Panacea Journal of Medical Sciences

109-112

Authors: Kawthalkar Anjali1, Kose Varsha2, Joshi Sulabha, Bhalerao Anuja, Kumare Bhavana, Somalwar Savita.

Blood transfusion is an important part of patient management in Obstetrics and Gynaecology. There is a need to periodically assess the blood transfusion practices to identify the areas of improvement. A retrospective analysis of ninety cases was done to study the indications of blood transfusion, use of whole blood and blood components and measures taken to minimize the need of blood transfusion. The indications in obstetric cases are evenly distributed between three – anaemia complicating pregnancy, obstetric haemorrhage and postpartum correction of anaemia. In Gynaecology, majority of the subjects (53.1%) received blood transfusion for preoperative correction of anaemia in cases of abnormal uterine bleeding. in 51.1% cases, whole blood transfusion was given for correction of anaemia. Special measures to minimize BT requirement were practiced in 41.4% of obstetric cases and 25% of gynaecology cases. There is a need to change the inappropriate blood transfusion practices such as use of blood transfusion for preoperative correction of anaemia in elective surgery, use of whole blood for correction of anaemia. Use of alternative measures to reduce the need of blood transfusion should be practiced more aggressively.

119-123

Authors: Nirmal Sankalp, Bansod Abhijeet, Faye Abhijeet, Gawande Sushil, Tadke Rahul, Kirpekar Vivek, Bhave .

Being posted for cataract surgery can be source of anxiety for the patient. This study was conducted to assess the presence of anxiety symptoms and their correlations with various socio-demographic variables in patients posted for cataract surgery. It was a cross-sectional, non-randomized, single interview study. 50 consecutive patients posted for cataract surgery were included. Each patient was individually interviewed using a semi-structured proforma prepared for the study which included socio-demographic profile, clinical and psychiatric profile and ophthalmological diagnosis. To assess various domains of anxiety, Hamilton Anxiety Rating Scale (HAM–A) was administered. About 80% of patients reported at least 2 or more anxiety symptoms but most of these symptoms were transient in nature. 92% had anxiety scores less than or equal to 13 on HAM–A. Only 14% patients reported worries on MSE. We did not found a diagnosable anxiety disorder in patients posted for cataract study. Only 8% of subjects had mild to moderate scores on Hamilton anxiety rating scale. Also the patients with mature cataract have statistically significant correlation with HAM–A scores.

130-136

Authors: Ayyamperumal Balaji, Peter Babu, Vanitha K.

The study was carried out to evaluate the different parameters of cerebral blood perfusion in ischemic areas and to determine the most appropriate parameter to identify infarcted and non-infarcted zone. A prospective study in patients with hemispheric stroke to The Stroke Service over a period of two years was undertaken. Initial CT with CT perfusion and MRI diffusion-weighted imaging was done. Total of 47 cases were studied. NIHSS score was determined. Renal function was done. Time since the onset of stroke as told by the patient or relative was recorded. CT perfusion studies were performed using a 4-slice CT scanner (TOSHIBA) with CT perfusion software. MRI was performed with a 1.5-T clinical whole-body unit. MR DWI images were visually analysed to match the sections on PCT images. The PCT maps and MR images were co registered manually. Statistical analysis used ROC. Mean age was 55.9 years. The Mean NIHSS score was 15.9. Mean CT scan time was 10. 2 hours after symptom onset. The thresholds for rCBF (54%) and rMTT (142%) found would allow differentiation of core and pneumbra. We found a longer MTT with more severe ischemia, in accordance with the central volume principle that states that MTT is inversely related to the perfusion pressure. This statistical analysis of the parameters confirms that rMTT is a better separator of viable and nonviable tissue than is rCBV. Furthermore, higher sensitivity and accuracy were obtained for rMTT than for rCBV and MTT maps. Relative MTT, with an optimal threshold of 142%, provided the most accurate prediction of the final infarct size.

145-149

Authors: Jethani N, Rathore H, Pachori G, Bansod P, Ratnawat K.

Head and neck swellings are the most common and challenging lesions in the field of FNAC diagnosis. FNAC is simple, inexpensive and fairly accurate alternative to the time consuming, complicated and invasive excision biopsy. The study was carried out to access the role of FNAC in diagnosing various head and neck lesions. This prospective study was undertaken on palpable head and neck lesions in all age groups for the duration of 9 months from September, 2013 to May, 2014 in Pathology Department of tertiary care hospital. Total 756 cases were evaluated in the cytopathology section and aspiration was done using 10 ml syringe and 22-26 gauge needles. The results of material positivity were compared with histopathology material obtained in follow-up. Out of the total 756 patients, 376 were males and 380 were females. Overall male to female ratio was 1:1. Head and neck swelling were present most frequently in the third decade. Lymph node swellings were the most common lesion (64.3%), followed by thyroid (17.5%), skin and soft tissue (13.5%) and salivary gland swellings were least common (4.8%). Non - neoplastic lesions were the commonest (67.3%) followed by malignant lesions (13.1%). Histopathological correlation was performed in 40 cases. We concluded that FNAC is a reliable, cost effective, convenient and easily accessible method as the best initial work up and management of head and neck lesions. In expert hands accompanied by good clinical information, proper history and relevant laboratory investigation the results are even better.

153-157

Authors: Jejani Ayushma, Kawthalkar Anjali.

The aim of the present study was to study the demographic profile, type of antepartum haemorrhage, maternal and perinatal complications in cases of antepartum haemorrhage and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of antepartum haemorrhage. This retrospective study period extends from 1st May 2013 to 30th June 2013. Fifty-seven diagnosed cases of antepartum haemorrhage were included in the study. The data was collected on a predesigned proforma and percentage analysis was done. Out of total 57 diagnosed cases of antepartum haemorrhage, multiparty was the major risk factor observed in present study. Placenta previa was the commonest type of antepartum haemorrhage, abruptio placentae being the second major type. In spite of tertiary care, there was 1 maternal death and high perinatal mortality (21.1%). The present study indicates that uncorrected anaemia (71.9%) is still common in India contributing to increased maternal mortality and also necessitating high requirement of blood transfusion (66.7%). Multiparty (61.4%), previous LSCS (21%) were the major etiological factors contributing to antepartum haemorrhage. Based on the observations made during the study, it can be concluded that antepartum haemorrhage is the major cause of maternal morbidity and perinatal mortality.

161-163

Authors: Pandya Jayshri, Waghmare Sudatta, Thakre Makrand.

Teratoma of mesentery is uncommon. It is a germ cell tumour which originates from the gonads, seen in females of reproductive age groups. Teratomas are usually found in the sacrococcygeal area in the gonads and less frequently at other sites and rarely in the mesentery (1). We report a case of mesenteric teratoma in a 17-year-old male patient. Mesenteric teratoma should be kept in mind while dealing with cystic lesions in abdomen. Clinical presentation is vague but radiology helps in pre-operative diagnosis.

166-170

Authors: Amarnath C, Sathyan G, Periakarupan A, Ganga Devi R, Kanimozhi D.

The sinus of Valsalva aneurysm (SVA) is a small dilatation caused by a separation between the aortic media and annulus fibrosus. A 30-year-old female presented with complaint of pain abdomen. She was evaluated with CT abdomen, scanogram showed ventricular wall calcifications. There was history of intermittent palpitation and exertional breathlessness. On further evaluation with echocardiogram and 64 slice CT scanner, it turned out to be unruptured aneurysm arising from the left coronary sinus. It is a unique aneurysm, which bifurcated into superior part giving origin to the left coronary artery and inferior part dissecting as a complex multilobated aneurysm. The aneurysm had three components in the groove between left atrium and aortic root, dissecting aneurysm into the inter-atrial septum with thrombus, and dissecting aneurysm into the anterolateral free wall of the left ventricle, protruding into the lumen.

61-72

Authors: Vinayak R, Behal M

Diarrhea and pneumonia are the leading causes of illness & death in children upto 5 years of age. Zinc supplementation is effective for treatment of acute diarrhea and can prevent pneumonia. The study was carried out to compare duration of hospitalization among zinc supplemented and placebo group, in children aged 3 months to 5 years admitted with severe pneumonia: A double blind placebo controlled randomised clinical trial and to see whether the use of oral zinc therapy when compared to placebo, as an adjuvant to antibiotics, when compared to placebo reduce the duration of hospitalization by one day in children aged 3 months to 5 years with severe pneumonia. This randomized controlled trial was conducted in the Department of Pediatrics at Goldfield Hospital and Research centre, Village Chhainsa, Faridabad from 1st April 2013 to 30th April 2014. 83 Eligible Children aged 3 months to 5 years with a clinical diagnosis of severe pneumonia were taken and given Zinc supplementation for 14 days (10 mg in < 6 months age and 20 mg in 6 months or more in age) and compared against placebo groups for duration of hospitalization and other secondary variables. Results of our study showed that clinical resolution in both the groups (zinc versus placebo) was comparable in terms of median duration of hospitalization (137.23 hours versus 132.98 hours), duration of resolution of severe pneumonia (54.1 hours versus 53.83 hours), resolution of lower chest indrawing (54.1 hours versus 53.83 hours), resolution of fast breathing (69.65 hours versus 73.73 hours), time to start oral feeds (29.3 hours versus 26 hours), duration of intravenous fluid therapy (60.08 hours versus 57.43 hours) and duration of oxygen therapy (22.63 hours versus 19.80 hours). Thus there was no difference in the primary or secondary outcome variables between the zinc and placebo groups. In this randomized controlled trial, conducted to study the efficacy of zinc supplementation, as an adjunct to antibiotics, in the treatment of severe pneumonia, we conclude that short term supplementation with zinc, given during the course of illness does not shorten the duration of resolution of severe pneumonia in children between the age group of 3 months to 5 years. Zinc supplementation also does not shorten the duration of resolution of lower chest indrawing, fast breathing and inability to feed. Zinc supplementation also does not shorten the duration of intravenous fluid therapy, oxygen therapy and duration of hospitalization.

78-80

Authors: Sable M, Sable S, Kowale R, Ingole A, Somwanshi SD

The purpose of this study was to evaluate lung functions in forty athletes and forty non-athletes in age range of 13-20 years. The athletes selected for this study are given training since last three years in running event. The variables studied were tidal volume(TV), forced vital capacity (FVC), forced expiratory volume in one second(FEV1), forced expiratory volume in three seconds(FEV3), forced expiratory volume in six second(FEV6), Inspiratory capacity(IC), expiratory reserve volume(ERV), & maximum voluntary ventilation(MVV) were found significantly higher in athletes than non-athletes. The findings suggest that during adolescence, development of lung under proper nutritional and health conditions is governed by the process of growth with negligible additional effect of physical activity. However, physical exercises during growth may help in developing a reduced resistance to expiration and a greater endurance in respiratory muscles. .

85-86

Authors: Kaur S, Kawthalkar A

There is a rise in number of induced labour in modern obstetrics. Improved fetal monitoring helps in detection of compromised foetuses necessitating induction of labour. Caesarean section rate is more with induced labour as compared with spontaneous labour. Hence there is a need to evaluate current trend of induction of labour.

92-95

Authors: Litake MM, Moger J, Parasnis A

Being a rare site of metastasis, breast carcinoma metastasis to thyroid is rare. Presenting herewith a case of carcinoma breast operated one year ago in a 65 year old woman with negative for ER/PR and HER-2-neu status. She presented a year later after postoperative chemo-radiotherapy to our hospital with thyroid swellings and cervical lymphadenopathy. PET scan revealed spinal metastasis in thoracolumbar segments and suspicious thyroid malignancy. Ultrasonography of the neck was suspicious of thyroid neoplasia. Histo-pathological examination of total thyroidectomy revealed metastatic invasive ductal carcinoma of breast and immunohistochemistry was positive for GCDFP-15 and negative for thyroglobulin and TTF-1.

102-105

Authors: Gundewar T, Kale Y, Ghike S, Gundewar S

A type of morbidly adherent placenta in which chorionic villi completely invade the myometrium and may invade the serosa or adjoining organs, is known as Placenta Percreta. It is a very rare pregnancy problem and is associated with a high maternal and fetal morbidity and mortality. We present a case of placenta praevia percreta with massive intra-partum hemorrhage requiring an emergency cesarean hysterectomy.

2-6

Authors: Gupta M

Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity internationally. The aetiology of this disease is unknown, though widespread endothelial dysfunction is considered to be the major reason. Early identification of this disease would be helpful in early identification of the high risk patients, diagnosis and better prenatal care. Several biomarkers either individually or in combination have been identified which either increase or decrease in PE and may be of utility either as predictors or diagnostic tools. This review focuses on various available biomarkers and their utility from the already existing literature.

14-19

Authors: Gupta A, Date K

The aim of this study was to identify the organisms causing neonatal septicemia and their antimicrobial susceptibility at Neonatal Intensive Care Unit in a tertiary care hospital; to evaluate the maternal and neonatal risk factors and to establish a correlation between the hematological markers and septicemia. This cross sectional study period extends from 1st May to 30th June 2011. 40 neonates suspected to have septicemia or had maternal history of risk factors were enrolled after ethical clearances. A septic work up was carried out in all these infants that included Complete blood counts, C-reactive protein, and blood cultures with antimicrobial sensitivity pattern. The analysis of the peripheral smear was done. Statistical analysis was done by ‘Z’ test. Out of total 40 suspected cases; male: female ratio was found to be 1.6:1.The blood culture was positive in 26(65%) cases, whereas negative in 14(35%). Early onset septicemia was in 27(67.5%) and late onset septicemia was in 13(32.5%). Out of these, 26 positive blood cultures, non-fermenting gram-negative bacilli (65.3%) were found to be the commonest; followed by Pseudomonas species (11.5%); Serratia species (7.69%); Enterococci (3.84%).The organisms showed highest sensitivity to Imipenem and Cefotaxime. The significant risk factors were perinatal maternal fever, prolonged rupture of membranes (>12 hours), Neonatal Resuscitation, Low Birth Weight. Hematological markers TLC<5000 cu.mm and increased CRP were highly indicative of septicemia. As of now, non-fermenters have not been reported to be isolated from the maternal genital tract. This strongly suggests that early onset hospital – acquired sepsis due NFGNB should be an area of concern and future research. But for this, a study on larger sample size is required.

24-28

Authors: Khandelwal R, Tamhane A, Khandelwal R

Amblyopia is one of the major causes of childhood blindness. Screening of all pre-school children for refractive errors and strabismus is important to detect amblyopia and prevent a child from losing his/her eyesight permanently. We evaluated the efficacy of Canon Powershot SX-260 HS digital camera as an amblyopia screener for identifying amblyogenic risk factors. We obtained Bruckner reflex photographs using consumer digital camera. There were 77 subjects, 42 were amblyopes and 35 were diagnosed to be normal. Of the 42 subjects, 23(55%) were strabismic amblyopes and 19(45%) were anisometric amblyopes. Overall mean sensitivity of was 95% for all amblyopes, 82% for strabismic and 83% for anisometric amblyopes. The specificity was found to be 94% for all amblyopes, 87% for strabismic and 88% for anisometric amblyopes. The consumer digital camera appears to be a simple, quick and feasible option to screen for amblyogenic risk factors. It is easy to interpret by not only the ophthalmologists but by students and paramedical staff.

33-39

Authors: Choudhary S, Tayade BO, Kharbade S, Sontakke A, Khan S, Abraham R

Bronchoscopy is very useful for diagnosing Sputum smear-negative pulmonary tuberculosis (SSN-PTB). Our aim is to find out the diagnostic yield of fiber optic bronchoscopy in sputum smear negative under RNTCP and radio logically suspected new cases of pulmonary tuberculosis and the complications of fiber optic bronchoscopy. A cross-sectional prospective study in which consecutive 108 patients was carried out in patients whose two sputum smear for Acid Fast Bacilli was negative and chest X-ray suggestive of pulmonary tuberculosis were included into the study. Fiber optic bronchoscopy was carried out in all patients. The yield for tuberculosis was 78 %( 85/108) i.e. made a final diagnosis of tuberculosis.29 (26.85%), 41(37.96%) and 30(27.78%) patients had positive AFB smear on Bronchial brush, Broncho alveolar lavage and post bronchoscopy sputum of which 11(12.94%), 22(25.88%) and 13(15.29%) patients had exclusive diagnosis from the respective procedures. The immediate yield combining positive smear samples from different procedures and histopathological evidence of caseating granuloma in present study is 56%(61/108). In Broncho alveolar lavage culture 57/108(57.08%) were confirmed tuberculosis diagnosis and 24(28.4%) patients had exclusive diagnosis on bronchial culture. Bilateral, advanced, and non cavitatory disease had 52, 53 and 64 patients diagnosed as pulmonary tuberculosis and was more as compared to different site, extent and type of disease on chest x-ray which were initially negative for tuberculosis. Our study suggests that fibre-optic bronchoscopy and its procedure can provide excellent material for early as well as confirming the diagnosis in suspected patients of pulmonary tuberculosis when smears of expectorated sputum do not reveal mycobacteria and helps in diagnosing different diseases and disorders having clinical picture mimicking tuberculosis.

43-46

Authors: Warpe B, Thakur S

Giant cell tumor (GCT) is a primary benign neoplasm of bone accounting for 5% of all skeletal tumors. Although considered benign, it has propensity for local recurrence, distant metastasis as well as malignant transformation. GCTs of bone usually arise in the epiphyseal region of the limbs, and rarely it affects the ribs. We report a case 52-year-old male who presented with left sided rib mass. Total excision of rib mass with thoracic reconstruction with prolene mesh was done. Microscopic examination of the mass showed features of giant cell tumor. Authors consider the rarity location of this entity along with unusual clinical presentation worth to publish.

50-51

Authors: Akhtar M, Fulare S

Cutaneous horn is a rare clinical entity. Sebaceous horns are commonly seen in sun-exposed areas. They are rare in chest wall or covered areas. Their association with malignancy makes proper identification of these lesions essential. A case of a cutaneous horn on the chest wall in an elderly male is reported.