International Archives of Integrated Medicine

1-4

Authors: Allwin James, Prem Kumar Karunakaran, Rabindranath Eswaran, Venkateswaran A R.

Introduction: Choledochal cyst is a type congenital anomaly in which there is dilatation of the intra or extrahepatic biliary tree. Choledochal cysts are classified into five types based on location or shape of the cysts. Materials and methods: A prospective analytical study was conducted from January 2015 to June 2017 at Madras Medical College, Chennai, India. All patients who underwent ERCP and had finding of choledochal cyst on cholangiogram were included in the study. Patients were assessed on their demographic data, clinical findings, presentation, and complications. Results: The incidence of symptomatic choledochal cyst was 2.5%. Type 1C was the most common type of choledochal cyst with obstructive jaundice due to large CBD stones as the most common presentation in this study. None had 30 day post-operative mortality. Conclusion: Type IC is the most common type among symptomatic choledochal cyst in south India. As it is a premalignant condition management includes endoscopic retrograde cholangiography followed by surgery with good clinical outcome.

14-19

Authors: Rama Ashok, K Haridev Kumar, K.B. Chandra Bhanu

Background: Congenital cataracts present very important ophthalmological and socio economic problem. It is one of the causes of blindness continuous to receive emphasis as a school health problem throughout the world. Aim: Clinical evaluation and visual outcome following surgery in congenital cataract. Materials and methods: It was a clinical study on the patients who have attended out-patient department of Ophthalmology for a period for a period of 2 year. 50 cases under the age of 12 years who were operated by SICS with PCIOL (PMMA) and Phaco with foldable IOLs were included in study. All the cases were followed for a period of 3 months. Results: Among the 50 cases, positive family history of congenital cataract was present in 6%. Systemic and ocular abnormalities were present in 3 (6%) and 10 (20%) cases of congenital cataract. Majority of children presented with visual acuity of PL. Majority of children got vision between 6/36 to 6/24. 48% presented with total cataract followed by lamellar cataract 36%. Most of the children had amblyopia followed by squint and optic atrophy. Most of the intra operative complications were posterior capsular rupture followed by premature rupture, hyphema and iridodialysis. Posterior capsular opacification was common followed by iritis, shallow AC and corneal edema. IOL implantation was done in 90% of congenital cataract cases and in 5 % of cases secondary IOL is implanted. Mean IOL power calculated was + 18.00D. Conclusion: Early diagnosis and meticulous management of congenital cataract may give satisfactory vision with minimal complications.

27-37

Authors: Kamera Sateesh Kumar, Veena Narisetty, Changala Praveen

Background: Idiopathic epilepsy is defined as disorder in which there is no underlying cause or structural pathology other than a possible hereditary predisposition for generating seizures which can be generalized or focal in nature. Objective: To study the occurrence of executive dysfunction in patients with idiopathic epilepsy and its association with age, gender, seizure type, duration of epilepsy, age at seizure onset, antiepileptic drug therapy and seizure control &the association of the interictal EEG pattern. Materials and methods: 100 cases of epileptic patients with normal CT scan brain / MRI brain were studied. Frontal Assessment Battery &The Executive Interview (EXIT) were used to assess the executive functions. Results: The FAB score were normal in 46% and abnormal in 54% of the cases. Executive dysfunction as per the FAB score was mild in 32% and moderately severe in 22% of the cases. Impairment in Executive function as per EXIT score was mild in 84% and moderate in 16 % of the cases. Executive Dysfunction was more in cases with either primary or secondarily generalized seizures, cases with a higher seizure frequency, longer duration of epilepsy, uncontrolled epilepsy and seen in 17.5% with normal and 10% cases with an abnormal EEG. Conclusion: Our study found a significant proportion of patients with idiopathic epilepsy have Executive Dysfunction, which adds to the seizure burden by reducing the capacity of an individual to successfully engage in self-care, social, academic and occupational pursuits.

44-51

Authors: P. Sivaramakrishna, Mallapu Gangadhara Reddy

Background: Transthoracic Fine Needle Aspiration Cytology is regarded as the most effective of the cytological methods for diagnosing lung cancer, in particular peripherally-located lesions. Aim: To evaluate the role of sonography in percutaneous Fine needle aspiration Cytology of peripheral pulmonary lesions. Materials and methods: This was the prospective study done in peripheral pulmonary lesions. Total number of patients in the study was 81. Results: 61 patients (75.3%) were Males, while 20 (24.6%) were Female. The Male: Female ratio was 3:1. The mean age of patients in this study was 48. The youngest patient was aged 26 years and oldest was aged 71 years giving an age range of 26 to 71 years. 54(66%) patients of this study were smokers. Only 3 female patients were smokers. The most common symptom was cough and sign was anemia. Left side and Left Upper Zone of lung was most involved area in lung. Squamous cell carcinoma was the commonest cytological type noted accounting for 60% followed by adenocarcinoma. In non-malignant lesions tuberculosis was most commonly observed in total 81 Complications of needle biopsy were 2 cases (2.4%) were with Hemoptysis and 3 cases (3.7%) were with Pneumothorax. Conclusion: It is concluded that Ultrasound Guided Transthoracic Fine Needle Aspiration cytology of peripheral pulmonary lesions abutting the chest wall is Acceptable, Simple, Safe, Quick, Accurate and Useful.

55-60

Authors: Priyanka Poonam, Preety Saha

Generally patients with breast tumors complain of lump in the breast which may be painful or painless and may be associated with nipple discharge or not. Benign tumors of the breast are common among younger age group <30 years. But the chances of malignancy increases with increasing age. Most of the cases of breast cancer are found in age group >50 years. FNAC forms the initial diagnostic method in patients with breast lump. A total of 250 patients with different breast lesions attended cytology section of our Pathology department for FNAC. Out of which 197 cases came for histopathological correlation in the study period of 2 years from January 2016 to December2017. Among these majority were benign tumors (114 cases) but an alarming number of 51cases were malignant. Next in number were benign breast diseases (24 cases). There was one case each of ductal papilloma, gynaecomastia. The commonest benign breast tumors were fibroadenoma whereas the commonest malignant tumors were infiltrating ductal carcinoma. There was one case each of lobular carcinoma in situ, infiltrating lobular carcinoma, medullary carcinoma, ductal carcinoma in male breast, inflammatory carcinoma, sarcoma breast. Hereby, we have analyzed different types of breast lesions in different age groups based on cytological evaluation followed by its histopathological confirmation.

72-76

Authors: G. Sunil, I. Ranganayakulu, R.S.V.M. Raghu Ram

Maxillary canine has a significant importance in functional and esthetic aspect of the occlusion. Clinicians must have a sound knowledge regarding the management of impacted maxillary canines as is second most common teeth prone for impaction after third molars. With early detection and timely interception and well planned orthodontic treatment the impacted canines can be successfully bought to the occlusion. This article gives an overview of etiology, diagnosis and prognosis of impacted canine.

1-7

Authors: I.D. Chaurasia, Anshul Siroliya, Manish Parihar

Introduction: CT plays a key role in accurate diagnosis and important diagnostic tool in the management of traumatic brain injury. Materials and methods: Present study was under taken in the Department of Surgery Gandhi Medical College and Hamidia Hospital, Bhopal in the duration of July 2015 to July 2016. Total 105 patients (M: 80, 76.1% and F: 25; 23.80%) with traumatic head injury were admitted and managed and were include in this study. They were followed by serial CT scan and analyzed. Results: Commonest cause of brain injury was road traffic accidents (75 cases 70%). Altered sensorium was the most common symptom in 88 cases (88.0%), followed by vomiting in 49 cases (75.38%). Contusions were the most common radiological findings in 80.95% (85 cases) followed by extradural haematoma in 18.46% and pneumocephalus in 16.92%. Out of these the most common location for contusion was frontal (14 cases), followed by parietal (12 cases) and then bilateral contusions in 10 cases. Repeat scan showed increase in volume of contusion in 29 cases (44.61%), no change in 26 cases (40.0%) and decrease in 10 cases. The increase was mainly due to edema in 18 cases (27.69%) and due to actual increase in contusion in only 11 cases. Only 4 cases needed operative intervention. Conclusions: Sequential serial CT scan results in the management changes and has role in the management even in the patients without any clinical deterioration in early stages.

14-20

Authors: Manivannan Dhanraj, Nachiappan Meenakshisundaram, Vinodh Duraisami, Vinayak Rengan

Introduction: Fistula in ano is the benign anorectal condition, but became a major problem for surgeons to cure the disease. For proper treatment of fistula in ano, a thorough knowledge of Anorectal anatomy and etiopathogenesis of the anorectal abscess is required. More than 90% cases of perianal abscess and anal fistulas occur due to cryptoglandular infections in the intersphincteric plane. Less than 10% occurs due to the complications of Crohn's disease, malignancy, Tuberculosis, and Radiation Exposure. The aim of the study: To study the different modalities of treatment for fistula in ano (Fistulotomy/ Fistulectomy/ Fibrin Glue Injection/ LIFT procedure). Materials and methods: Patients who met inclusion and exclusion criteria for the study selected and all patients discussed the nature of the disease and possible complications (recurrence, anal incontinence, and anal stricture) expected after surgery was explained. Written consent for the study and surgery was obtained. In proforma, thorough history, signs and symptoms, we identified internal opening and external opening by thorough digital rectal examination and proctoscopic examination under the adequate light were noted. Results: In our study, out of those 15 cases of Fistulectomy, 4 cases developed intraoperative bleeding, 3 cases developed sphincter injury and 3 cases had prolonged surgery more than 1 hour. Of 10 cases with Fistulotomy, 3patients developed intraoperative bleeding, 2 developed sphincter injury and 2cases had prolonged surgery more than 1 hour. Cases proceeded with Fibrin Glue Injection did not develop any obvious intraoperative complication. Conclusion: Fistulectomy has a moderate degree of intraoperative and postoperative complications with a moderate chance for stricture and incontinence and less chance for recurrence. Moreover few cases required second sitting for the completion of treatment.

27-32

Authors: Paul Praveen, Ranjini O.M., T. Murugan

Introduction: Post-operative pain and swallowing difficulty following tonsillectomy remain one of the most difficult pain states to manage in Otolaryngology. Many therapeutic modalities - ranging from non-steroidal anti-inflammatory drugs (NSAIDs) to systemic opioids, acetaminophen, and tramadol - have been used for posttonsillectomy pain control in patients. Gabapentin has been recently found to be useful for reducing acute post-operative pain when administered preoperatively. Although various dose regimens have been tried in different surgical settings, the minimum effective dose is not established. The aim of the study: To study the analgesic property of a single of dose oral Gabapentin for postoperative pain relief, to study the hemodynamic variables in patients receiving oral Gabapentin Materials and methods: A total number of, 60 patients were included in the study group between 6 to 16 years. P group (Placebo group) 30 ASA I patients for tonsillectomy receiving oral placebo, G group 30 ASA I patients for tonsillectomy receiving oral gabapentin during a 24-hour post-operative period, the outcomes of interest being postoperative pain intensity; rescue analgesic consumption; or adverse effects such as sedation, nausea and vomiting, dizziness, and headache. Results: The pain score reported by the physician during the first 8 hours, as well as the need for analgesics during 24 hours postoperatively, were significantly decreased in the gabapentinoids group versus the control group. Additionally, there was no significant difference between gabapentinoids and control groups for adverse effect during 24 hours postoperatively. Statistically, significant sedation was observed up to 4 hours in the postoperative period. After 5 hours there was no statistically significant difference in both groups. Conclusion: Oral Gabapentin is effective for postoperative pain relief, reduces the requirement of supplementary analgesics in the postoperative period. Oral Gabapentin has a better hemodynamic profile. Gabapentin is safe for use in pediatric patients.

38-44

Authors: Ranjini O.M., Paul Praveen, T. Murugan

Introduction: I-gel and the ProSeal laryngeal mask airway (PLMA) are two supra-glottic airway devices with gastric channel used for airway maintenance in anesthesia. This study was designed to evaluate the efficacy of I-gel compared with PLMA for airway maintenance in patients under general anesthesia with controlled ventilation. The aim of the study: To compare the supra-glottic airway devices, I-Gel and ProSeal Laryngeal mask airway with respect to Ease of insertion, Time taken for insertion, Airway leak pressure, Hemodynamic response during intubation. Materials and methods: A total number of, 40 patients were randomized into two groups of 20 each. After induction of anesthesia using a standardized protocol for all the patients, one of the supra-glottic airway devices was inserted. Insertion parameters, ease of gastric tube insertion, airway leak pressure, hemodynamic changes, were noted. Results: There was no significant difference in the incidence of adverse effects in both the groups. One incidence of airway trauma was noted in I-gel group. No gastric insufflations and laryngo or bronchospasm in both groups. Conclusion: Based on the result of our study we conclude that I-gel had an acceptable airway leak pressure of 23 cm H2O when compared to ProSeal whose airway leak pressure is significantly higher i-e 29 cm H2O.Both the devices provided optimal oxygenation and no fall in saturation was observed in both the groups.

51-56

Authors: S. Kalaichelvi, Daranendaranchellapa

Introduction: Diabetes is a polygenic disease characterized by abnormally high glucose levels in the blood. There is evidence that patients with diabetes have an increased risk of Urinary Tract Infections (UTIs). UTI is the most common bacterial infection in diabetic patients. They are also more often caused by resistant pathogens. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. The aim of the study: To determine the clinical characteristics, risk factors, causative organisms and antimicrobial susceptibility in diabetics. Materials and methods: This was an observational study conducted in the medical unit of a tertiary care hospital over a period of 6 months. A total of 100 type 2 diabetic subjects were studied. History, clinical examinations, and the duration of diabetes were recorded in all patients at admission. Diabetes was diagnosed based on the WHO criteria. An immunoturbidimetric method was used to estimate glycosylated hemoglobin (HbA1CDiagnosis of UTI was made from Midstream urine samples of patients if the urine cultures have>103 to >105 colony forming units (CFU)/mL of a pathogen. A pure culture of Staphylococcus aureus was considered to be significant regardless of the number of CFUs. Results: Gram-negative bacilli were isolated from 129 (87.2%) patients which included E. coli in 75 (50.7%), Klebsiella in 30 (20.3%), Pseudomonas species in 12 (8.1%) and Citrobacter in 12 (8.1%). Gram-positive cocci were responsible for UTI in 15(10.1%) of subjects including Enterococcus in 13 (8.9%) and Staphylococcus in 2 (1.3%). Gram-negative bacilli including E. coli, the Klebsiella species, Pseudomonas and Citrobacter had a good response to piperacillin-tazobactam, cefoperazone- sulbactam, imipenam, and amikacin. Gram-positive cocci (Enterococcus and Staphylococcus) responsible for UTI showed good susceptibility to vancomycin (81 and 94% respectively) but a high resistance to ciprofloxacin and tetracyclines (68 and 57% respectively). Conclusion: There is no indication to treat diabetic patients with asymptomatic bacteriuria. Escherichia coli is the most common isolate in the community and hospital-acquired infections in non-diabetics, while Escherichia coli was common in community-acquired infection and pseudomonas was the predominant isolate in hospital-acquired the infection in diabetics.

63-68

Authors: Premlal KV

Background: Spinal dysraphism refers to a spectrum of congenital anomalies of the spine resulting in a defective neural arch through which meninges and / or neural elements herniated leading to a variety of clinical manifestations. Aim: This study aimed to evaluate the incidence, clinical presentations, and surgical outcome in spinal dysraphism patients. Materials and methods: This study was a retrospective study which consisted of 32 patients conducted in Academy of Medical Sciences, Pariyaram over a period of March 2015 to March 2017. All the patients were admitted in Department of Gynecology and Pediatrics. Results: The incidence was high in females 54.29% than males 45.71%. Spina bifida aperta (open type) was present in 44 patients (62.86%) and more common than Spina bifida occulta (closed) which was present in only in 26 patients which constituted 37.14%. The commonest site of occurrence of spinal dysraphism was the lumbo sacral region in 32 patients which constituted to 45.7%. Most common finding was myelomeningocele in 41 (58.6%) cases; myelocele was seen in 6 cases (8.6%). Lipomyelomeningocele was seen in 8 cases which was most common finding in closed type. The most common associated anomaly was hydrocephalus in 25 patients and next common was Arnold Chairi malformation type 11 in 20 cases. Motor weakness in the form of paraparesis or paraplegia present in25 patients preoperatively, out of which only 14 improved. Major cases of sensory deficits did not improved and remained static. In the majority of cases of 11 sphincter function, 6 cases remained status quo same as in the preoperative period. Conclusion: The most common congenital cause of disability in children is spinal dysraphism encountered by paediatric neurosurgeon. Open type spina bifida is more common than closed one .At peripheral centres, inadequatetreatmentshouldbeavoided.Spinaldysraphismpatientsshould be referred to higher tertiary centre where all the facilities are provided to the patients.

79-82

Authors: Veena Narisetty, Kamera Sateesh Kumar, Changala Praveen

Background: IIH is defined as an elevated intracranial pressure but no clinical, laboratory or radiological evidence of hydrocephalus, infection, tumor or vascular abnormality. Aim: To study the clinical and radiological profile of Idiopathic Intracranial Hypertension (IIH). Materials and methods: Total 31 IIH cases were studied. Patients were subjected to Fundoscopy, CT/MRI brain and CSF analysis. Results: Females were predominant and Headache was the most common presenting symptom. All patients had papilledema. Mean CSF pressure was 318.1 mm of H2O. MRI findings included prominent subarachnoid space, vertical tortuosity of optic nerves, flattening of posterior sclera. Conclusion: IIH predominantly affects women with headache being the most common symptom. Medical management and Life style medication is mostly useful. Surgical management is imperative in patients with impending vision loss.

87-91

Authors: Abirami Gunasekaran, Jayalakshmi Ramasamy, Kamatchi Karunanidhi

Introduction: Pericardial effusions can be caused by multiple disease states, including any process that results in pericarditis or myocarditis. The inflammatory reaction in these disease states can result in fluid accumulation in the pericardial space. Systemic manifestations of hypothyroidism can significantly vary according to the thyroid function, the presence of associated diseases and the duration of autoimmunity. Long-term overt hypothyroidism significantly affects growth as well as heart, liver, skin, and kidney functions, causing signs and symptoms that promptly lead to its diagnosis. The aim of the study: To analyze the important diagnostic tool ECG and X-ray finding among diagnosed pericardial effusion adult hypothyroid patients. Materials and methods: The study was conducted in 2017. Patients attending the Outpatient Clinic of the Department of Endocrinology who satisfied the inclusion criteria were registered for the study after obtaining their consent. A detailed questionnaire was used to elicit symptoms of hypothyroidism. ECG and x-ray findings were predicted accordingly. Results: Low voltage complexes were found in 17 patients (24.29%), sinus bradycardia was found in 6 patients (0.09%), the poor progression of R waves in 3 patients (0.04%). The remaining 44 patients had a normal ECG. Chest films showed Mild cardiomegaly in 20 patients (28.57%). 11 of these 20 patients had pericardial effusion on echocardiography. One patient with echo proven pericardial effusion had normal chest X-ray. So chest X-rays can be used to look for clues for pericardial effusion. Conclusion: Clinical features of pericardial effusion show statistically significant association with its presence on echocardiogram. ECG and CXR can be used to predict the presence of a Pericardial Effusion.

98-103

Authors: Ankush Agrawal, Bhuvanesh Kahar, Sushma Pandey

Background: Malaria is a life threatening disease caused by Plasmodium parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Aim: To study of effect of malaria parasitemia on serum electrolytes in south east Rajasthan. Materials and methods: It was a hospital based study done on malaria indoor patients from June 2017 to March 2018 in Jhalawar Medical College, Jhalawar in South East Rajasthan. The relevant history, systemic examinations and thick and thin peripheral blood smear, malaria antigen detection rapid card test was performed and serum electrolytes like sodium, potassium and calcium level were done for all patients. All patients were categorized into three groups like P.falciparum, P.vivax and mixed infection (both P.falciparum, P.vivax). Results: We observed that female was out numbered than male. Most common affected age group was 35-45 years and most of the patients came from the rural region. Severe dyselectrolytemia was noted in mixed infection (both P.falciparum and P.vivax) and P.falciparum cases. Conclusion: Serum electrolytes level are influenced by the presence of all types of malaria severely with mixed infection and P.falciparum positive cases so severe dyselectolytemia in malaria infections should be treated timely to prevent grave complications.

111-116

Authors: B.M. Monisha, G. Kannan, Muthusamy

Background: Acne is one of the most commonly prevalent skin conditions. It commonly affects the adolescents and young adult age groups. The lesions start as microcomedones and progress to nodular or inflammatory acne with post inflammatory hyperpigmentation. Although acne is not life threatening it has multiple impacts in the affected individual’s quality of life and psychological morale. Hence this study was undertaken to analyze the clinical profile of patients having acne vulgaris to facilitate better management. Materials and methods: A cross sectional observational study was conducted among patients attending the dermatological outpatient department in a tertiary care hospital. A pre-tested semi-structured questionnaire was administered to the individuals after obtaining informed written consent. Data on demographical variables, menstrual history and clinical features of acne were collected and presented. Results: A major proportion of the population was comprised of adolescents and young adults similar to previous studies. Around 13% of them had a positive family history of acne. Associated factors such as menstrual flare, increased consumption of dairy products and high glycemic index foods were also present. Almost 88% of the participants had mild acne. Half of them had post inflammatory hyperpigmentation. Conclusions: Most patients of acne vulgaris are either adolescents or young adults. This group is more prone to endocrine co-morbidities such as polycystic ovarian syndrome and impairment in quality of life. Hence considering the above factors, early diagnosis and management of acne vulgaris is essential. This is expected to yield better results in the long term in improving the quality of life in the affected persons.

121-128

Authors: Vasanthakumar M, Gnanaprakasam J

Introduction: Obesity causes reduction of Lung compliance leading to decrease in lung volumes producing mostly a restrictive type of ventilatory defect. Compression of the thoracic cage by excessive fat and increased pooling of blood in pulmonary vasculature mainly contribute towards a reduction in respiratory compliance. Deposition of fat in diaphragm causes mechanical obstruction to the descent of diaphragm thereby causing increased work of breathing and metabolic demand thereby producing breathing difficulty. The aim of the study: To measure the association of body mass index (BMI) to lung volumes assessed by a digital spirometer. Materials and methods: Apparently healthy individuals above the age group of 15 years attending Master Health Check-up OP and attenders of in-patients of wards of general medicine department, Govt. Chengalpattu Medical College, Chengalpattu of either gender were recruited. Height and weight were measured and BMI was calculated as kg/m2. Subjects were categorized as normal (BMI=18.5 to 24.9 kg/m2); overweight (BMI=25 to 29.9 kg/m2); obese Class 1 (BMI=30 to 34.9 kg/m2) and obese class 2 (BMI=35 to 39.9) on the basis of BMI. Lung volumes were measured by digital spirometer and were reported as a percentage of predicted values for forced vital capacity (FVC%), forced expiratory volume in the first second (FEV1%) and the ratio of FEV1 to FVC (FEV1: FVC). Groups were compared using t-test and ANOVA, the correlation was assessed by Pearson's 'r'. Results: Significant differences in lung volumes were found in different BMI categories. Obese subjects had significantly lower FVC% and the significant difference calculated by using One Way ANOVA F = 11.9 with p = 0.0001. Similarly, obese participants have significantly lower values of FEV1% when compared to participants of normal BMI. The significant difference calculated by using One Way ANOVA F = 6.46 with p = 0.0001. Gender and age had no significant effect on mean values of PFTs. Conclusion: Obese individuals in this sample had a significant decline in lung volumes. The presence of nutritional abundance and a sedentary lifestyle, and importantly influenced by genetic endowment, this system increases adipose energy stores and obesity develops which produces adverse health consequences.

138-145

Authors: Sreenivasu Kotagiri, Anup Kumar Songa, Mayuri Vijay Gad, Jaideep Lad

Background: The glenohumeral joint consists of dynamic and static stabilizer, which works, in concert to allow for stability and mobility through a large arc of motion, in recent years there has been significant focus on shoulder motion, particularly in overhead throwing athletes. Glenohumeral internal rotation deficits (GIRD) are common physical impairments in evaluated both adolescent and overhead sports such as baseball, cricket, and tennis. Therefore the aim of the study firstly was to determine the effectiveness of mobilization with exercise in patients with glenohumeral internal rotation deficit and secondly to determine whether mulligan internal rotation MWM with stretching in patients with glenohumeral internal rotation deficit. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. All the subjects were randomly selected and assigned to each group. A pretest measurement with the help of two measures - Oxford Shoulder Instability Score (OSI) for disability, and inclinometer for an internal range of motion shoulder was done in each group. Subjects in Group-A were given mobilizations with stabilization exercise for capsule for a total of 12 minutes a minimum of 4 times per week over a 4-week period and Group-B were given mulligan mobilization with Posterior Capsule Stretching As follows, 1st day 3 glides, 2nd day 3 sets of six glides, 3rd day 3 sets of 10 glides were given and 4th day again 3 sets of 10 was given. A patient who failed to come for 4 days with stretching performed 3–5 repetitions each repetition was held for 30 seconds, four days a week for four weeks total 16 sessions. Results: On comparing Group A and Group B for post-treatment OSI score, results showed a significant difference (p=0.001) in improvement in terms of OSI. On comparing Group A and Group B for post-treatment inclinometer score, results showed a significant difference in improvement in terms of the inclinometer. This study showed that Mulligan MWM along with stretching exercises was more effective to that patient as compared to mobilization with strengthening exercises given to a patient with glenohumeral internal rotation deficit. Conclusion: The study showed a significant difference between both the groups when the values obtained were analysed. It indicated that Group B in Range mulligan mobilization with Posterior Capsule Stretching of Motion in internal rotation and external rotation. Their scores in Index Oxford Shoulder Instability Score (OSI) have reduced which indicates the decreased level of disability and better functional ability.

156-166

Authors: Deepak Bhimani, Varun Garasiya, C. Raychaudhuri

Introduction: Ultrasound helps by detecting lesions, give idea about its internal structure and also give opportunity to evaluate other abdominal organs. However evaluation by CT scan can give additional information, which can modify the course of treatment and prognosis of patient. Materials and methods: Study comprise of 84 patients who were evaluated with ultrasonography and CT scan of abdomen and pelvis. Ovarian pathologies were categorized with benign, malignant and metastasis and compared with histopathological diagnosis or conservative treatment follow up. Results: 84 patients were evaluated; CT scan and sonography are excellent noninvasive modality to differentiate ovarian masses from benign and malignant lesions and both imaging techniques seem to be comparable in differentiation of malignant from benign ovarian tumors. CT scan was more sensitive than ultrasonography, but sonography is more specific than CT scan in diagnosis of malignant lesions. Ultrasonography has high positive predictive value as compare to CT scan to diagnose malignant lesions. Conclusion: Ultrasound by virtue of non-invasiveness, lack of radiation hazard and by ability to demonstrate structural changes in organ is investigation of choice in ovarian pathology and it can easily detect solid to cystic lesions and characterize the size, shape and extent of lesion. Computerized Tomography is particularly useful to know the enhancement pattern of the lesion, density and extent and staging of malignancies.

174-177

Authors: Praphull Deepankar, Umashankar USA, Manish Kumar

Fibrocalculous pancreatic diabetes (FCPD) is a type of chronic calcific non-alcoholic pancreatitis. This type is reported mostly in the developing tropical and subtropical countries. Definite diagnosis of FCPD requires younger age of onset, history of malnutrition, and presence of diabetes mellitus along with extensive pancreatic calcification and ductal calculi. Pain abdomen is one of the classical clinical triad of the disease with steatorrhoea and diabetes. In this case report we are presenting a case of 17 years old girl with past history of recurrent pain abdomen for last two years. She came to casualty with complaints of generalized weakness along with pain abdomen. She was diagnosed as case of FCPD with uncontrolled hyperglycemia on subsequent investigations. Importance of this case is that patient has multiple episode of abdominal pain over two years and she consulted several practitioners for the same and she was treated symptomatically without proper work-up. However, FCPD is a rare entity but should be considered in case of recurrent abdominal pain in young patient.

1-6

Authors: Rathod S, Santosh Kumar, Rathod GB, Parmar P

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level.

17-22

Authors: Abhinav Agarwal, J.E. Jeffin Shanu, Shankar K

Background: Hepatitis B is a global public health problem that causes chronic liver disease and death due to Cirrhosis of liver and Hepatocellular carcinoma. Prevalence of Hepatitis B is increasing in developing countries and there is a paucity of information among medical students regarding its transmission and vaccination. Scientific knowledge regarding the same is necessary for medical students for taking protective measures as Hepatitis B is highly communicable. Aim and objectives: To evaluate Knowledge, Attitude and Practice (KAP) among medical students towards HBV and correlate the level of awareness with the attitude they behold towards the disease, its transmission and prevention and to determine the vaccination status for Hepatitis B among medical students. Materials and methods: Cross sectional study where a total of 200 subjects including House surgeons were interviewed using a validated structured questionnaire Results: A total of 145 (72.5%) students were completely vaccinated with HBV vaccine. Among these, preclinical students were 76 (38 %) and clinical 69 (34.5%) in number. Around 96(48%) students felt they would not get Hepatitis B infection while 26(13%) thought Hepatitis B is self-curable by the body. Students having good knowledge regarding HBV were 86 (43%), good attitude towards HBV were 125 (62.5%) and 145 (72.5%) followed good practice for HBV prevention. Conclusion: This study showed fairly moderate outcomes with important gaps. Lack of vaccination of all the students makes them vulnerable to liver disease. It is mandatory that they be fully vaccinated prior to their entry into professional practice. In spite of having good knowledge, their practice for prevention was not satisfactory.

29-35

Authors: Ramana PV, Vijaya Nirmala B, Srujana Shyamala

Background: Squash cytology has shown to be of great value in intraoperative consultations of central nervous system lesions. Intraoperative smear cytology provide a rapid and reliable diagnosis and guidance to the neurosurgeon during surgical resection and lesion targeting. Squash smear technique saves time and amount of tissue needed. Aim: To study the validity of rapid intraoperative diagnosis of central nervous system lesions by examining the squash cytologic smears of central nervous system lesions. Materials and methods: A total of 111 cases of intracranial space occupying lesions were studied. This squash smears were prepared from the intraoperative biopsy samples and remaining tissue fixed in formalin and sent for histopathological examination. Squash smears were stained with toluidine blue and rapid haematoxylin and eosin. Squash smear cytological diagnosis was correlated with histopathological findings. Results: Out of 111 cases, in 11 (9.9%) cases showing discordance was observed between squash smear diagnosis and histological diagnosis. In 100 (90.1%) cases, squash smear diagnosis was in accordance with the final histologic diagnosis. Thus the value of squash smear technique in rapid intraoperative diagnosis of neurosurgical biopsies was corroborated by above study and the accuracy of this study match with other studies done in the past on squash smear technique. Conclusion: Squash smear cytology should be used regularly for rapid intraoperative diagnosis of central nervous system lesions, as squash smear technique is economical, reliable, feasible intraoperative rapid diagnostic method and has a place in determining the immediate management.

48-58

Authors: Ajay Kumar Reddy Bobba, D. Bhanu Kiran, Naidana Partha Sarathy

Background: A Juvenile is a person or child who has not completed the age of 18 years. A Juvenile delinquent is a child who has not attained 18 years of age and who committed an offence under existing law. Juvenile delinquency is a behavior disorder of deviant adults. Its spectrum extends from misbehavior to assault and includes robbery and heinous crimes. Aim: To study the health, nutrition status, socio-demographic profile and risk factors of the juvenile delinquents. Materials and methods: The present study was a cross sectional study undertake in government observation home for boys to study the health status of 175 juvenile delinquents in 8 months period of time. Results: Higher Age Group Delinquents are having more habits which were statistically significant when compared with other age group delinquents. The parents of the majority of the delinquents were illiterates and working as a daily laborers and belong to low socio economic group. The findings of the study proves that the risk factors for juvenile delinquency were lack of parental supervision, parental negligence, single parent, illiteracy, poverty, ignorance, child abuse, low socio economic status, urbanization of the society and life pattern, lack of cultural influence, non-exposure of juveniles to good recreational facilities and hobbies. In Nuclear Families, habits in delinquents are at higher side which is statistically Significant when compared with Delinquents who lived in other type of families. The majority of the juveniles have behavioral disorders like smoking, drinking alcohol, absconding and doing theft. Most of the juvenile delinquents are healthy and very few of them are anemic. Conclusions: Well-trained Health Workers, Social Workers, Psychologists, Nutritionists, Artists, Sportsman, Teachers are of immense importance and much needed for the task of juvenile correction and development. Parents must be given proper counselling to avoid repetition of the juveniles.

68-80

Authors: Bhanu Kiran Daniyala, Ajay Kumar Reddy Bobba, Naidana Partha Sarathy

Background: Occupational risks alone account for 1.7% of disability adjusted life years (DALY) lost worldwide. Occupational exposure to airborne particulates is estimated to cause 12% of deaths due to chronic obstructive pulmonary disease. Aim: To study the socio demographic profile and morbidity status of jute mill workers exposed to occupational hazards. Materials and methods: It was a cross sectional study carried out for a period of 9 months. Simple random sampling technique was applied to select the samples from jute processing departments like Selection, Batching, Carding, Preparing, Spinning, Winding, Beaming, Weaving and Finishing. Results: There was a no statistical significant association (P>0.05) found between per duration and type of work. There was a statistical significant association (P<0.05) found between Section of work and Housing condition of workers. P value 0.000 statistical significance was found between the total number of workers and drinking habit. There was a statistical significant association (P<0.05) found between Section of work and Addictions of workers. Statistical significant association (P<0.05) was found between other Health problem and Sex. Conclusion: The results highlight a lack of adequate work safety practices in the jute mill workers. Workers experience various work-related hazards and health problems.

87-91

Authors: Jalli Padmaja, Kuthadi Swarupa

Background: Before onset of labour if premature rupture of membranes occurs, then it is called premature rupture of membranes. This study was conducted to evaluate the maternal and perinatal outcomes in term PROM cases. Materials and methods: This was a prospective study which was conducted during May 2015 to June 2016, on 75 cases of rupture of membranes spontaneously after 37 completed weeks who were admitted in department of obstetrics and gynaecology, Osmania Medical College, Hyderabad. Results: History of term PROM was seen in 15% of the patients, History of abortion was seen in 12% of the patients and history of preterm PROM was observed in 7% of patients. When risk factors and PROM were compared, anaemia was 20%, UTI was 10%, lower genital infections were 8%, cervical stich was 2%, mal-presentations were 4%, hydramnias were 4% and there were no risk factors in 27% of the patients. Favourable bishop score was observed 30 patients undergoing vaginal delivery, 10 in LSCS, and unfavourable bishop score was observed in 20 patients undergoing vaginal delivery, 9 in LSCS. Number of cases in maternal morbidity was highest in > 24 hours i.e. 26.7%, perinatal morbidity cases were highest in 12-24 hours i.e. 30% and mortality among perinatal cases were 5% in 12-24 hours and >24 hours of PROM. Conclusion: This study concluded that premature rupture of membranes incidence was higher in women of unbooked cases and in those with previous history of abortions and premature rupture of membranes. The concomitant increase in incidence of maternal morbidity and perinatal morbidity and mortality with an increase in the duration of labour and delivery and thus rate of caesarean delivery was increased.

100-106

Authors: Bhavik Prajapati, Shirish Raval, Jigar Patel, Ishwar Parmar, Janak Chokshi, Nilay Thakore

Background: In today’s era lifestyle related diseases like diabetes mellitus, have emerged as a major public health problem. Diabetes mellitus, a common metabolic disorder, which accounts for a high incidence of morbidity leads to various events including micro and macro vascular complications. This study aims to assess the baseline levels of (KAP) knowledge, attitude and practices of general population of Vadodara. Materials and methods: The present cross sectional study was carried out on general population of Vadodara with the help of a suitably designed and validated KAP questionnaire. The questionnaire was pretested and verified for errors. The data was analyzed statistically. Results: Altogether, 60.12 % of respondents scored 100% in the questions related with knowledge. However 23.54% scored 100% in the attitude questions and12.80% scored 100% in practice questions. Conclusions: We can conclude that the responders had good knowledge but poor attitude and practice towards diabetes. We can overcome this by increasing quality of health education and improving applicability of scope of health education at all level. The effect of the hormonal changes associated with menopause may play an important role in most cardiovascular disorders in post-menopausal women. So the present study was undertaken to identify various cardiovascular profile changes in postmenopausal women and women were recruited for the study. We check for various parameters like hypertension, diabetes, Ischemic heart disease, Cerebrovascular Stroke, metabolic syndrome, anaemia, fundus examination. Results: Prevalence of Hypertension, dyslipidaemia, metabolic syndrome, CV stroke, ischemic heart disease is higher in postmenopausal women. Five deaths due to cardiovascular disease were observed. This study showed high prevalence of most of the conventional cardiovascular risk factors, especially diabetes, hypertension, dyslipidemia, obesity, and other risk factors in postmenopausal women. Therefore it is important to consider each and every postmenopausal woman to undergo screening for cardiovascular profile and very important to identify and treat these cardiovascular risk factors properly to prevent mortality and morbidity.

113-118

Authors: Praveena K.R., Pramod Kumar K.R., Prasuna K.R., Krishna Kumar TV

Background and objectives: Thyroid disorders are among the common endocrine disorders in pregnant women. Our aim was to know the prevalence of thyroid dysfunction in pregnancy and its impact on obstetric outcome in Indian population. Materials and methods: It was a prospective study which involved screening of 1000 pregnant women coming to routine antenatal check-up in first trimester. TSH level was estimated. If it was deranged, then FT3 and FT4 levels estimated. Patients were managed accordingly and followed till delivery. Their obstetric and perinatal outcomes were noted. Results: Prevalence of thyroid dysfunction was high in this study, with subclinical hypothyroidism in (6.9%) and overt hypothyroidism in (3.4%) women. Overt hypothyroids were prone to have preeclampsia preeclampsia (14.7%), abruptio placenta (2.9%), preterm delivery (8.8%), abortion (11.8%), IUGR (11.7%), LBW (11.7%), still birth (2.9%), which is comparable to other studies. Overt hyperthyroids were prone to have miscarriage (66.7%) which was significantly high. Conclusion: Prevalence of thyroid disorders, especially subclinical hypothyroidism (6.9%) and overt hypothyroidism (3.4%) was high. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.

126-130

Authors: Priyanka Poonam, N.K. Bariar

Generally patients suffering from leukemia complain of very vague symptoms of low grade fever for 2-3 months, weight loss, loss of appetite, fatigue, recurrent infections, petechiae in the body. Thus high index of suspicion and proper diagnosis is needed. The patients who attend tertiary care centre with above symptoms should be initially diagnosed by doing complete blood count, peripheral blood smear examination followed by bone marrow aspiration and its examination. It provides high quality visualization of cell morphology and enables differential count. A total of 1793 patients attended Department of Pathology in the tertiary care centre for bone marrow examination. Of this majority of cases were diagnosed with erythroid hyperplasia with megaloblastic reaction. 152 cases were diagnosed with leukemias. There were 66 cases of ALL, 46 cases of AML, 35 cases of CML, 3 cases of CLL and 2 cases of CEL. Few cases of Multiple Myeloma, plasma cell dyscrasias and immune thrombocytopenic purpura were diagnosed. In this study, we have analysed the incidence of different types of leukemia in different age groups and their presenting sign and symptoms.

139-143

Authors: Wakil Paswan, Bankey Behari Singh

Background: Seizure is the most frequent sign of neurologic dysfunction in the neonate. Biochemical disturbances occur frequently in neonatal seizures either as an underlying cause or as associated abnormalities. Early recognition and treatment of biochemical disturbances are essential for optimal management and satisfactory long-term outcome. The aims were to study the biochemical abnormalities in neonatal seizures and to describe the clinical presentation, time of onset and its relation to etiology of neonatal seizures. Materials and methods: The present study included 125 neonates presenting with seizures admitted to neonatal unit. Detailed antenatal, natal and postnatal history was taken and examination of baby was done. Then relevant investigations including biochemical parameters were done and etiology of neonatal seizures and their associated biochemical abnormalities were diagnosed. Results: In the present study out of 125 neonates studied. 112 were full-term of which, 97 (77.6%) were AGA and 15 (12%) were SGA, 11(8.8%) were preterm and 2 (1.6%) was post-term babies. 121 (96.8%) were hospital deliveries and 110 (88%) were spontaneous vaginal deliveries. 78 (62.4%) were with birth weight > 2.5 kg. In our study, 90 (72%) cases had on set of seizures within first 3 days. The highest number was seen on first day of life 70(56%). Subtle seizures were the most common type of seizures in our study 52 (41.6%). Birth asphyxia was the most common cause of neonatal seizures in our study 68(54.4%), followed by neonates meningitis 21 (16.8%) and metabolic disorders 12 (9.6%). The most common biochemical abnormality detected in neonatal seizures in Hypocalcemia and Hypoglycemia. Conclusions: Hypoxic ischemic encephalopathy was the commonest etiology of neonatal seizures and in them most of the seizures had on onset in the first 72 hours. Overall focal clonic and subtle seizures were the commonest seizure types encountered. Hypocalcemia was the commonest biochemical abnormality in primary metabolic seizures. Biochemical abnormalities were commonly associated with other etiologies like asphyxia, intracranial hemorrhage and meningitis; hence these should be actively sought for and treated for optimal seizure control.

153-160

Authors: S.A. Krithika, N. Nalini Jayanthi, S. Subramanian

Background: Tuberculosis is a leading infectious killer disease worldwide. Early diagnosis and prompt treatment on the part of the health care providers is essential for TB control. Their knowledge, attitude and practice have an impact on the tuberculosis patients regarding compliance to treatment and follow up. There are limited studies in India assessing the knowledge of nursing professionals regarding TB transmission, prevention and control. This study seeks to assess the same. Materials and methods: A cross-sectional study was conducted at SRM Medical College and Research Centre, Potheri, Kanchipuram district. A pre-tested self-administered questionnaire was given to 224 nursing staff. The responses were then analyzed. Results: A high proportion (71.80%) of awareness was found regarding the causation of TB by bacterium, air-borne method of spread and over-crowding being a significant risk factor. A lesser proportion of the participants were aware that TB does not spread by breast feeding (54.9%) or hand shaking (33%) and that ATT should be continued during pregnancy. Levels of knowledge on the preventable nature of TB infection (56%) and the availability of ATT were also found to be low. Conclusions: This study indicates the need for addressing the gaps regarding the knowledge and transmission of TB among the nursing care professionals. Nursing professionals still are in need of continuing educational programs regarding treatment and control of TB. Improved knowledge on TB will thus contribute to effective TB control and in the long term, will help India achieve the goal of End TB.

1-7

Authors: Amrit Kejriwal, Arpan Singh Chouhan, Jaishree Ghanekar

Background: Hematocrits have always been helpful to doctors as they are important parameters used on a daily basis. With the latest technology one can measure different indices of platelets mainly Plateletcrit, PC, MPV, PDW. Aim and objectives: To study the role of platelet distribution width as a prognostic factor of outcome in hemorrhagic stroke. Materials and methods: This study included 35 patients of hemorrhagic stroke coming to MGM hospital, Kamothe. Results: The study contained of 13 females and 22 male patients. Group A consisted of 5 patients. As the patients expired within 24 hours, only a single value of PDW was available in these patients. The mean of the PDW of these patients was 16.92 with a SD of 1.22. Conclusion: PDW may act as a prognostic factor of mortality in hemorrhagic stroke.

15-22

Authors: G. Indhumathi, K. Suresh Kumar

Introduction: Sedentary lifestyle, low fiber, high fat and energy-rich foods have penetrated even the rural India in the name of globalization. All these will come not without cost. India is now facing the paradox of malnutrition on one hand and epidemic of obesity on the other. Indians three times higher risk of developing Coronary Artery Disease (CAD) compared to Chinese and are 20 times more likely to die due to CAD compared to native black or white South Africans. The aim of the study: To find out the prevalence of Central Obesity, Hypertension, Impaired Fasting Glucose or Diabetes mellitus, Hypertriglyceridemia and low HDL cholesterol and to analyze the differences in their prevalence among the age groups, sex, social class and chronic and acute coronary syndromes. Materials and methods: All patients belonged to a low socioeconomic group attended medical outpatient department or those who were getting admitted medical ward of Govt. Dharmapuri Medical College, Dharmapuri with coronary artery disease (CAD) were included. Results: Mean of age for males (CI: 55.49± 22years) and females (CI: 51.87±24.7years) lied within one standard deviation from the sample mean. 59 patients (52.2%) had central obesity. 64.2% patients in age group <40 years, 41.4% in age group 40-60 years and 72.4% in age group >60 years had central obesity. This increase in the prevalence of central obesity among younger (<40 year) and older age group (>60 years) was significant. 84 patients (74.34%) had hypertension. 71.43% patients in age group <40 years, 77.14% in age group 40-60 years and 68.96% in age group >60 years had hypertension. There was no significant difference in prevalence of hypertension among age group.57 patients (50.44%) had diabetes or IFG. 50% patients in age group <40 years, 40% in age group 40-60 years and 75.86% in age group >60 years had diabetes or IFG. This increase in the prevalence of Diabetes and IFG among younger (<40 year) and older age group (>60 years) was significant. 48 patients (42.48%) had hypertriglyceridemia. 50% patients in age group <40 years, 32.86% in age group 40-60 years and 62% in age group >60 years had hypertriglyceridemia. 54 patients (47.78%) had metabolic syndrome. 50% patients in age group <40 years, 37.14% in age group 40-60 years and 72.41% in age group >60 years had metabolic syndrome. This increase in the prevalence of metabolic syndrome among younger (<40 year) and older age group (>60 years) is significant (X2- 10.25, p=.006). Conclusion: The result of the present study suggests that in urban patients who live below poverty line with symptomatic coronary artery disease there in the increased prevalence of metabolic syndrome, central obesity, hyperglycemia, hypertension, and dyslipidemia. The higher prevalence particularly noticeable in those with the premature coronary artery disease and that might have resulted in earlier onset of CAD in them.

30-33

Authors: Ganesamoorthy Karupasamy, K. Karthick

Introduction: In 20 to 40% of all diabetes mellitus patients some abnormalities of autonomic function is present. Diabetic autonomic neuropathy can involve both sympathetic and parasympathetic nervous system. Parasympathetic abnormalities appear earlier and sympathetic innervations may remain intact even in presence of severe Parasympathetic damage. The aim of the study: To determine the various aspect of autonomic neuropathy in the diabetic population using series of standardized test, to interpret the different type of presentation of autonomic neuropathy in diabetes mellitus. Materials and methods: Sixty patients with mean age of 57.7% who had non-insulin dependent diabetes mellitus, varying from one year to fifteen years duration with normal 12 lead electrocardiograph were selected for the study. With standard autonomic function test procedures for both sympathetic and parasympathetic were done with suitable inclusion criteria. Results: Peripheral neuropathy was observed in 40% (24/60) of patients. In 46.6% (28/60) patients Pupillary changes were observed. In patients with peripheral neuropathy, 95.8% (23/24) had Pupillary changes. Postural hypotension was observed in 36.7% (22/60). The results of various tests of autonomic function are as follows. While interpreting the results all borderline cases were considered as normal. The rise of heart rate less than ten was observed in 40% of study group with mean of6.94.Among the patients, 36.7% (22/60) had fallen in blood pressure of more than 30millimeter of mercury. Conclusion: Newer drugs have to be tried for comforting many diabetics with clinical autonomic neuropathy afflicted with this condition in that at least the quality of life of with diabetic neuropathy will improve.

44-54

Authors: Giridhar Bellamkonda, Sri Kavya

Background: Cataract surgery and intraocular lens implantation restores near normal visual acuity in otherwise healthy eyes, safe surgery, postoperative emmetropia and early resuming of normal activities are three major considerations of present day cataract surgery. Aim: To evaluate and compare surgically induced altered refractive status following superior versus temporal incision in small incision cataract surgery. Materials and methods: 100 cases of cataract surgery were selected for study of post-operative refractive status in superior versus temporal incision in cataract surgery. A complete ocular examination including anterior and posterior segment examination and general physical examination was performed in all cases. Results: Majority (75%) of patients of the present study who underwent cataract extraction belonged to age group of above 50 years with maximum preponderance in the age group of between 61-70 years. The minimum amount of astigmatism one week after surgery in Group – 2 was 0.5D and the maximum amount was 6.0D. The average amount of astigmatism one week after surgery in Group – 2 was 2.75D. The minimum amount of astigmatism 6 weeks after surgery in Group – I was 0.25D and maximum amount was 4.0D. The minimum amount of astigmatism 6 weeks after surgery in Group – 2 was 0.25D and maximum amount was 2.0D. The complications were seen in early postoperative period more in superior incision group than in temporal group. Astigmatism was cleared in temporal group when compared to superior incision group. After 6 weeks of postoperative follow-up, visual acuity of every patient was recorded after giving proper pseudophasic correction. Temporal Incision had 92% 6/6 -6/9 and 6/12-6/18 visual acuity. Conclusions: Amount of astigmatism was less in temporal incision SICS than superior incision SICS. The postoperative refractive status, is also good in temporal incision SICS than superior incision SICS.

60-70

Authors: Muath Aleid

Clinically, six minute walk test (6MWT) is the most common exercise test. It is used to estimate the level of physical fitness among patients. The aim of this research to measure the beat by beat heart rate slopes instead of depending on the covered distance to predicate and estimate the level of physical fitness during 6MWT. Seventy (70) healthy adult male students aged between 18 to 27 years were recruited randomly from the general Saudi population in Riyadh. 6 MWT using 50 meter corridor was performed according to standardized American Thoracic Society (ATS) guidelines. Mean distance walked in 6 minutes (470.5±64.6 meters) and beat by beat heart rate (HR) was calculated by heart rate monitor. In addition Body mass index (BMI), Body surface area (BSA), Borg Rating of Perceived Exertion (BRPE) and Maximum predicted heart rate percentage (MPHRP) was also calculated. A stepwise regression equation was used to predict six minute walk test distance (6MWTD), six minute walk test slope (6MWTS) and recovery slope. There was a significant correlation between 6MWTS and the recovery slope (r= -0.460, p <0.001), 6MWTS with 6MWTD (r= 0.264, p<0.05) and recovery slope with 6MWTD (r= -0.249, p <0.05). In conclusion, both 6MWTS and recovery slope can predict the 6MWD.

77-87

Authors: Shadab Maqsood, Tasaduq Ahmad Khan, Shaafiya Ashraf

The challenge in the imaging of abdominal trauma is to accurately identify injuries that require early exploration and at the same time avoid unnecessary operative intervention in cases that can be managed conservatively. To ascertain degree of trauma, a rapid, cost effective, safe and reproducible investigation used is ultrasonography. However limited information by USG limits its role in trauma. The advent of Multi Detector Computed Tomography (MDCT) is a major advancement in evaluation of patients of abdominal trauma by offering decreased scanning time, increased resolution owing to thinner collimation and reduced partial volume and motion artefacts. The aim of the present study was to assess role of Multi detector computed tomography (M.D.C.T) in evaluation of patients of blunt abdominal trauma and to assess the utility of multi planar reformations (MPR), maximum intensity projections (MIP) and 3-D reconstruction in patients of blunt trauma abdomen. At the outset of the study, a detailed history was taken, general physical examination and relevant local examination findings were recorded. Relevant laboratory examination findings were recorded. The most common mode of injury was road traffic accident (RTA) accounting for approximately 69.5% (32/46) of cases Pattern of the injuries showed that the liver was the most commonly injured organ accounting for 34.78% (16/46) of injuries The management plan of the patients prior and after MDCT examination which was guided by demographic profile like age, clinical status of the patients; time elapsed since injury and initial sonographic findings if done was studied. The use of multi detector CT in initial triage of clinically stable patients with blunt abdominal trauma results in reduction in number of unnecessary laparotomies by 91% and helps guiding initial management in emergency department in virtually every patient with high success rate of around 95%. The MDCT grade of solid organ injury does not correlate with management plan in patients with blunt abdominal trauma. The high resolution MPR, MIP, 3-D volume rendered images not only helped in displaying complex injuries but also increased diagnostic capabilities, accuracy and shortened the reporting time. The high resolution MIP and 3-D volume rendered images gave quick and prompt diagnosis of associated vascular and bony injury.

97-105

Authors: K. Sharada, Hema Warrier, Ajay Kumar Reddy, P. Thulasi

Background: Induction of labor is defined as the process of artificially stimulating the uterus to start labor. It is usually performed by administering oxytocin or prostaglandins to the pregnant woman or by manually rupturing the amniotic membranes. Objective: Main objective of the study was to find out are there any differences in maternal and neonatal / fetal outcomes after induction labor with misoprostol and oxytocin beyond 37 weeks of gestation. Materials and methods: This was a hospital-based study carried out in 431 inductions of labor during the study period. Total 327 women met the criteria and were enrolled into study. Misoprostol of 25 μg was inserted in posterior fornix of vagina or oxytocin infusion was started from 2.5 units on whom induction was decided. Maternal and fetal/ neonatal outcomes were observed. Collected data were analyzed using SPSS and MS Excel. Results: Analysis of onset of labor led to the finding that mean onset of labor was much rapid in oxytocin (7.2 h) than misoprostol (12.7 h). However, there is similarity in induction–delivery interval in both groups. Overall, the rate of normal delivery and caesarean section was found to be 64.8% and 38.2%, respectively. Fetal distress was found as the most common reason for caesarean section. The overall occurrence of maternal complication was found to be similar in misoprostol and oxytocin groups, nausea/vomiting being the most common complication followed by fever. Besides this, the most common neonatal complication found in overall cases was meconium stained liquor. Conclusion: It was found that misoprostol was used most frequently for induction of labor compared to oxytocin. The onset of labor was found to be rapid in oxytocin than misoprostol. However, the occurrence of side effects was found to be similar in both misoprostol and oxytocin groups.

113-119

Authors: Mohanakrishna Meka

Background: This study was to show the advantage of Honey dressing over conventional saline dressing in the management of chronic non healing ulcer. Materials and methods: This was an open study comparing conventional normal saline dressing and honey dressing in the management of chronic non healing ulcers done during July 2014 to June 2015 in general surgical wards of government TD medical college, Alappuzha. Results: Factors assessed include average hospital stay, culture sterility pre and post dressing, their outcome plan (discharged, amputated or grafted), whether diabetes and vascular compromise has altered the results in two groups etc. As in evidence with ancient literature and studies in modern literature it was proved that irrespective of age, sex, distribution of diabetes and vascular compromise in Doppler; honey dressing was significantly advantageous over conventional normal saline dressing in terms of culture sterility, better outcome plan as well as less stay in hospital. Conclusion: The honey dressing is a better alternative to conventional normal saline dressing which can also pave way for decrease in antibiotic resistance.

124-127

Authors: Saba Khan, Meenu Rani

Thyroid malignant tumors are rarely associated with hyperfunctioning thyroid. The incidence of this co-incidence is highly variable. Here we report a rare case of papillary thyroid cancer associated with hyperthyroidism with brief literature review. 34 years-old female, presented with palpitation, excess sweating and weight loss for two months duration. There was asymmetrical swelling of the neck, more on left side which moves with deglutition. The result of histopathological examination confirmed papillary thyroid carcinoma. Literature review has showed an increasing number of papers reporting the association of high level of thyroid function tests and thyroid malignancy. Although the coexistence of them is rare, thyroid malignancy should be put in the differential diagnosis of hyperthyroid goiter and we can conclude that histopathology is the gold standard for the confirm diagnosis.

1-5

Authors: Gamit DN, Mishra A

Introduction: India leads the world with largest number of diabetic patients and is often referred to as the diabetes capital. Diabetic dyslipidemia in India is one of the main causes for Coronary Artery Disease (CAD) mortality of the world. Dyslipidemia are disorders of lipoprotein metabolism, including lipoprotein overproduction or deficiency. It is a preventable risk factor which is mostly observed in diabetes patients and that may precipitate the cardiovascular disorders. Our aim of the study is to determine the impact of type 2 diabetes mellitus (T2DM) on lipid profile of diabetic patients reporting at tertiary care hospital. Materials and methods: It was a cross sectional study conducted at Civil Hospital and Gujarat Medical Education Research Society, Medical College, Valsad, Gujarat, India. Total 140 diabetic patients were randomly selected form OPD and IPD of our hospital and they were examined for dyslipidemia. Fasting blood glucose concentration and Lipid Profile [Total Cholesterol (TC), High Density Lipoprotein (HDL), Very Low Density Lipoprotein (VLDL) and Triglycerides (TG)] were investigated by using commercially available reagent kits in Biochemistry analyzer. Collected data was analyzed by using appropriate software. Results: Out of total 140 diabetic patients examined, the mean age of patients was 48.93 ± 12.1 years. In present study we found the mean Fasting Blood Sugar (FBS) was 188.76 ± 54.63 mg/dl. The prevalence rates in our study for high Total Cholesterol (TC) and Triglycerides (TG) were 13.6% and 41.4% respectively. The prevalence rates for high LDL-C, very high LDL-C and low HDL-C in the diabetic subjects were 8.6%, 5.0% and 72.9% respectively. Conclusion: The diabetic patients had elevated serum total cholesterol, elevated triglyceride (triacylglycerol) and slightly elevated low density lipoprotein (LDL-C) and reduced levels of high density lipoprotein (HDL-C) indicating that diabetic patients were more prone to cardiovascular diseases.

12-19

Authors: J. Radhika, P. Kayalvizhi

Background: Control of post-operative pain is a major concern for the patients and also for the treating physicians. Various analgesic agents such as opioids, nonopioids through various routes such as oral, intravenous, neuraxial, regional for the management of postoperative pain exist. Magnesium has anti-nociceptive properties with additional enhancement of opioid anti-nociception when used epidurally. Materials and methods: The study was a randomized open labelled controlled trail, conducted in the department of anaesthesiology, Govt. Mohan Kumaramangalam Medical College and Hospital, Salem, Tamil Nadu. The data collection for the study was done between June 2016 to June 2017. The study population included people who were undergoing lower limb surgery for various disease conditions. The key outcome variables assessed were highest sensory blockade, time taken for highest sensory level (min), duration of surgery (min), time for regression to L1 (min), duration of analgesia (min). Results: Duration of analgesia was longer in the Magnesium sulphate group, with analgesia lasting for 143.4 +39.57 minutes which was statistically significantly higher compared to Epidural Fentanyl group with 107 (±25.82) minutes. The mean time for regression to L1 was 118 minutes and 119 minutes in group F and FM respectively, there is no statistically significant between two study groups (P value>0.05). There was no statistically significant difference between the groups in the time taken for the highest sensory level (P value>0.05), the duration of surgery and the time taken for the highest sensory level (P value>0.05). Conclusion: Magnesium being a relatively harmless and inexpensive molecule, a non-competitive, N-methyl-D-aspartate receptor antagonist with its anti-nociceptive properties has a huge role to play in the coming years for postoperative analgesia.

27-29

Authors: Akshay Caudhary, Pragnesh Parmar

Introduction: All over the world, cases of snake bite via poisonous snakes are common and as India is a tropical country great variety of snakes are present. Almost 60,000 people are bitten by snakes every year in India with a mortality rate of almost 25%. Various ocular manifestations like angle closure glaucoma, optic neuritis, external ophthalmoplegia and vitreous hemorrhage following snake bite may result in blindness. The present study was conducted with an aim to study various ocular manifestations of snake bite among cases came to tertiary care hospital, Valsad. Materials and methods: Total 100 cases were included with history of snake bite with ocular manifestations over a period of 2 years from January 2015 to December 2017 from records at tertiary care hospital, Valsad. Detail history and complete ophthalmologic examination findings of every case were taken for study. Results: Out of 100 cases, 78 were male and 22 were female. Maximum cases (26%) were in age group of 41-50 years while least cases (4%) were in age group of < 10 years. Most common snake was viper (71%) unknown (17%) followed by cobra (12%). Most common ocular manifestation was subconjunctival hemorrhage (70%), followed by acute anterior unveitis (32%). Least common finding was external ophthalmoplegia (12%). Conclusion: Subconjunctival hemorrhage is the most common finding in snake bite case with ocular manifestation. Male are more prone to snake bite and cases are common in age group of 41-50 years

38-42

Authors: S Vijayalakshmi

Background: Ulcer healing in the diabetic patients is challenging due to a prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence. Recombinant human epidermal growth factor (REGEN-D 150), which was cloned and over expressed in E. coli, has shown enhanced healing of chronic diabetic foot ulcers (DFU) by significantly reducing the duration of healing in addition to providing excellent quality of wound healing and re-epithelization. Aim: To compare the efficacy and safety of collagen granule dressings and conventional dressing in deep wounds in terms of reduced healing time, number of dressing, healing quality and complications. Materials and methods: Thirty patients with foot ulcer were evaluated. A recombinant human Epidermal growth factor gel or conventional dressings were applied, and the patients were followed as per standard post-application treatment protocol. Patients underwent dressing changes every day until wound healing or for maximum period of 12 weeks. Changes in wound size were recorded when the dressing was removed; and at 4 and 12 weeks. Results: Common age groups were 41-50 and 51-60 years of age. Complete healing was present in 12 cases. Conclusion: There was statistically significant difference between the results of Recombinant human epidermal growth factor gel and saline dressings as collagen dressings had better healing response rate as compared to placebo when given along with standard treatment of diabetic foot ulcer.

48-56

Authors: Sheshrao S Chavan, Siddheshvar V Birajdar, Nikhil R Pawar

Introduction: Present study aimed to evaluate the clinical profile of patients with alcohol use disorder and to study the associated derangements in their haematological and biochemical profile. Materials and methods: A hospital based observational study was conducted in medicine ward of a tertiary care Hospital during January 2016 to June 2017. Study subjects included 150 patients of alcohol use disorder admitted to general medicine ward during the study duration. A similar number of age matched controls were also included. Patients included in study were asked for detailed clinical history and history of alcohol consumption, type, quantity and its duration. Alcohol use disorder was diagnosed as per DSM V criteria. All the study subjects underwent following laboratory tests: complete blood profile, lipid profile and liver function tests. Results: Out of 150 patients, maximum patients were in the age group 41-60 (46.7%), 46% were in age group 25-40, and 7.3% were in age group 60-80. All patients were male and there was no woman. Most common diagnosis encountered in study patients was liver cirrhosis (38%) followed by anaemia (9.3%). On the basis of discriminant analysis TC, Apo B, and LDL/HDL-c among lipid measures and AST and GGT among liver enzymes emerged as the variables which can significantly discriminate between alcohol dependents and non-dependents. Conclusion: Heavy alcohol consumption for prolonged periods results in marked derangement of lipid profile and various biochemical and hematological parameters. Combination of more than one marker can be used in non-specialized settings in identifying alcohol-dependent and non-dependent subjects by using limited number of tests. Screening for alcohol use disorder should be done in all adult patients presenting to hospital, to detect alcohol use in its early stages so that interventions can be planned effectively.

64-71

Authors: A.K. Rajendran, C. Arun Babu, Gnana Sezhian

Background: Surgical site infection is a common cause of morbidity for the operated patients. Hence a cost effective and simple method was formulated and studied on cases of laparotomy and appendicectomy patients which can be categorized as dirty and contaminated wounds. Materials and methods: 25 cases and adequately matched controls were selected from patients who underwent laparotomy or appendicectomy which can be categorized as dirty or contaminated wounds. Cases were given local application Inj. Amikacin over the subcutaneous plane preoperatively and for the subsequent three post-operative days through a subcutaneously placed feeding tube along with systemic iv antibiotics. The control patients only received systemic IV antibiotics. ASEPSIS scoring was used to grade the post-operative surgical site infection in the cases and the corresponding controls, at the end of the first and second week after surgery. Various criterions were specifically evaluated such as the isolation of microbe from the wound site or the requirement of change of antibiotic at the end of the 1st or 2nd week and the tendency of prolonged stay in the hospital for more than 2 weeks. Results: It was observed that the cases that received the local Amikacin application as an adjuvant to systemic antibiotic showed significantly lesser incidence and/ or grading of SSIs in the first week and also lesser, but not statistically significant reduction of SSIs in the second week. The incidence of antibiotic change, hospital stay and isolation of microbe from the wound site was statistically found be to lesser in the study group compared to their controls. Conclusion: It is observed that the local therapy as an adjuvant is cost effective and without any significant local or systemic adverse effects in the prevention of SSIs in dirty and contaminated patients. But it was also observed that it did not have sustained effect for prolonged period beyond its time of administration (as evidenced by its lesser effect in the second week after surgery). It may be suggested that a further combination of suction drainage of the subcutaneous DT along with local antibiotic treatment may have added advantage in further preventing SSIs.

84-93

Authors: Amita S Patel, Jignasha M Patel, Kamlesh J Shah

Introduction: Ovarian tumors are now the one of the leading cause of death involving a wide spectrum of clinical, morphological and histopathological diagnosis. It frequently does not result in symptoms until the tumor has spread extensively and pose difficulties to clinicians. Objectives: The aim was to study the incidence and histopathological spectrum of ovarian tumors according to WHO classification in different age group and its clinical correlation. Materials and methods: A study was undertaken during a period of May 2011 to December 2017. The tumors were classified according to WHO classification after thorough examination of H&E slides. Data of clinical presentation of patient was also recorded in each case. Results: There were total 162 cases were studied, amongst which surface epithelial tumors were the commonest variety accounting for 126(77.7%) cases, followed by Germ cell tumors 30(18.5%) cases and Sex-cord stromal tumors 6(3.8%) cases. Benign tumors (93.2%) were more common than malignant (6.2%) and borderline (0.6%). Among benign tumors, serous cystadenoma (57.4%) were the most common followed by mucinous cystadenoma (16%) and mature teratoma (16%). Most of the ovarian tumors were unilateral (89.5%) with left sided predominance (49.4%). Majority of benign tumors presented with cystic consistency (67.9%) and mixed consistency (4.3%) in malignant tumors. The age range was 4 year to 70 years. Abdominal pain (48.8%) was the commonest clinical presentation. Conclusion: Ovarian tumors were found to occur in wide range of age with bimodal peak for malignant tumors. Benign tumors were more common across the all age group. An accurate histopathological diagnosis and staging is important for therapeutic and prognostic purpose.

105-110

Authors: Shaik Sulaiman Meeran, M. Agila Saravanan, S. Geetha, S.V. Sangeetha, Krishnakumar S

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia encountered in clinical practice. This study is about the etiological and clinical profile of paroxysmal, persistent and permanent AF. Aim: The aim of this article was to review the clinical epidemiological features of atrial fibrillation. Materials and methods: A hospital-based descriptive study was conducted among 50 patients, diagnosed as atrial fibrillation in Cardiology Department, from 2016 to 2017. Results: Out of 50 patients with atrial fibrillation, 32% were aged between 60 – 69 years and 42(84%) were females and 8 (16%) were males. Permanent AF was seen in 56% patients. Conclusions: Palpitation followed by dyspnoea was the major symptoms encountered with atrial fibrillation, and in females within the age group of 50 years and above are prone to develop AF.

116-123

Authors: Dr. T. Badrinath, Dr. Talapula Sreelaxmi

Introduction: Trauma increase in incidence may be the price marking paying for the increased sophistication of industrialization and various paying for the increased sophistication of industrialization and various rapid transport systems. Aim: The aim of the study was to evaluate the incidence of abdomen trauma, clinical presentation, morbidity, and mortality. Materials and methods: This prospective clinical study was carried out on patients admitted for a period of 1 year in 120 cases of abdominal trauma treated in our hospital. After admission, data for the study were collected by detailed history, thorough clinical examination, and relevant diagnostic investigations performed over the patient. Results: Most common age group were 21-30 (43.3%) with a mean age group of 29.5 years. In present study, there were 98(81%) male and 22(19%) female with a ratio of 4.5:1. Most of them were operative management. There were 87(73%) cases of homicide, 23(19%) cases were suicide and 10(8%) were accidents. Injury pattern showed that 51(42.5%) cases had entry wound in umbilical region followed by right iliac, right lumbar. Intra-abdominal injuries included small intestine (n = 41, 34.17%), stomach (n = 24, 20%) and Ileum (n = 17, 14.17%). It was found that average drain output was 60ml/day for small bowel perforation and patient started oral feeding on POD 5, removal day of drain was averaging sixth day after starting orally. Conclusion: A thorough and repeated clinical examination and appropriate diagnostic investigations lead to successful treatment in these patients.

135-140

Authors: Siddheshwar V. Birajdar, Sanjay S. Chavan, Deepak R. Patil

Background: India is a country with low HIV prevalence, yet it has the third largest number of people living with HIV/AIDS. Availability of antiretroviral medications is improving, making it is important to develop feasible strategies for the management of antiretroviral therapies in resource-limited settings. Aim and objectives: To study clinical profile of HIV infected patients with special respect to total lymphocyte count (TLC) and CD4 count and study the correlation between Total Lymphocyte count (TLC) and CD4 count in HIV infected patients. Materials and methods: An observational study was conducted on patients admitted in general medicine ward at the tertiary care hospital, fulfilling inclusion and exclusion criteria, for duration of 24 months. The detailed history and examination findings of the patients were recorded. To analyse the data we used statistical software SPSS 16.0 was used. Results: Fever was the most common symptom reported. CD4 counts corresponded to various opportunistic infections. The Pearson correlation of TLC with CD4 counts was 0.388 i.e. moderate correlation at p<0.05 (0.005) and this showed the statistical high significance between TLC and CD4 count. Conclusion: TLC is a widely available and inexpensive parameter, which can be used in place of CD4 count, for monitoring immune status in HIV infected individuals. TLC values may be useful, but less sophisticated and less costly methods of determining CD4 counts such as microvolume fluorimetry and ELISA techniques be evaluated and made available for use in resource-limited settings.

150-159

Authors: V. Vishnu Vardhana Reddy, K. Panduranga Rao

Background: Emphysematous pyelonephritis should be suspected in every diabetic patient, presenting with features of acute pyelonephritis. E.coli is the most common organism associated with EPN. Aim: To study the clinical features, radiological classification and risk factors assess the prognostic factors and to study different management modalities of Emphysematous pyelonephritis and their outcomes. Materials and methods: It was prospective study done on 48 patients who were diagnosed to have Emphysematous pyelonephritis from various departments in Osmania General Hospital from October 2004 to October 2006 were included in the study. The diagnosis of EPN was confirmed by plain CT KUB scan. Results: All the 48 patients with EPN had diabetes mellitus (DM). All the 48 patients had poorly controlled DM. Left kidney was involved in 54.1% and Right kidney in 37.5% of cases. 6.25% of cases had bilateral involvement. Fever (93%) and tachycardia (64.5%) were most common presentation in patients. Thrombocytopenia was seen in 50% of these patients and 12% of patients with thrombocytopenia required platelet transfusion. Shock during initial presentation was seen in 22.9% of patients. 16.6% of patients presented with altered sensorium. E.coli was grown in 78% of patients and klebsiella in 6% of patients. There were 6 patients with dry EPN and 42 patients with wet EPN. 41.6% of patients had Class 2 EPN (Commonest class in our study), 25% of patients had class 3A EPN, 22.9% had Class 1 EPN, 6.25 had Class 4 EPN. 15.63% of patients were treated conservatively with antibiotics according to culture and sensitivity. 78% of patients required minimally invasive intervention. Nephrectomy was done in 6% of patients. Mortality rate in our study was 8.3%. Conclusions: Nephrectomy should be promptly attempted for patients not responding to conservative methods and patients with extensive, fulminant course of disease. Pre-existing CKD status, shock at presentation and altered sensorium are the poor prognostic factors in this study.

168-173

Authors: Srividya Nemani, Mary Manjula Dasari, Vamsi Mudadla, Sudharani Balla

Introduction: Magnesium sulphate has been the drug of choice for the prophylaxis of convulsions in women with preeclampsia for many years. The use of this drug for the treatment of preterm labour originated in the observation that it causes a decrease in frequency and intensity of contractions in preeclampsia women in labour. The present study is conducted to study the effectiveness of intravenous magnesium sulphate in arrest of preterm labour. Materials and methods: The present study was conducted among 50 patients admitted in labor wards of obstetrics and gynecology department. Study was conducted at Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. Study duration was from February 2016 to March 2017. Fifty patients with a diagnosis of preterm labor between 28 to 36 weeks period of gestation were included. A loading dose of intravenous magnesium sulfate 4 gm bolus over 20mins followed by 2g/hour infusion was administered until uterine quiescence was achieved. Results: The mean time taken for uterine quiescence was 74 mins after starting treatment. The magnesium sulfate dosage requirement for uterine quiescence was 1-2 gm/hour in 87.5% cases. Majority of the mothers experienced mild side effects but none were as serious as to discontinue the drug. Toxicity features were observed in 4% of cases, which need to discontinue the drug. Conclusion: Intravenous magnesium sulphate is effective in postponement of preterm labour at least for 48 hours. This is the minimum time considered sufficient to allow benefit if corticosteroids are administered to decrease the possibility of respiratory distress syndrome in premature infants. Thus magnesium sulphate plays a vital role in preterm labour.