International Archives of Integrated Medicine

1-5

Authors: Ramasamy Suresh, Victor Theophilus Premkumar

Background: Pulmonary tuberculosis is the most frequent cause of death by an infectious agent worldwide. Among the extra pulmonary presentations after tuberculous lymphadenitis, pleural TB is the second most frequent Failure to diagnose and treat pleural TB can result in progressive disease with the involvement of other organs in as many as 65% of patients. Conventional methods have proven to be insufficient for diagnosis of pleural TB. Hence, this study was aimed to determine whether combined use of pleural fluid lymphocyte neutrophil ratio and ADA activity would provide a more efficient means for diagnosing tuberculous pleurisy than the use of ADA levels. Aim: To determine whether the combined use of ADA activity and lymphocyte/neutrophil ratio would provide a more efficient means for diagnosing tuberculous pleural effusion than with the use of ADA alone. Materials and methods: Present study was hospital based prospective observational study carried out from February 2016 to July 2016. All the patients with pleural effusion admitted in medical ward at GRH Madurai. Information collected through preformed and pretested proforma. The qualifying patients were undergoing detail history, clinical examination and investigation. Patients were classified as exudative and transudative pleural effusion based on light’s criteria Patients with MRS score of 5 and 6 were declared as very poor outcome and MRS of 3 and 4 as poor outcome. Patients with MRS 0, and 1 were considered as good outcome. Statistical analysis was done by One way ANOVA, Pearson correlation and Chi square test. Results: There was significant correlation between the combined use of ADA along with L/N ratio than ADA alone for diagnosing tuberculous Pleural effusion. Conclusions: The combined use of ADA along with L/N ratio would provide a more efficient means for diagnosing tuberculous Pleural effusion than the use of ADA alone.

12-18

Authors: M. Arivumani

Introduction: Peripheral vascular disease (PVD) is one of the significant Macro vascular complications of type 2 diabetes mellitus. Peripheral vascular disease assumes importance, for prevention of morbidity and mortality related to diabetic foot. PVD is the single most important factor which raises the incidence of leg amputation risk in type 2 DM patients. While peripheral neuropathy alone leads to, trophic ulcer which has a chronic indolent course provided super added infection is prevented and controlled, the presence of PVD leads to the ischemic foot which leads to rapid spread of infection. The aim of the study: To investigate the prevalence of PVD among type 2 diabetes patients, to assess the risk factors associated with the development of pvd.to correlate the prevalence of cardiovascular risk factors and vascular complications of type 2 diabetes patients. Materials and Methods: Cross sectional observational analytical study was conducted. Patients were interviewed with a special note on elicitation of history regarding symptoms of PVD, in the form of intermittent claudication, Ischemic rest pain, history of foot ulcers in the past and present. Smoking was recorded in pack-years of cigarettes smoked. Duration of diabetes since diagnosis was recorded and they were grouped accordingly. The anthropometric measurements were recorded and the body-mass index was calculated. Waist-hip ratio was also recorded. The blood pressure was recorded in both the upper limbs and both the lower legs using the standard B.P cuff. An comprehensive physical examination was done and findings recorded. Special importance was given to foot examination. Peripheral neuropathy assessment was done using Simmel-Weiss monofilament testing and timed vibration sense perception recordings. Symptoms of peripheral neuropathy were also noted. Results: The duration of diabetes ranged from newly detected to 28 years, with a mean duration of 8.2 years + 6.24 S.D. For patients affected with PVD, the duration of diabetes was found to be longer than others. The mean FPG for the PVD sub group is 173.6mg % + 34.9 SD, while for the other subjects the mean FPG is 151.8 mg % + 36.3 SD and the difference was statistically significant. (P = 0.006). Among the hypertensive diabetic subjects (n=57), 26.3% had peripheral vascular disease and the prevalence of PVD among normotensive diabetes subjects (n = 55) was 9.1% (P = 0.0329). Smokers among Hypertensive Diabetic males had 58.3% prevalence of PVD (ABI < 1) compared to 14.3% among non – smoking Hypertensive Diabetic males. Difference in the lipid parameters above was all statistically significant. This shows that individuals with a triad of increased LDL – cholesterol, lower HDL – cholesterol (Higher LDL / HDL ratio) and increased triglycerides were more at higher risk for peripheral vascular disease. Conclusion: As the duration of diabetes increased, the risk of PVD increased. There was relatively poor glycemic control in the PVD sub-set. Hypertension, when associated with Type2 Diabetes raised the risk of PVD nearly threefold. The duration of Hypertension also significantly correlated with the risk of PVD.

25-31

Authors: G. Indumathi

Introduction: Tobacco use has long been known to be a major risk factor for cardiovascular disease. Recent studies have identified a positive association between smoking and incidence of diabetes. The evidence that smoking is an independent risk factor for the development of diabetes is still considered preliminary. Some studies have shown a dose response association between smoking and incidence of diabetes. Aim of The Study: To assess whether smokers are more likely than non-smokers to develop clinically relevant glucose intolerance or diabetes and to assess whether total pack years’ correlates with the severity of glucose intolerance/ diabetes. Materials and Methods: We have evaluated Hundred smokers and FIFTY nonsmokers Baseline characteristics of the study were as follows; age, sex, occupation, Education status, family history of diabetes, comorbid illness of smoking. Our Baseline examination included Ht, Wt, BMI, BP, HC, WC, Waist Hip ratio (anthropometric measurements), Lab investigation – Blood sugar (F and PP) and Lipid profile. Participants were defined as current smokers and former smokers. Former smoker were those who, at baseline, reported previously using cigarettes but denied current smoking. Results: Nearly 5% of the case population were obese. Among the control population, obesity accounted for 2% of them. There was a significant statistical difference between cases and controls with respect to BMI (‘p’ = 0.0116). With regard to Blood Pressure, there was no significant statistical difference between cases and controls (‘p’ = 0.4989). Glucose Intolerance among case population were found to be 29% and among the control population, found to be 22%. Thus there was no significant statistical difference between cases and controls (‘p’ = 0.4727). 53 cases of the study group (53%) had high Triglyceride. 46% of the control group had high TG. Thus, there was no significant statistical association between study and control group (p =0.52) 13 cases of the study group (13%) had low HDL. 14% of the control group also had low HDL. Thus there was no significant statistical association between study and control group (p = 0.93). 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. 10% of the case population had metabolic syndrome and 6% of the control population had the same. There was no significant statistical association. Conclusion: Smoking stimulate symathetic system, which inturnleads to anelevated catecholamine levels and there by insulin resistence.Smoking influences visceral adipose tissue and there by insulin resistance.Smokers(especially heavy smokers) are prone for unhealthy food habits and low physical activity which in turn leads to visceral fat accumulation and insulin resistance.

36-42

Authors: G. Ranjani

Introduction: Infection is a leading cause of hospitalization among diabetic patients. Diabetes is associated with increased risk of developing infection increased severity of infection and prolonged hospital stay. Urinary tract infection, respiratory tract infection and soft tissue infection are common infections with increased incidence of diabetes. Altered host defenses, vascular abnormalities, frequent hospital admissions are responsible for increased incidence. Aim of the study: To find out the prevalence of Asymptomatic Bacteriuria in type 2 diabetic women, to analyze the spectrum of organisms responsible for Asymptomatic Bacteriuria in this group and its antimicrobial sensitivity pattern. Materials and methods: There was 164 participants in the study group and 56 non-diabetic women in the control group GROUP-I: Women with type 2 diabetes were recruited randomly from the Female patients of General Medicine OPD and Diabetic OPD, Government Dharmapuri Medical College Hospital, Dharmapuri. GROUP-II: Women without diabetes were selected randomly from the general population. They were relatives and friends of inpatients admitted in general medical ward. The following laboratory data were included: fasting plasma glucose, blood urea, serum creatinine, albuminuria, glycosuria, and leucocyturia. These patients were evaluated for microvascular and macrovascular complications of diabetes. Results: Overall the prevalence of ASB was 22.56% in the study group and 5.36% in control group. Conclusion: Asymptomatic bacteriuria was significantly more among diabetics with nephropathy. Simple bedside method to screen asymptomatic bacteriuria is leucocyturia and it has a positive predictability (72.7%) to detect bacterial isolates. Among asymptomatic bacteriuria, gram-negative isolates were greater than gram-positive ones Isolates were resistant to most of the commonly used antimicrobials (Ciprofloxacin, Ofloxacin, Gentamicin, and Cefotaxime) in clinical practice.

47-53

Authors: G. Ranjani

Introduction: Hypertension remains the leading cause of death worldwide and one of the world's great public health problems (WHO). Affecting 1 billion people worldwide, systemic hypertension remains the most common, readily identifiable and reversible risk factor for myocardial infarction, stroke, heart failure, atrial fibrillation, aortic dissection and peripheral arterial disease. In this study, total serum calcium levels and corrected serum calcium levels of essential hypertension patients are compared and correlated with matched normotensive controls. Aim of the study: To compare the total and corrected serum calcium levels among patients with newly detected essential hypertension and normotensive controls. Materials and methods: This study was a cross sectional study, with cases and controls enrolling 100 newly detected essential hypertension patients as cases and 50 suitable healthy individuals with normal blood pressure as controls, as per JNC-8 guidelines. Cases were selected from those who visited hypertension clinic and those who were admitted in wards during the study period. Controls were selected from those who attended medical outpatient department for minor ailments and healthy volunteers. Serum calcium and phosphorus levels were estimated using standard levels and the interpretation was done with blood pressure values. Results: Group A was the study group which included 100 newly detected essential hypertensive patients. Group B was the control group which included 50 normotensive individuals. In Group A, 52 (52%) were males and 48 (48%) were females and in Group B, 26 (52%) were males and 24 (48%) were females. There was a negative correlation noted between the total and corrected serum calcium levels as against the systolic blood pressure. There was no correlation noted between the total and corrected serum calcium levels as against the diastolic blood pressure. Conclusion: The total and corrected serum calcium levels were found to be significantly lowered in cases when compared to controls. Also, a significant negative correlation between the calcium levels and systolic blood pressure was noted while there was no correlation noted with the diastolic blood pressure in the cases. This study also noted that there is no significant difference in both the calcium levels with age, sex, BMI, lifestyle, smoking, alcohol, family H/o hypertension in newly detected essential hypertensive patients.

59-66

Authors: Meena M, Mantan K, Saxena M, Dhawan S, Sethia S, Meena A

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.

75-81

Authors: Cervical Lymphadenopathy, FNAC, Tuberculosis, Malignancy, Lymphoma.

Background: Swellings of thyroid are frequently encountered in surgical practice. With clinical evaluation it is difficult to distinguish early malignant lesions from common benign goiters. Surgical excision is the only means by which a definitive diagnosis is obtained based on HPE. An alternative approach is called for other than surgery as most cases are benign. FNAC is a simpler and safer procedure carried out in the OPD with minimal equipment and has good patient compliance. The present study aims at correlating the cytological diagnosis with the final histological diagnosis to evaluate the sensitivity, specificity and accuracy of FNAC smears, thereby its role in preoperative diagnosis in planning proper management. Aim: To determine the accuracy and the role of fine needle aspiration cytology (FNAC) as a diagnostic modality in the diagnosis and treatment of thyroid diseases. Materials and methods: A proforma was drafted for the study of all patients presenting with history of palpable thyroid swelling and undergo surgery in our hospital. Clinical presentations, FNAC and histopathology of all cases were documented. Results: 100 cases who presented with thyroid swellings were studied and their histopathological diagnosis was compared with the FNAC. Of the 86 cases which were seen benign by FNAC, 82 were confirmed by histopathology. Of the 18 cases which were proved to be malignant by histopathology 14 were only seen as malignant by FNAC. The sensitivity of FNAC in the diagnosis of benign lesions was found to be 77.78%, specificity was 100%, positive predictive value 100% and accuracy is 96%. Conclusion: Most of our patients were between third and fourth decade, with females being predominant. Most cases were benign of which multinodular goiter being the most dominant pathology (25%). Among the malignancies, majority being papillary carcinoma (78.94%). The sensitivity, specificity and predictive value of positive smears being 77.78%, 100%, and 100% respectively. FNAC was of greater help in the preoperative management of thyroid swellings. Multinodular goiters and colloid goiters were distinguished easily by FNAC but confusion prevailed in cases of follicular adenomas. In patients who cannot be followed up regularly clinical suspicion should be one of the indications for surgery despite of FNAC being negative. FNAC is simpler, safer, quicker and more informative, when compared with other sophisticated methods in the diagnosis of thyroid lesions.

91-97

Authors: C. Arun Babu, Somanatha Sharma, Gnana Sezhian

Context: Hernia is defined as an abnormal protrusion of viscus through normal openings in the body. The lowness of pubic tubercle is associated with narrow origin of internal oblique muscle from lateral inguinal ligament which fails to protect the deep inguinal ring. The structural anatomy is altered i.e. the obliquity of the inguinal canal gets decreased, arching of conjoint tendon gets narrowed, and the shutter mechanism of internal oblique gets diminished leading on to the ineffective defence mechanism ending up in the development of inguinal hernia. Aim: To find out the prevalence of inguinal hernia in low lying pubic tubercle at our tertiary hospital setup. Materials and methods: The ST and SS Line measurements of the case were compared with those of controls to find out whether there was tendency of having low lying pubic tubercle in case of inguinal hernia. An attempt was also made to observe any correlation between ST segment and height, weight of the patients. The quantitative variables were summarized as mean and standard deviation while qualitative variables as percentage and proportion. To the statistical significance between the two independent two groups student ‘t’ test while in more than two groups ANOVA (one way) was applied and to show correlation Pearson’s correlation applied. The difference was considered significant when p value was less than 0.05. The statistical package used was SPSS 23. Results: This study showed that the people with low lying pubic tubercle have a reduction in efficiency of shutter mechanism of inguinal canal leading to the development of inguinal hernia. Conclusion: Group of people with low lying pubic tubercle are at high risk of developing inguinal hernia.

105-109

Authors: P.S. Ganesh Babu, T.M Balakirshnan, Ramadevi

Introduction: Tracheo Oesophageal Fistula (TEF) is a major cause of morbidity and mortality necessitating complex clinical evaluation and decision making for optimal management. It is best treated in a specialty tertiary care setting by a multidisciplinary team approach. In acquired non-malignant causes of airway-oesophageal fistulas, the patients suffer from significant morbidity due to recurrent pulmonary sepsis. These diseases are complex and mandate critical preoperative evaluation for optimal management. Prolonged endotracheal intubation combined with a nasogastric tube may lead to a TEF. This results from pressure necrosis generated by a ventilating cuff in the trachea and a prolonged feeding tube in the esophagus. Aim of the study: To study the results of function preserving pedicled perforator based sternocleidomastoid muscle as an inter position flap after primary repair of cervical trachea-oesophageal fistula. Materials and methods: The study was conducted from the period of one year from 2015-2016 at IRRH and Plastic Surgery Department of Government Stanley Medical College, Chennai. Totally 15 patients were included in the study. Patients with clinical presentation were evaluated, a pre operative investigation like Bronchoscopy, OGD MRI, CECT of the neck was taken. All patients with tracheal oesophageal fistula in the cervical region following corrosive poisoning (organophosphates) on prolonged intubation who under went closure with the pedicled sternocleidomastoid muscle as an interposition flap. Results: All patients diagnosed with Tracheo oesophageal fistula following corrosive poisoning on prolonged intubation were included. (N = 15). The study period was from 2015 to 2016. Patient’s demographic data and clinical course were closely monitored and recorded. All Patients recovered well. Oral feeding started (liquids) on 4th post-operative day after doing gastro Graffin study, and solids on the 10th day. No recurrence in 1 year follows up. Conclusion: In our technique, we maintained the intramuscular cock screw perforators from the transverse cervical artery. This constant anatomy favored us to use sternal head component separate from the clavicular head and interposed them between the repaired trachea and esophagus. Preserving the clavicular head of SCM maintains the form and function of the muscle. The vascularized muscle flap prevents both tracheal and oesophageal strictures and stenosis.

119-124

Authors: Mohammed Abdul Azhar

Introduction: Mandibular swelling are common entity in dental and general surgery practice requiring prompt intervention, imaging techniques such as plain radiography and especially multi-detector computed tomography (MDCT) which offer the potential to improve the outcome buy increasing the accuracy of diagnosis. Materials and methods: In the present study, 30 patients with clinically diagnosed mandibular swelling were evaluated with conventional radiography; MDCT and HPE wherever performed to establish the value of MDCT and to evaluate the role of MDCT in establishing the diagnosis. Results: In the present study, majority of the cases were in the age group of 21-30 years with an male: female ratio of 1:1.5. Most commonly found lesions were odontogenic lesions (27 out of 30 cases) accounting about 90% of all the mandibular swellings. Among the odontogenic lesions ameloblastomas was the most common diagnosis followed by odontogenic keratocyst constituting 48%and 29% respectively in the present study, unilocular ameloblastoma were more common than multiocular ameloblastomas i.e. 7 out 13 cases (53.85%) among non-odontogenic lesions, central ossifying fibroma was the common diagnosis i.e. 2 out of 3 cases (67%) in the present study, being lesions were common than malignant i.e. 28 out of 30 cases (93.3%) and 2 out of 30 cases (06.66%) were malignant. Conclusions: MDCT provided excellent visualization and delineation of mandibular anatomy when compared to plain radiography. MDCT images ideal for pre-operative evaluation as they provide thin sections (

133-135

Authors: Singh Y, Pasha A, Suhail Bin Ahmed

Background: The prevalence of thyroid dysfunctions is encountered high in known diabetic patients. It is quiet commonly understood that patients who has one autoimmune problem generally tends to develop another. Materials and methods: Three hundred twenty known diabetic patients who attended the Department of Internal Medicine were taken up for the study. This study was done in the Department of Internal Medicine, Deccan Medical College, Hyderabad. Results: Both hypothyroidism and hyperthyroidism was significantly seen in known diabetics. Conclusion: Hypothyroidism was the most common kind of thyroid disorder encountered in our study.

145-155

Authors: Naveen Kumar S, Vidyadhara Rani P

Background: Thyroid ultrasound has undergone a dramatic transformation from the cryptic deflections on an oscilloscope produced in A-mode scanning, to barely recognizable B-mode images, followed by initial low resolution gray scale, and now modern high resolution images. Aim: The aim of the present study was to evaluate the diagnostic role of ultrasonography (USG) and multi-detector computed tomography (MDCT) in thyroid swellings, compare the ultrasonographic findings with multi-detector computed tomographic findings and to correlate the radiological findings with histopathological examination (HPE). Materials and methods: The present study was carried out in the Department of Radiology, Kamineni Institute of Medical Sciences, Narketpally. In this study, 50 patients with thyroid gland swellings diagnosed clinically, referred to Radiology Department were selected during the period from October 2008 to September 2010. Histopathological examination was acquired in 35 cases. The study was carried out to observe the sensitivity, specificity and diagnostic accuracy of USG and MDCT in thyroid gland swellings. Results: Maximum number of patients belonged to the age group of 21-40 years that was 27 cases (54.00%) and maximum number of patients were females – 41 cases (82.00%). Most common diagnosis was multi-nodular goitre on USG-16 cases (32.00%) and MDCT- 14 cases (28.00%), solitary thyroid nodule is common in the right lobe of thyroid by USG -5 cases (62.50%) and MDCT-5 cases (62.50%). Most common malignancy was papillary carcinoma of thyroid -5 cases (62.50%) and most common inflammatory disorder was hashimoto’s thyroiditis -5 cases (10.00%). Conclusion: The present study has concluded that USG is the fast and cost-effective modality of imaging investigation of choice in thyroid diseases and for differential diagnosis of thyroid nodules. MDCT is superior to ultrasound in evaluating retrosternal extension, relations and infiltrations in large lesions. It is also very helpful in evaluating extra-capsular, mediastinal, vascular invasion, lymph nodal involvement and metastasis. MDCT is very crucial in preoperative planning in malignancies of thyroid and large benign lesions.

164-170

Authors: G. Elango, C. Ramesh, D.D. Venkataraman

Background: Chronic kidney disease (CKD) is emerging as a major public health problem in India. The links between CKD and Tuberculosis have long been established but the exact nature of interaction is poorly understood. Bulk of the association was studied on subjects undergoing dialysis or renal transplantation, with limited studies on CKD subjects without dialysis. The amount of data is further scarce on Indian population. Hence the present study was conducted to assess the prevalence and profile of pulmonary tuberculosis in CKD patients presenting to a tertiary care teaching hospital in south India Materials and methods: The present study was a prospective study of all the CKD patients presenting to a tertiary care teaching hospital in south India diagnosed with chronic renal failure, as per the hospital protocol. The data was collected from the prospective case records of all the CKD patients diagnosed between April 2015 to 2017. Results: There were a total of 2927 patients with CKD, who satisfied the inclusion criteria and were included in the study. The average prevalence of tuberculosis among the study population was 1.16%. The age distribution of the tuberculosis cases have shown that highest proportion of subjects (47.05%) was aged above 60 years. There was a high male preponderance in study population, as 88.23% affected by tuberculosis were males and 11.77% were females. The most common x-ray finding was infiltration seen in 12 (35.29%) of the patients with TB. Cavities were present in 14 (41.17%) subjects- fibrosis was seen in 4 (11.76%) subjects. There was no statistically significant difference in blood urea nitrogen (BUN) or serum creatinine values between the two groups (P value > 0.05) Conclusion: Chronic Kidney disease patients are at high risk of tuberculosis, as the prevalence in CKD patients is higher than that of general population. Considering the alterations in the immune system, the immunological response of the host to tuberculosis infection is altered in CKD patients- this makes routine investigations like sputum examination and manteaux test less reliable in CKD patients. Chest-X-ray may be more useful in these patients.

178-186

Authors: Dharani Sudha G, Nirmala P, Ramanathan R, Sylvia S

Back ground: Impetigo is the most common bacterial infection in children. This acute, highly contagious infection of the superficial layers of the epidermis is primarily caused by Staphylococcus aureus or Streptococcus Pyogenes. The Objective of this study is to find out the role of probiotic among children suffering from impetigo. Materials and methods: This was a prospective, randomized, single-blinded interventional study, conducted in Paediatric OPD, Dermatology OPD and Paediatric Ward in Rajah Muthiah Medical College and Hospital for a period of 6 months. A total of 50 patients were enrolled in the study as per the inclusion criteria. They were treated with probiotic (50 million spores of Lactobacillus sporegenes, Streptococcus faecalis 30 million spores, Clostridium butyricum 2 million spores, Bacillus mesentericus 1 million spores) twice daily for 5 days. As a conventional treatment, Azithromycin 10 mg/kg/day once a day for 5 days given along with probiotic. Microbiological examination of pus from the first swab was used to prepare smears and was stained by Gram’s method. The pus from the second swab was inoculated on blood agar and Mc Conkey’s agar. Results: Bacteriological response and the clinical response were highly significant from baseline to the fifth day of treatment with probiotic along with azithromycin. Conclusion: The result of our study explores a new possibility in the horizon of treatment of impetigo. Since the adverse effects caused by probiotic are minimal and tolerable, it could be further exploited for the treatment of other inflammatory or immune conditions that are refractory to treatment with current chemotherapeutic agents.

191-194

Authors: Arun Prasath R, Krishnapriya R, R. Srinivasan

Pulmonary siderosis or Welder’s lung is a rare occupational lung disease which occurs due to long term inhalation of iron compounds. It is most commonly seen in arc-welders. Most of the patients are asymptomatic with mild or no functional impairment. We report a case of pulmonary siderosis with symptomatic respiratory disease and restrictive pattern in pulmonary function test.

1-11

Authors: Sujatha Audimulapu, M. Sudeepti

Background: AUB is a common gynecological complaint and it may involve females at any age group. 33% of women referred to gynaecology clinics have AUB and the figure rises to 69% in premenopausal and postmenopausal women. Aim: To compare the diagnostic efficacy of transvaginal ultrasonography and hysteroscopy in detecting uterine abnormalities in abnormal uterine bleeding by correlating the results with histopathological examination. Materials and methods: This was a prospective and comparative study which was conducted in Modern Government Maternity Hospital, Petlaburz, Osmania Medical College, and Hyderabad and it was conducted from November 2013 to July 2015. This study had 50 patients with AUB. Inclusion criteria: Women with abnormal uterine bleeding such as Heavy menstrual bleeding, intermenstrual bleeding, irregular and heavy bleeding, Regular, frequent and Heavy bleeding , postmenopausal bleeding , continuous bleeding , related to uterine causes. Exclusion criteria: Pelvic infection, Pregnancy, drug intake that can lead to vaginal bleeding (anticoagulants, hormonal replacement therapy, hormonal contraceptives), vaginal, vulval or cervical causes of bleeding. Informed consent was taken for all the patients, subjected to the study. Results: In the study, diagnostic hysteroscopy, transvaginal ultrasonography and hysteroscopy were done in 50 cases of abnormal uterine bleeding. Mean age of the patients enrolled in the study was 44.5±5.36 years. Most common bleeding pattern observed was Heavy flow with regular cycles (Menorrhagia) which was observed in 42% of the patients followed by Heavy flow with irregular cycles (Menometrorrhagia) which was observed in 26% of the patients in the study. With respect to parity of subjects, maximum incidence of abnormal uterine bleeding was seen in the parity of 2 (36%) followed by parity 3 (32%). Majority of patients came with 1-6 months duration of bleeding of AUB. Most common histopathology finding is Proliferative endometrium. Out of 50 cases, 38 cases (76%) of Hysteroscopy findings correlated with Histopathology and discrepancy in findings was noted in 12 cases (24%). In 26 cases (52%), TVS findings correlated with histopathology findings, and the results differed in 24 patients (48%). Sensitivity and specificity for Transvaginal ultrasonography is 62.8% and 86.6% in comparison with Sensitivity and Specificity of Hysteroscopy which is 74.3 % and 93.3 % respectively. Positive predictive value is 96.3 % and Negative Predictive value is 60.8% for hysteroscopy. Whereas, for Transvaginal ultrasonography, Positive predictive value is 91.6% and Negative Predictive Value is 50%. According to these findings, Hysteroscopy is superior to transvaginal ultrasonography in evaluating abnormal uterine bleeding because of higher sensitivity, specificity, positive predictive value, negative predictive value. Transvaginal ultrasonography is non-invasive, relatively cheap, causes minimal discomfort to the patient and can be used as the initial modality in patients with abnormal uterine bleeding. However, it has inferior diagnostic value when compared to hysteroscopy. Conclusion: In conclusion, although Transvaginal ultrasonography represents a practical approach for the initial evaluation of uterine pathologies, a hysteroscopy examination would be necessary in most of the suspicious cases. Hysteroscopy remains the best option for the assessment of AUB owing to its diagnostic performance when compared to Transvaginal ultrasonography. It allows direct visualization of the cavity and also sampling for histopathological examination.

20-32

Authors: T. Sundari Devi, Rajyalakshmi, S. Srujana, K.R.K. Prasad, O. Shravan Kumar

Background: Vaginal cytology is an efficient inexpensive and a rapid method for identifying diseases including establishing the hormonal condition of the patient. The Evaluation of the endocrinologic status of the female patient by means of the study of vaginal cells is actually one of the earliest diagnostic applications of clinical cytology. Though the vaginal cytologic characteristics of gynecologic patients have been studied throughout the world this subjected has received little attention. Vaginal cytology is useful for assessing ovarian function from puberty throughout the reproductive years, menopause and senium. Also it is used to estimate time of ovulation, to determine ovarian dysfunction, to assess placental function or dysfunction in obstetrics, to assist in selecting hormonal therapy and to follow hormonal treatment results. Aim and objectives: To ascertain the effective utilization of cost effective test of vaginal hormonal cytology as a supplement for costly biochemical hormonal estimation. A prospective study was undertaken with the following objectives: To study the normal hormonal patterns in females of different age groups and to study abnormal hormonal patterns in high risk pregnancies and in different clinical situations. Materials and methods: A prospective, hospital based study was done on vaginal smears obtained from One hundred and Sixty (160) patients, attending Gynecology and Obstetrics Out-patient department and few In-patients at Gandhi hospital, Secunderabad during the period of August 2004 to October 2006. The study group included randomly selected female patients of reproductive age groups (18 years to 35 years.);.with normal menstrual cycles; normal perimenopausal (36 years to 45 years.) and postmenopausal (above 45 years.) women, pregnant patients in the 1st, 2nd, 3rd trimesters and 1st stage of labour as well as post partum patients. The study group also included patients with primary infertility, menorrhagia, secondary oligomenorrhoea (scanty menstruation), threatened abortions, inevitable abortions, pre mature rupture of membranes, post maturity and patients with neoplastic lesion i.e. ovarian tumor. The material collected for the vaginal smear dried very rapidly during collection. Hence fixation was done within 30 sec. of spreading. The fixatives used were – 95% Ethanol or 80% Isopropyl Alcohol. Other fixatives used were ether / 95% alcohols; 100% methanol; Rapid fixative as cytospray; 2 to 10% carbowax in 95% ethanol (for mailing unstained smears). The stains used were Papanicolaou’s stain and Giemsa stain. Results: Vaginal hormonal cytology is a useful diagnostic aid in the female reproductive process. It may also provide a key to more effective conception control, as well as improvement in the treatment of menstrual disorders, anovulation, and other underlying disorders. In the present Indian scenario with lack of adequate clinical history available to the pathologist, in a rural setup as well the urban conditions; vaginal hormonal study is still a low cost diagnostic and prognostic test procedure. Hence the present study emphasizes the utility of vaginal smear study even today compared to the costly biochemical parameters available in the market which is a financial burden to poor patients. Conclusion: Vaginal smear collected between 4-11 days and 12-16 days of the normal menstrual cycle showed scattered intermediate and superficial cells. Vaginal smears collected between 17-28 days of normal menstrual cycle showed, predominately intermediate cells with folding and crowding. The KPI peak is between 12-16 days. This is extreme midzone shift, with clusters of navicular cells in all the three trimesters, of pregnancy. First stage of labour could be suspected with identification of increase in the number of superficial cells, with marked decrease in the intermediate cell values.

41-48

Authors: Karla Ravi, Nandigama Pratap Kumar, Savarapu Sai Kalyan

Background: Spondylolisthesis is defined as a displacement of one vertebra over the next lower vertebra in the sagittal plane. High-grade spondylolisthesis (HGS) is defined as greater than 50% slippage of a spinal vertebral body relative to an adjacent vertebral body as per Meyerding classification, and most common location being L5/S1 followed by L4/L5. The treatment of symptomatic high grade lumbo sacral spondylolisthesis has its own technical difficulties for surgical stabilization and fusion unlike low grade listhesis. We used single transvertebral fibular graft and implant stabilization to the vertebra one level above the pathological vertebra via posterior approach to treat the high grade spondylolisthesis of lumbo sacral spine. Materials and methods: Prospective study done from January 2012 to January 2016 for the management of High grade spondylolisthesis (Grade 3 and Grade 4), patient aged between 15-60 years. Total 15 patients were included in the study. High grade listhesis patients who were not willing for surgery were excluded from the study. All the patients were operated posteriorly with pedicle screw and rod stabilization with trans vertebral single fibular graft with posterolateral fusion was done under fluoroscopic guidance Results: Preoperative and post-operative status was analyzed in reference to the clinical symptoms and radiological evaluation. All the patients showed improvement following surgery without any implant failure. Conclusion: This procedure is technically simple, safe and effective method to treat high grade listhesis with no additional peri operative or postoperative complications.

64-67

Authors: Laxman Kumar, Prabhat Kumar Lal, Dhirendra Kumar, Jitendra Kumar, Sunil Kumar

Open defecation has many health hazards. Still, it is rampant in different parts of the country. The present study was conducted to find the prevalence of open defecation and factors associated with this behaviour among residents of rural area of Nalanda District. Open defecation was practiced by 35% of rural population. It was significantly associated with age (p=0.02), sex (p=0.01), education (p=0.00) and occupation (p=0.00). Association with caste (p=0.23), type of family (p=0.63) and type of housing (p=0.053) was not significant. Open defecation has strong roots in our culture and access/ availability of toilets poses many challenges.

72-76

Authors: Deepa Kalikavil Puthenveedu, Sundaraj Ravindran

Background: Diabetes mellitus is a major independent risk factor for cardiovascular disease (CVD). Excess abdominal fat, assessed by measurement of waist to hip ratio, is independently associated with a higher risk for cardiovascular disease. Aim and objectives: To study the fasting and post prandial lipid levels in patients with type 2 diabetes mellitus and to assess the significance of post prandial dyslipidemia with respect to fasting dyslipidemia as cardiovascular risk factor in these patients. Materials and methods: The study was conducted on 100 patients from General Medicine ward and Diabetology OPD of Government Rajaji Hospital, Madurai, and 100 age and sex matched healthy subjects as controls during the period of March 2016 To August 2016. Subjects believed to fulfil all eligibility criteria, and none of the exclusion criteria were included in the study. A predesigned proforma was used to collect the demographic and clinical details of the patients and the controls. By Clinical examination abdominal obesity was measured by waist hip ratio WHR>.90 in men and WHR>.80 in women were taken as having significant cardiovascular risk. Laboratory investigations fasting Blood Sugar, 2hr Post Prandial Blood sugar, fasting lipid profile and 6 hours post prandial were done. Comparison of various parameters were done and significance assessed by Student t test. One way ANOVA, Pearson Correlation and Chi square test and P value of < 0.05 was taken as significant. Results: Among the 100 cases of Type 2 Diabetes mellitus, by taking value of WHR 0.90 for males and 0.8 for females, the cardiovascular risk was assessed. 96 had cardiovascular risk (50 male, 46 females). By comparing with the standard reference values of the lipid profile out of the 100 diabetic subjects 53 had fasting dyslipidemia (29 males, 24 females) and 64 had post prandial dyslipidemia (23 males , 41 females). We observed a significant increase in both fasting as well as postprandial blood glucose levels in the Type 2 Diabetic subjects, as compared to those of their respective controls. Also, the postprandial blood glucose level was significantly increased as compared to that in the fasting state in the Type 2 Diabetic subjects but the HDL-cholesterol level was not significantly decreased in fasting as well as postprandial state in the Type 2 DM patients as compared to that of control subjects in our study. Conclusion: Persistent postprandial hypertriglyceridemia may result in a proatherogenic environment leading to atherosclerosis and macrovascular disease in type 2 diabetes subjects. LDL oxidation in the postprandial state seems to be affected by an acute increase in glycemia. Thus, oxidative modification of LDL may contribute to higher CVD risk among diabetic patients, and elevated levels of TG may contribute to the rapid LDL oxidation seen in Type 2 DM. Hence, it is important and beneficial to estimate the postprandial lipid profile, in addition to the fasting lipid profile, in the cardiovascular risk assessment in the patients with Type 2 DM.

81-86

Authors: Ganganesamy, S. Dharmarajan

Background: Gallstones, complex biomineralized deposits formed in the gallbladder, are still a major health problem all over the world. Cholelithiasis is common with the incidence ranging from 10% to 20% of the world population. Over the past two decades, a great deal has been learned about the epidemiology of and risk factors for gallstones. Ultrasonography has played a major role in this process, providing a rapid, risk-free method of screening large populations. Prior to the availability of ultrasound, most studies relied on highly selective autopsy data and limited oral cholecystography. Aim and objectives: To determine the Biochemical analysis of Gall stones and to study the clinical spectrum of acute cholecystitis. Materials and methods: About 50 consecutive cases were admitted, examined, investigated and diagnosed as calculus cholecystitis during the period of January 2016 to September 2016 are selected and detailed history of all the 50 cases were taken according to the proforma. Information regarding the age, nature of the symptoms, and duration of the symptoms, diet history, and history of OCP intake, Alcohol ingestion, and diabetes were obtained. All patients’ undergone detailed examination underwent investigations. Results: All cases fall between 22 and 75 years. There is an increased incidence in the 5th and 6th decade with the maximum incidence in the 5th decade. Pain abdomen was the most common presenting symptom in our study seen in 49 (98%) of the cases followed by fever in 17 (34%) cases. Dyspepsia was seen in 12 (24%) cases, 7 cases (14%) each presented with nausea/vomiting or jaundice. Among the ultrasonographic findings of cholelithiasis most common finding was thickened gall bladder wall seen in 40 cases (80%) Ultra sonogram revealed 76% (38 cases) had multiple stones and 24% (12) has solitary stone. Mass was seen in 5 cases (10%).Of the total 50 cases with cholelithiasis 38 patients (76%) had mixed stones, followed by pigment stones in 8 cases (16%) followed by cholesterol stones in remaining 4 cases (8%). Majority of the patients were in the age group 41-50 (32%) followed by the 51-60 age group (24%). Conclusion: Majority of patients underwent Laparoscopic cholecystectomy (86%) with reduced number of stay in the hospital, pain and disability as compared to open cholecystectomy. The commonest type of stone was mixed stone. Most of the gallstones were associated with grade 1 cholecystitis (78%), Grade 2 cholecystitis was seen in 20% of our study patients, Grade 3 was seen in 2% of our study patients.

91-95

Authors: P. Gunasekaran

Background: The common cause of skin infections are dermatophytes and opportunistic fungi. Aim of this study was to isolate and identify the fungal agents from clinical samples from patients with different mycoses. Superficial mycoses are among the most frequent forms of human infections, affecting more than 20–25% of the world’ population. They are predominantly caused by a group of closely related keratinophilic mycelia fungi (dermato-phytes) in the genera of Trichophyton, Microsporum, and Epidermophyton. These groups of fungi invade the stratum corneum of the skin or other keratinized tissues derived from the epidermis such as hair and nails. Aim and objectives: The present work aims at evaluation of rate of incidences of dermatophytic infections (group wise), and etiological agents with associated symptoms. In addition, we also determine to test the sensitivity of present diagnostic procedures. Materials and methods: Samples were collected from 100 patients. A portion of each sample was examined microscopically and the remaining portion of each sample was cultured onto plates of Sabouraud’s dextrose agar containing chloramphenicol with and without cycloheximide. Dermatophyte isolates were identified by studying macroscopic and microscopic characteristics of their colonies .Preliminary identification was done by conventional methods and confirmed by Polymerase Chain Reaction – Restriction Fragment length Polymorphism (PCR -RFLP) technique. Results: All over 62/100 specimens were KOH positive and 48/62 (82.7%) samples were culture positive. Of these, highest isolation rate was obtained in opportunistic mycoses such as candidiasis (29/29, 100%). Dermatophytes were isolated in 41/62 (66.3%) specimens and Trichophyton rubrum was the commonest isolate in skin samples (44/62) among the patients suffering from dermatophytosis. Phaeoannellomyces Wernicke was isolated in a patient suffering from tinea nigra. The study signifies the importance of mycological examination in the diagnosis of various mycoses for their effective management. Conclusion: Dermatophytoses are distributed worldwide with increased incidence especially in a tropical country like India. Several factors such as age, sex, illiteracy, poor hygiene and social economy influence the dermatophyte infection. In the present study we have attempted to understand the epidemological status of the dermatophytes in a tertiary care centre in Cuddalore, Tamil Nadu, India. Tinea corporis was the predominant clinical site from which dermatophytes were isolated. T. Rubrum and T. Mentagrophytes have been the major etiological agents and that has been evinced by our study.

103-107

Authors: N. Sreemani Kumari, Madhavi Parigi, Seema Afroze

Background: Rhinosporidiosis is a chronic granulomatous disease caused by Rhinosporidium seeberi which was once believed to be a sporozoan and then was included in phycomycetes, and now included under Mesomycetozoa. It is one of the common tropical diseases, most commonly affecting the mucosa of upper respiratory tract, chiefly the nose and nasopharynx. Other sites such as conjunctiva, lacrimal glands and subcutaneous tissue may also get infected. It presents as polypoidal mass. Aim and objective: To study incidence, age and gender distribution and clinicopathological features of Rhinosporidiosis. Materials and methods: A retrospective study of 20 cases was undertaken over a period of 5 years (July 2012 to June 2017) in the Department of Pathology, Government ENT Hospital, Hyderabad. The resected tissue specimens were subjected to routine processing, cutting; staining and histopathological features were studied with Hematoxylin and Eosin stain. Results: Nasal cavity was most commonly involved site, excepting in one case, where sub-glottis was involved. Males were predominantly affected i.e. 17 (85%) cases, whereas 3 (15%) cases were reported in females. Age range was between 8-70 years. (Both of them were males). Conclusion: Rhinosporidiosis most commonly presents as polypoidal mass in the nasal cavity and may also present at extra-nasal sites. Histopathology is the standard method for confirmation of diagnosis.

116-120

Authors: V. Sivagangailakshmi, D. Rajkumar

Introduction: Cigarette smoking is one of the major causes of cancer and cardiovascular diseases leading to millions of premature deaths each year all over the world. Scientists have identified about 4,000 different substances in tobacco all of which have certain degree of toxic effects. At least 43 of them are known carcinogens. Cigarette smoking is an important and independent risk factor for atherosclerosis, coronary artery disease and peripheral vascular disorders. Apart from active smokers, passive-smokers are also prone for the development of smoking related disorders. Smoking adversely affects the concentration of the coagulation profiles which causes abnormalities in circulation. Aim and objectives: This study aimed to investigate the effects of smoking on coagulation profile in chronic smoking population. Materials and methods: This present study was a case‐control study conducted among 50 smokers (subjects) and 50 non‐smokers (controls) aged 20‐50. Coagulation profile markers such as Prothrombin time (PT), activated partial thromboplastin time (APTT) and fibrinogen levels were estimated with standard methods. Results: The results showed that the mean values of PT and APTT of smokers were significantly prolonged compared to non-smokers (P < 0.05), while platelet and fibrinogen levels were significantly lowered in smokers compared to non-smokers (P < 0.05). PT and APTT were also significantly prolonged with increasing duration of smoking as well as number of cigarettes per day, while there was a relative decrease in platelet and fibrinogen levels with increasing duration and number per day. Conclusion: It was concluded that cigarette smoking alters PT, APTT, platelet and fibrinogen values, while age, duration of smoking and number of cigarettes per day were determinant factors to the extent of coagulation dysfunction in smokers.

126-132

Authors: Singh L, Garg P, Rathore S, Nishant, Singh VP, Lal BB

Background: POAG occurs in elderly, rarely seen earlier than 40 years of age and tends to run in families. Glaucoma is a neurodegenerative disease characterized by the slow, progressive degeneration of retinal ganglion cells. Aim: To study the changes, in retinal nerve fibre layer thickness in primary open angle glaucoma (POAG). Materials and methods: The present cross sectional study was carried out at a tertiary care hospital in North India. 100 patients of primary open angle glaucoma were matched with 100 controls and evaluated with the aim to assess their RNFL thickness and compare with each other. Results: The data distribution analysis of retinal nerve fibre layer thickness in different optic nerve head quadrants in POAG group in relation to overall severity of glaucoma shows that in superior quadrant maximum number of patients in preperimetric group 6 (50%) cases, in mild 9 (45%) cases and in moderate group 25 (44.6%) were in the range 100±10μm. But in severe glaucoma cases majority 7 (58.3%) cases had the RNFL thickness in the range of 60±10 μm. The temporal quadrant RNFL thickness was least in all grades of severity of glaucoma i.e. preperimetric 6 (50%), in mild cases 9 (45%), in moderate 25 (44.6%) cases and in severe 8 (66.7%) cases. Conclusion: Overall RNFL thickness variation, regardless of severity of glaucoma, follow the normal pattern of thickness being thicker in superior and inferior quadrant compared to nasal and temporal quadrant. It was interesting to note that the RNFL thickness in all the quadrants of optic nerve head area continues to become thinner as the severity of glaucoma increases.

139-142

Authors: Chandra A

The current World Health Organization classification of renal epithelial tumours recognises malignant lesions such as, clear cell, papillary, chromophobe and collecting duct renal cell carcinomas (RCCs), and benign entities such as oncocytoma and angiomyolipoma. Chromophobe renal cell carcinoma (RCC) is a rare variety of kidney neoplasm that represents approximately 5% of RCC. As the prognosis of chromophobe RCC depends upon early detection and typing of the RCC, meticulous histopathological examination of nephrectomy specimen is must.

1-7

Authors: Allanki Suneetha Devi, Jalem Anuradha

Background: The most common infections among all age groups are the urinary tract infections, mostly among pregnant women. Aim and Objective: To screen pregnant women for ASB with wet mount, reagent strip test such as UROCOLOR 10, by which both nitrite and leukocyte esterase was detected. Materials and methods: This was a multi-centric study conducted at Government Hospital Nizamabad and CKM hospital, Warnagal. 150 pregnant women in the age group of 18-40 years without any symptoms of UTI were selected. Control group consisted of 75 non pregnant women who had no signs of UTI and who were within the age group of 18-40 years. Informed consent was taken from all the subjects who participated in the study after explaining the study details in the respective mother's tongue. All the pregnant women without signs and symptoms of UTI were included. Results: Out of 150 pregnant women, 128 (85%) were sterile, in 15% (22), pure growth of organisms in significant numbers >105 CFU/ml were obtained. There was no growth contamination in any of the urine samples. Wet film had highest specificity of 95% and least sensitivity of 35%, Leukocyte esterase had high specificity of 92% and low sensitivity of 44%, and nitrite test had highest specificity of 97% and highest positive predictive value of 80%. Conclusion: UTI’s are more common among pregnant women than non-pregnant women. ASB is present in 22% of antenatal women. This can be prevented by earlier diagnosis and proper antimicrobial treatment in women and thus prevent obstetric complications. Culture is the standard test, but it is time consuming and very expensive, none is 100 % sensitive even though many screening tests are available now. Leukocyte esterase and nitrite test are a rapid and inexpensive methods to rule out UTI in women. Wet film can also be used as an alternate screening method.

18-22

Authors: Allanki Suneetha Devi, Jalem Anuradha

Background: Pessary is a medical device inserted into the vagina, either to provide structural support or as a method of delivering medication. For the treatment of urinary incontinence, pelvic organ prolapse, pessaries have been utilized. Aim: The aim of the study was to evaluate the differences in vaginal discharge between postmenopausal women who wear pessaries and those who do not to explain pessary related, bacterial vaginosis vaginal discharge by microscopy, gram staining. Materials and Methods: 150 women were selected for the study and the study was conducted at Government hospital Nizamabad and CKM hospital, Warangal. 75 Women were post-menopausal who had worn Pessaries for at least 4months and were in group A. 75 Women didn’t wear Pessaries and were presenting for pessary fitting. Women who were postmenopausal, women who had worn pessaries for atleast 4 months or had never worn pessary and were presenting for pessary fitting were included. Results: Group A was older and had been for a longer time menopausal when compared to Group B. Years since menopause was higher in group A when compared to group B. Women in group A were more bothered by discharge when compared to group B. Women in group A were more likely to meet amsel’s and nugent’s criteria for bacterial vaginosis. In group A, the WBC’s were greater than 10 per hpf when compared to group B by microscopy. Clue cells were higher in group A when compared to group B. pH also was higher in group A when compared to group B. Conclusion: Bothersome vaginal discharge may be due to vaginal inflammatory process and it develops early and is pessary related.

33-38

Authors: Allanki Suneetha Devi, Jalem Anuradha

Background: Compared to cephalic presentation with respect to fetal morbidity and mortality, breech delivery management was a high risk. Aim: To evaluate the outcome of breech deliveries in nulliparous women. Materials and methods: This was a retrospective study conducted from October 2012 till September 2015 .The study was conducted at Government hospital Nizabmabad and CKM hospital, Warangal. The selection criteria were gestational age ≥ 32 weeks which was validated by ultrasound examination performed before 20 weeks gestation when calculated from last menstrual period, a singleton with breech presentation and normal fetal heart beats in nulliparous women. Adequate pelvis, frank or complete breech, estimated weight of foetus lesser than 3500 grams, no other obstetric complication were the inclusion criteria. Results: During these 3 years survey, 12000 deliveries were done. Out of which, 3000 were nulliparous, and there were 400 cases of breech presentation, and there was an incidence of 3.33%. A total of 250 women met the inclusion criteria and had undergone delivery by VBD or by Caesarean section. There were 120 caesarean deliveries, of which 56 (46.66%) were elective and 64 (53.33%) were emergencies. The main indication for emergency CS was acute foetal distress accounting to 42 (65.63%) cases. The main indication for elective CS was foetal birth weight ≥3500 grams accounting to 25 (44.64%) cases. Out of 130, 15 (11.54%) neonates had poor APGAR score (<7) at the 5th minute of birth. In elective caesarean section, none had poor APGAR score at 5th minute. In emergency, caesarean section, 6 (9.38%) had a poor APGAR score at the 5th minute. Out of the 6 cases, the indication for the emergency caesarean section was acute foetal distress, 2 in 35 years old patients carrying foetus of 3300 grams and 3200 grams, others had cord prolapsed. In APGAR score between the group of elective and emergency caesarean section, there was a statistically significant difference in the mean 5th minute. Conclusion: It can be concluded from this study that in cases of inadequate pelvis, foetal weight ≥3500 grams or ≤1800 grams, footling breech presentation, post term pregnancies, vaginal breech delivery is unsafe.

45-55

Authors: Neerja Sharma, Shafia Sarfi, Avdesh Sharma, Mandeep S Grewal

Background: Cleaning and shaping the root canal is an important phase in endodontic therapy. A prepared root canal should have a shape that flares from apical to coronal regions, maintaining the apical foramen and not changing the original canal curvature. Aim: To compare canal transportation, canal centring ability and remaining dentin thickness, in curved root canals using Twisted Files, PathFiles-ProTaper System, RaCe files, WaveOne reciprocating files and hand NiTi K-files with Cone Beam Computed Tomography. Materials and methods: 125 canals with completely formed apices and angle of curvatures ranging from 10 degrees to 60 degrees were used. The teeth were divided in five experimental groups of 25 each. Instrumentation was performed in Group I with Twisted files, Group II with PathFile-ProTaper, Group III with Hand NiTi files, Group IV with RaCe files and Group V with WaveOne reciprocating files. CBCT images were obtained before and after instrumentation with Kodak CS9300 equipment (CS3D Imaging Software 3.1.9). The amount of canal transportation, centering ability and remaining dentin thickness was calculated at nine levels. Results were analysed using ANOVA test and Post-hoc Bonferroni Multiple Comparison test. Results: Statistically significant difference was noted among the groups at the middle and apical third level with WaveOne files showing the least and hand NiTi files showing the highest transportation. The mean centering ratio was statistically highest with WaveOne and smallest with hand NiTi files at the middle third level. At the apical level (p < 0.05) the mean remaining dentin thickness was highest with WaveOne and smallest with PathFile-ProTaper. Conclusion: WaveOne and Twisted files were similar in terms of canal transportation, centring ability and remaining dentin thickness. Hand NiTi files and Pathfile-ProTaper systems produced maximum amount of canal aberrations.

61-66

Authors: Aruna Shanmuganathan, Krishnaveni R, Meenakshi Narasimhan, Viswambhar V, Ragulan R, Nisha Ganga, Gangaiamaran M, SSJ Shiek Fareeth Ahmed

Background: Pregnancy is a physiological state causing significant physical and functional changes in Cardiovascular and Respiratory system. It is important to recognize the adaptive changes during pregnancy in order to identify and manage Respiratory impairment. The Respiratory system undergoes structural and functional alterations affecting the thoracic cage, abdominal cavity and diaphragm. There is a decrease in Functional Residual Capacity (FRC), Expiratory Reserve Volume (ERV), Chest wall Compliance & increases in Tidal Volume (TV), Minute Ventilation (MV) during pregnancy. However, Airway function is postulated to largely remain unchanged during pregnancy with Peak Expiratory Flow Rate (PEFR), FVC and Forced Expiratory Rates like FEV1 showing little change. Hence, PEFR which is a simple, portable, cheap and reproducible parameter can be utilized to assess airway function during pregnancy. Due to conflicting reports of PEFR with advancing gestation in different ethnic groups and limited studies in the South Indian population, the present study was undertaken to evaluate the PEFR variation in different trimesters of normal pregnancy. Aim: To Evaluate the Peak Expiratory Flow Rate in Pregnancy in different trimesters. Materials and methods: Total of 165 pregnant women in the age group of 20-35 year with no respiratory illness or co morbidities (55 in each trimester) were included in our study. Control group consisted of 55 age and height matched non pregnant women. Informed consent was obtained and PEFR was performed using Mini Wright s Peak Flow Meter and best of three recordings noted. Data analyzed using SPSS package version 21.0. Association between PEFR with Age and BMI performed using Pearson correlation. The Bonferroni’s Multiple Comparison Test executed to determine the significant variance of PEFR between control and study groups. Results: PEFR was significantly lower in all trimesters of pregnancy compared to controls. However, there was no significant difference in PEFR across trimesters. Age and BMI did not correlate with PEFR. Conclusions: PEFR was significantly lower in all trimesters compared to controls. Hence, prospective Indian studies with larger samples are needed to arrive at Normograms for PEFR in each trimester of normal pregnancy which would enable us to use PEFR as a simple tool to assess airway obstruction in pregnancy.

74-82

Authors: G. Swarnalatha, K.R. Karthik, N. Bharathi, S. Raghavendra, K. Siva Parvathi, A. Deepti, T. Gangadhar

New onset diabetes after transplantation (NODAT) is one of the serious side effects of immunosuppressive medications used in renal transplant recipients. Diabetes in transplantation increases the risk of cardiovascular disease and has adverse outcome on graft and patient survival. The aim of this study was to evaluate the incidence of NODAT in renal transplant recipients, the risk factors for the development of NODAT and its effect on graft and patient survival. Total 210 patients underwent renal transplantation from Jan 2010 to June 2016. Mean follow-up period after renal transplantation was 38.14 + 20.12 months. NODAT was defined as two consecutive fasting blood glucose determinations above 126 mg/dL. Thirty five (16.66%) recipients developed NODAT, the duration of onset of NODAT was 4.22 months (range 1 month to 30 months) after transplantation. All of them required insulin treatment. NODAT disappeared in 3(8.57%) recipients with reduction in tacrolimus dose and conversion to everolimus. Cox-Regression analysis was done to estimate the hazard ratio at confidence interval to assess whether the age more than 50 years, deceased donor, induction therapy, graft dysfunction, graft rejection, tacrolimus toxicity, everolimus based immunosuppression, HCV and CMV infection were risk factors for the development of NODAT. Induction therapy and graft dysfunction had 2 fold increased risk of development of NODAT and tacrolimus toxicity had 4 fold increased risk of development of NODAT. Fungal infection (17.14% Vs 2.28%, P value 0.00) was significantly higher in NODAT group compared to recipients without NODAT. There was no significant difference in 6 months, 1, 2, 3 and 5 years patient survival or the death censored graft survival of recipients with NODAT compared to patients without NODAT.

89-104

Authors: Sharma IK, Garg KK, Saxena D, Sharma N

Background: Malnutrition generally implies under-nutrition and refers to all deviations from adequate and optimal nutritional status in infants, children and in adults. In children, under-nutrition manifests as underweight and stunting (short stature), while severely undernourished children present with the symptoms and signs that characterize conditions known as kwashiorkor, marasmus or marasmic-kwashiorkor. Materials and methods: The present study was carried out in the department of pediatrics and microbiology at UP Rural Institute of Medical Sciences and Research, Saifai, Etawah (U.P) during April 2014 to March 2015. Total 85 children were included in study. Results: Although under reported UTI is common in children with SAM as came out in our study. Prevalence of UTI is common (22.4%) in children with SAM in our study. In our study, Urinary tract infection was more common in females than males in SAM children with maximum prevalence among 37-59 months of age .but there is no significant difference between sex. Conclusion: Most sensitive first line oral Antibiotic was Nitrofurantoin and parentral antibiotic was Amikacin for UTI in children with SAM, in our study.

111-117

Authors: Rolaniya SL, Dhawan S, Meera Kumari, Jain R, Pareek A, Sehtia S

Background and Aim: Anesthetic techniques are based on hemodynamic stability during anesthesia and surgery. Dexmedetomidine is centrally acting α2 agonist with sedative, sympatholytic and analgesic. Aim of this study was to compare effect of conventional dose with low dose infusion of dexmedetomidine on hemodynamic stress response, induction agent requirement & postoperative analgesia. Materials and methods: Single randomised prospective study done on 100 ASA Ι and ΙΙ patients aged 18-65 years scheduled for elective laparoscopy cholecystectomy under general anesthesia. Patients were divided in to two groups of 50 each, Group A: 1 µg/kg loading dose of dexmedetomidine I.V. started 15 min before procedure and infusion. 5 µg/kg/hr after induction and continued till end of surgery. Group B: 0.5 µg /kg/hr of dexmedetomidine I.V. started 15 min before procedure and continued till end of surgery. Results: Hemodynamic stability more in group B by avoiding complications like hypotension and bradycardia (p value < .05). Reduction of induction dose was more in group A than group B as compared to standard doses (P value <0.01). Hypotension and bradycardia were observed in 5 cases after 15 min of infusion in group A ( p value <.01). Mean VAS score in Group A was at 330 min was 3.10.39 and 3.150.94 at 210 min in group B. Conclusion: Low dose infusion of dexmedetomidine provides more hemodynamic stability. Requirement of induction agent was decreased more in group A than group B. Postoperative analgesia more in group A.

122-125

Authors: Manoj Kumar Choudhary, K.K. Lohani, Neeraj Kumar

Introduction: Acute Kidney Injury is a common medical problem. AKI is responsible for major mortality and morbidity of hospitalized patients because of serious nature of the underlying illness and incidences of complication. Materials and methods: A total number of 100cases of Acute Kidney Injury who fulfill the inclusion criteria were studied with a detail history, clinical examination and investigation according to need. Results: Out of 100 patients 78 were male and 22 were female. Maximum numbers of patients were in age group of 51 to 60 years. Vomiting (60%) and Oliguria (48%) were common presenting features. The study showed various etiological factor associated with Acute Kidney Injury like Septicemia (43%), Acute gastroenteritis (10%), Malaria (9%), Nephrotoxicity (8%), Cirrhosis of Liver and Obstetrical cause cause (7%), Glomerolonepritis (6%), CCF (5%), Snake bite (4%), and Leptospirosis (1%). In this study, Hypotension (40%) were common complication of acute kidney injury followed by Hyperkalemia (35%). Conclusion: We observed that early diagnosis and early investigation were probably responsible for good survival rate in acute kidney Injury.

131-138

Authors: Nkanga DG, Ibanga AA, Nkanga ED, Etim BA, Nwachukwu KU, Ogba PO

Introduction: Central Corneal Thickness (CCT) is gaining increasing significance in the management of glaucoma patients due to the recognized relationship between CCT and intraocular pressure (IOP) levels. The Objective of this study was to evaluate to what extent CCT modified Goldmann Applanation Tonometry (GAT), and thus management decisions in the care of glaucoma patients and suspects in Calabar, Nigeria. Materials and methods: All consenting patients seen from January to December 2015 in University of Calabar teaching Hospital (UCTH) eye clinic and Zerah Eye Hospital and Laser Center, Calabar who were diagnosed as Glaucoma suspects/patients were included. IOP was measured by Goldmann Applanation Tonometry (GAT), and CCT measured by handheld contact ultrasound pachymetry. Data entry and analysis was performed using STATA 12 software. Results were summarized in frequencies, percentages and means while comparison was done using 95% confidence interval. Results: The study sample was 256 with 133(51%) females and 123(48%) males. The mean age was 45.52years ±17.82. The mean CCT was 530µm. An inverse relationship between CCT and age was seen; mean CCT of 518.29µm and 548.93µm for the oldest age and youngest age groups respectively. Increasing age is a known risk factor for glaucoma, but it remains to be elucidated if the progressive thinning in CCT with age confers an independent risk factor. The mean IOP was 15.835 and CCT adjusted values for IOP varying from -7 to +7 mmHg with mean IOP adjustment of 0.84mmHg ± 2.66mmHg for right eye and mean IOP adjusted value of 0.98mmHg ± 2.69mmHg for the left eye. Over 50% had adjusted IOP values of ≥1.5mmHg, while 36% had adjusted values of ≥3mmHg. Conclusion: Measurement of CCT was important for management decisions as 36% of study subject required IOP adjusted values of ≥3mmHg, thus affecting diagnostic criteria and modifying decisions on ‘Target IOP’ during management. Routine CCT measurement at diagnosis should be part of a minimum package of care even in low resource settings, for the glaucoma patients to avoid under-treatment/overtreatment from ‘falsely’ elevated or lowered IOPs.

144-150

Authors: Priyanka Poonam

In developing countries like India, patients seek medical help usually during advanced stage of ovarian tumors. Thus, patients with the tumors of ovaries need high index of suspicion. In early stage it present with very vague symptoms like pedal edema and dyspepsia. So, regular screening in females >35 year with serum ca-125 and annual transvaginal USG can help in early diagnosis and treatment. Total of 2275 Gynecological cases were received at the department of Pathology in tertiary referral centre during the period of 2 years from January 2015 to December 2016. In these 454 cases of ovaries both cystic, benign and malignant ovarian tumors were studied. Among these 366 cases included inclusion cyst corpus luteal cyst and follicular cyst in decreasing order 62 cases were of benign tumors included serous cyst adenoma, mucinous cyst adenoma and mature tetratoma. 26 cases were malignant included serous cystadenocarcinoma, mucinous cystadenocarcinoma, malignant teratoma, Krukenberg tumor, yolksac tumor.

161-166

Authors: Ragulan R, Viswambhar V, Krishnaveni R, Meenakshi Narasimhan, Aruna Shanmuganathan, Nisha Ganga, Gangaiamaran M

Introduction: Mean platelet volume (MPV) and Platelet Distribution Width (PDW) is a relatively simple, inexpensive tool that indicates the platelets size, the rate of platelet production, platelet activation and the severity of inflammation since inflammation plays an important role in COPD, any alteration in platelet activity can cause alteration in MPV. Red blood cell distribution width (RDW) reflects morphology of erythrocytes whereas RDW can also vary due to systemic inflammation and ineffective erythropoiesis. Hence we aimed to study Platelet indices in patients with exacerbation of COPD. Aim and objectives: Our aim is to evaluate the role of platelet Indices in COPD patients. Since only limited data were available on the relationship between COPD and platelet indices, we aimed to evaluate and find out the correlation between Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW) and Plateletcrit (PCT) in exacerbation of COPD patients at a tertiary care hospital in south India. Materials and methods: A total of 135 subjects, 79 men and 56 women, who were admitted in our hospital with exacerbation of COPD during a period of one year were enrolled in this prospective observational study. The levels of MPW, RDW, PDW and PCT were assessed during the course of hospital stay in patients with COPD exacerbation Results: In our study we found out that there exists a statistical significance among male and female COPD exacerbation patients with respect to Mean Platelet Volume (P=<0.0001) and Red Cell Distribution Width (P=<0.0001). There also exists statistical significance between our COPD patients with other study stable controls (p=<0.005). Using ROC curve, considering optimal level of MPV <8.8Fl, male population showed sensitivity of 95% and specificity of 85% with Average age in men with diagnosed COPD is 49 and average age of female COPD patient is 55. Conclusion: Our study suggests that Mean Platelet Volume and Red Cell Distribution Width values may be useful for identifying patients who are at high risk for exacerbation of COPD. RDW per se is an important risk factor for Ischemic heart disease (IHD) and elevated RDW may suggest increase in risk of IHD in patients with COPD.

173-178

Authors: Murugan, Sathvika

Introduction: Coronary heart disease is the leading cause of death in Western countries and it is now an increasing problem in developing countries too, due to changes in life style and dietary habits. Heart Disease is responsible for more deaths and disability among Western Population, both male and female, than any other killer disease, and it is quickly establishing itself as the leading cause of death and disability among Indians as well. Aim of the Study: To study relation between risk factors for atherosclerosis and fasting and postprandial triglyceride levels in patients of Coronary artery disease. To establish that post-prandial triglycerides level is a better indicator as a ‘risk factor’ for atherosclerosis. Materials and methods: A complete physical and cardiovascular system examination performed. Blood pressure measurements were performed with mercury sphygmomanometer in a standardized fashion. Waist circumference was measured at umbilical level. Hip circumference was measured at maximum girth at hip. Recording of ECG was done with 12 leads recording in standard fashion with B.P.L machine. Fasting samples of blood glucose, Fasting Lipid profile was measured. Results: In our study, out of 56 male 34 (62.5%) were suffering from diabetes mellitus while 30 female out of 44 were (68.18%) diabetic. So out of 100 patients 64 patients were suffering from diabetes. In our study, 57 patients were hypertensive. 32 male patients out of 56 male patients were hypertensive (57.14%) and 25 female patients out of 44 patients (56.81%) were hypertensive. In the present study, postprandial hypertriglyceridemia was found in 16 patients out of 23 patients (69.5%) in the age group 35-45, 31 patients out of 46 patients (67.39%) in the age group 46-55, 9 out of 21 patients (42.8%) in the age group 56,-65, and 8 patients out of 10 (80%) in the age > 66 years. Conclusion: In our study with reference to patient of ischemic heart disease, postprandial Hypertriglyceridemia was found in 64% patients, having normal fasting triglyceride level. There is statistically a significant correlation between postprandial triglyceride and ischemic heart disease, even in patients having normal fasting triglyceride level. It means that patients having high postprandial triglyceride levels have higher risk of Ischemic heart disease. The relative risk is 1.44.

186-190

Authors: M. Arivumani

Introduction: Rising incidence of Diabetes mellitus, Systemic hypertension and Dyslipidemia, the well-known risk factor for cardiovascular disease is the leading cause for increased incidence of cardiovascular diseases1. Till today, body mass index and waist circumference are the two popular parameters used to assess the cardiovascular risk factors. Though Asian people are not overtly obese, they are still at an increased risk of cardiovascular disease and this may be due to presence of visceral obesity, but the cut off value for waist circumference. Aim of the Study: To assess the effectiveness of the newer anthropometric index, Waist/Height ratio in identifying cardiovascular risk factors. To compare the effectiveness of various anthropometric indices Body mass index, Waist Circumference and Waist/Height ratio in identifying Cardiovascular risk factors. Materials and Methods: 135 patients were included in our study. Careful history taking was first taken in these patients regarding pre-existing diabetes mellitus, systemic hypertension and dyslipidemia and about the treatment for these illnesses. In all these patients the following anthropometric measurements are done: Height, weight, waist Circumference were measured using standard methods. Results: In our study, 135 patients was selected randomly. The cut off values of anthropometric indices which was taken as abnormal were Body mass index > 25kg/m2, Waist Circumference Males > 90 cm Females > 85 cm, Waist/Height ratio > 0.5. Conclusion: Waist/Height ratio with cut off > 0.5 was found to be an effective, newer and cheaper anthropometric index in identifying cardiovascular disease.

196-200

Authors: P. Ravikumar

Introduction: Hypertension is a major cause of morbidity and mortality. The heart, arterial vessels, brain, kidney and retinal vasculature are major target organs adversely affected by high blood pressure. In adults there is a continuous incremental risk of target organ damage across levels of both systolic and diastolic blood pressure. Cardio vascular disease risk doubles for every 20mmHg systolic and 10mm Hg diastolic rise in blood pressure. Aim of the study: To study different cardiac geometry in newly diagnosed hypertensives and to correlate proteinuria and LV mass in hypertensives. Materials and methods: Fifty newly registered patients at Government Dharmapuri Medical College Hospital from October 2016 - April 2017 were included in the study. In all these patients, history of substance abuse, comprehensive clinical examination and appropriate imaging and bio-chemical evaluation done. Results: Patient distribution between stage I and stage II hypertensives were almost equal. Among the distribution of patients with pulse pressure gradient, 20 patients (40%) had pulse pressure in the range of 41-50, 15 patients (30%) had pulse pressure in the range of 51-60. 7 (14%) and 8 (16%) had pulse pressure below 40 and above 60 respectively. In the study, 18 patients (36%) had urine protein in Mircoproteinuria range as detected by early morning spot urine protein - creatinine ratio. Among 18 patients with Micro- Proteinuria, 15 patients (83%) had abnormal cardiac geometry. Among 26 patients with abnormal cardiac geometry, 15 patients (58%) had micro proteinuria. There is significant association between microproteinuria and abnormal cardiac geometry in patients with essential hypertension. Conclusion: A significant association was seen between widened pulse pressure and LVH Majority of patients with pulse pressure above 50 had LVH. While most of the patients with pulse pressure < 50 had normal geometry. Majority of patients (70%) with proteinuria and LVH were in stage-II hypertension. Patients were almost equally distributed between stage I and II Hypertension. Majority of patients had normal cardiac geometry in stage I while stage II patients had LVH of whom majority had microproteinuria.

207-212

Authors: P. Sasikumar

Background: Despite impressive strides in diagnosis and management of acute myocardial infarction in the past three decades, acute myocardial infarction continues to be a major health problem. About 50% of death from acute myocardial infarction occur within 1 hour of the event and are attributable to arrhythmias most often ventricular fibrillation. Ischemic injury can produce conduction blocks at any level of the atrioventricular or Intraventricular conduction systems. Such conduction block can occur in the atrioventricular node producing various grades of AV block. Conduction block can occur in either main bundle branch producing right or left bundle branch block or in the anterior and posterior fascicle of left bundle branch, producing left anterior &left posterior fascicular blocks respectively. Aim of The Study: To study the incidence of rhythm disturbances in acute myocardial infarction, to evaluate the age, sex distribution and various other risk factors in relation to rhythm disturbances occurring in acute myocardial infarction, to correlate between the different types of rhythm disturbances in relation to the location and type of acute myocardial infarction. Materials and methods: The study was conducted in Government Dharmapuri Medical College Hospital during the period from November 2016 to May 2017. The patients admitted to ICCU were taken up for study. A detailed history physical examination &laboratory work up was done in all patients. Results: 100 Patients of acute myocardial infarction were included in this study. They consisted of 77 male and 23 female patients. The youngest patient was a 23 year old male and the oldest patient was an 84 year old male. Out of 100 patients with myocardial infarction 80 were males and 20 were females. Out of 80 males 37 had rhythm disturbances with a percentage of 46.25 and out of 20 females 9 had rhythm disturbance with a percentage of 45. 8 patients had previous ischemic heart disease prior to present episode. Of these 4 developed rhythm disturbances. All female patients were postmenopausal. 6 patients had COPD and 3 developed rhythm disturbances. Out of 100 patients 25 patients had Intraventricular block, of these right bundle branch block was common with an incidence of 10. Conclusion: The distribution of rhythm disturbances were almost equal in males and females ( p value 0.3365). Rhythm disturbances were more common in the age group 50-59. The incidence of rhythm disturbances in patients with Diabetes mellitus and hypertension was high.

218-221

Authors: R. Bharathidasan, Reny Jayaprakash, Subith P. Bhaskar, G. Ambujam

Background: The link between varicocele and infertility was first reported by cessius in 1st century AD but it was not widely acknowledged until TULLOCH and colleagues reported the improvement of sperm parameters in 26 of 30 patients undergoing varicocelectomy. Varicocele is defined as excessive dilatation of pampiniform venous plexus of spermatic cord. varicocele is an important cause infertility which can be corrected by surgery. Several methods have been used for its treatment including open surgical ligation of spermatic veins as well as laparoscopic varicocelectomy. Open varicocelectomy has more risk of recurrence and complications whereas laparoscopic varicocelectomy is simple, has less risk of recurrence and complication in expert hands. Objectives: To compare Laparoscopic varicocelectomy with open varicocelectomy, in terms of post-operative pain, recurrence rate, hospital stay, cost, cosmetic and complication. To prove hospital stay was more in open group than laparoscopic group and also patient of laparoscopic group return to normal activities earlier than open group. To standardize the laparoscopic varicocelectomy procedure for varicocele. Materials and methods: It was a randomized clinical trial done in Department of General Surgery, Vinayaka Mission Medical College, Karaikal. Study was carried out from 1st March, 2015 to 1st March, 2016. A total 70 patients was taken in our study of its 36 patient undergone open varicocelectomy and 34 patient undergone laparoscopic varicocelectomy. Results: Recurrence rate 0% in Laparoscopic Varicocelectomy and 5.6% in open varicocelectomy. Wound complication was 0% in Laparoscopic varicocelectomy and 2.5% in open varicocelectomy. Post-operative pain was more in open group as compared to laparoscopic varicocelectomy. Laparoscopic varicocelectomy has less post-operative morbidity and early return to normal activity. Also there was improvement in seminal analysis in both groups. Conclusion: We would like to standardize laparoscopic varicocoelectomy and make it as a gold standard for Varicocele by replacing open technique provided there is good experienced surgical team and good instrumentation. Cost of the procedure is comparatively high.

228-233

Authors: M. S. Shruthi, T. Elavarasan, R. D. Puvitha

Introduction: The HIV epidemic is a convincing illustration of the balance between the power of science and the humanism of modern medicine. The epidemic is so serious that between 1981 and 2000, 21.8 million people had died of HIV/AIDS. Clinically significant hematologic abnormalities are common in HIV infection. These abnormalities may occur as a result of HIV infection itself, as sequelae of HIV related opportunistic infections or malignancies or as a consequence of therapies used for HIV infection and associated conditions. Aim of the Study: To analyzes the hematological profile of people living with HIV/AIDS (PLHA’s) and to identify the possible correlation between WHO clinical stage and hematological abnormalities. Materials and methods: All patients with HIV infection attending Govt. Dharmapuri Medical College Hospital, Dharmapuri during the study period were evaluated for the conditions which could alter the Hematological parameters and if found so, they were excluded from the study. Those included in the study were investigated for Hb% total count, differential count, ESR and platelet count. CD4 count done by flow cytometric analysis was obtained. Results: The mean total count was found to be 587+ 2210 cells / mm2 out of the 100 patients 41 of them had leucopenia. In our study the differential count distribution showed neutropenia in 30 patients, lymphocytopenia in 30 patients and monocytopenia in 20 patients. The median CD-4 count was 89 cells/microliter. Almost all the patients enrolled in our study had CD4 count <200/microlitre with only a minor fraction having counts >200/microliter. All patients who had lymphocytopenia were having CD4 count<200/microliter. This establishes the relationship between lymphocytopenia and low CD4 counts. The mean platelet count was 1.56+ 0.35 lakh/mm3 thrombocytopenia was found in 40 patients. The mean value ESR was 24.63 + 10.92 mm /hr. Elevated ESR was found in 71%. ESR has not much of diagnostic value and therefore can be elevated in any chronic inflammation (or) infection. Hence, this finding may not be that significant. Conclusion: Majority of them were in stage III (55%) and had CD4 count <200/microliter (87%). Leucopenia was found in 41% of them. Neutropenia was detected in 29%. Thrombocytopenia was found in 40%. Anemia and elevated ESR detected in 79% and 71% respectively.

241-243

Authors: Wasala Mudiyanselage Asoka Sameera Bandara Wasala, Wasula Sampath Rathnaweera WS, Gunaratnasingham Rajiv Nirmalasingham, Kuda Banda Galketiya, Mihindukulasooriyalage Vasanthi Gertroud Pinto, Henri Gunarathnage Duminda Tharaka Gunarathna

Careful monitoring and adjustment of anesthetic technique minimize the complications and improve the outcome of laparoscopic trans hiatal esophagostomy.

1-7

Authors: Prabhakaran R, Marannan N, Ponnusamy Kumar, Vijayakumari Vrinda

Background: Poisoning with organophosphorous substances is the commonest cause of inpatient mortality among all poisonings in developing countries like India. This study is undertaken with an aim of assessing simple parameters like GCS and QTc (marker of ventricular arrythmias) in predicting the outcome and complications of organophosphate compound poisoning considering the mortality and sufferings of Organophosphorous poisoning patients. Aim: To assess the utility of GCS score and QTc interval in predicting prognosis in patients who had consumed organophosphate and carbamate poisoning and to assess whether the above parameters helps to identify the high risk groups requiring mechanical ventilation. Materials and methods: This study was conducted among 200 organophosphate and carbamate poisoning patients who were admitted at Government Rajaji Hospital, Madurai from February 2014 to September 2014. After taking detailed history and physical examination and investigations the Glasgow coma scale score and QTc interval at the time of admission was calculated. Patients with GCS score < 13 and QTc interval > 0.44s in males and 0.46s in females as poor outcome. Results: There was a linear relation with QTc interval and severity of Organophosphorous poisoning i.e. as the QTc interval increases the severity of poisoning increases. There was an inverse relationship between the GCS score and severity of Poisoning, .i.e. as the GCS decreases the severity of poisoning increases. Conclusion: Our study showed that respiratory failure in patients with OP compound poisoning can be predicted at admission by simple parameters like lower GCS and prolonged QTc interval in ECG.

13-19

Authors: Anupama Priyadarshini N

Background: Succinylcholine remain unsurpassed in providing ideal intubating conditions in the shortest time among all available neuromuscular blocking agents hence is advocated as the drug of choice for rapid sequence endotracheal intubation. Aim: Study compared the effects of succinylcholine and rocuronium bromide on intraocular pressure. Materials and methods: Study was done in 30 samples of ASA physical status 1 and 2 were selected through simple random sampling technique. All patients were scheduled for elective non-opthalmologic surgery for which general endotracheal anesthesia at various intervals at various intervals intraocular pressure changes, pulse rate, systolic and diastolic blood pressure were recorded at each of the above periods. Results: Intraocular pressure was elevated after giving succinylcholine high above the baseline values while in rocuronium group the intraocular pressure reduced below the baseline values. Though in both the groups IOP rose after intubation and decreased after three and five minutes after intubation, in group S it remained above the baseline after five minutes where as in group R it remained below the baseline value. Increasing after intubation nearing baseline value after five minutes after intubation. Conclusion: To conclude rocuronium in a dose of 0.9 mg/kg provides good to excellent intubating conditions comparable to that succinylcholine. It is a suitable agent for tracheal intubation in patients undergoing elective and emergency ophthalmic surgery where raise in intraocular pressure is undesirable.

26-30

Authors: G. Indumathi, M. Arivumani

Introduction: Ingestion of oleander seeds results in a clinical picture similar to that of digoxin overdose. Severely poisoned patients may die in dc shock resistant ventricular fibrillation. It can lead to severe Hyperkalaemia is a marker of a poor outcome in cardiac glycoside poisoning, which may worsen further toxicity and lead to serious Arrhythmias. Aim: To analyse Clinical Profile, ECG Changes, Electrolyte Status among the patients with acute yellow Oleander seed Poisoning. Materials and methods: All patients admitted with consumption yellow oleander poison within 48 hours was studied. The study was carried out over a nine-month-period beginning June 2016. Clinical parameters, CBC, Blood sugars, Serum Urea, Creatinine, Serum Na+, Serum K+, LFT, ABG, ECG, and Gastric aspirate analysis were done to analysis the changes on hourly basis. Results: Among the 72 patients, the significant ECG abnormalities were found in 45(62.5%), 37.5% had normal rate and rhythm. No significant abnormalities were found in Renal and Liver functions. No significant change in Serum Sodium level was noted. But significant change in the Serum Potassium levels was noted in 28.1% of patients. In this 19.7% had Hyper-Kalemia and 8.4% had Hypo-Kalemia. Conclusion: Oleander seed is still used as a suicidal agent. Oleander plant is easily available as an ornamental plant in urban, semi-urban and rural areas. ECG abnormalities were found in majority of the individuals. Prognosis was poor among those who presenting with Hypo-tension, Electrolyte disturbances especially those with Hyperkalaemia, and complex Arrhythmias.

38-44

Authors: Yashvardhini Siddareddy, Himabindu Sangabathula

Introduction: Mid-trimester termination of pregnancy is one of the most controversial areas of gynaecological practice. It has moral, emotional, social and technical issues. There is continuous need for termination of pregnancy in second trimester, more recently due to increase in the use of antenatal diagnostic procedures. The objective of the present study is to compare acceptability, safety, efficacy, complications and induction-abortion interval of ethacridine lactate with vaginal misoprostol versus vaginal misoprostol alone for mid trimester abortion Materials and methods: This was a comparative study s200 women of 13-20 weeks pregnancy were randomized in two groups. Out of these 100 patients were selected at random for intravaginal misoprostol 400 μg stat followed by 200 μg misoprostol P/V 4th hourly and 100 cases for extra amniotic ethacridine lactate instillation with tablet misoprostol 400 μg Stat followed by tablet misoprostol 200 μg 4th hourly. The relative efficacy, induction- abortion interval, complications of each was studied. Results: The patients studied belong to all categories of marital status, married, and unmarried, widowed. The age ranged from 15-34 years. The gestational age from 14-20 weeks most of them were primi para. Mean induction abortion interval with misoprostol is 15.2 hours while that of emcredil with misoprostol is 16.44 hours. Success rate with misoprostol is 94% while that of emcredil with misoprostol is 95%. Incomplete abortion with misoprostol 2% while that of emcredil with misoprostol 1%. No major complications are noted in both the methods. Conclusion: Misoprostol is safer, more effective and acceptable than ethacridine for mid trimester termination of pregnancy.

51-54

Authors: Theerupally Jaya, Pottekula Sridevi

Background: Aim of the present study was to assess the technical difficulties and complications of double puncture laproscopy in camp setup in urban areas. Materials and methods: Laproscopic sterilization camps are held in the urban area (Hyderabad) from April 2014 to March 2016 a total of 7112 cases were done. The technical difficulties and complications are analyzed. Results: Failure to do the operation was technical failure mainly due to adhesion followed by pelvic inflammatory disease. The most common complication encountered was bleeding from the port site and infection at the port site. No major morbidity or mortality was reported. Conclusion: Laproscopic sterilization by Falope rings is very popular as it has very few complications and large number of patients can be operated in a day by an experienced laproscopic surgeon and safe alternative to modified Pomeroy’s technique.

60-63

Authors: P. S. Rani, P. Sasikumar

Introduction: The incidence of diabetes in India is 3.8%34. It is well known that diabetes is a systemic disease; it affects almost all organ systems. Non-alcoholic fatty liver disease (NAFLD) is being increasingly recognized today as a potentially serious complication of diabetes, especially type 2. The spectrum of NAFLD extends from simple steatosis or steatosis with mild inflammation to severe non-alcoholic steatohepatitis (NASH). Aim of the study: The Aim was to analyse the prevalence of Fatty Liver (Non Alcoholic Fatty Liver Disease) in Patients with Diabetes. Materials and methods: The study was to be conducted in Government Dharmapuri Medical College Hospital, Dharmapuri, and Tamil Nadu. It was an observational type of study. Interview technique was used to collect information on a predesigned proforma. All diabetes patients both type 1 and type 2. Both male and female patients were included in the study. Results: Among the 75 diabetics who were studied, fatty liver was found in 31patients (41.33%). No. of patients with fatty liver was 31. No. of patients without fatty liver was 44. The number of males with fatty liver were 2 (2.6%) and females 29 (38.6%). The number of patients with fatty liver who had central obesity (waist hip ratio >1) was 23 (74.19%). All the patients with fatty liver had central obesity (waist hip ratio >1 in males and >0.85 in females). Conclusion: The prevalence of non-alcoholic fatty liver disease was 41.3% and it was present mainly in patients with type 2 diabetes mellitus. It occurred more commonly in women (38.66%) than men.

71-74

Authors: K. Sureshkumar, P. S. Rani

Introduction: Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. Since 1970s the treatment of CHF has been transformed, resulting in major benefit to patients. This advance has been the consequence of better understanding of the pathophysiology, investigations, the introduction of newer drugs and cardiac transplantation. Aim of the study: To find out the prevalence of congestive heart failure among the patients admitted in the hospital and to analyse their presenting features and precipitating factors. Materials and methods: A total of 196 cases that satisfied the inclusion and exclusion criteria stated above were taken up for subsequent study. Results: During the study period, 6072 patients were admitted in the medical wards. Out of them 196 satisfied the inclusion criteria. So the prevalence was 3.2 % (196/6072). Among the 196, 7 were expired, thus case fatality rate was 3.5% (7/196). Conclusion: The prevalence of congestive heart failure among hospitalized was 3.2 %Congestive heart failure was common among the age group of 45 – 65 years. Drug intake mainly Non-steroidal anti-inflammatory drugs, anaemia and infections were the most common precipitating factors.

82-87

Authors: Patel S, Vachhani A, C. Raychaudhuri

Background: The thymus is a central lymphoid organ that plays a vital role in the development and maturation of the immune system during childhood, the thymus appears as a bilobed triangular structure located in the anterior mediastinum. Aim and objectives: To provide radiologists a comprehensive understanding of Recognition of the variable appearance of thymic lesions and evaluation of thymic lesions on different radiological modalities like X-Rays and CT-scan for early diagnosis as well as management. Materials and methods: 10 cases of either strong suspicion or symptoms related to thymic lesion were evaluated who came to Dhiraj Hospital with different radiological modalities (X-ray, CT-scan). Results: Out of total no. of 10 patients who were diagnosed and evaluated with thymic lesion on X-rays and CT-scan are: Thymic Hyperplasia, Thymic Cyst, Thymic Lymphoma, Thymoma, Benign Teratoma, Malignant Teratoma. Conclusion: CT Imaging remains the ideal scanning modality to evaluate Radiologists play a major role in differentiating normal thymus from its variants, various thymic lesions and tumor. But common associated radiological modality used along with CT scan done is X-ray.

93-98

Authors: Santosh Kumar, Monika Padwal, Nirali Naik, Harshal Panchiwala, Raghav Pandya, Dhrupad Patel

Background: Hypertension is the one of the important disease of the world and increases the risk of coronary heart disease (CHD), ischemic heart disease (IHD), stroke, peripheral vascular disease, and renal failure etc. Aim: To study the Epidemiological and clinical profile of hypertensive patient came in Dhiraj General Hospital, Vadodara. Materials and methods: This was a descriptive cross sectional study of the patients who came in medicine OPD of Dhiraj General hospital in a period from Janurary 2017 to April 2017. Data related to patients were collected with standard questionnaire performa and blood pressure was measured twice during medical visit with the help of manual mercury column sphygmomanometer. Information of patients relating to epidemiological features (age, sex, place of residence), blood pressure levels, cardiovascular risk factors (diabetes, dyslipidemia, family history of early coronary heart disease, smoking, alcoholism) were noted. Results: There were total 175 patients registered, out of these 124 (70.85%) were male and 51 (29.14%) were female. The age range was 18 years to 100 years. Out of 175 patients, 6.85% were professionals, 32.57% were belonging from low social class. In 175 patients 8.9% had diabetes, 16% had dyslipidemia, 12.5% smoked cigarettes, 15.4% had history of tobacco abuses and 7.45% had given a history of alcohol intake. Family history was present in 19.42% cases. Conclusion: Hypertension is a significant health problem in our society and more common low socioeconomic class. Effort should be made to create hypertension awareness; life style changes, de-addiction and need for regular blood pressure check up should be emphasized in society tries to keep a good control on hypertension through regular and adequate medication through medical advice.

102-104

Authors: R. Abraham Jebakumar, P. Ezhil

Background: Delayed wound healing is a significant health problem, particularly in older adults. In addition to the pain and suffering, failure of the wound to heal also imposes social and financial burdens. Vacuum-assisted closure (VAC) therapy has been developed as an alternative to the standard forms of wound management, which incorporates the use of negative pressure to optimize conditions for wound healing and requires fewer painful dressing changes. Aim: To assess whether the management of non-healing wounds using VAC therapy will result in improved efficacy and safety outcomes compared with conventional methods. Materials and methods: Present prospective, time bound study was done for 1 year from January 2016 to December 2016 over 50 subjects (25 cases and 25 controls). Details of cases were recorded including history and wound characteristics. Routine investigations were done. Follow up with size of wound, appearance of granulation tissue after day 0, 3, 6, 9, 12 and so on dressings were done. Results: Patients managed with VAC had increased rate of r epithelialization and fewer patients required repeat split thickness skin graft to the same site. VAC was more effective at treating various chronic and complex wounds, as there was a significantly greater reduction in wound volume, depth and treatment duration. Conclusion: VAC results in better healing than standard methods, with few serious complications. More rigorous studies with larger sample sizes assessing the use of VAC therapy on different wound types are required.

109-124

Authors: Muley P, Odedara T, Memon R, Sethi A, Gandhi D

Introduction: Tuberculosis (TB) remains a major public health problem, despite noteworthy socio-economic development and advances in medical science. It is a curable disease but still millions of people suffer every year and a number of them die from this infectious disease, resulting in devastating social and economic impact. TB treatment requires several months of swallowing a combination of 3 to 4 drugs every day. Patients often forget to take their medicines or stop taking them when they start to feel better. The Revised National TB Control Programme (RNTCP), based on the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy was launched. Studies of paediatric TB are scantily available both in global and national context. Reliable data on the treatment of paediatric TB and its follow up are not available. Hence, a study of paediatric TB is designed to evaluate the clinical profile of childhood tuberculosis and following up the treatment outcome upto 6 months Materials and methods: The study was carried out in the Department of Pediatrics at Dhiraj Hospital, Piparia. Recruitment took place from February 2014 to February 2015. The clinical profile of 71 patients was studied. Results: There was preponderance of males (60.56%, n=43) in study population as compared to females (39.44%, n=28). Most of the patients were belonging to age group of <6 years (32.4%, n=23) and >10 years (38.0%, n=27). Among 6 to 10 years, 21 (29.6%) patients were included in study. Most common form of TB was extra-pulmonary TB (60.56%, n=43) followed by pulmonary TB (39.43%, n=28). Non-specific symptoms like fever (82.5%, n=66) was the commonest presenting symptoms. Other symptoms included cough (33.8%, n=24), altered sensorium (19.71%, n=14), swelling (15.5%, n=11). From all, the patient with follow up (n=50), 44 (88.0%) were cured, 3 (6.0%) patients expired during the course of treatment, 3(6.0%) patient showed no improvement. Conclusion: Diagnosis of paediatric tuberculosis still continues to be a challenge. In the study TB was more common in extra-pulmonary than pulmonary forms in our setting. Diagnosis was based on a combination of epidemiological and clinical suspicion supported by results of various investigations. Presence of paediatric TB is an indication of prevalence of TB in that community. As the source of transmission of TB to children is usually an adult, control of tuberculosis in adult is necessary to decrease the prevalence of TB in children. DOTS is an effective strategy for treatment of TB.

132-135

Authors: Shaik Sulaiman Meeran, Paranthaman Poongavanam, Subashri Mohanasundaram

Poisoning is one of the commonest health problems in patients who present to Emergency Department, causing significant morbidity and mortality in them. The present study is aimed at assessing the incidence, clinical profile and outcome of poisoning patients admitted during a 2- month period of December 2016 - January 2017 in Government Royapettah Hospital, Chennai. 132 cases of acute poisoning in adults due to drugs and chemicals were included. Data on age, sex, type of poison, route of exposure, associated co-morbid conditions and outcome of poisoning were recorded and analysed by descriptive method. Among 132 cases, 90 cases were of intentional poisoning and 42 cases were of accidental poisoning. In all the cases the route of exposure was oral. The percentage of poisoning patients was equal in both males & females. Peak occurrence was in the age group 21-30 years. Rat killer was the commonest toxic agent. Associated comorbidities were found in 11 patients. The incidence of acute poisoning, morbidity and mortality can be substantially reduced by implementing effective strategies that prevent the easy availability of pesticides & over-the-counter medications.

144-148

Authors: Srivastava N, Yadav A

Background: The purpose of present study was to know the relation between the four blood groups (A, B, AB, and O) and high academic scores among students of Government medical colleges of North India. Materials and methods: Study was conducted in Department of Physiology, Dr BSA Medical College, Delhi and UCMS, Delhi on 247 medical students both males and females of age group 18-20 years. Blood groups were collected from past medical records during the time of admission and Confirmation was done during the blood grouping practical classes. Blood group, completion test marks, internal assessment marks (theory, practical and viva-voce) in percentage were tabulated. Statistical analysis was done by SPSS 16.0 software. Results: Out of 247 students 98 students were B group, 76 students were O group, 57 students were A group and 16 students were AB group. Total number of Blood group B students (N=22) who scored high marks were more than the other blood group students. While the %age of students of A blood group (29.8%) were more than other blood groups. Conclusion: Though our study showed that there was a variation in the academic scores between the blood groups A, B, O and AB, there was no significant association (p < 0.05) found between any blood group and academic scores. So, the conclusion of our study was that there was no real correlation between blood groups and academic scoring.

157-169

Authors: G. Thulasikumar, Vijayasarathy S

Introduction: The association of peripheral arterial disease in diabetic foot ulcer is an emerging risk factor for accelerated limb amputations. Presence of ischemia delays the wound healing increasing the likelihood of limb loss. Most amputations can be prevented and limbs salvaged through a multimodal treatment of infection control, wound debridement and revascularization procedures. Materials and methods: This was a prospective study which involved type 2 diabetic patients with isolated foot ulcer (DFU). WIFI- G score was incorporated in the wound assessment. A total of 100 patients were evaluated in this study. Once diagnosed with PAD, patients underwent vascular surgery consultation and were put on appropriate treatment. The patients were followed up for a period of 3 months from definitive procedure to assess the ulcer healing and limb salvage. Results: There was significant association of PAD with high WIFI index. Osteomyelitis was strongly associated with PAD (59%, p=0.003). PAD was associated with higher amputation rates (53.8%, p=0.003). Of minor lower limb amputations, only 47% were associated with PAD whereas of all major amputations, 87% were associated with PAD (p= 0.002). Also higher amputation rates correlated with a high WIFI score (p<0.0001). Conclusion: Revascularization limits the level of amputation and facilitates healing of stump. Major amputations were reduced to half with revascularization. Revascularization if indicated should be done at the earliest onset to attain the benefit of limb salvage.

175-180

Authors: Chinta Vittal Prasad, Nagababu Pyadala

Background: This study focused on introducing MRI into the diagnostic pathway for suspected scaphoid fracture management. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardize management of our patients with scaphoid fracture and now report our findings. Materials and methods: A consecutive series of 104 patients referred to the orthopedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a three-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management. Results: 25 (24%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 45 patients (43.3%). Of those, 32 (30.8%) were triangular fibro cartilage complex (TFCC) tears and 13 (12.5%) were intercarpal ligament injuries. Bone marrow oedema with no distinct fracture was discovered in 35 (33.6%) cases. In 12 (11.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 27 examinations (25.9%). Conclusion: MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.

187-191

Authors: Santosh Prasad, Sarbil Kumari, Jairam Singh, Laxman Kumar

Hypertension is major risk factor for many illnesses. Studies have shown that burden of hypertension in children is increasing. Hence, this study was conducted to find distribution of blood pressure and correlates among School Going Children of Nalanda District. Mean SBP was 107.1±7.8 mm of Hg and mean DBP was 71.0±4.4 mm of Hg. It was seen that mean SBP and DBP were higher for males as compared to females (p=0.00) and higher age (p<0.05) and not related to religion (p>0.05) and socioeconomic status (p>0.05). Routine BP measurement in children is vital.

196-200

Authors: Sandhya Kumari Suman, Binod Prasad

Adolescence is the most crucial period for establishing healthy practices. Menstrual hygiene is effective in preventing RTIs and promoting reproductive health. The present cross-sectional descriptive study was conducted to find the menstrual profile and knowledge and practices regarding menstrual hygiene among adolescent girls of RHTC, ANMMCH, Gaya and included 213 school going girls. It was found that 80.8% thought menstruation to be normal, 78.9% knew the correct periodicity of menstruation and 87.3% the correct duration. 43.2% thought that menstrual blood comes from uterus and 50.7% to be coming from vagina. 23% respondents used sanitary napkins, 89.2% took regular bath and 34.7% cleaned their genitalia regularly. 79.4% disposed it with domestic waste or reused while 11.7% threw it at roadside. Proper awareness and promotion of hygienic practices will be helpful in promoting reproductive health.

204-208

Authors: Priyanka Poonam

Takayasu arteritis also known as Aortic Arch Syndrome or Pulseless disease is an uncommon condition mainly affecting aorta and its branches. It is chronic inflammatory disease of unknown cause, so also called as non- specific aortoarteritis. Though it is rarely seen in children, I am hereby presenting a case of 8 year old girl presenting with constitutional symptoms, claudication of lower limbs, anasarca altered sensorium and decreased urinary output.

213-216

Authors: Priyanka Poonam, Navin Kumar Bariar

Adenoid Cystic Carcinoma is a rare malignant salivary gland tumor comprising <1% of all malignancies of head and neck and 10-15 % of the malignant tumors of salivary glands. Most of it arises in minor salivary glands nearly about 60%. Intraorally, about 50% of adenoid cystic carcinomas occur in the palate. Here by, we present a case of adenoid cystic carcinoma affecting the left maxillary antrum and palate on the same side in 30 years old male along with a brief review of literature.

1-7

Authors: Hrituraj Singh, C. Raychaudhuri

Background: A solitary pulmonary nodule is defined as a discrete, well - marginated, rounded opacity less than or equal to 3 cm in diameter that is completely surrounded by lung parenchyma, does not touch the hilum or mediastinum , and is not associated with adenopathy, atelectasis or pleural effusion. Lesions larger than 3 cm are considered masses and are treated as malignancies until proven otherwise. It is not uncommon for a patient who currently has or has previously had extra pulmonary neoplasm to develop a solitary pulmonary nodule. Such a nodule may be detected with chest radiography or computed tomography performed as part of the work - up or follow - up of the known extra pulmonary malignancy. The determination of the etiology of such a nodule is usually important to direct the appropriate therapy. Aim and objectives: To evaluate the Chest Radiographs and CT characteristics of solitary lung nodule with a primary extra pulmonary neoplasm and to determine the presence and/or frequency of single lung metastasis , primary lung cancer and benign lesions in patients with solitary lung nodule and a primary extra pulmonary neoplasm. Materials and methods: A retrospective analysis of CT and Chest Radiographs of 9 patients with an extra pulmonary malignant neoplasm and a solitary pulmonary nodule, done in our Dhiraj General Hospital. Images were reviewed for the presence of solitary lung nodule. If present, the following nodular characteristics were recorded: Distribution, CT attenuation, Shape, Size, Margins and Calcification. The histological characteristics of the nodule were correlated with those of the extra pulmonary neoplasm and with patient age and smoking history. Results: Out of total number of 9 patients that were included in this study showed different pathologies and those were then those were evaluated in detail and showed: benign pulmonary nodule (1 case), metastatic deposit (1 case), primary bronchogenic carcinoma with brain metastasis (1 case), lung metastasis (1 case), lung carcinoma in upper lobe of left lung (1 case), actinomycosis (1 case), lung metastasis with renal cell carcinoma (1 case), oesophageal carcinoma with primary bronchogenic carcinoma (1 case), primary bronchogenic carcinoma with bony metastasis (1 case). Conclusion: Solitary lung nodule in patients with extra pulmonary malignancies showed a variety of patterns on CT. Nearly half of the non – calcified solitary pulmonary nodules identified in this series were malignant. The likelihood of a spread depends on the histological characteristics of the extra pulmonary neoplasm and the patient's smoking history. Lung cancer was more common than metastatic disease.

13-16

Authors: Akanksha Narula, Jayesh Shah, C. Raychaudhuri

Introduction: Imperforate anus is a defect that is present from birth (congenital) in which the opening to the anus is missing or blocked. In female infants, imperforate anus is typically characterized by the rectum, bladder and vagina sharing one large opening called a cloaca. The condition develops in utero during the 5th to 7th weeks of pregnancy. This condition often happens in conjunction with other defects of the rectum. Incidence is 1 in 5000. It is more common in males. Diagnosis is usually made shortly after birth. Aims and objectives: To study the presentation of imperforate anus using various radiological modalities. Materials and methods: 10 cases of either strong suspicion or symptoms related to imperforate anus were evaluated who came to Dhiraj hospital with different radiological modalities like plain radiograph lateral invertogram, cross table lateral radiograph, erect radiograph and contrast studies (MCUG). Results: Out of total number of 10 patients who were diagnosed and evaluated for imperforate anus 3 i.e. 33.3 % were diagnosed with plain radiograph lateral invertogram, 2 i.e. 20 % were diagnosed with prone cross table lateral radiograph, 2 i.e. 20 % were diagnosed with abdominal erect radiograph and 2 were found to have recto-vesical fistula with the help of micturating cystourethrogram. Conclusion: It was concluded that plain radiograph lateral invertogram proves to be the most important modality in diagnosing imperforate anus. It is followed by prone cross table lateral radiograph and abdominal erect radiograph. Micturating cystourethrogram proves to be important in diagnosing associated anomalies such as recto-vesical fistula.

21-25

Authors: Modiya S, Shah J, C. Raychaudhuri

Background: Acute disseminated encephalomyelitis is an acute demyelinating disorder of the central nervous system and is characterised by multifocal white matter involvement. Diffuse neurological signs with multifocal lesions in brain and spinal cord characterise the disease. It do not invade central nervous system. Aim: To evaluate role of MRI in acute disseminated encephalomyelitis. Materials and methods: A prospective study of 10 cases which was conducted in the pediatric department in Dhiraj hospital. MRI brain was done on 1.5 Tesla MRI machine. Results: ADEM can be distinguished from acute viral encephalitis because the disease is not the result of primary tissue invasion by an infectious organism. It was thought to be immune-mediated and is characterized neuropathologically by perivenular inflammation and demyelination. Conclusion: ADEM is more common in female and more associated with previous infection as compared to previous vaccination. Neurological deficit is mostly associated with it. CSF showed raised protein in almost cases. It showed hyperintense lesion on T2W and FLAIR sequences. Periventricular area of brain is commonly associated.

31-36

Authors: B. Bheeshma, B.S. Nithyananda, Sumaiyya Fatima, Fatima Anjum

Background: Placenta accreta is a severe pregnancy complication and is currently the most common indication for peri partum hysterectomy. It is becoming an increasingly common complication mainly due to the increasing rate of cesarean delivery. Placenta accreta is considered a severe pregnancy complication that may be associated with massive and potentially life-threatening intrapartum and postpartum hemorrhage. It has become the leading cause of emergency hysterectomy. Maternal morbidity had been reported to occur in up to 60% and mortality in up to 7% of women with placenta accreta. In addition, the incidence of perinatal complications is also increased mainly due to preterm birth and small for gestational age fetuses. Placenta cretas are defined as abnormal adherences and/or ingrowths of the placenta to the uterine wall. Placenta creta is currently classified according to the depth of abnormal adhesion and invasion of the chorionic villi to the myometrium in the absence/deficiency of decidualization. The incidence of placenta accreta, defined as the abnormal adherence of the placenta to the uterine wall, has been increasing alarmingly in the developed as well as the developing world.. The exact pathogenesis of placenta accreta is unknown. Generally, placenta accreta has been diagnosed on hysterectomy specimens when an area of accretion showed chorionic villi in direct contact with the myometrium and an absence of decidua or in placental basal plate. Aim: The aim of this study was to determine the incidence of placentas cretas in our hospital and to profile the associated risk factors. Materials and Methods: The patients who underwent gravid hysterectomies for placenta creta at Modern Government Maternity Hospital from 2013 to 2016 were included in study. A total of 25 cases during 4 year period were included out of 33063 deliveries. The indications for hysterectomy in majority of cases were heavy bleeding after removal of placenta or inability to remove the placenta manually either partially or totally. The specimens received in pathology department were thoroughly examined grossly and the representative sections were taken from all the specimens after proper fixation which was submitted for tissue processing and H&E stained sections were studied for final diagnosis. Results: Amongst 33093 deliveries which occurred at our institute from January 2013 to December 2016, there were a total of 25 patients with placenta accreta diagnosed by histopathology, which was a rate of 0.7% cases per 1,000 . This total included 2 cases of focal placenta accreta (8%), 10 cases of placenta accreta vera (40%), 9 cases of placenta increta (36%), and 4 cases of placenta percreta (16%). Conclusion: The incidence is considerably higher in women with both a previous caesarean delivery and placenta praevia. Therefore it is important to have a high index of suspicion in such cases. Women with a placenta previa overlying a uterine scar should be evaluated for the potential diagnosis of placenta accreta and arrangements should be made for delivery accordingly to reduce maternal and fetal morbidity and mortality.

45-51

Authors: Lodha R, Nepalia R

Background: Diabetes mellitus is one of the most common endocrine disorders affecting about 6% of the world’s population. Diabetes mellitus is the leading cause of end stage renal disease (ESRD), a major cause of non-traumatic amputations, responsible for preventable blindness and a leading cause of cardiovascular mortality. Objective: The objective of the study was to assess the glycemic control by estimation of glycated hemoglobin (HbA1c), and lipid profile in patients of Diabetes mellitus without complications and in Diabetes mellitus with complications like neuropathy, retinopathy and nephropathy and compare with controls. Material and methods: The present study comprised of 100 clinically diagnosed and confirmed cases of type 2 Diabetes mellitus attending and admitted in RNT Medical College and Hospital, Udaipur, Rajasthan, India. Glycosylated hemoglobin (HbA1c), Total Cholesterol, Triglycerides, HDL-Cholesterol, LDL-Cholesterol and VLDL-Cholesterol were calculated in all groups using Friedewald’s formula. Result: Our study showed that HbA1c levels were significantly higher (p<0.01) in all groups of patients as compared to controls. The increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels were statistically significant (p<0.01) in Diabetic retinopathy and Diabetic nephropathy group as compared to controls, whereas in Diabetic neuropathy group and in Diabetes mellitus without complication, the increase in Serum Cholesterol, Triglyceride, LDL-Cholesterol, VLDL-Cholesterol and decrease in HDL-Cholesterol levels was not statistically significant as compared to controls. Conclusion: Our study revealed that poor glycemic control and dyslipidemia are associated with Diabetic complications like neuropathy, retinopathy and nephropathy. Estimation of glycosylated hemoglobin and lipid profile helps in predicting the development of microvascular complications. Therefore intensive glycemic control and aggressive treatment of dyslipidemia can help in reducing Diabetes mellitus associated complications.

56-60

Authors: Patel K, Zala S, C. Raychaudhuri

Background: Neurocutaneous syndromes encompass a group of disorders that affect the embryonic ectodermal plate, which includes the central and peripheral nervous systems, as well as the overlying skin. Materials and methods: All patients were known case of neurofibromatosis type 1. All patients for this study had undergone MRI whole spine with brain screening. Conventional radiographs were also taken when and where needed after taking informed consent. Results: In our study we found that 15 (60%) patients having lumbar neurofibromas, 7 (28%) patients having cervical neurofibromas, 2 (8%) patients having thoracic neurofibromas and 1 (4%) patients having sacral neurofibromas. Conclusion: MRI allows non-invasive detection of spinal neurofibromas and helps determine intrdural or extradural origin and their relationship to the neural foramina, spinal canal, and thecal sac and spinal cord. The target sign (bright on T2, with dark collagen centrally) is highly suggestive of a peripheral neurofibroma on MRI.

79-87

Authors: Pereira EM, Tambekar MY, Sahu S, Dhar R

Background: Carcinoma of the breast is a leading cause of death in women and needs to be evaluated at an early stage. FNAC helps in rapid diagnosis of breast lesions and their management. Objective: To study the diagnostic efficacy of FNAC in breast lesions. Materials and methods: Three year retrospective study of 105 cases of breast lump was conducted which included cases, where FNAC and histopathological correlation was available. The cytological diagnosis was classified as inflammatory lesions, benign, atypical probably benign, suspicious for malignancy and malignant. Results: On cytology out of 105 cases, 57 were benign, 7 inflammatory lesions, 34 malignant and 7 were inadequate. Fibroadenoma was the most common benign lesion noted in age group of 21-30 years and infiltrating ductal carcinoma was the most common malignant lesion in 31-40 years age group. Diagnostic accuracy, sensitivity and specificity of this study were 96.93%, 91.89% and 100% respectively. Conclusion: FNAC of breast lesions is a simple, safe and effective modality in pre-operative assessment of benign and malignant lesions and shows high accuracy, sensitivity and specificity.

98-102

Authors: S. Appandraj, V. Sivgamasundari

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) including aspirin are among the most frequently prescribed drugs worldwide and are available ‘Over-The-Counter’ (OTC) also. Though reasonably safe in most cases in prescribed dosages and for short durations, these drugs cause serious gastrointestinal toxicity in a large number of cases. They can affect all segments of the gastrointestinal tract causing ulcers, severe bleeding, perforation, and obstruction. Aim: To study the endoscopic abnormalities in fifty cases of drug induced UGI bleeding. Materials and methods: Fifty patients (32 males and 18 females) admitted with drug-induced hematemesis and or malena were studied with respect to age group, number of bouts of hematemesis, approximate quantity of total blood loss, causative drug responsible for UGI bleeding, risk factors of GI bleeding, number of individual risk factors in each patients. Thorough clinical and laboratory investigations were done. UGI scopy was done for all patients. Results: NSAIDs were the commonest cause for UGI bleeding. Age > 50 years (66%) was the commonest risk factor for UGI bleeding. It was observed that ten patients were having normal endoscopic study, twenty five patients were having lesions in stomach only, ten patients were having lesions in duodenum only and five were having lesions in both stomach and duodenum. None of the patients studied, had lesions in the esophagus. It was found that ulcers were more common than erosions. Conclusion: Stomach is the commonest site affected (50%) and ulcers (64%) were common than erosion.

111-116

Authors: Rana-Khara R, Lakhani SJ, Vasava S, Panjwani D

Background: Sepsis is one of the most common clinical conditions that cause substantial morbidity and mortality all over the world. Blood culture is considered to be the gold standard for the identification of bacteria as a cause of sepsis along with the pattern of antibiotic susceptibility that helps clinicians to choose the appropriate empirical antibiotic. E. coli, belonging to the family Enterobacteriaceae, is a very important pathogen causing infections in humans. It causes a number of important clinical conditions like urinary tract infections, diarrhea, peritonitis, visceral abscesses, endovascular infections, septicemia pneumonia, meningitis, osteomyelitis, wound and soft tissue infections. Due to increased resistance to drugs and ability to produce variety of beta-lactamase enzymes (extended-beta lactamases) poses a difficulty in treating infections caused due to E. coli. Objectives: Objectives of this study were (a) to detect ESBL production amongst the E.coli isolated from the blood cultures of patients with sepsis and (b) to determine its effect on the outcome of sepsis patients from a rural based tertiary hospital in Vadodara district of Gujarat. Materials and methods: A total of 48 E. coli isolates were obtained from the blood culture of 46 patients with clinically diagnosed sepsis. These 48 E. coli isolates were tested for detection of ESBL production according to the CLSI guidelines using phenotypic screening & confirmatory methods. Results: From a total of 48 E. coli isolates obtained from blood culture of 46 clinically diagnosed sepsis, 24 were female patients (as 2 patients had 2 blood samples cultured) and 22 were males. Of the total 48 E. coli isolates tested for ESBL production, 23 (47.91%) isolates from 23 (50%) patients were found to be producing ESBL and 25 (52.08%) isolates from other 23 (50%) patients did not produce ESBL. Of the 23 patients with ESBL producing E. coli, 14 (60.86%) patients did not survive the episode of sepsis, whereas 7 (30.43%) survived and for 2 (8.69%) patients the outcome was not known as they took discharge against the medical advice. Amongst the 23 patients with 25 blood samples yielding non-ESBL producing E. coli, 8 (34.78%) did not survive, 14 (60.86%) survived and for 1(4.34%) patient the outcome was not known. Thus the mortality was more in patients with sepsis due to ESBL producing E. coli as compared to patients with non-ESBL producing E.coli. Also the urinary tract/kidneys were the common source of infection and kidneys were the organ affected. The ESBL producing E. coli showed a higher resistance to most of the antibiotics used but a higher susceptibility to Imipenem and Ertapenem. Conclusion: The findings of our study suggests a higher prevalence of ESBL producing E. coli, which exhibit a higher resistance to most of the antibiotics, are associated with greater mortality and pose a real challenge in the management of patients with sepsis.

122-127

Authors: K. Padma Malini, Tami Arasi, K. Sudha, O. Shravan Kumar

Background: Blood Transfusion plays a vital role in patient management and is lifesaving in many instances. It plays a pivotal role as a specialized modality of treatment and saves millions of lives worldwide each year and reduces morbidity. It is well known to be associated with a large number of complications, some of them trivial while others are life threatening, demanding for meticulous pre transfusion testing and screening. The priority objective of BTS is to ensure safe, adequate accessible efficient blood supply at all times. The magnitude of TTI varies from country to country and depends directly on the TTI load of society and also effective screening of donors at blood bank. Materials and methods: A retrospective study was conducted in our hospital blood bank from 2014-1016, to study the sero- prevalence and trends in TTI, including HIV, HBV, HCV, VDRL, and malaria. The total number of voluntary and replacement donors increased steadily in 3 years. Results: The sero- prevalence of HBV, HCV and HIV decreased steadily over 3 years, whereas incidence of syphilis increased steadily. HBV was noted to be more in voluntary donors than in replacement donors. Blood unit utilization index was calculated and ranged from 90.9% in 2014 to 88.9% in 2015 and 91.6% in 2016. Most common cause for discard of the blood units was TTI followed by expiry of products. Conclusion: Strict selection of blood donors is mandatory and is recommended to ensure safe blood supply. Voluntary blood donations need to be increased to decrease the incidence of TTI.

133-139

Authors: Porika Ram Mohan Lal, V. Dhananjay

Background: It describes a spectrum of conjunctival and corneal epithelial neoplasia, manifesting as Dysplasia, Carcinoma in Situ and Ocular squamous cell neoplasia (OSSN). Aim: To study the association between human immunodeficiency virus and ocular surface squamous neoplasia. Materials and methods: It was a prospective interventional study on total 60 eyes of 60 patients with Ocular squamous cell neoplasia (OSSN) was included in this study diagnosed Histopathologically. Bilateral and recurrent OSSN cases, which were diagnosed by repeat excision biopsy and HPE were included only once to exclude HIV statistics. Results: A total of 72 patients of clinical OSSN attended, the OP Department of Occuloplastics. 3 patients did not consent for surgery and were dropped from the study (2 HIV reactive 1 HIV non-reactive). 9 patients HPE negative for OSSN and were dropped from the study. 60 eyes of 60 patients were included in the study all had histopathologically confirmed diagnosis of OSSN. Minimum age was 6 years and maximum age was 80 years. HIV reactive and HPE positive OSSN was 12. 1 patient had lower lid palpabral conjunctival tumor OSSN – A typical presentation. CD4+ T lymphocytes of the patients were around 250 cells / cuml and below in all HIV positive patients. OSSN can occur from 6 years to 80 years Common age group for affection was 51 - 60 years i.e. above 50 years but it can affect any age group. This disease has male preference. HIV association was 20% of cases. Neglected old patients reported late i.e. 3.3% had radical surgery. Recurrence of the tumour was 3.3% so regular follow up is needed. OSSN develops when the CD4 counts were less than 250cell/cu ml. Conclusion: It can be concluded from the study that there is an association between HIV infection and OSSN.

143-145

Authors: Jain A, Patel N, Chandra Raychaudhuri, Dashore S

Nasal septal lesions are relatively common. Although most manifest with symptoms of nasal destruction, some are incidentally found. Acquired septal lesions may appear due to chronic inflammation and relative ischemia induced by repeated trauma due to nose picking. Because their imaging features often are nonspecific, the diagnosis usually is based also on the clinical history. Rhinotillexomania is a common and generally benign habit in adolescents and adults and only rarely leads to mutilating self-injury. Chronic self-mutilation with resultant loss of body parts occurs most often in schizophrenic and severely obsessive-compulsive patients. The most common symptoms produced by such lesions include nasal obstruction, nasal discharge, epistaxis, facial swelling, and pain. If a physical examination confirms the presence of a trauma, both MR imaging and CT may be used to characterize the finding.