International Archives of Integrated Medicine

15-22

Authors: Shadab Maqsood, Iqubal Hussain Dar, Shabir Ahmad Bhat

Background: The imaging modalities for evaluation of temporal bone are plain radiographs, multidirectional tomography, angiography, CT and MRI. Plain X-ray is an inexpensive method to study temporal bone, but results in an inaccurate diagnosis. Multidirectional tomography provides excellent bony details; however, soft tissues can’t be delineated. Also, there is increased radiation to the eye lens. Angiography is the gold standard for evaluation of vascular lesions but is invasive with the risk of complications. The aim of the present study was to evaluate Role of High Resolution Computed Tomography in Temporal Bone Diseases and correlate HRCT image based findings with the operative and pathological findings to determine the accuracy of HRCT findings wherever possible. Materials and methods: This prospective study was done in Department of Radiodiagnosis & Imaging of Govt. Medical College Srinagar, J&K in collaboration with the Department of Otorhinolaryngology, in patients suspected of having temporal bone disease. All the patients who were, suspected of unsafe chronic serous otitis media (CSOM), evaluation of congenitally deaf child, having known or suspected deformities of inner, middle or external ear, tinnitus or vertigo, tumors of temporal bone and temporal bone fracture were included in the study. While exclusion criteria included, Patients of age <1 or >70 years. Results: Various findings associated with temporal bone trauma on HRCT showed 10 cases of Hemotympanum, 6 with facial nerve involvement, 2 with Labyrinthine involvement and Intracranial involvement was seen in 6 cases. In the current study 9 patients had symptomatic congenital anomalies involving various structures of the ear and temporal bone. Conclusion: With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy has become a practical reality. The improved contrast and soft tissue definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. However HRCT has its own limitations like in evaluation of labyrinthine soft tissue structures, evaluation of enhancement pattern and associated radiation hazards to the eye lens. Despite its limitations, HRCT of the temporal bone is a highly efficacious modality for accurate delineation of the anatomy and various pathologies of the temporal bone and it has revolutionalized the role of radiology in diagnosis and management of temporal bone diseases.

29-34

Authors: T.N. Tamil Selvam, V.A. Sowndhariya, N.K. Senthil Nathan

Introduction: Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) have key differences in clinical presentation, radiographic findings, comorbidities and pathogenesis to distinguish between these common forms of chronic inflammatory arthritis. Joint involvement is typically, but not always, asymmetric in PsA, while it is predominantly symmetric in RA. Bone erosions, without new bone growth, and cervical spine involvement are distinctive of RA, while axial spine involvement, psoriasis, and nail dystrophy are distinctive of PsA. Aim of the study: To Compares the comorbidities between Rheumatoid Arthritis (RA) and Psoriatic Arthritis (PSA). Materials and methods: This was a prospective observational study conducted for a period of 6 months at Institute of Rheumatology, Government K.A.P.V. Medical College and MGM Government Hospital. Totally 241 patients who were fulfilling inclusion criteria has been included. Patients diagnosed with and treated for PsA on the basis of clinical, radiological and laboratory findings and expert opinion was monitored using standardized examination methods and jointly prepared forms. Clinical status, accompanying systemic diseases and surgical history was recorded. Routine clinical examination and basic comorbid findings have been assessed by standardized methods. Results: Two hundred and forty-one patients were included in the study. 179 patients were diagnosed with RA (male -15, female -164) and 62 were diagnosed with PsA (male - 44, female -18). Comorbid systems such as diabetes, hypertension, metabolic syndrome, cardiovascular disease, transaminitis, malignancy, hyperuricemia were more in RA group when compares to PsA. Which shows statistically significant of p-value <0.005. Conclusion: Though both Rheumatoid arthritis and Psoriatic arthritis are associated with enhanced cardiovascular morbidity, markers of morbidity are more in the RA group when compared to PsA except that patients with psoriatic arthritis have more hyperuricemia and transaminitis.

40-50

Authors: Aijaz Ahmad Hakeem, Irshad Mohiuddin

Background: A large variety of inflammatory and neoplastic lesions are known to occur within internal auditory canal and cerebellopontine angle. Imaging techniques are now available to guide the search for the underlying cause of most patient complaints. The advent of MRI has revolutionized the medical diagnostic imaging because it allowed tissue characterization of many lesions. High resolution MRI scan is highly sensitive in detecting lesions of internal auditory canal and cerebellopontine angle. More recently, diffusion imaging is playing a substantial role in evaluation of CPA masses. High ADC values of solid vestibular schwannomas were in conformity with increased diffusion rates, indicating the presence of increased amounts of extracellular water (a relatively loose tissue in tumor matrix). This study was undertaken with purpose to present MRI findings in cases of CPA and IAC lesions and to assess the impact of MRI on the diagnosis management and follow up, after treatment, of these lesions with an attempt to compare MRI findings with operative and H/P findings in the cases where surgery was done. Materials and methods: The present study was conducted in Post Graduate Department of Radiodiagnosis, Government Medical College, Srinagar on patients presenting with otoneurological signs and symptoms suggestive of CP angle and IAC lesions referred for MR imaging by various departments of GMC Hospital Srinagar during the one year period of study. Results: Majority of lesions found in this study were tumors (33 lesions), next common in our series were inflammatory lesions and vascular lesions (4 each case). Among all lesions and tumors most common MR diagnosis in our study was acoustic neuroma 20 of 41 lesions (48.78%) and 20of 33 tumors (60.60%) respectively. Next common among tumors was meningiomas 3 out of 33 cases (9.09%). Conclusion: The results of the present study concluded that, MRI has particular advantages over CT for study of internal auditory canal and cerebellopontine lesions because it is non-ionizing investigation, better soft tissue contrast and resolution, multiplanar capability permits more reliable distinction of lesions, better identification of structures involved by lesions, tissue characterization of lesions and absence of beam hardening artifacts makes MR imaging superior ion evaluating the lesions in CP angle and IAC. The radiological features of various lesions are often sufficiently distinctive to permit a specific diagnosis to be made. MR imaging due to its multiplanar capability helps in knowing the exact site and extent of these lesions. MRI shows inflammatory and vascular lesions with exquisite detail and is better for detection of such lesions as compared to CT. MRI allows a confident perspective pathologic diagnosis to be made (Using FSE T2 weighted images, diffusion imaging, SE images, thin section post gadolinium scans) and this predictive value far exceeded the CT.

61-65

Authors: C.R. Parvathavarthine, Soorya Sridhar, Neelee Jayasree

Introduction: The Human Orbit is a complex structure containing muscles vessels, nerves, fat and the lacrymal apparatus. The perimeter of the orbit is found to be a significant factor while planning and in placing facial implants or any in mode of facial reconstruction procedures. It plays an important role in numerous specialities such as OMFS, Ophthalmology, plastic and trauma reconstructive surgeries. While among the daily practitioners of Ophthalmology the orbital perimeters are important in more common procedures such as orbital anesthesia to avoid damage to inbuilt structures and also in procedures such as enucleation, exentration, optic nerve decompression. Aims and objectives: The present study aimed to provide morphometry of orbital perimeter using 200 CT images from the Department of Radiology, of various Radiology centers across Chennai collected retrospectively, to approximate the perimeter including the soft tissue contained thereby standing to be of greater clinical importance. Materials and methods: The parameters recorded were analysed using inbuilt CT system generated digital measures. Results: The study noted a significant difference in the morphometry between two sexes, while no significant difference was observed between the two sides. Conclusion: Accurate measurements of orbital parameters are important in facial reconstructive procedures and maxillofacial surgeries. They are also important in designing protective eye wear. Therefore, during structuring of implants of the zygoma and structures around the orbit the race and sex needs to be kept in mind as it is a factor for Morphometric variations thus seen.

72-76

Authors: Stalin R, Raja Manikandan S

Background: Endotracheal intubation is required for giving general anesthesia for which adequate muscle relaxation is necessary. Suxamethonium is still used as a relaxant for endotracheal intubation Rocuronium, a nondepolarizing muscle relaxant was compared here for tracheal intubating conditions. Aim of the study: To compare the intubating conditions achieved in patients undergoing elective surgeries under General Anaesthesia with Suxamethonium or Rocuronium in 60 secs and complications in both groups. Materials and methods: This study was conducted in Institute of Anaesthesiology and Critical care at Madras medical college, Chennai during the period 2014 – 15100 patients of ASA I and II were divided randomly into 2 groups undergoing elective surgeries: Group I - Suxamethonium Group II - Rocuronium assessed for intubating conditions after administration of the corresponding drug. Results: The intubating conditions were excellent in group I Suxamethonium as against Group II Rocuronium in 60 secs. According to the cooper scoring system the scores of vocal cord movement in group I (Suxamethonium) was 2.68 (mean) ± 0.471 and in group II (Rocuronium) was 2.34±0.557, the scores of response to intubation in group I (Suxamethonium) was 2.98±0.141 and in group II (Rocuronium) was 2.70±0.463 with better intubating conditions in group I receiving Suxamethonium than Rocuronium. The results were significant with a p-value of<0.05 whereas the scores of jaw relaxation in group I patients (Suxamethonium) was 2.70 (mean)±0.463 and group II patients (Rocuronium) was 2.52±0.544 with better jaw relaxation. Conclusion: Rocuronium can be used as an alternative when suxamethonium is contraindicated for rapid intubation but not if the anticipated difficult airway is present. Rocuronium can be chosen as an alternative to it even in rapid sequence intubation in emergency cases, provided the airway is properly assessed and no anticipated difficult intubation is present.

83-89

Authors: Janak Chokshi, Ishvarlal Parmar, Bhavik kumar Prajapati

Background: Seizure disorder is a one of major health problem in adults mostly in late adulthood in which chances of seizures are increased especially due to comorbidities like cerebrovascular stroke, CNS infection (tuberculoma, viral encephalitis), degenerative disease of brain, and brain tumor. Materials and methods: We studied 50 adult patients to identify various etiology of seizures. We checked for various parameters like complete blood count, blood sugar level, renal function tests with electrolytes, liver function tests, brain imaging and Electroencephalogram (EEG). Results: With the help of this study, we identify that most common cause for seizure was idiopathic in less than 50 years of age and post stroke epilepsy in more than 50 years of age. Generalized tonic clonic seizure was most common type of seizure. With the help of newer neuro-imaging modalities and EEG it was possible to find out specific etiology of seizure, so EEG and imaging study should be integral part of investigation work of patient with seizure disorder. Conclusion: The present study was an effort to find out the various etiology and type of seizures in adult its types and clinical profile and response to antiepileptic drugs. Every patient should be investigated thoroughly and diagnosed and best suitable drug given depending upon type of seizures to the patient for proper control of seizures and also improve morbidity and mortality due to seizures.

96-101

Authors: Yassar Shiekh, Aamir Javed Khan, Mohammad Iqbal Bhat

The shoulder socket is called the glenoid fossa. This socket is shallow and is part of the scapula (shoulder blade). The surface of the humeral head and the inside of the fossa are covered with articular cartilage. The glenohumeral joint consists of an articulation between the scapula and humerus. Retroversion angle of humeral head (or retrotorsion angle, RA) is an important parameter in total shoulder arthroplasty and is one of these important reference factors which can influence the outcomes of total shoulder arthroplasty. This study was undertaken to evaluate the correlation between retroversion angle of humeral head and position of intertubercular sulcus. The present study is a prospective one which was conducted in the Department of Radiodiagnosis and Imaging at Government Medical College and Hospital, Srinagar. The 60 dry adult humeri were analyzed by multiplanar computed tomography (CT). CT data were transferred to a workstation (Silicon Grafics; Sunnyvale, CA) for multiplanar CT-reformation. The mean retroversion angle of the humeral head in relation of the transe-picondylar axis was 12.3 degree. The mean ITS orientation was 40.7 degree. The Pearson correlation coefficient between the retroversion of the humeral head and the ITS orientation was -0.37. There was an inverse correlation between the retroversion of the humeral head and the ITS orientation. This variation is due to several factors, including the definition of humeral head retroversion, different methods of measurement, ranges of normal values, and accuracy of anatomic landmarks to guide determination of anatomic retroversion. Humeral head retroversion is generally defined with respect to the plane of the humeral head articular surface proximally; distally, however, the reference axis has been debated, including the transepicondylar axis, trochlear tangent axis and forearm axis. The study concludes that there is a reverse correlation between the retroversion of the humeral head and the orientation of the intertubercular sulcus.

111-115

Authors: S. Sumathi, M. Ramadevi

Introduction: Insulin affects many sites of mammalian lipid metabolism. It stimulates synthesis of fatty acid in liver adipose tissue and in the intestine. The insulin has also been reported to increase the cholesterol synthesis. The activity of lipoprotein lipase in white adipose is also increased. From this point of view, the assessment of various lipid fractions and lipid peroxide in the cases of Diabetes Mellitus may be of some help in the prognosis of patients and in preventing the possibilities of complications or secondary disorders. Aim of the study: To study the level of lipid peroxide in IDDM and NIDDM. To find out the correlation between Lipid peroxide and Lipid profile in both types of diabetes mellitus Materials and methods: Participants of the study group were selected from the outpatient's population of the Department of Medicine, Government Thiruvarur Medical College, Thiruvarur. 100 patients were selected for this study. Out of which 50 patients belong to NIDDM and 50 to IDDM group. 50 persons served as a healthy control. Results: There was a very good positive correlation between MDA and Cholesterol, TGL, LDL, VLDL in both NIDDM and IDDM cases. There was a negative correlation between MDA and HDL in NIDDM and IDDM cases. Conclusion: In the diabetes mellitus abnormally increased levels of lipid, lipoprotein and lipid peroxides in plasma may be due to the abnormal lipid metabolism. The maximum increase in lipid peroxide was found in a group of diabetes mellitus with complication. Elevated levels of lipid peroxide in diabetes mellitus may be due to the alteration of function of erythrocytes membrane. This inhibits the activity of superoxide dismutase enzyme leading to accumulation of superoxide radicals which cause the maximum lipid peroxidation and tissue damage in diabetes.

125-133

Authors: R. Vimal, A. Sivanoli

Background: In anesthetic practice, the introduction of multiple novel laryngoscopes has simplified visualization of the vocal cords and has reduced the complications arising due to difficult or failed tracheal intubation. Both Truview scope and C-Mac video laryngoscope have been reported to provide a comparable or superior glottic view on comparison with conventional Macintosh laryngoscope. Materials and methods: A randomized controlled study was conducted in 100 subjects scheduled for elective surgery equally divided into 2 groups. Conventional Macintosh laryngoscopy was done initially in all subjects enrolled for the study. For the Glottic view, One Group (n=50) underwent Truview laryngoscopy while the other (n=50) underwent C-Mac video laryngoscopy. Results: The improvement in glottic view from original MCL (Modified Cormack & Lehane) grading obtained from Macintosh laryngoscope was 40% (n=23) in Truview compared to 46% (n=23) in C-Mac video laryngoscope while downgrading of view was observed in 10% (n=5) in group– T compared to none in C-Mac video laryngoscope. There were no statistically significant difference in Intubation Difficulty Scale (IDS) scores between the groups (P = 0.072). The mean duration of time for endotracheal intubation with C-Mac video laryngoscope (23.10 seconds) was significantly shorter compared with Truview laryngoscope (31.26 seconds). Conclusions: There was an improvement in view of the glottis in both Truview and C-Mac video laryngoscope from the initial Macintosh laryngoscope view. But C-Mac video laryngoscope offered better view improvement and also required a shorter time for intubation compared to Truview laryngoscope.

140-145

Authors: J. Sasi Kumar, P. Rahul Tej, A. Sri Balram, B. Srinivas, Y. Anil Reddy, B. Swapnil, N. Rama Murthy

Polyurethane Double-J ureteral stents are widely used in the field of urology. Postoperatively, patient education about the ureteral stent and making sure it is removed at the prescribed time is an utmost necessity. Forgotten ureteral stents are not only disastrous for the patient but also fraught with serious medico-legal implications for the urologist. The recent increase in usage of ureteral stents in the management of a variety of urinary tract disease processes mandates familiarity with these devices, their consequences, and their potential complications, which at times can be devastating. Here we presented 2 cases of retained fractured DJ stents which presented as perurethral foreign body.

152-160

Authors: Singh Durgesh, Singh Vishram, Yadav Yogesh, Tiwari Richa, Tandon Ashutosh

The aim of the present review was providing help for the assessment of the correct interpretation of gallbladder wall thickening and differential diagnosis at ultrasonography. Gallbladder wall thickening is a frequent son graphic finding and has been subject of great interest for being considered as a hallmark feature of acute cholecystitis, despite the fact that such a finding is observed in a number of other medical conditions. An appropriate characterization and interpretation of ultrasonography finding are of great importance, considering that the correct diagnosis has a direct impact on the treatment that in some cases includes surgery. In this article, describe a set of son graphic finding that is an association with the clinical and laboratory findings can reduce the number of diagnostic hypotheses allowing a more accurate establishment of the cause for gallbladder wall thickening through a rational data evaluation. Sonography is used as the initial imaging technique for evaluating patients with suspected acute calculus cholecystitis because of its high sensitivity at the detection of GB stones, real-time character, speed, and portability. Cholescintigraphy has the highest sensitivity and specificity in the patients who are suspected of having acute cholecystitis. The use of cholescintigraphy is limited in clinical practice Due to a combination of reasons including logistic drawbacks, broad imaging capability, and clinician referral pattern. CT is particularly useful for evaluating the many complicated cases of acute calculous cholecystitis. Relatively high cost of MRI and lack of widespread availability the MRI is prohibits its primary use in the patients with acute calculous cholecystitis The US are currently considered the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis.

8-13

Authors: B. Vijayanirmala, T. Sundari Devi, Shahistha, P.V. Ramana

Background: The salivary glands, mainly parotids are the site of origin of a wide variety of neoplasms. At the same time, they are relatively uncommon and show racial and geographical variations. Majority (80%) are benign tumors, only about 20% are malignant. Histopathology of parotid neoplasms is most complex and diverse of any organ in the body. Also histopathology plays a major role in the diagnosis of these neoplasms with very few contribution using special stains, immunohistochemistry and cytogenetic studies. Aim: The aim of the present study was to analyze the relative incidence, clinical presentation and spectrum of neoplasms in the parotid glands with their micromorphology at Gandhi hospital, Secunderabad, which is a tertiary referral hospital in Telangana state. Material and methods: A retrospective and prospective study of all parotid gland tumors received in the department of pathology for histopathological examination at Gandhi hospital, Secunderabad during a period of 5 years, from January 2013 to January 2018 was done. The clinical data like age, sex, duration were recorded. Grossly representative bits from the tumors were processed, sections made, stained with routine Hematoxylin and Eosin and examined under microscope. Data of 48 cases recorded during the 5 years period was analyzed. Results: 48 cases were studied during the 5-year period. Of them 39 cases were benign neoplasms and 8 cases were malignant. Benign tumors were more common in the parotid gland compared to malignant tumors, the most common benign tumor being Pleomorphic adenoma. Mucoepidermoid carcinoma was the most common malignant tumor. Most of the benign tumors occurred in the 3rd and 4th decade while the malignant tumors were more common in the 6th decade. Conclusion: Pleomorphic adenoma is the most common benign tumor and Mucoepidermoid carcinoma is the most common malignant tumor.

19-27

Authors: Debashis Roy Burman, Sujit Kumar Dutta, Indranil Dhar

Though incidence of Colorectal carcinoma is relatively less in consideration of world wide data, Indian scenario differs in higher incidence of Grade 3 carcinoma with signet ring cell component. We tried to find association between intercellular adhesion and propagation of cancer cell in Adenocarcinoma of Colorectal region. E-cadherin (ECAD) is the strongest intercellular adhesion molecule of epithelial cells and Autocrine Motility Factor (AMFR) is known propagator of cancer cell. We studied simultaneous immunohistochemical expression of these two molecules in 92 already diagnosed cases that were treated surgically by Colectomy or Abdomino Pelvic Resection. Normal Colorectal mucosa reacted strongly with ECAD and weakly with AMFR. With increasing dedifferentiation of the tumor, reversal manifested- more aggressive grades showed varied expression in comparison to its less aggressive type. Gastric 3 adenocarcinoma show weak ECAD (83% vs. 35%) and more AMFR (93% vs. 35%) expression in comparison to Grade 1. Weak ECAD and strong AMFR was also associated with increase in depth of tumor invasion. As ECAD and AMFR is at least partially responsible for varying histologic grade and behavioral pattern of colorectal adenocarcinoma, simultaneous evaluation of both parameters is helpful to understand pathway of progression of such cancer cell.

32-39

Authors: V. Ramya, Dunnuthala Sreenivasulu Reddy, Shafath Ahmed

Background: Hypocalcemia occurs as a manifestation of nutritional deficiency of calcium and vitamin D. Deficiency of calcium in the diet has been identified as a leading cause of nutritional rickets. Infants less than 6 months are reliant on mothers for their daily calcium requirements. Calcium has a wide range of biological functions in both the ionized form as well as the bound complexes. It also plays an important role in skeletal mineralization. Aim of the study: To rule out the prevalence of hypocalcemia in the mothers of the infants and to establish if there was an association between the infant and maternal serum calcium. Materials and methods: Totally 50 children who were admitted in pediatric ward between Ages 1 Months to 6 months were assessed. A standard questionnaire was administered and venous blood samples collected from the mother-infant pairs. The samples were analyzed for calcium and albumin and corrected calcium levels calculated. Results: A total of 93 mother-infant pairs were screened. 94(78.3%) of these gave samples which were analyzed. The mean age of the infants sampled was 3.5 months. The mean age of the mothers was 27.2 years with a standard deviation of 5.8 years. 78 (83%) infants were born at term and 16 infants (17%) were born preterm. 58 of 93 infants (62.4%) were exclusively breastfeeding whereas 35 of 93 infants (37.6%) were breastfeeding but not exclusive. Prevalence of hypocalcemia was 34% in the infants with 95% CI of 29.4-45%. Prevalence of hypocalcemia in the mothers of the infants was 39.4% with a 95% CI of 29.8. There was no statistically significant association between hypocalcemia in the mother and infants. OR 1.4 (95% CI 0.6-3.4) and P= 0.447. Conclusion: There is a high prevalence of hypocalcemia in breastfeeding infants as well as in lactating women. However, there is no significant association between maternal and infant hypocalcemia. The recorded prevalence values .from the general population is quite high and were found to be due to dietary deficiency of both calcium and vitamin D. The values are much higher than those obtained during our study. The study population is ideal as it has taken into account the general population.

44-49

Authors: Farida Begum, P. Ravi Kumar

Introduction: Fine needle aspiration cytology (FNAC) has revolutionized the approach to diagnosis and management of breast and various other lesions. Its accuracy in many situations avoids any unnecessary surgical procedures. The aim of this study was to analyze and correlate the diagnosis of breast lesions on cytology with histopathology. Materials and methods: This prospective study was done at Government Medical College, Nizamabad, and Telangana State (TS) during June 2016 to May 2018 and total numbers of cases included were 200. A detail clinical and family history was taken before the procedure of FNAC and examination of both the breast was done. Results: The study included 200 breast masses/ cases, which were diagnosed on cytology. The age group included in this study was between 16 years and 75 years. Most of the cases in this study were in the age group 16- 30 years (91 cases) followed by 31- 45 years group (66 cases), followed by 46-60 years (34 cases) and least numbers of cases were noted in 61-75 years age group (09 cases). In this study, most common diagnosis was Fibroadenoma and least common diagnosis given on cytological examination was tubular Adenoma. Conclusion: FNAC is an important diagnostic adjunct in the management of patient with a breast lump. Recently FNAC popularity has grown many folds and has become a most valuable tool in the diagnosis of palpable breast masses owing to its distinct advantages of being sensitive, specific, expedient, economical and safe. Lack of local or general anesthesia makes the procedure more comfortable for the patient and the pathologist.

63-69

Authors: Sivabackiya C, Srinivasan B, Maignana Kumar, Sabari Sridhar OT, Kailash S, Shabeeba Kailash, Gopalakrishnan

Background: Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM). Diabetes with depression is associated with a low quality of life (QoL). Complications in DM and depression still remain poorly identified and inadequately treated. But treatment of depression among DM patients is almost totally ignored and the QoL is poor. Materials and methods: A prospective observational study was conducted on 100 type 2 Diabetes mellitus patients diagnosed with clinical depression (ICD-10) at a tertiary care hospital. They were treated for depression along with DM medications and followed up till 6 months was assessed by WHO Quality Of Life (WHOQOL) – BREF scales. Results: There was a statistically significant improvement in overall WHO QOL scale from 5.96±1.23 at baseline to 6.71±1.15 at 6 months (P value < 0.001). Among various domain, the mean Physical health domain was 17.72±2.281 at baseline, which has improved to 25.56±3.367 at 6 months follow up and the mean Psychological domain score was 16.32±2.174 at baseline and has improved to 22.64±2.343 at 6 months follow up. Conclusion: QoL is a domain of major importance and it affected in patients with DM and depression. Treatment of depression in DM patients is almost ignored. In the current study, treating depression in DM patients enhanced the quality of life (P value < 0.001). Hence diagnosis and treatment of depression in these patients is particularly important in order to reduce complications and improve quality of life.

77-83

Authors: B. Lakshminarayana, Rammohan, G. Saisoumya, J. Tulasi, V. Srinivaskumar

Background: Tzanck smear named after Arnault Tzanck (1886-1954), to evaluate Cytopathology as a quick less invasive method for early diagnosis of bullous lesions. Aim: To determine the diagnostic value of Tzanck smear in vesiculobullous skin lesions, to evaluate the vesiculobullous lesions and correlating the diagnosis with Tzanck smears and histopathological findings and when required with Immmunoflourescence. Materials and methods: 565 patients clinically diagnosed as vesico-bullous skin lesions were included in the present study from July 2011 to July 2018 for a period of 7 years. Tzanck smear preparation and biopsy as well as immunoflouresence tests were done in all 565 patients. Results: Out of the 565 patients with vesiculo bullous lesions, 297 were males, and 268 were females. The concordant results between cytology and histopathology was observed in majority (92.7%) direct immunoflouresence test was done in some which also confirmed the diagnosis. Conclusion: The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for vesiculo-bullous lesions of skin diseases and can be recommended as a bedside first line investigation.

89-92

Authors: Hardik Gandhi, Nehal Tiwari

Synchronous primary neoplasms are defined when two or more neoplasms take place concurrently in the same patient. Double synchronous primary gynaecological neoplasms are relatively uncommon and the incidence rate ranges from 0.6% to 5.4%. Synchronous malignancies of the ovary and the uterine cervix are rare situations in which the prognosis is established not only by clinical stage but also by the histological grade of the adenomatous component. Here we have presented the case of a 60 year old patient who presented for diffuse abdominal pain and weight loss that was diagnosed with synchronous cervical and ovarian carcinoma on histopathology. This case report of double synchronous primary neoplasm of the cervix and ovary is presented here because of its rarity.

10-13

Authors: A. Shaik Sulaiman Meeran, Anuradha Hariharan, M. Praveenkumar

Background: A cough can be the result of a respiratory tract infection such as the common cold, acute bronchitis, pneumonia, pertussis, or tuberculosis. In the vast majority of cases, acute coughs, i.e. coughs shorter than 3 weeks, are due to the common cold. In people with a normal chest X-ray, tuberculosis is a rare finding. Pertussis is increasingly being recognized as a cause of troublesome coughing in adults. Aim: It was diagnosed mainly by simple sputum acid-fast staining, and in some cases, gene expert was needed to prove the diagnosis for starting ATT Materials and methods: This observational study was conducted in Govt. Royapettah Hospital, Chennai, included patients presenting with >2 weeks duration of a cough irrespective of age and sex. Among 45 patients for a chronic cough, with X-ray finding, the diagnosis was confirmed by other radiological and laboratory methods. Results: Among other infective causes, major organisms causing pneumonia was Klebsiella pneumonia, Streptococcus pneumonia, and E.coli. All these patients were treated with culture-specific antibiotics and recovered. 7 patients (14%) were admitted for a chronic lung in X-ray. All these patients were chronic smokers and had a cough for the long term with minimal mucoid sputum production. Conclusion: Thus from our observational study it was concluded that Tuberculosis is still the most common etiology for a chronic cough, and how simple X-ray could guide us to diagnosis is seen

21-36

Authors: Mohd. Anwar Miya, G. Vandana, S. Swarnalatha, S. Sandhya

Introduction: Colorectal cancer is the major cause of mortality and morbidity worldwide. Incidence in males - 4.3 /1, 00,000, in females - 3.4/1,00,000. The etiology of colorectal cancer is complex, involving interplay of environmental and genetic factors. Colorectal cancers have been reported to show BCL-2 over expression although, in comparison with adenomas, there is lower intensity of expression in the invasive tumors. There may also be a loss of expression with loss of tumor differentiation and it would appear that the role of BCL-2 is probably more important in the early development of colorectal tumors than in later tumor progression. Aim and objectives: To perform and interpret BCL-2 immunostaining on all diagnosed colorectal carcinomas, to infer the rate of positivity and negativity of the BCL-2 expression in the colorectal lesions, to correlate the BCL-2 expression with the grades of the colorectal carcinomas, to indicate the prognostic value of BCL-2 expression in colorectal carcinomas. Materials and methods: A present study was done in MGM Hospital, Warangal for duration of 5 years. A total of 64 cases were studied. All colorectal carcinoma cases are subjected to BCL-2 immunostaining. Results: In present study, the commonest age group were from 60-69 years with majority of the lesions diagnosed as adenocarcinomas. Males contributed to large number of cases (33) and rectum is the most common site in the present study. Majority of cases (40.6%) in this study were well differentiated carcinomas. BCL-2 overexpression was seen in 42(65.6%) cases, majority were colorectal adenocarcinomas. 96.2% of well differentiated, 75% of moderately differentiated adenocarcinomas and 10% of poorly differentiated adenocarcinomas showed overexpression of BCL-2 and 12.5% of mucinous carcinomas showed BCL-2 positivity. There was a significant correlation between grade and BCL-2 expression. Higher scores were seen in well to moderately differentiated carcinoma than poorly differentiated carcinoma. In well differentiated carcinoma, 19 cases showed score 3 and in moderately differentiated carcinoma, 5 cases showed score 3 which contained strong BCL-2 expression. In poorly differentiated carcinoma, majority (9 cases) were score 0 and in mucinous carcinoma as well, 69 majority (7 cases) were score 0 which contains negative BCL-2 expression. In rectal cancers BCL-2 overexpression was more common that colon cancers. Rectum shows 47% positivity and left colon 36%. Thus in present study rectal cancers showed high BCL-2 expression. Males (23 cases) showed higher BCL-2 expression than females (20 cases). Conclusion: There is a significant correlation (P<0.00001) between BCL-2 over expression and grade of colorectal adenocarcinoma, but there is no significant correlation is observed with variables like age, gender, tumor location. BCL-2 over expression serves as good prognostic marker in colorectal adenocarcinomas and it will help to assess the responsiveness of patients to standard treatment.

44-49

Authors: Sylvester Satish Romero, Sudhir Hebbar

Background: Panic disorder is the most prevalent among anxiety disorders in psychiatry clinics. Randomized controlled trials and open studies in research settings and studies from naturalistic settings have proved the efficacy and effectiveness of cognitive behavior therapy (CBT) for panic disorder (PD). Panic disorder responds in only a few CBT sessions. In India studies in this regard are practically non-existent. Materials and methods: This study was a part of study titled “The utilization pattern and effectiveness of Cognitive Behavior Therapy for anxiety disorders in adults: A naturalistic study from a medical college hospital”. Out of 80 anxiety disorder patients taken for study, 26 PD patients attended at least one CBT session. In these 26 patients’ pre and post CBT scores on Panic Disorder Severity Scale (PDSS) were assessed and analyzed for clinically significant change (CSC) and response rate. Effect size, refusal and dropout rates were assessed. Results: Pre and post PDSS score reduction was statistically significant at P<0.5. Large effect size of 1.78 was noted. Though 30% of patients were on medication, they were stably on same medication throughout the evaluation. CSC, as defined by twin criteria proposed by Jacobson and Truax, was noted in 57% of patients. In the intent to treat analysis number needed to treat to achieve CSC/recovery was about four. Response (defined as 40% reduction in PDSS rating) rate was 88%. There was about 50% CBT refusal rate. Conclusions: This open prospective naturalistic study shows that CBT of panic disorder can be effective, when it is conducted by a psychiatrist who has not received rigorous training from certified training centers. Effect size is comparable to that observed in other settings. CBT can be integrated along with medications for PD in general hospital psychiatry setting. Response and recovery can be obtained in as few as 5 sessions. More than half of treatment seeking panic disorder patients refused to take cognitive behavior therapy reducing its effectiveness.

50-55

Authors: Farida Begum, Kontham Praveen

Introduction: Donated blood can be lifesaving for persons who have lost large amounts of blood because of serious accidents, new medical and surgical procedures, civil conflicts, and military wars as well as for patients who have become severely anemic because of serious hematological diseases or treatments such as cancer therapy. Therefore, availability of blood is an important concern to the society. Encouraging and engaging youth in these kinds of voluntary activities will increase the supply of blood. The aim of the study was to compare the reasons for blood donation and knowledge about blood donation among medical students. Materials and methods: This study was done at Government Medical College, Nizamabad, Telangana state between April 2017 and March 2018. Only MBBS students who were willing to be a part of study were included- total students participated were 350. A predesigned, pretested, self administered questionnaire was devised to collect data. Data were collected after obtaining informed consent. Ethical clearance from the institute was obtained before the study. Results: A total of 350 students were considered for this study. Total male participants were 216 which constituted 61.7% and total female participants were 134 which constituted 38.3%. Age group included in this study was 18 years to 24 years. Majority of the students participated in this study were in the 3rd and 4th year of MBBS. Out of the 350 students, only 69 students were new to blood donation/ never donated blood in their life time due to various reasons, 46 participants donated only once, 77 participants donated twice, 75 participants donated thrice, 48 participants donated four times, 21 participants donated blood 5 times and only 14 participants donated blood more than 5 times. Conclusion: A considerable percentage of students have low awareness of and negative attitude towards blood donation. The low awareness and negative attitude towards blood donation can be considered as important factors contributing to the lack of interest and poor participation in blood donation among this population.

63-72

Authors: V. Aruna Devi, M. Nagalakshmi, P. Rajitha

Introduction: Medical method of abortion has advantages over surgical methods as it is non-invasive. Hence, no complications of anesthesia and administration of drugs is easy in medical methods. There is a need for evolving a safe and effective method for safe and effective method for terminating pregnancy in the first trimester. Aim: We have taken up the present study to know the efficacy of combination of mifepristone and misoprostol versus single drug misoprostol alone for 1st trimester abortion. Materials and methods: It was a Cross-Sectional Study carried on pregnant women coming for MTP under family planning op at CKM hospital for 2 years. The study included two groups Group-A and Group-B. Group-A consisted of 50 randomly selected cases received Vaginal Misoprostol 600 micrograms stat dose followed every 4th hourly by 400 micrograms for 24 hours, for a maximum of 4 doses. Group-B has 50 cases received Oral Mifepristone 200 mg and simultaneously 600 micrograms of vaginal Misoprostol stat dose followed every 4th hourly with 400 micrograms vaginal Misoprostol for a period of 24 hours maximum 4 doses. Depending on response USG was done within 24-48 hours in both studies and rescan after 2 weeks. Results: Among Group B subjects 86% had expulsion within 5-10 hrs and remaining 14% had expulsion within 10-15 hours. Among Group A subjects 76% required >24 hrs for expulsion, 10% required 20-24 hrs, 6% required 15-20 hrs and 8% needed 10-15 hrs for expulsion. The difference between grouping and induction to abortion interval was found to be statistically significant. In Group A, 15 subjects (30%) had complete expulsion of products. 35 subjects (70%) required D&C. In Group B, 43 subjects (86%) had complete expulsion, 7 subjects (14%) required D&C. The difference between grouping and final outcome was found to be statistically significant. Majority of study subjects who require D&C were present in Group A compared to Group B. The difference between grouping and D&C was found to be statistically significant. Conclusion: Thus combination of Mifepristone and vaginal Misoprostol is more efficacious than vaginal Misoprostol alone.

81-86

Authors: Kani Sheikh Mohamed, Venkateswaran A R, Thinakar Mani Balusamy, Bharat Narasimhan, Rajkumar Solomon, Malarvizh Murugesan, Sibi Thooran Karmegan, Murali R

Background: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Materials and methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining 9 presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed non-operatively. 9 patients had severe injury (>grade 3) – of which 4 underwent endotherapy, 3 had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed non-operatively, 3 underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

95-100

Authors: V. Srinivas Kuma, V. Geeta, Nikhil Kumar Voruganti, O. Shravan Kumar, Tamilarasi

Background: Adnexal tumors of skin are uncommon in routine practice and may cause diagnostic problems clinically. Presence of Multiple tumors can be considered as marker for visceral malignancy e.g. multiple trichilemmoma-breast malignancy. Adenexal tumors of the skin are classified into four groups. Aim: To correlate skin adenexal tumors with age, sex and location and incidence in the Department of Pathology, Gandhi Hospital, Hyderabad. Materials and methods: Total number of cases was 136, during study period from April 2007 to March 2017 (ten years) in present study. All slides stained with routine Hematoxylin and Eosin and special stains accordingly. Results: Total number of Adenexal tumors were 136; benign tumors were 134 (98.4%), malignant tumors were 02 (1.6%), Largest group was sweat gland tumors (42.1%) e.g. chondroid syringoma, eccrine poroma, syringo cystadenoma papilleferum, hair follicle tumors (35.4%) e.g. trichoepithelioma, pilomatricoma and sebaceous adenoma and sebaceous carcinoma. Undifferentiated and others (21%) e.g. benign trichogenic tumors were also noted. Conclusion: The incidence of benign skin adenexal tumors was more as compared with the malignant tumors. Malignant tumors were seen predominantly in elderly.

109-113

Authors: Dharmendra Pandey, Rohidas Laxman Mahale

Introduction: Meningitis is an inflammatory disease of the leptomeninges, the tissues surrounding the brain and spinal cord. Recently improved awareness, extensively available antibiotics and vaccines can change the epidemiological pattern of the disease. Materials and methods: The present observational study was conducted in the Department of Medicine, Lokmanya Tilak Municipal Medical College and Hospital from February 2016 till August 2017. The study population consisted of 100 patients admitted with features of acute meningitis. All meningitis and meningococcemia cases diagnosed according to the clinical and/or laboratory criteria during the study period were included in the study. Demographic and clinical data of the patients were recorded. Results: Of all the patients included in the study, 38% were diagnosed as bacterial meningitis, 54% as tubercular meningitis and rest as viral meningitis. All patients presented with symptoms of fever and neck stiffness. Headache, vomiting and altered sensorium were other common complaints. Most common CT head findings were that of a basal meningeal enhancement (89%). CSF was clear in 62% of the patients and raised erythrocyte count was observed in 74% of the patients. Mean adenosine deaminase (ADA) of the CSF in the study population was 7.93 ± 6.24 IU/L, ranging from 1 to 43 IU/L. Mean CSF C-reactive protein (CRP) in the study was 5.83 ± 7.11 mg/L, ranging from 0 to 25 mg/L. Conclusion: Understanding the current and future trends in meningitis are needed to improve the quality of patient care and outcomes.

121-126

Authors: A. Padma, D. Sudhavani, M. Shahana, N. Bhavana, G. Narsimharao Netha

Background: Geriatric age is generally taken as the age beyond 65 years. Geriatric skin has a high risk of toxicity due to increased surface area to volume, decreased subcutaneous fat, and high ambient temperature and humidity. Both physiological and pathological changes can occur in this age group. Aim: The aim of the study was to assess the frequency of geriatric physiological and pathological cutaneous conditions and their management. Materials and methods: The patients above 65 years attending the dermatology OPD at Osmania General Hospital, Hyderabad from September 2009 were taken into study to a total of 100 cases Results: Physiological lesions (100) were more common than pathological lesions (37). In our study, senile xerosis (83/100) was the most common condition among physiological conditions and fungal infections (23/100) were more common among pathological conditions. Conclusion: Among geriatric skin conditions, physiological ski conditions were more common manifestations when compared to pathological conditions. Among physiological conditions senile xerosis, senile pruritus and acrochordons were the common manifestations requiring treatment whereas the rest of the conditions like seborrheic dermatitis, cherry angiomas, cutaneous horns, cutis laxa, dermatoheliosis occur rarely.

138-141

Authors: Shilpan Sathwara, Jasmin Jasani

Fine Needle Aspiration Cytology (FNAC) is very valuable in diagnosis of a periarticular lesions and thereby confirming the nature of an associated arthritic process. Gout is a disorder of uric acid metabolism that causes deposition of monosodium urate crystals in the joint spaces. It often presents with painful joint effusion or swelling over toes. Radiological features may also be atypical and misleading. FNAC of gouty tophi is an easy alternative to synovial biopsy or fluid analysis since it is much less traumatic and simpler and thus should be encouraged in clinical practice. This case report of gouty tophi at the left knee is presented because of its rarity.

147-152

Authors: Muthu Saravanan A, I. Gurubharath

Desmoid tumors are rare slow growing, monoclonal, fibroblastic proliferation characterized by variable and often unpredictable clinical outcome, sometimes with aggressive infiltration of adjacent tissue but with no metastatic potential. Desmoids are histologically benign. On a molecular study level, they have been characterized by mutations in the β-catenin gene, APC (Adenomatous Polyposis Coli) gene or the CTNNB1. Gene studies are useful when the pathological diagnosis is difficult. Application of various multidisciplinary assessments along with multimodality treatment forms the basis of management for these patients. In selected asymptomatic patients, watchful waiting might be the most appropriate management. But for patients with desmoid located in other sites like the mesentery or at the head and neck region which might present with serious complications, thus requiring a more aggressive approach of treatment. In this article, we reported a 28-year-old female with a desmoid tumor of the anterior abdominal wall who underwent surgical resection. Preoperative evaluation was done using abdominal ultrasound, computed tomography, and magnetic resonance imaging. The histopathological examination of the resected specimen revealed a desmoid tumor. Because of the heterogeneity of the desmoid tumors, treatment needs to be individualized. However, complete surgical resection with negative margins seems to be the treatment of choice for this tumor entity and postoperative radiotherapy can help reduces the local recurrence rate.

157-162

Authors: Tarak Patel, Gurubharath I, Harshavardhan B

Neuroendocrine tumors may develop throughout the human body with the majority being found in the gastrointestinal tract and bronchopulmonary system. Neuroendocrine tumors are classified according to the grade of biological aggressiveness (G1–G3) and the extent of differentiation (well-differentiated/ poorly-differentiated). The well-differentiated neoplasms comprise typical (G1) and atypical (G2) carcinoids. Large cell neuroendocrine carcinomas, as well as small cell carcinomas (G3), are poorly-differentiated. The identification and differentiation of atypical from typical carcinoids or large cell neuroendocrine carcinomas and small cell carcinomas are essential for treatment options and prognosis. Pulmonary neuroendocrine tumors are characterized according to the proportion of necrosis, the mitotic activity, palisading, rosette-like structure, trabecular pattern, and organoid nesting. These neuroendocrine tumors of the lung arise from Kulchitzky cells of the bronchial mucosa and comprise typical carcinoid, atypical carcinoid, large cell neuroendocrine carcinoma (LCNEC), and small cell lung cancer (SCLC). Here is a case report of the 75-year-old male patient presented with complaints of a cough and sudden onset of breathlessness and weight. On Computed Tomography (CT) a large heterogeneous lesion noted in the left anterior mediastinum which was subjected to CT guided biopsy. On histopathology and immunohistochemistry, the tumor was confirmed as small cell neuroendocrine tumor.

171-178

Authors: Sanjay Ballari, Gurubharath I

Intracranial dermoid cysts are tumors which are rare and are derived from ectopic epithelial cells. These dermoid cysts are slow-growing and are benign; they can cause morbidity by compressing the neurovascular structures. They also do rupture rarely into the subarachnoid space. Dermoid cystic tumors arise from the inclusion of ectodermal committed cells at the time of neural tube closure during the third to fifth week of embryogenesis. These lesions are slow growing due to the active production of hair and oils from the internal dermal elements. This is a case of a ruptured intracranial dermoid presenting as slurring of speech caused by the fat droplets.

184-187

Authors: Hardik Gandhi, Nehal Tiwari, S.S. Goswami

Ameloblastoma is benign odontogenic tumor of epithelial origin which is often aggressive and it originates from remnants of the dental lamina and dental organ (odontogenic epithelium). It is generally a painless and slow growing tumor causing expansion of the cortical bone and infiltration of the soft tissues. Its incidence peak is in the third and fourth decade of life and it is most common in black individuals. The ratio of ameloblastoma of the mandible to maxilla is 5 to 1, with higher sensitivity in the mandible. Here we are reporting the case of Ameloblastoma in 36 years old female patient and we are able to find and document the typical histopathological features of Ameloblastoma

6-10

Authors: Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Satyala Satya Priya, Syed Shehnaz

Background: Hypertensive disorders of pregnancy (HDPs) affect about 10% of all pregnant women around the world and are an important cause of maternal and perinatal mortality and morbidity. In Asia and Africa, nearly one tenth of all maternal deaths are associated with hypertensive disorders of pregnancy. Predicting the onset of these complications could aid in timely interventions such as increased surveillance, treatment of symptoms, transfer to higher care facility and delivery when necessary, which could reduce morbidity and mortality from the HDPs. Aim: It was to calculate the total number of women admitted with hypertensive disorders and eclampsia in the labor room and their case fatality rate, to calculate the number of mothers died from preeclampsia and eclampsia, to critically analyze all the mothers who died from preeclampsia in order to identify the root causes of substandard care leading to maternal deaths. Materials and methods: This prospective study was carried out in the labor room, Department of Obstetrics and Gynecology, King George Hospital, Andhra Medical College for a period of twelve months from November 2016 to October 2017. All the mothers who died from severe preeclampsia and eclampsia were included in the study and they were all analyzed modeled on the United Kingdom Confidential Enquiries into maternal deaths. Results: In one year there were 530 women admitted with hypertensive disorders and 144 with eclampsia giving a prevalence of 9.04% and 2.45% respectively. Case fatality rate of preeclampsia was 2.26% and eclampsia was 4.1%. During the study period there were 44 total maternal deaths. Out of 44 maternal deaths, 12 were from severe preeclampsia and eclampsia making it the second leading cause of maternal mortality in our institute. Conclusion: The majority of deaths related to hypertensive disorders can be avoided by providing timely and effective care to women presenting with complications. Thus, optimization of health care for women during pregnancy to prevent and treat hypertensive disorders of pregnancy is a necessary step towards achievement of the Millennium Development Goals.

17-27

Authors: Shweta P. Bijwe, Arun P. Bakshi

Background: In the country like India where oral cancer with its associated tobacco chewing habit exists in epidemic proportions, constitutes a major public health hazard. The high percentage of oral cancer if not preventable is curable only if detected in its early stage which require large scale screening of the population at risk carried out repeatedly from time to time. Exfoliative cytology plays important role in this. Aim: To study age and sex wise incidence of oral lesion, to study the clinical presentations, to study the role of tobacco chewing, gutkha, pan with areca nut and smoking in benign, premalignant and malignant lesions of oral cavity, to study the cytomorphological changes in oral cavity of different clinico- pathological lesions of chronic tobacco users, to corelate oral cytology with histopathology where ever possible. Materials and methods: A prospective study was carried out in total 135 chronic tobacco users. Patients above 15 years age who presented with oral lesion and with history of tobacco use in any form for more than 1 year were included in the study. Samples were obtained by scrape method using wooden spatula. All the smears were stained by Papanicolaou stain. Results: In the present study of 135 chronic tobacco users 73.33% were male and 26.67% were females. Male to female ratio was 2.75:1. Maximum 34.07% chronic tobacco users were in the age group of 31-40 year.30 cases of oral submucous fibrosis, 5 cases of leukoplakia and 59 cases of clinically suspected malignancy seen. Most common presenting symptom were ulceration in oral cavity in 51.11%. Commonest site of lesion was buccal mucosa in 56.30% cases. Cytological examination of smear showed dysplasia in 58.52% cases, smears positive / suspicious for malignancy in 37.04% cases and inflammatory smears in 3.70% cases. Clinically suspected malignant lesions were seen maximum (40 cases) in age group of 41-60 years which were using tobacco+lime, kharra, gutkha and tobacco smoking as habits. Incidence of malignancy was seen increasing with increased duration and frequency of tobacco use. Maximum 24 cases of malignancy (40.68%) were seen with use of tobacco for more than 25 years, affecting males commonly. Squamous cell carcinoma was the only histological type seen in all the cases. Percentage accuracy of cytologic diagnosis in oral cancer when compared with histopathological diagnosis was 84.75%. Conclusion: Cytology is a reliable method for diagnosis of oral cancer but histological examination remains the gold standard.

36-41

Authors: Shweta P. Bijwe

Background: Various hemoglobinopathies are one of the major public health problems of India. Aim: To study spectrum of sickle cell disease in Central India based on HPLC, to identify abnormal hemoglobin requiring counselling and PND and to monitor treatment modalities. Material and methods: A retrospective study of total 5819 patients was done during January 2003 - December 2012, at RHDMC, IGGMC, Nagpur. Inclusion criteria were patients presenting with anemia, joint pain and jaundice, relatives on patients diagnosed with sickle cell disease and all antenatal cases. Tests performed in every case were hematological indices, Solubility test, Alkaline hemoglobin electrophoresis at PH- 8.9. All patients showing abnormal pattern on electrophoresis were subjected to HPLC on biorad variant. Results: Total 2590 cases were identified with various hemoglobinopathies. Sickle cell trait was seen in 1172 cases (20.15%), homozygous sickle cell anemia was seen in 969 cases (16.65%), Hb S - β Thalassemia double heterozygous state in 222 cases (3.82%), HbS - Hereditary persistence of fetal haemoglobin in 82 cases (1.42%), Hb E trait in 59 cases (1.01%0, Hb D trait in 52 cases (0.9%), Hb J in 9 cases (0.17%), Homozygous Hb E and Homozygous Hb D in 7 (0.12%0 cases each, Sickle cell - Hb D double heterozygous state in 6 cases (0.1%), Sickle cell - Hb E double heterozygous state in 4 cases (0.07%) and Hb Q in 1 case (0.02%). Conclusion: Various hemoglobinopathies have different clinical profile, thus their identification is important. Antenatal screening for hemoglobinopathies is important for preventing development of severe disease in newborn, which can be achieved by counselling and prenatal diagnosis in select cases. Region wise documentation of prevalence of various hemoglobinopathies is essential for epidemiological studies. HPLC is best tool for screening of hemoglobinopathies and Thalassemia. However, DNA studies in select cases are essential for confirmation.

50-63

Authors: Shweta P. Bijwe, Arunkumar D. Chopwad

Background: Thyroiditis is the second most common thyroid lesion next to endemic goitre diagnosed on FNA in iodine (I2) deficient areas. Although FNAC is the gold standard for diagnosis of thyroiditis, accurate diagnosis of a thyroid lesion at FNAC requires not just an in depth study of the cytomorphology but also a thorough clinico- radiological and serologic correlation. Aim: To study and correlate the clinical, radiologic, serologic and cytomorphological spectrum of autoimmune thyroiditis. Materials and methods: Retrospective study involving 150 cases was conducted. Clinical history (age, sex, symptoms with their duration and other signs, other significant medical/surgical history), TFT, were noted from the medical record available with the patient and also from Endocrinology department records. Results: Incidence of autoimmune thyroiditis was found to be 13.4%. Majority of the patients were females (96.7%), 53.3% of cases were seen in the age group of 21-40 years. 80.6% patients had a diffusely enlarged thyroid gland clinically. 92.7% patients showed grade I/II goitre. USG also showed a diffuse enlargement in 85.3% cases. Of the 150 patients with autoimmune thyroiditis, 110(73.3%) patients were euthyroid while 32 (21.3%) patients were hypothyroid at the time of FNAC. Only 8(5.3%) patients showed evidence of hyperthyroidism. 8% patients showed subclinical hypothyroidism. Prevalence of euthyroid autoimmune thyroiditis appeared high in our study. Among the cytomorphological features, presence of lymphocytes was consistently seen in all cases of chronic lymphocytic thyroiditis /mixed thyroiditis. Hurthle cells were seen in 68.6%, eosinophils were seen in 16.6%, giant cells and granulomas were noted in 29.3% and 8.6% cases respectively. L:E ratio was high in 101 (67.3%) cases ranging from 2:1 to 10. TFC destruction and grade III thyroiditis showed a significant association. Conclusion: Autoimmune thyroiditis was seen more commonly in females. Majority cases were seen in age group of 21-40 years of age. Lymphocytes, germinal centre cells, thyroid follicular destruction and Hurthle cells form important cytological features, while giant cells, eosinophils, granulomas were other cytomorphologic features in the diagnosis of autoimmune thyroiditis. Clinically and radiologically most of patients showed diffuse enlargement of thyroid gland. Majority of patients in our study were euthyroid at time of presentation. Prevalence of euthyroid autoimmune thyroiditis appeared high in our study. TFC destruction and grade III thyroiditis showed a significant association.

70-76

Authors: Premjit Ray M, Kodandagirirao D, Vijayasekhar Manda, Mahipal Rathod

Background: One of the most common neurosurgical entities is chronic subdural hematoma and its characteristic presence of enveloping subdural membranes. The membrane study acts as a rough guide to estimate the time since injury, the nature of the entity and the associated clinical condition. Aim and objectives: To study the demographics, incidence, symptomatology, neurological status, histopathology, risk factors, diagnosis, treatment and outcome of the patients presenting with subdural membranes. Materials and methods: The study was conducted in the Department of Neurosurgery, Government General Hospital (GGH), Kakinada (referral teaching hospital of Rangaraya Medical College). The study population comprised of all patients from both sexes who were diagnosed to have subdural collections with membranes that presented in GGH during the study period. Patients who met inclusion criteria had their independent variables ascertained were included in the study. The study was designed as prospective study. Neurological status, symptomatology, histopathology and Postoperative outcome were assessed immediately after surgery in the ward, and then two weeks and one month afterwards in the OPD. Relevant investigations were done as patient‘s condition dictated. Results: A total of 19 patients were included in the study for the final analysis. All the patients presenting with the diagnosis of Chronic Subdural Hematoma, or diagnosed after screening for symptoms suggestive of subdural collections were included in the study. CT/ MRI scan was used for diagnosis and preoperative evaluation of the patients. After procedure the specimen was sent for pathological evaluation. All the patients were thoroughly examined clinically and findings noted. The Pathological reports according to Nagahori, et al was followed and was noted. Surgical management was offered for all the patients. All the patients were evaluated preoperatively for any co-morbidity and managed accordingly, to be fit for surgical procedure. Adequate blood was reserved. Patient and attendants were explained in detail about the nature history of the disease, the prognosis and the need for surgery with its associated complications. Informed consent was obtained for surgery. Post operatively, antibiotics were given and patients observed for any CSF leaks, wound infection or meningitis. Patients were discharged after 7-9 days post-operatively. Neurological status was assessed at discharge and follow up. It was noted that most common age group affected was between 61-70 years, males were more commonly affected than females. Most common risk factors were hypertension 47.38% followed by diabetes 21.05%. Most commonly associated risk factor noted in the present study was both alcoholism with smoking. Most common presenting symptom was hemiparesis 52.6% followed by headache 29.41%. Most common type of membrane in our study was Type III 68.38% followed by Type II 15.58%. Most common type of membrane in our study was Type III 68.38% followed by Type II 15.58%. Most common type of lesion encountered in our study was chronic followed by acute on chronic. Most lesions were observed on the right side. Most common site of lesion was fronto-parietal followed by fronto-temporoparietal in location. Associated lesions were seen in 57.86% of cases. Generally outcome based on (GCS) preoperative and postoperative scores were good in about 78.90%. Generally outcome based on (GCS) preoperative and postoperative scores were good in about 78.90%. Conclusion: This study underlines that craniotomy and subtotal membranectomy is still an acceptable, safe, efficient and even a better procedure for patients presenting with subdural membranes.

82-94

Authors: Dr. Shweta Nitturi, Dr. Olvyna D’souza

Background: We sought to compare the effects of intranasal Dexmedetomidine a more selective alpha 2 receptor with the effects of Midazolam administered via the same route Materials and methods: After approval by hospital research ethics committee, informed written parental consent for anesthesia was taken. 60 patients with ASA grade I or II in age group (2-9 years) were enrolled for this. The study was carried out from February 2014 to May 2015 in a tertiary care hospital. For the study, 60 patients were divided in two groups: Group M: 0.2 mg/kg intranasal Midazolam and Group D: 1 µg/kg intranasal Dexmedetomidine. All patients in either group have received general anaesthesia using a standard balance anesthesia technique. Comparisons between the study groups were conducted using ANOVA by using multivariate ANOVA test, one-way ANOVA test, repeated measures ANOVA and Kruskal–Wallis ANOVA test as well as comparing mean and standard deviation. Results: Our study demonstrated that intranasal Dexmedetomidine produces better sedation than intranasal Midazolam in pediatric age group. Ease of parent child separation at 30 minutes was satisfactory in group D though group M offered less satisfactory ease of parent child separation. In our study, the changes in heart rate and systolic blood pressure in group M and group D were clinically insignificant and modest. There were no episodes of significant bradycardia, hypotension, bradypnoea, apnea, airway obstruction, emesis and arterial oxygen desaturation at any time during the study. None of the children were sedated to the extent that they failed to respond to stimulation or were unarousable. Ease of induction after 30 minutes was better in group D compared to group M. Conclusion: Dexmedetomidine, in a dose of 1 microgram/ kg administered intranasally produces better sedation, better parental separation and mask acceptance as compared with intranasal Midazolam 0.2 mg/kg. The hemodynamic change produced with Dexmedetomidine are clinically insignificant (<20% of baseline) and modest.

100-106

Authors: Mohamed Jan, Haja Abdul Nazeer M.J.

Introduction: Surgical site infections are one among the commonly reported nosocomial infections. The present study was aimed at determining the possible risk factors involved in development of SSIs and the microorganisms responsible for SSIs with their antibiogram in a rural tertiary care teaching hospital. Materials and methods: This was a prospective observational study conducted in the Department of Surgery in association with the Department of Microbiology at Vinayaka Missions Medical College and Hospital over a period of six months. Detailed history such as age, sex, operation category (elective/ emergency), history of diabetes were recorded. Swabs were collected from clinically suspected of surgical site infections. Specimens collected were subjected to standard microbiological procedures. Antimicrobial susceptibility of the isolates was determined by Kirby Bauer disk diffusion method on Muller Hinton agar plates according to Clinical and Laboratory Standard Institute (CLSI) guidelines. Results: A total of 342 patients underwent surgery during the study period. 59 cases were clinically diagnosed of surgical site infection, out of which 55 patients’ samples yielded growth and accounted for 16% infection rate. The incidence of infection was high in case of emergency surgeries (22%) compared to elective surgeries (13%). SSI rate was low in clean surgeries (7%) whereas contaminated and dirty wounds showed 43% and 75% respectively. Staphylococcus aureus (27.5%) was the predominant pathogen isolated. Linezolide was the most susceptible antibiotic against Gram positive cocci. Second predominant organism was Escherichia coli 14 (20.2%). and showed good susceptibility to imipenem, cefeperazone/ sulbactum and piperacillin/ tazobactum including ESBL producers. Conclusion: In this study, surgical site infection rate was 16%. Staphylococcus aureus (27%) was the most frequently isolated bacteria followed by E.coli (20%). Good susceptibility observed towards linezolide against Gram positive cocci. Imipenem, cefeperazone/ sulbactum and piperacillin/ tazobactum were effective against Gram negative bacilli.

111-120

Authors: Shweta P. Bijwe, Arunkumar D. Chopwad

Background: Thyroiditis is the second most common thyroid lesion next to endemic goitre diagnosed on FNA in iodine (I2) deficient areas. Aim: This study was carried out to study correlation between various cytomorphological features with anti-thyroid antibodies in cases of autoimmune thyroiditis diagnosed on FNAC. Materials and methods: This was a retrospective study carried out in a tertiary care teaching hospital. 150 cases diagnosed as autoimmune thyroiditis in a two year period from January 2010 to December 2011 formed the study group. The cytological findings and AMA tires were noted from the medical record available with the patient and also from Endocrinology department records. Results: Incidence of autoimmune thyroiditis was found to be 13.4%. Majority of the patients were females (96.7%), 53.3% of cases were seen in 21-40 years age group. In 97 patients anti-microsomal antibody titre (AMA) was available, 83 were positive i.e.85.6% positivity. Association between grade of lymphocytes, grade of thyroiditis and high L:E ratio with AMA titre was found to be statistically significant. Of the cytologically diagnosed cases of autoimmune thyroiditis, 14.4% cases showed AMA negativity. Thus FNAC remains the gold standard for the diagnosis. Conclusion: Grade of lymphocyte infiltration and grade of thyroiditis correlated well with AMA positivity. Association between high L:E ratio and AMA titre was found to be statistically significant.

129-132

Authors: Senthilkumar J, Rajasigamani K, Kurinji Kumaran N, Baskar V

Introduction: Aesthetic appearance including dental appearance plays a vital role in a person’s personality especially among Adolescents. Malocclusion is a Handicapping dentofacial anomaly, which can be prevented in the earlier stage. Aim and objectives: To find out the prevalence of Malocclusion and association between gender and malocclusion among 14- 17 years old adolescents in Karaikal population. Materials and methods: 425 participants between the age group of 14-17 years were examined for malocclusion over a period of 15 months and classified according to Angle’s classification. Results: Prevalence of Malocclusion in this study was 32% (136). Around 20.2% had Class I, 9.7% had class II and 2.1% had class III malocclusion. No association was found between gender and malocclusion. Conclusion: In this study, class I malocclusion is more prevalent. Dental public health services should be trained to diagnose malocclusion at primary health care level to treat malocclusion in the earlier stage.

138-144

Authors: B. Sandhya Rani

Background: Carcinoma of the cervix is 3rd most common carcinoma of women. It is a leading cause of morbidity and mortality in India. About 86% of cases occur in developing countries and 88% deaths occur due to cervical carcinoma in developing countries. Pap smear is a simple, non-invasive, cost-effective tool in every Gynaecological OPD which can detect abnormal cytological findings of cervix. It can detect pre-cancerous lesions of the cervix at the earliest and effective early treatment can save women from morbidity and mortality. Aims and objectives: To determine the prevalence of pre-cancerous conditions of the cervix in hospital to study demographic & other associated risk factors. Materials and methods: A Hospital based cross -sectional study was conducted. This was questionnaire based study. Questionnaire was administered to 500 women attending Gynaecological OPD. The questionnaire consisted of the questions regarding the knowledge and awareness about different aspects of cervical cancer. All relevant socio-demographic parameters, detailed history, clinical examination, per speculum examination, Pap smear cytological study was done. This study was approved by Institutional ethical committee. 500 women coming to Gynec OPD with chronic discharge P/V, post-coital bleeding, Post-menopausal bleeding P/V, other menstrual abnormalities, lower abdominal pain and routine Pap smear screening between age group 18 (0r age of 1st coitus-whichever was low) till 65 years of age were included in the study. The data collected during the survey was entered in micro -soft excel and analyzed via SPSS (Statistical Package for the Social Sciences) SPSS VERSION 20. Results: Out of 500 cases studied, 458 cases (91.6%) were satisfactory according to Bethesda System. The epithelial cell abnormalities constituted 42 (8.4%). Maximum no. of cases 210(42%) were in age group > 40 years. Co-relation of early marriage/1st coitus and increasing age with abnormal cytological findings was statistically significant (p value 0.001) along with cervical morbidity on per speculum findings. The statistically significant co-relation was found (p value 0.001) between multi -parity (40.7%) and abnormal cervical smear findings. ASCUS was (5.4%) followed by LSIL (1.4%), HSI L (0.8%) and SCC (0.8%). Conclusion: The study clearly shows relatively high prevalence of epithelial abnormalities in cervical Pap smear with increasing age, parity and early age at first coitus in symptomatic women with clinical lesions on per speculum findings. Effective screening with Pap smear definitely helps in early detection of Precancerous lesions of cervix Effective, frequent Pap smear screening programmes should be organised in India, even in the remotest rural areas to prevent the incidence of invasive cervical carcinoma.

149-151

Authors: Shweta P. Bijwe, Arunkumar D. Chopwad, Praveen Lagdive

Benign tumors involving peripheral nerves of the upper extremity are uncommon. The swelling may be misdiagnosed as other soft tissue neoplasm like lipoma, ganglion or lymph node. Schwannomas also known as neurilemmoma usually originate from Schwann cells located in the peripheral nerve sheaths. They account for about 5% of all the benign soft-tissue neoplasms in the adults and 19% of the tumors occur in upper extremities. Schwannomas generally presented as an asymptomatic mass causing discomfort. With the increasing size of the tumor pain, numbness, and fatigue may occur. We report a case of schwannoma on forearm which was clinically misdiagnosed as foreign body granuloma and was excised. Diagnosis was made on histopathology. Diagnosing the peripheral nerve schwannomas can be challenging clinically. Hence, a detailed clinical, radiological and histopathological evaluation is essential. Peripheral nerve schwannoma is rare and observation of a single patient can add to our understanding this rare disease.

6-11

Authors: P. Elango, G. Indumathi

Introduction: In India, OP compounds cause more self-poisoning deaths in southern and central India. In Northern India, aluminum phosphide causes most deaths with a fatality ratio. Poisoning due to occupational exposure, accounted for about one fifth of the incidents, with a fatality ratio of less than 1%. More than 90% of the non-occupational incidents were suicidal, with a fatality rate more than 10% and the majority of the subjects are young males. Accidental exposures accounted for 8-10% of the incidents and homicidal use (less than 1%) were other forms of poisoning. The reported overall mortality following OP insecticide poisoning varies from 4-30% in different countries and institutions. Aim: To estimate serum Amylase levels in acute organophosphorus compound poisoning and the find out the clinical outcomes. Materials and methods: The study was conducted in Government Dharmapuri Medical College Hospital, Dharmapuri. Study duration was from January 2017 to June 2017. Of a total of 145 patients with organophosphorus compound poisoning admitted to the hospital during the study period, 40 were included in the study. 10 healthy (age matched) individuals were kept as a control. Biochemical evaluation which includes Serum Amylase Blood glucose, urea, creatinine, and Liver function tests were analyzed and matched among the two groups. Results: The biochemical results have not shown much variation from the normal levels in our study. In the study, the Amylase levels were significantly elevated at the time of admission (185.2 U/L) and have shown a gradual remission with proper treatment. The mean Amylase level in severely poisoned patients was 297.7 U/L which was significantly (P < 0.01) higher than the healthy control group. On comparing the Amylase levels in first 24 hours against control, the variations were considered to be significant (P < 0.01). Conclusion: From the observation we made, it could be suggested that OP pesticide poisoning is a serious condition that needs rapid diagnosis and treatment. The mean Amylase level in first 24 hours of OP poisoning was 154 U/L which is significantly higher than the control groups.

19-24

Authors: P. Elango, G. Indumathi

Introduction: Cirrhosis liver, is characterized by diffuse destruction and regeneration of hepatic parenchymal cells leading to deposition of connective tissue with resulting disorganization of the lobular and vascular architecture. Despite the remarkable regenerative capacity of the liver, once hepatic parenchymal reserve is exceeded, clinically overt or decompensated cirrhosis ensues. Portal hypertension develops due to resistance to blood flow through the liver resulting increase in portal venous pressure leading to diversion of blood flow through low resistance portosystemic collaterals thereby bypassing the liver. The current study was designed to precisely evaluate the cardiovascular system in a group of patients with hepatic cirrhosis based on clinical examination. Aim of the study: To clinically evaluate patients with hepatic cirrhosis with respect to changes in heart rate, blood pressure, mean arterial pressure, ECG jugular venous pressure and precordial examination. Materials and Methods: 50 patients of cirrhosis liver were selected for the study. These patients were admitted in the general medical wards. All patients were subjected to routine investigations. All patients were subjected to ultrasound scan abdomen to confirm the diagnosis of cirrhosis. Patients with ascites underwent abdominal paracentesis and fluid was analyzed for protein content and cells. All patients were then subjected to electrocardiography, chest X-ray and M-mode 2-Dimensional echocardiography. Results: Out of the 50 patients studied 35 (70%) were males and 15 (30%) were females. The age of the patients ranged from 19 years to 75 years. 5 Patients (10%) were alcoholics, 14 patients (28%) had past history of jaundice or, 8 patients (16%) presented with haemetemesis. Among this 4 patients were HbsAG+ (8%) and 2 patients were diabetics 4%. All patients had sonographic evidence of cirrhosis.with portal hypertension. Out of 50 patients, 3 patients had elevated blood pressure. Previous studies show that the systolic blood pressure more than 160 mmHG and diastolic blood pressure more than 95 mmHg are the range for hypertension in cirrhotic patients. The electro cardiac gram showed an average heart rate of 82/ m. The low QRS voltage in chest leads and limb leads were found in 10 patients. T wave inversion was found in chest leads (V1 to V3 / V6) in 4 (8%) patients, in II, III avf in 7 patients (14%). The chest roentgenogram showed Hepatic Hydrothorax in 5 patients (10%). Cardio megaly was evident in chest X – ray in 11 patients (22%). Conclusion: The result of this study clearly showed that a large number of patients with hepatic cirrhosis are asymptomatic (40%) about cardiovascular system, have evidence of cardiac involvement in electrocardiography and echo cardiograph. cardiac decompensation in cirrhosis is rare despite the high output state and its presence as indicated by left ventricular systolic dysfunction.

32-35

Authors: Santhosh Bukya, Sudarshan

Background: A Fistula is an extra anatomic communication between two or more epithelial lined body cavities or skin surface. Most of the vesicovaginal fistulas in industrialized and well developed countries are iatrogenic and most of the vesicovaginal fistulas in underdeveloped and developing countries are obstetric. Materials and methods: 10 cases of VVF presented to OGH OPD from October 2013 till September 2016 with age range 22 years to 43 years were included in study. Radiation fistulas, malignant fistulas, complex obstetric fistulas were excluded. Eight of the Ten cases were post hysterectomy (TAH) supra trigonal fistulas (7 single fistulas 1 case had two fistulas side by side), One case was post obstetric trigonal fistula, One case was post caesarean section where the fistula was in the anterior fornix close cervix. Results: Out of 10 patients, we had 1 port site infection, fever in 2 cases, increased drain for initial 2 days in 1 case. None of the 10 cases required blood transfusion, and there was no leak per vagina in all cases before and after catheter removal. All the patients were working patients, and resumed their work as early as 12 days after surgery. Conclusion: Conventional open repair with bivalving of bladder is associated with morbidity in the form of higher pain scores, higher HB % drop, prolonged hospitalization, prolonged catheterizations, and delayed resumption of work. Laparoscopic repair with limited cystotomy overcomes all the disadvantages of the conventional repair with equal results.

43-46

Authors: M. Thirumaran, M. Danasegaran

Introduction: Iron deficiency anemia is the most common form of anaemia in India. Haemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Glycosylated hemoglobin (HbA1c) is used as a gold standard for monitoring glycemic control and as a predictor of diabetic complications. Conditions that affect erythrocyte turnover affect HbA1c concentration. Although many forms of anemia are associated with lowering of HbA1c, iron deficiency anemia tends to increase HbA1c. Aim of the study: To Compare the Hba1c Level and hemogram levels among Iron Deficiency Diabetic Patients With Non-Iron Deficiency Diabetic patients. Materials and methods: 25 Non-iron deficiency diabetic patients (controls) and 25 iron deficiency age matched diabetic patients (cases) with good glycemic control were enrolled in the study. Absolute HbA1c levels were measured in both the patients. The levels of hemoglobin, mean corpuscular hemoglobin (MCH), hematocrit, mean orpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), were measured by an automated counter these values were compared with those in the control population. Results: The mean baseline HbA1c level in iron deficiency diabetic patients (8.60) was significantly higher than that of controls (4.48) however, after 3 months of iron deficiency treatment, a significant decline from 8.60 to 6.5. Conclusion: Our study proved that iron deficiency anemia has a straight forward correlation with HbA1clevel in diabetic patients Moreover, with correction of iron deficiency in the anemic diabetic patients and HbA1c levels decrease.

54-58

Authors: Naresh Kumar, Jyoti Kumar Dinkar, Chandrakishore

Background: Macrovesicular fat accumulation in more than 5% of hepatocytes without significant alcohol consumption is the defining criteria of Non-alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease is often associated with diabetes mellitus which is associated with a 60-70% of frequency of Non-alcoholic fatty liver disease. The prevalence of NAFLD among the Type 2 Diabetes mellitus (T2DM) patients is higher compared to non-diabetics. Type 2 Diabetes mellitus and Non-alcoholic fatty liver disease are common conditions that commonly co-exist and can act reciprocally to bring adverse outcomes. Aim and objectives: The aim of this study was framed to determine the prevalence of Non-alcoholic fatty liver disease in Type 2 Diabetes mellitus patients and also to study the risk factors. Material and methods: The present cross sectional, prospective study was conducted at Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital of Bihar, over a period of 5 months. A total of 140 patients with Type 2 Diabetes mellitus that satisfied inclusion criteria were included in the study. All patients included in the study were subjected to ultrasonography and relevant history, thorough clinical examinations and biochemical tests were performed and recorded. Results: Out of 140 patients participated in the study, 44 (31.43%) were found to have Non-alcoholic fatty liver disease (NAFLD). The most common ultrasonographic grade of NAFLD was grade I (mild) fatty liver disease 30(21.43%), followed by grade II (moderate) fatty liver disease 13 (9.29%). The grade III (severe) fatty liver disease was found in 1 (0.71%) of the diabetic patients. NAFLD patients were compared with those with normal liver ultrasonographic findings. The risk factors of NAFLD were also evaluated. The highest prevalence of NAFLD was recorded in the age group of 51-60 years and it was more prevalent among females than males. Conclusion: An observation into the predisposing factors of Non-alcoholic fatty liver disease, revealed a higher prevalence of obesity, hypertension, hyperlipidemia, hyperglycemia and sedentary lifestyle in the subjects with NAFLD. Type 2 Diabetes mellitus patients having non-alcoholic fatty liver disease are at increased risk of developing progressive forms of the disease. The liver disorder constitutes another potential complication in T2DM patients that requires early and prompt intervention in the associated risk factors and prevents the emergence of chronicity of NAFLD.

67-74

Authors: R. Maheshwari, Rakesh Fernando

Background: Cervical lymphadenopathy can be a confounding problem in surgical practice. The analysis of cervical lymphadenopathy is never straightforward and the difficulty is compounded by the differential diagnoses that include several diseases that resemble each other. Clinical evaluation, aspiration cytology, and open biopsy are some of the methods available for this purpose. Aim: To study the prevalence of the cervical lymphadenopathy in respect to age, sex, to study about the various clinical presentation of cervical lymphadenopathy, to correlate the pathological findings with the clinical diagnosis and to study the role of FNAC by correlating with confirmed biopsy report. Materials and methods: 75 patients with cervical lymphadenopathy were selected from the General Surgery OPD of Tirunelveli medical college. They were subjected to FNAC and excision biopsy of the nodes after a thorough history and clinical examination. The results were tabulated and analyzed. Results: The most common diagnosis was Tuberculous lymphadenitis (67%) followed by reactive (9%) and non-specific lymphadenitis (9%) with malignant secondaries (11%) and lymphomas (4%). There was a slight male preponderance (57.3%) The most common presenting age groups were between 31 to 40 years followed by 21 to 30 years. The most common presenting symptom was neck swelling (88%) followed by fever (37.3%) and Loss of weight (18.7%). Conclusion: Tuberculous lymphadenopathy continues to be the major reason for cervical lymphadenopathy with malignancy as an important differential diagnosis. FNAC is a versatile diagnostic tool and one of the least invasive tests in the workup of cervical lymphadenopathy. It is very accurate in diagnosing malignancy and lymphomas and reasonably so in diagnosing tuberculosis.

82-90

Authors: Fine needle aspiration cytology, Thyroid swelling, Accuracy, Positive predictive value.

Background and Aim: Alpha-2 agonists as adjuvant to local anaesthetic agents for PNB enhance the quality and duration of analgesia. Aim of this prospective, double blind, randomised placebo controlled study was to compare the affect addition of Dexmedetomidine and clonidine to Ropivacaine with respect to onset, peak, and duration of sensory-motor block and duration of analgesia in Supraclavicular brachial plexus block. Materials and methods: Ninety ASA grade I or II patients of either sex, aged 18-60 years age scheduled for elective upper limb surgery were equally divided in three groups (n=30).Group R received 0.75% Ropivacaine 30 ml + 1ml NS, Group RC received 0.75% Ropivacaine 30ml +1µgm/kg of clonidine, Group RD received 0.75% Ropivacaine 30ml + 1µgm/kg of Dexmedetomidine in Supraclavicular plexus block by using nerve locator. Results: Onset (sensory=7.6± 1.56, 6.13± 1.59, 4.13±1.35, in motor 10.23± 1.79, 9.03± 2.31, 6.50± 1.57 respectively), peak(sensory 17.33±2.89, 13.66±3.16, 10.63 ±2.89, in motor 21.76±2.56, 18.46±3.0, 15.66±3.20 respectively) and duration(sensory 239.83±39.96, 322.0±58.21, 375.0±53.69, in motor 206.0±40.71, 285.0±56.30, 332.50±57.84 respectively) of sensorimotor block and duration of analgesia (279.0±43.67, 357.16±55.85, 412.16±50.06 respectively)were prolonged in Dexmedetomidine group as compared to other both group. VAS and sedation score was better in dexmedetomidine group than clonidine group. Hemodynamic stability was comparable in all three groups and no complications were seen in any of the group. Conclusion: Dexmedetomidine (1µg/kg) is better than clonidine as adjuvant to 0.75% Ropivacaine in supraclavicular brachial plexus block for upper limb surgeries.

98-104

Authors: Jookanty Santosh Kumar, K. Mahesh Kumar

Background: Surgeries are associated with significant postoperative pain. Postoperative pain is usually of longer duration and recurs after few hours. The caudal epidural block is considered as the procedure of choice for pain relief in such cases. The purpose of this study is to evaluate the postoperative analgesic efficacy of epidurally administered Bupivacaine and Tramadol in surgeries including cesarean sections and other gynecological surgeries. Aim of the Study: Effectiveness of bupivacaine and tramadol in postoperative pain management Materials and methods: A total of 100 cases were included in this study between the age group of 15 years and 65 years. They were grouped into group A - Bupivacaine group and group B - Tramadol group. Results: The mean interval between 1st and 2nd dose in Group A was 268.15 minutes and in Group B was 398.35 minutes. Dose intervals between 2nd and 3rd dose in Group A were 279.52 minutes and in Group B 371.41 minutes. Dose intervals between 3rd and 4th dose in Group A were 266.42 and in Group B was 321.15 minutes. There were no cases which required the 4th dose of the drug in this study. Conclusion: Postoperative consumption of analgesia was higher in the Bupivacaine group. Epidural tramadol 100 mg in 10 ml provides better and longer duration of anesthesia with rapid onset and no incidence of complications.

110-118

Authors: Ibanga AA, Nkanga DG, Asana UE, Duke RE, Etim BA, Nkanga ED, Utam UA, Agweye CT, Udofia OO

Background: Monitoring of patients’ experiences and satisfaction provide the health institution one of several parameters to measure quality of services and determine areas where improvement and or additional services are needed. Aim: To determine patients’ satisfaction regarding the services in the ophthalmic out-patient clinic in University of Calabar Teaching Hospital. Materials and methods: A descriptive cross sectional study was conducted among patients attending the eye clinic of the department of ophthalmology, University of Calabar Teaching hospital, Calabar from 1st October to 31st December 2016. All consecutive registered adult patients who gave consent, along with consenting guardians of patients who were younger than 18 years were included in the study and interviewed. An Interviewer-administered pretested and validated questionnaire was used for data collection. Data obtained were analyzed using SPSS (Statistical Package for Social Sciences version 20 software). Frequencies and percentages were used. Parametric analyses included bivariate analysis and multiple logistic regressions and Pearson coefficient of correlation with p 0∙05 being considered statistically significant. Results: The level of satisfaction with accessibility to the hospital and medical care in the eye clinic was very high 95.4%. On time spent in clinic, majority of respondents (50.8%) felt that the waiting time for emergency treatment was good. However, only 39.9% of the respondents felt that the waiting time to be attended to by a doctor in the routine clinic was short. Waiting time for performing an investigation and subsequently getting the result was reported as poor by 62.5% and very poor by 69% respectively. Conclusion: This study demonstrated that only 35.2% of respondents were satisfied with the overall quality of the medical care service received from the eye clinic of the UCTH, Calabar.

125-132

Authors: P.S. Ganesh Babu, R. Saravanan, V. Ramadevi

Back ground: Devastating defects are those defects where the major structures like bones, joints, nerves, and blood vessels are exposed. These defects may be due to road traffic accidents, train traffic accidents, post burn scar contracture release raw area etc. Skin grafting or simple flaps may not help in these cases making reconstruction challenge. To study the various flap options for the coverage of the elbow defects and its outcomes. Materials and methods: From the period of 2016 to 2017, all patients with elbow defects that required local or locoregional flaps were chosen for the study. Investigations included plain X-ray of the elbow. Hand held Doppler was done for patients in whom the perforator based flaps were selected for reconstruction. Results: In our study (23 patients) were males and (4 patients) were females. The most common cause was the road traffic accident (18 patients). Two patients were due to a post burn contracture release raw area. One of the patients was due to a work place accidental injury. Six patients were due to train traffic accident and of which 5 patients presented with total amputation (stump raw area). The site of the wound played a major role in determining the flap selection. In our series, most of the patients presented with defects over lateral (6 patients) and posterior lateral (7patients) elbow region. Conclusion: Meticulous planning for their construction of devastating elbow defects is necessary to achieve satisfactory results. The choice between different flaps depends on the nature of the defect, availability of donor tissues and the patient’s needs.

136-144

Authors: N. Srivani, B.V.N. Sravani, Shyamala Srujana, O. Shravan Kumar

Introduction: Lichenoid tissue reaction or interface dermatitis embraces several clinical conditions, the prototype of which is lichen planus and its variants. Others include drug induced lichenoid dermatitis, special forms of lichenoid dermatitis, lichenoid dermatitis in lupus erythematosus, and other disorders all of which have salient clinical and histological features. The aim of this study was to correlate the clinical features with histopathological findings in all clinically suspected cases of lichen planus and assess the clinical diagnostic accuracy. Materials and methods: This study had been carried out over a period of 2 years from July 2015 to June 2017 in the Department of Pathology, Gandhi Hospital. Histopathological sections of skin biopsies from 85 patients were studied after routine H and E staining and morphological changes were noted. The patients’ clinical findings were then correlated with the histological changes. The results were then analysed. Results: Total numbers of biopsies inclusive of LP and LP like lesions were 85. Among them, the number of patients having LP was 50. The age ranged from 18 to 65 years (mean 37.1 years). The mean duration of the lesion was 12.02 months (approx 1 year). Males were affected more than females. Out of the 85 cases, 50 were Lichen planus and 35 were lichenoid eruptions. Of the Lichen planus, 31 (61.6%) cases were of classical lichen planus, 6 (13.3%) cases were of hypertrophic lichen planus, 4 (8.3%) cases were of lichen planus pigmentosus, 4 (6.6%) cases were of actinic lichen planus, 3 (5%) cases were of eruptive lichen planus, 1 (1.6%) case each of atrophic lichen planus, annular lichen planus. Conclusion: In the present study, maximum number of cases occurred in age group of 18-28 years. Though pruritis is a common symptom, it is nonspecific. Therefore, histopathology remains the most important diagnostic tool for proper evaluation of Lichenoid eruptions/ Lichen planus.

156-163

Authors: K. Bhramaramba, Sunethri Padma, S. Hemalatha, N.L.N. Murthy

Breast carcinoma is showing an increasing trend amongst urban women population. Breast Imaging Reporting and Data System (BI-RADS) is a widely accepted risk assessment procedure for carcinoma breast in clinical practice. Fine needle aspiration cytology (FNAC) is an established and important preoperative diagnostic modality. We have done a two year comparative study of these two procedures in the department of Pathology, at Gandhi Hospital from June 2014 to May 2016. We have done 720 FNACs for breast lesions during this period and compared the results with BI-RADS classification by mammography / ultrasound screening at the department of radiology, Gandhi Hospital. Out of total 720 patients who underwent FNAC, BI-RADS grading was available for only 540 cases. Cytological patterns were compared with BI-RADS grading for these 540 cases. The Concordance and Discordance among these findings are discussed with special emphasis on grade 4 and Grade 5 BI-RADS lesions in which carcinoma breast risk is high.

171-177

Authors: Prakash S, Giridhar, Harshila Jain

Background: Posterior capsule opacification (PCO) is the commonest complication of extracapsular catraract surgery in pediatric patients with an incidence as high as 95%. But there is inadequate evidence on appropriate intervention to prevent PCO. Aim: To compare the efficacy of plasma knife assisted posterior capsulotomy versus manual primary posterior capsulorhexis in Pediatric Cataract surgery. Materials and methods: The current study was a randomized open labeled controlled study, conducted in the department of ophthalmology, All India Institute of Medical Sciences, New Delhi between July 2015 to June 2016. The study population included 32 children in each of < 2 years age, suffering from bilateral cataract and each eye was randomized to different intervention groups consisting of manual posterior capsulorhexis or and posterior capsulotomy using plasma knife. Anterior vitrectomy was performed in all the eyes. Visual acuity, axial length, Intra ocular pressure, and refraction etc. were measured using appropriate methods. The retro-illuminated clinical photograph was taken using NEW CARL ZEISS f340 CANON camera and was analyzed by EPCO software. Results: There was no statistically significant difference in any of the ocular parameters at baseline and at 6 months following surgery. The log MAR visual acuity was significantly higher in intervention 1 (0.465±0.143) as compare to intervention 2 (0.397 ± 0.108) at 1 year, which was statistically significant (P value 0.036). There were no statistically significant differences in the proportion of Visual Axis Opacification (VAO) between the intervention groups. Conclusion: Visual axis opacification after pediatric cataract surgery remains comparable in both techniques at one year (plasma knife assisted posterior capsulotomy and manual capsulorhexis). Hence it can be concluded that plasma knife assisted posterior capsulotomy does not have any added advantage over manual posterior capsulorhexis in preventing visual axis opacification.

187-190

Authors: Punam Kumari Jha, Nalin Chaudhary, Abhinav P

Phenylketonuria is a rare genetic disorder caused by an inborn error in aromatic amino-acid metabolism resulting a lack of mental abilities and developmental changes. Phenylketonuria is an autosomal-recessive inherited metabolic disease in which excessive accumulation of phenylalanine occurs which further leads to neurological impairment. In this paper we report a case of a one-year-old child born with the consanguineous parent with distinct amino acid analysis and radiological findings.

195-206

Authors: L. Veenakumari, C. Sridevi

Actinomycosis is a chronic, suppurative granulomatous inflammation caused by Actinomyces israelli which is a gram positive organism that is a normal commensal in humans. Multiple clinical features of actinomycosis have been described, as various anatomical sites can be affected. It most commonly affects the head and neck (50%). In any site, actinomycosis frequently mimics malignancy, tuberculosis or nocardiosis. Physicians must be aware of clinical presentations but also that actinomycosis mimicking malignancy. In most cases, diagnosis is often possible after surgical exploration. Following the confirmation of diagnosis, antimicrobial therapy with high doses of Penicillin G or Amoxicillin is required. This article is intended to review the clinical presentations, histopathology and complications of actinomycosis in various sites of the body.