasimhamurthy V, Dayananda SB

Atypical, bizarre, symplasmic (symplastic), or pleomorphic leiomyoma contains bizarre tumor cells with variation in size and shape, hyperchromatic nuclei, giant cells and occasional multinucleated giant cells but no coagulative necrosis or increased mitotic activity. Mitotic counts higher than 10/10hpf in such a tumor indicates a high malignant potential smooth muscle tumor (leiomyosarcoma). Bizarre leiomyoma closely mimics leiomyosarcoma. We report a case of 31 years old, nulliparous woman who presented with a history of infertility. On examination she was found to have uterine fibroid of 28 weeks size over a period of 5 years. She was diagnosed to have fibroid clinically and on ultrasonographic examination. Hence, a myomectomy was performed. Histomorphological features are of atypical (Symplastic) leiomyoma which closely mimics leiomyosarcoma and immunohistochemical markers are certainly of help to exclude malignancy in case of dilemma.

115-118

Authors: Pawar JA, Nere NP

Medical disorders may be mistaken for a primary psychiatric disturbance because of prominent and commonly associated psychiatric or behavioural manifestations. As Vitamin B12 is essential for normal blood synthesis and neurological function; its deficiency association with many psychiatric disorders like mood disorders. In this case report, we have studied the case that presented with treatment for Schizophrenia since 7 years and investigated and treated for megaloblastic anemia.

124-129

Authors: Rathod GB, Jain A

Ovary is an important organ as it is concerned with the production of progeny. Ovary is the commonest site of neoplastic and non-neoplastic lesion, can present in childhood to postmenopausal age group and accounts for the most prevalent cause of hospital admissions. Non-neoplastic ovarian lesions are classified as inflammatory (infectious and non-infectious), non-inflammatory (cystic and non-cystic) and pregnancy related disorders.

1-5

Authors: Kamdar DJ, Shah NA, Patel DJ, Parmar H

Background: MDR-TB is defined as resistance to isoniazid and rifampicin with or without resistance to other drugs. India is one of the countries with largest burden of MDR TB in the world. Second line Anti-tuberculous therapy is now available for patients with MDR-TB under the RNTCP Category IV. But there are many challenges for MDR- TB control in India. This study was done to analyses the RNTCP data for MDR-TB maintained at a TU, in the city of Ahmedabad, Gujarat, and to compare it with the data available in literature. This study also aimed to identify challenges faced while treating MDR-TB and to address the same. Material and methods: We had retrospectively analyzed 353 patients referred to the TU from the respective Direct Microscopy Center (DMC) with suspicion of MDR-TB during a period of January 2014 to December 2014. Results: Of the 353 suspected MDR-TB patients referred to the TU, 48 patients (13.597%) were diagnosed to have MDR-TB. Of these 48 patients, 46 patients had pulmonary TB (95.833%) and 2 patients had extra-pulmonary MDR-TB (4.166%). Of the 48 patients, 08 (16.67%) patients were transferred to their respective TU and 40 patients (83.33%) were enrolled for Cat IV from our TU. Of the 40 patients enrolled at our TU, 30 patients (75%) were continuing Category IV at the end of 2014 (25 were on intensive phase and 05 were on continuation phase), 03 patients (7.5%) died during treatment, 01 patient (2.5%) defaulted treatment, 05 patients (12.5%) refused treatment and 01 patient had XDR-TB (2.5%). Of the 40 patients, 05 patients (12.5%) had ofloxacin resistance. No patients had intolerance to any oral or injectable ATT. None of the diagnosed MDR-TB patients had HIV co- infection. Conclusion: Drug resistance in tuberculosis is a “man-made problem”. Anti-TB chemotherapy must be given optimally by (i) ensuring adequate absorption of drugs, (ii) timely diagnosis and management of drug toxicities and (iii) treatment adherence. To ensure that all patients get adequate treatment and to have a close follow-up of defaulters and patients who refuse treatment; we need to strengthen our existing management information system and also incorporate private sectors into our system.

11-15

Authors: Ahmad Z, Singh A, Goel S, Gupta A, Panesar S, Surana A, Rajesh DR, Chitti Babu G, Bharat M, Singh LK

Background: Sinusitis causes inflammation of the middle ear mucosa with increased and persistent mucoid/ mucopurulent discharge and remains as a active mucosal disease. Without correcting the sinusitis the management of ear including surgery has frequently led to failures and poor prognosis. Objectives: To establish the role of Sinusitis as Focal sepsis in Chronic Otitis media active mucosal disease. An additional objective was to accentuate the need of proper diagnostic endoscopic evaluation and improvement in middle ear mucosal disease status after functional endoscopic sinus surgery. Material and methods: A total of 50 patients aged 18-49 years with Chronic otitis media active mucosal disease (Tubotympanic type of C.S.O.M.) patients with persistent ear discharge even following culture directed topical and systemic antibiotics with 3 months and more of ear discharge seeking care at Otorhinolaryngology outpatient department were included in this study. Results: Mean age of patients was 42.5 ± 10.6 years. 76% subjects were found having septal deviation/ turbinoseptal deformity which was the most common anatomical variant, 34% had enlarged middle turbinate, 32% had medialised uncinate, 30% had enlarged bulla, 22% had enlarged bulla with prominent agger and 18% had paradoxical middle turbinate. Of these 22 patients had the accessory ostium in the posterior fontanel and 10 patients had accessory ostium in the anterior fontanel. Majority (26, 52%) of subjects had Grade I disease i.e. minimal disease limited to Osteo Meatal Complex followed by Grade II 24% i.e. moderate incomplete opacification of one or more sinuses. On otoendoscopy, 36 patients (72%) had a large central perforation, while 14 patients (28%) had a subtotal central perforation. Conclusion: A thorough diagnostic nasal evaluation of all Chronic Otitis Media active mucosal type of patients is essential in comprehensive management of the disease. Deviated nasal septum, enlarged middle turbinate, medialised uncinate predispose to sinusitis.

25-29

Authors: Ahmad Z, Singh A, Goel S, Gupta A, Panesar S, Surana A, Pathania D, Singh AK, Shamsi MS, Singh LK

Background: Despite having a well documented relationship of cleft palate with middle ear effusion, little data exists regarding otopathology in Indian children with cleft palate. Objectives: Therefore, the present study was planned with an objective to determine the various otological manifestations that occur in patients with cleft palates seeking care at a tertiary care teaching hospital. Material and methods: The present study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of northern India during June 2012 to May 2014 among 30 cases of cleft palate. On the first visit, history and thorough clinical examination are undertaken. Next, common and special investigations are undertaken to evaluate and assess the status of disease. X-ray mastoids, Pure tone audiometry and Tympanometry were also carried out. Results: The ears are found affected in 86.7%, 60.1% ears had an intact but dull tympanic membrane whereas 16.7% ears had CSOM with a central perforation. On pure tone audiogram (n=18) 33.33% had a hearing loss in one ear and 44.44% had a hearing loss in both ears in the form of a mild or moderate degree of conductive deafness. On tympanogram, 23.3% had an ‘A’ type of tympanogram whereas 44 ears had a `B’ type of tympanogram indicative of recurrent effusions in the middle ear. Majority from this sub-group >80% had associated conductive hearing loss-mild to moderate degrees. Conclusion: Cleft palate individuals should always be evaluated for possible otological manifestations.

36-41

Authors: Kumar A, Dasgupta A, Biswas D , Sahoo SK, Das S, Preeti PS

Introduction: Snake bite is a very common problem in rural India which even today leads to a large number of deaths. This is because the uninformed community members take recourse to harmful traditional healing measures which cause loss of vital time which is very important for the survival of the patient. Objectives: To assess the knowledge of the study population on snake bite and to elicit any association of this knowledge with their demographic and socioeconomic characteristics. Material and methods: An observational, cross-sectional study was done in a village in the Singur Block of Hooghly district of West Bengal. The head of the family or in his absence the senior most members was interviewed with a pre- designed, pre-tested schedule. Results: Farming was the occupation of the majority (36%) followed by business (20.6%) and service (17.7%). 45% belonged to the social class I and II (modified B.G. Prasad) while 39% were in the social class IV and V. Only 58.85% of the study population were aware that the incidence of snake bite can be reduced. 68% were aware of immobilisation of the affected part was the initial first aid measure and only 4% had the correct knowledge that application of collar was unnecessary and harmful. . Correct knowledge on the availability of specific treatment was present among 85.1% and 77.1% knew where specific treatment is available. Education OR 2.51 (1.26 – 5.00), Occupation OR 4.44 (2.35-8.40), PCI OR 2.05 (1.12-3.76) were significantly associated with good knowledge. Conclusion: There is a paucity of knowledge on different domains of snakebite. Hence dissemination of correct knowledge is necessary to remove their misconceptions.

49-54

Authors: Hosapatna M, Bangera H, D Souza A, Das A, Supriya, D Souza AS, Ankolekar VH

Introduction: The description of development of human kidney given in various textbooks doesn’t include detail microscopic appearance of kidney at various fetal ages. So an attempt was made in this study to gather information on this topic. Material and methods: The present study was carried out on 15 human fetuses of known gestational age (GA). The sections of kidney were processed and were stained using Hematoxylin and Eosin. Results: At 12th week of GA various stages of developing glomeruli were observed in the substance of the kidneys. In the cortex, various cut sections of the tubules were observed without any differentiation as proximal (PCT) and distal tubules (DCT). The second trimester section showed well differentiated the PCT and DCT by 16th week. Distinct brush border was observed in PCT by the 16th week. Immature duct system was observed in the medulla. The nephrogenic zone was appreciated till 36 weeks. By 28th week the sections of DCT were observed adjacent to the renal corpuscles indicating the developing juxtaglomerular apparatus. Conclusion: As it is essential to know the developmental morphology of kidney, the present study explains every component of it in detail.

69-75

Authors: Tomar S, Sharma A, Shukla Y, Saxena V

Aim: To identify histopathologic features of HSV keratitis and correlate them to their clinical findings following penetrating keratoplasty for suspected HSV keratitis and predict the graft outcome on oral Acyclovir treatment. Material and methods: A clinical study of 20 patients who presented to us with clinical picture suspected of HSV keratitis that underwent penetrating keratoplasty at a teaching hospital situated in rural area of India. Out of 20 patients 18 were primary grafts and in 2 patients repeat penetrating keratoplasty was done following graft failure due to rejection. A detailed review of the histopathology of the excised corneal button was performed to identify associations between clinical data (disease activity, vascularity, graft outcome) and histopathologic data (inflammation, neovascularization, gross). Patients with features of HSV keratitis on histopathology were started on oral prophylactic acyclovir therapy post penetrating keratoplasty. Results: All patients had clinically quiescent disease for at least 6 months before surgery. The visual outcome was better in 14 patients on oral acyclovir post penetrating keratoplasty in suspected HSV keratitis positive on histopathology including 2 repeat keratoplasty which were not earlier started on oral acyclovir. Histopathology of 12 cases including 2 repeat Penetrating keratoplasty revealed active corneal inflammation with epithelial irregularities along with patchy loss of Bowman’s membrane, infiltration of anterior stroma by lymphocytes, leukocytes and plasma cells. Diffuse fibrosis and neovascularisation of stroma was present which was correlated clinically. No recurrence was seen in these patients on follow up of 1 year. Of the 6 patients without any histopathologic inflammation in their corneas, only 1 experienced an allograft rejection. Conclusion: Histopathological inflammation is a marker for HSV status and its correlation helps in judicious use of acyclovir and reduces the risk of recurrence of HSV keratitis. Oral acyclovir therapy post penetrating keratoplasty acts as adjunct to improve the visual outcome in patients with positive histopathological changes.

82-86

Authors: Shamsi MS, Goel S, Singh A, Gupta A, Bhardwaj A, Goel S, Chhoker VK, Surana A, Singh LK

Background: Acne vulgaris is one of the most common skin disorders in puberty. The widespread and indiscriminate use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. Aim: The study aimed to analyze the microbiological spectrum in acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne. Material and methods: The present cross sectional study was carried out by the Department of Microbiology and Dermatology, MSDS Medical College, Fatehgarh among the patients seeking care for acne vulgaris with pustular and nodulocystic skin lesions in the Dermatology OPD of a rural medical school from western Uttar Pradesh. Patients with pregnancy or endocrinal problems like hirsutism, menstrual dysfunction or adrenal dysfunction and those taking drugs or contraceptives were excluded. The samples were cultured individually on blood agar and Muller-Hinton media. The cultures were then incubated under both aerobic and anaerobic conditions for 2-7 days. Bacteria were identified and their resistance to common antibiotics was evaluated according to the standard procedures. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Aerobically, Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acne and Micrococcus spp were detected in 44%, 47%, 1% and 46% of samples respectively whereas anaerobically these were 39%, 21%, 34% and 1% respectively. Propionibacterium acne, Staphylococcus epidermidis and Staphylococcus aureus were more sensitive to rifampin (almost 90%) compared to other drugs. Neomycin was found to be least sensitive. Conclusion: The study highlighted the need to discourage antibiotics' abuse. Rifampin is a suitable antibiotic for acne patients, but to achieve a better result, combination of rifampin with other antibiotics should be tried. It is also suggested that studies with bigger sample size on evaluation acne vulgaris treated by rifampin should be undertaken.

93-98

Authors: Jai Krishna, Singh AK, Goel S, Singh A, Gupta A, Panesar S, Bhardwaj A, Surana A, Chhoker VK, Goel S

Background: A medication error is an episode associated with use of medication that should be preventable through effective control system. Investigating the incidence, type, and nature of medication errors are very crucial to prevent them. Aim: The study aimed to analyze and ascertain profile and pattern of medication errors among admitted patients in a tertiary care teaching hospital. Material and methods: The present prospective study was carried out by the Department of Pharmacology in collaboration with the Department of Internal Medicine and Office of Medical Superintendent, MSDS Medical College, Fatehgarh, among the patients admitted to the General medicine ward during October 2013-February 2014. Hospital/medical records, Case sheet of the study subjects, a 46 item self administered questionnaire and Medication error reporting and documentation form served as study tools. Results: Overall incidence of medication errors was found to be 28.3%. 31.4% were ‘Errors in medication ordering and transcription’, 24.4% were ‘Errors in medication dispensing’, whereas 44.2% were observed as ‘Nursing errors in medication administration’. Most frequent nursing errors in medication administration was found to be ‘Medication not given’ i.e. Omission error. 67.4% were due to nurses, 22.1% were due to pharmacists and remaining 10.5% were due to physicians. Most of the nurses attributed cause of this error to ‘Repeated distraction’ and ‘High activity duty hours’ 41.4% and 39.6% respectively. Conclusion: A robust surveillance system to detect such medication errors is need of an hour. Competencies of pharmacology department hibernating in a tertiary care teaching institution could be utilized in the early detection and prevention of medication errors and thus can improve the delivery of care quality to the patients.

105-115

Authors: Siddharam Jamgond, Liyakhath Ali, Manjunath M.

Background: Supraglottic airway devices (SAD’s) have revolutionized airway management both inside and outside the operating room ever since the invention of the LMA Classic. Objectives: Objective of this study was to compare efficacy of LMA classic, Ambu Aura laryngeal mask and I-gel in terms of ease of insertion, fiberoptic bronchoscopic assessment of the glottic view, oropharyngeal leak pressure, intra and post-operative complications. Material and methods: Ninety patients of ASA Grade 1 or 2, aged 18–70 years, scheduled for elective short surgical procedures requiring general anesthesia were randomly divided in to three groups as LMA Classic, Ambu Aura40 laryngeal mask and I-gel group whose airway were secured with these devices. Anesthetic technique was standardized and maintained on spontaneous breathing. The number of attempts for the correct positioning (at least 6 square Etco2 traces on the capnograph and 4 ml/kg tidal volume) of the device were counted. Glottic view was noted by fiberoptic bronchoscope passed into the supraglottic device and graded as 1 = Vocal Cords entirely visible, 2 = Vocal Cords or Arytenoids Cartilages partially visible, 3 = Epiglottis only visible, 4 = No laryngeal structures visible. Oropharyngeal leak pressure (OPLP) was measured. Intra and post-operative complications were looked for and recorded. Results: Ambu Aura40 could be positioned successfully in a single attempt in 90% of the patients (27 out of the 30), whereas it’s only 80% in both the LMA Classic and the I-gel groups without a statistical significance (P = 0.518). Successful positioning during the next or second attempt was more with I-gel compared to LMA classic (20.0% and 16.7% respectively). 63.3% of Ambu laryngeal mask group had a glottic view grade of 1 while only 46.7% and 13.3% of patients in the LMA classic and the I-gel group had a similar glottic view respectively which was statistically significant (P = 0.000). Significantly higher mean OPLP with I-gel 36.23 ± 3.00 and least with LMA classic 30.90 ± 2.15 (p=0.000). 3 patients (10%) in the LMA Classic group complained of sore throat in the post-operative period which was statistically significant (P = 0.045). Conclusion: Over all Ambu Aura40 laryngeal mask airway device is superior in comparison to the other devices with respect to parameters studied. I-gel due to high oropharyngeal pressure leak could be useful in positive pressure ventilation. The LMA Classic is associated with a minimal incidence of sore throat in our study.

121-123

Authors: Patel D

Laparoscopy is an important milestone in the history of surgery. Almost all abdominal surgeries can now be approached laparoscopically. Laparoscopic perforated duodenal ulcer (DU) repair has been shown to be feasible. However, whether its superior to open repair is yet to be established and has not become the standard of care. Laparoscopy offers better visualization and early recovery.

127-131

Authors: Ravishankar P, Suba Ananthi K, Radhakrishnan PL, Muthusamy R

This paper aimed to report a rare case of fusion of 6th and 7th cervical vertebrae, called as block vertebrae. Block vertebrae was observed in the Department of Anatomy, SRM Dental College. The bodies of C6 and C7 were completely fused. Anterioposterior radiograph of the fused vertebrae bodies showed hypoplastic inter vertebral disc. Lateral radiograph showed partial fusion of articular processes on left but remain unfused at the right side. Congenital cervical vertebral fusion results due to non-segmentation of sclerotomes. It may be asymptomatic or may result in various clinical symptoms with limitation of neck movements. Knowledge about the variations in vertebrae especially in cervical region is essential for orthopedic surgeons, oral- maxillofacial surgeons and physical therapists for planning any surgeries involving the neck region.

137-140

Authors: Rathod GB, Jain A

Periarticular nodules may not be recognized as tophi because the clinical diagnosis of gout in many instances is not straightforward. In such a setting, fine needle aspiration cytology (FNAC) of gouty tophi would facilitate the clinical diagnosis and treatment. FNAC is valuable in confirming the nature of periarticular nodules especially in case of gouty tophi as compared to the histopathology. Thus FNAC is the gold standard for the diagnosis of gouty tophi presenting as periarticular nodules.

147-151

Authors: Dhakre A, Yengkhom I, Nagori H, Kurele A, Patel SB

Adenocarcinoma of the gastro-esophageal junction (GEJ) remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis. The majority of patients present with advanced disease and less than 50% undergo curative treatment. To diagnose GE junction mass with conventional procedure like Barium swallow where endoscopy cannot be performed, CECT is done to access the potential spread of disease.

157-161

Authors: Deepak MB, Mahsheena KM, Begum CRS, Hana Abdul Kareem

Basaloid squamous cell carcinoma (BSCC) in tonsil is a rare and aggressive variant of squamous cell carcinoma. The tonsil is an uncommon site of BSCC and just fourteen cases have been accounted for in the worldwide writing. Most common tonsillar malignancies are squamous cell carcinoma and lymphoproliferative lesions. We have presented here a rare case of incidental finding of BSCC in a 62 years old female patient who presented with unilateral enlargement of tonsil without ulceration and no preceding history of associated high risk factors like tobacco chewing, cigarette smoking or alcoholism. It is for these rarities we are presenting this aggressive tumor of tonsil.

1-8

Authors: Akpan Sylvia Iquoabasi, Megbelayin Emmanuel Olu

Background: World sight day is marked yearly and provides the opportunity to create awareness about eye health. The global event can also serve as an avenue to appraise impacts of health promotions and interventions on blindness prevention. Aim: To determine the prevalence of blindness and common ocular conditions among the studied population. Materials and methods: It was a cross-sectional study involving workers at Uyo Mechanic Village and University of Uyo Teaching Hospital. Instrument was developed in line with study’s objectives. Subjects’ responses to questionnaires and ocular assessment formed the core of data generated which was analyzed by Statistical Package for Social Sciences (version 20.0) Observation: A total of 121 males and 280 females with a ratio of 1:2.3 were analyzed. Age range was from 18 years to 66 years with a mean of 39.8+9.2 years. Prevalence of blindness was 1%. Intraocular pressure, indicated in 81 subjects, ranged from 11 to 33 mmHg with a mean of 16.2+4.8 mmHg. Absolute glaucoma was recorded in 5 patients (1.2%), 71 patients (17.7%) were glaucoma suspects and 19 patients (4.7%) had glaucoma. Refractive error 167 (41.6%) was the commonest finding. Statistical analysis of data revealed no significant relationship between sex and diagnoses (p value = 7.967, X2= 0.826, 95% CI = 0.821-0.836) or age and diagnoses (p value = 509.522, X2= 0.601, 95% CI = 0.591-0.510). Conclusion: Refractive errors were the commonest ocular finding in the population studied.

14-19

Authors: K N Prasad, M Kamali, S Kanimozhi, G Kanmani, M Kannan, A Karthikeyan, R Kaviyarasi

Introduction: Food intake is diminished among old age people due to ill health, disability, co-morbid condition. Hence the quality of life of elderly affects nutrition & protein deficiency contributes to high percentage of DALY. Objectives: To know the calorie deficiency and nutritional status among elderly people Material and methods: This was a cross sectional and community based study done on 300 elderly people among 17079 in rural village of Puducherry during March and April 2015. Data were collected by two methods (questionnaire, basic anthropometry measurement) at their residence. Data was analysed for calorie deficiency and body mass index. Results: There were equal number of men and women. Sixty percent of the subjects were aged between 60-70 years and 7% were aged more than 80 years. Caloric deficit was more in males than females and 35% of them were either overweight or obese according to body mass index. Conclusion: There were no serious micro nutrient deficiency individuals but more than 35% are already obese/ overweight and 50% are suffering from age related problems. The rehabilitation service of old age group is strongly recommended in order to give quality of life.

28-39

Authors: Prakash Gurudevarahalli Madegowda, Sanju R

Background: Stroke is a leading public health problem, it is second to heart disease as a worldwide cause of death and a leading cause of long term disability. The treatment for patients with ischemic stroke is still not very effective and prevention of stroke is a better option. The incidence of stroke can be reduced by adequate control of risk factors. Aim: To evaluate the risk factors in patients with ischemic stroke. To find out the prognosis of ischemic stroke with reference to risk factors. To identify the patients having modifiable risk factors so that preventive care can be taken to improve the prognosis and prevent recurrences. Materials and methods: 65 patients with ischemic stroke who met the inclusion criteria were evaluated with a comprehensive clinical history and detailed physical examination and relevant investigations. Their prognosis during the hospital stay was also determined. Results: At the end of the study it was noted that the incidence of stroke in males was 58.46%. 50.9% of stroke occurred in people aged above 60 years. The most common risk factors were smoking (46.2%), hypertension (38.46%), dyslipidemia (18.46%), alcohol consumption (15.39%), diabetes mellitus (13.09%), heart diseases (10.7%), tobacco chewing (9.23%), history of recent delivery (1.6%) and family history of stroke (1.6%). It was also noted that 72.3% of patients had multiple risk factors of which 7% had complete recovery while 22.2% of patients with single risk factor had complete recovery. Conclusion: It was found that stroke was more common in males when compared to females and increasing age (>60 years) was associated with increased incidence of stroke. Most common modifiable risk factors were smoking, hypertension, dyslipidemia, alcohol consumption and diabetes mellitus. The most common non modifiable risk factors were increasing age, male sex and family history of stroke. Prognosis depends on the number of risk factors present. It was also found that increasing age, hyperglycemia and multiple risk factors were associated with poor prognosis.

47-53

Authors: Gulamus sibtain asad, Himanshu Singla, Ankit vasoya, P. J. Jhala

Aim: To evaluate the features, pattern and extension of the different pathologies affecting the knee joint with help of MRI scans. Materials and methods: This study was performed using MRI scan 1.5 tesla of knee joint in 65 patients. Routine blood investigations were documented in all patients. Results: Distribution of pathologies according to patient’s age, sex, site of involvement and etiology was observed and p-value of knee joint tears by using MRI as gold standard was calculated. Conclusion: MRI scans have proved to be successful modality in evaluating the knee joint; MRI results increased the physician’s confidence in the diagnosis. MRI is an excellent noninvasive modality in imaging of the knee and a noninvasive replacement for arthrography and non-therapeutic arthroscopy.

64-68

Authors: Dharita Manubhai Khatri, Neeta Jayprakash Vyas, Megha Sandeep Sheth

Introduction: Knee osteoarthritis (OA) is a major public health problem. Knee OA leads to impaired balance and reduction in speed of walking, which is accentuated under dual-task conditions. Walking relies on continuous visual processing to obstacles as one navigates through a visually defined environment. Objectives: The study aimed to compare the speed of walking with and without visual distraction in subjects with OA knee and with normal individuals. Material and methods: Fifteen subjects with OA knee and 15 without OA knee of same age and gender were selected. Subjects were selected according to inclusion and exclusion criteria. Experiment was carried out over straight path of 50 m length and 2.5 m width. Subjects walked on two consecutive days at preferred speed 3 times back and forth covering total distance of 300 m. Charts were shown on either of the two days. Subjects passed 12 times through charts of various objects held by two assistants. Some objects were kept upright or inverted and subjects needed to reply by saying ‘yes’ or ‘no’. Charts of various colors were also shown and they were asked to identify them. The speed was noted. They also walked same distance without distraction. Level of significance will be kept at 5%. Results: Wilcoxon test was used for within group analysis for speed of walking with and without distraction. Significant difference was seen for both subjects with OA knee (W=-2.897, p=0.004) and normal subjects (W=-3.266, p=0.001). Mann Whitney U test was used for between groups analysis. With distraction groups showed significant difference (W=-2.219, p=0.026). But there was no significant difference in analysis in between groups without distraction (W=-1.701, p=0.089). Conclusion: Visual distraction leads to reduction in speed of walking in subjects with OA knee as compared to normal subjects.

77-82

Authors: Anupsingh Dhakre, Harshin Nagori, Harsh Shah, Anil Rathwa, Chinmay Parikh, Dhara Patel

Background: To recognize different pathologies affecting the shoulder joint with the help of ultrasound and MRI scans and to evaluate the features, pattern and extension of the different pathologies affecting the shoulder joint with help of ultrasound and MRI scans so as to help the clinician for further management. Aim: To estimate role of ultrasound and MRI in examination of shoulder joint. Material and methods: Study comprised of an observational hospital based study. Out of 65 patients, 20 underwent only ultrasound investigation, 25 underwent only MRI scans whereas 20 patients were evaluated by ultrasound and MRI. These were performed by 3-5 MHZ curvilinear probe and 8-10 MHZ linear probe on HD 7 and HD 9 Philips ultrasound machines and 1.5 T Philips MRI machine. MR arthrography was performed as a follow up in some of the patients in outside centre. Results: USG study also showed that the most commonly occurring rotator cuff tears were supraspinatus tears whereas alone infraspinatus and subscapularis tears were very rare. MRI study showed supraspinatus tears were the most frequently occurring in the rotator cuff whereas subscapularis and infraspinatus tears were rare. MRI is 100% confirmative in almost all cases of Rotator cuff tears but may sometimes need extra imaging by MR arthrography in partial bursal tears. Conclusion: Rotator cuff tears are the most common pathologies affecting the shoulder joint according to this study. It was proved that, there is no evident difference in the accuracy of ultrasound and MRI in detecting this pathology, even though MRI has proved to be more accurate in evaluating almost all other pathologies as compared to ultrasound.

91-97

Authors: Parikh Hemant Chimanlal

Introduction: Happiness is a very subjective feeling and may mean absence of sorrow to indefinite pleasure; to different persons! Material and methods: We derived happiness index of teenagers by asking them 20 questions having score of 1 – 5. We measured happiness amongst teenagers studying I year M.B.B.S., I year B.Sc. nursing and I year physiotherapy. Comparison of happiness levels, was done between these groups. Results: Many of the physiotherapy students were happy with their present. Nursing students were the least happy with present day turmoil. Medical students had reasonably good count on many criteria. However they were involved in lowest social activity. Conclusion: 32 – 40 percent individuals in our study had happiness index less than 73. They were given tips for happiness enrichment.

108-115

Authors: Jai Krishna, G. Chitti Babu, Shewtank Goel, Abhishek Singh, Aakansha Gupta, Sanjeet Panesar, Avinash Surana, Deepak Pathania, Lalit Kumar Singh

Background: The wide and indiscriminate use of drugs has increased the incidence and the modes of presentation of cutaneous drug reaction. Understanding the nature of ACDRs may help narrow down the search for the offending agent. Aim- The study aimed to evaluate incidence, assessment of causality, severity and preventability of Adverse Cutaneous Drug Reactions as a part of Pharmacovigilance from a rural northern Indian medical school. Material and methods: The current survey was executed by the department of Pharmacology in collaboration with Department of Dermatology, MSDS Medical College, Fatehgarh among 7692 patients attending Dermatology OPD during March-December 2014. CDSCO ADR Reporting Form, WHO causality assessment scale, Hartwig and Siegel’s Assessment scale and Modified Schomock and Thronton’s preventability assessment scale were used as study tools. All the doctors, residents, interns and students were encouraged to notify any suspected ACDRs. Patients were screened and recruited if they presented with visible skin lesions suspected to be drug related. As per Modified Schumock and Thornton Scale, 43.5% of ACDRs were ‘Definitely preventable’ followed by ‘Probably preventable’ (30.4%) and ‘Not preventable’ (26.1%). Results: 23 patients (0.3%) were detected to have one or other type of ACDRs. Fixed drug eruption was most common form (34.8%) of ACDRs followed by Acneform eruption and Urticaria in 21.7% and 13% respectively among study subjects. The most common drugs responsible for ACDRs were prednisolone, betamethasone and isoniazid for Fixed drug eruption, while metronidazole, cotrimoxazole and paracetamol for acneform eruption. Antimicrobials, other steroids and NSAIDs were responsible for other spectrum of ACDRs. On assessment of Causality of ACDRs, it was noted that more than half (52.2%) of them fall under probable category. Severity assessment of ACDRs revealed that majority (65.3%) of them was moderate in nature. Conclusion: Awareness on part of the physician can help in timely detection of cutaneous reactions, thereby restricting damage from them. Pharmacovigilance activity is significantly effective in increasing the reporting of ADRs. Study with long-term follow-up and monitoring of the patients with bigger sample size is warranted.

123-135

Authors: Nirav Patel, Niket Domadia, Konark Sarvaiya, Anil Rathwa

Background: Diagnosis of abdominal trauma is a real. Diagnostic tools that help the treating doctor in optimum management of abdominal trauma include; Focused Assessment with Sonography for Trauma (FAST), Diagnostic peritoneal lavage (DPL) and CT scan. Objectives: The aim of this communication was to define the recent role of FAST and CT scan of the abdomen in the diagnosis of abdominal trauma. Material and methods: This study aimed at evaluating patients who came to the Radiology Department of Dhiraj General Hospital, by using USG and CT scan. This study comprised of 50 patients. Results: Out of 50 patients of abdominal trauma, 12 patients (24%) were in age group 21-30 years with male to female ratio of approximately 5.2: 1. The commonest mode of trauma was road traffic accident according for 54% of total cases. Spleen and liver were the most common organs injured, followed by kidney. USG showed overall sensitivity 57.48%, specificity 97.77%, positive predictive value 88.9125, negative predictive value 97.185 and accuracy of 90.75%. CT scan showed highest sensitivity of 95.35%, specificity of 100%, positive predictive value of 100%, negative predictive value 77.78% and accuracy 96%. Conclusion: FAST is useful as the initial diagnostic tool for abdominal trauma to detect intra abdominal fluid. With proper training and understanding the limitations of ultrasound, the results of FAST can be optimized. DPL is indicated to diagnose suspected internal abdominal injury when ultrasound machine is not available, there is no trained person to perform FAST, or the results of FAST are equivocal or difficult to interpret in a hemodynamically unstable patient. In contrast, in hemodynamically stable patients the diagnostic modality of choice is CT with intravenous contrast. It is useful to detect free air and intra peritoneal fluid, delineate the extent of solid organ injury, detect retroperitoneal injuries, and help in the decision for conservative treatment. Helical CT is done rapidly which reduces the time the patient stays in the CT scan room. Furthermore, this improves sagittal and coronal reconstruction images which are useful for detecting ruptured diaphragm.

145-150

Authors: Meeravali SK, Dasaraiah CV

Background: Study was designed to analyze the effects of surgical management of fractures of both bones of forearm with dynamic compression plate with screw fixation. Material and methods: From August 2008 to October 2010, data from 56 patients with fractures of both the radius and ulna were collected and evaluated retrospectively. Patients were managed with early surgical debridement, open reduction and internal fixation with a DCP. All patients had complete functional and radiographic assessments. Results: Patient regained full range of movements within 6-8 weeks. At 12-14weeks check X-ray showed good radiological union. In this series out of 56 cases 42 (75%) cases are graded excellent, 7 (12.5%) cases are graded good, fair 5 (9%) cases and poor 2 (3.5%) cases. Conclusion: Our study has proven that open reduction and internal fixation of diaphyseal fractures of radius and ulna can be best done with dynamic compression plating technique which has given a good result. The technique of DCP fixation is a simple procedure which can be done by the junior orthopedic surgeon with an excellent result.

160-171

Authors: Eyad AlShammari, Rafia Bano, Shahida Banu, S. Bushra Fatima, Asma Sattam

Objectives: Adequate nutrient intake during pregnancy is important to fetal and maternal health. The purpose of this study was to investigate the factors affecting pregnancy outcome and to provide basic data to promote more favorable pregnancy outcomes. Material and methods: Data were collected from 100 pregnant women at two hospitals in Hail region of Saudi Arabia. Demographic characteristics, anthropometric measurements and health related habits were obtained using a questionnaire at the hospital visit soon after the delivery. Data on pregnancy outcomes, including birth weights and gestational ages, were obtained from hospital records. Birth weights were divided into three groups, a low birth weight group (birth weight <2.5 kg), a normal birth weight group (2.5 - 3.9 kg) and a high birth weight group (≥4 kg). Results: The Socioeconomic status was significantly with the birth weight (p<0.05), with high birth weight group babies belonging to high income group and low birth weight babies from lower income groups only. Weight and BMI of the mothers before pregnancy, total weight gain during pregnancy and hemoglobin levels were found to be significantly correlated with the birth weight.(p<0.05). Few health related habits and risk factors were significantly different among the three groups. Birth weight or sex of the baby was not significantly affected by gestational age. Conclusion: Birth weight remained an important factor affecting the neonatal infant and childhood mortality and morbidity. Low birth weight babies are more likely to have disabilities in four of developmental delay, poor growth and mental disabilities. For reducing the prevalence of low birth weight, public health strategy needs to focus attention on better maternal nutrition and education.

183-191

Authors: Ishita Sarkar, Aparajita Dasgupta

Background: Declining sex ratio is an issue of major concern. In spite of legal rules and regulations prenatal sex determination and sex selective abortion is going on in this country. The root of the problem is male child preference and unawareness about the rules forbidding prenatal sex determination. Aim: To elicit the gender preference and perception regarding prenatal sex determination among rural ever married women and to find out the contextual factors influencing the perception. Material and methods: This community based cross-sectional study was undertaken under the rural field practice area of All India Institute of Hygiene and Public Health, Kolkata. All ever married women in that area was line listed out of which the required number of women (i.e. 96) was selected by simple random sampling. A predesigned and pretested semi structured schedule was used for data collection. Firstly a univariate analysis was done. The variables which were found to be significant were entered into the multiple logistic regression model. P value of <0.05 was considered significant. Results: 90.6% of the study population felt that at least one male child is necessary in a family and 59.37% agreed with prenatal sex determination. Multivariate analysis showed that women with higher education had better perception of prenatal sex determination techniques and the PNDT Act with Adjusted Odds Ratio (Confidence Interval) 19.25 (5.58-66.34). Conclusion: Intensive IEC campaigns to increase awareness and enforcement of law are the need of the hour to check this social problem.

197-204

Authors: Tejal C Nalawade, Shyam D Ganvir

Background: Postural control involves controlling body’s position in space for dual purpose of stability and orientation. Postural stability or balance is defined as the ability to maintain the projected Center of motion (COM) within the limits of Base of Support (BOS). During quite stance there is a separate Center of Pressure (COP) under each foot. The net center of pressure lies between the feet and depend on each limb support. Normally no one stand erect, instead the body sways in small amount, mainly forward and backward. Thus quite stance is characterized by small amount of spontaneous postural sway. The device (sway meter) consists of inflexible 40 cm long rod with vertically mounted pen at its end. The rod was mounted 20 cm wide metal plate which will be fitted at the level of PSIS (Posterior superior iliac spine) over lower back region of participants by firm belt. A low tech Sway meter was designed to address the needs of clinicians and researchers with limited resources (e.g. no access to force plates or motion laboratories). It is a useful field test, as it is compact, lightweight, has short administration and data processing time. Unlike other lightweight and easily applied systems, such as accelerometers and gyroscopes, the Sway meter involves no electronics or computer processing. Thus, assessment can be conducted in a variety of community settings and health care facilities. Several research groups have found the Sway meter to be feasible for use in different populations of young and older people. The Sway meter has been used in numerous studies of balance as well as retrospective and prospective investigations of falls risk in older people. The purpose of study was to find out normative data of postural sway by using sway meter in among young adults and the validity of the Sway meter against the floor and foot print. Aim and objectives: To study the normative data of postural sway by using sway meter among young healthy adults, to study the normative data of postural sway by using sway meter among young healthy adults with eye open and eye close, to study the normative data of postural sway by using sway meter compare with the normal values of the lord’s and Sherrington’s study. Material and methods: The subjects were instructed to keep their hand by their sides during standing. Subjects were informed about procedure before starting. Duration of each trial was 30 second. A starting point was marked on the graph paper. At end of the 30 seconds, the rod of the sway meter was taken away from the graph sheet. 5-10 seconds rest was given during trial, but they were not allowed to move away from the foot print. The procedure was repeated for each trial. A total of six trials were taken including, 3 trial with eyes opened and 3 for eyes closed. Maximum duration for all trial was 6-7 minutes and maximum deviation in 3 trials was taken for analysis. Results: In eye open condition, in anterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In Posterior direction, total 60 (100%) subjects are had sway in 0.1 to 2 cm. In right lateral direction, total 59 (98%) subjects had sway in 0.1 to 2 cm; remaining 1 (2%) subject had sway in 2.1 to 3 cm. In left lateral direction, total 56 (95%) subjects had sway in 0.1 to 2 cm; remaining 2 (3%) subjects had 2.1 to 3 cm sway and 2 (2%) subjects had 3.1 to 4 cm sway in left side. In eye closed condition, in anterior direction 57 (95%) subjects had 0.1 to 2 cm sway in anteriorly, but remaining 2 (3%) subjects had 2.1 to 3 cm sway, and 1 (2%) subject had 3.1 to 4 cm sway. In posterior direction 59 (98%) subjects had 0.1 to 2 cm sway in posterior; rest 1 (2%) subject had nil sway in posterior. In right lateral direction 56 (93%) subjects had 0.1 to 2 cm sway, and rest of the 2 (4%) subjects had nil sway, and 2 (3%) had 2.1 to 3 cm sway in right direction. In left lateral direction 57 (95%) subjects had 0.1 to 2 cm sway, and 1 (2%) subjects had nil sway, rest 2 (3%) subjects had sway in 2.1 to 3 cm. Conclusion: It has been concluded that this study support the self constructed sway meter as a clinical tool for identifying sways in various directions (anterior, posterior, right lateral and left lateral). Similarly 100% of sway was seen in anterior and posterior direction with eye open.

210-213

Authors: Makhela J, Kaushal K, Choraria S, Ranka M, Patel S B

The mucopolysaccharidoses (MPS) are a group of inherited metabolic disorders that result in widespread skeletal, visceral, and mental abnormalities. A defect in metabolic degradation leads to the storage of mucopolysaccharide macromolecules in the nervous system and other body tissues. The MPS are classified into various types, and there are additional diseases, such as the mucolipidoses and a gangliosidosis, that demonstrate similar clinical and radiologic findings. We hereby present 3 cases of Hurler Syndrome, Type I mucopolysaccharidoses, and enumerate there radiological characteristic radiological findings.

220-222

Authors: Jacob K J, Mini K, Sreeja K.R.

Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. There is increased risk of developing severe complications and development of persistent trophoblastic disease. A 28 years old 2nd gravida, with 1st vaginal delivery reported to the hospital at 20 weeks gestation as a case of dichorionic twin pregnancy. On routine USG, it showed a complete mole with a coexisting live fetus. The patient had features of anemia and severe preeclampsia. After explaining the risk to the patient and bystanders, they requested to terminate the pregnancy. She was induced for the same and delivered a normally appearing fetus. This was accompanied by evacuation of the mole. Diagnosis of complete mole was confirmed by histopathology. Twin pregnancy with a complete mole and a coexisting healthy fetus is a rare condition. The decision regarding management of this condition is difficult due to the various complications associated especially development of choriocarcinoma.

227-231

Authors: Ashish Devgan, Amit Batra, Shivani Dua, Vivek Bansal, Sudhir Punia, Shubham Joshi, Harnam Singh Madan, Vinit Verma, NK Magu

Patellar tumors are rare and are usually benign as opposed to malignant tumours. The most frequent benign lesions of patella are giant cell tumor (common in adults), chondroblastoma and osteoid osteoma. A solitary exostosis is the most common benign bone tumor which occurs around the growth plate of long bones. The treatment of choice is extra periosteal resection of exostosis and ensuring complete removal of cartilaginous cap. Indications of surgery are when the exostosis is interfering or disturbing the growth of extremity, malignant transformation, presence of bone erosion, neurovascular compression, interference with joint motion, bursitis, fracture through the stalk and cosmesis. We report a rare case in an adult patient with an extra-articular skeletal osteochondroma of the patella located antero- superiorly which presented as an enlarged bursa and a bony swelling over knee joint.

236-239

Authors: TH Kalidas Singh, Gunvanti B. Rathod

Fine needle aspiration (FNA) of the breast has gained significant credibility in the diagnosis of breast diseases especially malignancy. Fat necrosis of the breast is a phenomenon that occurs within breast adipose tissue following exposure to trauma. It can mimic breast cancer clinically or radiologically. FNA of fat necrosis is a useful tool in directing management and treatment of the patients and avoiding unnecessary surgeries although histopathological examination is the gold standard for the final diagnosis.

1-4

Authors: Nilesh D. Patel, Rakesh M. Rajat, Rajesh S. Katara

Introduction: Salmonella typhi is widely prevalent in India and it causes endemic and epidemic typhoid fever. Early and proper antibiotic administration is necessary to reduce morbidity, complication and mortality of typhoid. Material and methods: A total of 1006 febrile patients, receiving treatment at Guru Govindsingh Hospital, Jamnagar, were included in this study. 1006 blood culture samples for S. typhi were collected from these patients. Blood cultures were tested for clinical bacteriology, as per standard protocol. Results: 30 blood cultures grew positive for S. typhi with the isolation rate of 2.98%. 60% S. typhi isolates were resistant to chloramphenical, ampicillin, and co-trimoxazole and hence, were multidrug resistant S. typhi. Ciprofloxacin was the most effective drug with 93.33 % sensitivity. Conclusion: Ciprofloxacin remains the drug of choice for treatment of typhoid fever. Unchecked use of ciprofloxacin antibiotic should be rationalized, since selection pressure has now emerged as ciprofloxacin resistance in S. typhi.

10-17

Authors: S. Govindu, B. Gopi Krishna, G. Ravi Prabhu

Background: The National Urban Diabetes Survey in India (2010) has reported an age standardized prevalence of diabetes to be 12.1%. The prevalence of diabetes mellitus is known to vary with lifestyle factors. Aims and objectives: The present study was conducted to find the prevalence of diabetes mellitus among adults and its association with certain life style factors like current smoking, alcohol intake, saturated fat intake and physical exercise. Material and methods: This present study was a cross sectional and analytical study carried out in 900 adults in the age group of 30 years and above during June 2014 to December 2014. A random blood sugar test was conducted among the selected study subjects and the prevalence of diabetes mellitus was estimated using the cut off level of 180 mg%. Those subjects who were already known to be diabetics with or without treatment were also classified as diabetics. The findings were analyzed using Epi-info software 7 version (CDC, Atlanta, USA). Results: The prevalence of diabetes mellitus in the present study was found to be 12.4%. Significantly higher proportion of current smoking was found in diabetics (17.0%) than in non-diabetics (6.1%). Current alcohol intake was significantly higher in diabetics than in non-diabetics (8.0% vs 2.4%); current saturated fat (ghee) intake was similar in diabetics and non-diabetics (5.4% and 5.5% respectively). Paradoxically higher proportion of physical exercise was found in diabetics (15.2%) than in non-diabetics (5.1%). Conclusion: The prevalence of diabetes mellitus showed significant association current smoking and current alcohol intake.

26-29

Authors: Vani Isukapalli, Radhika M

There is a substantial rise in diabetes complicating pregnancies in south Asian countries especially India. Until many decades, insulin eras thought to be the only management option to maintain euglycemia in these cases. But metformin can be a safe and convenient alternative in such cases. In this background we have conducted a study I 40 women with diabetes complicating pregnancies and studied the outcome of the mother and neonate in important parameters. Metformin was found to be a safe, effective and cheap alternative to insulin therapy in pregnant diabetic women.

37-42

Authors: Jignesh Jethva, Pallav Patel, Jaydeep Gadhavi, Hiren Parmar

Background: Fistula-in-ano forms a good majority of treatable benign lesions of the rectum and anal canal. 90% or so of these cases are end results of crypto glandular infections. Despite the easy of diagnosis, establishing a cure is problematic on two accounts. Firstly, many patients tend to let their ailment nag them rather than being subject to examination, mostly owing to the site of this disease. The more important second factor is that a significant percent of these diseases persist or recur when the right modality of surgery is not adopted or when the post-operative care is inadequate. Aim and objectives: To know the usefulness of investigative procedures in early and accurate diagnosis of fistula in ano. To study the efficacy of different modalities of surgical approach with reference to post-operative hospital stay and complications like pain, bleeding and sphincter incontinence and outcome in respect to persistence/ recurrence of fistulae. Material and methods: A total of 25 patients with clinically diagnosed fistula in ano were included in the study. Clinical history was obtained in all the patients. Clinical examination including per rectal examination and proctoscopy was done in all the patients. All the patients were processed by routine investigations, ECG, chest X - ray etc. prior to surgery. Patients were followed up to a period of 1 year. Results: 6 patients i.e. 24% had similar illness out of them two previously operated for fistula with recurrence, and four patients with similar illness and resolved without treatment. In this study, 72% of patients had low level of fistula and another 28% of patients had an internal opening situated above the ano rectal ring. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. In this study 60 % of patients underwent fistulotomy, 12 % of patients fistulectomy and another 28% seton placement. Patients with low level fistula were treated with fistulotomy and fistulectomy and patients with high level fistula were treated with seton placement. Conclusion: Fistula-in-ano is an important, commonest disease due to crypto glandular infection (anal glands) and has a complication of ano rectal abscess. It is curable disease by the treatment of surgery and higher antibiotics, local antibiotics with good post-operative wound management, like sits bath for twice a day without closing the wound.

48-55

Authors: Jignesh Jethva, Jaydeep Gadhavi, Pallav Patel, Hiren Parmar

Background: Hernia is a common surgical problem which requires good surgical skill as well as good knowledge about anatomy and various repair of hernia. Hernia is a protrusion of a viscous of part of viscous through a normal or abnormal opening in the wall of its containing cavity. Inguinal hernioplasty can be done under general anesthesia, spinal/epidural and local anesthesia. The choice of anesthesia depends upon a variety of factors viz patient's acceptance, surgeon’s wishes, safety, feasibility and cost etc. Recently there has been revival in the use of local anesthetic technique for hernioplasty. Aim: To study comparison of local anesthesia v/s spinal anesthesia for per-operative and post-operative outcome measures. Material and methods: We have done comparative study of total 100 patients (50 patients under local anesthesia and 50 patients under spinal anesthesia), with follow up period of 60 days. The present study included male patients of uncomplicated inguinal hernia with ASA grade 1 to 3. Patients were selected without bias of type (Direct/Indirect) and extent. All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (Total 100, 50 in each group). Results: All patients were explained about both the methods of anesthesia for hernioplasty, those who willing for local anesthesia were selected for this group and similarly spinal anesthesia group selected (Total 100, 50 in each group). In local anesthesia group 7 (14%) patients had intra-operative discomfort in form of pain. 64% of patients of local had mild pain and 38% had moderate pain. None of the patients belonged to serve pain group. In spinal anesthesia, 6% of patient had serve pain, 22% patients had mild pain and 72% patients had moderate degree of pain. Local anesthesia was associated with less post-operative complication, in our study no patient develop complication like nausea, vomiting, urinary retention, or headache. Conclusion: hernioplasty under local anesthesia was an acceptable alternative to spinal anesthesia for hernioplasty especially with regard to operative condition, patient’s surgeon’s satisfaction, post-operative pain relief, complications and cost effectiveness.

63-71

Authors: Ravikumar Edwin, Harish Babu R, Subrahmanyam G, Ramalingam K, Mahaboob V Shaik

Background: Cardiovascular disease/Coronary artery disease (CAD), leading cause of global morbidity and mortality covers any disease of the circulatory system. In-vivo antioxidant nutrients which include vitamin C, trace elements such as Se, Zn and Cu play a crucial role in defending against oxidant damage. Objective: The aim of the present study was to investigate the changes occurring in the levels zinc (Zn), copper (Cu), and Selenium (Se) in coronary artery tissues of patients with CAD. Material and methods: Coronary artery samples collected from these patients during bypass surgery from known CAD patients. These samples were analyzed for Se, Zn, and Cu; results are expressed in terms of wet weight. Normal Healthy serum Se, Zn, and Cu levels were also analyzed to compare with coronary artery samples. Results: The levels of Zn, Cu and Se in patient’s coronary artery samples were observed to be very low when compare to Zn, Cu and Se levels of healthy person’s serum samples. In addition, our study showed that the levels of Zn and Cu in coronary artery samples were low when they compared to heart tissue Zn and Cu levels from CVD patients from other studies. Whereas, Se levels in coronary artery samples in our study are same as heart tissues samples in previous other studies. Yet, there was limited/no observational studies were published to identify levels of trace element levels in coronary artery samples. Hence our present observations interpreted the levels of Zn, Cu and Se in coronary artery samples with 20 numbers of sample size only; further, higher number of samples needed to formulate the standard reference ranges of these trace elements in setting up a newer biochemical marker in correlation/interpretation of CVD/CAD. Conclusion: The finding of our results showed that Se levels in coronary artery observed to be same as heart tissue levels from other study. The myocardial clinical manifestation seems to be due to alteration of levels of these trace elements in serum, tissue levels in patients. In our studies, however, the patients with coronary heart disease had, in general, lower concentrations of Zinc, copper in serum than the healthy controls.

79-87

Authors: SK Reddi Basha, A Penchalaiah, Y Venu Gopala Sarma

Background: Helminthic infestation is common in children because of their habits and opportunity for exposure. The present study was undertaken in the Narayana Hospital, Nellore to determine the incidence of various helminthes, the symptomatology and clinical manifestations of various helminthes and to correlate type of helminthic infestation. Material and methods: This is a prospective study, was done in 1 to 15 years children who attended O P D or admitted to the pediatric ward, Narayana Hospital, Nellore. The material for the study comprises of 500 children’s, who attended OPD or admitted to the Pediatric ward belonging to 1 to 15 years age groups. A detailed clinical examination including stool examination was done for all the 500 children. Blood examination was done for knowing the degree of anemia. Results and discussion: Out of 500 children examined in various age groups, 275 children’s were found to be positive for one or other helminthic ova in the stool samples examined giving an overall incidence of 55%. Number of stool samples examined Number of stool samples infested with Helminths. Out of 500 children examined, 235 were males and 265 were females, of which 130 males and 145 females were found to be infested for one or other helminthic ova. Out of 500 stool examples examined 275 were positive for one or other helminthic ova, 160 were positive for ascariasis, 20 were positive for Hookworm, 40 were positive for Trichuris trichura, 10 were positive for hymenolepis nana and 5 was positive for Taenia infestation. Out of 500 children studied, 130 children belong to class V Socio –economic class, 150 children belong to class IV socio – economic class, 120 children belong to class III Socio – economic class and 100 children belong to class II Socio – economic class, giving a percentage of infestation according to socio –economic class as 80% in class V, 63.3% in class IV, 41.7% in class – III and 30% in class II respectively. Anemia in hookworm infestation was of mild degree in all 15 children. Anemia in mixed infestation was of mild degree in 20 children and moderate degree in 5 children. Out of 500 children studied 300 children had normal nutritional status a nd positive percentage of helminthic infestation in them was 26.7%, 140 children had Grade – I malnutrition and positive percentage of helminthic infestation in them 96.4. 40 children had Grade-II and 20 children had Grade – III malnutrition. Positive percentage of helminthic infestation in Grade – II and Grade – III malnutrition was found to be 100%. Conclusion: This study confirms the finding of the other authors all over India regarding helminthic infestations in respect to epidemiology, clinical manifestations and relation with nutritional status. There was a high co-relation with poor nutritional status.

95-103

Authors: Sridhar Reddy S, Praveen Kumar K, Mastan Valli B, Madhav Desai

Background: Sepsis is the most common trigger for acute kidney injury (AKI) in critically ill patients. This study is to monitor changes in urine neutrophil gelatinase- associated lipocalin (uNGAL levels between septic and non-septic AKI and also to evaluate differences between septic and non-septic AKI with uNGAL. Material and methods: This was a prospective observational study of critically ill patients with acute kidney injury (AKI) Patients were evaluated for presenting complaints and on evaluation those who satisfied for SIRS criteria are taken up for study. In those patients with evidence of infection and positive for at least two criteria for SIRS are taken up as cases (n=30) and rest are taken as controls (n=30). All the patients were serially monitored for urine output, renal parameters, urine NGAL, APACHE II score and SOFA score. Patient urine was collected immediately after admission followed by 12, 24 and 48 hours for measuring NGAL. Results: Mean change in NGAL (ng/ml) at 12 hour, 24 hour and 48 hour was -12.5±5, -20.5±6.74 and -29.3±10.25 respectively in septic AKI and was -0.94±6.08, -0.92±6.31 and -0.10±6.12 respectively in non septic AKI. Within group analysis showed statistically high significance (p<0.0001) in septic AKI but not in non septic AKI group (P=0.97). On evaluating between group analysis, we found significantly high difference of NGAL in septic AKI at 12 hrs, 24 hrs and 48 hrs as compared to non septic AKI (P<0.0001) Conclusion: Septic AKI patients have higher detectable urine NGAL compared with non-septic AKI patients. These differences in NGAL values in septic AKI may have diagnostic and clinical relevance as well as pathogenetic implications.

112-120

Authors: Manjeet S Dhanda, Nadeem Ali, Abedullah Bhat, Firdous A Bangroo, Sansar C Sharma, Mehreen Maqsood, Sagar Parashar, Arti Dhingra

Background: Fractures of the proximal humerus have been a challenge to orthopaedic surgeons with treatment modalities changing from time to time. Locking plates have revolutionised the treatment of these fractures. Currently proximal humeral locking plates (PHLP) and proximal humeral interlocking osteosynthesis (PHILOS) are two types of locking plates available for fixation of these fractures. Aim of this study was to evaluate the results of proximal humeral locking plate (PHLP) for Neers’s two and three part proximal humerus fractures. Material and methods: Neer’s two and three part fractures treated by open reduction and internal fixation with proximal humeral locking plate from August 2012 to April 2014 were retrospectively evaluated for complications, time to radiological union and final functional outcome using Constant-Murley Score (CMS). Results: Twenty (12 male; 8 female) patients with 8 Neer’s 2-part and 12 Neer’s 3-part fractures managed by open reduction and internal fixation with proximal humeral locking plate (PHLP) with an average follow up of 23.2 months were evaluated. All the fractures united at an average of 16 (12 to 20) weeks. Eight complications were seen in 5 (25%) patients, namely, inadequate anatomical reduction (n = 1), superficial wound infection (n = 1), deep infection (n = 1), subacromial impingement (n = 1), axillary nerve neuropraxia (n = 1), adhesive capsulitis (n = 1) and secondary varus collapse (n = 2). There was no patient who developed avascular necrosis (AVN), non-union, primary or secondary screw perforation, implant failure and vascular injury. Average Constant-Murley Score at final follow up was 84.75 ± 11.6. 85% patients had very good and good functional results. No patient had poor functional results. Conclusion: Proximal humeral locking plate (PHLP) is an excellent implant in Neer’s two and three part fractures of the proximal humerus. Complications can be minimized by meticulous surgical technique and proper placement of screws and plate. In case of medial comminution, use of PHILOS with placement of medial support screws and bone grafting should be preferred to prevent varus collapse.

129-134

Authors: R. Sambasiva Reddy, Y. Venugopal Sarma

Objectives: To compare the demographic profile of mothers who delivered term low birth weight babies with that of mothers who delivered normal birth weight babies and study the association between the demographic variables of mother and the delivery of low birth weight babies. Material and methods: Study conducted at Department of Pediatrics and Department of Obstetrics of Narayana medical college hospital, Nellore, India. Participants were 120 postnatal mothers who delivered babies in the preceding 7days. 60 mothers who delivered term low birth weight babies and 60 mothers who delivered normal birth weight babies were include in the study. Five demographic variables: age of the mothers at the time of conception, educational status of the mothers, monthly family income, occupation of the mothers and presence or absence of consanguinity were recorded. Using chi-square test these variables are compared between two groups of mothers and association of these demographic variables with the delivery of low birth weight babies is studied. Results: Significant association was found between the family income and low birth weight (P-value 0.002) and between consanguineous marriage and low birth weight (P-value 0.000). Significant association was not found between the age of the mothers and low birth weight (P value 0.924), between occupation of the mother and low birth weight (P value 0.15) and between educational status of the mother and low birth weight babies (P value 0.062). Conclusion: Low family income and consanguineous marriage have significant association with delivery of low birth weight babies.

140-146

Authors: Ankur Mittal, Ramprasad R, Biju R, Siva Prasad Y, Ganesh Kumar Reddy M

Introduction: Risk of Nonunion, residual shoulder disability and symptomatic malunion are higher in conservative treatment of displaced midshaft clavicle fractures which are reportedly decreased by operative method but plating these fractures, however, have hardware-related problems. Low-profile anatomically precontoured plates may reduce the rates of plate prominence and hardware removal. Objective: To assess the rate of plate prominence, rate of hardware removal, rate of complications, radiological and functional outcome of a pre-contoured congruent clavicle plate in the treatment of acute, displaced, mid-shaft clavicle fractures. Materials and methods: This study presented the results of 50 patients treated with an anatomical congruent clavicle plate for acute displaced, mid-shaft fractures of the clavicle from October 2011 to December 2013 admitted in Narayana General Hospital. Results: The fracture united in all cases with minimal complications and high patient satisfaction on the Disability of the Arm and Shoulder (DASH) score, American Shoulder and Elbow Surgeons score (ASES) and Pain Visual analogue score (VAS). The results compare favorably with other published studies Conclusion: A congruent clavicle plate prove to be a better option for mid shaft clavicle fracture in terms of patient compliance, hardware complication, radiological and functional outcome.

152-155

Authors: Pankaj Chhikara, Dinesh Chillar, S K Dhattarwal

Unnatural deaths of married women amongst the total female deaths have shown an increasing trend in Indian society during the recent years. These unnatural deaths may be suicidal, homicidal or accidental but suicidal deaths are most common. In India, dowry is an persistent evil, even among educated societies, there is no escape from the brutality of in-laws if expectations are not met and some of these oppressed young women choose to commit suicide, either by burning, poisoning or by some other means. The burden of finding the cause of death lies on the shoulders of forensic experts. In this peculiar case, history and findings were confusing and inconclusive. Then as the ray of hope, flies of autopsy room came to teach us importance of patient observation in Forensic Medicine.

160-163

Authors: Bhartiya SK, Bhattacharya SK, Basu S, Srivastava A, Shukla VK

Venous aneurysm is saccular or fusiform dilatation of vein, usually congenital origin. Among acquired variety post intravenous cannulation leading to venous aneurysm is extremely rare entity. Non invasive diagnostic procedure MRI and duplex scanning are very useful modality for anatomical localization of the aneurysm. Although an ascending venogram is an invasive test and should take a backseat for diagnosis of such aneurysm. Symptometic case needs surgical management. Anatomical delineation is an important pre requisite for planning surgery. Aneurysmorrhaphy preserves the affected venous segment because it does not produce luminal compromise.

168-173

Authors: Menon Narayanankutty Sunilkumar

Parotid gland is one of the major salivary glands and when there is infection/inflammation of the parotid gland, the condition of parotitis ensues. A parotid abscess (PA) results as a complication of the primary parotitis. Literature review has revealed that it is very rare in the pediatric population and many predisposing factors are present for the formation of a PA in children. PA is seen often in the adults when compared to the paediatric subset. The management with intravenous broad spectrum antibiotics, drainage of the PA and surgery is the main stay of treatment in an adult patient. In this case report, a seven year old female child who detected to have a PA and managed only conservatively has presented and discussed.

178-182

Authors: Bhavani K, Vani Isukapalli, Nagamani T, Silpa Hasa S

Endometrial stromal tumors (EST) arise from stromal component of endometrium and are rare and common in peri or postmenopausal age group. EST are partially estrogen dependent tumors and their histopathology resemble the stromal cells of normal proliferative endometrium. They present in varied forms pathologically ranging from most benign to most malignant variants. Diagnosis essentially is by histopathology and prognosis is based on the mitotic activity of the tumor. We have presented here a case of EST presenting in a young nulliparous woman.

187-194

Authors: M.C. Songra , Sanjay Jain, Romil Jain, Rahul Ahluwalia, Naveen Patbamniya, Pragyey Nawalakhe

Catecholamine-secreting tumors that arise from chromaffin cells of the adrenal medulla and the sympathetic ganglia are referred to as pheochromocytomas and extra adrenal catecholamine-secreting paragangliomas (extra adrenal pheochromocytomas), respectively. Bladder paragangliomas are rare entities with initial non-specific presenting symptomatology. Differentiation of urinary bladder pheochromocytomas from other bladder tumors has important treatment implications. We have presented here the case of a 55 year old female who presented to our outpatient urology clinic with complains of hematuria for 3 months and headache for 1 month. Cystoscopy revealed diffusely thickened bladder wall with a well circumscribed smooth surfaced mass protruding from the right lateral wall of the bladder. Multiple biopsies were taken and sent for histopathology. After cystectomy, diagnosis of paraganglioma of bladder was done by histopathology and immunohistochemistry.

200-204

Authors: Yogesh M Borse, Rashmi V. Bengali, Rajesh D. Subhedar, S.A. Thorat

Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It is bilateral in 10% of cases. A 24 year lady with bilateral Pheochromocytoma operated for resection under epidural with general anesthesia. Diagnosis was confirmed with 24 hour urinary VMA levels, USG, CT scan and MIBG scan. Tumor resection was incomplete on left side so patient underwent reexploration. Preoperative BP controlled with Phenoxybenzamine and Prazocine. Intra-operative BP fluctuations managed with sodium nitropruside and esmolol. Post operative hypotension was tackled with higher doses of Dopamine and Noradrenaline due to down regulation of adrenergic receptors. Patient was discharged on oral steroids after 3 weeks.

210-212

Authors: Harish Kumar Y, Sridhar K, Srinivas MG, Thankappan KR

A 50 year female presented with dysphagia for 2 months and she denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice, abdominal pain, vomiting, loss of weight or loss of appetite. Upper gastrointestinal (UGI) endoscopy revealed a web at 17 cm from incisors. Post endoscopy patient developed pain over the upper abdomen which worsened during swallowing and breathing. Because of rapid development of these symptoms we suspected esophageal perforation/dissection. Complete blood picture suggestive of neutrophilic leukocytosis and other parameters were normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with Salivary-Gilliard dilators and procedure was uneventful and oral feeding was initiated.

218-224

Authors: Ambesh Kumar Rai, Bipin Kumar Yadav

The implementation and execution of effective infection control protocols among all health care communities cannot be overstressed. Infection control becomes even more significant in dentistry as more microorganisms are found in the oral cavity than in any other part of the body. Saliva is about half as infectious as blood, and the most likely modes of transmission in dental offices are through puncture wounds, skin abrasions, or lesions. Dental aerosols, splattering, and instrument contamination can also transmit virus, which can survive for several weeks at room temperature. With Orthodontists showing the second highest incidence of hepatitis B among dental professionals, the need of stringent infection control protocol in an orthodontic office becomes mandatory. This article discusses various sterilization protocols with their relevant scientific data keeping the instruments longevity in mind to facilitate the discerning orthodontist in make an informed decision towards their implementation.