International Archives of Integrated Medicine

1-6

Authors: Morbiwala S, Parikh Y, Hapani P, Kalathia M, Shah Z, Soodhana D

Background: Poisoning among children is one of the common medical emergencies encountered in Pediatric practice. Rapid industrialization and exposure to harmful chemicals, introduction of newer range of drugs have widened the spectrum of toxic products to which children are exposed. Objectives: To study clinical course, hospital stay and recovery in childhood poisonings, to assess clinical recovery in correlation with hematological, biochemical and radiological changes, to study various complications and mortality in childhood poisoning. Materials and methods: A prospective observational study was conducted and all patients of childhood poisoning under the age of 12 years and meeting the selection criteria admitted in the tertiary health care center in Saurashtra region were included. Results: Maximum incidence of childhood poisoning was between 1-5 years of age (63%) and 56 % were males. Commonest route of exposure was ingestion (53 %) followed by percutaneous route (38%). Among the poisoning agents, envenomation (39%) and kerosene (24%) were the most common. Vomiting (39%) was the predominant clinical feature. Respiratory failure (22%) and pneumonia (22%) were the most common complications. 3 % needed ventilator care. In the present study, the case fatality was 3%. Conclusion: The trends for childhood poisoning noted at our center were different from previous hospital-based studies in two important ways such as in the nature of the poisoning agents used and the higher incidence of accidental poisoning.

16-19

Authors: K. Ravi Sekhar Rao, N. Krishna, G. Sreenivas, Vasantha

Cataract is a major cause of decreased vision in elderly aged population. In rural areas till last decade small incision cataract surgery with IOL implantation is the only surgical option for treating cataracts. In recent past after introduction of the phacoemulsification with foldable IOL implantation is becoming popular surgical technique in urban areas. In our study conducted at rural eye center, phacoemulsification with IOL is gaining popularity over SICS with IOL. This shows increased awareness among the rural population towards minimal invasive surgery and latest surgical techniques regarding better recovery procedures.

38-43

Authors: Shivnath Nandan, M. Madan Mohan Rao, G. Obulesu

Diabetes mellitus is the most prevalent metabolic non communicable disorder in the world. Diabetes mellitus type 2 is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Type 2 diabetes is typically a chronic disease associated with a ten-year-shorter life expectancy. This is partly due to a number of complications with which it is associated, including: two to four times the risk of cardiovascular disease, including ischemic heart disease and stroke. To study the prevalence of microvascular, macrovascular, nonvascular complications and associated risk facters such as dyslipidemia obesity and hypertention in newly diagnosrd type 2 diabetes patients.

50-57

Authors: M. Madan Mohan Rao, Shivnath Nandan, G. Obulesu, Salma Mahaboob R

Chronic kidney disease (CKD), also known as chronic renal disease, is progressive loss in kidney function over a period of months or years. The symptoms of worsening kidney function are not specific, and might include feeling generally unwell and experiencing a reduced appetite. Chronic liver disease in the clinical context is a disease process of the liver that involves a process of progressive destruction and regeneration of the liver parenchyma leading to fibrosis and cirrhosis. "Chronic liver disease" refers to disease of the liver which lasts over a period of six months. It consists of a wide range of liver pathologies which include inflammation (chronic hepatitis), liver cirrhosis, and hepatocellular carcinoma. The entire spectrum need not be experienced. Lipid profile or lipid panel is a panel of blood tests that serves as an initial broad medical screening tool for abnormalities in lipids, such as cholesterol and triglycerides. The results of this test can identify certain genetic diseases and can determine approximate risks for cardiovascular disease, certain forms of pancreatitis, and other diseases. Aim of the present study To study the changes in Lipid Profile Induced after Ingestion of Single High-Cholesterol Test Meal in Subjects of Chronic Liver Disease and Chronic Renal Disease. Materials and methods, present study was conducted in the department of General Medicine, RIMS, Kadapa, by taking 50 patients of both the sexes. Serum was separated within four hours by centrifugation and the tests are serum total cholesterol (STC), serum Triglycerides (STG), HDL-cholesterol, LDL-cholesterol and VLDL-Cholesterol. Statistical analysis of the data was done by using paired ‘t’ test and student ‘t’ test. As no such comparative prior studies have been done on COPD patients, it was strongly urged that further studies with larger sample groups be carried out to elucidate the quantitative and qualitative significance of these changes.

64-67

Authors: Savior Selva Suresh, O. Gambhir Singh, M. Parasakthi

The present study consists of 100 road traffic injury cases admitted in our tertiary health care centre. In the present study, males victims (84 cases, 84%) outnumbered the females victims (16 cases, 16%) with an approximate male female ratio of 5:1. Four wheelers and two wheelers involving mainly pedestrians were the most common cause for fatal head injury seen in 66 cases, 66%. Multiple abrasions were the most commonly seen external injury, seen in 68 cases, 68%. Skull bone fracture was seen in 40 cases, 40%. Temporal and parietal bones were common site of fracture seen in 41 cases, 41%.The mean survival period was 73.42 hours, range being 6 hours to 600 hours.

72-77

Authors: Y. Kishore Kumar, Jaya Sahu, Ajay Basod, Nityam Sagar Patel

Background: The presbycusis patients (usually beyond 50 years) come to us with much loss of hearing sensitivity. The deafness unperceived starts much earlier before their perception. Objectives: To identify the severity of the subtle deafness in the cosmopolitan, small town and rural areas. Materials and methods: We had selected the people with absolutely normal hearing (claimed by the subjects) between 21-50 years. They were confident of their hearing status, even on deep probing. We divided the people into three categories like cosmopolitan, small town and rural. We had selected the people of Mumbai under the cosmopolitan category. The audiological evaluation was carried out in sound treated room meeting the ANSI Standards of permissible ambient noise levels in sound treated room.Manual Pure Tone Audiometer in a two room set up that confirm to ANSI S-3.6-1996 standard was used. The instrument used for this study was calibrated ALPS AD 2100 audiometer with TDH 49 ear phones. Results: The cosmopolitan population were affected most. Later small town people and lastly rural area people were affected. In cosmopolitan population the 4 kHz was mostly affected, suggesting the significant impact of noise on their hearing. In town population also the 4 kHz is affected, but not to the extent of cosmopolitan people. The cosmopolitan people were affected worst among the three categories. And interestingly the small town population and rural population have almost the same hearing thresholds. Conclusion: The severity of subtle deafness is most in cosmopolitan, lesser in small town and least in rural population. The pure tone audiometry should be done in cosmopolitan people in early twenties, in small town people in early thirties and in rural population in early forties.

85-95

Authors: C. Narender Kumar, B. RangaRao

Introduction: The health care industry is undergoing transformation to meet the demands of the patients. Hospitals are shifting from viewing patients as illiterates and with little health care choice, to that of educated consumer who has wider health care choices. Patient satisfaction is regarded as an important indicator of quality of care and survey is one of the tools for measuring consumer experiences in the hospital. Objective: To study “Patients’ perceived satisfaction with diagnostic MRI services” in a Teaching hospital situated in Hyderabad. Materials and methods: A cross–sectional survey, conducted in 200 respondents attending hospital for MRI investigation. Pilot tested, pre-structured, self-completion questionnaire is used to collect data. The data isanalyzed using SPSS (statistical package for social sciences version 10.0.2). Results: The result showed that 79% (n=158) were males and 21% (n=42) females. Among two hundred respondents 54 (27%) were outpatients, 77 (38.5%) inpatients of same hospital, 50 (25%) subjects from private nursing homes, 9 (4.5%) patients from other hospitals and 10 persons not responded. Overall 74.5% of the patients satisfied with the waiting time, 80.5%, 77.5% and 86.5% of the patients satisfied with guidance to reach MRI facility, staff behaviour and staff communication respectively. 85.5% opined that utilization of waiting time by providing information regarding MRI is useful, and 62% of them requested to have trained personnel by their side during the procedure. Conclusion: Hospital administration shall take feedback from patients and their attendants and identify deficiencies and drawbacks in providing services and improve them to their satisfaction which in turn increases indirect publicity of the hospital.

104-109

Authors: Niveditha R, Sai Lakshmi V.S., Rageswari T, Lakshmi Manasa S

Background: Vascular diseases remains the chief cause of death and disability in industrialised countries. Clinical and experimental data suggest that some kind of neurologically mediated myocardial injury exists especially in subarachnoid hemorrhage but not as a manifestation of joint ischemic heart disease. Objectives: To study the spectrum of changes in ECG and echocardiographic patterns in the cases of cerebrovascular disease and to assess these different changes have got any prognostic significance. Materials and methods: 100 patients with acute stroke were considered, and ECG and the 2D echo of these patients were done within 24 hours of admission. In-hospital follow-up was done to know the prognosis of all the patients. Results: ST segment depression (53.1%) and U-waves (56.2%) followed by QTc prolongation (0.5±0.7 ms) were the most common abnormalities in haemorrhage group. Whereas in infarct type of stroke U-wave was the most common ECG finding (50.0%) among infarct group followed by QTc (0.45±0.08 ms) and T-wave inversion (29.4%). None of the ECG changes had much significance on mortality and was statistically insignificant (p>0.05) with either ischemic or hemorrhagic stroke. LV dysfunction, the most common abnormality was (29.4%) in infarct and haemorrhage (46.9%) stroke. LV dysfunction did not show significant impact on mortality in either of stroke subtypes (p>0.05). Conclusion: In our experience, both ECG and ECHO abnormalities in stroke patients do not have any prognostic significance predicting mortality in CVA.

116-121

Authors: Joshi AG

Introduction: Conventional USG/ Doppler is considered investigation of choice in patients of chronic renal failure. However when multi-systemic involvement is suspected so also for technical reasons when sonography fails to give optimal required information we feel that spiral CT should be implemented. The present study focused on its benefit over sonography in certain conditions. Aim: Role of non-contrast enhanced spiral ct in patients of chronic renal failure. Materials and methods: The study design was a cross-sectional study done in 96 patients who were suspected to have chronic renal diseases. Results: In the present study, we have found most commonly affected age group was 38-47 years, with male dominance. Chronic and end-stage parenchymal diseases, males were more affected than females. By occupation farmers were most affected group. It was observed that 27% of the patients had no specific history; the disease progressed silently until the symptoms appeared. The most common etiological cause of renal parenchymal diseases was Hypertension and diabetes (36%). Pleural effusion was most common associated finding in this series. Conclusion: Spiral CT is a reliable and supportive investigation in management of chronic renal disease when associated multi-systemic pathologies are suspected.

127-130

Authors: Champaneria NN, Shah SR, Goswami SS

Introduction: Glioblastoma multiforme (GBM) is the most common malignant neoplasm of the central nervous system most frequently located in the supratentorial site and carries a grim prognosis. Case report: A 52 years old male patient presented with headache and vomiting since 3 months. In MRI T2W images showed peripheral hypointense rim with central heterogeneously hyper intense signals suggestive of high grade glioma. Patient was underwent neurosurgery and resected tumor was sent to histopathology department. Discussion: Grossly glioblastomas are relatively circumscribed and often appear to be more clearly demarcated from neighboring tissues. In our case microscopic examination showed presence of dense cellularity, striking pleomorphism, and zones of coagulative necrosis lined by ‘palisading’ tumor cells characterize the prototypical glioblastoma. Conclusion: As GBM carries poor prognosis and the treatment of malignant gliomas is still a challenge for us, further research on this disease is needed so that better treatments may be developed to improve the quality of life and prognosis of these patients.

134-136

Authors: Anthonypillai Ravikaran, Galketiya KB, Shaminda RAA, Pinto V

Pancreaticoduodenectomy (PD) is the curative surgical option for periampullary tumors. Minimally invasive pancreaticoduodenectomy (MIPD) is gaining popularity as the open PD has considerable morbidity and mortality. MIPD was first described in 1994 by Gagner and Pomp. Since then the literature is flourishing with case reports and systematic reviews and are rapidly increasing in recent past. The first Sri Lankan report of laparoscopic pancreatico-duodenectomy with all anastomosis done by mini-laparotomy is in 2015. The patient presented in this report underwent pancreatico-duodenectomy and the hepatico-jejunostomy laparoscopically followed by mini-laparotomy for the other two anastomoses.

1-8

Authors: N. Rama Murthy, Ravi Jahagirdar, G. Mallikarjun, T. Jagadeeshwar, G Ravi Chandar, R. Amar Kumar

Background: Vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina that results in continuous and unremitting urinary incontinence. It is the most distressing complications of gynecologic and obstetric procedures. Materials and methods: It was a prospective study conducted at Gandhi Medical College and Hospital in Department of Urology from February 2014 to July 2015 for a period of 18 months. All cases were subjected to clinical examination, ultrasonography, IVP, cystoscopy, vaginoscopy, and cystogram for confirmation of diagnosis. All cases were managed surgically by different modalities and results were analyzed. Results: Our study included the patients in the age group of 18 to 56 years. 22 patients presented with continuous urine leak with voiding and 13 patients presented with voiding in addition to incontinence of urine. Out of 35 cases 25 were secondary to Gynecological surgeries and 10 were of Obstetric fistulas. Conclusion: The diagnosis of VVFs has traditionally been based on clinical methods and dye testing. The best chance of a successful repair is at the first attempt. The arguments about the most appropriate route for repair continue and are not clarified by the publications so far. However, the role of interposition grafts at both abdominal and vaginal repairs is viewed positively.

23-33

Authors: J. Lalithkumar, T. Chitra, N. Kodieswaran

Background: Acute pancreatitis is an acute inflammation of the pancreas is an increasingly common abdominal disorder presenting as major surgical challenge to general surgeons worldwide. Early identification of patients at risk of developing a severe attack has great importance for instituting therapeutic interventions and improved outcome. Accurate prediction of severity is important in order to improve survival. There are several assessment criteria in order to predict prognosis and severity of acute pancreatitis, which help in guiding patient triage and management. However, nothing is proven to perform significantly better in clinical settings than good clinical judgment. Ideal predicting criteria should, therefore be simple, non-invasive, accurate and quantitative and assessment tests are easily available. Aim and objectives: It was a prospective study to assess the accuracy of BISAP scoring system vs Ranson’s scoring system in predicting Severity in an attack of acute pancreatitis and to compare predictability of organ failure, necrosis and mortality between BISAP scoring and Ranson’s Scoring system. Materials and methods: All patients admitted to Govt. Stanley Hospital with complaints of pain abdomen diagnosed to have Acute Pancreatitis on clinical examination and further investigations. Sample size consists of 100 patients with acute pancreatitis. BISAP score and Ranson’s score is calculated in all such patients based on data obtained within 24 hours of hospitalization and at 48 hours. Results: In this study, the two different scoring systems (BISAP and Ranson’s) were compared and analyzed to assess the severity in patients with acute pancreatitis. An attempt also made to compare this study with previous similar studies done by others. Acute pancreatitis found to be 10 times more common in males than females in this study. The mean length of hospital stay was 12.03 ± 6.8 days in this study. In this study, increasing BISAP and Ranson’s scores was correlated well with the duration of hospital stay. In this study, 86 patients were diagnosed to have mild and moderately severe acute pancreatitis grouped under MAP, and 14 patients found to have severe acute pancreatitis. All the 14 patients were correctly predicted by BISAP score. The scores were assessed by correlating the scores with three factors: organ failure, necrosis and mortality. The analysis for organ failure showed BISAP score has sensitivity of 71.43%, specificity of 95.35%, PPV of 71.43%, NPV of 95.35%, diagnostic accuracy of 92%; whereas Ranson’s score has sensitivity of 78.57%, specificity of 74.42%, PPV of 43.33%, NPV of 95.52 %, diagnostic accuracy of 88%. In this study, 7/20 patients with BISAP> 3 and 8/14 patients with Ranson’s >3, developed pancreatic necrosis. The statistical analysis for the prediction of necrosis has sensitivity of (81.82%, 90.91%), specificity of (94.35%, 77.53%), PPV of (64.29%, 43.56%), NPV of (97.67%, 98.57%), diagnostic accuracy of (93%, 91%) for BISAP and Ranson’s respectively. In this study, 4 patients with severs acute pancreatitis were expired. All 4 deaths were correctly predicted by BISAP score. The statistical analysis for the prediction of necrosis has sensitivity of (100%, 88.57%), specificity of (95.83%, 64.42%), PPV of (50%, 31.33%), NPV of (100%, 96.52%), diagnostic accuracy of (96%, 93%) for BISAP and Ranson’s respectively. In this study, patients developed pancreatic necrosis, acute renal failure, MODS, septicemia. These complications were more likely seen in patients with BISAP ≥ 3, and Ranson’s > 3, hence concluded that these are the patients in high risk group, who requires intensive monitoring and probably early intervention if necessary. Conclusion: From this study, alcohol (59%) was found to be the most common etiological factor for acute pancreatitis. Males were more commonly affected than females with a ratio of 10:1. The most common age groups of patients affected were in 4th decade of life. The overall mortality in patients with severe acute pancreatitis was 4% BISAP score is equally effective in finding out the frequency of severity and predicting mortality in patients with acute pancreatitis as Ranson's score. Moreover, its components are easily available and it does not require 48 hours for completion of assessment as compared to Ranson's score. It is an accurate tool to classify patients into mild and severe disease; it is easy to perform and can be done on the bedside of patients with acute pancreatitis in every setup.

40-46

Authors: N.D. Srinivasaprasad, G. Chandramohan, M. Edwin Fernando

Background: Despite technical, immunological, and therapeutic advances in the field of renal transplantation, infections remain a major barrier to successful outcome. Fungal infections (14%) after renal transplantation, despite a lower incidence than bacterial and viral infections, remain a major cause of morbidity and mortality. This study was conducted to assess the impact of invasive fungal infections in our renal transplant recipients. Aim: To study the clinical profile, risk factors for acquiring fungal infections, its outcome and the factors influencing outcome in living and deceased donor renal transplant recipients. Materials and methods: Renal transplant recipients both cadaveric and living-related during the time period between August 2008 and May 2011 admitted with systemic fungal infections in nephrology ward were included in the study. Data gathered included age, sex, date of transplantation, date of diagnosis, fungal pathogen, organs affected by infection, treatment and patient outcome. Microsoft excel 2007, Binomial and Student t tests were used for statistical analysis. Observation: Twenty two patients were diagnosed with systemic fungal infections during this period. The mean age of the study patients was 35.55 years. The male to female ratio was 1.75:1.Candida species (62%) are the commonest organisms causing fungal infection. Fungal infections commonly occurred in gastrointestinal tract (GIT), lung and urinary tract, each 22%. Fifty percent of patients with fungal infections expired. Graft loss occurred in 41% of patients. Conclusion: The mortality rate was 50%. Bone marrow suppression {Leukopenia (50%)} and hypoalbuminemia (59%) contributed to high mortality. Overall immunosuppression should be monitored periodically and kept at optimal level just enough to avoid rejection, thereby avoiding opportunistic infections.

54-60

Authors: Singh K, Kaushik NK

Background: Seasonal fluctuation in incidence of invasive pneumococcal disease, pulmonary embolism, deep vein thrombosis and coronary heart disease etc has been reported since long time. So, the present study was conducted to evaluate the seasonal variation in hematological and hemodynamic parameters, heart rate and blood pressure in the month of November, February and May. Materials and methods: 15 male subjects in the age group of 18.5±1 year were matched on haematological parameters, heart rate and blood pressure in three different seasons and the results were compared. Results: Packed cell volume in winter (February), Erythrocyte Sedimentation Rate in summer (May) were increased (P< 0.001) as compared to basal level in November month with non significant variation in Hemoglobin concentration and Red Blood Cell count. Total Leukocyte count significantly increased (p <0.001) in winter, while on differential and absolute leukocyte count Eosinophil, Basophil, Monocyte, Lymphocyte (%) were elevated (p <0.001) and Neutrophil (%) decreased (p <0.001) in summer. Total Protein concentration, serum Albumin level was higher in winter. Heart rate shows insignificant seasonal changes but blood pressure, both systolic and diastolic was lower (p< 0.001) in summer and rate pressure product (RPP) was higher (p<0.05) in winter. Conclusion: So, these findings indicate that variations in different parameters do occur to adapt to the environmental conditions which may be responsible for susceptibility to different diseases e.g. asthma and ischemic heart diseases in different seasons.

66-73

Authors: Patel V, Chaudhary H, Patel HJ, Agrawal R

Background: Epidural opioids have been widely used for post thoracotomy pain relief. One such drug is Fentanyl, a short acting lipophilic opioid analgesic, structurally related to Pethidine for its opioid activity. Adding Fentanyl, as an adjuvant to Ropivacaine, also reduces total consumption of Ropivacaine and incremental doses of rescue analgesics. Materials and methods: 50 patients of either sex aged 18-60 year belonging to ASA class II-III scheduled for elective thoracotomy were included in this study and divided into two groups: Group R receiving 0.1 ml/kg/hr of 0.2% Ropivacaine continuous epidural infusion for 24 hour and Group RF receiving 0.1 ml/kg/hr of 0.2% Ropivacaine + 4 µg/ml Fentanyl continuous epidural infusion for 24 hour. Results: There was no significant difference between two groups regarding to Age, sex, height, weight and ASA grade and preoperative vitals as well as VAS score at rest. There was highly significant difference between groups at 30 minute and 6 hour regarding to this variable with P <0.001. Patients in group RF were more comfortable during PEFR measurement than group R. Conclusion: A continuous thoracic epidural infusion of 0.1 ml/kg/hr of 0.2% Ropivacaine + Fentanyl 4 µg/ml provided better pain relief than 0.2% Ropivacaine alone after thoracotomy; both at rest and during spirometry. The use of 0.2% Ropivacaine alone was associated with worse pain control during spirometry, larger consumption of IV Diclofenac Sodium and worse performance during spirometry. Addition of Fentanyl to Ropivacaine for continuous epidural analgesia in post thoracotomy patients provides better pain relief and improves spirometry performance.

79-86

Authors: Rajalakshmi Preethi G, Mariappan M, Madhusudhanan J, Arun AC

Background: Blunt abdominal trauma is a frequently encountered emergency with associated significant morbidity and mortality. Since conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, CT imaging is useful in detecting severe solid organ and bowel injuries which require surgical management. Objective: To analyze the profile of abdominal injuries presenting to the emergency medicine department of a tertiary care teaching hospital. Materials and methods: The study was a retrospective analysis of hospital records conducted in Velammal Medical College and Hospital, Madurai, which is a tertiary care teaching hospital in south India. The study was conducted from May 2014 to January 2016. People reporting to the emergency, with suspected abdominal injuries and evaluated for the same by CT abdomen were included in the study. Results: CT had 100% negative predictive value and highly specific in ruling out significant abdominal injuries. Spleen was the most common organ injured in study population, seen in 32 (42.10%) patients. The other common organs injured were liver and kidneys, which were injured in 24 (31.57%) and 16 (21.05%) patients respectively. Only 25% of the patients in our study required surgical intervention, which was for Grade IV/V splenic injuries, hepatic injury with active contrast extravasation, hepatic pseudo aneurysm, bowel and diaphragmatic injuries. Conclusions: CT is highly useful in evaluation of hemodynamically stable patients with suspected blunt abdominal trauma. Majority of the patients with abdominal injury were successfully managed conservatively.

93-97

Authors: CH. Sheethal

Background: Endometrial cancer is one of the commonest cancers in women. Unopposed estrogen stimulation of the uterus is amongst one of the etiologies postulated for this condition. It is generally assumed that women with polycystic ovary syndrome are more likely to develop endometrial carcinoma. Aim: This study hypothesized comparing the ovarian morphology of women diagnosed with endometrial carcinoma and those with benign gynecological conditions. Materials and methods: The present study included a total 64 patients who had been diagnosed with endometrial carcinoma and with 42 age matched control. All biopsy samples were undergone routine histological process with Hematoxylin-Eosin stain to check morphological differentiation. Results: There was found no significant difference in the prevalence of PCOS (using this as a marker of PCOS in the absence of information on biochemistry) in the ovaries of patients diagnosed with endometrial cancer compared to women with benign gynaecology disease. Conclusion: Although our numbers were small, these results challenge the assumption that PCOS is a risk factor for endometrial cancer. Investigation of patient records revealed there was no significant difference in the demographic profile between subjects with endometrial carcinoma or benign gynecological conditions.

103-107

Authors: Nidumuru S, Kollur PB, Kollur BP, Kashinakunti SV, Pyadala N

Background: Worldwide urolithiasis is most common urological disease affecting both males and females. A kidney stone is a disease caused by some multi-factorial reasons like biochemical, environmental, epidemiological, genetic factors and especially diet will play an important role in expression of the tendency to stone formation. Aim: The present study was aimed to determine the composition of renal calculi by biochemical analysis. Materials and methods: A total of 43 study subjects of both sex groups were selected from the surgical urology unit of S.V.I.M.S Tirupati, and private Nursing homes in Tirupati, during the period of 16 months (May 2009 to September 2010). Results: A total of 50 renal stones were analyzed qualitatively, from 43 patients. In 43 patients, 39 were Males (90.69 %) and only 4 were Females (9.31%) and the incidence in male and female was in the ratio of 10:1. The highest number of cases, 40% of the total case is present in age group of 35-40 years followed by 32% in age group of 30-35 years. The Qualitative chemical analysis of renal stones revealed the presence of mixed stones with highest percent of CaOx (Calcium Oxalate) with CaP (Calcium Phosphate) stones for followed by uric acid. Conclusion: The present study concluded that knowing the biochemical composition of renal calculi is important during the treatment of renal stone disease and also giving advice to people for taking preventive measures for reducing the stone formation.

115-125

Authors: T. Ravi, N. Dheeraj Kumar, Bhrungi Shireesh Kumar

Background: Pain is an unpleasant subjective sensation which can only be experienced and not expressed, especially in children. The primary reason to treat or prevent pain is humanitarian. Aim and objectives: To assess Ultrasound Guided Ilioinguinal / Iliohypogastric nerve block versus Caudal block for post-operative analgesia in children undergoing unilateral groin surgery in ASA grade I and II children. Materials and methods: Sixty patients aged between 3-12 years undergoing unilateral groin surgery were included. The objectives of this study were to compare the effects of caudal block and ultrasound guided Ilioinguinal/ Iliohypogstric nerve block in terms of duration of analgesia, quality of analgesia and hemodynamic. Results: The mean age of two groups was comparable with Mean ± SD 4.67 ± 1.4 for B group and Mean ± SD 4.7 ± 1.34 for C group, which was statistically not significant. In the present study, major number of cases came for herniotomy being 47% of total cases in both groups followed by high ligation 27% in US II/IH nerve block,23% in cauadal group, and orchidopexy 27% in II/IH nerve block group and 30% in caudal group. Mean duration of surgery of B group was 28.17±8.56 minutes, and for C group was 29.67±8.60 minutes. The difference between the means was statistically not significant (P>0.05). The baseline, intra operative heart rate changes between two groups were comparable and were statistically not significant and therapeutic interventions were not required. There was no significant difference in quality of analgesia in both groups with P-Value >0.05. Duration of Postoperative analgesia is comparable in both the groups with Mean±SD values being 4.95±0.51 for B group and 4.78±0.49 for C group which is statistically not significant with P- Value being >0.05. Conclusion: Ultrasound guided Ilioinguinal / Iliohypogastric nerve blocks is an ideal procedure for unilateral groin surgeries in children, regarding quality of analgesia with less pain scores and duration of analgesia is comparable with that of caudal block, with lower volume of local anesthetic.

134-139

Authors: Sreemani Kumari, Annapurna Sireesha, Shyamala Srujana, O. Shravan Kumar

Background: The gallbladder is a surgically important organ of the body which may be affected by a variety of pathological processes, which are often, under appreciated. It has a wide spectrum of diseases ranging from congenital anomalies, gallstones and its complications, non-inflammatory, inflammatory to the neoplastic lesions. Gallbladder pathology is a frequent source of patient complaint, presenting as acute or chronic right upper quadrant pain, jaundice, or dyspepsia. Gallstones are the commonest pathology of biliary system causing morbidity and mortality. Absolute diagnosis of the premalignant and malignant lesions is possible only after histopathologic examination of the specimen, as pre-operative imaging techniques fail to identify the lesions. Aims and objectives: To study the histomorphology of various gall bladder lesions, to determine the age and sex distribution of the lesions and to ascertain the frequency of abnormalities. Materials and methods: This was a prospective study conducted at Gandhi Hospital, Hyderabad for a period of 1.5 years, i.e. from December 2014 to May 2016. A total of 170 cholecystectomies were received, (including both conventional and laparoscopic types of surgeries) from Department of General Surgery. After gross examination, representative bits were taken and submitted to routine processing, paraffin embedding, cutting and staining. Sections were stained with conventional hematoxylin and eosin and were analyzed. Results: In the present study, various types of lesions were identified and categorized as follows. Congenital anomaly (a single case of Duplication) was noted. Chronic cholecystitis (79), Chronic Cholecystitis with Cholelithiasis (59), Gangrene (13), Gangrene with perforation (3), Empyema (2), Xanthogranulomatous Cholecystitis (3), Adenomyosis (4), Follicular Cholecystitis (1), Cholesterolosis (1), Eosinophilic Cholecystitis (1), Porcelain gall bladder (1), Mucocele (1), and Carcinoma (1). Conclusion: Biliary disorders affect considerable portion of the population. 90% biliary diseases are attributed to cholecystitis. All cholecystectomies should be subjected to histopathological examination in order not to miss the spectrum of gall bladder lesions and their significance.

148-160

Authors: G. Sharmila, Prasanna

Background: Antepartum hemorrhage is defined as any bleeding from or into the genital tract after the period of viability and before the end of second stage of labour. Aim: To study the maternal and perinatal outcome in antepartum hemorrhage. Materials and methods: The present study was a prospective observational study undertaken during a period of 2 years from September 2012 to August 2014 in 50 cases of antepartum hemorrhage. Only patients with APH >28 weeks gestational age willing to participate in study were included. Results: The incidence of antepartum hemorrhage was 3.8%. Abruptio placenta (56%) constituted the largest group. Maximum number of patients was in the age group 20 to 30 years in both abruption (53.5%) and placenta previa (52.5%). In abruption 53.6% and in placenta previa 79% of the patients were multiparous. Majority (56%) of the patients with antepartum hemorrhage had GA of 28 to 34 weeks. Mean period of gestation in APH patients was 33.4 weeks. In abruption, 64% of the patients and in placenta previa 42% were in the age group of 31-34 weeks and 6 days. In the present study, 64% of the patients were anemic at the time of admission. Majority 34% of the anemic patients had Hb of 7.5-9.9 gm. Maximum 35.7% of the patients with abruption had Hb of 5 to 7.4 gm and 42.1% of patients with placenta previa had Hb of 7.5 to 9.9 gm. Pre-eclampsia (36%) was the most common risk factor for APH. The commonest mode of delivery was cesarean delivery i.e. 60%. In abruption majority 53.6% had normal delivery. 89.5% of placenta previa had cesarean section which was the largest group. Post partum hemorrhage was the most common complication observed in 22% of the cases. 5.3% of the patients with placenta previa had placenta accreta. DIC and renal failure were seen in 3.6% each. Majority (64%) of the patients in this study required blood transfusions. 64% of abruption and 68% of placenta previa patients required blood transfusion. IUD or still births were noted in 31% of the cases. Neoantal deaths were observed in 5.8%. Prematurity was the most common complication observed in the present study in 82.8% of the cases followed by neonatal jaundice which was observed in 51% of the cases. NICU admissions were present in 8.5% of the cases. In the present study, 56% of the patients had an APGAR score of <7 at 1 min and 63% had an APGAR of 4 to 6 at 5 min. Maximum number of births had birth weight of 1.5-2 Kg. In previa 17, majority (39.2%) of births had birth weight of 1.5-2 Kg and in undetermined majority (66.7%) had birth weight of 2.5-3 Kg. Conclusion: From the present study it can be concluded that antepartum hemorrhage is still a leading cause of maternal morbidity and mortality in our country.

164-169

Authors: DVSRK Prasad, Srinivas S, Yugesh M, Santosh B

Urethral stricture is a common disease with changing etiology and changing practices in management. Management options were grossly determined by cause, site, length of stricture and also by other factors like prior attempts of repair and local genital skin condition. Treatment options vary from dilatation, optical urethrotomy to various types of urethroplasty. Substitution urtethroplasty is done using various types of graft materials like skin, buccal mucosa, bladder mucosa or colonic mucosa. Over the past 10-15 years buccal mucosa grafts have been increasingly used in the urethral reconstruction. Barbagli technique (Dorsal onlay technique) has the advantages of no sacculation which is seen with ventral onlay grafts, good neovascularity and less shrinkage (10%) rate. We have presented the results and complications of doral onlay buccal mucosa graft urethroplasty (Barbagli technique) in 20 cases performed over a period of 30 months in our institution. Our study showed a success rate of 80% at the end of 2yrs follow up, comparable with other studies, with a restructure rate of 20%. None of our patients developed urethrocutaneous fistula and urethral diverticulum.

177-181

Authors: DVS Ramakrishna Prasad, Srinivas S

Amongst the congenital anomalies of the Ureter, Megaureter is one of the commonest, next only to the various types of duplications. Though every dilated and large ureter can be described as Megaureter, Primary obstructive megaureter is the entity wherein the dilated ureter is associated with a short, juxtavesical, narrow, adynamic segment and is not associated with reflux. This is a study of 8 patients who presented with primary obstructive megaureter in the department of urology, Osmania General Hospital, Afzalgunj during 2013-2015. Apart from the clinical presentation of this disorder, the modalities of arriving at the Diagnosis, the associated complications and the management are discussed.

189-193

Authors: Patel Y, Baria B, Gohil K, Parmar H

Background: Gastroesophageal reflux Disease is a highly prevalent gastrointestinal (GI) disorder and is one of the most common GI illnesses encountered in clinical practice. Gastroesophageal reflux disease (GERD) is one of the most common conditions presenting to primary care physicians and gastroenterologists. It refers to the abnormal exposure of the oesophageal mucosa to refluxed gastric contents, including acid and pepsin, resulting in symptoms and/or tissue damage. Our aim was to compare the result of nissen and toupet procedures and to determine which procedure is better in terms of symptomatic improvement symptom recurrence and post-operative complications. Materials and methods: This was the both prospective and retrospective study included 29 patients with GERD who were operated upon by Laproscopic Nissen Fundoplication and Laproscopic Posterior Fundoplication. Demographic and clinical profiles of all patients were recorded. All patients were subjected to thorough clinical evaluation, upper GI endoscopy done in all patients, esophageal Manometry and 24 ph study done in selected patients. All preoperative data compared with the postoperative data. Results: In our series 68.9% of the patients were below 50 years. 31.03% was above 50 years. The average age of occurrence was being 41.4 years. In our series Sex distribution were 75.8% of Males and 24.1% of Females. Wound (port site) infection 5 (17.2%) was treated with antibiotics and drainage, chest infection (atelectasis) 7 (24%) treated with IV antibiotics, Pleural effusion 2 (6.8%) was treated with physiotherapy settled down 2-3 days, mild surgical emphysema 2 (6.8%) may be due to good hiatal dissection and proper esophagus mobilization, it settled down in 2 days, urinary tract infection 3 (10.3%) was treated with antibiotics, port site hematoma 3 (10.3%) was managed conservatively. Conclusion: Both Laparoscopic Nissen fundoplication and Laparoscopic posterior fundoplication provides excellent results for GERD in terms of postoperative morbidity and complications.

200-209

Authors: Radhika Rani, R. Srikanth

Introduction: Cervical cancer is the third most common malignancy in women worldwide, and it remains the leading cause of cancer related deaths in women in developing countries. In the management of cervical cancer, both intracavitary brachytherapy (ICBT) and external radiotherapy (ERT) are essential as they deliver a high dose to the primary tumor and low doses to adjacent organ. The dose can be delivered either by conventional orthogonal radiograph mapping or by the 3-dimensional computed tomography mapping. In the present study, we have compared both the techniques. Aim and objectives: To compare intracavitary brachytherapy (ICBT) planning methods for cervical cancer based on orthogonal radiographs (conventional plan) and computed tomography sections (CT plan). Materials and methods: This was a prospective study, conducted in the department of Radiotherapy, MNJ Institute of Oncology and Regional Cancer Centre, over a period of two years from November 2012 to November 2014. The study consisted of total 25 registered patients having confirmed diagnosis of Squamous cell carcinoma of cervix. All the patients underwent conventional and CT planning for brachytherapy. One arm received the conventional plan of radiotherapy while the other arm received computed tomography (CT) based plan. Results: The patient age ranged from 35 to 65 years. The mean age was 47 years. The results of the study demonstrates that CT-guided brachytherapy planning is superior in terms of both conformity of target coverage and evaluation of OARs .Although this superiority was clear for small GTVs, for large GTVs both the conventional and CT-Plans had the drawbacks of inadequate target coverage and /or excessive radiation doses to normal organs. Conclusions: The conventional plan with the point A calculation relies on reference points on orthogonal films ,not tumor volumes defined on CT, which may cause underestimation of tumor doses. Likewise, the calculation of rectum and bladder doses made with ICRU reference points, not with bladder and rectal volumes may not reflect the actual organ doses. To overcome such problems, 3D CT-guided brachytherapy treatment planning is recommended.

218-221

Authors: P. Krishna Kishore, B. Manju Sruthi, G. Obulesu

Background: The rectum serves the function of a temporary reservoir for faeces and unfortunately when hemorrhoids raise their ugly heads, the natural process of eliminating waste from the body causes discomfort to the patient. Aim: The aim of my dissertation topic was to compare stapler hemorrhoidectomy (MIPH) with open hemorrhoidectomy in the management of 3rd / 4th degree hemorrhoids with reference to complications like pain, retention of urine, bleeding and anal incontinence, comforts to the patient, comforts to the surgeon, Intra operative complications, hospital stay, cost of surgery. Materials and methods: Inclusion criteria were primary III and IV degree hemorrhoids. Exclusion criteria were patients with associated co-morbid conditions, associated gastrointestinal diseases, recurrent hemorrhoids. Parts of a PPH 03 stapler device: Icon hea, Anvi, Shaft of instrument, Handle with safety lock. Results: Most of the patients belong to age group 41-50 and above 67% of the patients are between the age group of 41-60. About 83% of patients where males; females accounted for only 17%. The average post-operative stay for patients who underwent stapler hemorrhoidectomy was 3 days, whereas for open hemorrhoidectomy 4.6 day. Out of 100 patients only 60 cases came for follow up. The period extended from 2 months to 30 months. Stenosis was more common after open hemorrhoidectomy whereas recurrence was more common after stapler hemorrhoidectomy. Conclusion: Hemorrhoids is a common problem worldwide, a penalty paid by human beings for their erect posture. Lack of fiber in diet and chronic constipation are the root causes for this problem. The common mode of presentation is painless bleeding, prolapsing pile mass and pain when complicate.

228-237

Authors: Kuppa Prakash, A. Ravi Chandran, M. Vijay Kumar

Background: Head and neck cancers are the most common malignancy among males in India. Carcinoma of buccal mucosa is the most common cancer among head and neck cancers due to high rate of tobacco chewing habit. Aim and objectives: To study the comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. Materials and methods: It was a prospective study of acute toxicity and response in patients diagnosed with head and neck malignancy. Patients with oral cavity site, previously untreated locally advanced III, IV-A and IV -B, age of 20-60 years. Results: Primary tumor site of the patients included in the both CRT arm and HFRT was not significant (P=0.755). Majority of patients included were T3 (44% in CRT arm and 46.7% in HFRT arm) and T2 (24% in CRT arm and 26.7% in HFRT arm) lesions. The tumors with respect to T stage, the difference between two arms was not statistically significant (P = 0.988). Most of the patients presented with N1 (44% of CRT arm and 40% of HFRT arm) and N2 (28% of CRT arm and 26.7% of HFRT arm) stage. With respect to nodal (N) stage at presentation, CRT arm and HFRT arm were comparable (P=0.987). In HFRT arm, 7 (46.7%) patients were presented in stage III and 8 (53.3%) patients were in stage IV. With respect to TNM stage, CRT arm and HFRT arm were comparable (P=0.87). Radiotherapy treatment compared in both CRT Arm and HFRT arms was not statistically significant (P=0.493). In CRT arm Grade 2 toxicity: 13/22 (59%) patients developed skin toxicity, 12/22 (55%) patients developed mucous membrane toxicity, 15/22 (68%) patients developed nausea, 8/22 (36%) patients developed vomiting, 10/22 (45%) salivary gland toxicity. Grade 3 toxicity: 2/22 (9%) patients developed skin toxicity, 10/22 (45%) patients developed mucous membrane toxicity, 5/22 (23%) patients developed nausea, 6/22 (27%) patients developed vomiting. Conclusion: Standard chemo radiation is better than HFRT in Head and Neck (oral cavity) cancers because of less toxicity, less mean overall treatment time, less number of treatment breaks and better response.

242-246

Authors: Thajuddin MD, E.A. Ashok Kumar

Marfan syndrome is an autosomal dominant, multisystem connective tissue disorder. Mutations are present in the FBN1 gene on chromosome 15, which encodes for the connective tissue protein fibrillin, occasionally a mutation in TGFBR1 or 2. This disorder is characterized by skeletal, cardiovascular and ocular abnormalities. Pulmonary abnormalities occur in approximately 10% of patients, the commonest being spontaneous pneumothorax and emphysema. Cardiovascular abnormalities being Mitral valve prolapse (MVP), is a relatively frequent abnormality and Aortic dilatation. Aortic root dilatation is one of the cardinal features of Marfan syndrome. But aorta may be dilated anywhere in its course, most common being ascending aorta. In this case report, a 17 years old boy with Marfan syndrome presented with combination of emphysema, dilatation of ascending aorta, mitral valve prolapse, which is rare.

1-10

Authors: D. Dorai, J. Lalith Kumar, T. Chitra, G. Prasanna

Background: After gastrointestinal surgery like anastomosis, patients are usually not allowed to take feed orally for five days. This is to prevent post operative nausea and vomiting and also to protect the anastomotic site allowing it to heal. Aim: This randomized control study sought to compare the outcome of early Enteral feeding versus delayed feeding after gastrointestinal surgery. Materials and methods: 60 patients were randomly selected and classified into two groups, early feeding group and late feeding group and following were noted; anastomotic leak, infection (wound, intra-abdominal abscess, pulmonary complication, sepsis), length of hospital stay. Results: The mean length of hospital stay was 9.3 vs 10.90. The difference was 1.6 days (P value: 0.129). Wound infection was 20% vs 26.7%. 6.7% had intra-abdominal abscess in the early feeding group which was statistically insignificant. There were two patients (6.7%) with sepsis in late feeding group (p= 0.150). There were no anastomotic leak and no deaths in the both the groups. Conclusion: The present study indicated that there was no significant difference between the two groups. Late feeding doesn’t confer any significant advantage. There was no advantage of dietary restriction. Hence we recommend that early post-operative feeding is safer.

16-22

Authors: J. Murli Manoher, Praveena, Anju Kochar, Anil Chauhan

Background: The corneal-conjunctival intraepithelial neoplasia (CCIN) is an ocular surface neoplasia commonly found among populations exposed to strong UV light. Although surgical excision is mainstay treatment, topical Mitomycin-C (MMC) 0.02% has been tried as a sole therapeutic treatment of non- invasive Ocular Surface Squamous Neoplasia (OSSN). Aim: The aim of this study was to report the long term outcome of treatment of non invasive ocular surface squamous neoplasia with topical Mitomycin C (0.02%) as primary therapy. Materials and methods: Total six eyes of six patients with CCIN were treated with topical mitomycin C (0.02%) alone as a sole therapy. All patients received topical MMC (0.02%) four times daily as a cycle therapy of two week ON and two week OFF for 12 weeks. The patients were followed up to two years. Results: All patients showed total cure with no recurrence during 2 years follow up period. Ocular irritation and mild conjunctival hyperemia were observed in 4 eyes during treatment with MMC. There were no serious complications noted at the end of the follow-up period. Conclusion: We concluded that Topical Mitomycin C (0.02%) may be used as a sole therapeutic treatment of non invasive Ocular surface squamous neoplasia with close on going follow-up.

29-35

Authors: K. Bhramaramba, B. Vijaya Nirmala, N.L.N. Murthy, O. Shravan Kumar

Hydatid disease is a zoonotic infection caused by Echinococcus granulosus, which belongs to phylum Platyhelminthes. It is endemic in many parts of the world including India. Though Hydatid disease commonly occurs in liver and lung no organ or tissue is immune in the body. When it presents in unusual sites Hydatid disease often poses a diagnostic challenge. A high index of suspicion, comprehensive radio imaging investigations are often required to evaluate these cases. In the study we have conducted for 4 years, we reported a total no of 7 Hydatid cases that presented at unusual sites. Most common rare presentation in our study was renal hydatid disease, 3 cases; and one each in pancreas, Spleen, peritoneum and pelvis.

45-52

Authors: Surendran Sujit, N. Gopalakrishnan

Background: Hepatitis C virus infection confers 1.62-2.39 fold increase in risk of death for hemodialysis patients. The quality of life, morbidity and mortality of chronic kidney disease patients on maintenance hemodialysis is worse when compared to the quality of life, morbidity and mortality of patients undergoing renal transplantation. For these reasons, renal transplantation is better therapeutic option for hepatitis C virus infected patients on maintenance hemodialysis. Aim: To study of clinical outcomes of renal transplantation in hepatitis C virus positive renal transplantation recipients. Materials and methods: Single arm prospective observational study done on 28 hepatitis C virus positive patients who underwent either live related or deceased donor transplantation in our department during 2010 -2013 were followed in our ward and outpatient department. Results: Delayed graft function was present in 11 (39%) patients. Acute cellular rejection was present in 8 patients (26%). New onset of diabetes mellitus after transplant (NODAT)/ Post Transplant Diabetes Mellitus (PTDM) was present in 16 patients (57%). Sepsis occurred in 17 recipients (61%). Cytomegalovirus infection was present in 11 recipients (39%). Invasive fungal infection was present in 7 recipients (25%). Conclusion: The short term patient and graft survival of HCV positive recipients was better. There was high incidence of NODAT in HCV positive recipients, and occurrence of NODAT was within 3 months after transplant. The incidence of sepsis and cytomegalovirus in HCV positive recipients was higher, it is better to keep minimal level of immunosuppression. The incidence of acute rejection, interstitial fibrosis, fungal infection and graft survival in HCV positive recipients was not statistically significant from HCV negative recipients. The short duration of follow up is a main limitation of the study.

59-65

Authors: Mane NM, Pednekar JL, Pednekar S

Introduction: Noninvasive positive-pressure ventilation is a safe and effective means of improving gas exchange in patients with many types of acute respiratory failure. This study focuses on use of NPPV in the intensive care unit and in the care of patients with acute respiratory failure due to various diagnoses. Materials and methods: We included 50 consecutive patients admitted to medical intensive care unit satisfying our inclusion/exclusion criteria from April 1, 2014 till March 31, 2015. Various clinical and physical parameters were monitored during the period of the stay. All the complications experienced by the patients were also noted. Data was analyzed by applying appropriate statistical tests. Statistical analysis was applied P < 0.05 was considered as significant. Results: Average age of the patients was 42 years and the most common diagnosis was Acute Respiratory Distress Syndrome (ARDS) followed by pneumonia. Our analysis we did find a statistically significant association between the type of diagnosis and non-invasive ventilation failing (chi-square = 22.22; p-value = 0.004). This was however not true for patients’ clinical outcome in terms of mortality (chi-square = 13.51; p-value = 0.09). In our patients air leak was the most common complication and hemodynamic instability was the least common. We also observed that death occurred in patients who failed to recover on NIV. Conclusions: Our study showed that non-invasive failure has no statistically significant relation to age of the patient. The diagnosis of patient is a good predictor for NIV success or failure. We recommend the use of full face mask with proper exhalation device for preventing air leak.

73-78

Authors: Ather Fatima, Farida Begum, Kandukuri Mahesh Kumar

Background: Blood transfusion is a life-saving therapeutic intervention and millions of lives are saved each year globally through this procedure. However, blood transfusions are associated with certain risks which can lead to adverse consequences. It may cause acute or delayed complications and carries the risk of the transmission of blood borne infectious agents. Materials and methods: This study was done in Government general hospital blood bank, Nizamabad district, Telangana state, India. Study duration was six years, from June 2010 to May 2016. Blood was collected from apparently healthy donors after following the questionnaire put forth by National AIDS Control Organization (NACO) through blood camps organized by voluntary organizations, voluntary and replacement donors in the government blood bank and motivated student bodies. Results: In our study, total screening positives were 532 out of the total 55291 units accounting to 0.96%. Among the positives, most of the positives belonged to Hepatitis B virus, HBsAg positives were 384 cases (0.69%), Human Immunodeficiency Virus (HIV) were 117 cases (0.20%), Venereal Disease Research Laboratory test (VDRL) positives were 22 cases (0.03%) and minimal positives were noted in Hepatitis C virus (HCV) those were 09 cases (0.01%). Conclusion: Transfusion of blood and blood products is an established mode of treatment in many conditions. However unnecessary transfusions and unsafe transfusion practices expose patients to the risk of serious adverse transfusion reactions and transfusion-transmitted infections. This risk can be minimized by encouraging voluntary non-remunerative donation and screening of blood for TTI before transfusion with better screening methods like Enzyme Linked Immuno-sorbent Assay (ELISA), Nucleic Acid Amplification technique (NAT).

83-92

Authors: Md. Yousuf Khan, C. Venkateshwarlu, G. Sreenivas, P. Rahul

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common hospital acquired infections and a leading cause of morbidity and mortality in hospitalized patients with various life threatening complications. Hence, this study was aimed to determine the incidence, risk factors of CAUTI in a tertiary care hospital so as to find out better preventive measures to reduce the prevalence of CAUTI and their complications so as to reduce the hospital stay and mortality. Materials and methods: Present study included 200 adult patients who received indwelling urethral foley’s catheter and urinary drainage system in various wards in Government General Hospital, Nizamabad from Jan 2015 - May 2016. Patients were diagnosed to have CAUTI according to CDC guidelines to study its incidence and associated risk factors which were analyzed using multi variate analysis. Results: Overall incidence of CAUTI was 59%. The incidence of CAUTI was maximum (70.58%) in the age group of 51-70 years. The incidence of CAUTI was more (69.44%) in females and was directly proportional to the duration of catheterization. The high incidence in the present study reflects the practice of frequent disconnections of urinary closed systems. Multi-variate analysis shows age, duration of catheterization, catheter- tubing disconnections, absence of antibiotic use and renal insufficiencies as important risk factors for CAUTI. 88.66% of CAUTIs were asymptomatic among 75 clinically evaluable CAUTIs. Conclusion: CAUTI is an important preventable hospital acquired infection seen in all age groups however incidence increases with age, common in both sexes, incidence can be reduced by minimizing the catheter procedures, taking the maximum aseptic precautions, reducing the duration of catheterization and avoiding frequent disconnections, this becomes more significant in patients with underlying renal disease , prophylactic antibiotics prevent CAUTI. As most of the CAUTI are asymptomatic, all catheterized patients should be screened for CAUTI and be treated depending upon antibiotic sensitivity of uropathogens.

97-110

Authors: E. A. Ashok Kumar, P. Jijiya Bai

The clinical study of cerebral venous thrombosis in antiphospholipid antibody syndrome in young females at peripartum was done to study the incidence of antiphospholipid antibodies in highly susceptible population groups most commonly at peripartum women. The presence of these antibodies points towards increased susceptibility to thrombosis and ischemic stroke apart from other manifestations in peripartum period. The age group most affected was between 20-25 years. Most of them were primipara. Many of the patients underwent Cesarean section before the presentation with the specific neurological complaint. None of the patients gave positive history for use of oral contraceptive pills. This study showed a 69% incidence of antiphospholipid antibodies out of the total patients studied. It was also found that 66% of the APL positive patients had radiological evidence of cerebral venous thrombosis. To help clarify the significance of aCL in CVT, this study was systematically analyzed and the clinical, radiological, treatment, and outcome information of patients with CVT tested for aCL immunereactivity at our institution and the pertinent literature was systematically reviewed. It was also studied that the most of the patients improved with corticosteroids.

126-131

Authors: Contractor ES, Agnihotri DS, Patel RM

Background: Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Patients with Adhesive capsulitis have difficulties in everyday activities (dressing, grooming, and performing overhead reaching activities and so on for a period of several months to several years) and shoulder pain disturbing sleep at night on the affected side. Muscle energy technique helps in increasing shoulder range of motion. MET is unique in its application as the client provides the initial effort while the practitioner facilitates the process. One of the main uses of this method is to normalize joint range, rather than increase flexibility, and techniques can be used on any joints with restricted Range of Motion (ROM) identified during the passive assessment. So the study was done to evaluate the effect of MET on adhesive capsulitis. Aim: This study was designed to evaluate the effect of Spencer MET on Pain and Functional Disability in Adhesive Capsulitis of Shoulder joint. Materials and methods: An Interventional study was conducted at Out Patient Department of General Hospitals in Ahmedabad. The subjects were selected according to inclusion criteria. The Pre-training outcome of Pain (VAS) and SPADI was taken and then subjects were divided into two groups’ one case and other control. Group A: was given conventional treatment along with MET for adhesive capsulitis. Group B: not getting any additional training for adhesive capsulitis other than conventional treatment. The study was conducted for 6 months and treatment was given for 4 weeks 3 days a week and once a day. After 4 weeks post treatment outcome data were analysed for results. Results: Data was analysed using SPSS software version 20 and Microsoft Excel 2007. In case and control both pain (VAS), SPADI showed significant improvement (p; 0.05). But there was more significant improvement in case as compared to control group in SPADI but not in VAS. Conclusion: The Spencer MET is more effective increasing functional ability in patients with adhesive capsulitis as compared to conventional treatment.

140-145

Authors: Mosby S, Magar S, Magar S, Ranpise SG, Agarwal PK, Agarwal S

Background: Numerous studies are quoted in literature which focuses mostly on evaluating the specific head and neck lesion such as tumours of odontogneic origin. Only limited studies are quoted in literature focusing on the prevalence the whole spectrum of biopsied oral and maxillofacial lesions in various countries. Hence; we planned this retrospectively analysis to evaluate the frequency of all biopsied jaw lesions in order to assess the discrepancy between clinical diagnoses and histopathologic diagnosis. Materials and methods: The present study was planned in Vananchal Dental College, Jharkhand and involved analysis of records of all the patients whose biopsy specimen was submitted to the Department of Oral Pathology from June 2010 to July 2014. All the jaw lesions were divided predominantly into three main groups depending on the type of lesions. Complete analysis of the record of the patients and their histopahtologic reports was done and comparison was made between the clinical diagnosis and histopathologic diagnosis to assess the coordination between the two diagnoses of the jaw lesions. Results: 1500 patient’s records were evaluated in the present study. Group I, II and III had 400, 800 and 300 patients respectively. More male population was observed in the present study. Lesions diagnosed in the maxilla and in the mandible were approximately same in number. More than 75 percent of cases in this group were Periapical granulomas. The most prevalent lesion in Group II was radicular cyst followed by dentigerous and residual cyst. Conclusion: Collaboration of histopatholgocial details and radiographic findings should be done along with the clinical history to reach the final diagnosis.

153-158

Authors: Dasari Krishna Chaitanya, Dasamandam Srihari

Background: A surgical site infection occurs when micro-organisms get into the part of the body that has been operated on and multiply in the tissues. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. CDC provides guidelines and tools to the healthcare community to help end surgical site infections and resources to help the public understand these infections and take measures to safeguard their own health when possible. In this study, a sincere effort has been put to understand and thus help the practising surgeons to help them manage the post – operative complications in infective wounds. Materials and methods: The study was conducted in the Department of General Surgery, Nimra Institute of Medical Sciences (NIMS), Vijayawada on two hundred patients who were admitted for various surgeries were selected for the study randomly. The study was conducted between November 2015 and July 2016. Two hundred patients were included in the study. Results: The overall infection rate was found to be 25 percent. In the case of clean surgical site of infection is found to be nil where as in the case of contaminated surgeries the rate infection rate was high. It was found the statistically significant. The complications faced during the surgery involved failing to see the proper field of vision at the surgical site, difficulty in approaching the site involved, bleeding and a significance higher level of surgery time involved. The post - operative complications were delayed wound healing at the surgical site, pain at the operated site, wound gaping and increased hospital stay. Conclusion: The study concluded that the pre-operative wound management is a necessity in cases where the wounds or the parts of the body to be operated are infected in order to minimize the complications faced during the operative and post-operative periods.

164-169

Authors: P.A. Ramani, Rao KJ, Chinth JR, Prakash GR, Krishna KS

Intestinal obstruction is an emergency condition which when unrelieved at the earliest will lead to strangulation and gangrene of the bowel. The aim of this study was to find the various causes for small intestinal obstruction and methods of prevention. About 303 cases of intestinal obstruction were recorded and studied regarding the type and cause of small bowel obstruction in a tertiary care hospital. All the cases of intestinal obstruction presenting to emergency and outpatient department were admitted, excluding neonatal and paediatric cases. After initial resuscitation, patients were evaluated for the cause of obstruction, by plain X-ray abdomen and CT scan abdomen. There were 206 cases of small bowel obstruction, with 155 cases due to post operative adhesions, hysterectomy being most common earlier operation. History of multiple operations was present In 35 cases. 18 cases were managed conservatively. Diagnostic lap could be done in11 cases with adhesiolysis. Resection and anastomosis was done in 89 cases. The mortality rate was 12.5 %.morbidity was 44% cumulatively.

179-184

Authors: Srivalli Mokkana, Ananta Ramani Pratha, Vani Isukapalli

Peripartum or obstetric hysterectomy is the removal of the corpus uteri alone or with the cervix at the time of a cesarean section, or shortly after a vaginal delivery. It is a challenging though life-saving obstetric procedure it is associated with morbidity and mortality. The medical records of 20 patients who had undergone peripartum hysterectomy, between April 2015 to April 2016 (1 year), in a tertiary teaching hospital, King George Hospital, Visakhapatnam, covering north coastal Andhra Pradesh and surrounding districts of Odisha were reviewed retrospectively. The results were analyzed. Emergency peripartum hysterectomy is a most demanding obstetric surgery performed in very trying circumstances of life threatening hemorrhage. The indication for emergency peripartum hysterectomy in recent years has changed from traditional uterine atony to abnormal placentation. Antenatal anticipation of the risk factors, involvement of an experienced obstetrician at an early stage of management and a prompt hysterectomy after adequate resuscitation would go a long way in reducing morbidity and mortality. Prompt performance of peripartum hysterectomy before patient clinical conditions deteriorate is the main key to success and less postoperative complications.

193-198

Authors: Devineni K, Sodumu N

Background: 22% of the population are constituted by women of child bearing age of 15-45 years in India. They are a vulnerable risk group which is due to pregnancy and child bearing. For providing access to essential obstetric care, the referral system is an essential component of any health systems which are important in pregnancy and child birth. Aim: This study was done to review the pattern of obstetric cases referred and to identify the clinical course, mode of management, maternal and perinatal outcomes. Materials and methods: This prospective observational study reviewed 100 obstetric cases. Thorough history was taken; complete physical and obstetric examination and relevant investigations were done. Management of the patient, clinical course, mode of delivery, both maternal and perinatal outcomes were documented. Results: Most common diagnosis at referral was medical disorders complicating pregnancy (45%) among which hypertensive disorders accounted for 34%, followed by severe anemia (17%). Twenty-one percent of the patients were in serious or critical condition on arrival, 29% patients required surgical intervention, 19% received intensive care management and there were no mortalities. Total number of live births were 73 (78.5%) among which 28 (30%) required neonatal admission and 5 (5.3%) had early neonatal death. Vaginal delivery rate was 78% in spite of high risk conditions and various complications. Only 30% had the required three visits and 18% had a delay ranging from 3hrs to 18 hours to reach the referral centre. Conclusion: Most common diagnosis at the time of referral was hypertensive disorders of pregnancy and its various presentations like eclampsia, HELLP, DIC, Abruption. There is still scope for improving antenatal care, reduce 1st delay, 2nd delay and need to strengthen FRU and emergency obstetric care centres at some of the districts.

206-211

Authors: Animireddy Kishore, G. Obulesu, Rudramadevi

In the present investigation, anti-Candida activity of three essential oils that is Betel leaf (Piper betel), Black cumin (Nigella sativa) and Curry leaf (Murraya koienigii) were screened against three human pathogenic species of Candida namely Candida albicans, Candida glabrata and Candida tropicalis. The minimum inhibitory concentration (MIC) values of the oils ranged between 14.80 and 236 µl/ml while studied through the dilution method. The oils retained their anti-Candida activities even after heat treatment (at 450C, 600C, 1000C for 1 hour) and also on autoclaving. Black cumin leaf oil showed better anti-Candida activity against Candida albicans, resulting in an irreversible damage to the cells. The anti-Candida activity of these essential oils could be attributable to the membrane inhibition mechanism. The activity of the cells is reported to be microbicidal.

219-227

Authors: Animireddy Kishore, G. Obulesu, Madhu Babu

Background: Among all the microbial organisms Enterococcus faecalis and Candida albicans were the most commonly seen and most resistant organisms in persistent or failing root canals. Even after chemomechanical preparations and treatment 40 to 70% of the microorganisms survive. Aim: This in vitro study was done to evaluate the antimicrobial efficacy of intra canal medicament in root canals charged with Enterococcus faecalis. Materials and methods: Forty eight extracted human single rooted teeth were taken. Biomechanical preparations and access preparations were done. Specimens were sterilized by autoclaving and later contaminated with Enterococcus faecalis and incubated for 24 hours. Confirmation of Enterococcus faecalis was done and then divided into 3 experimental and 2 control groups. Groups (n=12) A) Ozonized Sesame Oil, B) Calcium Hydroxide, C) Calcium Hydroxide + Ozonised Sesame Oil. Control groups Group 1:- (n=6) Negative Control, Group 2:- (n=6) Positive Control. Intra canal medicament was placed in each root canal corresponding to the groups and incubated at 370C. First sampling was done after 24 hours and second or final sampling was done after 72 hours of placement of intra canal medicament. Microbial growth was checked by counting CFU (Colony Forming Units). Results: In the first sampling ozononised sesame oil was 100% efficient, next efficient was Calcium Hydroxide group, and combination of Ozonised sesame oil and Calcium Hydroxide also showed almost similar results. But in the second and final sampling after 72 hours Ozonised sesame oil was highly efficient when compared to other two groups. Calcium Hydroxide was moderately efficient whereas combination of both the drugs was least effective as it showed highest CFU/ml. Conclusion: Ozonised sesame oil was most effective for longer duration when compared to other groups and can be used as an alternative intra canal medicament.

236-240

Authors: Pandit CV

Background: The old people are prone to chronic diseases such as cardiovascular illness, cardiovascular attacks, cancers, diabetes, diseases related to musculoskeletal and mental illness. These disorders affect the health related quality of life of elderly and do affect the burden on systems dealing with health in India. Aim and objectives: To study the effect of impairment and disability on health related quality of life of elderly in urban areas. Materials and methods: It was a cross-sectional study was conducted which was community based. For this study, delineated area which has around 200 households with approximately a population of 60,000 with mix of different religions, regional, social and economic statuses was taken. The study subjects selected were having age of above 60 years and both sexes were selected. 300 subjects were studied. Results: Out of a total 300 elderly, 110 males and 190 females were selected. The mean age of the subjects was 68±7.9 years. With increase in age, the number of subjects decreased consistently. In all age groups, females were higher. For both sexes, the age distribution was uniform (p>0.05). 85 % were Hindus, 5% were Muslims, 5% were Christians and 2.5% were Sikhs and rest were others. The largest group of study population were with impairment i.e. 48.5%. Of which females were having more impairment i.e. 55.8%. Females had the most self appraisal of their health i.e.115 out of 190. The worsening of health seen in people who complained since last was higher as age increased (P<0.05). HOQRL got worse as age increased. The difference in HOQRL scores in young-old and old-old were highly significant (p<0.001). Males showed decrease in HOQRL scores as age increased and it was statistically significant across the age groups (p<0.05). Conclusion: It is concluded that there is an immediate need for specific preventive measures to be taken for protecting HOQRL among elderly people in India. Various health schemes and policies must be designed by the Government on seeing the findings.

248-257

Authors: Pushkal SR, Shenoy V, Prabhu K

Background: Thyroid hormone plays an important role in carbohydrate, protein, and lipid and electrolyte metabolism. Studies have demonstrated the association of hypothyroidism with dyslipidaemia. However the impact of high normal TSH on lipid profile is lacking. Also, thyroid hormone is known to influence glomerular filtration rate, and renal electrolyte handling. So, this study compared TSH levels in normal ranges with fasting lipid profile and electrolytes. Objectives: To measure and compare the levels of serum TSH, fasting lipid profile and electrolytes in euthyroid individuals with normal TSH and to correlate serum TSH with lipid profile and electrolytes across different age groups in both sexes. Materials and methods: After obtaining ethical clearance, 2 ml of fasting venous blood sample was drawn from 200 subjects (males=100, females=100) aged between 20-75years who consented to participate. Serum was used for estimation of TSH, lipid profile and electrolytes. TSH was measured by 4th generation Immunoassay in Cobas 6000 e601 autoanalyzer (Roche). The lipid profile and electrolytes were assayed in Cobas 6000 c501 autoanalyzer (Roche). Results: Serum TSH values showed significant positive correlation with total cholesterol (p=<0.001), triglycerides (p=<0.001) and LDL cholesterol (p=<0.001), but did not show any significant correlation with HDL cholesterol. Also serum TSH showed significant negative correlation with sodium (r=-0.185, p=0.048) and potassium (r=-0.205, p=0.028) levels. Conclusion: TSH and thyroid status can influence lipid and electrolyte metabolism. High normal TSH level may predispose to hypercholesterolemia and hypertriglyceridemia. High normal TSH patients can have lower serum electrolytes.

266-269

Authors: Saxena S, Gupta P, Akansha, Yadav ML, Nag BP, Mathur A

Uterus Didelphys “double uterus” is a congenital malformation that results from complete failure of fusion of the ipislateral paramesonephric ducts during embryonic development. Ideally, diagnosis should be made before pregnancy and labor to prevent adverse outcomes. Here we report a case of uterus didelphys in 30 year old female Gravida4 Para3 Living2 at 31st week of pregnancy admitted with prolonged rupture of membrane, hypovolemic shock and intrauterine fetal death. Postoperative recovery of the mother was uneventful. Clinicians should have high index of suspicion of uterine anomaly when assessing cases of dysfunctional labor to avoid delayed diagnosis and the associated adverse outcome.

274-277

Authors: Saxena N, Dhamija JP

A middle aged female patient, a case of Primary Sjogren’s Syndrome with renal tubular acidosis as revealed by severe hypokalemia along with normal anion gap, metabolic acidosis and acidic urinary pH had brain stem lesion which presented as quadriplegia, dysphagia and dysarthria. Laboratory tests revealed that anti-nuclear antibodies (ANA) and anti Ro/SSA antibodies were positive. MRI showed hyper intense lesion in T2W images in middle pons, typical characteristic of central pontine myelenolysis. So, patient was diagnosed as Primary Sjogren’s Syndrome with renal tubular acidosis with central pontine myelinolysis. She recovered with correction of hypokalemia, intravenous methyl prednisolone and cyclophosphamide.

283-285

Authors: Choudhary A, Tyagi VS, Choudhary A, Kalra R, Jain A

Giant cell tumors of soft tissue (GCT-ST) are rare primary soft tissue tumor with low malignant potential, considered as the soft tissue counterpart of giant cell tumor of bone. We reported a rare case of soft tissue giant cell tumor of neck in a 46 years old male with painless swelling in left side of neck after a history of trauma 3 months back. Computed tomography suggested a small soft tissue mass and or post biopsy hemorrhage, but the diagnosis of giant cell tumor was confirmed after cytohistological examination. Wide local excision of the tumor was done.

290-294

Authors: Shukla P, Dahiya V, Majid A

If the search for beauty is timeless, then having the perfect smile is always in style. One of the techniques to achieve that is regaining the lost interdental papilla. There has been a definitive void in the dental arena pertaining to papilla esthetic. Loss of interdental papilla prompts to phonetic, functional, and esthetic problems. Surgical techniques are multifarious, but are perplexing and very erratic. The refurbishment of the lost papilla is elusive. Previous attempts have been made to augment the interdental papilla using displaced flaps, connective tissue grafts and repeated inflammatory stimulation with diverse results. This clinical study was aimed to reconstruct the lost or blunted interdental papillae with connective tissue graft and plasma rich fibrin for esthetic purpose and for maintaining oral health with the objective to determine the extent to which the procedure can revert the maxillary esthetic.

1-4

Authors: Garg P, Bundela R, B.B. Lal, Nishant

Background: Today computers are main and rapid source of information exchange and have become an indispensible piece of office equipment. As a result the computer users are increasing many folds with every passing year. Purpose: To assess the magnitude of ocular problems faced by computer users. Design: An observational study was conducted on people working for at least two hours or more per day on computer. Materials and methods: Individuals were assessed for their work related symptoms on a preset questionnaire and accordingly were classified into asymptomatic and symptomatic. Symptomatics were further divided into occasional, frequent or everyday symptoms. Results: Of 913 computer users of age group 16 to 40 years, 65.27% were males and 34.72% were females. 81.48% suffered from ocular symptoms of which 68.01% had occasional symptoms, 19.48% had frequent symptoms and 12.5% had regular symptoms. The symptoms were more pronounced in individuals working >6 hours on a computer. Conclusion: Ocular symptoms in computer users are directly proportional to the number of work hours on computer. Therefore proper knowledge of working on computers should be given to all as it will increase the work efficiency.

11-20

Authors: Rathore AS, Aiyer SG, Sethi A

Background: We all know, increase in survival of NICU graduates result in increment in numbers of very low birth weight babies and extremely low birth weight babies. Intra uterine milieu provides unlimited supply of nutrients, protection from hypothermia and microbial invasions, which turns into intermittent supply of nutrients and risk of sepsis when a neonate comes outside. Aim: To observe the growth parameters in VLBW infants postnataly up to 40 weeks post menstrual age (PMA) by plotting the growth trends on Fenton’s postnatal growth curves and on WHO growth charts at 40 weeks PMA. Materials and methods: Prospective observational study was carried out at Level III NICU in West India. 110 VLBW infants admitted from July 2012 to September 2013 were included in the study. Length, head circumference (HC) and mid arm circumference were measured within 48 hours of birth and then weekly. Growth pattern obtained till 40 weeks PMA and then plotted. Results: We found that average daily weight gain of this cohort was 17.7(+/-7.8) g/kg/day which was comparable to intrauterine growth velocity. In addition, the average weekly increment in length and HC was 0.52 and 0.39 cm/wk respectively, not comparable to intrauterine growth. On Fenton’s 2013 sex specific growth curves, all infants showed significant growth lag and at 40 weeks PMA, on WHO standard growth curves, 2006 they all lie at 3rd centile or below. Conclusions: We need large multi centric prospective cohort study to explore the growth trends of VLBW babies in India to develop Post natal growth nomograms for VLBW babies. Long term growth of VLBW infants should be monitored as they are at risk of growth failure.

28-35

Authors: S. S. S. Quadri, Shyamala Srujana, S Mahesh, B. Bheeshma

Introduction: For medical students, second year is crucial, as they enter the clinical postings for the first time and are taught about the pathogenesis of disease, which will enable the students understand medicine with better concept. It is an agreed fact that regular reviewing of teaching learning methods of the teachers is necessary for improvement. Hence to find out the perception regarding the didactic lecture method being followed, the present study was conducted using feedback in form of questionnaire from students. Materials and methods: 197 II year MBBS students appearing for their Part II final university exams were asked to fill up the structured pre-validated feedback questionnaire regarding the didactic lecture method of teaching being followed at pathology department. Questionnaire included set of questions on T/L methods and on the changes recommended. Descriptive statistics were used in the form of frequency distribution and percentages were used to analyze the data. Results: Study showed female preponderance. Majority of the students found the subject to be interesting and agreed that knowledge about pathology helps in clinical posting. 35.53% of the students found general pathology to be difficult subject. Students were satisfied with clinical correlation, content and explanation given to clarify the subject during the lectures. Most of the students agreed that they were encouraged to asked questions and give answers during lectures, and were satisfied with the delivery and pace of lecture. Readability, usefulness and innovative methods during lecture presentation were found to be satisfactory. 56.33% of students agreed that didactic lecture is a very effective teaching learning method. Majority of the students felt the strong need for introduction of integrated teaching, case based and group discussion. Conclusion: Taking feedbacks from the students is one of the accepted and reliable methods of assessment. Majority of the students were satisfied with the present teaching learning method. Introduction of integrated teaching and case based and group based discussion was favored by majority of the students.

42-49

Authors: Pasha SA, Pasha SA, Kusuma B, T. Suhasini

Background: In diabetic patients, the glycemic control is usually represented by hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG), which are usually referred as the “glucose triad”. Apart from these three, “glucose variability” (GV) has been considered as an additional marker, and may be equally important. Materials and methods: The study was a prospective observational study conducted in critical care unit of NRI General Hospital. The study has included all the critically ill neurological patients admitted in the study setting during the study period. A total of 114 participants were included in the study. All critically ill neurological patients were included in the study and were assessed with hourly Glucometric random blood sampling (GRBS) for 6 hours for initial 15 days of admission. Glycemic variables have been recorded including Mean blood glucose (MBG), Glycemic liability index (GLI), Standard deviation of blood glucose. APACHE II scores were also recorded. Results: The mean age of the study participants was 51.69 (±20.21) years. Males constituted 57% and females constituted 43% of study population. The proportion of subjects with diabetes was 51.8%.The mean days of ICU stay was 8.19 (±3.86) days. The morality risk in study population was 28%. Univariate logistic regression analysis showed highest mortality in < 30 year age group. When compared to below 30 year age group, the risk of mortality in 30 to 49 year group was 44%, was 27.6% in 50 to 69 years age group and 71.4% in above 70 years age group. The mortality was almost similar in both genders. The mean APACHE II score was 4 units higher in mortality group, compared to non-mortality group (95% CI 1.64 to 6.37, p value 0.001). Even though the mean GLI, SD GLI values were 39.24 and 73.67 times higher in people with mortality these differences were statistically not significant. The differences in the mean values of mean blood glucose and SDBG were very negligible between the subjects with and without mortality. Conclusion: The study findings reveal that though, APACHE II scores seem to positively associated with mortality among critically ill neurological patients, the glycemic variability though positively influenced the mortality, it is not significant. Further studies assessing the role of GV specifically among such patient groups with a larger sample might reveal the true influence of such interaction.

59-65

Authors: Mathur S

Background: Enterococci, though commensals in adult faeces are important nosocomial pathogens. Their emergence in past two decades is in many respects attributable to their resistance to many commonly used antimicrobial agents (aminoglycosides, cephalosporins, aztreonam, semisynthetic penicillin, trimethoprim-sulphamethoxazole). Objectives: To study the prevalence of Multidrug resistant (MDR) Enterococci plus Vancomycin resistance and High Level Gentamicin Resistance (HLGR) in different enterococcal isolates. Materials and methods: Total 125 enterococcal isolates were studied. Identification was done by conventional biochemical methods. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller–Hinton agar and results were interpreted as per CLSI guidelines. Enterococci resistant to more than three drugs plus high level Gentamicin (120 µg) resistance were labelled as multidrug resistant (MDR). HLGR was determined by disc diffusion method using high level Gentamicin disc (120 µg). Minimum inhibitory concentration (MIC) determination for detecting Vancomycin resistance was done by HiComb MIC Test strips and microbroth dilution method. Results: Total 125 entetococcal isolates were studied. In this study the multiple drug resistance was verified in 44 (35.20%) isolates of Enterococcus species and only 2 isolates (1.72%) were found to be VRE but HLGR was detected in 53.6% of the isolates. Conclusion: During past two decades, enterococci resistant to multiple antimicrobial agents have been recognized, including strains resistant to vancomycin, β-lactams and aminoglycosides, making it a formidable nosocomial pathogen. Such strains pose therapeutic dilemmas for clinicians. Thus, it is crucial for laboratories to provide accurate antimicrobial resistance patterns for enterococci so that effective therapy and infection control measures can be initiated.

72-76

Authors: Pallapothula N, Reddy BS

Introduction: Paraphynylenediamine (PPD) in hair dye causes angioneurotic edema leading to acute respiratory distress, rhabdomyolysis, i.e. necrosis of skeletal muscle resulting in acute renal failure and liver injury upon ingestion. We studied the time course of treatment on organ damage markers such as plasma Creatine phosphokinase (CPK), Lactate dehydrogenase (LDH) and Total leukocyte count (TLC) of these patients till discharge. Materials and methods: We reviewed the case records of 10 Patients of suicidal hair dye poisoning. Data was collected in pre-specified data collection forms regarding WBC count, CPK levels, age, gender, time to index admission, ventilator support, the volume of ingestion and outcome. We followed the values of CPK and TLC of these patients till discharge. Results: The average age was 25.8±10.5, the mean volume of consumption of hair die was 102.5±17.5, and time to reach emergency room was 7.6±3.2 hours. On arrival, all patients were intubated and received gastric lavage, antihistamines, parenteral steroids, and sodium bicarbonate. Duration of ventilator support was 2.9±0.7 days and length of hospital stay was 10.1±2.7 days. At admission, CPK, TLC, and LDH were elevated, during hospital stay values CPK, LDH and TLC gradually decreased by day-5 after that they showed a marginal increase by day-7. Conclusion: We observed significantly elevated levels of CPK, LDH and TLC at index admission after oral ingestion of hair dye suggesting muscle, hepatic and hematological injury. The rate of decline of these values (recovery) is parallel.

87-92

Authors: B. Dharma Raju, M. Venu Madhav, D. Sindhu

Background: Pterygium is a triangular fibrovascular, subepithelial in growth of degenerative bulbar conjunctival tissue encroaching over the limbus onto the cornea located commonly horizontally in inter palpebral fissure on either nasal or temporal side of cornea or sometimes on both sides. Aim and objectives: To study the efficacy of amniotic membrane grafting in prevention of recurrence, to know the complications associated with amniotic membrane grafting, and to assess the visual prognosis. Materials and methods: This was a prospective observational study for a period of 1 year, a total of 70 pterygia of 70 patients were studied, and who attended the outpatient department. Each patient was totally evaluated by complete history, total ocular and systemic examination with necessary investigations. They were diagnosed as various grades of pterygia, depending on the extent of cornea involved. Results: This study group consisted of 70 patients; the patients were followed up for 6 months. Out of which 24 (34.28%) were male patients and 46 (65.71%) were female patients. Highest prevalence of pterygium was seen in age group of 31-40 years. 20 eyes (28.57%), followed by 41-50 years 18 eyes (25.57%), followed by 20-30 years 17 eyes (24.28%), followed by 51-60 years 10 eyes and 61 years 5 eyes (7.14%). Commonest presenting symptom was foreign body sensation, redness, watering followed by fleshy growth and defective vision. There were no cases with complaints of diplopia. Out of 70 operated cases, 39 (55.71%) were right eye and 31 (44.28%) were left eye. Out of 70 patients, 68 cases had only nasal pterygium (97.14%), 1 case had double pterygia (1.42%), 1 case (1.42%) had only temporal pterygium. During post-operative follow up, 1 case of granuloma, 1 case graft retraction with foreign body sensation, 2 cases of loose suture with graft dislodgement were noticed. During the follow-up period of this study, pterygium recurred in 3 patients. The average duration of recurrence was 2.3 months. The average age of the patient with recurrence was 30 years. More recurrence in GII and GIII pterygia were noticed in this study. Out of 70 patients, best corrected visual acuity remained stable in 21 cases (30%), improved in 49 cases (70%). The post-operative cosmesis was graded as good in 58 (87%) cases, as fair in 7 (10%) cases and as poor in 5 (2.85%) cases. Conclusion: AMT is a safe and effective procedure in the management of pterygium. AMT is a better method with regard to visual outcome, improvement of astigmatism, incidence of recurrence and complications.

115-119

Authors: Khurana E, Oomenn ER

Background: With the advent of remote culture, we are becoming physically inactive and becoming prone to cardiovascular disease. Exercise is often used to evaluate the function of cardiovascular system. Objectives: The study aimed to assess the cardiovascular response to exercise in young healthy medical students. Materials and methods: On the basis of physical activity performed subject were categorized into 3 category light, moderate, vigorous exerciser. Cardiovascular response was assessed by using treadmill exercise as per bruce protocol. Pulse rate, B.P., E.C.G were recorded before and after undergoing the treadmill test. Results: Data were analyzed using the paired t-test. The resting heart rate and systolic blood pressure was significantly lower in vigorous group of exerciser. During exercise heart rate, B.P. increased significantly during peak of exercise and recovery occurs within 6 min but recovery was faster in vigorous group of exerciser. Conclusion: It was observed in the study that vigorous exerciser had better parasympathetic tone than moderate and light exerciser.

132-136

Authors: Narala Srivani, Shyamala Srujana, Syeda Shahista, O. Shravan Kumar

Introduction: Salivary gland tumors are common neoplasms of head and neck region. These tumors are complex and exhibit great clinicopathological variation which may show racial and geographical differences. Aim: The aim of the present study was to analyze the relative incidence, clinical presentation and the spectrum of neoplasms in the salivary glands at our institute which is a tertiary referral hospital in south India. Material and methods: A retrospective and prospective study of all salivary gland tumors which were received in the department of Pathology for histopathological examination at our institute during a 5 year period from March 2010 to February 2015 was done. The clinical data like age, sex and site of the tumor were recorded. Grossly representatitive bits from the tumor were processed, sections made, stained with H& E and examined microscopically. Data of 53cases recorded during the 5yr period was analyzed. Results: 53 cases were studied during the 5 year period. Of them 40 cases were benign neoplasms and 13 cases were malignant. The commonest site of presentation of benign tumors was the parotid gland whereas malignant tumors occurred more commonly in the minor salivary glands. Pleomorphic adenoma was the commonest benign neoplasm. Adenoid cystic carcinoma was the most common malignant neoplasm. Most of the benign tumors occurred in 4th decade while the malignant tumors were more common in the 6th decade. Conclusion: Benign tumors are more common than malignant tumors. The majority of benign tumors occurred in the major salivary glands whereas the minor salivary glands harbor malignant neoplasms.

150-158

Authors: T. T. Sreeja, S. Chandrasekhar, S. Lokesh Rao Magar, K. Durga

Background: Epithelial ovarian carcinoma is worldwide the sixth most common female cancer. This malignancy carries the highest mortality among all gynecological cancers. Aim and objectives: To perform and interpret p53 immunostaining on the diagnosed serous and mucinous malignant surface epithelial ovarian tumors and to correlate expression of p53 with histological type of malignancy. Materials and methods: 2 year prospective study was done i.e. from October 2011 to September 2013 on “p53 interpretation on surface epithelial ovarian tumors” in MGM Hospital, Warangal. All the ovarian surface epithelial tumor specimens, received in the pathology department during this period were considered. Results: A total of 120 cases were studied, out of which benign tumors were the most common (64.2%), followed by malignancy (25.8 %) and 12 cases (10%) of borderline malignancy. Most of the benign tumors were unilateral, the cases which showed bilateral involvement were mostly malignant. The maximum number of cases in the present study was seen in the age group of 31-60 years. The youngest patient was 16 years old and the oldest was 68 years old. Serous cyst adenoma was the most common neoplasm found and accounted for 53 cases (44.2%) , followed by mucinous cystadenoma, which accounted for 21 cases (17.5%). 9 cases of serous cystadenofibroma (7.5%), 3 borderline serous tumors (2.5%) and 11 serous cystadenocarcinoma (9.1%) were found in the present study. Out of the 44 mucinous tumors, 21 were benign (17.5%), 3 were of borderline malignancy (2.5%) and 20 were malignant (16.7%). One case of mucinous cystadenocarcinoma was found to be associated with adenocarcinoma of ascending colon. One case of benign Brenner tumour was also found in the present study. Conclusion: The rate of p53 abnormalities varies with histologic type, grade and stage of the tumor. P53 expression was more in malignant serous tumors as compared to the malignant mucinous tumors.

166-170

Authors: S.A.K. Noor Mohamed, Edwin Fernando

Introduction: Renal transplantation is currently the preferred treatment modality for virtually all suitable candidates with end-stage renal disease. Compared with dialysis, kidney transplantation improves both patient survival and quality of life. Nonetheless, post transplant cardiac complications are associated with increased morbidity and mortality after renal transplantation. Aim of the Study: To analyze the risk factors for cardiovascular disease in the renal transplant recipients. Materials and methods: All renal transplant recipients were ABO compatible and cross-match negative and they are followed up regularly in nephrology transplant OPD. Recipients’ demographic factors like Age, Gender, Occupation, and Literacy were noted. Nature of donor, post transplant duration, graft function was noted Blood pressure was reported as the average of three manual Measurements taken at 3-minutes intervals. Echocardiograph changes were assessed by standard methods. Results: Although all the determinants of enhanced CVD risks in renal transplant recipients had not been well defined, both conventional and unconventional risk factors had been suggested to be contributory. The former risks included diabetes mellitus, hypertension, dyslipidemia, obesity, smoking, and family history. The latter risks include pre-existing left ventricular hypertrophy, coronary artery vascular calcification, impaired allograft function, proteinuria, anemia, acute rejection episodes, hyper homocysteinemia, and inflammatory cytokines. Conclusion: Cardiovascular mortality is increased in patients with chronic kidney disease. Mortality from cardiovascular disease is10–20 times higher among individuals treated with dialysis, as compared to general population. The incidence of cardiovascular disease in kidney transplant patients is nearly twice that of the general population. Even young transplant recipients (aged 35–45 years) experienced an almost 10-fold increase in cardiovascular disease-related mortality.

181-186

Authors: Srujana Shyamala, Vijaya Nirmala B, Ramana P. V., Srivani N, Shravan Kumar O

Background: Evaluation of the reasons of nephrectomy specimens in pediatric age group who presented with severe renal failure or mass lesion, which may be useful in the management of pediatric end stage renal disease. We aimed to evaluate the reasons for nephrectomy in pediatric population and to determine the frequency of various lesions. Materials and methods: It was a retrospective study of nephrectomy specimens received in our department during the period of June 2006 to June 2011 (5 years). Reasons of nephrectomy, age and sex of the patients were assessed. Results: Total 36 nephrectomy specimens were analyzed. These included 25 male children, and 11 female child. Age was ranging from 15 days to 16 years. The kidney size was small in most of the patients. The following causes were evaluated by HPE of specimens: Infantile polycystic kidney – 3, Mesoblastic nephroma – 1, Wilm’s tumor – 2, Cystic renal dysplasia – 1, Blunt injury – 4, PUJO with hydronephrosis – 15, Hydronephrosis and chronic pyelonephritis – 10. Conclusion: Nephrectomy in pediatric age group is an ultimate indication which is generally realized in neoplastic involvement of the kidney. Providing histopathological features of nephrectomy specimens and reasons, which could be useful to reduce the incidence of non tumoural nephrectomy in the pediatric population. There is need to emphasize the importance of early diagnosis of renal lesion in pediatric age group to prevent nephrectomy.

196-202

Authors: Gosavi S, Asgaonkar D

Introduction: Stroke is global health problem and is a leading cause of disability. It is usually the end result of predisposing conditions that originated years before the ictus. Identification of its modifiable risk factors can help in planning preventive strategies. The present study aims at evaluating the role of various risk factors in stroke and their effect on functional outcome in ischemic and haemorrhagic stroke. Materials and methods: The study was carried out on total of 150 new onset acute stroke patients admitted at a tertiary care centre. Risk factors were evaluated in all the cases. The patients were categorized as Infarction or haemorrhagic stroke based on CT findings. For the purpose of analysis, the patients were divided into two groups as Ischemic or Haemorrhagic stroke. The risk factors and outcome between the two was compared between the two using appropriate statistical measures (using SPSS ver. 20). Results: Overall the prevalence of Ischemic stroke was higher than haemorrhagic stroke (81.3% vs 18.7%). Hypertension was the single largest risk factor for stroke (50.7%) with a significant association with hemorrhagic stroke (78.6% vs 44.3%; p< 0.01). Overall mortality rate was 10.7% with a significantly poor outcome was associated with hypertension (17.1%) and IHD (31.3%). Overall survival rate was more in patients with infarct as compared to patients with IC Bleed (93.4% vs 71.4%). Conclusion: Hypertension, dyslipidemia and diabetes are the biggest risk factors for stroke. Preventive strategies aimed at early detection and treatment of these factors, appropriate medication, life style changes and public awareness about ill effects of cigarette smoking and excessive alcohol use can contribute in reduction of stroke burden

211-215

Authors: Manga Muralidhar, P. V. Chalam

Background: Laparoscopic appendicectomy has become the preferred procedure for treating appendicitis in last 10-15 years. The reasons are laparoscopy provides a better visualization of the operating field, pelvic organs like ovaries can be visualized in female patients, causes less postoperative pain, needs lesser hospital stay, gives faster recovery and most importantly a better cosmetic scar. The standard laparoscopic appendicectomy needs 3 ports to be introduced into the abdomen. Many modifications were introduced recently like SILS (Single port/Incision Laparoscopic Surgery), NOTES (Natural Orifice Transluminal Endoscopic Surgery), TUSPLA (Trans Umbilical Single Port Laparoscopic Appendicectomy), etc. with an intention to decrease the postoperative pain, decrease the hospital stay and give better cosmetic outcome. We present a series of twelve cases of laparoscopic appendicectomy performed using two ports and a needle instead of third port, which when performed successfully gives a better cosmetic outcome as the third port is avoided. Aims and objectives: The aim of the study was to assess the feasibility of two ports needle assisted laparoscopic appendicectomy. Materials and methods: This was an observational study done on a total number of 42 laparoscopic appendicectomies performed by a single operating team between June 2015 and May 2016. Two port appendicectomy were attempted. But, the procedure could be successfully performed in only 12 cases because of various reasons. Results: Out of 42 cases TPNAA could be performed successfully in 12 procedures. 30 cases needed regular 3 port procedure because of various reasons. Conclusion: TPNAA is a modification of regular three port appendicectomy and is a simple procedure and gives a better cosmetic outcome which can be performed in selected cases.

222-227

Authors: P. V. Balaji, M. Thirumaran, V. Sharath babu

Introduction: Hypothyroidism is a common endocrine disorder resulting from deficiency of thyroid hormone or, more rarely, from their impaired activity at tissue level. In its clinically overt form, hypothyroidism is a relatively common condition, with an approximate prevalence of 2% in adult women and 0.2% in adult men. Deficiency of the hormone has a wide range of effects, because all metabolically active cells require thyroid hormone. Aim of the study: To determine the incidence of deafness in patients suffering from goiterous hypothyroidism exclusively and to evaluate the role of L-thyroxine therapy in improving the hearing in this group of patients. Materials and methods: Two groups were included: a hypothyroidism group (HG, n-30), and a control group (CG, n-30). Parameters studied: gender, time of hypothyroidism, co-morbidities, cochleovestibular symptoms, biochemistry and hormonal exams (TSH, T4), tonal audiometry, TOAEs and BERA. Results: All participants were women, 70% of the HG had Hashimoto thyroiditis, and 60% of the HG had had the diagnostic of the hypothyroidism for at least five years. Depression and hypertension were frequent in HG. All HG patients had altered TSH values and 50% had diminished T4 values. Sensorineural hearing loss was detected in 22 ears from the HG and in seven from the CG. BERA was normal in the CG and altered in 10 ears from the HG, showing L-V increase. TOAEs were absent in 12 ears from the HG and in four from the CG. Conclusions: HG patients had more cochleovestibular symptoms, higher audiometric thresholds, and increase in L-V in the BERA and absence or reduction in TOAEs amplitudes. Such alterations were not associated with THS and free T4 levels.

233-238

Authors: Jasrotia RB, Kanchan A, Harsoda JM

Background: The cyclic hormonal changes during different phases of menstrual cycle are responsible for various physiological changes including its diverse role on reproductive organs. Their effects on extra-reproductive systems like airway dynamics and respiratory efficiency are very few in literature. Aim: To evaluate the effects of menstrual cycle on various parameters of lung functions and respiratory efficiency in young females. Materials and methods: 75 young non-pregnant females of age group 18-30 years were selected randomly for this study. Their menstrual phases were estimated based on menstrual history questionnaires and last date of menstrual bleeding, namely, menstrual, follicular and luteal. Their pulmonary function tests and respiratory efficiency was measured using computerized spirometer thrice in each phases of menstrual cycle. The various parameters evaluated were: forced vital capacity (FVC), forced expiratory volume in 1st sec (FEV1), Maximum mid expiratory flow rate (MMEFR), peak expiratory flow rate (PEFR), maximum voluntary ventilation (MVV), 40 mm respiratory endurance test (RET), breath holding time after full expiration and maximum inspiration (BHT ex and BHT ins) and maximum expiratory pressure (MEP). Results: FVC, FEV1, and MMEFR were significantly higher during the luteal phase as compared to menstrual and Follicular phase; whereas PEFR and MVV were significantly higher during the luteal phase as compared to menstrual phase only. On respiratory efficiency tests the BHT ex, BHT ins and MEP were significantly higher during the luteal phase as compared to menstrual and Follicular phase; also it was observed that BHT ex were significantly higher during the follicular phase as compared to the menstrual phase. Conclusion: Respiratory efficiency and pulmonary functions parameters were higher during the luteal phase of menstrual cycle. Main reason behind this could be the progesterone hormones’ effect on respiratory apparatus, whose levels remains on higher side during the luteal phase.

245-249

Authors: G. J. Vani Padmaja, S. S. S. Quadri, O. Shravan Kumar

Background: The evaluation of data of prevalence of Transfusion Transmitted Infections (TTIS) among blood donors permits an assessment of infections in donor population and consequently the safety of collected donations. It also gives an idea of the epidemiology of these infections in the community. Aim: To find out the seroprevalence of transfusion transmissible infections, namely HIV, HBV and HCV, among voluntary and replacement donors, coming to the Department of Transfusion Medicine at Gandhi Hospital. Materials and methods: Total of 16,872 units of blood were collected from voluntary and replacement donors during the study period from January 2014 to December 2015. All blood samples were screened for (HIV) Human Immuno deficiency Virus, (HBV) Hepatitis B Virus and (HCV) Hepatitis C Virus. Results: out of the total of 16,872 units of blood donors, replacement donors were (91.6%) more compared to voluntary donors (8.4%). The seroprevalence of TTI was 1.85% in total donors. The seroprevalence of HIV was 0.18% in total donors. No voluntary donor was found to be reactive for HIV. The seroprevalence for HbsAg was more in replacement donors (1.58%) as compared to voluntary donors (0.04%). The seroprevalence of HCV was 0.10% and no voluntary donors were reactive. Conclusion: The prevalence of TTI was more in replacement donors when compared to voluntary donors. Hence, more emphasis should be given to motivation of voluntary donors.

255-259

Authors: G. J. Vani Padmaja, S. S. S. Quadri, O. Shravan Kumar

Background: Perimenopausal bleeding is one of the commonest conditions for which patients come to the gynecological outpatient department. The prevalence increases with age peaking just before menopause. Anovulatory cycles causing excessive, uncontrolled and prolonged bleeding, irrespective of the etiology, are the commonest cause for such bleeding in the perimenopausal women. Perimenopause is 2-8 years proceeding and 1 year after menopause. It occurs in women between the ages of 40 to 50 years. Aim: To evaluate the histomorphological profile of Endometrial Biopsies of 200 women with perimenopausal bleeding coming to the Gynaecological outpatient Department Gandhi Hospital, from January to December, 2015. Materials and methods: Endometrial curettings were obtained from 200 women clinically diagnosed to have perimenopausal bleeding. The curettings were fixed in 10% formalin, which were then processed. The slides were stained with Haematoxylin and Eosin (H&E) and their histomorphological pattern was noted. Results: Out of a total of 387 cases with dysfunctional uterine bleeding (DUB), 200 cases had perimenopausal bleeding. Most of the patients were between 46 to 50 years of age. The most important cause of perimenopausal bleeding was proliferative endometrium seen in 85 cases, followed by secretory endometrium in 49 cases. We had 36 cases of fibroids, 16 cases of simple hyperplasia, 5 cases of endometrial polyps, 4 cases of complex hyperplasia without atypia, 3 cases of complex hyperplasia with atypia and 2 cases of endometrial carcinoma. Conclusion: Perimenopausal bleeding is common between the ages of 40 to 50 years, with a peak in the ages between 46 to 50 years. Though the commonest histomorphological profile of the endometrial curettings obtained from such patients was proliferative phase, there were cases of hyperplasia’s both simple and complex with atypia. There were 2 cases of endometrial carcinomas. Hence it is important to understand the cause of such bleeding and study the histomorphological pattern to diagnose hyperplasia’s which are premalignant lesions of the endometrium and endometrial carcinoma at an early stage and prevent its complications.

267-273

Authors: T. Murali Venkateswara Rao, Murali Krishna TV, B. Bhaskara Rao

Introduction: Tuberculosis was the major infectious cause of death in the world. Even though, in developing western countries it is less common the mortality rate of abdominal TB was because of less awareness, and lack of proper understanding Aim: The study was aimed to study the clinical profile of abdominal tuberculosis presenting to a tertiary care teaching hospital in south India. Materials and methods: The study was a prospective observational study. The study was conducted in NRI Academy of Sciences, a tertiary care teaching hospital in south India. All patients admitted to the Departments of Internal Medicine, General Surgery and Gastroenterology at NRI general hospital. Results: In the current study, study population included 76 members. Males and Females were in equal distribution (50%). The mean age of the study participants was 37.0 (±13.59) years. Age wise majority of study participants were in between 21 to 40 years of age. Only few members were under 20 years and above 50 years. Abdominal pain, distension, and vomiting were the most common clinical symptoms. 88.2% were with abdominal pain, 46.1% were with abdominal distension and 43.4% were with vomiting. Other common symptoms were Fever, weight loss and anorexia were reported 39.5%, 27.6%, 25% respectively. Mass per abdomen, bleeding per rectum was few other rare symptoms. 60.5% were with abdominal tenderness. Hepatosplenomegaly was present in 3.9%. Abdominal distension, Ascites and mass per abdomen were reported in 46.1%, 17.1%, and 13.25% respectively. Obstruction was the most common finding observed in abdominal X-ray seen in 70% of the 10 subjects, who underwent screening. Pneumoperitoneum and obstruction wit pneumoperitoneum were the other findings reported in 205 and 10% of the screened subjects. In 41 subjects, who underwent ultrasonography of abdomen, ascites was the most common finding reported in 65.9% of the subjects. Hepatosplenomegaly (21.9%), only splenomegaly (19.5%) and obstruction (17.1%) were the other common findings. Mass and lymph nodal enlargement were the other common findings observed. Mass and lymph nodal enlargement were the common findings reported in the CT abdomen. Conclusion: Abdominal Tuberculosis is one of the major problems facing in developed countries. Among extra pulmonary tuberculosis cases abdominal tuberculosis is the major one.

281-286

Authors: Animireddy Kishore, G. Obulesu

Background: Over the last four decades Methicillin Resistant Staphylococcus aureus (MRSA) has spread throughout the world and has become highly endemic in many geographical areas. Materials and methods: Methicillin resistance was determined by 2 methods: Disk diffusion method using Oxacillin 1µg disk and MIC HiComb strips. Results: Out of 170 isolates 105 strains were Coagulase Positive and 65 strains Coagulase Negative Staphylococci. Most effective markers were Thermonuclease test and growth on high salt agar. 89 (84.76%) of the 105 isolates showed resistance to Penicillin, 54 (51.42%) to Amyoxyclav, 81 (77.14%) to Cefdinir, 61 (58.0%) to Cefepime, 86 (81.92%) to Gentamicin, 44 (41.9%) to Clindamycin, 40 (38.0%) to Amikacin, 82 (78.0%) to Erythromycin, 51 (48.57%) to Cotrimoxazole and 69 (65.71%) to Ofloxacin. Maximum resistance was seen for Penicillin and least to Amikacin. Oxacillin Disc diffusion method: Among 105 isolates 48 (45.7%) were susceptible to Oxacillin, 9 (8.57%) showed intermediate sensitivity and 48 (45.7%) were resistant to Oxacillin. MIC Determination by MIC HiComb strips: Among 105 isolates 59 (56.1%) showed MIC ≤ 2 µg indicating susceptible strains and 46 (43.8%) isolates showed MIC 4 > µg indicating Methicillin resistance. Conclusion: The antimicrobial resistance pattern in the present study gives serious reason for concern because majority of the strains are highly resistant to commonly available antibiotics. Surveillance studies should be carried out in every geographical area to detect the prevalence of MRSA strains and appropriate infection control measures should be performed. In conclusion, considering the increasing occurrence of MRSA infections, highly reliable, accurate and rapid testing for Methicillin Resistance is essential for both antibiotic therapy and infection control regimens.

297-301

Authors: Chandran R, Shetty SK, Shetty A, Balan B, Lawrence J Mathias LJ

Introduction: Osteoarthritis is thought to be the most prevalent chronic joint disease. Total Knee Arthroplasty (TKA) is now a reliable treatment for severe arthritis and is now commonly done for end stage arthritis of knee. The results of TKA are predictable in majority of cases, but with geriatric population, arthritis is often associated with other co-morbid condition along with age, which makes the results of TKA less predictable. So, the present study was conducted to evaluate the clinical and functional outcome of TKA in this subset of population. Materials and methods: This prospective study was done at a tertiary care center of Mumbai. A total of 30 consecutive patients who consented and underwent TKA were assessed clinically, functionally and radiologically using the Knee Society Score at an interval of 6 weeks and 6 months. All the data was entered in Microsoft Excel sheet 2013 and analyzed using appropriate statistical tests using SPSS software ver. 21 Results: The average pre-op Knee Clinical Score (KCS) was 28.13 which improved to an average post-op score of 95.38. At 6 month follow up, 26 patients (87%) had Excellent, 3 patients (10%) had Good, and 1 patient (3%) poor results as per KCS. The average pre-op Knee Functional Score (KFS) was 41.53, which improved to a post-op score of 88.49. At 6 month follow up, 16 patients (53%) had Excellent, 11 patients (37%) had Good, 2 patients (7%) had Fair and 1 patient (3%) had poor results as per KFS. Conclusion: Primary Total Knee Arthroplasty improves the functional ability of the old patient above 70 years and the ability of the patient to get back to pre-disease state, which is to have a pain free mobile joint, as reflected by the improvement in the post-op Knee Clinical Score and Knee Functional Score.

310-313

Authors: Dasari Krishna Chaitanya, Dasamandam Srihari

Background: Inguinal hernia repair using mesh is one of the most frequently performed operations in general surgery. We evaluated pain, recurrence, complications such as wound infection, mesh infection, return to work and length of hospital stay after hernia repair using standard mesh. Materials and methods: A prospective clinical study was conducted with standard polypropylene mesh repair of a hernia. Data were collected from admission till discharge from the hospital, one month, two months and three months after surgery. At each visit clinical examination and ultrasound was done to evaluate chronic persisting inguinal pain and recurrences. Results: A total of 80 patients underwent tension free hernia repair with standard mesh. There were 36 males and 44 females. The mean age of the patients was 54±8.2 years. The average duration of stay in the hospital was 5.2±1.4 days. 4/80 (5%) had wound infection, 2/80 (2.5%) had mesh infection and only 7/80 (10%) had recurrent pain after one year. Conclusion: In our study, low recurrence rates, early return to work and a low percentage of persistent pain suggest that open repair with standardised mesh for hernia repair remains a good option for the low-income group patients. Additionally, it is easy to perform, inexpensive and can be done under local anesthesia.

321-326

Authors: Rathna R, S. Rajarajeswari

Background: Medical field requires the faculty development, because Quality of patient care is depending on the learning environment of physicians, they need good and effective teaching. Few studies have evidence that self-assessment can be improved by feedback, particularly video and verbal, and by providing explicit assessment criteria and benchmarking guidance. There was also some evidence that the least competent are also the least able to self-assess accurately. So there is a paucity of research demonstrating the effectiveness of these interventions in Indian context. The goal of this study is to fulfill this vital gap in the knowledge. Aim: To assess the perceptions of the teachers regarding self-assessment and its impact on self and student’s performance. Materials and methods: The study was a cross sectional study, conducted in a tertiary care teaching hospital, in Madurai, Tamil Nadu. A total of 63 study participants were included in the study, after checking for compliance with inclusion and exclusion criteria. The study participants were included in the study by convenient sampling. Results: A total of 63 faculties from various streams participated in the study. Majority (about 95%) of the faculty either agreed or strongly agreed that self-assessment is useful method and can improve the teaching skills. But the proportions of faculty who strongly agreed that teaching can have positive impact on student’s performance is relatively low (30.2%). In fact many (9.5%) of the faculty disagreed with this. common methods of self-assessment methods reported by 33 to 43 % of faculty. Videotaping were reported by 3 (4.8%) and other methods were reported by 7 (11.1%) of faculty members. Conclusion: Self-assessment is one of the good methods to assess and improve the teaching skills of faculty in medical field. Self-assessment also help full to improve planning, communication and also in career growth of medical faculty.

334-344

Authors: N. Sreemani Kumari, Shyamala Srujana, O. Shravan Kumar

Background: Soft tissue sarcomas are uncommon malignant mesenchymal tumours, of unknown etiology, accounting for less than 1% of the all the malignant neoplasms, with a median age of occurrence at 65 years, having male preponderance, 3/4th of them occurring in the deep soft tissues, especially thigh, with median diameter of 9 cm. 2/3rd of them metastasizing to the lung. Sarcomas need thorough evaluation by radiology to assess the extent, depth and neurovascular involvement. Morphology has to be correlated with histochemistry and immunohistochemistry. Aim: To study the prevalence, in relation to age, sex, site and size. To correlate histopathological findings with immunohistochemistry marker studies at our institution, studying and comparing with changing overviews and evolving literature. Materials and methods: All the soft tissue mass specimens submitted to the Department of Pathology, Gandhi Hospital, Hyderabad, from January 2011 to December 2015, were subjected to routine processing and those cases on histopathology, suspected to be sarcomas were included in the study, analyzed with ancillary techniques to arrive at final diagnosis. Results: A total of 40 sarcomas were encountered out of 20460, histopathology biopsy load at Gandhi Hospital, Hyderabad, constituting an incidence rate of 2%. Majority of the tumours were seen in the age groups of 40-49 years and 60-69 (20% each) with male preponderance (67.5%), occurring mostly in the trunk region (50%), with average size of 10 cm and constituting 0.6% of cancer incidence. Liposarcoma was the commonest soft tissue sarcoma in the present study. Conclusion: Liposarcoma was the commonest soft tissue sarcoma in the present study followed by Undifferentiated Pleomorphic sarcoma and Leiomyosarcoma. Most of the tumors presented with mass lesion, pressure symptoms and incidentally detected on imageology. FNAC was not very helpful in present study. Prediction of the course of the disease was difficult as most of the patients were referred to cancer institutions in the city, for further management.

353-357

Authors: G. Anitha, R. Salma Mahaboob, G. Obulesu

Background: Tuberculous pleurisy is thought to be the result of a delayed hypersensitivity reaction in response to the presence of mycobacterial antigens in the pleural space. This Immunologic reaction causes the stimulation and differentiation of lymphocytes, which release lymphokines, which in turn activate macrophages for an enhanced bactericidal effect. Aim: To study the adenosine deaminase levels in the diagnosis of tuberculous pleural effusion. Materials and methods: Present study was done in the Department of Biochemistry, Fathima Institute of Medical Sciences, Kapada. Parameters studied were total cell count, differential cell count, glucose, total proteins, lactate dehydrogenase, and adenosine deaminase. Results: In our study, all the parameters were elevated in disease condition that was tuberculous pleural effusion compared to non-tuberculous pleural effusion. Conclusion: Study of these parameters is not enough to know about the tubercular plerural effusion. The adenosine deaminase levels were significantly raised in pleural fluid in tuberculous pleural effusion than non tuberculous pleural effusion.

362-365

Authors: Shah S, Champaneria N, Pasle RK

Neuroblastoma is one of the most common childhood malignancies. Patients diagnosed under 1 years of age (40%) have a much better prognosis than those diagnosed in later childhood. Neuroblastoma originates from neural crest cells of the adrenal medulla or sympathetic ganglia. Neuroblastomas commonly present as an asymptomatic mass in a child. The treatment of neuroblastoma depends on the stage, and it includes surgical excision, multi agent chemotherapy, and bone marrow transplantation.

1-5

Authors: Patel V, Sheth M, Vyas N

Background: Low back pain and pelvic pain are most common symptoms of Primary dysmenorrhea. Most commonly used treatments are pharmacological drugs. TENS has been found to be effective for primary dysmenorrhea according to Parisa P. Transcutaneous Electrical Nerve Stimulation (TENS) can be given in pre-menstrual days or during menstrual cycle and in both phases TENS has been shown to be effective. So this study was done to see and compare the effect of TENS in primary dysmenorrhea in both phases. Aim: The present study aimed at assessing effect of Transcutaneous Electrical Nerve Stimulation on Pain in Subjects with Primary Dysmenorrhea. Materials and methods: A quasi-experimental study was conducted in community of Ahmadabad. Non athletic females between 18-25 years of age, diagnosed with primary dysmenorrhea with regular menstrual cycle and no other medical conditions were included in this study. 30 subjects included by convenience sampling were randomly divided in 2 groups. Both groups were given 20 minutes of TENS, to back over para spinal region (L5-S1) at 100 Hz frequency with 80 µs at comfortable intensity, once daily for 3 days. One of 2 groups was treated on three premenstrual days and other group was treated at same dose during initial three days of menstrual cycle. Outcome measure used was visual analogue scale. Level of significance was kept at 5%. Results: Wilcoxon test was used to compare mean preVAS, 5.36±1.652 and postVAS, 2.85±1.711, in group A (W/z= -3.413, p= 0.001). Wilcoxon test was used to compare mean preVAS 4.61±1.187 and postVAS 2.77±1.102, in group B (W/z= -3.408, p= 0.001). Mean difference between group A and B was 2.17± 0.87.Applying Mann-Whitney U Test (U= 63.500, p=0.042) showed significant difference between groups. Conclusion: Use of TENS for 3 days before or during menstrual cycle is effective in reducing pain. However use of TENS in premenstrual phase is more effective for reducing pain.

11-15

Authors: Pandya H, Vyas N, Sheth M

Background: The growth of population, industry, number of vehicles and improper implementation of stringent emission standard makes the problem of air pollution worse. Automobile exhaust consists of particulate matter and gases which cause injury to the terminal bronchioles and decrease in the pulmonary compliance and vital capacity and PEFR. Aim: The present study aimed at assessing the Peak expiratory flow rate (PEFR) in healthy working women in the Ahmedabad compared to healthy housewives of same age to see the effect of short duration daily exposure of traffic air pollutants on PEFR. Materials and methods: An observational study was conducted in the community of Ahmedabad with 30 females between the ages of 30-40 years, divided into 2 groups. Group 1 comprised of 15 healthy housewives and Group 2 comprised of 15 healthy working women. Peak expiratory flow rate (PEFR) using a Wrights peak flow meter was measured in liter per minute. Three such readings were taken in standing posture. The highest of the three values obtained was treated as the peak expiratory flow rate. Results: The mean PEFR of the housewives and working women was 304±60.80litres/min and 285.33±45.01 litres/min respectively. There was no statistically significant difference between the two groups of the study (p=0.208, z= -1.259). Conclusion: There is no difference between the Peak Expiratory Flow Rate between healthy housewives and working women in Ahmedabad.

23-26

Authors: Pandey D, Pandit A, Pandey AK

Background: Improved quality of life is prime concern of management of diabetes, which is affecting vast population in later years. Audio vestibular function monitoring and care in the diabetics is part of such concern. Materials and methods: A cross sectional investigation was carried out, of type 2 diabetes patients at different stages of disease and therapy to evaluate audio vestibular dysfunction profiles. Results: Hearing loss (HL) was fairly common even in mild early disease while, tinnitus and vertigo too, occurred in all age, gender, disease duration and therapy categories of diabetics. Some 39% of patients bearing tinnitus or vertigo had normal audiograms. Aged males were found to have more exaggerated prevalence of audio vestibular problems than females. Insulin therapy in presumably, patients of long standing disease had lower prevalence of vertigo. Conclusion: Findings imply, more complex relation of audio vestibular complications to diabetes than, to glycemic status or duration of disease. Monitoring of such complications from the earliest, may alone, bring understanding of their pathogenesis and proper prevention and management.

32-41

Authors: Sarkar KN, Mandal SK, Kabiraj P, Mallik R, Gupta DK, Sarkar M

Background: Exact surface localization of foreign body is vital prior to its surgical removal. Preoperative localization errors lead to excessive soft tissue exploration, prolonged surgery, increased morbidity and post-surgical complications. Aim: Determination of percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings. Materials and methods: Prospective observational study was conducted on 100 patients over duration of eight months from September 2015 to April 2016 at our institution. Preoperative surface marking of foreign body was done using Ultrasound machine PHILIPS HD7 (2.0.1) with 7 MHz linear transducer, Excel mark premium black stamp ink 2oz, Acco smooth steel wire paper clip, Trade mark 45 cm wooden measuring scale and Apsara glass marking pencil. Percentage agreement of preoperative surface marking of subcutaneous foreign body by colour comet tail artefact with its intra-operative positional findings was studied in 100 patients prospectively. All analysis was done by using IBM SSPS statistics 24 and MS Excel. Results: The color tail artifact technique showed percentage agreement of 93.5% for accurate surface marking of vertical line within ≤ 5 mm of actual location and percentage agreement of 92.5% for surface marking of horizontal line within ≤ 5 mm of actual location. Conclusions: Blind surgical procedures of foreign body removal have been replaced by real time ultrasound guided removal under strict sterile conditions in most of the affluent nations. However in developing nations and semi urban places where there is limited and underrated sterilization and disinfection technique, real time ultrasound procedures for foreign body removal remains a challenging option. This study shall suffice to the needs of developing nations and semi urban places with precise preoperative surface localization, advantages of minimal surgical exploration, minimal local tissue injury, reduced patient’s morbidity and no real time ultrasound associated nosocomial infection. The study shall also be helpful with special emphasis to those underserved villages where surgeons still rely on blind foreign body removal procedures, causing massive tissue exploration, increased hospital stay, increased cost of treatment, failure of removal and increased patients morbidity.

49-58

Authors: K. Aruna Kumari, E. Swathi, Sarada Saranu

Background: Intra-partum and early postpartum blood loss are increased in conjunction with Cesarean delivery. Misoprostol is a potent uterotonic agent that has been extensively studied in the prevention and treatment of PPH after vaginal delivery, however, its use in conjunction with CD has not been investigated as much. Objective: To evaluate the effect of preoperative administration of rectal misoprostol on blood loss during and after elective Cesarean delivery. Materials and methods: A randomized controlled trial was conducted among 200 women scheduled for elective Cesarean delivery. The study group (n=100) received 200 µg of misoprostol. The control group (n=100) received placebo. The main outcome measures were intra-operative blood loss, postpartum blood loss at 24 hours, and difference between preoperative and postoperative hematocrit values. Results: The mean intra-operative and postpartum blood loss was lower in the study group than the control group: 374 ± 69.9 ml and 131 ± 31.8 ml versus 401 ± 79.9 and 145 ± 35.6 ml, respectively. The difference between the preoperative and postoperative hematocrit values was also significantly lower in the study group than the control group (4.3 ± 2.26 and 5.25 ± 2.61, p =0.006). Admissions to the neonatal intensive care unit and Apgar scores at 1 and 5 minutes were comparable between the two groups. Conclusion: Preoperative administration of 200 µg rectal misoprostol significantly reduced blood loss related to elective Cesarean delivery.

65-70

Authors: Ch. Sheethal

Background: Accurate prediction and diagnosis of uterine abnormalities has become a core part of the fertility work-up. A variety of modalities can be used for the diagnosis of uterine abnormalities Transvaginal ultrasonography (TVS) is one among all. Aim: To determine the efficacy of TVS ultrasonography in screening for endometrial disease and studied the concordance of abnormal endometrial thickness, as measured by ultrasonography, with diagnoses based on histopathological examination of endometrial biopsy specimens. Materials and methods: A total 200 Subjects were elected from OPD of ESIC Hospital, Hyderabad. All subjects were undergone to the routine clinical and blood investigation, ultrasound, transvaginal and colour doppler investigations. Results: Study of primary infertility the diagnosis by transvaginal ultrasound and histopathology matched in 82% cases, while in 18% cases there was a disparity among the two modes of investigation. Conclusion: TVS can play an effective role in diagnosis and management of primary infertility, as it has a greater patient compliance with non-invasive technique and without necessitating full bladder. It can replace the EB in the diagnostic work up of female infertility.

77-81

Authors: R. S. Pushpa Kumari, Priya John, V. A. Vipula

Background: The incidents of CAD is increasing alarmingly and evidence is emerging about the role of novel risk factors. hs-CRP is emerging as a crucial risk factor for premature atherothrombosis and cardio vascular events. Elevated hs- CRP concentrations early in Acute Coronary Syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. Aim: This study was undertaken to measure the levels of serum hs-CRP in patients with CAD as established by CAG. Materials and methods: This study included 100 patients admitted in General Medicine and Cardiology departments with a spectrum of coronary artery disease and undergoing coronary angiography. Routine blood investigation, ECG, Chest cardiograph, and 2D Echo test were performed. Results: A total 100 patients established that hs-CRP were elevated in all the patients irrespective of risk factor status. Also there was statistically significant difference between the levels of hs-CRP and angiographic extent of lesion. hs-CRP levels were also found to be higher in in patients with positive family history of CAD and elevated LDL-C, decreased HDL-C. Conclusion: measurement of hs-CRP should not be used as an alternative for but as an adjunct to major risk factors in assessing and thus better define the intensity of preventive therapies to be initiated.

88-92

Authors: Radha Mohan M, Alimelu M, Sudershan Reddy P, Shyam Sunder M

Tuberculosis is the most common infectious cause of death worldwide. Young children especially infants usually are more susceptible to tuberculous infection. Disease usually develops within 1 year of infection. The present study has been conducted upon 41 children in whom Mantoux test was positive (n=41). These children were coming to our outpatient department, in a Teaching Hospital, Nizamabad, Telangana State with mild fever, cough, night sweats, anorexia, and loss of weight. The age group selected for this study was 1 to 12 year, and the period of study was from August, 2013 to December, 2015. Among the 41 children under study 13 children were 1 to 4 year and 28 were 5 to 12 year. Among the total 41 cases of Mantoux positive, 16 (39%) were found to be suffering from tuberculous disease and anti tuberculous drugs were started. In these cases 7 were 1 to 4 year (n=13), and 9 were 5 to 12 year (n=28). After 3 months follow up, all the children who were on ATT became free from their symptoms. It shows association between mantoux positivity and tuberculosis is more in children between 1 and 4 year than children between the age of 5 and 12 year. Most of the other children needed antipyretics, other symptomatic drugs and antibiotics only. But in 3 cases symptoms were not relieved either with antibiotics or with trial ATT. The factors for deciding tuberculosis are history of contact, clinical picture, CBP, ESR, chest- x- ray, Mantoux test, sputum for AFB, antibiotic trial, follow up, trial ATT. All these factors are put together and then only we will decide whether to start ATT or not.

101-106

Authors: E. A. Ashok Kumar, P. Jijiya Bai

Thirty cases of CNS Tuberculomas were studied as suggested by the CT Scan Brain (Plain and Contrast) from 2007 to 2009, at Gandhi Medical College, Hyderabad, India. It was most common in second and third decade of life. The most common clinical presentation was convulsions. Routine investigations did not yield the diagnosis of tuberculosis. All patients were treated with Anti Tuberculous Treatment (ATT), for 6 months and oral steroids. ATT consisted of 2 months of intensive phase of HRZE and 4 months of continuation phase of HR. No surgical intervention was done. After completion of chemotherapy, they were followed up for 6 months. Repeat CT Scans were done, which showed clearance of all tuberculomas.

113-123

Authors: C. Suman, B. Ramesh Kumar, B. Prabhakar

Background: Cirrhosis is a common hepatological disorder seen in clinical practice. Liver plays an essential role in lipid metabolism, several stages of lipid synthesis and transportation. It is reasonable to expect an abnormal lipid profile in those with severe liver dysfunction Aim: To assess the lipid profile abnormalities in patients with cirrhosis of liver correlate with the severity of cirrhosis and whether lipid profile can be used to predict severe cirrhosis of liver. Materials and methods: This is a cross sectional study performed for a period of 2 years. Age and sex matched controls were selected from the patients attending Out Patient Department of Gastroenterology. 150 patients with cirrhosis of liver were included in the study. Diagnosis of cirrhosis of liver was based on characteristic findings. Results: Mean serum total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol and serum triglycerides were significantly (p <0.05) lower in patients with cirrhosis of liver when compared to healthy controls. Serum lipids progressively decreased with increasing severity of cirrhosis as assessed by Child criteria and MELD score. There was no statistically significant difference in serum total cholesterol, LDL cholesterol, VLDL cholesterol, HDL cholesterol and triglycerides among alcoholic and non alcoholic cirrhotic patients with similar severity of cirrhosis. Among the various parameters of lipid profile, total cholesterol and LDL cholesterol had the highest areas under the roc curve; hence may be considered as the best predictors of Child C cirrhosis and MELD > 24 respectively. Conclusion: Among the various parameters of lipid profile, total cholesterol and LDL cholesterol have the highest areas under the roc curve; hence may be considered as the best predictors of Child C cirrhosis and MELD > 24 respectively.

130-135

Authors: Arige Subodh Kumar, N L Eshwar Prasad, Avula Krishnaveni, Anuradha

Introduction: Small bowel tumors are amongst the uncommon in the gastrointestinal tract. The accumulation of data regarding their clinical presentation, etc. has been difficult. Most of the symptomatic lesions and tumors detected during surgery are malignant. Aim: To observe the clinical presentations of the small bowel tumors. Materials and methods: This was a prospective study of 17 cases of small bowel tumors done in Osmania General Hospital between 1994 and 1997, included both benign and malignant tumors and both primary and secondary tumors as well. Results: These tumors were seen between 30-80 years of age. Male to female ratio of the benign and malignant small bowel tumors was1.8: 1 and 1.75:1 respectively. 65% were Incidental findings. Anemia was seen in 58.8%. 83% of benign and 90% of malignant tumors presented with pain. 47.1% of the cases were diagnosed pre-operatively and 41.2% of the cases during emergency surgery. Benign tumors constituted 35.3% and the rest were malignant. 83.3% of the benign lesions were in the jejunum and 16.6% in the duodenum. Amongst, the malignant lesions, 54.60% of them were in the duodenum, 36.3% were in the jejunum and 9% were in the lleum. Conclusion: 65% of the small bowel tumors were found incidentally. Pain, obstruction, bleeding, palpable mass were the other modes of presentation, while anorexia and weight loss were noted in only the malignant ones. High index of suspicion is required to prevent delays.

142-147

Authors: B. V. Anuradha Devi, S. Chandra Sekhar, C. Saritha, S. Sanhya Anil, H. Sandhya Rani

Introduction: Breast cancer is one of the most common cancers among Indian women. Although breast cancer is an epithelial malignancy, stroma plays a key role in modulating tumor invasion and metastasis. Stromal markers are now emerging as novel markers in assessing the prognosis of invasive breast cancer and have not been studied extensively till date. Aim and objectives: To estimate the frequency of expression of stromal CD10 in invasive breast carcinomas, to assess prognostic significance of stromal CD10 expression and its correlation with other clinicopathological factors like age, menopausal status, tumor size, grade and lymph node status. Materials and methods: A total of 59 cases of breast cancer were included in the study. Representative sections were taken and hematoxylin and eosin staining was done. Immunohistochemistry was performed with CD10. Stromal expression of CD10 (>10% stromal positivity was considered positive) in invasive breast carcinoma was noted and was statistically analyzed with different known prognostic markers of breast carcinoma. Results: Stromal expression of CD10 was found to be significantly associated with increasing tumor size (P = 0.03), increasing tumour grade (P =0.001), worsening prognosis (P = 0.002) and lymph node status (0.0005). No correlation was found between CD10 over expression and age, menopausal status. Conclusion: Tumor grade is a major prognostic indicator of breast carcinoma. Tumor size and nodal status on the other hand, are important determinants of tumor stage. Therefore, our findings concerning the positive correlations between stromal CD10 expression and tumor grade, tumor size, and nodal status suggest a strong effect of stromal CD10 expression on aggressive behavior of breast carcinoma and introduce this marker as a potential prognostic determinant in breast cancer.

152-156

Authors: Nagababu Pyadala, Prudhvi Chand Mallepaddi, Rajaneesh Borugadda, Soumendra Nath Maity, Rohit C. P., Rathnagiri Polavarapu

Background: HCV is a blood borne virus. Mainly HCV infection attacks the liver and can cause chronic Hepatitis, liver cirrhosis (27%) and liver cancer (25%) and shows significant mortality and morbidity. Aim: The present study was to assess ICT kit used in the preliminary screening process of HCV infection among blood donors in a rural teaching hospital, Sangareddy. Materials and methods: In this study, 1050 number of blood units were collected from donors containing both voluntary and replacement donors for a period of one year from January 2015 to December 2015. 1050 donors were tested for HCV by using ICT kit and ELISA method. Results: We found 4 out of 1050 subjects tested positive for HCV by using ICT kit and conformed by ELISA method. Conclusion: The present study concluded that the overall performance of the rapid ICT kit for HCV was equally sensitive to ELISA and yet they were cheap and quicker. It can be recommended that ELISA comparable rapid devices may be allowed to be used for preliminary screening of Hepatitis C especially, in remote areas or where cost is an issue.

164-169

Authors: Banothu Srinivas, B. Shailendra

Background: Rectal bleeding is the most common symptom of large bowel pathology which comprises 14 to 19% in adult population. Sigmoidoscopy is a feasible and safe method for diagnosing colorectal problems than colonoscopy and proctoscope. Aim: The present study was an attempt to evaluate the patients with bleeding per rectum sigmoidoscopically and to select the best possible approach to treat the underlying pathology. Materials and methods: A total 54 patients with bleeding per rectum were considered from outpatient department form April 2013 to April 2015 and all the subjects were undergone for routine blood, urine and stool investigations, and sigmoidoscopic investigation. Results: A total of 26 cases were examined sigmoidoscopically for rectal bleeding in that 73.08% cases were able to confirm as definitive source of bleeding and 26.92% cases have other lesions which could not be detected by sigmoidoscope. Conclusion: Sigmoidoscopy has a very high diagnostic yield and would be recommended in the workup of patients presenting with bleeding per rectum. Haemorrhoids followed by ulcerative colitis were the leading cause of bleeding per rectum in this study.

178-181

Authors: S. Shanmugam, Manoharan, K. Anbarasan

Background: Thyroidectomy remains to be one of the most common surgeries done and has been associated with few specific complications. One major complication of thyroidectomy is hypocalcemia, which often occurs as a result of inadvertent intra-operative injury to parathyroid glands. Transient hypocalcaemia, which is usually noticed after surgery, resolves well most of the times as it respond to replacement therapy in few days. Aim of the study: To study the incidence of transient hypocalcemia occurring in patients undergoing total thyroidectomy Materials and methods: The methods for the study included screening of patients who presented with thyroid swelling alone or along with pain, hoarseness of voice and dysphagia symptoms. Such patients were studied in detail clinically and investigated as per proforma detailed below. Hematologic and biochemical investigations were done. All patients were subjected to ultrasonographic evaluation and thyroid function tests initially. Following which they had undergone a fine needle aspiration biopsy for histological diagnosis. Patients who were suspected to have malignancy were made to undergo other imaging modalities as CT. Results: 28% of cases developed hypocalcaemia by 6 hours while 24% of cases had hypocalcemia after 72 hours. Post-operatively only 5 patients had developed symptoms of hypoparathyroidism. These were found to have reduced calcium levels at both 6hrs and 72 hours of surgery and hypocalcemia had resolved in 5 patients by 72 hours who had drop in 6 hours post-operatively. Conclusion: The maximum incidence of clinically symptomatic hypocalcemia was found in the age group of more than 35 to 65 and those cases had reduced serum calcium levels measured at both 6 hours and 72 hours.

192-198

Authors: Kumar A, Jan SM, Behl R, Nazir R, Khairat RU, Ganaie TA

Introduction: Periosteum is a highly vascular connective tissue sheath covering the external surface of all bones except sites of articulation and muscle attachment. Regenerative potential of periosteum is due to inner layer which contains mesenchymal progenitor cells. Laterally pedicle flap technique is frequently used for recession coverage in isolated, denuded roots that have adequate donor tissue laterally and vestibular depth. Pedicle flaps have been modified in past, this pilot study utilized the technique which included auto transplant of periosteum in combination with laterally positioned flap. Materials and methods: 20 teeth with gingival recession, Millers’s class 1 and 2 with ≥ 3 mm defect were included and laterally positioned flap with periosteal graft was performed. Results: After 12 months of follow up, a stable result was obtained and the pilot study revealed significant reduction in recession defect. There was a mean percentage of 95.6% for root coverage, 80% predictability for recession coverage. Conclusion: Laterally positioned flap with periosteal graft technique can successfully be clinically utilized for the treatment of gingival recession defects, with less trauma and good esthetic results.

207-210

Authors: Jereen Varghese, Krishnapriya R, R. Srinivasan

Granulomatosis with Polyangiitis (GPA) is a rare multisystem autoimmune disease. It is characterized histopathologically by necrotizing granulomatous vasculitis. The classical clinical triad consists of upper airway involvement (characterized by sinusitis, otitis, nasal mucosa ulcers, bone deformities, and subglottic stenosis), lower respiratory tract involvement (cough, chest pain, hemoptysis) and glomerulonephritis. We reported here a case of Wegener’s granulomatosis presenting as a thick walled cavity.