International Archives of Integrated Medicine

1-7

Authors: Nitin Nagpal, Salvinder Singh Toor, D. S. Sidhu

Background: Acute pancreatitis is a common condition with wide clinical variation, ranging from mild self-limiting pancreatic inflammation to extensive pancreatic necrosis with life-threatening consequences. The present study aimed to assess the clinical profile of acute pancreatitis in Malwa region of Punjab where there increased prevalence of alcoholism and gall stone disease and to assess the efficacy of Ranson’s score and Balthazar Computed tomography severity index (CTSI) in predicting the prognosis. Materials and methods: 50 patients with proven acute pancreatitis were included and data was collected to study their clinical, laboratory and radiologic profile to obtain prognostic indices Ranson’s score and CTSI which were then compared with outcome. Results: Mean age recorded was 43.40 ±12.004 years with a range of 19-64 years and male to female ratio 2.12:1. 62% of patients had alcohol induced pancreatitis and 32% had gall stone pancreatitis. Observed morbidity rate was 44% and mortality rate was 6%. Most common complications encountered were pleural effusion (18%), Hypocalcemia (20%) and sterile pancreatic necrosis (20%). 18 patients had Ranson’s score more than 3, whereas 11 patients had CTSI more than 7 indicating severe acute pancreatitis. On correlation Ranson’s score was found to be more sensitive while CTSI was more specific for an adverse outcome. Conclusion: Severe acute pancreatitis remains a significant cause of morbidity and mortality due to increased prevalence both alcoholism and gall stone disease in Malwa region of Punjab. In our setup Ranson’s score and CTSI when used in combination showed improved sensitivity for detection severe acute pancreatitis.

14-19

Authors: Shetty R, Mukherjee S, Dutta N, Bhagat DK, Sushma K N, Pandey V

Background: Tobacco is mostly regarded as one of the primary etiologic factor in causing oral cancer. Literature quotes studies have depicted the alteration of nuclear (NA) and cytoplasmic area (CA) induced by tobacco smoking and chewing. Also some authors have stressed on quantifying the role of cytomorphometric analysis in analysing these cellular alterations. Therefore, we evaluated the cytological and cytomorphometric changes in the oral squames using brush biopsy from buccal mucosa of tobacco users. Materials and methods: 200 patients of age group of 40-65 years attending the hospital OPD with history of smoking were included in the study. The patients were broadly divided into two groups; smokers (n=150) and Non-smokers (n=50). The cytological samples were taken from clinically normal appearing oral mucosa, stained and analysed using Image analysing software. Independent-Samples T Test and One-Way ANOVA were used to assess the level of significance. Results: significant increase in Mean NA was observed in smokers as compared to non-smokers. Also, Mean CA decreased in smoker’s group as compared to non-smokers. Likewise, N/C ratio was found to be significantly elevated in smokers group. Cytomorphometric parameter changes showed significant alteration with increasing duration of smoking. Conclusion: Cytomorhometric analysis can be used to analyse the alterations occurring in cellular and nuclear level.

24-28

Authors: Challa Venkata Suresh, Nagendar Rao Yeedulapally

Background: Cardiovascular disorders continue to be one of the major causes of death in the world. The central nervous system serves as a bridge for the transition; and it links psychological factors to cardiac dysfunction. The interplay of biological and psychological factors in the development of cardiovascular disorders has long been suspected. Aim: This study aimed to assess the differential influence of various psychosocial adjustments, psychiatric morbidity in patients with cardiovascular diseases. Materials and methods: The subject of the present study was divided in to three group’s i.e. cardiovascular patients, non-cardiac patients, and normal subjects. This study focused on three inventories temperament, type-A behaviour and self-esteem. Results: Cardiac subgroups showed some similarities with normal and non-cardiac subgroup as well. Type-A behavior didn’t have much influence on CVD patient and all patients had less self-esteem. Cardiac patients had less stable temperament and objective temperament was less than the normal subjects, more than non-cardiac patient. Sociability was not a scale to predict the CVD’s. Conclusion: The importance of understanding the psychological correlates of cardiovascular diseases has been undoubtedly established. The interplay of physical and psychological factors in the development of cardiovascular diseases is a truth and not a myth.

38-45

Authors: Meena S, Bhati K, Meera

Background: The preoperative period is stressful in the paediatric patients; oral premedications make the experience of anaesthesia and surgery more pleasant and less traumatic. Aim: To evaluate and compare the effects of midazolam and clonidine as oral premedicant for sedation, ease of parental separation, facemask acceptance at the time of induction of anesthesia, hemodynamic stability, postoperative recovery and complications. Materials and methods: Total fifty children of either gender belonging to ASA grade I and II between 2-8 years age scheduled for elective surgery under general anesthesia were randomly and equally divided in two groups, 25 patients in each. Group M received oral midazolam (0.5 mg/kg) and group C, oral clonidine (4 µg/kg) 90 minutes before induction of anesthesia. Drug acceptability score, sedation score and parental separation score at 60 minutes and 90 minutes after the test drug administration and facemask acceptance at the time of induction were recorded. Hemodynamic stability and postoperative recovery were also observed. Results: At 60 minutes after the test drug administration, the level of sedation and parental separation score were better in midazolam group while at 90 minutes, better in clonidine. Drug acceptability and quality of induction score, hemodynamic stability and postoperative recovery was better in clonidine group. Conclusion: We concluded that if we have proper time before induction, then oral clonidine is better sedative and anxiolytic drug, if not then oral midazolam is better sedative and anxiolytic drug in pediatric patients.

53-57

Authors: Bhattacharya R, Nandy M, Bhattacharjee U, Baisya R

Takayasu’s arteritis is a chronic, progressive, granulomatous vasculitis involving large arteries especially aorta and its branches. Hyperthyroidism is a condition which involves excess synthesis and secretion of thyroid hormones by the thyroid gland. A 36 year old female patient presented at the General Medicine Outdoor of a tertiary-care hospital situated in the Eastern part of India with clinical features and laboratory reports suggestive of hyperthyroidism. There was also history of ischemic stroke 8 years back leading to right sided weakness in this patient. On careful physical examination left sided radial, brachial, femoral and dorsalis pedis arterial pulses were found to be impalpable. Digital subtraction angiography of aorta and its branches revealed narrowing of left common carotid and left subclavian artery suggestive of Takayasu’s arteritis. This existence of Takayasu’s arteritis and hyperthyroidism may not be just fortuitous. An underlying autoimmune mechanism might be a possible explanation.

64-73

Authors: Dhabarde M, Malliwal A

Background: There is an ongoing quest to know which agent is the best for induction as well as maintenance of anesthesia. Desflurane is known to have a rapid onset and offset of action, thereby making it possible for the anesthetist to control the depth of anesthesia rapidly. Intravenous propofol with raid induction and recovery is currently a popular induction agent for surgical anesthesia. The present study was thus carried out to compare desflurane and propofol as single agent anesthesia in short elective surgeries. Materials and methods: In this hospital based prospective comparative study, 60 patients scheduled for elective short surgery were taken. After routine pre-anesthetic work up, patients were induced with either Group D: O2:N2O (50:50) + Desflurane 3-4% or; Group P: O2:N20 (50:50) + Propofol 3-5 mg/kg. Baseline parameters, relevant intra-op details, ease of procedure, hemodynamic changes, recovery, and complication rate were compared between both groups. Statistical analysis was done using SPSS ver. 21. Results: Baseline variables and other parameters like jaw opening, attempts for LMA and ease of insertion was comparable in both the groups (p> 0.05). Time to loss of consciousness and time to LMA insertion was significantly shorter with Propofol (p<0.05). Mean pulse rate and MAP was significantly higher in Desflurane group (p< 0.05). The Bispectral Index value and RASS score were comparable in both groups after 2 min. and 40 min. respectively. Modified Aldrete score was significantly higher in Desflurane group while Complication rate was comparable. Conclusion: Inhaled desflurane provided acceptable conditions for LMA insertion and the intra-operative hemodynamic profile during anesthesia was stable. Desflurane can be considered as an alternative induction agent when inhalational induction is required; bearing in mind that caution still needs to be exercised when desflurane is used in this manner.

81-84

Authors: K. Vinod, Singh R, Suryavanshi R, Ashok Kumar, Singh RK, Ranjan R

Introduction: Tooth eruption marks a milestone in a child’s development and is synchronous with growth and development of the craniofacial complex. Thus, the present study was carried to evaluate the timing and sequence of eruption of deciduous teeth among children of India. Materials and methods: The present study was carried out on 60 children (30 boys and 30 girls), aged between 5 till the emergence of II deciduous molar in the oral cavity, who were local residents, born and residing in that area and were visited regularly at monthly intervals at their homes. All the data were compiled and tabulated using the SPSS software package version 18. Comparison was made between the data obtained and the standard tooth eruption table. The Student t’ test was used to assess the significance of difference in the mean age of tooth eruption with p value of <0.005 as significant value. Results: Comparing the maxillary and mandibular arches, mandibular central incisor at 8.85 ± 1.05 was the first tooth to erupt and maxillary second molar was erupted at 28.12 ± 1.5 months were the last deciduous tooth to erupt in the oral cavity. Females showed delayed eruption compared to males in case of anterior teeth, and males showed delayed eruption in case of posterior deciduous teeth. Though the difference was not significant (p> 0.05), there was a systematic tendency for early eruption of left sided primary teeth, though the difference was not significant. Conclusion: The present study found delay in eruption. Hence, studies conducted to evaluate time to time estimation of variation of eruption sequence among different populations is important for general dental practitioners, and pediatric dentists to contend with the anxiety of the parents.

89-93

Authors: Gosavi S, Karande S, Raut K

Introduction: Diabetes mellitus is considered a disease with a major impact on the vascular tree with both microvascular and macrovascular complications. Hyperglycaemia is independent risk factor for cardiovascular diseases. HbA1c could be considered as a good marker for glycemic control. Recent reports have found that elevated HbA1c levels are also predictive for cardiovascular disease and mortality. Present study was undertaken to find out the correlation between HbA1c levels and complications and outcome in patients of acute myocardial infarction. Materials and methods: Present prospective observational study was conducted on 200 patients admitted to the medical wards in hospital with acute myocardial infarction with or without diabetes mellitus. After a detailed history and physical examination, HbA1c, lipid profile, cardiac enzymes, ECG and echocardiogram were performed in all patients. The patients were then divided into two groups based on the HbA1c levels i.e. good glycemic control (HbA1c< 7%) and poor glycemic control (HbA1c>/= 7%).Data was analysed using SPSS software ver. 21 using appropriate statistical tests. P-value of less than 0.05 was taken as level of significance Results: Poor glycemic control was seen in 52.5% patients. No difference was observed between the groups with respect to gender distribution, duration of hospital stay and patient’s outcome. Past history of MI was found to be significantly associated with poor glycemic control (53.3% vs 38.9%). On comparing the association of outcome in high risk groups as per glycemic control, we observed that poor outcome in MI was significantly associated with elderly population (16.9% vs 3.5%; p< 0.05). Conclusions: In patients with age greater than 60 years, the occurrence of higher HbA1c levels is found to be associated with increased incidence of mortality. So, high HbA1c in elderly population should be considered a risk factor for mortality and hence active management should be done to keep HbA1c level strictly below 7 in this population.

101-105

Authors: Tipnis NA, Shah S

Background: The National Institute of Health asthma guidelines recommend assessing PEF during hospitalization including improvement to a PEF of >70% of the predicted value before discharge. The Global Initiative for asthma recommends monitoring of PEF in hospitalized patients. Current guidelines for correct PEF maneuver include standing, but it has been observed that many respiratory therapists and patients use supine position. Aim: To determine which one of the 3 different positions i.e. standing, lying back at 450 angle on pillows and sitting up slumped forward 100 with legs extended generates higher peak expiratory pressure and can be used as optimal position for generating peak expiratory flow in asthmatics. Materials and methods: A cross sectional study was performed in 20 asthmatic subjects aged 18-50 years in whom correct instructions for PEF technique were given according to guidelines of National Institute of Health. The steps were repeated 3 times in each position and the best of 3 attempts in each of the 3 positions were used for analysis. Level of significance kept at 5%. Results: Mean and SD of lying back at 450 was 254.5±29.28, sitting up with slumped forward 100 was 281±28.26 and that of standing was 302.5±27.88. Statistically significant result was found using nonparametric test i.e. Friedman test where χ2=40 and p=0.0001. Conclusion: There is significant difference between PEFR values in standing, sitting with slump forward 100 and lying back 450 position. Standing position is the best option for adult asthmatics to measure their PEF values as it generated maximum PEF.

113-119

Authors: Tanwar S, Devra V, Dhawan S, Jain S

Introduction: A lot of researches have been done to support the role of vasopressors in elective Cesarean section to prevent hypotension in patient under spinal anesthesia resulting in better hemodynamic control in mother and fetus. This study was conducted to compare the effect of low dose ephedrine (60 mg) and phenylephrine (2 mg) on hemodynamic stability and fetal acid base profile in patient posted for elective caesarean section under spinal anesthesia. Materials and methods: Ninety three patients were enrolled in this study and randomly divided into three groups. Group C received ephedrine infusion; group B received phenylephrine infusion while group A were preloaded with crystalloid. Maternal vital signs (blood pressure, heart rate, and arterial oxygen saturation) and fetal APGAR score and acid-base status were recorded. Results: Hypotension was significantly recorded in crystalloid group as compared to phenylephrine and ephedrine group. Apgar scores in newborns were above 8 in all three groups. Umbilical cord blood pH was higher in phenylephrine and ephedrine groups in comparison to crystalloid group. Conclusion: Prophylactic low dose phenylephrine and ephedrine infusion were more effective than crystalloid preloading in prevention of hypotension and fetal acidosis during spinal anesthesia for elective Cesarean section.

127-132

Authors: Balaganesan H, Ilangovan G, Tirumalasetty H, Jayajothi A, Venkataraman S

Among the Intracranial lipomas which are reported to be rare, the choroid plexus lipomas are mostly associated with pericallosal lipomas which also presents isolated. The retrospective study for evaluation of solitary choroid plexus lipoma (SCPL) using Computed Tomography (CT) by altering CT window level settings showed increased negative predictive value and specificity. The solitary choroid plexus lipomas which on routine CT scan could be overlooked as the lipoma and the surrounding cerebrospinal fluid (CSF) appears hypodense in routine CT scan can be better identified by viewing with altered window settings. This can aid in better identification of the other intracranial lipomas.

138-145

Authors: Kodakandla K, Maddela G, Pasha MS

Background: The absolute number of diabetic population worldwide has raised from 108 million in 1980 to 422 million in 2014. Many western studies documented that diabetes affects the patient’s sleep quality negatively and also imbalance in sleep quality considerably influences the adequacy of glycemic control. Little attention is given to this vital aspect in clinical care of diabetic population in India due to scarcity of studies on the subject. Aim: To assess the prevalence of poor sleep quality and factors influencing it in type II diabetes mellitus patients and also to assess the impact of sleep quality on glycemic control. Materials and methods: The study is a hospital based descriptive cross sectional study, conducted in a tertiary care teaching hospital. A total of 100 Patients of type II diabetes mellitus attending the study setting were recruited sequentially into the study. Sleep pattern was assessed by Pittsburg Sleep Quality Index (PSQI), a person with PSQI global score of 5 and above was considered as “poor sleeper”. HbA1 c level of ≥ 7 was considered as poor glycemic control as per Standards of Medical Care in Diabetes, 2016 guidelines. Results: Sleep pattern (PSQI global score ≥5) was poor in 64% (54.2% to 72.7%) of the study subjects. The odds of poor glycemic control were 3.56 (95 % CI 1.47 to 8.60, p value 0.004) times higher in people with poor sleep quality, compared to people with good sleep quality. Multivariate logistic regression analysis showed higher risk of poor sleep with increasing age, male gender and combined insulin and OHA therapy. Diabetic neuropathy had the strongest association with poor sleep pattern, with an Odds ratio of 3.5 (95% CI 1.27 to 9.59, p value 0.05). Conclusion: The prevalence of poor sleep quality is very high in diabetic patients and is strongly associated with diabetic neuropathy. Poor sleep quality is associated with poor glycemic control.

151-158

Authors: K. B. S. Prabhakar, G. Purushotham, K. Uma

Background: Diabetic foot ulcer is a challenging problem to every clinician in day to day practice. Super-oxidized Solution is a newer concept in the wound management. The present study was aimed to compare the efficacy of dressings with super-oxidized solution versus povidone iodine in the management of infected diabetic ulcers. Materials and methods: This one year randomized controlled trial was conducted on a total of 60 patients presenting with infected diabetic ulcers. Patients were divided into two groups of 30 each based on computer generated randomization that is, group A (Topical super-oxidized solution dressing) and group B (Topical povidone iodine dressing). Wound was observed for decrease in size of the ulcer, granulation, tissue quality and discharge from the wound at the end of each week for two weeks. Results: In the present study, 76.67% of patients in group A and B were males and the male to female ratio was 3.2:1. The mean group A was 55.90 ± 14.27 years compared to 51.50 ± 13.18 years in group B. Type 2 diabetes was present in 96.67% and 93.33% of patients in group A and B. The mean initial ulcer area in group A was 3882 ± 1890 mm2compared to 3992 ± 2000 mm2in group B. The mean final area in group A was significantly low (1607 ± 862 mm2) compared to group B (2351 ± 1240 mm2; p=0.009) and the comparison of mean change in ulcer area was significantly high in group A compared to group B (2215 ± 1060 mm2vs 1641 ± 856 mm2; p=0.024). The mean percentage reduction in ulcer area among patients with group A was significantly high (58.90 ± 5.21 percent vs. 40.90 ± 8.76 percent; p=0.024).The commonest organism isolated in group A was Escherichia coli (26.67%) and in group B, it was staphylococcus. The culture was positive in 26% of the patients in group A compared to 50% in group B (p=0.063). Conclusion : Overall, topical super-oxidized solution dressings accelerated the healing process resulting in faster recovery through reduction in ulcer area in patients infected with diabetic ulcers compared to topical povidone iodine dressing.

166-173

Authors: Gundala S, V.V. Sastry, T. Manmohan, V. Geeta

Back ground: It is human tendency to obey doctor’s advice to get relief from suffering, however once the symptoms subside they don’t follow instructions. In case of chronic diseases such as diabetes, hypertension, cerebrovascular disease the treatment is lifelong and for a quality life the patients suffering with chronic problem should adhere to the treatment guidelines in strict compliance. Unless patient understands the importance of adherence to treatment guidelines it is very difficult to prevent various complications due to diabetes. Objectives: To find out factors responsible for non adherence to treatment and dietary guidelines among type 2 diabetes patients. Materials and methods: 200 known diabetic patients attending diabetic clinic in a teaching hospital were subjected to a pre tested questionnaire and information was collected by interviewing the patients. Results: A total of 200 (101 male and 99 female) patients were studied and assessment of adherence to dietary guidelines and treatment regimen in terms of demographic, anthropometric, nutrition survey, treatment and preventive and personal care was done. Adherence to dietary and treatment guidelines was significantly high in literate group to that of illiterate group, with ‘p’ value < 0.0005. Strong family history in male sex with chi square value after Yates correction 19.49 and ‘p’ value was <0.00001. Conclusion: Compliance or adherence problems are common in diabetes management. Many factors are potentially related to these problems, including demographic, psychological, social, health care provider and medical system, and disease- and treatment-related factors. Literacy is showing a positive impact as higher the literacy, higher is the adherence for treatment guidelines.

184-187

Authors: Prakash Babu B, Huban Thomas, Henry T, Punnose

Stylohyoid ligament, lesser cornu of hyoid bone and styloid process form stylohyoid complex derived from cartilage of 2nd pharyngeal arch. The anatomy of the ossified stylohyoid ligament and styloid process has immense embryological and clinical importance. The present report is of a fully ossified stylohyoid ligament on right side in an adult male cadaver. On the left side the stylohyoid ligament was remain unossified. Stylohyoid ligament in adults may retain its embryonic cartilage and thus has the potential of ossification. Abnormalities of stylohyoid complex may compress nearby neurovascular structures leading to mild to severe symptoms, such as foreign body sensation and pain in throat, etc. Dentists, otolaryngologists and anesthetists should be aware of the natural variations of the styloid process.

1-10

Authors: Modi D, Rathod GB, Delwadia KN, Goswami HM

Background: Investigation of the structure and biosynthesis of glycosylated Hemoglobin (HbA1c) in the past decade have provided a means to objectively access the average level of glycemia in diabetic patient. The use of Glycosylated hemoglobin level as integrated index of long term blood glucose level, represent a significant tool in our research and therapeutic armamentarium. In this study, we have estimated glycosylated Hemoglobin (HbA1c) in diabetic and non diabetic person and its relationship with fasting and post prandial blood sugar levels. Materials and methods: In present study, Glycosylated hemoglobin levels were estimated by using cation exchange resin method. The study was conducted from November 2012 to October 2014. Measurement of total HbA1c and blood sugar were carried out at Diabetic research laboratory, Tertiary care centre, Teaching Institute. 110 Non diabetic persons studied as a control, which were proved to be Non diabetic from history, FBS, PPBS, Urine sugar. Persons with family history of diabetes were not included in control group (Group: X). 350 diabetic patients which included new and old cases, IDDM and NIDDM cases, complicated and non complicated cases, among them 241 were having NIDDM and 109 were having IDDM type of diabetes (Group: Y+Z). All cases thoroughly studied and details about personal data, history, clinical examination, laboratory investigations, complication of diabetes and type of treatment were noted. Results: In IDDM, there was higher value of mean GHb (13.13%), than in NIDDM (mean GHB 11.89%). Patients having Insulin therapy had higher value of GHb (13.08%) than with on oral hypoglycemic agents (11.91%) and patients on dietary modification had level 9.44%. There was no significant difference in GHb among patients with complication (12.26%) and patients without complications (12.29%). Conclusion: Glycosylated hemoglobin assay defines an end point as the fuel of diabetic therapy and provides a powerful stimulus to the patients to improve their compliance. Glycosylated hemoglobin assay may provide an alternative method of screening for diabetes.

15-20

Authors: Acharya A, Modini P., Lakpati G

Chronic dacryocystitis results very often from obstruction to the nasolacrimal duct. It manifests as epiphora or watering of the eyes. The lacrimal sac gets expanded and also the wall of the sac gets thickened as a result of collection of mucopus due to obstruction of the nasolacrimal duct. Treatment of chronic dacryocystitis is by a surgical approach which consists of making an opening between the lacrimal sac and the nasal cavity above the obstruction. This operation is called dacryocystorhinostomy which can be done by external approach or nasal endoscopic approach. The intranasal or nasal endoscopic approach is the more functional route of surgery because it preserves the lacrimal apparatus as near normal as possible. Hence this surgery is being advocated as the first line of treatment for epiphora of chronic dacryocystitis. Experience of nasal endoscopic dacryocystorhinostomy done at Government Medical College, Government General Hospital, Nizamabad, Telangana is being reported with comparison of results published in literature.

27-36

Authors: Modi D, Rathod GB, Delwadia KN, Goswami HM

Background: A spectrum of pathological bone lesions can be presented in any form from inflammatory to neoplastic conditions. Diagnosis of all bone lesions is made by radiological modalities like plain X-ray, CT scan, MRI and bone scintigraphy. Aim and Objectives: To study histopathological features of bone lesions and correlate them with age, site and type of lesions. Material and Methods: The study was carried out at tertiary care center from April 2013 to November 2013. A total of 102 bone lesions were analyzed. Bone biopsy was performed after detailed clinical and radiological examination. After fixation, decalcification, processing and H&E staining, histopathological diagnosis was made. Results: Out of all 102 cases, 44.11% bone lesions were found between 25-50 years with male predominance. The incidence of non neoplastic lesions was 74.5% and neoplastic lesions were 25.4%. Amongst neoplastic lesions, incidence of benign tumors was 17.64% and malignant tumors were 7.8%. The Tuberculous Osteomyelitis was most common non neoplstic lesion while giant cell tumor and osteochondroma were common among benign tumors and osteosarcoma and Secondary metastasis were common among malignant bone tumors. Conclusion: Though Bone tumors are less common, if viewed in perspective of clinico radiology and histopathology, correct diagnosis can be made.

53-56

Authors: Nepalia R

Introduction: The menstrual cycle is the regular natural change that occurs in the uterus and ovaries that make pregnancy possible. The cycle is required for the production of ovocytes, and for the preparation of the uterus for pregnancy. Up to 80% of women report having some symptoms during the one to two weeks prior to menstruation. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability, and mood changes. Aim and objectives: The purpose of this study was to evaluate the changes in serum Calcium, Magnesium and Phosphorus levels during various phases of menstrual cycle in healthy normally menstruating female. Materials and methods: The 90 healthy female volunteer students participated as subjects in this study. The blood sample was collected three times from each subject during their menstrual, proliferative and secretory phase. Estimation of serum calcium, magnesium and phosphorus was carried out on the same day of collection of blood sample. Results: Highest level of serum calcium was seen in proliferative phase. Highest level of serum magnesium was seen in secretory phase. Study showed gradual decrease in serum phosphorus level from menstrual to proliferative phase and also from proliferative to secretory phase. Highest level of serum phosphorus was seen in menstrual phase. Conclusions: These variations could be due to the impact of the changing estrogen and progesterone secretion on the parathyroid glands.

66-71

Authors: Desai A, Panchal H, Parmar H

Background: This study was intended to throw light upon the topic of acute pancreatitis, its incidence, etiology, pathogenesis as well as its management. Aim and objectives: To review and study the patients who presented with acute pancreatitis, to find out the incidence of acute pancreatitis and study the various etiological factors, to study the various modalities of treatment of acute pancreatitis, both conservative as well as operative, to study the incidence and management of complications of acute pancreatitis, factors influencing incidence as well as its outcome. Materials and methods: This was a prospective study of management of 50 cases of acute pancreatitis, admitted in surgical department. All admitted patients underwent work up for the diagnosis and cause of Acute Pancreatitis. The severity grading was done according to the Ranson’s criteria. All patients were monitored with serial examinations and investigations. Patients with mild pancreatitis were treated conservatively at first and surgical intervention was done only in cases of gallstone pancreatitis with diagnosed GB or CBD calculi. Surgical intervention was in form of cholecystectomy or ERCP. Patients with severe pancreatitis were treated conservatively at first. Outcome was monitored in terms of discharge from hospital or mortality. Each patient was evaluated as per the predesigned proforma of the study, a copy of which is attached. Follow up of a minimum of six months was kept and patients with recurrent attacks were monitored and treated either conservatively or surgically as indicated. Results: The highest incidence of acute pancreatitis was found in the age group of 41 to 60 years followed by the age group of 21 to 40 years. Acute pancreatitis was found more commonly in males. (41 out of 50 that is 82%) compared to females (9 out of 50 that is 18%). Alcohol was found to be the most common cause of acute pancreatitis (44%) , followed closely by Gallstones (36%), While in 10% of patients no cause could be found (idiopathic group). Overall conservative management is favorable over surgical management in terms of mortality in about 70% of cases. Mortality was not found in the mild pancreatitis group and all 34 patients were discharged. However, 6 out of 16 patients with severe pancreatitis expired (37.5%). Conclusion: Conservative management is more favourable in both mild and severe type of acute pancreatitis.

78-83

Authors: Lakshmi Rajesh Channareddy, Eshwar Reddy Ravula, G. P. Vignan Kumar

Background: We assessed the prevalence of depression and quality of life and their associations in patients with severe and very severe COPD. Materials and methods: Sixty individuals who gave consent and who met the gold criteria for severe and very severe COPD were recruited for the study. The results of spirometry (FEV1%) which gives the severity of COPD were noted. The recruited individuals were screened for depression through a clinical interview and ICD-10 criterion was used to diagnose depression. The severity of depression of each individual participating in the study was estimated using Hamilton Depression Rating and the quality of life of each individual was estimated using the WHO Quality of Life Questionnaire –BREF Version. Results: Mean age of the patients was 53±4.5 years. The duration of COPD was 8.68±4.3 years. 93.3% of the individuals recruited for the study had severe COPD. 68.3% had been mild to severe depression while 31.7% were normal. The mean HAM-D and quality of life total score of these patients were 17±9.09 and 52±15.1 respectively. HAM-D scores in patients suffering from very severe COPD were much higher when compared to that of patients suffering with severe COPD. Patients with severe depression have poor quality of life on all aspects in comparison with moderate and mildly depressed. Numbers of exacerbations and hospitalizations have a significant correlation with severity of depression and a significant negative correlation with all domains of quality of life. Conclusion: The prevalence of depression in patients with severe to very severe COPD is as high as 68.3%. There was a positive correlation between the number of hospitalizations and exacerbations to the severity of depression. Quality of life in COPD patients with depression was found to be poor in all the four domains namely physical, psychological, social and environmental when compared to those having only COPD as an illness. The severity of COPD was positively correlated with severity of depression and showed a negative correlation with the quality of life.

91-96

Authors: Pednekar S, Singh N, James E, Pandey D

Background: Coronary artery disease (CAD) due to atherosclerosis is an epidemic in India. The incidence of coronary artery disease has doubled during past three to four decades. The role of diabetes mellitus (DM) in relation to CAD was believed to be as important as CAD itself. Owing to the similar vasculopathy characteristics, patients with DM were frequently combined with Peripheral Artery Disease (PAD). However of outpatients, clinically suspected of having CAD, the relationship and interaction between DM and PAD remains unknown. Previous investigations have shown that ankle brachial index (ABI) is a quick and useful tool for assessing and evaluating the presence of peripheral arterial disease of the lower extremities. The aim of current study was to determine the relation between ABI with angiographic stenosis and major cardiovascular risk factors in type 2 DM patients with suspected CAD. Materials and methods: A cross sectional study was conducted at a tertiary care centre including 100 consecutive diagnosed cases of diabetes. CAD was diagnosed by a history of angina/ any past history or treatment for CAD/ ECG changes and 2 D echo findings and CAG. Ankle Brachial Index (ABI) was calculated for all patients by using Duplex Colour Doppler and ABI <0.9 was diagnosed as PVD. Statistical Analysis of data was done by using SPSS software ver. 21. Results: About 68.9% of the cases with established CAD proven by angiography had abnormal ABI while 64.1% of the cases with normal coronary angiography had an abnormal ABI thus predicting a future risk of CAD. Mean HbA1c and uric acid levels and number of cases with microalbuminuria was significantly higher among cases with CAD. About 92.9% of the cases with Triple vessel CAG had Positive ABI which was significantly more as compared to 68.0%, 66.7% and 47.8% of the cases who had Single, Normal and Double vessel CAG respectively. Conclusion: Ankle brachial index is a sensitive, non-invasive predictor of coronary artery disease in diabetic patients. It however needs other markers in association for better specificity for predicting CAD.

105-110

Authors: Parmar P, Rathod GB, Rathod S, Parikh A

Background: Informed consent is way of providing necessary information to the patients and helping them for decision making. All the pros and cons of procedure must be explained to the patients in the language he or she can understand. Just taking signature of patient on consent form without proper explanation and understanding of him is violating entire process of informed consent. Materials and methods: A cross sectional, observational study was conducted over 121 patients aged 18 years and above who came to Gayatri Hospital, Gandhinagar after obtaining their informed written consent for participation in survey regarding informed consent. All participants were subjected to pretested and validated questionnaire (Likert type scale) regarding legal aspects of informed consent. Results: Out of 121 participants, only 100 participants’ responses were included for analysis. Among 100 participants 73 were male and 27 were female. 78% agreed that informed consent is must for any procedure. 61% agreed that signing consent form is just a formality. 91% believed that informed consent is protective shield for doctors. 88% believed that informed consent is legally necessary. Only 52% agree that consent form is meant to protect patients’ rights. 77% felt that signing consent form eliminate patients’ right to compensation. 82% wanted to know everything but letting decision left on doctor. Conclusion: The study concluded that there is a vide gap between actual concept of informed consent and perceptions of patients for the same. Patient awareness programs must be conducted by appropriate authority with help of media and television to improve their knowledge and preserve their rights.

118-124

Authors: Patel NJ, Khandra HP, Chhabra SR, Singh CBP

Background: Hydatid disease is the parasitic infestation which is endemic in many sheep and cattle raising area of India. Previously open surgical treatment with albendazole remains the mainstay for treatment. But in the recent era of minimal invasive surgery and its advantages give privilege to laparoscopic surgery to become one of better option for the treatment of the liver hydatid disease. Objectives: The purpose of this study was to compare the difference of incidence of post-operative complications, operative duration, length of hospital stay, duration of return to work, and recurrence in patients undergoing laparoscopic or open surgery for the liver hydatid disease. Materials and methods: The present study was a multicenter study which had been carried out at the tertiary care centre. Total numbers of 36 cases were studied and were followed up for the period of 6 months to 30 months (mean 15 months). All the patients were operated either by laparoscopy or open surgery by the same surgical team depending on below mentioned criteria. Inclusion criteria for laparoscopy surgery were cyst in the segments 1, 2, 3, 4, 5, 6 of liver, cyst over the anterior surface of liver, cyst more than 6 cm. Inclusion criteria for open surgery were cyst in communication with the biliary tree, intra parenchymal and posterior cyst, cyst in the segment 7, 8 of liver, cyst lying in relation to the vital structure, infected cyst, cyst with thick or calcified wall. Results: Out of total 36 patients, 20 (55.55%) were male and the 16 (44.45%) were females. The predominant chief complain of presentation was abdominal pain in 14 (38.89%) patients followed by abdominal lump in the 13 (36.11%) patients followed by other complains. The right lobe of the liver was involved in the 20 (55.55%) patients, left lobe in 14 (38.89%) patients and both lobes involved in the 2 (5.56%) patients. The single cyst were seen in 33 (91.66%) patients and the more than one in 3 (8.34%) patients. 16 patient underwent laparoscopic surgery while 20 patient underwent open surgery. The mean operating time for the laparoscopy group was 110.0 min compare to 137.5 min for the open group ( p value <0.0001 ,which was statistically significant). The post-operative analgesic requirement was much less in the laparoscopy group (mean 2.37 days) than in the open group (mean 6.85 days; p value <0.0001, which is statistically significant). The drain was removed in the laparoscopy on an average of 4.56 days compared to the average 4.75 days for the open group; (p value = 0.36, which was >0.05; was statistically insignificant). The mean hospital stay in the laparoscopy group was 5.87 days compared to 10.85 days in the open group (p value <0.0001, which was statistically significant). Patients in the laparoscopy group resumed routine activities earlier (11.56 days) than those in the open group (27.8 days; p value=0.0006, which was statistically significant). We found no statistical significant difference in post-operative complications in the two groups except perhaps slightly higher rate in the open group than the laparoscopy group. Conclusion: Laparoscopy management of liver hydatid cyst is feasible, safe and effective provided that surgeon has good knowledge of basic laparoscopic surgery and proper selection of the patient is done.

130-135

Authors: Gahlot A, Mogra N

Introduction: Bronchogenic lesions are undoubtedly one of the most common diseases worldwide. Pulmonary cytology and biopsy are simple and resourceful methods of early diagnosis of respiratory diseases. The use of bronchoscope has increased the variety of diagnostic specimen obtainable and extended the scope of cyto-pathology. Fiberoptic bronchoscopy has an excellent result in diagnosis of lung diseases when combined with brushing cytology and biopsy. The present study aims to ascertain the yield of diagnostic bronchoscopic procedures in lung lesions and to calculate the incidence of various types of malignancies. Materials and methods: This hospital based observational study was carried out in the Pathology department of Geetanjali Hospital. A total of 110 patients of clinically suspected lung lesion were included and bronchoscopy was carried out in all patients. Various samples such as bronchial brushing, bronchial biopsy and bronchial washing were taken as and when required and samples were given to pathology and microbiology department for reporting. Data was analysed by SPSS ver. 21. Results: Out of 110 biopsies 61 were found to be malignant, 20 were inflammatory lesions, 16 were non-malignant, 11 were inadequate material and 2 were inconclusive. Overall diagnostic yield of bronchial biopsy was 88.2%.The most common type of malignant was Squamous cell carcinoma (34.5%) Adenocarcinoma (9%) and Small cell carcinoma (7.2%). Conclusion: Bronchial biopsy is a valuable tool and helps in the diagnosis of lung lesions.

140-145

Authors: Sridevi A, Ragi V

Background: In modern era, Osteoporosis is become a major public health problem, associated with substantial morbidity and socio-economic burden. Osteoporosis is a disorder having the characteristic features of low bone mass and structural degeneration, promoting the development of brittleness of the bones. An early detection can help in reducing the fracture rates and overall socio-economic burden. Aim: To find out the prevalence of osteoporosis and the associated risk factors and to find out the impact of intervention on osteoporosis with reference to education, diet supplement and yoga. Materials and methods: A total 940 members were selected for prevalence study, among them 92 subjects were selected for the intervention study. All subjects were divided in to four groups and parameters used to manage osteoporosis were education, diet and yoga. Results: The prevalence of osteopenia was 26% and osteoporosis 14% along with 60% of normal among women. As the age increased the prevalence of osteoporosis also increased. The prevalence of osteopenia and osteoporosis (low BMD) was found to be high (73%) among women in the age group of 51-60 years compared with that of 41- 50 years (27%). improvement of knowledge in all the groups, physical performance in the EDY and EDDY group. Conclusion: The assessment of risk factors related to low bone density revealed that age, educational status, menopause, duration of menopause, height (short) and exercise of women were significantly associated with low bone mineral density resulting in osteopenia or osteoporosis.

162-167

Authors: Yerrajwala KS, Saradhini V, Reddy BR, Gudimella S

Background: Acute pancreatitis is an important cause of morbidity and mortality worldwide. Alcohol and gallstone disease remain the commonest causes of acute pancreatitis but metabolic abnormalities, obesity and genetic susceptibility are thought to be increasingly important etiological factors. Serum enzymes amylases and lipase are used as conventional biomarkers of acute pancreatitis. Objectives: To assay serum enzymes amylase, lipase, adenosine deaminase (ADA) and gamma glutamyl transpeptidase (GGT) in acute pancreatitis of alcoholic and non-alcoholic etiology. The present study also aimed to find the correlation among the enzymes. Materials and methods: The study subjects were categorized as non-alcoholic acute pancreatitis (n=30), alcoholic acute pancreatitis (n=30) and healthy controls (n=30). Levels of amylase, lipase, adenosine deaminase and gamma glutamyl transpeptidase were estimated in serum samples by standard spectrophotometric methods. Results: The levels of amylase, lipase, ADA and GGT were significantly higher in acute pancreatitis patients than controls. With respect to amylase and lipase, more pronounced increase was seen in non-alcoholic than the alcoholic acute pancreatitis patients. Increase in GGT was more in alcoholic acute pancreatitis while increase in ADA was comparable in acute pancreatitis of alcoholic and non-alcoholic etiologies. Serum amylase showed significant positive correlation with lipase, GGT and ADA in alcoholic acute pancreatitis and with lipase in non-alcoholic acute pancreatitis. Conclusion: Serum levels of enzymes amylase, lipase, ADA and GGT served sensitive markers of acute pancreatitis. Future studies employing larger sample size and differentiating various etiologies of acute pancreatitis, findings correlation among enzyme biomarkers are required.

175-180

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

Flourosis has a world wide occurence posing a serious health problems. Approximately 25 to 30 million people are exposed to water polluted with flouride. Half to one million people are suffering from severe forms of flouride intoxication in our country. In Telengana,Flourosis was detected as early as in 1937, the problem being acute in Nalgonda District. It is observed that hidden renal disease is one of the main factors for development of skeletal flourosis early. Individuals suffering from latent renal disease develop skeletal flourosis early,even while consuming low levels of flouride. In this study, 52 cases of skeletal flourosis with chronic renal failure were described between 1983 to 1998. A detailed clinical evaluation and skeletal survey were carried out for flourosis. Renal function tests were carried out to assess renal function. Ultra sound examination of abdomen was carried out to assess the size of the kidneys. The results and pathophysiology were also discussed.

187-190

Authors: Pathak S, Nagar M, Kavad M, Patel H, Patel K, Patel M

Toxic epidermal necrolysis is a severe cutaneous drug reaction, mainly involving skin and mucous membranes. We have presented here a case report of 16 year old female patient who was diagnosed with toxic epidermal necrolysis clinically as well as histopathologically. The patient presented with history of fever, oral cavity ulcer, skin lesions which were ill defined, erythematous macular with darker hemorrhagic centre. Skin biopsy showed full thickness necrosis of dermis, dermal-epidermal separation and paucity of upper dermal cellular infiltration. The patient was treated with intravenous immunoglobulins, low dose steroids and systemic antibiotics and the patient improved significantly. The main purpose of the case report was to emphasize that even one single dose of amoxycillin can induce a toxic epidermal necrolysis.

196-207

Authors: Namathabad R, E.A. Ashok Kumar

Catastrophic antiphospholipid syndrome (CAPS) is a rare, potentially life-threatening condition, acute in onset , characterized by diffuse vascular thrombosis, leading to multiple organ failure in a short period of time in the presence of positive antiphospholipid antibodies (aPL). Lupus anticoagulant and anticardiolipin antibodies are the predominant antibodies associated with CAPS. Treatment options for CAPS include anticoagulation, steroids, plasma exchange, cyclophosphamide therapy, and intravenous immunoglobulin therapy. The high rate of mortality warrants greater awareness among clinicians for early diagnosis and treatment of CAPS. In this case report, 30-year-old post-partum female presented with progressive weakness, shortness of breath of grade IV and swelling of all the four limbs of 15 days duration with an episode of seizure. Investigations revealed MRV - cortical sinus venous thrombosis (CSVT) of transverse and sigmoid sinus, Raised anti-ds DNA anticardiolipin and lupus anticoagulant, 24 hour urinary proteins – 540 mg/day indicating clinical lupus nephritis. Weakness of all the limbs with areflexia indicated acute inflammatory demyelinating polyneuropathy (AIDP). 2D echocardiography- post partum dilated cardiomyopathy (DCMP).

215-218

Authors: Arumugam B, Nagalingam S

This article aimed to implement concept-mapping as a tool to improve the learning quality that enhances the higher order cognitive skills among medical students. A concept map typically represents ideas and information as boxes or circles, which it connects with labeled arrows in a downward-branching hierarchical structure.

1-11

Authors: Saraladevi R, Nirmala Kumari T, Shreen B, Usha Rani V

Background: Thyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction. Aim: A prospective and comparative clinical study to know prevalence of thyroid disorder in pregnancy and pregnancy outcome was done. Materials and methods: This study was carried out in pregnant women during 1st trimester who attended antenatal clinic of maternity hospital to know the prevalence of thyroid disorders in pregnant women living in and around and also to know the outcome of pregnancy in women suffering from thyroid disorders. Results: In this study, prevalence of thyroid disorder was 11.6% with 95% CI of 9.64 to 13.54 which was high when compared to other regions in India and in other parts of Asia. Subclinical hypothyroidism and Overt hypothyroidism was 6.4% and 2.8% respectively. Subclinical and Overt hyperthyroidism was 1.8% and 0.6% respectively. Subclinical hypothyroidism was more prevalent and hidden, leading to the poor obstetrical outcome and fetal complications. Rate of miscarriage was high in overt hyperthyroid patients. Conclusion: Due to the immense impact that the maternal thyroid disorder has on maternal and fetal outcome, prompt identification of thyroid disorders and timely initiation of treatment is essential. Thus, universal screening of pregnant women for thyroid disorder should be considered especially in a country like India where there is a high prevalence of undiagnosed thyroid disorder.

17-24

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

The diagnosis of Invasive Pulmonary Aspergillosis (IPA) and therapy with Amphotericin B appear to improve survival, but the early diagnosis is difficult. There are no pathognomonic clinical findings for IPA. The commonest presentation is compatible with any of bacterial, fungal, viral or protozoan infections. In addition, IPA may coexist with or arise during the therapy of other infections in immune compromised patients. It was thought that ante mortem isolation of Aspergillus species from respiratory secretions in pathologically confirmed cases occur infrequently. Demonstration of tissue invasion by fungal hyphae remained the accepted standard for diagnosis of IPA. Sputum culture is regarded as not useful for the diagnosis of IPA. Colonization of aspergillus may occur without invasion, hence, culture of respiratory secretions were not reliable. Aggressive diagnostic methods to establish the diagnosis of IPA are warranted. However there may exist important subsets of patients where sputum culture of Aspergillus may still be diagnostically useful. The underlying disease, i.e. immune suppression, neutropenia/ leukemia is a critical factor in selecting patients where sputum cultures may be useful. The degree of immune suppression increases, the diagnostic specificity of isolation of aspergillus from sputum. In this article, a meta analysis of 21 studies, spanning 27 years, the methods adopted for diagnosing IPA by various authors is analysed and discussed. The detailed pathogenesis of IPA is also discussed.

29-34

Authors: Goyal SK, Chhabra UK, Bansal SK, Choudhary D, Goyal PK, Singal G

Mechanical bowel obstruction presenting acutely is a common surgical emergency and a frequently encountered problem in department of surgery. Intestinal obstruction continues to remain a challenge to surgeons despite advances in field of medicine, pathophysiology, surgical technique and conservative management. This retrospective study in patients operated for acute mechanical bowel obstruction in our department, was intended to highlight the common causes of intestinal obstruction in this geographical location of the study which had suggested measures for prevention and treatment of the condition. 150 patients who underwent exploratory laparotomy for intestinal obstruction were compared in terms of age, sex, symptoms, etiology of intestinal obstruction, site of obstruction, operative procedure performed.

42-47

Authors: Venkat Narsimha Reddy Nandyala

Background: E learning refers to the use of Internet technologies to deliver a broad array of solutions that enhance knowledge and performance. It is more often used by medical educators in basic science courses than in a clinical evaluation. Materials and methods: An observational study was carried out in the Department of General Surgery among undergraduate medical students to know the impact of e-learning in the acquisition of clinical skills required during evaluation of an inguinoscrotal swelling. A total of 60students were divided into two groups of 30 each. Group A students were trained by conducting bed side clinics on patients while students from Group B were trained using You tube videos. Results: At the end of these sessions, all the students were assessed by Objective Structured Clinical Examination on patients presenting with inguinoscrotal swelling with a check list. Out of 20 marks students from group A had a mean of 16.4 and the mean in the E learning group was 14.1 and the P value was .004 which was statistically significant. Conclusion: E learning by using videos cannot substitute traditional bed side teaching but it can impart basic clinical skills to a certain extent in a resource constrained situation.

52-64

Authors: Rathva AM, Singla H

Background: CT has evolved from single–detector row scanners into multi–detector row helical volumetric acquisition techniques, and these advances have had a significant impact on imaging of the urinary tract. Aim and objectives: To evaluate the CTU compare to other imaging modalities for urinary tract abnormalities in light of present knowledge, To study the role of CTU in evaluation of various abnormalities those are not detected by conventional IVP, Benefits of CTU over IVP, To provide information about the extent of the lesions involving kidneys and its relation to surrounding structure and Characterizing the lesions whether they are benign or malignant and helping the surgeons for the further management, Grading the renal injuries. Materials and methods: Data was collected from patients who attended the surgical O.P.D. or emergency of S.S.G.H., Baroda with clinically suspected renal abnormalities. A study was conducted over a period of two years on 50 patients with clinically suspected renal abnormalities. Informed consent was taken from every patient. Patients were evaluated with Multidetector Computed Tomography (G.E. Bright Speed). Results: Our Study included 10 patients of renal stones, 8 patients of renal masses, 3 patients of pyelonephritis, 7 patients of renal injury, 5 patients of PUJ obstruction, 7 patients of ureteric stricture, 5 patients of anomalies, and 5 patients of bladder mass. Among all pathology CT urography is more helpful and gives better imaging findings as compare to conventional urography that helps in better management of patients. Conclusion: CTU gives reliable information not about the extent of lesion but also the characteristics of lesions which makes surgeons to take proper decision aboutthe further management of patients, it also avoids unnecessary laparotomy surgery in case of blunt abdominal trauma patients by giving the precious extent of renal injuries. For all these gold standard benefits of MDCTU over conventional IVP makes MDCTU as “one stop shop” for urinary tract abnormalities and nearly completely replacing the IVP in recent era.

70-75

Authors: Ragi V, Sridevi A

Background: Intertrochanteric fractures are the most commonly treated fractures by Orthopedic surgeon. Many techniques are described in literature but internal fixation with Dynamic Hip screw is most efficient method. Aim: The present study was conducted to compare the results of conservative methods and internal fixation with dynamic hip screw in management of intertrochanteric fractures of the femur. Materials and methods: This study included 40 patients of intertrochanteric fractures of the femur, out of which 30 patients were treated by conservative methods considered as Group I and 10 patients were treated by internal fixation with Dynamic Hip Screw (DHS) considered as Group II. All the results were evaluated by using Kyle’s criteria. Results: In Group I, 4 (13.3%) cases had excellent results, 6 (20%) case had good results, 20 (66.6%) cases had poor results. In Group II, 8 (80%) cases had excellent results, 6 (20%) cases had good results. In Group I, 73.3% of cases had unstable fractures and in Group II, 80% of cases had unstable fractures Conclusion: The quality of results was better with internal fixation with dynamic hip screw (DHS) as compared to conservative methods.

81-86

Authors: N L Eshwar Prasad, V Ravi, P Anuradha

Background: Breast cancer is the most frequent cancer in women globally and represents the second leading cause of cancer death among women. Materials and methods: This study was a retrospective which constituted of 30 cases of breast cancer admitted during the period of 1 year. Investigations were done for confirmation and to know the extent of the disease. Treatment adopted after clinically evaluating and investigating. Post operatively breast with tumor and axillary lymph nodes had been sent for histopathological examination. Results: Incidence of breast carcinoma was highest in the age group of 30-40 years and 51-60 years with 61% of patient in this group. 3.56% patients presented with less than 6 months duration of symptoms. Majority of the patients presented with stage – 2nd and stage – 3rd diseases constituting 73% of the cases. Majority of patients suffering from carcinoma Breast were multiparous, constituting about 60% of total. The duration of the symptoms varied widely from one month to 2 years, with majority 17 patients presenting before 6 months.17 patients out of 30 were prenatal with less than 6 months duration of symptoms, constituting 56.1% of cases. 16 out of 30 patients were presented with N 1 lymph nodal metastasis constituting 60% of cases and 8 patients out of 30 were presented without N0 lymph nodal metastasis constituting 26.6%. Type of surgical treatment adopted for the patient was depending on the stage of the disease. Post operative treatment in the form of radiotherapy, chemo-therapy and Tamoxifen was given for all patients except for stage – 0 and stage – 1 cancer patients. Conclusion: Good disease free survival rate and overall survival improvement neoadjuvant chemoradiation is to be followed.

95-98

Authors: Koramutla Harsha Kumar, Jaya Someswar Narreddy

Background: Clavicle fractures are one of the most common bone injuries seen in adult population. Generally all the fracture clavicles were treated non-surgically by figure-eight bandage and surgical intervention like plating with cortical screws is infrequently required. Non-union rates, strength and endurance deficits are familiar in cases treated conservatively. We evaluated functional and radiological outcomes in non operative versus operative management of fracture clavicle, in patients visiting to orthopedic OPD in a tertiary care hospital in Andhra Pradesh. Material and methods: In a prospective clinical trial study of 80 patients, with displaced mid-shaft fractures of the clavicle were referred to Orthopedic OPD in a tertiary care hospital. These patients were deliberately placed into two treatment groups: non-surgical (with figure-eight bandage) and surgical (with DCR plate fixation). All patients of the surgical group underwent ORIF. Clinical examination, fracture radiography and shoulder scores were recorded for all patients at the end of 12 weeks. Shoulder function is measured by the constant shoulder score which includes the pain score, functional assessment, range of motion and strength measures. Patient satisfaction according to strength, shoulder function and pain was also assessed. Results: There were 32 patients in operative in which 23 males and 9 females whereas in non-operative group (figure of eight) there were 35 males and 13 females. The mean age of the patient was 23±3.4 years in operative and 19±2.5 years in non-operative group. 61 fractures occurred on the right side and 10 on the left side. In the Surgical group mean time to reunion was 8±1.8 weeks where as it was 11.±2 weeks in non surgical group. The overall Constant shoulder score was 93.75% in surgical group where as it was 87.50% in nonsurgical group. Additionally the percentage of patients with excellent results was more in surgical group than non- operative group (figure of eight). Conclusion: In both figure of eight bandage and plating, there was satisfactory union of clavicle but due to appropriate bone proximity in cortical screw and plating, excellent functional outcome in the terms of early mobilization and quick union was much appreciated.

106-117

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

Earlier Diabetic nephropathy was thought to be a rare complication in Type II Diabetic patients. The incidence and prevalence of nephropathy in Type II Diabetes have been under estimated in the past probably because most patients with nephropathy succumbed to cardiovascular disease, even before nephropathy could manifest clinically. The current study was done to screen Type II diabetic patients for micro albuminuria and macro albuminuria, to identify the risk factors for development of nephropathy, and to note association of other micro vascular and macro vascular complications, and compare them with diabetics without proteinuria.

123-127

Authors: Naveen Kumar E, Ramesh K, Alugonda Y, Kothapalli J, Goud AK

Background: Negligence is the breach of a legal duty of care. Liability is the responsibility of a person for his acts of commission and omissions. Aim: This study aimed to determine the role of liability in medical negligence in teaching hospital. Materials and methods: A total 36 medical negligence cases reported during the period of 3 years i.e. from July 2011 to June 2014 were gathered from Hospital Case Records, Inquest Reports, Post Mortem Examination Reports, and Forensic Science Laboratory Reports. Results: Among these 36 cases of medical negligence doctors were liable for their negligence in 15 cases i.e. 41.7% and vicariously liable in 3 cases i.e. 8.3%. There was no liability for doctors in 18 cases i.e. 50%. Conclusion: It this study, male and female was equally suffered for medical negligence. Among the females pregnant cases were more common. Most of the medical negligence cases had come to the hospital with major health problem. Health care professionals are increasingly facing complaints regarding the facilities, standards of professional competence and the appropriateness of their therapeutic and diagnostic methods.

134-138

Authors: Saini S, Hasan N

Background: Understanding the future career interests of medical graduates is important, as they are the future workforce of the healthcare profession. Aim: The aim of this study was to determine the career choices and the factors that influence undergraduate medical students to choose a particular medical specialty. Materials and methods: A cross sectional observational study was conducted among ‘300’ undergraduate medical students of Sardar Patel Medical College, Bikaner, Rajasthan between January to March 2014. A self-administered questionnaire was used to collect data and the association between different variables was tested using Chi-square test. Results: Out of total ‘300’ respondents, 84% (n=252) considered post-graduation very important for future career and majority of them (99%) wanted to pursue the same in clinical subject. The most preferred specialty expressed by male students was Medicine, followed by Surgery and Orthopedic, while the female students were more interested in Radiology, Paediatrics and Obstetrics and Gynecology. Little interest was shown in other specialities. Personal interest was found to be the most common factor that influenced the choice of specialization. Conclusion: A variety of factors appeared to inspire medical graduates to opt for a particular specialty. All the substantial factors that influence the medical graduates’ decision should be equally justified and addressed, so that the quantitative and qualitative inequality of specialists can be nullified.

147-157

Authors: Patel P, Patel VP, Patel H, Rathod GB

Introduction: Organophosphorus compound (OPC) poisoning has assumed alarming proportions and it is primarily a problem of the developing countries. Serum cholinesterase levels are easier to estimate and usually depressed after OP poisoning. Peradeniya OP poisoning scale has not been studied much in Indian scenario. So, we decided to have first hand information and hence conducted this study. Aim and objectives: To find out severity of patients with OP poisoning by calculating Peradeniya OP Poisoning score, level of plasma and RBC cholinesterase level of patients of OP poisoning on admission before any treatment, and correlate the level with severity and outcome of patients and requirement of ventilator support with OP poisoning. Material and methods: All patients who presented to emergency department with history of poisoning with known compound were taken as study subjects. A detailed history, clinical examination and relevant biochemical investigations were performed. Peradeniya OP poisoning scale was applied to all study subjects and the severity of OP poisoning was graded as mild, moderate, severe. In all study subjects, 3 ml of plain blood was collected on admission before administration of atropine and plasma cholinesterase and RBC cholinesterase was estimated. Results: Most of the patients consumed poison with a suicidal intent. Majority had consumed poison orally. Most patients had consumed 50 – 100 ml of poison. Quantity of poison consumed did not correlate with severity of poisoning. In this study, requirement of ventilatory support was seen in 16% of patients. Mortality in our study was 9%. Pseudo cholinesterase levels were significantly depressed in patients who required ventilatory support and correlated with mortality. Miosis, Bradycardia, increased respiratory rate, impaired level of consciousness, all correlated well with need for ventilatory support and increased mortality. Peradeniya OP poisoning score of more than 8 correlated in predicting the need for ventilatory support and mortality. RBC and Plasma cholinesterase levels estimation in conjunction with Peradeniya OP poisoning score is a useful parameter for grading severity of OP poisoning and in predicting the need for ventilatory support and mortality. Conclusion: The POP scale and RBC Che and plasma cholinesterase levels both showed a significant association in predicting the need for ventilatory support and outcome. Lower grade of poisoning had a better outcome whereas higher severity of poisoning had a poorer outcome.

163-165

Authors: Raghuram Mohan S, Harika V, Sandhya Anil S, Sandhya Rani H

Fibroadenolipoma is a solid, rare benign tumor. It is a circumscribed lesion composed of fat and other breast tissues which may be normal or which may show various changes. The reported incidence of breast hamartomas is 0.7% of all benign breast tumors in females [1]. Clinical findings resemble fibroadenoma and if there is a palpable mass, the patients may receive an immediate diagnosis. Ductal hyperplasia, apocrine metaplasia, calcification and adenosis may occur within the hamartoma, with rarer instances of lobular or ductal intraepithelial neoplasms.

169-171

Authors: Kolandaivelu PG, Lakshmana R, Balamurugan R, Arun Prasath S

Primary omental torsion occurs when the mobile thickened segment of the omentum rotates around a proximal fixed point in the absence of any association or secondary intra abdominal pathology and is reported rarely in literature. Our patient was a 55 year old postmenopausal woman who presented with acute abdominal pain on the right side for 3 days and was diagnosed to have primary omental torsion.

177-180

Authors: Sharma MK, Joshi N, Yadav ML, Agarwal T

Tuberculosis is an infectious disease that has displayed increasing incidence in the last decades. In the ENT area, the most common onset is cervical lymphadenitis, which accounts for 95% of ENT cases. The posterior pharyngeal wall, tonsillar pillars, sidewalls, soft palate, and tongue are the least probable locations. A 40 year old male presented in the ENT OPD with a growth at base of tongue, involving the lateral sulcus, anterior tonsillar pillar and lower pole of tonsil left side. A biopsy was taken from the same area and sent for histopathological examination with a strong clinical suspicion of squamous cell carcinoma. The final histopathological diagnosis was tuberculosis of tongue. The patient showed good response on ATT.

1-9

Authors: SORO Tianga Yaya, MIAN Jean Claude, COULIBALY Sirabana, NENE-Bi Semi Anthelme, TRAORE Flavien

Daniellia oliveri is a common plant in Africa and widely used by the population. It is found in the wooded savannahs as well as in dry forests. The medicinal properties of Daniellia oliveri are attributed to its different parts. Thus the leaves are used to treat various diseases such as inflammation, fever and pain. The comparative study of the aqueous extract of leaves Daniellia oliveri and the indomethacin (INDOCID) on inflammation induced by carrageenan on the right hind paw of the rats showed anti-inflammatory properties of this extract. The phytochemical analysis of the aqueous extract of leaves Daniellia oliveri showed the presence of flavonoids which could cause anti-inflammatory properties of this extract. The toxicological study of aqueous extract of leaves of Daniellia oliveri allowed to determine an LD50 = 436.51 mg/kg body weight. According Classification of Diezi this plant is toxic. These results justify the traditional use of leaves of Daniellia oliveri as anti-inflammatory.

18-24

Authors: Ray S, Patel M, Parmar H

Background: The term acute abdomen designates symptoms and signs of intraabdominal diseases usually treated best by surgical operation. Many diseases, some of which do not require surgical treatment, produce abdominal pain, so the evaluation of patients with abdominal pain must be methodical and careful. The proper management of patients with acute abdominal pain requires a timely decision about the need for surgical operation. The term “acute abdomen” should never be equated with the invariable need for operation. The abdomen has been referred to as Pandora’s magic box. Very often an accurate diagnosis cannot be made without surgery and many wonders are revealed on opening the abdomen. So it is often the last court of appeal in investigating abdominal cases. The general rule can be laid down that the majority of severe abdominal pains that ensue in patients who have been previously well, and that last as long as six hours, are caused by conditions of surgical import. Materials and methods: The present study was a study of 110 patients presenting with acute abdominal pain. Out of these, 100 patients were managed surgically and 10 patients were kept conservatively. Sampling frame was done to study the incidence of non-traumatic, acute abdominal emergencies. Inclusion criteria were patients willing to participate in the study, patients with history of acute onset of pain in abdomen, positive findings in USG and X-ray abdomen standing. Results: From 61-70 years of age, 11 total cases were reported, out of which 5 were due to perforated duodenal ulcer, 2 each due to ileal perforation and gastric perforation, and 1 each for acute intestinal obstruction and acute pancreatitis. Out of 110 cases of acute abdomen, 42 were caused by acute appendicitis and hence it forms the major reason among the causes of acute abdomen. While comparing duration of pain and acute abdomen with its management, it was found that when the pain was less than 8 hours long, the final diagnosis of acute abdomen was obtained in 21 patients out of a total of 110. This formed 19% of the total cases. A Maximum of 15 cases of complications were seen in acute intestinal obstruction with 6 wound infections, 5 pulmonary complications , 2 cases of septicemia and 2 cases of skin excoriation. Also death of a patient was seen. This disease forms 13% of the total cases. Conclusion: Acute abdomen is often a surgical emergency and a challenge to any surgeon. Rigorous approach to diagnose is mandatory. Acute appendicitis was the most common cause of abdominal surgical emergency.

31-40

Authors: Patel VP, Patel P, Mehta SS, Rathod GB

Background: The international association for the study of pain has defined pain as unpleasant and emotional experience associated with actual or potential tissue damage or described in terms of such damage. Spinal anesthesia was first produced by Corning in 1885 and first used deliberately by Bier in 1898. Glucose containing solution for spinal anesthesia was introduced by Barker in 1907. Since then hyperbaric solutions are in use for spinal anesthesia. All these advantages of spinal anesthesia are offset by complain of postoperative pain when effect of local anesthesia wears off due to relatively shorter duration of action of local anesthetic drug. Aim: The present study was designed to evaluate the effect of intrathecal bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and bupivacaine 0.5% heavy 3.0 ml (15 mg) with neostigmine 5 mcg and nitroglycerin patch (5 mg/24 hour) in various surgeries divided 2 groups, 25 patients in each group. The objectives of study were to observe onset and duration of sensory and motor blockade, to observe duration of post operative analgesia, to observe perioperative hemodynamic stability, to observe perioperative complications. Materials and methods: The study was conducted by taking 50 randomly selected patients for various surgeries. Patients belonged to ASA Grade I/II aged 18 to 60 years were included. Patients were divided into 2 groups. Group - A: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg. Group - B: 0.5% heavy bupivacaine 3 ml (15 mg) + preservative free neostigmine 5 mcg + transdermal nitroglycerin patch (5 mg/24 hours), applied on a non anaesthetised area after 20 minutes. All the patients were evaluated preoperatively and those having history of allergy to any drug, having any contraindications to spinal anesthesia, any neurological disorder and psychiatric illness were excluded from the study. Detailed preoperative history of past and present illness was taken. Systemic and general examination was done and back of patients were examined to rule out any spinal deformity and infection at local site. Patients were investigated for laboratory investigations like complete blood count, blood Sugar, renal function test, serum electrolytes, serum bilirubin and chest X-Ray, ECG were reviewed. Results: In our study of 50 patients we observed that intrathecal neostigmine 5 mcg with bupivacaine 15 mg with transdermal nitroglycerin patch (5 mg/day) markedly prolong duration of post operative analgesia than intrathecal neostigmine with bupivacaine alone. Intra-operative complication like bradycardia do occur but it was not significant, and other complication like hypotension occur with both groups but more in group B which requires monitoring . Conclusion: Transdermal nitroglycerin patch increases post-operative analgesia of low dose intrathecal neostigmine with bupivacaine in spinal anesthesia with less side effects.

45-50

Authors: Todorova A, Gugleva V, Georgieva L

Background: Despite the wide variety and the increasing number of industrially manufactured pharmaceuticals in recent years, extemporaneous medications are still often prescribed and prepared. Materials and methods: The purpose of this study was to analyze doctors` points of view on pharmacy compounding and to characterize advantages and disadvantages, associated with extemporaneous prescribing and dispensing. We performed a direct anonymous survey among general practitioners and medical specialists in the Northeastern Bulgaria. Results: Our study findings showed that extemporaneous medications are still preferred by physicians to meet the need of a tailored approach to specific patient and to provide individualized drug dosing. The role of extemporaneous compounded medicines is significant in the field of dermatology, due to the possibility of combining different ingredients in order to achieve better therapeutic action and also to serve as an alternative when there are no available market preparations. Conclusion: The prescribing and compounding drugs is a possibility for ensuring optimal therapeutical success in a certain patient. The advantages of extemporaneous medicines define their important role in the personalized therapeutic approach. The question about the perspectives and the future of compounded drugs is complex and depends not only on the number of prescribed prescriptions, but also on the pharmacists’ willingness to dispense them, becoming equivalent partners of doctors in general treatment process.

60-68

Authors: D. Srinivasa Naik, K. Ravi Kumar, Surendra Babu, R. Pandu Naik

Aim: To evaluate the effects of Dexmedetomidine to reduce the intra ocular pressure and sedation in day care cataract surgeries. Materials and methods: This study was conducted in 50 patients of either sex, belonging to 40 – 60 years of age, ASA grade I and II admitted for cataract surgeries. Patients were randomized into two groups of 25 each. Group D received 1 mcg/mg of Dexmedetomidine as IM route, Group P received placebo as IM and intra ocular pressure changes, hemodynamic parameters, sedation levels and SPO2, anxiolysis and pain were monitored. Results: There was a statistically significant difference in group D before and after premedication in terms of intra ocular pressure reduction. This was not seen in placebo group. Systolic blood pressure, diastolic blood pressure and heart rate in the study was a statistically difference in group D before and after premedication. There was no statistically significant difference in group P before and after premedication. There was a statistically significant difference (P<0.05) between the group D and group P in terms of sedation. Oxygen saturation observed in group D and group P at intervals of 0, 10, 20, 30, 40, 50, 60 min showed no statistical significance (P>0.05). There was a statistically significant difference (P<0.05) between the group D and group P in terms of pain relief and anxiety after premedication. Conclusion: Results suggested that Dexmedetomidine produces sedation and a reduction of intra-ocular pressure with minimal hemodynamic side effects when given intramuscularly as premedication before cataract surgery under regional anesthesia.

74-78

Authors: Bharpoda NY, Leuva BR, Patel U, Patel SG, Srikranthi, Kothari A

Introduction: India is facing a double burden of under nutrition and underweight on one side, and a rapid rise in obesity and overweight, particularly in the urban settings on the other side. The aim of the present study was to examine the association of the maternal Body Mass Index (BMI) and the obstetric and the perinatal out comes in singleton pregnancies. Materials and methods: A total number of 100 cases were taken. All the cases were primigravida with singleton pregnancy and were booked. Patients with preterm delivery or any medical disorder like cardiac disease, hypertension, chronic renal diseases and endocrinal dysfunctions, pre eclampsia, eclampsia, gestational diabetes mellitus were excluded from the study. Patients with their BMI calculated in first trimester delivering in Dhiraj General Hospital were taken. Mode of delivery, birth weight of babies, APGAR score were noted. Results: In present study, we found that maternal BMI showed association with the birth weight of their babies. We found direct linear correlation between maternal BMI and perinatal outcome. We found no association between maternal BMI with mode of delivery and APGAR score Conclusion: It can be concluded from our study that mother’s with low BMI tend to give birth to babies with lower birth weight and mothers with higher BMI, in absence of complications, tend to give birth to babies of higher birth weight.

88-91

Authors: Vohra A

Introduction: The ideal bone graft substitute should provide osteogenetic cells to facilitate bone regeneration, osteoinductive factors to induce bone formation and an osteoconductive matrix to directly stimulate bone deposition. The present study was conducted to radiologically assess the regenerative potential of hydroxyapatite with collagen and to evaluate the clinical usefulness of these materials to enhance bone healing. Materials and methods: Orthopentomogram (OPG) were taken after extraction in the control group and after extraction but before graft placement in study group and post operatively after 8 weeks. Each image was analyzed for bone density of the post-extraction sockets through ‘densitometric analysis’ software in the OPG program. Chi-square test was applied to find the correlation. Results: Post-operative mean measurement for study group was 108.72±22.54 after extraction and was 136.59±23.20 after 8 weeks with significant p value (0.00). The value for control group was 119.69±18.41 after extraction and was 121.39±14.21 after 8 weeks with insignificant p value (1.96). Conclusion: Grafting of the surgical site results in faster regeneration of tissue and computer assisted image analysis software is an important aid in assessing the bone density changes at the surgical site.

98-103

Authors: Shankar O, Balraj N, Rakesh G

Background: Hashimoto’s thyroiditis, a well known condition affecting the thyroid gland is often under diagnosed due to its wide spectrum of clinical manifestations. As such it could present as a Multi Nodular Goitre, Diffuse Goitre or Solitary Nodule with features of Hypothyroidism, Hyperthyroidism or Euthyroid state. Materials and methods: Total 120 patients with Hashimoto’s Thyroiditis were studied with history, clinical signs and symptoms, recorded in the format and were subjected to hormonal assay, FNAC. Results: Out of 120 cases, 117 were females and 3 were males. All the 120 patients presented with complaint of swelling in the front of the neck, most of the patients presented within 6 months after noticing the swelling. Consistency of the gland was firm in all cases. 75 patients were Multi Nodular Goitre (62.5%), 42 were Diffuse Goitre (35%) and 3 were solitary nodule (2.5%). 57 patients were Hypothyroid (47.5%), 42 patients were Euthyroid (35%) and 21 patients were Hyperthyroid (17.5%). FNAC was positive in 111 patients (92.5%). Antibodies were positive in 105 patients (87.5%). 105 patients were treated conservatively and monitored regularly every 3 months. Conclusion: In Hashimoto’s thyroiditis, the hyperthyroid patients showed high positivity to Anti TPO Antibody, the hypothyroid patients were highly negative to Antibodies, and the Euthyroid patients responded well to Thyroxine therapy. Surgery was mostly required for patients presented with symptoms and signs of obstruction. Incidence of Lymphoma in patients with Hashimoto’s Thyroiditis was usually high.

114-118

Authors: Ramamurthi R, Kavitha G, Pounraj D, Rajarajeswari S

Background: Infertility rates were highest in women living in urban areas and increases proportionately with level of education. The social consequences due to infertility affect the women more often. It is necessary to identify and treat the amount of stress and various coping methods by infertile women population. We have evaluated psychological impact of infertility and coping strategies employed in women population attending infertility OPD at department of obstetrics in a tertiary care teaching hospital in Tamil Nadu. Material and methods: This was a hospital based cross sectional study done in 150 women attending infertility OPD at a tertiary care hospital in Tamil Nadu for a period of 12 months from January 2014 to December 2014. A structured and validated proforma was designed for the purpose of data collection. The tool was validated by including the inputs from five experts in the subject area. Categorical variables were presented as frequencies and percentages. Quantitative variables were presented as mean and standard deviation. IBM SPSS version 21 was used for statistical analysis. Results: Majority of the study subjects belonged to 21 to 25 years of age group 35.7% and 45.5% of the women had recent onset infertility. 17% women had difficulty in falling asleep was reported. 58.9% of the women reported with high levels of anxiety. 26% women have decrease in weight was noticed. Whereas 48.2% women reported feeling guilt and 35.7% women reported feeling of pessimism and suicidal tendency.16.28% women participants reported to have immersing in household activities followed by 13.95% with hobbies and 11.63% with crying spells. Conclusion: Our study revealed that infertile women experienced high levels of anxiety, guilt, feeling of pessimism and suicidal tendency. The coping strategy adopted by majority of the women was engaging in household activities and hobbies. There should be parallel psychological counselling should be advocated strongly to all women with infertility taking treatment along with family members.

129-135

Authors: Kar K, Sinha S

Background: Pregnancy induced hypertension may complicate to preeclampsia and eclampsia. The pathophysiology of the former is still confusing, many authors suggested different opinions, and indicated different parameters for the prognosis of this. Aim: To evaluate serum HDL and LDL cholesterol, alkaline phosphatase, ionized calcium in pregnancy induced hypertension patients. Materials and methods: We had selected normal non-pregnant females (Group 0), pregnant normotensive females (Group I) and pregnancy induced hypertensive females (Group II). All the above mentioned parameters were estimated in them. Statistical analysis was done by SPSS 17 software; ANOVA and post hoc Bonferroni analysis were used to compare them. Results: Significant increase of LDL and alkaline phosphatase as well as significant decrease of HDL and ionized calcium were found in Group II females. Conclusion: HDL and LDL cholesterol, alkaline phosphatase, ionized calcium can indicate the severity of gestational hypertension. Normalization of those parameters can prevent the complications like preeclampsia and eclampsia.

1-10

Authors: G Sharmila, Sindhuri G.K

Introduction: The unaided human birth process is not perfect. All round the world 10% to20% of all pregnant women receive assistance with their delivery. Aim: This present study was to analyze and study the contribution use of operative forceps with vacuum extractor. Materials and methods: The present prospective study was undertaken in the department of OBG for a period of 2 years. Cases were chosen at random 50 cases of vacuum extraction and 50 cases of forceps delivery were taken and the maternal and fetal outcomes were studied. Results: In the present study, it was observed that 66% of forceps deliveries were primipara and 34% were multipara. In the present study it was observed that occipito anterior position was most common (64%) position observed in forceps. Occurrence of OA position in forceps deliveries was significantly higher p<0.001 when compared to vacuum deliveries. it was observed that 100% of patients in forceps group delivered with 10 cm of cervical dilatation. Majority of forceps deliveries 96% occurred when head was at station +3, 4% forceps deliveries occurred when head was at +2 station. Application of vaccum was significantly more with no caput 58% compared to forceps 32 %. Fetal distress was the indication for 40% in forceps and 38% in vacuum. In the present study it was observed that the number of pulls required to extract the baby was significantly high in vacuum group p<0.001. 46% of forceps delivered babies had a birth weight of 2.6-3.0 kg, 36% of vacuum deliveries had a birth weight between 3.1-3.5 kg. The mean APGAR score at birth for forceps deliveries was 6.54 + 1.47 and vacuum deliveries was 6. 74 + 1.33. There was no significant difference in mean APGAR score at birth in either of the groups p=0.47. The mean APGAR score at 5 min for forceps deliveries was 8.06+1.33 and vacuum deliveries was 8.16+1.34. There was no significant difference in mean APGAR score at 5 min in either of the groups p= 0.71. In the present study there was not much of a variation in terms of maternal or perinatal out come with both the groups. While scalp lacerations, face marks were more common in the forceps groups, vacuum extraction had a slightly higher incidence of cervical laceration and cephalhematoma, though not statistically significant. The incidence of perineal injuries was comparatively higher in the forceps group though significant difference did not exist in terms of maternal outcome. Conclusions: The advantage of vacuum was its ease of application and hence an apparently safe alternative in the hands of poorly trained personnel.

19-25

Authors: N. Srivani, Sudha Madhuri, K. Padma Malini, O. Shravan Kumar, Nagamani

Introduction: Nasal polyposis is an inflammatory condition of varied etiology, of which fungal etiology is an important cause. Allergic fungal sinusitis (AFS) now is believed to be an allergic reaction to aerosolized environmental fungi in an immunocompetent host. Aim and objectives: To determine the incidence of fungal etiology in the patients presenting with nasal polyps and correlate the histopathological findings with microbiological fungal cultures. Materials and methods: This study has been carried out over a period of 2 years from July 2014 to June 2016 in the Department of Pathology, Gandhi Hospital. Histopathological sections of resected nasal polyps from 52 patients were studied for the presence of fungi and results correlated with fungal cultures done in Department of Microbiology. Results: Majority of the polyps were unilateral 92% (48), seen in males 54% (28), most common in 3rd decade 27% (14). Histologically, 80% (40) of cases showed eosinophils and 23% of cases (12) showed presence of fungal hyphae. Fungal culture was positive in 34.6% (18 cases) with Aspergillus being the most common comprising 21% (11 cases). Others were candida pseudotropicalis 1.9% (1 case), Rhizopus 5.7% (3 cases), Mucor 3.8% (2 cases), and penicillium 1.9% (1 case). Conclusion: The incidence of fungal etiology in nasal polyps is significantly higher in our study compared to the west. Hence it is crucial to look for the presence of fungus in nasal polyps before administering treatment as use of antifungal therapy will benefit patients and prevent recurrence.

33-40

Authors: Srinivas Rapolu, K Anil Kumar, Syed Ali Aasim

Background: Intraperitoneal instillations of local anaesthetic agents alone or in combination dexmedetomidine have been found to reduce post-operative pain following laparoscopic cholecystectomy. Aim: Comparing antinociceptive effects of intraperitoneal instillation of bupivacaine plain and bupivacaine with dexmedetomidine in patients undergoing laparoscopic cholecystectomy. Materials and methods: Study was conducted on 100 adult patients of ASA physical status 1 and 2 in the age group of 18 years to 60 years, posted for elective laparoscopic cholecystectomy under general anaesthesia. Patients were randomly divided on an alternate basis into two groups of 50 each. Group B: (n=50) patients received Intraperitoneal bupivacaine 50 ml 0.25% + 5 ml normal saline. Group DB: (n=50) Intraperitoneal bupivacaine 50 ml 0.25% + dexmedetomidine 1 μg/kg with normal saline 5 ml. Results: Mean pain scores were significantly lower in the group BD when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. Mean pain scores were significantly lower in the group BD when compared to group B during the entire duration of the study. There was statistically significant difference in VAS pain score at 6, 8, 12, 18, 24 hours after surgery. There was statistically significant difference between two groups of patients in terms of heart rate, systolic and diastolic blood pressure from 1 hour to 12 hours. 4 patients (8%) of group B and only 5 (10%) patients of groups B + D had postoperative nausea/vomiting, and 7 (14%) patients of group B and 2 (4%) patients of groups B+D had postoperative shoulder pain. Conclusion: Intraperitoneal instillation of dexmedetomidine with bupivacaine prolongs the duration of postoperative analgesia as compared to that with bupivacaine alone.

48-54

Authors: P. Yamini Shobha Vani, A. Niranjani Devi

Background: Unplanned and unwanted pregnancies are common occurrences in all societies, regardless of the level of medical, economic, educational or religious development present within them. Despite wider availability of contraceptive methods, the incidence of induced abortion is increasing. Aim: To study the efficacy of Mifepristone 200 mg orally followed 48 hours later by Misoprostol 600 µg per vaginally in women undergoing medical termination of early pregnancy (up to 73 days of gestational age). Materials and methods: The present study included 50 pregnant women requesting termination of pregnancy in first trimester attending the department of Obstetrics and Gynecology. Women with gestational age up to 73 days from the first day of the last menstrual period with previous regular cycles were studied. Patients without medical or surgical contraindications to Mifepristone and Misoprostol were included. Women without prior caesarean section were studied. Results: Majority of the patients were of age group between 21-25 years. 92% of these women were married, 15% were nulliparous and 35% were multiparous. The period of gestation varied from 38-73 days. Majority of women were between 36-50 days of gestational age, constituting 50%. 94% of the patients had complete abortion and 4% had incomplete abortion. Success rate was not affected by the parity or gestational age, 72% of the patients expelled the products of conception within 10 hours, 84% in 15 hours and almost all the patients within 24 hours of prostaglandin administration. Most of the adverse effects reported were of the gastrointestinal system of which nausea was reported by 40%, abdominal pain by 70%, vomiting by 16% and diarrhoea by 4% of the cases. 6% of the patients reported excess bleeding at the time of abortion but none of them required hospitalization or blood transfusion. The mean duration of bleeding was 7.24 days. A significant fall in hemoglobin was not observed in any patient (less than 1 gm/dl). This combination has the advantage of high complete abortion rate with low frequency of side effects. Conclusion: The combination of RU 486 200mg orally and misoprostol 600 µg intravaginally appears to offer safe, efficient, acceptable, out-patient procedure and an alternative to surgical abortion in early termination of pregnancy (up to 73 days of gestation).

59-67

Authors: K Tirumala Prasad, R V Apparao

Background: Haemorrhoidectomy remains the treatment of choice for symptomatic grade-III and IV hemorrhoids. Milligan and Morgan’s haemorrhoidectomy is the most widely used procedure in the surgical management of hemorrhoids. Aim: This study was done to evaluate and analyze statistically whether stapler haemorrhoidectomy is better than Milligan Morgan haemorrhoidectomy in terms of Post operative pain, Duration of Hospital stay. Materials and methods: Prospective analytical study of 124 patients of haemorrhoids Grade II to Grade IV admitted , all adults aged 18 to 75 years with grade II to grade IV haemorrhoids admitted with ASA GRADE < III were included in our study. Two groups were constituted a stapled haemorrhoidectomy group and a Milligan Morgan group operated using standard open haemorrhoidectomy. Pain was assessed and recorded at 0, 15, 30, 45, 60 minutes after the patient attains a score of 4/4 on Bromage scale. Pain was assessed using visual analogue scale (VAS). Results: It was observed that at 0 minutes out of 62 patients in Milligan Morgan group 47 patients had moderate pain, 15 had mild pain. (mean VAS score was 4.242), at 15 minutes out of 62 patients in Milligan Morgan group 38 patients had moderate pain, 24 had mild pain (mean VAS score was 3.82). At 30 minutes out of 62 patients in Milligan Morgan group 25 patients had moderate pain 37 had mild pain (mean VAS score was 3.50).At 45 minutes out of 62 patients in Milligan Morgan group 19 patients had moderate pain 43 had mild pain (mean VAS score 3.342). At 60 minutes out of 62 patients in Milligan Morgan group 14 patients had moderate pain 48 had mild pain.(mean VAS score 3.016)/ In the stapler group the VAS scale at the same intervals were 1.712, 1.06, 0.966, 0.647, and 0.407 respectively. At all the intervals the P value was <0.005. Thus establishing the fact that stapler haemorrhoidectomy is less painful procedure than Milligan Morgan hemorrhoidectomy. The mean duration of hospital stay in the Milligan Morgan group was 2.532 days and stapler haemorrhoidectomy was 1.136 days with a P value <0.005. Conclusion: The circular stapled procedure for haemorrhoids is superior in terms of postoperative pain, discomfort, anaesthesia time and return to normal activity.

75-83

Authors: K. Muthu Raj MS, S. Mathan Sankar

Background: Carcinoma Breast is the most common cancer among females after cervical cancer. An estimated 1 million cases of breast carcinoma have been diagnosed worldwide and it is the leading cause of cancer death among women of age 20-59 years. Aim: The aim of the study is to understand the epidemiological factors and prevalence of different receptor status in cases of Ca breast from the South Indian Population to Govt. Stanley Medical College. Materials and methods: The materials for our retrospective study were collected from the medical records department of Govt. Stanley Medical College (GSMC). All cases of Ca breasts who attended GSMC for admission, treatment, investigations of breast cancer from July 2015 to August 2016 were included in the study. All patients were triple assessed and ER, PR, Her2Neu status were assessed by IHC staining. The study population was grouped based on parameters such as age groups, parity, family history of breast cancer, menopausal status, TNM staging, grade and histological type. Results: In our Study most common age group affected by Ca breast is 41-60 years (57%). 39% of Ca breast cases are premenopausal women. Most common Grade was grade II (41.8%). Most common Histological type was Intra ductal carcinoma about 94.5%. Stage III is common (50.3%). Metastasis was more common in age group > 60years (23%). On comparing stage and grade of tumor 62.8% cases of Stage III were Grade II. Triple Negative cancer is the most common receptor status (25.5%). 57% of triple positive and 57.5% of triple negative cases were in the premenopausal age group. Stage II is the most common presentation in triple positive disease (76.9%). Stage IV is more common in Triple negative patients. Conclusion: In conclusion, our study shows there is an increasing trend of Ca breast in South Indian population among younger and middle age group with Triple Negative Receptors is being most common associated with poor prognostic factors. Hormone receptor status and grading evaluation is needed for targeted therapy. Therefore treatment strategies to be better tailored to effectively treat the carcinoma breast patients.

89-94

Authors: Roobal Behal, Suhail Majid Jan

Pain is the most pervasive and universal form of human distress. The costs of pain in human suffering and economic resources are extraordinary. It is the most common reason for seeking medical care, and it has been estimated that approximately 80% of physician office visits involve a pain component. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used class of drugs for the management of acute and chronic pain in dentistry. NSAIDs minimize edema, but they are associated with many adverse effects, like gastric irritability, as dyspepsia and gastric bleeding which lead to a number of contraindications. Diclofenac is a powerful anti-inflammatory and analgesic drug that is well suited for local use in the oral cavity. This study was conducted in order to determine the local anti-inflammatory and analgesic effect of 0.074% diclofenac mouthwash on patients with periodontal surgery. Twenty five chronic periodontitis patients (fifteen males and ten females) who were supposed to go for full quadrant flap surgery were selected for the study. The 10-point visual analog scale (VAS) was used to assess pain and the Modified Gingival Index (MGI). Additional parameters like swelling and burning sensation was evaluated on a 5-point scale (0=absent, 1=mild, 2=moderate, 3=intense, 4=not evaluated). Compared to baseline measurements, spontaneous pain was significantly reduced by diclofenac mouthwash on the first day of treatment which showed gradual decrease till 7th day. Other parameters, i.e. gingival inflammation, showed a highly significant reduction in the scores in the test group when compared to baseline. The new 0.074% diclofenac mouthwash is an effective and tolerable medicinal product for post-surgical symptomatic relief. This topical formulation is sufficiently effective for pain relief after minor oral surgical procedures without subjecting the patients to systemic side-effects.

99-107

Authors: G Sudarshan, B Santhosh, S Srinivas, K Seshu Mohan, D Aman Chandra

Pelvic fracture urethral injuries are typically partial and more often complete disruptions of the most proximal bulbar and distal membranous urethra. Emergency management includes suprapubic tube placement. Subsequent primary realignment to place a urethral catheter remains a controversial topic, but what is not controversial is that when there is the development of a stricture (which is usually obliterative with a distraction defect) after suprapubic tube placement or urethral catheter removal, the standard of care is delayed urethral reconstruction with excision and primary anastomosis. This paper reviews the management of patients who suffer pelvic fracture urethral injuries and the techniques of preoperative urethral imaging and subsequent posterior urethroplasty.

115-122

Authors: G Ramachandran, N. Chidambaram, S. Periyasamy, R. Santhaprabu

Introduction: Hypothyroidism is a common endocrine problem, state of deficient thyroid hormones, may be result of many etiologies. Primary hypothyroidism is a subset of Hypothyroidism which accounts for 95% of the cases, only 5% are due to secondary causes. Respiratory manifestations are seldom the major complaints in hypothyroidism. Lung volumes are usually normal, but few studies have shown findings suggestive of restrictive pattern of impairment. This has been attributed to decrease in both expiratory and inspiratory muscle strength, alveolar hypoventilation due to depression of hypoxic and hypercapnic ventilatory drives. Aim of the Study: To study the pulmonary functions of individuals with primary hypothyroidism by performing spirometry, to compare the spirometric findings of primary hypothyroidism patients with euthyroid individuals. Materials and methods: Sample size of the study was around 50 patients. 25 patients were controls who were free from thyroid disease. 25 subjects were diagnosed primary hypothyroidism patients were included in the study. The patients and controls were evaluated as per the predesigned proforma and relevant investigations were done to assess their cardiac status and pulmonary status. Results: The FEV1, FVC, PEFR were found to be decreased and the FEV1/ FVC % was found to be increased in Primary hypothyroidism group when compared to control group. Conclusion: Pulmonary functions of individuals with primary hypothyroidism patients was by assessed by spirometry and compared with euthyroid individuals. Spirometry values were consistently lower in primary hypothyroidsm patients .Females are more affected than males. Spirometry values shows restrictive pattern.

127-136

Authors: Ravindernath, Vishal Singh

Introduction: Assessment of the patient presenting with seizure disorder is a common problem in clinical practice. MR imaging plays a pivotal role in the evaluation of patients with seizures. Accurate diagnosis of the cause of seizure is crucial for finding an effective treatment. Materials and methods: A prospective study was conducted on 110 patients who presented with clinical impression of seizures from August 2013 to August 2015 who were subjected to MRI scanning. This study was carried out in 110 patients with clinical presentation of seizures by subjecting them to magnetic resonance imaging to evaluate the spectrum of findings, various etiologic factors for seizures, and the most common imaging abnormality. Depending on the radiological features a provisional diagnosis was made correlating the clinical features. Results: In our study, 110 patients who were clinically diagnosed of seizure disorder were undergone MRI examination of the brain. In our study, cerebral infarct 20%, NCC 7.27%, atrophy 5.45%, cortical malformation 3.64%, tuberculoma 3.64%, venous thrombosis 3.64% constitute the main etiological factors other being neoplasm, tuberous sclerosis, SWS and abscess. The most common abnormality was cerebral chronic infarct. The MRI findings were normal in 53 (48.1%) cases and revealed spectrum of abnormalities in 57 (51.9%) cases. The common abnormalities were cerebral infarction with gliosis (20%), infections – NCC (7.2%) and tuberculoma (3.6%), cerebral atrophy (5.45%), developmental cortical malformations (3.6%), venous thrombosis (3.6%), tuberous sclerosis (1.82%), developmental vascular malformations (1.82%), low grade glioma (1.82%), SWS (0.91%), meningioma (0.91%), cerebral abscess (0.91%) were among the abnormal findings. Conclusion: This study observed that MRI with appropriate imaging protocols adds sensitivity and specificity in evaluation of seizures.

148-155

Authors: T. Murali Venkateswara Rao, Naga Karthik Vanukuri

Introduction: The Morbidity and mortality due to non-communicable diseases specially attributed to diabetes mellitus and coronary heart disease is raising rapidly in India, causing nearly 5.8 million deaths per year annually. Considering the strong association between the levels of serum uric acid and the occurrence of coronary atherosclerosis in subjects with type 2 diabetes mellitus, the current study has been undertaken to assess the factors influencing the serum uric acid levels in patients with type 2 diabetes mellitus Materials and methods: The study was an analytical cross sectional study, conducted in NRI Medical College and General Hospital, Guntur in Department of General Medicine and Department of Biochemistry, from December 2014 to November 2015. The study has included 70 cases diagnosed with Type 2 diabetes mellitus and 30 healthy controls. Hyperuricemia has been arbitrarily defined as >7.0 mg/dL in men and >6 mg/dL in women. Results: Among diabetic cases, the proportion of subjects with hyperuricemia was 11.43% and among the controls, none of the controls had hyperuricemia in study population. The mean uric acid level increased from 4.30 ± 0.77 in people with duration diabetes 2 to 4 years to 4.57±1.01 in people with duration of diabetes 5 to 8 years. Among people who had diabetes for 9 to 12 years, the mean uric acid level was 6.47 ± 1.07. The association between duration of diabetes and serum uric acid level was statistically significant. There was a strong positive association between hypertension, Hyperlipidemia and serum uric acid levels. Conclusions: Serum uric acid levels were significantly elevated in diabetic population. Elevated serum uric acid levels were significantly noted among those with dyslipidemia with high triglycerides, hypertension. Serum uric acid levels increased with increasing duration of diabetes.

159-161

Authors: Sharma A, Yadav S, Chavda J, Sahni M

A term male infant presented with generalized hypotonia, paucity of lower limb movements, and diminished muscle stretch reflexes. At 3 weeks of age, motor nerve conduction studies demonstrated evidence of demyelination and axonal involvement. These findings indicated demyelination and patient was diagnosed to have congenital Guillain-Barre syndrome. Improvement was seen after a course of IVIG. We are reporting this case because of rarity of its occurrence and should be considered in differential diagnosis in floppy neonate.