International Archives of Integrated Medicine

10-14

Authors: Ananthi B, Sabari Sridhar O.T., Kailash S, Shajahan M Ismail, Srinivasan B

Background: Duration of the untreated psychosis has been predicted to be one of a factor which affects the outcome of disease and leading to poor prognosis in the patients. Previous studies had predicted that the longer the duration of psychosis the poor the outcome of the treatment. Aim: To assess the factors affecting the Duration of untreated psychosis among patients with first episode psychosis in General hospital setup. Materials and methods: Retrospective study was done on patients who got admitted for the duration of 6 months (1st June 2014 to 31st November 2014). Patients who were diagnosed to have first episode psychosis according to ICD-10 were taken up for the study. Duration of untreated psychosis and the socio demographic details were noted. Results: The duration of untreated psychosis was seen more in male (58%), 45% in age group of 20-29, 54% were married, 71% in lower middle economic status, 75% of people were from semi urban background and 41% of patients had duration of untreated psychosis for duration of 2-5 weeks. Mean average age is 30.75 and duration of untreated psychosis is 40 days. Conclusion: Mean average age is 30.75 and duration of untreated psychosis is 40 days. Age, gender, marital status, socio-economic status and residence (Environment) acting as a predictor for the long DUP is consistent with previous studies but significant findings couldn’t be found, when two groups were compared thus giving the conclusion that Sociodemographic factors alone doesn’t influence on DUP.

18-23

Authors: B Anil Kumar, K.A.S.S.N. Kalyan, M.M Rehman

Background: Appendiceal perforation in patients with acute appendicitis may cause a variety of potentially life-threatening complications. Escherichia coli endotoxin has been shown to impact physiological bile flow in vivo. This had led to the theory that hyperbilirubinemia and elevated CRP in patients with appendicitis may have a predictive potential for the preoperative diagnosis of appendiceal perforation. Objectives: The aim of this retrospective study was to investigate the diagnostic value of hyperbilirubinemia and elevated CRP as a preoperative laboratory marker for appendiceal perforation in patients with acute appendicitis. Thus a new marker for appendiceal perforation would be welcomed. Thus, the need for the study is to conclude whether the Serum Bilirubin or CRP can be considered as a new laboratory marker to aid in the diagnosis of Appendicular Perforation. Materials and methods: All patients admitted with clinical diagnosis of "Acute Appendicitis" or "Appendicular Perforation" and undergoing surgery in General Surgery Dept in Tertiary Care Teaching Hospital were taken as Subjects for this study. The primary data for this study were the blood investigations of the patients. 200 patients with concerned consent and meeting the inclusion criteria were included in the study. The necessary clinical and lab details were obtained in a prewritten format. The intraoperative findings were noted and documented precisely. Upon completion of data collection the preoperative bilirubin levels of the perforated and uncomplicated groups were compared. Other clinical and lab parameters obtained during the study were compared between the two groups. All parameters were subjected to statistical analysis and evaluated critically. Results: A total of 200 patients participated in the study. Of the 200 patients studied 132 patients were males and 68 patients were females. The youngest patient was 13 years old and the oldest 64 years. Among all the patients operated with a diagnosis of Acute Appendicitis 92 were found to have a perforated appendix, and 108 were found to have a non-perforated appendix. It was observed that among 92 patients with perforated appendix 86 patients showed a raised CRP levels and 58 patients had a raised Bilirubin levels. However in case of non-perforated cases it was found that among the 108 cases 82 patients had a raised CRP levels and 36 patients showed raised bilirubin levels. Conclusion: Hence Logistic Regression technique revealed that the C- reactive protein and Hyperbilirubinemia can be used to predict the appendicular perforation preoperatively and that their roles are comparable and that there is no definitive advantage of one over the other for the same.

30-36

Authors: Anita S, Senthil Anbumani

Background: Intra-abdominal abscess remains a significant cause of morbidity and mortality in the patient population. Despite therapeutic advances, it is a perplexing diagnostic and management challenges and remains a dreaded complication of surgery. Materials and methods: Forty eight patients underwent fifty one percutaneous drainage procedures in the Barnard Institute of Radiology at the General Hospital, Chennai. There were 44 men and 7 women. The youngest of the patients was 13 years old and the oldest 56 years old. Results: Of the 51 drainage, 35 were done under CT guidance and 16 under US guidance. Successful drainage of the collection with avoidance of operation was achieved in 43 of the 48 abscesses (89.5%). If the total number of drainages were considered, the success rate was 84.3% (43 out of 51). Conclusion: Percutaneous catheter drainage is an important treatment option for management of intra-abdominal abscesses. It is especially valuable in patients at high risk for general anesthesia. It is also an effective alternative to operative drainage in other healthier patients. Computed tomography is the imaging modality of choice for percutaneous abscess drainage.

43-49

Authors: Pooja Bharti, Mumta Chauhan, Kaisar Ahmed

Background: The measurement of body temperature is an important parameter in neonatal care as it is useful in the assessment of clinical state and necessary for the provision of appropriate nursing support. Hypothermia is one of the important risk factor in causing death in newborns of all weight and gestational age groups. Aim and objectives: To compare rectal, infra red tympanic and infra red skin temperature in term neonates and to assess the accuracy and effectiveness of these non invasive thermometers in term neonates. Materials and methods: It was a Hospital based prospective, non randomized study conducted at Department of Pediatrics in G.B Pant Hospital (neonatology section) an associated Hospital of GMC Srinagar. This study was conducted over a period of 1 year from April 2013 to march 2014. Results: Total of 300 term neonates between the age of 1- 29 days were included in the study. Mean temperature recorded with rectal thermometer was 36.58 0C, with Infra red tympanic thermometer was 36.47 0 C and with Infra red skin thermometer was 36.55 0C. Difference between means of rectal and Infra red tympanic thermometer was statistically significant (P=0.015) and difference between means of rectal and Infra red skin thermometer was statistically not significant (P = 0.18). Coefficient of correlation between rectal and tympanic was 0.772 and between rectal and skin was 0.955 which was statistically significant in both (P valve < 0.001). Conclusion: Non contact Infra red skin thermometer is a very simple, safe and reliable method for measurement of body temperature in neonates. It can be used in peripheral settings as it is user friendly as well as patient friendly.

56-59

Authors: Saxena S, Joshi N

Incidental detection of two primaries call for oncosurgeon’s own judgment to decide the best therapeutic approach as no guidelines exist for the rarity of condition. This is the rare case of incidental renal cell carcinoma in a patient of endometrial carcinoma. Renal cell carcinoma was detected on preoperative MRI in a patient who presented as postmenopausal bleeding and histology proven endometrial carcinoma. Final histology confirmed dual primaries with uterine primary being endometrioid adenocarcinoma, whereas renal primary was clear cell carcinoma stage II. Estrogen receptors (ER) have been identified in Hamster and Mouse kidneys as well as in renal cell carcinoma tissues. High plasma estrogen found in some patients of synchronous renal and endometrial cancer may partly explain the association of these two primaries, though not in all cases. Increased serum leptin levels and a common low penetrance susceptibility gene have been reported in both these cancers.

6-10

Authors: T. Babu Antony, S. Krishna Bharath

Background: Laparoscopic hernia repair has been in use for some time now and has been found to cause lesser postoperative pain and earlier recovery when compared with open methods of hernia repair although they are associated with higher costs and a steep learning curve. The various complications associated with laparoscopic hernia repair needs to be studied and compared with open methods. Aim: The aim of this study was to understand the intraoperative and postoperative complications of laparoscopic inguinal hernia repair and formulate methods to prevent them. Materials and methods: This is an observational study consisting of 50 patients who underwent laparoscopic inguinal hernia repair (TEP, TAPP) in our institution from September 2014 to March 2016. Intra operative and postoperative complications were documented. The following factors were considered: Type of hernia, Type of hernia vs complications, Operation time, Operation time vs complications, Post-operative hospital stay. Results: The mean operative time was 66.8 min. There were no major complications. There were 4 minor complications namely – surgical emphysema, groin pain, shoulder pain, scrotal pain. Surgical emphysema (21 patients, 42%) depends upon operation time. Groin pain (11 patients – 22% all are indirect) depends upon type of hernia mainly in indirect type, because of the dissection carried out for separating indirect sac. Shoulder pain (6 patients, 12%) is directly proportional to the time of surgery (all were >90 min) probably due to retention of CO2 which lead to diaphragmatic indentation. Scrotal edema (6 patients, 12%) depends upon the type of hernia as it occurred only in indirect hernias due to the dissection for indirect sac. All these minor complications subsided with supportive care without any surgical intervention. Mean postoperative hospital stay - 2.6 days. Laparoscopic hernia repair has a steep learning curve and time consuming initially Conclusion: Laparoscopic hernia repair has a steep learning curve and fearsome complications but once mastered, it is a safe and effective technique with early postoperative recovery. In our study we encountered only minor complications all those complications were managed conservatively.

16-20

Authors: T. N. Tamilselvam, Malarvizhi

Back ground: The joint hyper mobility syndrome is a condition that features joints that easily move beyond the normal range expected for that particular joint. Hyper mobility joints tend to be inherited. Symptoms of the joint hyper mobility syndrome include pain in the knees, fingers, hips, and elbows. Often joint hyper mobility causes no symptoms and requires no treatment. Treatments are customized for each individual based on their particular manifestations. Aim of the study: To assess the biochemical changes that occur in patients with Benign Hypermobility Syndrome in a rheumatic clinic in south part of Chennai. Materials and methods: The study was conducted from January 2016 - May 2016. Totally 50 young adults of age range between 17-34 who attended the rheumatic clinic with polyarthralgia and low back pain along with various other symptoms are included in the study. Detailed clinical history such as type of pain, duration of pain, musculoskeletal pain on various regions after activities of daily living are monitored and presence of BHMS was recorded using Modified Beighton Criteria. Biochemical investigations such as complete blood count thyroid profile, lipid profile, C - reactive protein, rheumatic factor were analyzed. Results: Totally 50 patients were included in the study. Among the 50 patients, 23 were male and 27 were female. The age was around 17-35 yrs. ESR was found to be increased in 42patients. Fasting blood glucose was found to elevated in 12 patients. Hypothyroidism found in 3 patients. C-reactive protein found to be normal. Conclusion: Asymptomatic biochemical abnormalities are not uncommon in patients with Benign Hyper mobility. These asymptomatic abnormalities pose a challenge to the general practitioners. Dyslipidemias could occur and decreased HDL cholesterol could partly attributed to decreased physical activity due vague aches and pains. Surprisingly elevated ESR warrants further evaluation to rule out relevant causes. Decreased physical activity may contribute to obesity.

26-34

Authors: Patel D, Kataria L, Bhardwaj R, Tanna K

Introduction: Coping responses are being targeted in psychological interventions as they have the capacity to distinctly influence the illness course. Identifying the coping strategies in patients of Bipolar Mood Disorder thus becomes essential part for treatment design, due to differential coping preferences having etiological and clinical implications. Most studies till date have focused on bipolar I disorder, the current study examines the cognitive coping profiles in both bipolar I (BD I) and bipolar II mood disorder (BD II) patients, and compared them. Aim: To examine the cognitive coping strategies in Bipolar I and Bipolar II patients and how they differ from each other. Material and methods: A total of 100 participants were segregated using MINI and divided into groups based on DSM-IV TR. Participants (62 BD I patients and 38 BD II patients) were analyzed for preferential cognitive coping strategies using the Cognitive Emotion Regulation Questionnaire. Results: BD I patients scored significantly higher on most adaptive coping subscales of CERQ as compared to BD II patients. Conclusion: BD I patients used more adaptive coping strategies as compared to BD II patients.

42-52

Authors: Pathak S, Yadav T, Joshi C, Sharma N, Gulabani S, Gandhi D

Background: Nearly half of all deaths in children under 5 are attributable to under nutrition. Under nutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and contributes to delayed recovery. The WHO recommends the use of Z scores or standard deviation score (SDS) for evaluating anthropometry, so as to accurately classify individuals with indices below the extreme percentile. In India most paediatricians use IAP classification to classify malnutrition. The aim of the study is to assess the nutritional status of children between 6 months to 5 years of age attending tertiary rural hospital according to WHO criteria and to compare the result of this study with IAP classification for grading malnutrition. The objectives of the study is to assess the knowledge of mothers regarding feeding practices among these children particularly below 2 years of age and to observe associated clinical problems and state of other nutrient deficiencies. Materials and methods: A cross sectional and observational study of 200 children admitted in pediatric ward and NRC (nutritional rehabilitation centre) of Dhiraj Hospital were taken for the study, Piparia, Waghodia, Vadodara. Study was carried for a period of 18 months from April 2015 to September 2016 to assess the nutritional status of children according to WHO criteria and to compare it with IAP classification. Assessment of the nutritional status was done by clinical examination and anthropometry. Interrogation was done with children’s mothers in the language they understood regarding young children feeding practices and accordingly their knowledge was assessed. Data was compiled, categorized and analyzed by appropriate statistical method in consultation with a statistician. Results: Total 200 patients were taken in the study. Result shows that out of 200 patients 108(54%) were males and 92(46%) were females. The distribution of patients was more in age group between 13 and 36 months with 86(43%), of which distribution of males more than females were. Distribution of patients according to SAM and MAM (WHO classification) shows 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM. Distribution of patients according to SAM and MAM (WHO classification) was studied. Result shows that out of 200 children taken in the study 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM according to WHO classification. Distribution of children according to IAP classification in the present study interprets that 103 (51.5%) of the total children came under grade II of IAP classification. WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. Comparison of MUAC (WHO) with WHO (SAM and MAM) of children taken in the present study interprets that 67 (33.5%) had SAM and 95 (47.5%) had MAM according to MUAC criteria, remaining 19% did not fall under SAM and MAM. Comparison of MUAC (SAM) with WHO (SAM) of children in present study interprets that only 67 (52.75%) children came under SAM according to MUAC criteria out of the 127 children of SAM according to WHO classification. Comparison of MUAC (WHO) and IAP classification of children in the present shows that 67 children had MUAC <11.5 cm, out of 67 children (with SAM according to MUAC criteria) 28 (41.79%) came under grade II and 21 (31.3 %) came under grade III of IAP classification. Out of 95 children (MUAC between 11.5 cm and 12.5 cm) 18 (18.94%) came under grade I and 58 (61.05%) came under grade II of IAP classification. Associated co morbidities among children in the present study shows that among 200 patient 152 (76%) had anaemia, 44 (22%) had diarrhoea, 14 (7%) had pedal oedema, 12 (6%) had vitamin A deficiency, 44 (22%) had URTI and 24 (12%) had LRTI. Knowledge Aptitude and Practice study was done among 50 mothers and the result shows that mothers had less knowledge regarding what to be given in complementary feed, importance of immunization, birth spacing interval, and danger signs indicating illness. Conclusion: The present study shows that WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. There was also disparity among results of WHO criteria IAP classification and MUAC classification. Single criteria can’t be justified in assessing malnutrition. KAP study reveals that mother’s knowledge is important in combating malnutrition.

60-63

Authors: Niket Domadia, Harshit Bheda, Shashvat Modiya, Chandra Raychaudhari

Background: HELLP syndrome is life threatening condition. Diagnosis of HELLP syndrome plays an important role in assessment of complication. It can be done by USG and CT scan. Objectives: The aim of this study was to define role of CT scan in assessment of HELLP syndrome. Materials and methods: A case report aimed at evaluation of patient who came with sign and symptoms of HELLP syndrome to Radiology Department of Dhiraj Hospital by using CT scan. Results: A 30 year old patient presented in post-partum state with fever, rigor, nausea and tenderness in the right hypochondrium. Case history showed patient had suffered from pre-eclampsia during childbirth. The Patient had undergone ultrasonography which gave a diagnosis of hepatomegaly with liver abscess. Her Blood investigation showed total count of 22700 with predominant polymorph of 70%, Hb- 4.7 gm, SGPT was 234, Patient has thrombocytopenia with platelet of 1.5 lac. She was subjected to pre and post contrast CT scan in Dhiraj general hospital which showed hepatosplenomegaly, multiple ill-defined hypodense lesions in both lobes of liver (HU value = 52-70) with perilesional oedema, suggestive of multiple liver hematomas with rupture of hematoma into the peritoneal space. Conclusion: CT scan plays the key-role in assessment of complications in pre-eclamptic postnatal patient with HELLP syndrome which may be missed by USG. There by helping in patient management and prognosis.

68-73

Authors: Rafiya Nazir Khan, Suhail Majid Jan, Tahira Ashraf, Rashidat-Ul-Khairat

Bisphosphonates, synthetic (Non-biodegradable) analogues of pyrophosphate, were initially used in industry as water softening agents in irrigation systems and lateron discovered as bone loss inhibitors. Bisphosphonates inhibit bone resorption by being selectively taken up and adsorbed to mineral surfaces in bone, where they interfere with the action of the bone-resorbing osteoclasts. Thus, they have been proposed in the management of periodontal diseases by inhibiting the osteoclastic bone resorption and hence are used as a host modulating factor for prevention of bone loss. The other indications being Osteoporosis , Paget’s disease, Malignant hypercalcemia , Bone metastasis, Multiple myeloma etc. Gastro intestinal intolerance, Renal and hepato-toxicity, Hypocalcaemia, Osteonecrosis of jaws seen especially after invasive dental treatment (called as Bisphosphonate related osteo-necrosis of jaw, BRONJ) are the main side effects of bisphosphonate therapy. To overcome such effects during dental management of patients, the recommendations focus on conservative surgical procedures, proper sterile technique, appropriate use of oral disinfectants and the principles of effective antibiotic therapy. The dentist should retain in his/her file the acknowledgment and consent for the treatment.

5-9

Authors: Chuppana Ragasudha, Atluri Phani Madhavi, Pulidindi Sanjana Sharon, Hyma, Sirisha, Syamala, Sravanthi, Sagarika

Background: Maternal mortality in India is reported to be 300 to 500 per 100,000 births in the Bulletin of World Health Organisation. It is far away from Millennium development goal 5 where it is required to reduce MMR to 109 per 100, 000 live births. Sepsis in pregnancy continues to be the third leading cause of preventable maternal deaths in India, still accounts for up to 10 to 50% of maternal deaths in our country. Aim: It was to critically analyze all the mothers who died due to sepsis in order to identify factors associated with 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 due to sepsis were included in the study and they were all analyzed modelled on the United Kingdom Confidential Enquiries into maternal deaths. Results: During the study period there were 44 total maternal deaths out of 5863 births giving maternal mortality ratio of 641 per 100,000 maternities. Out of 44 maternal deaths, 14 were due to sepsis making it the leading cause of maternal mortality in our institute. Out of fourteen deaths due to sepsis nine were due to direct causes and the remaining five were due to indirect causes such as pneumonia, sickle cell disease with malaria, and pancytopenia. The ages of the women who died ranged from 19 to 38 years with a median age of 26 years. All had normal body mass index. Five women who died were tribals, six from rural areas and the remaining three from slums of urban areas. Eight women were primigravid. Eight women died from sepsis in the antenatal period, two deaths were in the first trimester after criminal abortion, three due to pneumonia, one had intrauterine dead fetus infected and the other was due to pancytopenia. Four deaths were due to genital tract sepsis after cesarean section and two were due to genital tract sepsis after normal delivery. These six had risk factors such as anemia, prolonged rupture of membranes etc. Conclusion: In few cases, the outcome was inevitable, but for majority it might have been different had the infection been diagnosed and treated more promptly. There are lessons learned from the deaths of these women to improve the survival of mothers and to achieve millennium development goal 5.

16-25

Authors: Monil Thakrar, Kusum Mathur

Introduction: Cervical cancer is the third most common cancer in India. In women, it is the second most common after breast carcinoma. Human cancers arise from a protracted sequence of multiple genetic and epigenetic alterations which involve the growth regulatory genes like p53. Aim: This study aimed at correlation of immunopositivity of p53 with the histopathological type and grade of carcinoma cervix. Materials and Methods: A total of 100 cases of cervical biopsy/ hysterectomy specimens of carcinoma cervix received at the Department of Pathology, SMSMC Jaipur from January 2016 to September 2017 were examined for gross and microscopic features. Immunohistochemistry was used to study the p53 expression as proliferative index in cervical intraepithelial neoplasia, invasive squamous cell carcinoma as well as adenocarcinoma of the uterine cervix. Results: The demographic profile of SCC and CIN in this study was in concordance with that described by epidemiological studies in India with larger group of patients presenting with advanced stage tumors. Increased expression of p53 was found in increasing grades of CIN and SCC. The p53 positivity showed a statistically significant association with squamous cell carcinoma (SCC) histologic type (P = 0.005). Conclusion: The expression of p53 is greater in the malignant cervical neoplasms than pre-malignant cervical lesions, suggesting that p53 overexpression can be used as an early diagnostic tool and also as a prognostic indicator.

32-36

Authors: Jayesh Shah, Darshan Shah, C. Raychaudhuri

Background: Sarcoidosis is a multisystem inflammatory disease of unknown etiology that predominantly affects the lungs and intrathoracic lymph nodes. Sarcoidosis is manifested by the presence of noncaseating granulomas (NCGs) in affected organ tissues. It is characterized by a seemingly exaggerated immune response against a difficult–to-discern antigen. Materials and methods: All patients were known case of pulmonary sarcoidosis. All patients for this study had undergone X-ray and CT scan after taking informed consent. Results: In our study, we found that 17 (68%) patients with sarcoidosis have a characteristic radiologic appearance consisting of enlarged hilar and paratracheal lymph nodes, 24% of cases shows nonspecific or atypical findings, and in 4% of patients the radiograph is normal. Conclusion: Radiologists can play an essential role in the diagnosis and management of sarcoidosis. It is essential to recognize both the typical and the atypical manifestations of the disease and use information obtained from the correlation of imaging features with pathologic findings to help achieve an early diagnosis and reduce associated morbidity and mortality.

43-48

Authors: Sonal Garg, Himanshu Jain, Richa Srivastava, Prakhar Garg

Introduction: Diabetes mellitus is a leading public health care problem in developing and developed world, with increasing incidence and long term complications. It is the most common endocrine disorder in the world today. Objective: To study the anthropometric parameter in the children whose parents are diabetic and non-diabetic. Material and methods: 250 medical students of S.N Medical College, Agra, of age group 18–25 years were included in study from year 2015 to 2017. Their anthropometric measurements which included weight, height, BMI were taken. This study was done in physiology department of S.N.M.C. Agra. Subjects were divided into 2 Groups .Children of diabetics parents (Group-1) and Children of non-diabetic parents (Group-2). Results: Out of total 250 students, 15.2% students were overweight and 2.4% were obese according to WHO classification of BMI. In group 1, out of 64 students, 18.75% were found to be overweight and 3.1% were obese. In group 2, out of 186 students, 13.9% were overweight and 2.15% were obese. The mean BMI of Group-1 and Group-2 was 22.21 ± 3.50 and 22.15 ± 3.19 respectively. P value =0.73 and t=0.33. Conclusion: Higher percentage of overweight and obese are found in the children of diabetic parents as compare to non-diabetic parents and Mean BMI is slightly higher in group 1 i.e. in the children of diabetic parents but this difference in Mean BMI of both groups is considered to be not significant.

52-58

Authors: S. Maniselvi, T. Babu Antony, Ponmuthu, Deepak David Chellappa

Background: Modified radical mastectomy performed for CA breast is a life modifying surgery for most women. It creates a profound impact on the quality of life enjoyed by the women. The magnitude of change in quality may pave the way for more conservative surgery in the future. Aim: To assess the quality of life in patients undergoing modified radical mastectomy for early breast cancer. Materials and methods: This was a prospective study consisting of 50 patients who underwent modified radical mastectomy in our institution from 2013-2015 for early breast cancer. Quality of life was assessed 6 months after surgery using a translated version of a customized questionnaire, which was based on the Royal College of surgeons’ questionnaire. Results: In our study, the most common age group was found to be between 51-60 years (24). Most patients (30) had poor quality of life with 19 patients having an average quality of life. 23 patients with poor quality of life were from the lower socioeconomic class. 47 patients (94%) did not have any restriction of daily activities. Most of the patients (49) had mild pain and discomfort. Among the patients experiencing mild pain 59% (29 patients) had poor quality of life. Severe psychological impairment was present in 30 of our study population and was associated with poor quality of life in 29 cases (97%). 34 patients in the study population were not satisfied with their body image and was associated with poor quality of life in 30 (88%) of the cases. 27 patients in the study group were not satisfied with their sexual life and it was associated with poor quality of life in 23 (85%) of the patients. Conclusion: From this study we have concluded that the quality of life is poor in majority of the patients undergoing modified radical mastectomy for early breast cancer with most of the patients having psychological impairment, unsatisfied body image perception, unsatisfied sexual life and mild pain. In addition to these factors socioeconomic status of the patient also affects the quality of life in these patients.

64-69

Authors: Jayesh Shah, Ruchit Shah, C. Raychaudhuri

Background: Ovarian dermoid cyst is the most common ovarian neoplasm. It accounts for ~15% of all ovarian neoplasms. They tend to be identified in young women, typically around the age of 30 years. These slow-growing tumor contain elements from multiple germ cell layers and are easily detected with ultrasound and much better by CT scan and MRI. Materials and methods: Patients presented to Radiology department with known case of dermoid cysts of ovary or in whom accidental diagnosis of ovarian dermoid cyst was made eventually. Evaluation of ovarian dermoid with Ultrasound machine (Logiq P9 GE), CT scan Siemens (16 slice) and MRI Philips (1.5 Tim + dot system). Results: In our study we found that 25 (100%) patients had ovarian dermoid, 20 (80%) patients were of age group 21years to 40 years, 4 (16%) patients were of 41-60 years and 1 (4%) patients were of 0-20 year age group. In diagnosis of ovarian dermoid our results showed that CT scan was more sensitive (96%) than USG (92% sensitivity). Conclusion: Detection and morphological characterization of ovarian dermoid can be easily done on ultrasound. MRI and CT scan are useful adjunct to USG in its characterization and detection of associated pathology. In USG, when ovary shows heterogeneously hyperechoic lesion with fat fluid level without any vascularity highly suggestive of ovarian dermoid.

77-83

Authors: Kanwalpreet Kaur, Loveena Oberoi, Pushpa Devi

Background: Surgery has made great advances in last 3 quarters of this century and post-operative wound infection is the most common complication faced by surgeon since the advent of surgery. Aim: To determine the bacteriological profile and antibiogram of surgical site infections. Materials and methods: This prospective study was done for a period of one year (January 1, 2016 to December 31, 2016) in a Govt. Medical College, Amritsar. The study population included 712 patients suffering from Surgical Site infections in the various wards (Orthopedics, General Surgery, Obstetrics and Gynecology) of our hospital. Two sterile cotton swabs were collected aseptically. Gram stained preparation was made from one swab. The other swab was inoculated on blood agar and Mac Conkey agar and incubated for 48 hours. Growth on culture plate was identified by its colony characters and standard biochemical tests. Antimicrobial sensitivity testing was done by Kirby- Baeur disk diffusion method. Results: Rate of SSI was 58.00%. A total of 431 isolates were obtained, out of which 428 (99.30%) were bacterial isolates and 3 (0.69%) were fungal isolates. Monomicrobial growth was seen in 395 (95.64%) patients whereas polymicrobial growth was seen in 18 patients (4.35%). Out of 428 bacterial isolates, majority of bacteria were gram negative bacteria (60.74%) but most common isolate was Staphylococcus aureus. The microbiological profile of the 260 (60.74%) gram negative bacteria was Klebsiella pneumoniae followed by Pseudomonas aeruginosa, Escherichia coli, Acinetobacter spp., Citrobacter spp. and Proteus spp. Methicillin resistance was seen in 10.52% of all the S.aureus isolates and 21.05% of CONS isolates. No vancomycin resistance in enterococcus was detected. Out of 260 gram negative bacilli, 105 (40.38%) were ESBL producers. Conclusion: To conclude, there is emergence of MDR gram negative organisms. The prevention of surgical site infections encompasses meticulous operative technique, timely administration of appropriate preoperative antibiotics, and a variety of preventive measures aimed at neutralizing the threat of bacterial, viral, and fungal contamination posed by operative staff, the operating room environment, and the patient’s endogenous skin flora.

94-98

Authors: M Bhooma Reddy, Awais Ghori, Rajendra Prasad Kathula

Background: A duodenal ulcer is usually caused by an infection with a germ (bacterium) called Helicobacter pylori (H. pylori). A 4- to 8-week course of acid-suppressing medication will allow the ulcer to heal. Aim: To study changes in stomach wall at sites other than the ulcer in chronic duodenal ulcer patients. Materials and methods: This study was conducted in 150 patients in the department of surgery in Government General Hospital/ Government Medical College, Medical College, Nizamabad, during the period of July 2014 to May 2016. Results: In the present study, out of 150 patients in this study, 90 were males and 60 were females. Age ranged from 23 to 82 years old. In endoscopy findings, chronic gastritis of antrum was found to be 138 (92%), gastric ulcer was detected in 7% cases i.e. in 11 patients. The pangastritis rate was 65% and the inflammation was caused due to erythematous gastritis. In histopathology findings, chronic gastritis of antrum was found in 143 cases which constituted 95%. The pangastritis rate was 85%, common gastritis of antrum was atrophic type which constituted 80% of the patients, common gastritis of fundus was superficial type which was in 62% of patients, and intestinal metaplasia of stomach was seen in 5% of patients. From biopsy, helicobacter Pyroli in gastric antrum infection rate was 85%, Helicobacter Pyroli in gastric fundus infection rate was 40% and Helicobacter Pyroli in corpus of stomach infection rate was 5%. Conclusion: Chronic gastritis is caused by presence of Helicobacter pyroli. The most common site for Helicobacter Pyroli is the gastric antrum followed by fundus. In Chronic duodenal ulcers cases, the most common pathological abnormality is chronic superficial atrophic gastritis of antrum followed by pangastritis.

107-112

Authors: U. Srinivas Rao, CH. Venkata Subbaiah, K.S.R. Bargava

Introduction: Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular histologically benign, locally aggressive neoplasm of the nasopharynx. It accounts for 0.5% of all head and neck neoplasms with a high incidence of persistence and recurrence. Materials and methods: This was a retrospective observational study whereby the medical records of 32 patients treated for Juvenile angiofibroma between May 2010 and August 2016 were reviewed. Results: This study included patients aged between 13-25 years average was 19 years. More than 10 cases were in 14-18years group. This age group exhibits rapidity of growth high incidence of recurrence and early involvement of neibouring structures such as pterygopalatine fossa and infratemporal region and cheek. In 16 cases out of 32 there were attachments of tumor on the roof of nasopharynx. And 8 cases had attachments on the choana. Nasal obstruction and epistaxis is the most common symptom observed in study. CECT was the most common imaging modality utilized for diagnosis and staging of JNA and it was required in all cases. MRI was utilized as an additional investigation in cases with intracranial extention and was required in 37.5% of cases. Postoperative complications were not serious and only included malar defect, ectropion, epiphora and palatal defect. Total complication rate in all was about 28.2%, seen in 11 out of 32 patients. 7 patients were diagnosed with recurrence, with a recurrence rate of about 30%. These recurrences were diagnosed at varying intervals of follow-up 4 out of 13 cases with Stage IIIa and 3 out of 4 cases with Stage IVb diagnosed with recurrence. Conclusion: Radiologic follow-up is essential in the early identification of residual or recurrent disease.

117-121

Authors: Raja Vojjala, MNP Charan Paul

Background: Anaemia is a common problem in both elderly men and women of age greater than 65 years, and in men, the haemoglobin concentration below 13gm/dl and in women below 12 gm/dl respectively. Aim: To evaluate clinicopathological characteristics of anaemia in elderly patients. Materials and Methods: This study was a cross sectional study conducted on patients who were above 60 years of age, the males should have haemoglobin levels of less than 13 gm/dl and females should have haemoglobin levels of less than 12 gm/dl. Results: A total of 200 cases of anaemia were found in elderly patients. In the present study, males (142) were dominant in numbers compared to females (58) which constitute to males were 71% and females were 29%. The mean age of elderly patients was found to be 68.5 years, with maximum patients in 61-71 age groups. The age group of patients ranged from 61-100 years. The cases of normocytic normochromic constituted 99 (49.5%), microcytic hypochromic constituted 40 (20%), normocytic hypochromic constituted 10 (5%), macrocytic constituted 25 (12.5%) and dimorphic constituted 26 (13%). The dominant presentation was considered among which the most common presentation was generalised weakness which constituted to 35% (70) followed by breathlessness which constituted to 27.5% and other presentations such as headache, giddiness, abdominal pain, loss of weight, loss of appetite, diabetes were noted. Radiological findings showed that the bilateral renal disease which constituted to 90 (45%) and chronic kidney disease which constituted to 42 (21%) were the highest. Conclusion: In geriatric patients, anaemia is a common disease. It leads to severe morbidity and mortality given the age, if anemia is ignored or not investigated properly. Aggressive treatment of anemia in elderly patients can prevent severe morbidity followed by timely detection.

127-131

Authors: Gayatrri Anipindi, Vani I

Introduction: Heavy menstrual bleeding (HMB) is defined as prolonged (>7 days) or excessive menstrual blood loss greater than or equal to 80 ml per menstrual cycle. Levonorgestrel-releasing intrauterine device (LNG-IUS) has become one of the most acceptable medical treatments for menorrhagia, reducing referrals to specialists and decreasing the need for operative gynecological surgery. Aim: To study the efficacy of levonorgestrel intrauterine system (LNG-IUS) in conservative management of abnormal uterine bleeding (AUB). Materials and Methods: Fifty women between 40 and 50 years with AUB were included in a study conducted over a period of 2 years. Response was assessed monthly for first 6 months and then bi annually for total 2 years. Results: LNG IUS caused 80% decrease in median menstrual blood loss (MBL) at 6 months, 95% decrease in MBL by 1 year, and 100% decrease (amenorrhea) by 2 years. Mean hemoglobin (Hb) % showed a significant rise of 10.0% from baseline 6 months post insertion. LNG IUS is as an effective alternative in women with AUB of varied etiology. Hysterectomy could be avoided in most of the women. Conclusion: LNG IUS provides an incredible nonsurgical alternative in treatment of menorrhagia.

137-146

Authors: CH Manoj Kumar, Geethika Nutakki

Background: The traditional role of HbA1c analysis has been for assessing glycemic control in patients with diabetes. The results of semi-final studies demonstrated that early, intensive glycemic control could significantly reduce the risk of a range of diabetes related complications, and permitted the establishment of precise HbA1c target values for treatment goals. Aim: This study was to determine the effect of IDA on HbA1c levels in non-diabetic patients, so as to consider IDA as an important factor which influenced the HbA1c levels, while monitoring the glycemic status of diabetics. Materials and methods: Total number of 150 patients attending (both men and women) Medical department of PSIMS & RF, Chinaoutapalli and were enrolled after they provided written consent. This study was conducted over a period of two years (November 2014 to November 2016). Results: The mean HbA1c levels in anemic patients were 5.1%, 4.9% and 4.7%at baseline and after 1 and 2 months, respectively while that in the controls was 5.3%. The base line HbA1c levels were significantly lower in patients than controls, however, there was a significant decrease in HbA1c levels in patients after 2 months of treatment for iron deficiency anemia (P<0.01). The mean HbA1c levels were significantly lower in patients after 2 months of treatment than in the controls (P<0.01). The mean absolute HbA1c level in patients at baseline and after 1 and 2 months were 0.49g/dL, 0.57g/dL and 0.66g/dL, respectively while in that controls was 0.72g/dL. A significant difference was observed between the baseline values of patients and controls (P<0.01). Additionally there was a significant decrease in absolute HbA1c levels over the 2 month treatment period (P<0.01). However after 2 months of treatment, there was no significant difference between the absolute HbA1c levels of patients and controls (P>0.05). A significant correlation between hemoglobin and HbA1c levels in patients at baseline (coefficient of correlation) was observed. It was observed that a significant correlation between hemoglobin and HbA1c levels in patients at baseline (coefficient of correlation= -0.1316; p<0.001; and after 1 month of treatment (coefficient of correlation= -0.391; p<0.001. However, there was no positive correlation between hemoglobin and HbA1c levels at the end of the 2-month treatment period (coefficient of correlation= -0.42; p >0.05. Conclusion: This study concluded that before considering HbA1c as a diagnostic parameter and glycemic control in Diabetes, Iron Deficiency Anemia should be ruled out; as the severity of the anemia has effect on quantity of HbA1c.

153-157

Authors: Gundu Vanaja, Polumuru Usha Devi, D Hemalatha Devi, Usha Prasad, P Durga Kumari, Y Madhuri

Background: Multiple births have been a subject of great interest to various Scientists such as endocrinologists and geneticists, a source of fascination to some people and a causes concern to obstetrician and pediatricians. Multiple pregnancies are associated with many problems for the obstetrician during ante-natal, intranatal and postnatal periods. For the mother the prognosis is worse than a singleton pregnancy and for the fetus the prognosis is very depressing and it is associated with very high fetal mortality. Aim: To study various factors leading to maternal and fetal morbidity and mortality in multiple fetal gestations. Material and methods: Prospective observational study was carried out on 100 antenatal women with twin gestations who attended Victoria Government Hospital, a referral hospital for women and child at Visakhapatnam from October 2015 to September 2017. Maternal and perinatal morbidity and mortality and their causes were analyzed. Results: In this study, 73 women (73%) were booked and 27 women (27%) were unbooked. Maternal and perinatal complications were more in unbooked cases. Incidence of preeclampsia was 22%, gestational hypertension cases 10% and eclampsia cases twice more than the singleton pregnancy. Incidence of poly-hydromnios 5%, Anemia was 40%, APH was 1%, pre-term labour – 30%. Intrapatrum and postpartum complications like PROM – 20%, uterine inertia – 6%, cord prolapse – 2%, PPS – 13%, LSCS rate – 40%. Conclusion: Twin gestation is a high risk pregnancy associated with antenatal, intranatal and postnatal complications which cases increased morbidity and mortality of both mother and fetus. Early diagnosis, good antenatal care and treatment of antenatal complications, labor management in the tertiary center, liberal use of C-section also NICU will improve perinatal, maternal outcome.

163-167

Authors: Sivakumar, S. Shanmugam

Introduction: Wounds can cause painful lengthy hospital stay, multiple stages of surgeries, and enormous financial burden. Biological dressing’s collagen granule dressing has advantage over conventional dressing in terms of non-immunogenic, non-pyrogenic, being natural, easy application and decreased days of healing. Objectives: To compare the efficacy and safety of collagen granule dressings and conventional dressing in diabetic wounds in terms of reduced healing time, number of dressing, healing quality and complications Materials and methods: A prospective study was done in which 30 patients who presented with diabetic wounds were chosen by random sampling technique, and were grouped into 2 groups consisting of 15 patients. Thirty patients with foot ulcer were evaluated. A collagen or conventional dressings were applied, and the patients were followed as per standard post-application treatment protocol. Patients underwent dressing changes every day until wound healing or for maximum period of 12 weeks. Changes in wound size were recorded when the dressing was removed; and at 4 and 12 weeks. Conclusions: Our study is a hospital based case control prospective study done in 30 patients of chronic diabetic foot ulcers. There was statistically significant difference between the results of collagen and saline dressings as collagen dressings had better healing response rate as compared to placebo when given along with standard treatment of diabetic foot ulcer.

185-187

Authors: S. Shanmugam, Sivakumar

Background: Cholecystitis either acute or chronic is predominantly caused by gut bacteria. The etiology can be rarely due to other organisms. There is well documented evidence on the incidence of common organisms causing cholecystitis in western countries but it cannot be typically extrapolated to our set up and need to be evaluated. Aim: The aim of this study was to study the incidence, assess risk factors and evaluate the severity of cholecystitis caused by various organisms in patients coming to Govt. Stanley Hospital. Materials and methods: This was a prospective study consisting of 50 patients diagnosed as cholecystitis (calculous/ acalculous) who underwent laparoscopic or open cholecystectomy in our institution. With all aseptic precautions intra-operatively bile was aspirated from gall bladder and inoculated in culture media appropriately to detect the possible organisms. Results: Bile cultures grew bacterium in 48 of 50 patients. 32 patients’ cultures were positive for aerobes. 11 patients grew anaerobes. 5 patients had mixed flora. Among the mixed flora, 2 had only aerobes and the remaining had both aerobes and anaerobes. 2 patients had no growth in their cultures Conclusion: E.coli was found to be the commonest organism in our study as already been reported elsewhere. Klebsiella was the second commonest overall and among the aerobes. Bacteroids fragilis are the commonest anaerobes to be grown in the cultures.

195-198

Authors: G. V. Manoharan, T. Sivakumar

Background: Oral cancer being one of the most common malignancies in the low-income group in India. It usually presents in an advanced stage limiting treatment options. The mainstays of treatment being surgery and radiotherapy both being lifestyle changing procedures. Aims and objectives: The purpose of this study is to evaluate the quality of life for oral cancer survivors after surgery in comparison with radiotherapy using ICF questionnaire Materials and methods: Oral cancer patients who underwent surgery (25 patients) and Radiotherapy (25 patients) in Stanley medical college for stage 1 and stage 2 lesions of oral carcinoma for past 3 Years (2013-2015) were enrolled. Results: The study showed that surgery as primary therapy provided a better quality of life than radiotherapy alone in the treatment of oral cancer patients. Conclusion: After comparing the results primary surgery for oral malignancy seems to be the treatment of choice as long as the tumor is amenable to surgical resection. Radiotherapy though resulting in a lower quality of life is very efficacious for unresectable tumors.

208-213

Authors: Purohit S, Jain H, Purohit T, Garg S

Osteonecrosis is thought to result from the temporary or permanent loss of the blood supply to the bones. The most common symptom is pain which is localized to the affected con¬dyle. The medial femoral condyle is typically affected, the lateral femoral condyle, medial tibial plateau and patella may also be involved. The purpose of this case report is to highlight the importance of osteonecrosis as a cause of post-partum hip, knee and other joint pain and to review the literature in regards to pregnancy as a possible etiological factor. We presented a case of a 25 year old female who presented to us on 20th December 2015 with pain in the right thigh of 10 days duration at the distal half extending up to mid-calf.

6-13

Authors: Gayathri C.R., Vanitha Samuel, Senthilnathan A, Nirmala P

Background: Diacerein and S-adenosyl methionine (SAMe) are symptomatic slow-acting drugs in osteoarthritis (SYSADOA). Diacerein is a semisynthetic, anthraquinone derivative, an interleukin 1beta inhibitor with anti-inflammatory, anti-catabolic and pro-anabolic properties on cartilage and synovial membrane. SAMe is a dietary supplement used in the management of OA. The objective of this study is to find out compliance and tolerability evaluation of Diacerein versus S-adenosyl methionine inpatients suffering from Osteoarthritis. Materials and methods: This was a prospective, randomized, interventional study conducted in Orthopedic OPD and ward in Rajah Muthiah Medical College and Hospital for a period of one year. A total of 80 patients were enrolled in this study as per the inclusion criteria. 40 patients in each group were randomly assigned to receive either diacerein 50mg BD or SAMe 200 mg TDS for12 weeks. The NSAID diclofenac 50 mg BD was administered orally for a short course of one week to both the groups to relieve acute symptoms. Efficacy of both the drugs was assessed using Lysholm knee scoring scale. The tolerability profile was evaluated during each clinical visit on weeks 1, 4 and 12. Results: Diacerein and SAMe which were symptomatic slow-acting drugs show a profound reduction in pain starting from 4th to 12th week of treatment. Lower GI side effects like diarrheawere observed in the diacerein group and insomnia was reported in the SAMe group. Though the overall adverse effects were more in the diacerein group, compliance was better with regard to drug intake Conclusion: Both diacerein and SAMe were found to be effective in reducing the pain in Osteoarthritis patients. Diacerein with a good compliance factor was less tolerable because of the incidence of diarrhea. SAMe though better tolerated has a compliance score of fair to good.

18-26

Authors: N Sandeep, G. Ramaswamy Reddy, Kancham Kalyan Kumar Reddy, K Subash Chander, Vasanthi Bondugula, Ram B. Basany

Background: Mandibular incisors are the smallest among the permanent dentition, with thin enamel and dentin. Intact teeth do not fracture easily while mastication. Objectives: To evaluate the fracture resistance of mandibular incisors after endodontic treatment and metal ceramic crown placement. Materials and methods: Eighty recently extracted intact mandibular incisors were divided into four groups of twenty each based on root canal treatment and crowns, intact natural tooth without RCT and crown preparation was used as control group. Each tooth was mounted separately in acrylic block and subjected to loading in universal load testing machine until fracture, results were analyzed by one-way ANOVA and Turkey’s multiple post hoc procedures. Results: The results showed that Fracture resistance of teeth restored with metal ceramic crowns was very high when compared to the teeth without crowns (p<0.05).There was no statistically significant difference between intact and endodontically treated teeth (p>0.05). Conclusion: The study concluded that endodontic treatment and tooth preparation followed by metal ceramic restoration increased the fracture resistance of mandibular incisors.

37-46

Authors: Mudumala Issac Abhilash, NL Varun Mai, K.B.R. Sastry

Background: Raised serum uric acid has been reported to be associated with an increased risk of coronary heart disease and is commonly encountered with essential hypertension, even untreated hypertension, and type 2 diabetes, which are in turn associated with coronary heart disease. Aim: To estimate the levels of uric acid in patients with essential hypertension. To correlate the levels of uric acid with the severity of hypertension in newly detected hypertensive patients. To compare the levels of uric acid in hypertensives with that in non hypertensives so as to assess the role of uric acid as a risk factor for hypertension. Materials and Methods: This study was an age and sex matched prospective case control study. Matching for other confounding factors such as diet, alcohol and smoking was also done. The study was conducted during the period from September 2010 to September 2012 after obtaining the clearance from the Institutional Ethics Committee. Inclusion Criteria: Patients of age > 18 years, newly detected patients of essential hypertension and patients with essential hypertension on treatment. Exclusion Criteria: Patients with renal failure. Patients on treatment with drugs altering uric acid levels such as thiazides, loop diuretics, pyrazinamide and allopurinol. Lymphoproliferative or myeloproliferative disorders. Secondary hypertension and pregnancy induced hypertension. The study included a total of 142 patients of which 80 were cases (hypertensives) and 62 were controls (non hypertensives). Results: The range of the serum uric acid in cases was 1.40 to 11.30 mg/dl. In hypertensive males it was found to be from 1.40 to 11.30 mg/dl and in hypertensive females it was found to be from 2.70 to 11.10 mg/dl. The range of the serum uric acid in controls was 1.50 to 6.50 mg/dl. In hypertensive males it was found to be from 1.50 to 6.50 mg/dl and in hypertensive females it was found to be from 1.60 to 6.20 mg/dl. Serum uric acid is significantly elevated in hypertensives as compared to normotensive individuals. Serum uric acid can be used probably as an early biochemical marker to determine the severity of hypertension as stage 2 hypertensives had more elevation in serum uric acid levels as compared to other hypertensives. The uric acid levels did not differ significantly between hypertensives with and without treatment. There is a considerable difference in the mean serum uric acid levels between stages 1, 2 and isolated systolic hypertension in the newly detected hypertensives but it is not of a linear correlation The total number of newly detected hypertensives were 39 out of which 13 were diagnosed as stage 1 hypertension, 22 as stage 2 hypertension and 4 as isolated systolic hypertension. The mean of the serum uric acid was 4.20 (1.37) mg/dl, 6.56 (1.40) mg/dl and 4.40 (1.40) in stage 1 hypertension, stage 2 hypertension and isolated systolic hypertension respectively, in newly diagnosed hypertensives. Conclusion: Thus serum uric acid estimation can be used for aiding in the diagnosis of essential hypertension as well as in assessment of the severity.

52-60

Authors: S. Sudhakaran, S. Ashwini

Background: Combined spinal-epidural anesthesia technique for providing pain relief for orthopedic procedures has gained popularity. It combines the advantages of rapid onset and the reliability of blockade obtained spinally along with the flexibility given by epidural catheter avoiding the disadvantages of either technique used alone. Spinal anesthesia provides dense neural blockade of finite duration while epidural is more titratable producing less hemodynamic swings and postoperative analgesia. The epidural volume extension adds color to combined spinal-epidural anesthesia technique where the onset and the level of blockade obtained spinally are enhanced by administering saline or local anesthetic via the epidural catheter. The ideology behind this is the volume effect accomplished by injecting saline epidurally which would result in intrathecal compression and cephalad migration of spinal local anesthetic. Aim of the study: To identify the effectiveness of block profile provided by extending the epidural volume with normal saline for lower limb orthopedic surgeries using a low dose intrathecal hyperbaric bupivacaine without causing hemodynamic changes. Materials and methods: A prospective randomised controlled study involving 80 patients posted for elective lower limb orthopedic surgeries were divided into two groups of 40 each. Group A received combined spinal-epidural anesthesia with 10 mg of 0.5% bupivacaine with epidural volume extension of 10 ml normal saline. Group B received combined spinal-epidural anesthesia alone. The blood pressure and heart rate changes were observed at the 5th, 10th, 15th, 20th min and then every fifteen minutes. Results: Low dose of intrathecal hyperbaric bupivacaine (10 mg) with 25 micrograms of fentanyl with epidural volume extension (10ml normal saline) is associated with early onset of sensory and motor blockade, high level of sensory block, shorter time of two segment regression. Conclusion: In this study we can safely conclude that combination of spinal epidural with epidural volume extension with normal saline achieves an effective and shorter block time as evident by significantly lower maximum motor block time providing prolonged analgesia by requiring less top-up dose of bupivacaine with higher level of sensory block at the tenth minute with shorter mean maximum sensory block time.

76-84

Authors: B Saravanakumaran, S.R. Pradeepa

Background: Pain is regarded as a complex experience consisting of sensory, physiological, psychological and behavioral components. Management of pain can be best achieved by an approach that takes into consideration, the complex interactions between psychological, biological and socio-cultural factors. Effective pain management requires thorough preparation of the patient and a structured inpatient service for prevention of postoperative pain. Local anesthetic Ropivacaine is preferred nowadays for epidural postoperative analgesia as it has favorable sensory block profile. The aim of the study: The aim of the study was to compare the postoperative analgesic efficacy of epidural Ropivacaine and Ropivacaine with Tramadol in adults undergoing abdominal surgeries under general anesthesia. Materials and methods: A total of 60 patients were included in the study. Patients were divided into two groups of 30 in each into group R and group RT The study was a prospective non-randomized, double arm, single-blind, controlled study. The sample size was determined based on the study Postoperative analgesic efficacy of epidural Tramadol and adjuvant to Ropivacaine in adult upper abdominal surgeries” Patients who satisfied the above-mentioned inclusion criteria selected were counseled about the risks and benefits involved in the study. After getting consent, patients who were willing to be included in the study were enrolled and analyzed. Results: Our study showed the increased mean duration of postoperative analgesia, Ramsay sedation score in Ropivacaine with Tramadol group compared to the Ropivacaine group was statistically significant at the p-value was <0.0001. The association between pruritus status and intervention groups was considered to be nonsignificant since p-value was >0.05 as per Fisher's exact test. The association between heart rate, mean peripheral capillary oxygen saturation, mean respiratory rate in intervention groups was considered to be non-significant since p-value was > 0.05 as per unpaired t-test. Conclusion: From my study, I conclude that the addition of 1 mg/kg of Tramadol improves the postoperative analgesic efficacy of epidural 0.2% Ropivacaine by prolonging the duration of analgesia and providing good sedation with no significant hemodynamic alterations, nausea, vomiting and pruritus.

90-98

Authors: P. Chandra Shekar, Veena Narisetti, K .Sateesh Kumar, CH. Praveen

Background: Chronic Kidney Disease (CKD) is a major public health problem in developed and developing countries, leading to decreased quality of life across the globe. Aim: The clinical and electrophysiological features of peripheral neuropathy in patients with chronic renal failure. The correlation of various biochemical and hematological parameters to that of uremic peripheral neuropathy. Materials and Methods: It was a prospective cross sectional study in 50 Patients admitted with advanced stages of chronic kidney disease. Results: 50 CKD male patients were 30 (60%), female patients were 20 (40%). Among 20 females, 13 (65%) patients had ENMG evidence of polyneuropathy. Polyneuropathy was evident in 78%. Twenty one patients (42%) had clinical symptoms suggestive of polyneuropathy. In 8 patients (16%), it was only detected electrophysiologically. Motor conductions of the tibial, peroneal, median and ulnar nerves showed significant abnormalities in distal motor latency, compound motor action potential (CMAP) amplitude CV among the studied group. In patients with neuropathy there is predominant decrease in CMAP amplitudes with relatively decreased conduction velocity, and prolonged distal latency. Significant abnormalities were found in the peak latency, sensory nerve action potential (SNAP) amplitude and conduction velocity (CV) of the sural, median, ulnar nerves. In patients with neuropathy SNAP amplitudes were decreased significantly with relatively decreased conduction velocity. F wave parameters of peroneal, tibial nerves were abnormal in 30 (60%), and of median 17 (34%), ulnar 16 (32%). We have observed that lower limb involvement is more common compared to upper limb. Sural nerve involvement is seen in all patients with electrophysiological evidence of neuropathy. Conclusion: It can be concluded that axonopathic nature of polyneuropathy with predominant decrease in CMAP and SNAP was confirmed.

106-114

Authors: Jagadish Chandra Mishra, Pradip Kumar Maharana

Background: The study is to describe the efficacy of Midazolam when used with Bupivacaine as local anesthetic in Supraclavicular brachial plexus block. The focus will be on the onset and analgesic duration of nerve blocks along with any neurotoxic concerns or neuroprotective potential. Materials and methods: A prospective, randomised single blinded study was undertaken in 100 patients posted for upper limb surgeries under supraclavicular brachial plexus block and were assigned into 2 groups, each containing 50 patients. • Control group – Group B: received 30ml Bupivacaine 0.375% • Study group – Group BM: received 30ml of mixture of Bupivacaine 0.375% and Midazolam 0.05mg/kg. Results: The onset of sensory and motor block was significantly faster in group BM compare to Group B (p<0.05). Rescue analgesic requirements were significantly less in group BM compared to group B (P<0.05). Hemodynamics and sedation scores did not differ between groups in the postoperative period. Conclusion: Midazolam 0.05mg/kg when addded to 30ml of Bupivacaine 0.375% for supraclavicular brachial plexus block speeds the onset of sensory and motor blocks (P<0.05). The combination produces improved analgesia, resulting in a prolonged effect and reduced requirements for rescue analgesics.

122-127

Authors: Anitha S, Natarajan V

Introduction: Diabetic foot ulcer is one of the dreaded complications among the diabetic patients which are disabling, leading to repeated hospitalizations and even amputation, drastically reducing the quality of life. Hence proper management of diabetic foot infections by choosing appropriate antibiotic is crucial. The aim of the study: This study was undertaken to know about the prevalence of ESBL producing Enterobacteriaceae in Diabetic foot ulcers and their antibiotic sensitivity pattern to aid in the effective treatment of infection. Materials and methods: A total of 200 Pus samples were collected from the patients admitted and/ or attending in-patient or out-patient departments of Rajah Muthiah Medical College and Hospital. Only Enterobacteriaceae were isolated and antibiotic sensitivity testing was done according to CLSI guidelines. All the isolates were screened for ESBL and confirmed by phenotypic confirmatory tests. Results: A total of 60 Enterobacteriaceae were isolated from diabetic foot ulcer patients among which 27 (45%) isolates were ESBL producers. ESBL production is predominantly seen in E.coli (48.1%) followed by Klebsiella (44.4%), P. mirabilis (3.3%) and P. vulgaris (3.3%). ESBL producers were sensitive to Imipenam (88.9%), Amikacin (77.8%) and Gentamicin (55.6%) whereas highly resistant to Ampicillin, Amoxyclav, Cefuroxime and Ceftriaxone. Conclusion: This study shows the higher prevalence of ESBL producing Enterobacteriaceae in diabetic foot ulcers. Imipenam, Amikacin and Gentamicin can be used for empirical treatment but early identification and treatment according to antibiotic sensitivity pattern helps in preventing the emergence and propagation of multidrug resistance strains.

137-143

Authors: M Manjusha, Veena Narisetty, Sateesh Kumar Kamera, Dhairyawan Pokalkar

Background: Posterior reversible encephalopathy syndrome (PRES) is a clinic-radiological syndrome comprising of seizures, disturbed vision, altered mental function and headache in various combinations developing over hours. The most common risk factor being abrupt or accelerated hypertension, renal failure, immunosuppressive therapy, eclampsia, autoimmune disease and infections. MRI Brain is the gold standard for diagnosis PRES generally has a favorable prognosis, but neurological sequale and even fatalities can occur in some cases. Aim: The Aim of the study was to Review the clinical and neuroimaging findings in patients diagnosed with Posterior reversible encephalopathy syndrome (PRES). Material and methods: This was a Prospective study done for duration of 2 years from December 2014 to November 2016 in the Department of Neurology, Gandhi Medical College, Hyderabad, Telangana, a tertiary care teaching hospital in south India. The study group patients were selected from pool of inpatients and out patients from various specialities and subspecialities as neurology, internal medicine, obstetrics and gynecology, pediatrics and nephrology. Results: A total of 60 PRES patients included in the study. In the present study age group varied from 15 years to 65 years. Majority of cases 50% (30/60) were among 26-35 years age group. This was in accordance with majority of pregnant population in our series. Female to male ratio was 4:1. Highest incidence of cases i.e., 40% (24 /60) was with eclampsia, followed by autoimmune disease in 20% cases (12/60). 90% patients had predominant parieto-occipital hyper intense lesions on MRI. Conclusion: In the present study the mean age of presentation was 32 years and higher prevalence (85 %) was seen in females. Eclampsia is the commonest cause of PRES. Majority of patients are hypertensive with mean BP being 182/112 mm hg while normotensive PRES seen in sepsis.

153-159

Authors: K. Bhavani, S. Prasanthi, Y. Jyothsna, I. Vani, N. Uma

Background: Caesarean section (CS) wound infections represent a substantial burden to the health system and the prevention of such infections should be a healthcare priority in developing countries. Aim and objectives: Prospective study aimed to evaluate all postoperative wound sepsis or fever cases at KGH, VSP during 6 months period of time January and June 2017. Materials and methods: All postoperative cases with wound sepsis were evaluated. Detailed clinical data, investigations, bacteriological evaluation, sensitivity to antibiotics noted. Results: A total no of 1000 cases with postoperative sepsis in a 6months period of time was followed and results were analyzed. Conclusion: All postoperative cases with wound sepsis and fever were analyzed for etiological factors, associated co morbid factors and their sensitivity to antibiotics noted.

172-176

Authors: K. Bhavani, P. Vijaya Sheela, I. Vani, Y. Jyothsna, N. Uma

Background: Cancer cervix is a leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities in the rural and suburban areas or due to the lack of awareness amongst the women of developing countries. Cervical cancer is the fourth most common cancer in the world. Developing countries accounted to about 80% of the global burden. This study was conducted to highlight the importance of Pap smear study in differentiating premalignant and malignant lesions. Materials and methods: This was a prospective study aimed to evaluate all pap smears examined at KGH over a period of 6 months i.e. from December 2016 to May 2017. Detailed clinical data and pap smear cytology reports were obtained and data noted in a structured proforma. All PAP smears reported as per THE BETHESDA System 2014. Women with abnormal smears were followed up by repeat pap smears or acetic acid guided cervical biopsy. Results: Total of 770 pap smears were examined in 6 months duration. Max no. of patients (around 40%) were of 31-40 years age group. Most of the patients (90.77%) were categorized into NILM (negative for intraepithelial lesion or malignancy). Among the five organisms, we found trichomonas were 38 (4.9%), and candida 38 (4.9%) cases of total NILM cases. Epithelial cell abnormalities in cytological examination were found in total 61 cases constituting 7.92%. Among epithelial cell abnormalities, LSIL was the commonest (27 cases, 3.57%). Conclusions: Cervical cytology by Pap smear is an important tool for early detection of premalignant and malignant lesions of cervix. Regular Pap smear screening should be conducted in vulnerable age group.

182-186

Authors: Tahira Ashraf, Suhail Majid Jan, Roobal Behal

Introduction: Smoking is a known risk factor of periodontitis. Cotinine, a metabolic by product of nicotine is involved in the pathogenesis of periodontitis. Changes in gingival microvasculature, gingival epithelium take place which manifest clinically as decreased bleeding on probing and reduced inflammatory response, increased gingival thickness etc. Knowing the importance of gingival thickness in various root coverage procedures and restorative treatments in periodontics and the increased incidence and prevalence of smoking, assessing the relation between these two entities is becoming important. This clinical study is sought to compare the thickness of gingiva in systemically healthy smokers and non-smokers Materials and methods: 40 age matched smokers and non-smokers were considered for the present study. Gingival thickness was measured in the maxillary and mandibular anterior teeth by transgingival probing using UNC-15 probe midbuccally in the attached gingiva and at the base of the interdental papilla. Plaque index and gingival bleeding index were recorded. Student’s independent t-test was employed for comparing various periodontal parameters between smokers and non-smokers. A P-value of less than 0.05 was considered statistically significant. All P-values were two tailed. Results: Both groups had similar gingival bleeding index and plaque index. Smokers had a higher thickness of gingiva both mid bucally and interdentally as compared to non-smokers. Conclusion: Both midbuccal and interdental areas are thicker among smokers when compared to non-smokers at similar plaque and gingival bleeding levels.

193-195

Authors: Shah R, Shah J, C. Raychaudhuri

Background: Shoulder pain is the third most common musculo-skeletal complaint after low back pain and knee pain. The most common cause of shoulder pain is rotator cuff disease. For the evaluation of shoulder joint, MRI is the modality of choice and is considered over USG. MR imaging is the global assessment of all shoulder structures. Materials and methods: A prospective study of 65 patients were conducted, who were referred to the Department of Radiodiagnosis, Dhiraj General Hospital with shoulder pain. All the scans were done on Philps MR systems Achieva 1.5 tesla. T1 and T2 weighted images in the sagittal, coronal, axial planes were obtained in each patient. Results: In a retrospective review, 50 patients referred to our institution for diagnostic workup for shoulder complaints from June 2016 to December 2016. Out of these, only 7 had no visible pathology. Rotator cuff tendinopathy accounts maximum in which supraspinatus tendinopathy was found in 60% cases (26 patients), subscapularis tendinopathy were in 10% (4 patients), infraspinatus tendinopathy and rotator cuff tendinopathy was not found in any patient. Rest of the pathologies included soft tissue pathology, subacromial-subdeltoid bursitis. Conclusion: MRI provides elaborate diagnosis thus it replaces other investigations. Thus MR imaging is the standard among the imaging methods for optimal depiction of almost all shoulder pathology.

202-206

Authors: D. Aishwarya, Saranya S

Introduction: Anemia can increase the risk of maternal and child mortality, impair cognitive and physical development in children, and endanger physical performance in adults. Obesity is a growing global health problem; the prevalence of this condition has increased dramatically in recent years. Generally, it can be claimed that16-31% of children are suffering from obesity nowadays. One of the major causes of obesity is the rapid changes in lifestyles and dietary patterns namely, from traditional to new diets, a drastic shift which heralded large amounts of fat, sugar, and oil. The aim of the study: The presents study was undertaken to investigate the prevalence of anemia and interrelationship of anemia with BMI among the children population. Materials and methods: The study was conducted in 100 children in who were willing to participate in the study at Sree Balaji Medical College and Hospital, Chennai. Children were categorized into 4 group. Group I Normal weight subjects, group II underweight, group III overweight and group IV obese children. All the 100 children were age and sex-matched. Both the gender was in taken for the study. Parameters such as height, weight, BMI, Hb, serum ferritin were analyzed using standard techniques and results were analyzed accordingly. Results: Male children were more in the total population (65) when compared to female children (35). Group III (n=30) were more in our study population.The mean hemoglobin count was found to be less in Group II when compared with Group -1, Group-III, Group-IV. Serum ferritin level was found to be less in Group II when compared with Group -1, Group-III, Group-IV. Conclusion: This study suggests that the higher levels of total and central obesity should be taken into account when assessing the children’s body iron status and should be treated before providing dietary recommendations to correct anemia.

214-219

Authors: D. Radha, V. Sakthivadivel

Background: Risk factor modification remains as the principal aspect of care for stroke prevention. Understanding of risk factors has advanced and several options are now available to treat modifiable risk factors. Prevention of stroke begins with awareness of risk factors by patients and clinicians. Aim: The aim of our study was to study the association of various risk factors for acute ischemic stroke. Materials and methods: A total of 50 patients who presented with acute ischemic stroke were enrolled into the study after confirmation by CT scan. A detailed history regarding age, smoking, alcohol intake, diabetes, hypertension, dyslipidemia and ischemic heart disease were taken. Blood sugar, lipid profile and CRP estimation were done.50 normal persons without any evidence of stroke were taken as control subjects. The prevalence of risk factors in patients with ischemic stroke was studied and compared with control subjects. Results: Mean age of stroke patient was 60.62 years and control was 58.22 years. Smokers and alcoholic were 32% (case -21%, control 11%) and 36% (case -26%, control 10%) respectively. Diabetes, hypertension and IHD patients constituted 27% (case -20%, control 7%),37% (case -30%, control 7%) and 20% (case -13%, control 7%) respectively. High CRP level was found in 47% (case -35%, control 12%) of patients. Dyslipidemia was found in 44% (case -38%, control 6%) of patients. Conclusion: In our study smoking, alcohol, diabetes, hypertension, IHD, dyslipidemia and high CRP levels correlated well with ischemic stroke. Age and sex were not correlated with ischemic stroke.

229-240

Authors: Karla Ravi, Nandigama Pratap Kumar, Ginjupally Dhanunjaya Rao, Savarapu Sai Kalyan, Gollapudi Prakash Rao

Background: Spontaneous intracerebral haemorrhage (ICH) is associated with the high mortality among cerebrovascular events, and most of the survivors end with significant morbidity. Spontaneous intracerebral haemorrhage (ICH) is the second most common cause of stroke comprising 7.5-30% of all strokes. Surgery mainly helps in decrease in secondary injury and early rehabilitation. Aim: To analyse the outcome and advantages of minimal invasive surgery i.e., burr hole or twist drill craniostomy with intraclot streptokinase injection to dissolve clot and aspiration to reduce mass effect in primary intracerebral hematoma, this help to prevent secondary injury and recovery of salvageable brain. Materials and methods: Prospective study was done over from November 2014 to January 2017 in our department for the patients of spontaneous large intra cerebral hematoma > 80ml who underwent clot evacuation with fibrinolytic therapy with minimally invasive procedure with twist drill burr hole. Total 62 patients were included in the study. All the patients were followed with CT sequential scans to see for the clot size and followed with clinical status. Results: Our analysis of 62 patients was consistent with the hypothesis that hematoma evacuation leads to improved neurological outcome, the outcome has been correlated with the rate of clot reduction. Conclusion: Minimally invasive surgery is a safe and effective option in the management of spontaneous ICH especially in the patients whom major surgical procedures pose a significant risk. MIS is associated with lower mortality and better outcomes compared to surgical evacuation or conservative management. Our study have clearly shown an improved outcome after minimally invasive surgery and still there is some emptiness to determine the exact protocol to insist these type of studies to deal with bed occupancy and a burden to the society.

250-258

Authors: C. Geetha, L. Umapradeepa, K. Chandra Prakash, R. Pandu Naik

Background: Regional anaesthesia has come to occupy an important part in clinical anaesthesiology today. As with other fields, regional anaesthesia too has undergone major developments both in techniques and drug availability. Aim: To study and compare the effect of 0.75% Ropivacaine with 0.5% Bupivacaine for epidural anaesthesia in patients undergoing lower abdominal and lower extremity surgeries with respect to the following factors, Onset and Duration of Sensory Block and Onset and Duration of Motor Block. Materials and Methods: To conduct this study, it was decided to consider a random sample of at least sixty (60) patients of either sex between the age of 20-65 years belonging to the American Society of Anaesthesiologists (ASA) physical status I or II scheduled to undergo elective surgery. The study was conducted to compare 0.75% Ropivacaine and 0.5% Bupivacaine for epidural anaesthesia in lower abdominal and lower extremity surgeries across the following parameters; Time taken for the onset of sensory block T12, Time taken for maximum height of sensory block T6, Time taken for two dermatome segment regression, Time taken for regression up to T12, Time taken for the onset of maximum motor block and Duration of motor block. Results: The onset time for sensory block up to T12 and up to the maximum height of T6 were found to be statistically insignificant; there was no difference in the effect of both the drugs. The two dermatome segment regression and regression up to T12 were statistically significant; it was prolonged in the case of Ropivacaine compared to Bupivacaine. The onset of motor block was statistically significant and was found to be faster in the case of Bupivacaine. The duration of the motor block was also statistically insignificant and it was the same for both the drugs. Conclusion: From these results, this study provides a reasonable ground to conclude that Ropivacaine and Bupivacaine differ in terms of their onset and duration of both sensory and motor block in epidural anaesthesia. Thus Ropivacaine with its higher efficacy, prolonged sensory blockade, lower propensity for motor blockade, proven reduced potential for CNS toxicity and cardiotoxicity, appears to be an important option for regional anaesthesia, management of post-operative pain, labour pain making it the current local anaesthetic drug of choice.

264-268

Authors: Suhail Bin Ahmed, Ather Akhtar Pasha, Yogita Singh Thakur

Background: Patients with subclinical thyroid dysfunction are universally encountered in routine clinical practice. Advanced diagnostic techniques have created new categories of thyroid disorders such as subclinical hypo-and-hyperthyroidism. The management of subclinical thyroid dysfunction is controversial. Patients with subclinical thyroid dysfunction may have vague, nonspecific symptoms that do not aid the clinical apperception. This study aimed to screen the normal adult population for the incidence of subclinical thyroid dysfunction and discuss the optimal management strategy. Materials and methods: Four hundred subjects with no clinical evidence of thyroid dysfunction were included in the present study. Elaborate history in the form of a symptom questionnaire was obtained and clinical examination was performed. Laboratory analysis of thyroid function was done by electro-chemiluminescence immunoassay (ECLIA). Patients with normal free thyroxine (FT4) and tri-iodothyronine levels (T3) were further classified into subclinical hypo/hyperthyroid based on the serum thyroid-stimulating hormone (TSH) levels. The incidence of subclinical thyroid disorder in the sample population was detected and optimal management strategies were followed as per the European thyroid association (ETA) guidelines. Results: The normal TSH value by ECLIA was 0.27 - 4.2μIU/ml. Seventeen (4.25%) out of four hundred subjects included in the present study were found to have subclinical thyroid dysfunction. The Ratio of subclinical hypothyroid cases to subclinical hyperthyroid cases was found to be 12:5. Clustering of the cases was found around the age of 60 years and was significantly more common among females in comparison to males. Cases with subclinical thyroid dysfunction were managed by follow up after a thorough evaluation and treatment of other comorbid conditions. Conclusions: The study provides valuable insight towards understanding the epidemiology and management of subclinical thyroid disorders in the present scenario. Screening is recommended for a high-risk population since there is good evidence that subclinical thyroid dysfunctions may be associated with progression to overt disease in up to 5% of the population.

275-280

Authors: Unnikrishnan SR, C. Lakshmi Charan

Introduction: Anemia is defined as a reduction in the red blood cell volume or hemoglobin concentration below the normal range of values occurring in healthy population (2 SD below the mean for normal population) with respect to age and sex. Anemia is a common problem throughout the world and iron deficiency is the most prevalent nutritional deficiency in the world. It affects mainly the poorest segment of the population. The purpose of the study is to assess the prevalence of Anemia among Government school going children aged 10-16 years in Pammal, chennai. Materials and methods: This study was conducted in Government schools of Pammal, chennai, India. It was a cross sectional study conducted from January 2017 to September 2017, aged 10-16 years. The students, parents, school authority was assured for their confidentiality of their response. Results: Results of the study revealed that overall prevalence of anemia in 10-16 year age children was 51%, in that 64% of the samples in girls and 48% in boys. After analysis and interpretation of data, severe anemia in girls was 9% and in boys 4% and the prevalence of iron deficiency anemia was 95.3% in anemic girls and 54.1% in anemic boys. Conclusion: The prevalence of anemia is very high in adolescent age group. Iron deficiency anemia was the most common type seen. In order to reduce the prevalence, improvement in dietary habits related to consumption of green leafy vegetables should be included in diet plan, health education, seminars on menstrual hygiene for girls should be conducted at regular intervals.

285-288

Authors: Rameshwar R, Jagadeesan M, Mariraj I, Prasanna Karthik S, Kannan R, Magesh Kumar S

Hyperpigmentation may be the presenting sign of several systemic disorders and may be an important clue in their diagnosis. In Vitamin B12 deficiency, hyperpigmentation is due to the increase in melanin synthesis. Vitamin B12 deficiency is rare cause for hyper pigmentation which is reversible. It can be associated with various cutaneous lesions. Low levels of Vitamin B12 are also associated with pancytopenia which is reversible on treatment. It is also a reversible cause of pancytopenia. We report a 58 year old male presenting with hyperpigmentation and pancytopenia and diagnosed to have vitamin B 12 deficiency.

8-13

Authors: P V Praveen Kumar, P. Archana

Background: In contributing the patient care, Anaesthesia and endotracheal intubation have become a core part of anaesthesiologists. Via nose or mouth, the trans-laryngeal placement of endotracheal tube into the trachea is called endotracheal intubation. Aim: To compare responses of lignocaine and diltiazem and combination of both on cardiovascular endotracheal intubation in healthy, normotensive patients. Materials and methods: This was a prospective randomised study, 80 patients were scheduled for tubectomy, cholecystectomy, appendectomy, abdominal and vaginal hysterectomy. These patients were divided into four groups, 20 in each group. Group I received normal saline, Group II received lignocaine and normal saline, Group III received diltiazem and normal saline, Group IV received diltiazem and lignocaine. Results: Males were 12, 60% and females were 8, 40% in group I, males were 12, 60% and females were 8, 40% in group II, males were 12, 60% and females were 8, 40% in group III and males were 10, 50% and females were 10, 50% in group II. Most of patients were aged between 21-40 years, group I (90%), Group II (82%), Group III (86%) and Group IV (75%). The mean age of group I was 33.98±8.05, group II was 38.78±9.26, group III was 31.87±5.29 and group IV was 35.68±7.89. The attenuation was maximum in Group IV followed by group II and group III, with respect to heart rate and systolic blood pressure. Conclusion: In normotensive patients, the combination of diltiazem and lignocaine were more effective than when they were administered diltiazem and lignocaine individually for attenuating hemodynamic changes to laryngoscopy and tracheal intubation.

22-29

Authors: P V Praveen Kumar, G Madhavi

Introduction: Caudal block is one of the most popular and commonly used regional anaesthetic procedures in paediatric patients for most surgeries below the umbilicus. Because of the short duration of analgesia with bupivacaine alone various additive have been used to prolong the action of bupivacaine. Aim: The present study was aimed to evaluate the analgesic effect of tramadol or fentanyl added to bupivacaine for infraumblical surgeries in pediatric patients. Materials and methods: It was a prospective study, 80 patients randomly selected belonging to American Society of Anesthesiologist physical status I-II, in the age group of 1-12 years, of either sex undergoing infraumblical surgery under general anesthesia were divided into two groups. Group BT received 1 ml/kg of 0.25% bupivacaine with tramadol 2 mg/kg in normal saline and Group BF received 1 ml/kg of 0.25% bupivacaine with fentanyl 2 mg/kg in normal saline with maximum volume of 12 ml in both groups. All patients were assessed intraoperatively for hemodynamic changes, pain score and sedation score. Results: The mean duration of analgesia was 10-18 h in Group BT while in Group BF it was 7-11 h. The postoperatively period up to 10 h, Group BF had higher sedation score up to two as compared to that below one on Group BT. Conclusion: Caudal tramadol compared to caudal fentanyl significantly prolongs the duration of analgesia without any side effects.

36-39

Authors: K. Surendar Reddy, J. Sowmya, Bhaskar, Pradyut Waghray

Background and objectives: The objective of the present study was to study the the clinico-pathological profile of the lung cancer in Mahabubnagar. Materials and methods: We performed a retrospective analysis of histopathologically proven cases of bronchogenic carcinoma admitted in our hospital from January 2011 to May 2016. Results: Our study included 67 patients with confirmed cases of lung cancer. Male to female ratio was 1.7:1. The common age group was 40-60 years (52.2%). The most common histopathological type was Adenocarcinoma (38.8%) followed by Squamous cell carcinoma (31.4%). Endobronchial biopsy has more yields in squamous cell carcinoma 8 cases (38.1%), CT Guided biopsy has more yields in Adenocarcinoma 14 cases (53.8%), Small cell carcinoma 4 cases (66.7%), and in carcinoma in situ 6 cases (55.4%), pleural biopsy has highest yield in the diagnosis of malignant mesothelioma 1 case (100%). Among all the procedures CT Guided biopsy has the highest diagnostic yield 29 cases (43.2%). Conclusion: CT guided biopsy has the highest yield for the diagnosis of lung malignancies especially if the tumour is peripherally located.

52-58

Authors: Mudumala Issac Abhilash, NL Varun Mai, Shravan Kumar, Uma Devi

Introduction: Studies of renal perfusion when kidney function tests are still normal could be useful in understanding the pathophysiology of functional kidney impairment in cirrhosis. Kidney functional failure in cirrhosis is considered as a consequence of active renal vasoconstriction. The same have been studied by invasive and non-invasive methods. The present study is aimed at non-invasive assessment of renal artery resistance in patients of cirrhosis of liver. Materials and methods: The present study included 30 cases, patients with different stages of cirrhosis, who were clinically stable, while those with major complications like hepatic encephalopathy, major bleeding etc were excluded. All patients were evaluated clinically and a series of laboratory investigations were done. The resistance in the renal artery was calculates as Resistivity index, by using a color Doppler ultrasonography. Results: In our study, we found the main resistivity index was higher in cases with MELD >20. There was further increase in resistivity index as a severity of the cirrhosis increases. Similarly the MDRD EGFR was decreasing as the severity of cirrhosis was increased. Conclusion: Within limitations of the present study, we conclude that the estimation of the resistivity index in the kidney appears to be a sensitive and easy method for studying the early renal hemodynamic alterations in cirrhotic patients and thus by better understanding the Pathophysiology of hepatorenal syndrome.

67-71

Authors: Vani Chappidi, Pradeep Koppolu, Lingam Amara Swapna, Sridhar Reddy Erugula, Krishnajaneya Reddy Pathakota

Background: The localized inflammatory reaction to periodontal pathogenic bacteria or bacterial products is characterized by penetration of the periodontal tissues by inflammatory cells. Recent studies demonstrate the relation between periodontal disease (PD) and hyperlipidemia, which influence the likelihood of PD as an underlying factor for hyperlipidemia. Aim: The aim of this Randomized, case-control type of study was to elucidate the association between serum lipid parameters in periodontally diseased patients with healthy individuals. Material and methods: A total number of 44 subjects were segregated into two groups Group A (Control) Group B (Test). Periodontal parameters including Oral hygiene Index-Simplified (OHI-S), Gingival Index (GI), Probing Depth (PD) and Clinical Attachment Level (CAL) were recorded. Lipid profile comprising of Serum cholesterol, Triglycerides, HDL- Cholesterol and LDL was assessed and co related with periodontal parameters. Results: The results of the present study demonstrated a positive correlation between GI, PD, OHI-S and CAL with serum cholesterol, TG and LDL. The Serum cholesterol, Triglycerides and LDL levels between both the groups showed statistical significance. But the serum HDL levels when compared between both the groups were not statistically significant. Conclusion: The present study showed a definitive positive correlation between PD and increased lipid levels.

77-86

Authors: P. Divya Daniel, D. Anupama

Introduction: Hysterectomy is a very common surgery and can be performed by abdominal, vaginal or laparoscopic method though the abdominal route is more popular. Vaginal hysterectomy has distinct health and economic benefits. We designed this study to compare the outcomes in TAH and non-descent vaginal hysterectomy and to determine which route of hysterectomy is superior, safe and effective. Aims of the study: To determine the safety and effectiveness of abdominal hysterectomy versus non descent vaginal hysterectomy and to compare both in terms of duration of surgery, blood loss, intra operative complications, postoperative complications and duration of hospital stay. Materials and methods: This was a prospective, study done on total of 100 patients were divided randomly into two groups. One group underwent total abdominal hysterectomy and the other underwent vaginal hysterectomy. Both groups were compared for patient demographics, indications for surgery, size of uterus, duration of surgery, blood loss, need for blood transfusions, complications and duration of hospital stay. Results: Fibroid was the most common indication in both the groups. Most of the patients had 6 – 8 weeks size uterus. Mean intra operative blood loss in TAH group was slightly more than NDVH group. The need for blood transfusion was similar. The mean duration of surgery was 100.2 minutes in TAH group and 83 minutes in NDVH group. Fever was the most common complication in both groups. Abdominal wound infection and secondary suturing was seen in TAH group. The mean postoperative stay was 8.1 days in TAH group and 5.8 days in NDVH group. Conclusion: NDVH is associated with less duration of surgery, less blood loss, less postoperative stay than TAH. There was no difference between the need for blood transfusion between the two groups. Therefore, vaginal hysterectomy is safe and feasible in most of the women requiring hysterectomy for benign conditions and should therefore be attempted.

93-96

Authors: N. Sathish Kumar, D. Sundararajan, S. Veluchamy

Background: Myopia is a common pathologic change of the eye, especially in Asian countries undergoing rapid development. It is known that Asian people have a higher prevalence of myopia. High levels of myopia are associated with increased risk of cataract, posterior vitreous detachment, retinal tears and retinal detachment, increased risk of choroidal neovascularization, and myopic macular degeneration. Aim: To describe the corneal endothelial density and morphology in patients of low and moderate myopic in rural south Indian population and the relationship between endothelial cell parameters and other factors. Materials and Methods: Totally 100 patients were included. Noncontact specular microscopy was performed after taking a history and testing the visual acuity, intraocular pressure measurement, Schirmer’s test and routine eye examination by slit lamp microscope. The studied parameters included mean endothelial cell density (MCD), the coefficient of variation (CV), and percentage of hexagonality. Results: In low myopic eyes the MCD was 2892. 0±146.2/mm2, the mean CV was 38.4± 0.4 and the mean hexagonal appearance of the cell was 53.9± 0.9%. In moderate myopic eyes, the MCD was 35716± 142.0 mm2, the mean CV was 37.9± 3.4% and mean the hexagonal appearance of the cell was 59.83± 3.6. There were statistically significant differences in MCD (p<0.000) and hexagonal appearance of the cell (p<0.005) between low and moderate myopic eyes. Conclusion: The normative data of the corneal endothelium of eyes indicated that statistically, MCD decreased significantly with age. Previous studies have reported no difference in MCD, the percentage of CV, and percentage of hexagonality between genders. Nevertheless, significantly different percentages of CV between genders were presented in this study.

105-110

Authors: Deepikadevi SN, Sundararajan D, Namitha Bhuvaneshwari K, Murali Krishnan

Introduction: Refractive error is the most common visual impairment seen worldwide. This is one of the main cause for which patients come to ophthalmologist. This can occur at any age of the patient. Automated refractometer has become popularised method for doing refraction because of the busy practise of ophthalmologist and due to heavy patients load in screening camps. It is an easy method to learn, to operate and also time saving procedure. Patients are also very comfortable with it because of this easy procedure done in short time. But Streak retinoscopy which is considered as a Gold standard technique for refraction, has some difficulties like time consuming, dilatation of pupil and discomfort to the patient. Aim: Comparing the effect of the conventional method of refraction with computerized automated refraction in various refractive error patients. Materials and methods: It was an observational, cross-sectional study done in a 50 refractive error patients who attend Department of Ophthalmology OPD. Results: According to the statistical analysis done to compare the refraction values of the auto refractometer and streak retinoscopy with the patient's acceptance value, results came as streak retinoscopy values had no significant difference with the patient's acceptance value. This study also shows males were more affected by refractive errors than females and the mean age of affection in myopia was 19- 20 years and hypermetropia is 33-36 years. Conclusion: Since reteak retinoscopy values are accepted well by the patients, it is the better method for refrection than auto refractometer.

117-122

Authors: S. Sujatha, V. Srinivas Kumar, K. Durga

Background: Autopsy serves as a gold standard for the clinical diagnosis of cardiac arrest, which is important for quality assurance. Materials and methods: 44 medico legal cases of suspicious/ sudden deaths were examined by using various dissection techniques of the heart to identify the cause of death in a 2 year period. The main objective was to know the cause of death by correlating with the past history by the previous reports of the patients, the clinical diagnosis, photographic records, gross study of the heart and Histopathological examination and confirmation. The various methods used are inflow-outflow method; short axis method; window method; Valve plane method; Four chamber cut methods, etc. Different methods are used for different conditions of the heart, e.g., cardiomyopathy, valvular diseases, ischemic heart diseases etc. Results: In the present study males outnumbered the females constituting 26 and 18 respectively. At autopsy majority of the cardiac deaths were confirmed as ischemic heart disease by the short axis dissection method. One case of myocarditis identified with Inflow-Outflow method, one case of restrictive cardiomyopathy dissected with four chambered cut method. 1 case of replaced prosthetic valve dissected with valve-plane method. In three cases cause of death is not identified. Conclusion: Cardiac autopsy is backbone in diseases like Ischemic heart disease and cardiomyopathy etc. Its role in medico-legal case importance cannot be excluded.

128-132

Authors: Singh R, Mahanti M, Kumar N, Sen A

Vermiform appendix is one of the most variable organs inside the abdomen. Unusual positions pose diagnostic and surgical challenges. The present study was conducted on 38 cadavers in Narayan Medical College and Hospital to find the morphological variations of vermiform appendix and caecum. It was seen that the most common position of appendix was retrocaecal (61%) while second most common position was pelvic (21%). Mean length of appendix was found to be 5.98 ± 1.67 cm. Mean outer girth was 2.87 ± 0.36 cm. Mean distance of Vermiform Appendix from ileocaecal junction was found to be 2.58 ± 0.46 cm. Adult type is the most common shape (71%) followed by exaggerated one (18%). Mean length of caecum was 7.61 ± 0.80 cm. and mean width being 8.49 ± 0.88 cm. Knowledge about morphological pattern of appendix and caecum is helpful in proper clinical management.

137-142

Authors: S. Sujatha, V. Geeta, V. Srinivas Kumar

Background: Meningiomas are common CNS tumors arising from the meningothelial cells and usual sites are intracranial, followed by intra spinal. WHO 2007 has categorised meningiomas into 3 grades. This grading helps in predicting their behaviour and treatment. Aim and objectives: To study the frequency, clinical details, histological typing of meningiomas in comparison with squash cytology (intra operative diagnosis) and Histopathological examination post operatively. Materials and methods: The present study was a prospective study conducted from May 2015 to April 2017 in the Department of Pathology, Gandhi Hospital. We received 50 clinically as well as radiologically diagnosed cases of meningiomas, which were compared with squash cytology and Histopathological examination. Results: In our study, meningiomas constituted 15% of all CNS tumors received from the Neurosurgery Department in a period of 2 years. In the present study, the number of Meningiomas was 50. Females outnumbered males (36 out of 50). Common site was intracranial (45), followed by intra spinal-thoracic (5). The commonest sub type was meningothelial variant of meningioma (12), followed by transitional variant (11). Squash cytology matched with the Histopathological examination in 91.15% cases. Conclusion: Meningiomas are predominantly occur intra cranially with female preponderance, majority were of benign grade I neoplasms. Squash cytology plays a major role in their intra operative diagnosis.

151-156

Authors: M Balasundaram, Reny Jayaparakas, Subith P Bhaskar

Background: Breast cancer patients with the same stage of disease can have markedly different treatment responses and overall outcome. The strongest predictors for metastases (for example, lymph node status and histological grade) fail to classify accurately breast tumors according to their clinical behavior. The discordance in estrogen receptor (ER), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) status between primary and recurrent breast cancer are being intensively investigated and a large amount of data have been produced. Aim: To study the epidemiological and clinical profile of carcinoma breast with analysis of receptor status. Materials and methods: A descriptive study of 40 cases of carcinoma breast with receptor analysis, in Vinayaka Missions Medical College, Karaikal, from June 2015- June 2016 was done. Detailed history, clinical examination, and investigations were done, after staging, patients were treated with a suitable type of mastectomy, chemotherapy, radiotherapy and hormonal therapy as indicated. Cases were followed up for one year, data thus obtained was analyzed and results compared. Results: All our cases were unilateral- 26 (65%) right breast and 14(35%) left breast. Majority of the cases had lump measuring >5cm –30 (75%). 23 (57.5%) of cases had a tumor in the upper outer quadrant, followed by other locations. Most of the cases were stage III- 27 (67.5%), 3 (7.5%) had metastasis at the time of presentation. The predominant histological type was infiltrating ductal carcinoma 31 (77.5%). There was a predominance of ER+/PR+24 ( 60%), followed by ER-/PR-, ER+/PR- then ER-/PR+. Conclusion: Majority of the cases belonged to stage III, with a predominance of infiltrating ductal carcinoma. Reporting to the hospital in earlier stages of the disease is lacking in the study population and highlights the need for public education and screening methods. It also emphasizes to analyze hormone receptor status in patients, as receptor positive status significantly reduces recurrence if hormone therapy is initiated.

165-172

Authors: B. Kalyan Kumar, Ravi Kumar, J. Venkateshwar Rao

Background: There are very few published studies of heart disease in HIV infected children. The incidence of cardiovascular disease reported among HIV infected children ranges from 72% to 90%. Cardiac disease was primary cause of death in 25% of HIV Positive patients. Studies carried out in Indian subcontinent have demonstrated the presence of systolic and diastolic dysfunction on 2D Echo in HIV infected patients. Objectives: To determine the prevalence, and describe the type of heart disease among children with HIV attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital in collaboration Department of Cardiology, Gandhi Hospital. Materials and methods: 100 HIV infected children in age group of 1-18 years attending an ART centre in Gandhi hospital and centre of excellence Niloufer hospital from December 2011 to August 2013 were evaluated clinically, and investigated by chest X-ray, electrocardiography and 2D-echo.
 Results: Heart abnormalities were detected in 48 children (43 by 2D-echo, 4 by ECG, 1 by chest X-ray). The abnormalities included left ventricular systolic dysfunction (16%), left ventricular dilation (8%), left ventricular hypertrophy (11%), Pulmonary artery hypertension (11%), tricuspid regurgitation (14%) pulmonary regurgitation (4%), mitral regurgitation (4%), sinus tachycardia (4%), cardiomegaly on chest X-ray 1 of total 100 children taken for study. Conclusions: Heart abnormalities were common especially in HIV infected children. Clinical examination, chest radiograph and ECG may pick up manifest cardiac disease. Sub-clinical manifestations such as left ventricular dilatation hypertrophy and decrease systolic dysfunction can be detected only by echo cardiography. Annual echography and ECG examination is recommended to evaluate the progression of cardiac disease and treat the same before it become irreversible in HIV infected children.

181-187

Authors: S. Sukumar

Introduction: Acts of self-injury and self-poisoning that have not resulted in death are described by various terms such as attempted suicide, parasuicide, and deliberate self-harm. Due to the wider utility in various studies, the term attempted suicide is used in this study also. While suicide attempt is defined as intentional self-inflicted poisoning, injury or self-harm which may or may not have a fatal intent or outcome the term attempted suicide is used here for patients who have completely recovered from their attempt and referred for psychiatry opinion. Aim: Aim of the study was to evaluate the socio-demographic factors, methods of the attempt, psychiatric morbidity, and other causes of attempted suicide. Materials and methods: Victims of attempted suicide who were treated and referred from general medicine inpatient care for a regular psychiatric opinion were selected for this study. In the planned period of 3 months span 102 consecutively referred individuals were assessed. Through unstructured, comprehensive clinical interview individuals were evaluated and psychiatric diagnoses were made by using ICD-10-criteria. Datas were entered in a self-structured proforma, results were analyzed. Results: Women (63%), less than 30 years of age (74%), married persons (66%), studied up to secondary and higher secondary education (62%), rural population (80%), semi-skilled workers including housewives (60%), outnumbered others. 21% had a family history of suicide. 13% have attempted in the past. 56% have attempted through organophosphorus and natural plant poisoning. 39% had psychiatric morbidity. Depressive, alcohol, personality disorders were common. 57% of suicidal attempts have resulted from Dysfunctional family living in the form of Interpersonal conflicts and quarrels. Conclusion: Although identifying and treating the psychiatric condition is an immediate need, addressing the Healthy family functioning through school level educational and community level programmes would have long term impact on preventing suicidal attempts.

194-202

Authors: Sreenath S, Santhosh Kumar T.S., Parthiban, Jasen Joseph, Ratheesh Kumar V.R.

Background: Stroke is a major health problem in India. Stroke burden has been rising in India as compared to the developed countries. Recent studies have shown that high serum cholesterol is associated with clinically less severe ischaemic strokes and better outcome. Aim: The primary objective of the study was to compare the outcome of patients with ischaemic stroke to their cholesterol levels and to correlate the cholesterol levels to the stroke outcome. Materials and methods: This hospital based prospective follow-up study was conducted in 140 patients admitted with ischaemic stroke in the medical wards of Medical College hospital, Trivandrum. Patients were divided into 2 groups based on cholesterol levels as <160 mg/dl and >160 mg/dl. Their clinical severity at presentation was calculated by Scandinavian stroke scale (0=worst, 58=best) and outcome of these patients at the end of 1 year was measured by Modified Rankin scale (0=best, 6=worst).Serum cholesterol was measured using enzymatic method. Results: Mean age of 140 patients of at presentation was 63.4±11.9 years of which 53.5% (n=75) males, the mean Scandinavian stroke scale (SSS) being 28.3±12.5. The mean SSS score of high cholesterol group was 39.6 whereas 17 in the low cholesterol group (p<0.001). Similarly, the size of infarct in CT brain, outcome variables of modified Rankin scale and mortality were statistically significant between these groups (p<0.001). Bivariate correlation analysis showed that increased serum cholesterol level is associated with increased SSS score (positive correlation) with high statistical significance (p<0.001). Logistic regression adjustedwith other risk factors showed high cholesterol levels are associated with better outcome and decreased mortality, which is supported by Kaplan-Meier survival analysis. Conclusion: Hypercholesterolemia is associated with clinically minor strokes and better outcome, whereas major strokes are commonly seen in patients in the low cholesterol group. Hence post stroke outcome is inversely related to serum cholesterol levels in ischaemic stroke patients.

209-215

Authors: Nitin Kumar Singh, Himanshu Jain, Sonal Garg, Sachin Yadav

Background: Hip fractures in older patients are associated with impaired mobility, excess morbidity and mortality, and loss of independence. Objectives: To determine whether total hip arthroplasty is associated with lower reoperation rates, mortality, and complications, and better function and quality of life than hemiarthroplasty for displaced fractures of the femoral neck in older patients. Materials and methods: We prospectively as well as retrospectively studied 46 patients treated with total hip replacement or hemiarthroplasty. Pain, range of motion, hip function, haris hip score and complications were assessed clinically while hip stability, femoral anteversion, acetabular cup inclination and acetabular erosions were assessed radiographically. Results: In our study according to Harris hip score, group A (hemiarthroplasty group) showed 58.33% excellent to good result whereas 33.34% shows fair to poor result. In group B (total hip replacement group) 90.91% showed excellent to good result and 9.08% showed fair to poor result. In this study, the overall Harris hip score was 76.33 with SD±19.091 in hemiarthroplasty group and 86.45 with SD±6.363 in Total hip replacement group with p-value 0.0224(<0.05). Conclusion: So we concluded in our one year of study that total hip replacement had better functional outcome in fracture neck of femur in elderly treated by either hemiarthroplasty or total hip replacement and total hip replacement is less painful than hemiarthroplasty.

221-229

Authors: M Manjusha, B. Manoj Kumar, N. Venkat Rajaiah, P. Narayana

Background: Pericardial effusion in clinical practice is commonly under diagnosed or missed especially minimal to moderate effusion. Aim and objectives: To study the clinical and etiological profile of pericardial effusion and to recognize radiological, electrocardiographic and echocardiographic features that are characteristic of pericardial effusion and to analyze pericardial fluid in various etiologies. Materials and methods: It was prospective study in patients presenting with pericardial effusion in department of Medicine and Cardiology. Total of 30 patients who presented with pericardial effusion based on clinical criteria and confirmed by echocardiography were included in the study. Results: The causes of pericardial effusion in this study were Tuberculosis (33.33%), Uremia (20%), Viral /Idiopathic (16.67%), Bacterial (10%), Malignancy (10%), Hypothyroidism (3.33%), and post MI with ischemic cardiomyopathy (3.33%), SLE (3.33%). 3 cases (10%) were HIV positive among viral causes,1 patient had tuberculous pericarditis. ECG findings of low voltage complexes were present in 90% of patients and electrical alternans was seen mainly in tamponade cases. Chest X-ray finding of cardiomegaly was present in 90% patients with pleural effusion in 13.3% patients. ADA levels elevated in all 10 patients of tuberculous effusion with 100% sensitivity and among them smear for AFB was positive in 3 patients. Increased levels of ADA>60U/L was associated with increased incidence of effusive constrictive pericarditis in TB effusion. Pericardial fluid IFN-ᵞ increased greater than 200 pg/L, tuberculous etiology showed 100% sensitivity and specificity. In all 10 patients of 2Dimensional echocardiographic findings of right atrial, right ventricular collapse and left atrial collapse was seen predominantly in tamponade cases. Pericardiocentesis showed hemorrhagic effusion in malignancy and uremia, serous and serofibrinous in tuberculosis and purulent in pyogenic effusion. In 3 cases of pyogenic effusion, culture revealed Staphylococcus aureus in 2 patients and Klebsiella pneumonia in 1 patient. Among 3 cases of HIV, one patient had ADA >40 and smear for AFB positive suggesting tuberculous etiology and other 2 cases were directly due to HIV. In HIV with tubercular effusion the patient presented with cardiac tamponade. Conclusions: ADA>40U/L is diagnostic of tuberculous effusion which showed 100% sensitivity and specificity. Increase of ADA>60 U/L is associated with effusive constrictive pericarditis which has poor prognosis. IFN-ᵞ is increased >200pg/l in all patients of tuberculous etiology showing 100% sensitivity and specificity.

236-249

Authors: Ashwini Devarashetty, Humera Sultana, G. Nikhat Parveen, Yasmin Iqbal

Background: Infertility is a complex disorder with significant medical, psychosocial and economic aspects. Infertility causes great distress to many couples, causing increased numbers of them to seek specialist fertility care. Objectives: To measure the success rate of combined clomiphene citrate and gonadotropin therapy in anovulatory infertile patients overcoming the drawbacks of clomiphene alone treatment. Materials and methods: In this observational analytical study, total of 100 anovulatory infertile patients were selected for Combined Clomiphene Citrate and Human Menopausal Gonadotropin (CC – hMG) regime and maximum of three treatment cycle were given. Results: Out of 100 patients in present study, 46 patients became pregnant. Primary infertility was seen in 81 patients (81%) and secondary infertility in remaining 19(19%) of patients. Polycystic ovary disease (PCOD) was the commonest cause of anovulation seen in 62% of patients. Miscarriage was seen in 3 patients (3%). Multiple pregnancies were observed in 8 patients (8%). Number of patients conceived after 1 cycle was 12 (26%), 2nd cycle was 20 (43.47%), 3rd cycle was 14 (30.43%). Conclusions: Present study shows the success rate of 46% with CC-HMG combined regimen. Sequential clomiphene/ HMG regimen appears to be an effective protocol for controlled ovarian stimulation in infertile women who are resistant to clomiphene alone which has drawback of poor endometrial quality. It is easy to administer, requires less intense monitoring, fewer medications, and is cheaper without sacrificing efficacy, in other words it’s a cost effective technique in the management of infertile patients.

258-261

Authors: S. Uma Ganesh, Krishnapriya R, R. Srinivasan

Scleroderma is a chronic systemic autoimmune disease of unknown origin characterized by excessive collagen deposition and autoantibodies. Patients with autoimmune diseases are known to develop infections like tuberculosis due to the disease per se and also secondary to immunosuppressive treatment. Mycobacterial infections are also known to induce the development of autoantibodies. We present a case of simultaneous occurrence of interstitial lung disease and pulmonary tuberculosis (BAL positive for AFB) in a patient with features of systemic sclerosis. Antibody profile was done were found to be positive for ANA. She also had most of the classical features of scleroderma on clinical examination thus confirming the diagnosis. A detailed history, clinical examination, radiological examination, bronchoscopy and immunological test helped in the diagnosis of the patient. We highlight the importance of suspicion, careful general examination, radiological assessment and screening tuberculosis patients for autoantibody profile in presence of a multisystem involvement.